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Nebraska 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 $28 · 10th–90th $26–$2240%20%40%10th90th$28Professionalmedian $27 · 10th–90th $26–$810%50%10th90th$27$20.0$100.0$500.0$2.0K

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 / $26.92 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $26.92 / $44.67
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $28.84 / $30.20
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $190.55 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $34.67 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $38.02 / $52.48
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $26.30 / $57.54
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $31.62 / $51.29
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.38 / $204.17 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $45.71 / $64.57
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $23.99 / $27.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $38.02 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $120.23 / $125.89