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California 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 $87 · 10th–90th $69$2190%50%10th90th$87Professionalmedian $28 · 10th–90th $23$1380%20%40%10th90th$28$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
$25.70 / $26.92 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $26.92 / $112.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $218.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $69.18 / $109.65
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $23.99 / $53.70
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.91 / $12.59 / $27.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $177.83 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $165.96 / $269.15
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $13.18 / $30.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $28.18 / $194.98
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $125.89 / $125.89
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $17.78 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $125.89 / $158.49