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Minnesota 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 $46 · 10th–90th $23–$1120%20%10th90th$46Professionalmedian $100 · 10th–90th $21–$1260%20%10th90th$100$0.2$1.0$5.0$20.0$100.0$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 / $33.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $45.71 / $45.71
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $107.15 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $102.33 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $27.54 / $30.20
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $69.18 / $112.20
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $23.44 / $28.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $26.30 / $57.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $26.30 / $47.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $125.89 / $239.88