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Iowa rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,218.00 / $3,576.15 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.25 / $133.34 / $529.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.49 / $216.59 / $270.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.60 / $143.88 / $286.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.20 / $196.20 / $1,607.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.74 / $195.77 / $650.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $215.83 / $299.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.02 / $214.70 / $275.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $1,640.00 / $3,560.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.71 / $148.96 / $269.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.16 / $174.90 / $205.80