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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 July 2026.

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

$89.13

Typical negotiated rate. In Alaska, July 2026.

Insurers have agreed to pay about $89.13 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $39.81 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$100$26.92 to $295
FacilityA hospital or hospital-owned outpatient department$39.81$26.92 to $89.13

How much rates vary

Facilitymedian $40 · 10th to 90th $18 to $178Professionalmedian $100 · 10th to 90th $27 to $407
$10$50$200$1Kfacility $40professional $100

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$50.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$32.36
Typical High
$89.13
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$489.78
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$114.82
Typical High
$177.83
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$89.13
Typical High
$97.72
Providence
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$42.66
Typical High
$302.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$60.26
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$190.55
Typical High
$380.19

Where Alaska sits

The same service costs 3.3 times more in Minnesota than in West Virginia. 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· 2nd of 51

$89.13

MN $89.13WV $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.