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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 October 2026.

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

$117

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $107 from a physician practice, and about $145 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$107$29.51 to $126
FacilityA hospital or hospital-owned outpatient department$145$74.13 to $224

How much rates vary

Facilitymedian $145 · 10th to 90th $49 to $275Professionalmedian $107 · 10th to 90th $26 to $135
$50$100$200facility $145professional $107

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
Professional
Modifier
None
Typical Low
$28.18
Median
$29.51
Typical High
$29.51
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$48.98
Median
$117.49
Typical High
$309.03
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$100.00
Typical High
$223.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$263.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$15.49
Median
$31.62
Typical High
$75.86
Medica
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$26.30
Typical High
$134.90
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona 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.

Arizona· 20th of 51

$117

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.