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Idaho rates for HCPCS A2002

Mirragen Advanced Wound Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.43 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $128.82 / $177.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $302.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $251.19 / $302.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $218.78 / $251.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $117.49 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89