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Idaho rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,774.77 / $3,774.77 / $3,774.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $4,061.36 / $4,615.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,483.15 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,729.06 / $4,615.18 / $5,907.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $4,615.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,929.02 / $5,711.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,430.57 / $4,430.57 / $4,430.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14