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Idaho rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $117 · 10th–90th $98–$1780%50%10th90th$117Professionalmedian $102 · 10th–90th $95–$1660%50%10th90th$102$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $120.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $43.65 / $43.65
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $144.54 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $177.83
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $218.78 / $251.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $43.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $151.36
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $117.49 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $125.89