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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 July 2026.

How much does Integra Dermal Regeneration Template (DRT) or Omnigraft cost?

$28.18

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $28.18 for this service. The price depends on where it is billed: about $28.18 from a physician practice, and about $129 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 5 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$28.18$26.92 to $112
FacilityA hospital or hospital-owned outpatient department$129$26.92 to $245

How much rates vary

Facilitymedian $129 · 10th to 90th $27 to $339Professionalmedian $28 · 10th to 90th $27 to $120
$10.0$20.0$50.0$100.0$200.0$500.0facility $129professional $28

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
$23.99
Median
$26.92
Typical High
$26.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$36.31
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$112.20
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$234.42
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$128.82
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$245.47
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$134.90

Where Georgia sits

The same service costs 3.3 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Georgia $28.18 · 18th of 51
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.