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Iowa rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $245.47 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $380.19 / $1,047.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $309.03 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $870.96 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $870.96 / $1,202.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $363.08 / $1,047.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $257.04 / $302.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $302.00 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $302.00 / $1,000.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13