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Oklahoma rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.27 / $77.27 / $77.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $77.27 / $77.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $67.50 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $77.27 / $108.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.76 / $71.55 / $395.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $79.28