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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.

Facilitymedian $72 · 10th–90th $27$1450%10%10th90th$72Professionalmedian $62 · 10th–90th $27$1260%20%10th90th$62$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

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