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Oklahoma rates for HCPCS Q4107

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

Facilitymedian $89 · 10th–90th $81$2240%20%40%10th90th$89Professionalmedian $83 · 10th–90th $79$1380%50%10th90th$83$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $83.18 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $331.13 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $93.33 / $128.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $138.04 / $851.14
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $125.89 / $138.04