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Idaho rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $1,789.55 / $1,789.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $2,166.88 / $2,462.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $2,462.36 / $3,151.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,462.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,900.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,363.86 / $2,363.86 / $2,363.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89