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Iowa rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,029.31 / $3,489.13 / $6,298.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.68 / $1,068.06 / $3,901.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.88 / $1,903.91 / $2,452.21
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.64 / $1,199.02 / $2,204.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.12 / $1,819.81 / $5,023.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.37 / $1,672.00 / $5,262.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.64 / $1,745.03 / $2,306.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,282.02 / $1,745.03 / $2,341.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,401.80 / $4,451.58 / $7,305.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.91 / $1,220.33 / $2,468.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,225.29 / $1,512.20 / $1,824.70