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Idaho rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $71,483.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $26.75 / $31.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.44 / $31.11 / $36.84
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
$31.11 / $31.11 / $43.55