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Oklahoma rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.50 / $8.50 / $8.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.50 / $8.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.43 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $8.07 / $13.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.90 / $7.12 / $10.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.68