go back

Idaho rates for HCPCS Q4107

GRAFTJACKET, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $85.96 / $86.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $92.59 / $111.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.32 / $102.32 / $102.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $3,900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $136.47