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Idaho rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.12 / $49.12 / $49.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $48.18 / $49.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.36 / $38.54 / $38.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.74 / $48.18 / $54.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $39.31 / $48.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $98.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.25 / $46.25 / $46.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $41.30