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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 July 2026.

Facilitymedian $32 · 10th–90th $26$1910%20%10th90th$32Professionalmedian $27 · 10th–90th $27$1260%50%90th$27$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$26.92
Median
$26.92
Typical High
$26.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$29.51
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$67.61
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$144.54
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$27.54
Typical High
$81.28
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$208.93
Typical High
$269.15
Select Health
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$208.93
Typical High
$281.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$208.93
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89