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Idaho rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $14.48 / $14.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $14.48 / $16.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.80 / $14.48 / $19.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $13.50 / $16.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.19 / $24.14 / $55.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.43 / $15.43 / $15.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $18.00