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Iowa rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,230 · 10th–90th $1,230–$1,2300%50%$1,230Professionalmedian $1,230 · 10th–90th $479–$1,4790%50%10th90th$1,230$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,479.11
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
$416.87 / $1,148.15 / $1,380.38
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $1,230.27 / $1,778.28
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,412.54 / $3,311.31
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $1,412.54 / $1,995.26
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
$478.63 / $478.63 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.07 / $1,047.13 / $1,737.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,047.13
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27