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Iowa rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $101.13 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $83.94 / $101.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.16 / $166.16 / $178.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.76 / $109.30 / $148.58
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.82 / $206.55 / $264.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $105.78 / $167.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.09 / $136.47 / $272.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.76 / $116.59 / $136.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.78 / $116.64 / $167.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.69 / $192.40 / $194.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $150.12
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.01 / $91.01 / $91.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.90 / $91.01 / $91.01