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Kentucky 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 $26–$850%50%10th90th$27Professionalmedian $27 · 10th–90th $26–$500%50%10th90th$27$10.0$20.0$50.0$100.0$200.0$500.0

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
$25.70 / $25.70 / $25.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $28.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $38.90
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $42.66
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $28.84 / $38.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $28.18 / $38.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $125.89 / $125.89