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Oklahoma rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.01 / $98.01 / $98.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.01 / $98.01 / $99.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $102.85 / $121.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $459.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.71 / $110.00 / $124.30