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Oklahoma rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $616.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $147.91 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $3,019.95 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $4,073.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,511.89 / $2,818.38