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Oklahoma rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.89 / $13.89 / $13.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.99 / $13.89 / $13.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.50 / $15.63 / $21.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $14.48 / $17.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.36 / $12.86 / $14.53