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Wyoming 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 $129 · 10th–90th $38–$4790%10%20%10th90th$129Professionalmedian $27 · 10th–90th $23–$1260%20%40%10th90th$27$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $25.70 / $33.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $81.28 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $50.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $125.89 / $125.89