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Idaho rates for HCPCS A2009

Symphony, 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
$48.98 / $75.86 / $117.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $138.04 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $128.82 / $181.97
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
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $144.54 / $177.83
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
$91.20 / $125.89 / $125.89