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Integra Dermal Regeneration Template (DRT) or Omnigraft

Colorado 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?

$28.84

Typical negotiated rate. In Colorado, October 2026.

Insurers have agreed to pay about $28.84 for this service. The price depends on where it is billed: about $26.92 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$26.92$26.92 to $126
FacilityA hospital or hospital-owned outpatient department$145$126 to $191

How much rates vary

Facilitymedian $145 · 10th to 90th $27 to $240Professionalmedian $27 · 10th to 90th $27 to $141
$20$50$100$200facility $145professional $27

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
$26.92
Median
$26.92
Typical High
$26.92
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Cigna
Setting
Facility
Modifier
None
Typical Low
$102.33
Median
$158.49
Typical High
$239.88
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Denver HMP
Setting
Facility
Modifier
None
Typical Low
$14.79
Median
$26.92
Typical High
$87.10
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$257.04
Select Health
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$208.93
Typical High
$281.84
Select Health
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$186.21
Typical High
$229.09
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Colorado 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.

Colorado· 45th of 51

$28.84

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.