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Oklahoma rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $112 · 10th–90th $102–$2400%50%10th90th$112Professionalmedian $120 · 10th–90th $81–$1350%20%10th90th$120$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $117.49 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $331.13 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89