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Integra Dermal Regeneration Template (DRT) or Omnigraft

Nationwide 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)

Rates data updated July 2026.

Facilitymedian $79 · 10th–90th $27$2570%20%10th90th$79Professionalmedian $27 · 10th–90th $26$1260%50%10th90th$27$0.1$1.0$20.0$500.0$10.0K$200.0K

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
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$32.36
BCBS
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$87.10
Typical High
$295.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$67.61
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$173.78
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$125.89
Typical High
$125.89