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North Dakota 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 $26 · 10th–90th $26–$480%50%90th$26Professionalmedian $27 · 10th–90th $26–$720%50%10th90th$27$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. 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 / $37.15
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $61.66 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $29.51 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $30.20 / $48.98
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $26.30 / $29.51
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $125.89 / $239.88