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Idaho rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $78.70 / $89.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.95 / $78.70 / $114.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $78.70 / $89.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $139.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.86 / $85.86 / $85.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55