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Kentucky 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
$1,296.00 / $1,296.00 / $1,296.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,344.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.73 / $1,697.82 / $1,940.37
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,191.98 / $1,334.00 / $1,815.72
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,404.00