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Idaho rates for HCPCS Q4254

Novafix DL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $412.82 / $444.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $444.85 / $501.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00