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Iowa rates for HCPCS 15760

Graft Composite W/Primary Closure Donor Area

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
$715.35 / $1,056.81 / $1,281.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$990.15 / $1,829.19 / $2,428.84
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.95 / $1,143.78 / $2,034.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.00 / $1,786.01 / $5,023.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.00 / $1,673.57 / $5,194.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.00 / $1,723.57 / $2,277.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.00 / $1,723.57 / $2,277.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $5,023.00 / $7,305.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.67 / $1,268.59 / $2,606.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.22 / $1,473.10 / $1,781.40