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Idaho rates for HCPCS A2011

Supra SDRM, 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
$69.18 / $107.15 / $181.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $190.55 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $190.55 / $407.38
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
$151.36 / $190.55 / $239.88
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