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Colorado 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.09 / $26.94 / $26.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $28.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.42 / $25.42 / $35.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.89 / $28.56 / $45.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.37 / $29.64 / $38.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94