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Oklahoma rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.84 / $81.84 / $81.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.55 / $81.84 / $81.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $71.50 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.83 / $94.32 / $1,140.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.50 / $83.18 / $1,311.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $75.79 / $83.57