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Idaho rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.85 / $48.85 / $48.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.85 / $58.03 / $65.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.77 / $52.75 / $52.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.97 / $58.03 / $84.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $53.81 / $65.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.43 / $43.61 / $100.99
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.79 / $39.79 / $48.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.03 / $63.30 / $63.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $73.84