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Mississippi rates for HCPCS Q4105

Integra Dermal Regeneration Template (Drt) Or Or Integra Omnigraft Dermal Regeneration Matrix Per Square Centimeter (Desc Rvsd 1/1/17)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.29 / $28.29 / $32.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $28.29 / $32.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $26.94 / $26.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.59 / $26.94 / $35.02