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Georgia 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
$23.22 / $26.94 / $26.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $29.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $27.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.94 / $26.94 / $52.80
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
$30.28 / $30.28 / $362.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.80 / $49.85 / $239.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.66 / $63.94 / $63.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $41.22