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Michigan 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–$1020%20%40%90th$27Professionalmedian $26 · 10th–90th $10–$810%20%40%10th90th$26$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 / $26.92 / $26.92
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $32.36
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.31 / $6.31 / $6.31
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.61 / $10.23 / $10.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $125.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $85.11 / $229.09
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $85.11 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $102.33 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89