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Idaho rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $59.81 / $59.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.81 / $68.66 / $78.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $78.02 / $99.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $63.66 / $78.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $123.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.90 / $74.90 / $74.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41