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New Jersey 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 $2,455 · 10th–90th $26–$19,9530%5%10th90th$2,455Professionalmedian $26 · 10th–90th $23–$1260%50%10th90th$26$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$25.70 / $25.70 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $32.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $40.74 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $165.96
Horizon BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $8,709.64 / $23,988.33
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $23.44 / $23.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $35.48 / $35.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $34.67 / $125.89