go back

Idaho rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $89.18 / $89.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.18 / $117.37 / $133.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.66 / $106.70 / $106.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $133.38 / $170.73
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $108.83 / $133.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.13 / $104.69 / $142.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.04 / $128.04 / $128.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70