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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 October 2026.

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

$32.36

Typical negotiated rate. In Arkansas, October 2026.

Insurers have agreed to pay about $32.36 for this service. The price depends on where it is billed: about $32.36 from a physician practice, and about $29.51 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$32.36$29.51 to $126
FacilityA hospital or hospital-owned outpatient department$29.51$29.51 to $32.36

How much rates vary

Facilitymedian $30 · 10th to 90th $30 to $135Professionalmedian $32 · 10th to 90th $30 to $126
$50$100$200facility $30professional $32

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$32.36
Median
$32.36
Typical High
$32.36
Aetna
Setting
Professional
Modifier
None
Typical Low
$28.18
Median
$32.36
Typical High
$32.36
BCBS Arkansas
Setting
Facility
Modifier
None
Typical Low
$29.51
Median
$29.51
Typical High
$29.51
BCBS Arkansas
Setting
Professional
Modifier
None
Typical Low
$29.51
Median
$29.51
Typical High
$29.51
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$173.78
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$125.89
Typical High
$128.82

Where Arkansas 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.

Arkansas· 40th of 51

$32.36

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.