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Idaho rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.12 / $7.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $8.66 / $9.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $8.66 / $12.06
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.26 / $9.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.60 / $6.69 / $14.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.44 / $9.44 / $9.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87