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Oklahoma rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.24 / $115.24 / $115.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $115.24 / $115.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.66 / $100.66 / $106.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.32 / $101.14 / $564.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $89.18 / $1,448.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $117.66