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Oklahoma rates for HCPCS Q4254

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.35 / $384.35 / $384.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.43 / $384.35 / $384.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.67 / $403.57 / $480.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $1,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $529.29