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Iowa rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $3 · 10th–90th $3–$150%50%90th$3Professionalmedian $2 · 10th–90th $2–$160%50%90th$2$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$2.00 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $223.87 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $11.48 / $21.38
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.14 / $25.12 / $54.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $10.96 / $63.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $15.49
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.82 / $10.96 / $13.18
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $208.93 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $15.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.12 / $9.12 / $15.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $125.89 / $131.83
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $2.51
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $2.51