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Idaho rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,090.07 / $1,090.07 / $1,090.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $820.16 / $1,090.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$662.69 / $861.17 / $1,090.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $721.73 / $820.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $2,008.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.35 / $787.35 / $787.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12