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Integra Dermal Regeneration Template (DRT) or Omnigraft

Kansas 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?

$61.66

Typical negotiated rate. In Kansas, July 2026.

Insurers have agreed to pay about $61.66 for this service. The price depends on where it is billed: about $61.66 from a physician practice, and about $72.44 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$61.66$27.54 to $61.66
FacilityA hospital or hospital-owned outpatient department$72.44$31.62 to $102

How much rates vary

Facilitymedian $72 · 10th to 90th $27 to $145Professionalmedian $62 · 10th to 90th $27 to $126
$20$50$100$200$500facility $72professional $62

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
$31.62
Median
$31.62
Typical High
$81.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$27.54
Typical High
$81.28
BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$33.88
Typical High
$74.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$26.30
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$125.89

Where Kansas 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.

Kansas· 6th of 51

$61.66

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.