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Iowa rates for HCPCS E0300

Pediatric Crib Hospital Grade Fully Enclosed With Or Without Top Enclosure (Revised 01/01/13)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,899.77 / $1,899.77 / $2,287.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.08 / $1,743.08 / $2,623.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,950.00 / $1,950.00 / $3,128.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,950.00 / $3,128.37 / $4,514.06
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.55 / $496.76 / $4,372.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.33 / $3,692.86 / $17,045.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.77 / $1,447.70 / $3,348.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.33 / $359.33 / $849.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $443.27 / $849.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.17 / $1,253.32 / $3,113.21
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,939.94 / $2,939.94 / $2,939.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,322.55 / $2,939.94 / $2,939.94