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Oklahoma rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.12 / $43.12 / $43.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.12 / $43.12 / $43.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.12 / $45.28 / $61.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $136.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $49.15