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Iowa rates for HCPCS 80376

Drug/Substance Definitive Qual/Quant Nos 4-6

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $26.87
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.18 / $88.81 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.87 / $35.17 / $112.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $21.93 / $55.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.41 / $43.89 / $84.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.54 / $42.39 / $60.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.14 / $13.22 / $43.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.82 / $25.10 / $25.10