go back

Integra Dermal Regeneration Template (DRT) or Omnigraft

Illinois 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?

$126

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $195 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$26.92 to $126
FacilityA hospital or hospital-owned outpatient department$195$151 to $257

How much rates vary

Facilitymedian $195 · 10th to 90th $35 to $295Professionalmedian $126 · 10th to 90th $27 to $132
$50$100$200$500facility $195professional $126

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
$117.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$27.54
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$27.54
Median
$181.97
Typical High
$281.84
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$128.82
Typical High
$165.96
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$239.88
Typical High
$302.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
None
Typical Low
$22.91
Median
$32.36
Typical High
$245.47
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$144.54

Where Illinois 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.

Illinois· 6th of 51

$126

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.