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Idaho rates for HCPCS Q4235

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.48 / $80.48 / $80.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $96.77 / $109.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.00 / $87.98 / $87.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.48 / $109.97 / $140.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $89.74 / $109.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $94.93 / $185.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.57 / $105.57 / $105.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98