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Oklahoma rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.73 / $707.73 / $707.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $707.73 / $707.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $618.21 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.87 / $828.31 / $1,750.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.43 / $730.43 / $5,727.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $722.60