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Integra Dermal Regeneration Template (DRT) or Omnigraft

Florida 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?

$26.92

Typical negotiated rate. In Florida, July 2026.

Insurers have agreed to pay about $26.92 for this service. The price depends on where it is billed: about $26.92 from a physician practice, and about $126 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 7 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$26.92$26.92 to $29.51
FacilityA hospital or hospital-owned outpatient department$126$26.92 to $70,795

How much rates vary

Facilitymedian $126 · 10th to 90th $27 to $154,882Professionalmedian $27 · 10th to 90th $27 to $126
$100$1K$10K$100Kfacility $126professional $27

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
$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
AvMed
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$107.15
Typical High
$125.89
AvMed
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$85.11
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$102,329.30
Typical High
$208,929.61
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$85.11
Typical High
$131.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$41.69
United
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$125.89
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$128.82

Where Florida 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.

Florida· 41st of 51

$26.92

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.