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Oklahoma rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,217.92 / $3,217.92 / $3,217.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,009.34 / $3,217.92 / $3,217.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,810.90 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $3,290.48 / $4,767.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,788.50 / $2,901.66 / $9,975.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,285.56