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Integra Dermal Regeneration Template (DRT) or Omnigraft

Georgia 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?

$77.62

Typical negotiated rate. In Georgia, October 2026.

Insurers have agreed to pay about $77.62 for this service. Most negotiated rates run $40.74 to $112.

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 $158 · 10th to 90th $126 to $234Professionalmedian $78 · 10th to 90th $23 to $126
$20$50$100$200$500facility $158professional $78

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
$28.18
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$21.38
Median
$67.61
Typical High
$112.20
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$158.49
Typical High
$257.04
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$128.82
Typical High
$269.15
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$169.82

Where Georgia 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.

Georgia· 24th of 51

$77.62

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.