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Oklahoma rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.34 / $76.34 / $76.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $76.34 / $76.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.72 / $80.56 / $300.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.27 / $71.04 / $453.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.94 / $70.70 / $77.95