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Massachusetts 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 $87 · 10th–90th $26–$2290%20%10th90th$87Professionalmedian $27 · 10th–90th $26–$1260%50%10th90th$27$10.0$50.0$200.0$1.0K$5.0K$20.0K

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 / $36.31
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $125.89 / $707.95
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $125.89 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $269.15 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $181.97 / $2,951.21
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $257.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $44.67
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,882.50 / $12,882.50 / $12,882.50
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $125.89 / $707.95
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $125.89 / $263.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $50.12 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $26.92 / $125.89