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Oklahoma rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.88 / $2,117.88 / $2,117.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $2,117.88 / $2,117.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.00 / $1,850.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,059.05 / $2,223.77 / $3,137.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,884.52 / $1,961.00 / $6,720.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,162.39