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Iowa rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $63 · 10th–90th $63$980%50%90th$63Professionalmedian $65 · 10th–90th $62$1050%20%40%10th90th$65$0.1$0.5$2.0$10.0$50.0$200.0

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
$61.66 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $64.57 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $245.47 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $81.28 / $107.15
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $69.18 / $151.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $93.33 / $154.88
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $107.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $75.86 / $107.15
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $245.47 / $302.00
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $104.71 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.06 / $63.10 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $131.83
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10