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Oklahoma rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.84 / $149.84 / $18,621.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $149.84 / $149.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $130.88 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.56 / $154.41 / $282.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.04 / $136.18 / $201.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.33 / $138.74 / $152.99