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Missouri 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 $38 · 10th–90th $27–$3470%20%10th90th$38Professionalmedian $27 · 10th–90th $26–$1260%20%40%10th90th$27$10.0$50.0$200.0$1.0K

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
$26.92 / $27.54 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $26.92 / $44.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $97.72 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $223.87 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $36.31 / $81.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $26.30 / $134.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $33.88 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89