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Washington, DC rates for HCPCS Q4105

Integra Dermal Regeneration Template (Drt) Or Or Integra Omnigraft Dermal Regeneration Matrix Per Square Centimeter (Desc Rvsd 1/1/17)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $27.21
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.64 / $11.64 / $11.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.42 / $25.42 / $26.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $34.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.90 / $22.90 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $43.66