go back

Integra Dermal Regeneration Template (DRT) or Omnigraft

Arkansas 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 $30 · 10th–90th $30$320%50%90th$30Professionalmedian $27 · 10th–90th $27$1260%50%90th$27$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
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$32.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$32.36
BCBS
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$29.51
Typical High
$29.51
BCBS
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$29.51
Typical High
$29.51
Cigna
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$173.78
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89