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Idaho rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $38.65 / $44.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.20 / $41.97 / $49.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.86 / $44.22 / $44.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.38 / $69.66 / $87.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $67.05