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Iowa rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,063.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.08 / $360.22 / $390.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.07 / $1,052.89 / $1,905.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.22 / $998.00 / $1,341.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.24 / $871.37 / $1,325.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.31 / $360.22 / $462.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.08 / $360.22 / $462.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,137.11
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $871.37 / $871.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.38 / $871.37 / $871.37