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Maryland 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 $69 · 10th–90th $69–$1200%20%40%90th$69Professionalmedian $26 · 10th–90th $26–$1260%50%90th$26$10.0$20.0$50.0$100.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $32.36
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $138.04 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $128.82
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $158.49 / $204.17