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New York 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$1660%50%10th90th$28Professionalmedian $28 · 10th–90th $25$850%20%40%10th90th$28$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 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $35.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $63.10
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $138.04 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $125.89 / $125.89
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $138.04 / $338.84
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $199.53
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $28.18
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $28.18 / $28.18
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $28.18 / $28.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $25.12 / $50.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $26.30 / $125.89
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $29.51
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $28.18 / $28.18