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Idaho rates for HCPCS Q4165

Keramatrix or Kerasorb, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $45.25 / $45.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.19 / $48.08 / $57.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $3,900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $44.36