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Integra Dermal Regeneration Template (DRT) or Omnigraft

Alaska 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 October 2026.

How much does Integra Dermal Regeneration Template (DRT) or Omnigraft cost?

$67.61

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $67.61 for this service. The price depends on where it is billed: about $60.26 from a physician practice, and about $186 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$60.26$50.12 to $191
FacilityA hospital or hospital-owned outpatient department$186$72.44 to $316

How much rates vary

Facilitymedian $186 · 10th to 90th $42 to $550Professionalmedian $60 · 10th to 90th $50 to $309
$50$100$200$500$1Kfacility $186professional $60

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Aetna
Setting
Professional
Modifier
None
Typical Low
$27.54
Median
$50.12
Typical High
$50.12
Cigna
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$316.23
Typical High
$933.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
None
Typical Low
$26.92
Median
$50.12
Typical High
$72.44
Moda Health
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$407.38
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$34.67
Median
$114.82
Typical High
$177.83
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$81.28
Typical High
$97.72
Providence
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$302.00
Typical High
$933.25
Providence
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$50.12
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$190.55
Typical High
$346.74

Where Alaska sits

The same service costs 4.7 times more in Oregon than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Alaska· 30th of 51

$67.61

OR $126DC $26.92

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.