go back

Iowa rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $245.47 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $85.11 / $104.71
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $89.13 / $151.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $102.33 / $380.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $128.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $102.33 / $128.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $257.04 / $302.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $83.18 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $95.50 / $125.89
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62