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Ohio rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.13 / $155.13 / $24,991.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.35 / $155.13 / $218.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $4.38 / $256.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.48 / $301.48 / $313.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.41 / $293.41 / $293.41
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $315.92