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Idaho rates for HCPCS A2014

Omeza Collagen Matrix or Omeza Complete Matrix, per 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $125.89 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $131.83 / $186.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $125.89 / $131.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $89.13 / $109.65
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82