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Iowa rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.63 / $282.63 / $2,063.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $282.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.94 / $163.63 / $192.29
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $251.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.18 / $229.73 / $341.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.18 / $136.18 / $282.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.18 / $163.63 / $208.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.75 / $166.09 / $208.13
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.80 / $248.00 / $301.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $152.61
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.18 / $136.18 / $136.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.58 / $136.18 / $136.18