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Idaho rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $85.00 / $86.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.00 / $90.30 / $108.80
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
$160.91 / $160.91 / $225.29