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Idaho rates for HCPCS A2007

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $199.53 / $208.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $218.78 / $295.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $218.78 / $251.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $128.82 / $158.49
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 / $218.78