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Nationwide rates for HCPCS Q4105

Integra dermal regeneration template (DRT) or Integra Omnigraft dermal regeneration matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $74 · 10th–90th $26$2400%20%10th90th$74Professionalmedian $27 · 10th–90th $26$1260%50%10th90th$27$0.0$0.5$10.0$200.0$5.0K$100.0K$2.0M

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
$25.70 / $26.92 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $33.11
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $67.61 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $169.82 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $64.57 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $120.23 / $125.89