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Idaho rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $83.37 / $94.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.34 / $94.74 / $121.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $80.34 / $94.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $78.00 / $139.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.95 / $90.95 / $90.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79