go back

Oklahoma rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.41 / $67.41 / $67.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.04 / $67.41 / $67.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.59 / $67.83 / $99.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.48 / $59.81 / $332.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $68.81