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Integra Dermal Regeneration Template (DRT) or Omnigraft

Connecticut 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?

$67.61

Typical negotiated rate. In Connecticut, October 2026.

Insurers have agreed to pay about $67.61 for this service. Most negotiated rates run $30.20 to $126.

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.

How much rates vary

Facilitymedian $200 · 10th to 90th $145 to $295Professionalmedian $68 · 10th to 90th $28 to $126
$50$100$200$500facility $200professional $68

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
$44.67
Median
$44.67
Typical High
$44.67
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$28.18
Typical High
$28.18
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$69.18
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$234.42
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
ConnectiCare
Setting
Professional
Modifier
None
Typical Low
$28.18
Median
$29.51
Typical High
$67.61
United
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$125.89
Typical High
$141.25

Where Connecticut 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.

Connecticut· 32nd of 51

$67.61

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.