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Arizona rates for HCPCS A2013

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,312.20 / $1,312.20 / $1,312.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,312.20 / $1,344.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,099.01 / $2,596.41 / $6,420.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,116.18 / $1,373.76 / $3,245.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,312.20 / $1,539.00 / $2,663.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $2,929.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,350.00