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Oklahoma rates for HCPCS Q4151

AmnioBand or Guardian, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.68 / $145.68 / $145.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $145.68 / $145.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.25 / $127.25 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.16 / $155.58 / $211.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.84 / $137.19 / $202.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.63 / $134.88 / $148.74