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Idaho rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $1,020.00 / $1,032.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.00 / $1,083.59 / $1,305.59
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
$788.99 / $788.99 / $788.99