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Oklahoma rates for HCPCS Q4103

Oasis burn matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.42 / $13.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.62 / $13.49 / $13.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $11.78 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $13.37 / $19.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.90 / $12.38 / $6,184.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.49 / $13.77