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Integra Dermal Regeneration Template (DRT) or Omnigraft

Louisiana 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?

$115

Typical negotiated rate. In Louisiana, October 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $28.84 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$27.54 to $126
FacilityA hospital or hospital-owned outpatient department$28.84$28.84 to $28.84

How much rates vary

Facilitymedian $29 · 10th to 90th $29 to $234Professionalmedian $126 · 10th to 90th $27 to $126
$50$100$200facility $29professional $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
$27.54
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$27.54
BCBS Louisiana
Setting
Facility
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
BCBS Louisiana
Setting
Professional
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Christus
Setting
Facility
Modifier
None
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$223.87
Typical High
$338.84
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$131.83

Where Louisiana 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.

Louisiana· 21st of 51

$115

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.