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Oklahoma rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.72 / $716.72 / $716.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.26 / $716.72 / $716.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.05 / $626.05 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.00 / $775.20 / $1,085.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.79 / $717.78 / $3,800.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $813.61