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Iowa rates for HCPCS Q4107

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

Facilitymedian $91 · 10th–90th $91$1000%50%90th$91Professionalmedian $85 · 10th–90th $79$1260%50%10th90th$85$0.2$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $223.87 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $114.82 / $134.90
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $208.93 / $263.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $104.71 / $177.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $138.04 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $128.82 / $165.96
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $199.53 / $199.53
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $181.97 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.14 / $138.04 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $138.04
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20