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Idaho rates for HCPCS A2015

Phoenix Wound Matrix, 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
$60.26 / $91.20 / $154.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $169.82 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,096.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $162.18 / $416.87
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 / $77.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $177.83 / $1,412.54
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 / $1,445.44