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Oklahoma 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
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $194.98 / $257.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $147.91 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $223.87 / $223.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $173.78 / $501.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $257.04