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Idaho rates for HCPCS Q4128

Flex Hd Or Allopatch Hd Per Square Centimeter (Desc Revised 10/01/2022)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.70 / $30.70 / $30.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $32.90 / $37.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.22 / $29.91 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.70 / $37.39 / $47.86
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $30.51 / $37.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $42.82 / $55.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.89 / $35.89 / $35.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91