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North Carolina 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
$1,300.50 / $1,300.50 / $1,300.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.50 / $1,300.50 / $1,377.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.00 / $853.21 / $938.53
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.00 / $1,300.50 / $1,782.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.00 / $1,071.00 / $1,071.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,668.60 / $1,668.60 / $1,668.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,782.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,539.00 / $2,430.00 / $3,240.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,156.00 / $6,156.00 / $6,885.00