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Idaho rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.43 / $730.43 / $730.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $730.43 / $819.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.62 / $819.13 / $1,048.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $694.62 / $819.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $1,833.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.36 / $786.36 / $786.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29