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Idaho rates for HCPCS Q4185

Cellesta Flowable Amnion (25 mg per cc); per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,646.03 / $1,646.03 / $1,646.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.62 / $588.62 / $1,646.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.33 / $781.33 / $781.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $588.62 / $753.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $3,900.00