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Idaho rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.78 / $717.78 / $717.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $729.99 / $829.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.05 / $663.63 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$703.45 / $829.53 / $1,061.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $703.44 / $829.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $1,402.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.35 / $796.35 / $796.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63