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Oklahoma 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
$1,312.20 / $1,312.20 / $1,328.40
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 / $1,377.81 / $2,101.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $5,814.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,488.65