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Idaho rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $12 · 10th–90th $3–$1450%10%10th90th$12Professionalmedian $2 · 10th–90th $2–$1580%50%90th$2$2.0$10.0$50.0$200.0$1.0K

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
$2.00 / $2.00 / $10.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.23 / $13.49 / $19.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
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
$2.51 / $3.47 / $112.20
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $218.78 / $251.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $77.62
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
$9.33 / $117.49 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89