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Alaska 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 $40 · 10th–90th $18–$1660%10%20%10th90th$40Professionalmedian $29 · 10th–90th $26–$3020%20%40%10th90th$29$10.0$50.0$200.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $29.51 / $89.13
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $114.82 / $177.83
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $89.13 / $97.72
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $32.36 / $144.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $60.26 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $107.15 / $316.23