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Iowa rates for HCPCS Q4102

Oasis wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.50 / $13.50 / $17.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.05 / $10.05 / $10.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $14.41 / $16.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $24.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $13.50 / $19.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.70 / $24.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $14.41 / $18.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.90 / $14.41 / $18.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $18.10 / $22.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $15.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $11.70 / $11.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.24 / $11.70 / $11.70