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Idaho rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.73 / $1,370.73 / $1,370.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.73 / $1,570.20 / $1,784.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.65 / $1,427.45 / $1,427.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.73 / $1,784.31 / $2,283.92
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,498.82 / $1,784.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,149.98 / $2,704.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,712.94 / $1,712.94 / $1,712.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45