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Oklahoma rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $912.01 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $933.25 / $1,862.09