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Oklahoma rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $9,668.24 / $182,117.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $25.20 / $25.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $27.11 / $47.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.55 / $31.11 / $35.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.00 / $31.11 / $34.75