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Oklahoma 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 $30 · 10th–90th $26–$1350%20%40%10th90th$30Professionalmedian $27 · 10th–90th $26–$1260%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
$28.84 / $28.84 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $26.92 / $33.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $331.13 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $32.36 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $26.30 / $57.54
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 / $125.89 / $125.89