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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
$1,318.26 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,318.26 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,479.11 / $2,290.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,202.26 / $1,348.96