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Ohio 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 / $1,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,377.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,193.30 / $1,842.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,259.74 / $1,300.77 / $1,871.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.74 / $1,259.74 / $1,259.74
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,620.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,757.70