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Arizona 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 $47 · 10th–90th $22–$1260%10%10th90th$47Professionalmedian $27 · 10th–90th $26–$1260%50%10th90th$27$20.0$50.0$100.0$200.0$500.0

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
$46.77 / $46.77 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $26.92 / $36.31
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $37.15 / $120.23
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $33.11 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $29.51 / $61.66
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $56.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89