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Idaho rates for HCPCS A6025

Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.39 / $14.39 / $14.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.66 / $14.39 / $23.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.88 / $17.77 / $29.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,900.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.84 / $17.84 / $37.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.01 / $10.61 / $16.68