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Texas 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 $66 · 10th–90th $27–$3020%10%20%10th90th$66Professionalmedian $27 · 10th–90th $26–$1260%50%10th90th$27$2.0$10.0$50.0$200.0$1.0K

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 / $26.92
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $28.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $112.20 / $208.93
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $25.70
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $26.92 / $100.00
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $28.84 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $29.51 / $33.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $25.12 / $27.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $26.92 / $144.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $38.02 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89