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Oklahoma rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.78 / $105.78 / $105.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $105.78 / $105.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.40 / $92.40 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.70 / $122.38 / $206.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.73 / $107.92 / $258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.04 / $97.94 / $109.40