go back

Tennessee 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $26.92 / $46.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $28.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $26.92 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $26.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $147.91 / $147.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $95.50 / $125.89