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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.48 / $2.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.73 / $3.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.49 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $3.11 / $3.98
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.54 / $3.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.09 / $17.73 / $55.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49