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Iowa 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 $27 · 10th–90th $27–$810%50%90th$27Professionalmedian $27 · 10th–90th $26–$870%50%10th90th$27$0.0$0.1$0.5$2.0$10.0$50.0$200.0

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
$26.92 / $81.28 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $26.92 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $223.87 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $29.51 / $75.86
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $114.82 / $251.19
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $31.62 / $81.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $26.30 / $95.50
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $29.51 / $64.57
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $208.93 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $75.86 / $95.50
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $25.12 / $27.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $23.44 / $38.02
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $131.83
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $26.92
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $26.92