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Oklahoma rates for HCPCS Q4164

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,772.20 / $1,772.20 / $1,772.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,772.20 / $1,772.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.05 / $1,548.05 / $1,640.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,640.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.93 / $1,772.20 / $2,625.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.14 / $1,640.93 / $5,857.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.93 / $1,640.93 / $1,854.25