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Virginia 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–$1020%20%10th90th$28Professionalmedian $27 · 10th–90th $26–$1260%20%40%10th90th$27$2.0$5.0$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
$25.70 / $25.70 / $28.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $81.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $114.82
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $40.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $131.83 / $239.88
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $28.18 / $81.28
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $31.62 / $77.62
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $31.62 / $77.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89