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Idaho rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.15 / $231.15 / $231.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.13 / $247.86 / $369.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.05 / $369.15 / $472.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,000.00 / $3,900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $254.57