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Idaho rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $71.95 / $81.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.70 / $65.40 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.21 / $71.95 / $92.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $71.95 / $81.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.88 / $58.86 / $127.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $78.48 / $78.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41