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Integra Dermal Regeneration Template (DRT) or Omnigraft

Arizona 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?

$28.18

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $28.18 for this service. The price depends on where it is billed: about $27.54 from a physician practice, and about $69.18 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 5 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$27.54$26.92 to $87.10
FacilityA hospital or hospital-owned outpatient department$69.18$46.77 to $135

How much rates vary

Facilitymedian $69 · 10th to 90th $30 to $245Professionalmedian $28 · 10th to 90th $26 to $126
$20$50$100$200facility $69professional $28

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
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$50.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$30.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$97.72
Typical High
$331.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$138.04
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$208.93
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$15.49
Median
$29.51
Typical High
$61.66
Medica
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$56.23
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$120.23
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona 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.

Arizona· 19th of 51

$28.18

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.