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Oklahoma rates for HCPCS Q4113

GRAFTJACKET XPRESS, injectable, 1 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $741.31 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $812.83 / $1,047.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,995.26 / $1,995.26