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Integra Dermal Regeneration Template (DRT) or Omnigraft

Maryland 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?

$26.92

Typical negotiated rate. In Maryland, July 2026.

Insurers have agreed to pay about $26.92 for this service. The price depends on where it is billed: about $26.92 from a physician practice, and about $26.92 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 6 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$26.92$26.92 to $50.12
FacilityA hospital or hospital-owned outpatient department$26.92$26.92 to $26.92

How much rates vary

Facilitymedian $27 · 10th to 90th $27 to $69Professionalmedian $27 · 10th to 90th $24 to $126
$20$50$100facility $27professional $27

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$29.51
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Cigna
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$138.04
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$125.89
Typical High
$134.90
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$162.18
Typical High
$204.17

Where Maryland 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.

Maryland· 32nd of 51

$26.92

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.