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Idaho rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $97.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $97.72 / $204.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $218.78 / $251.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $151.36 / $151.36
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $117.49 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $125.89 / $125.89