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South Carolina 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 $38 · 10th–90th $26–$1740%10%10th90th$38Professionalmedian $26 · 10th–90th $23–$1150%50%10th90th$26$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
$28.18 / $38.02 / $38.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $25.70 / $28.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $50.12 / $83.18
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $117.49 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.62 / $29.51 / $89.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $47.86 / $83.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89