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Iowa rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,906.00 / $4,235.59 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.40 / $893.93 / $3,608.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.25 / $1,602.12 / $2,049.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.44 / $985.73 / $1,737.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$807.27 / $1,502.39 / $5,497.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.90 / $1,355.10 / $4,406.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.00 / $1,560.85 / $1,962.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,097.38 / $1,461.13 / $1,945.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,217.00 / $5,732.00 / $8,342.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.31 / $967.89 / $1,874.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.86 / $1,266.00 / $1,512.90