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Integra Dermal Regeneration Template (DRT) or Omnigraft

Mississippi 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 $28 · 10th–90th $13$1350%20%10th90th$28Professionalmedian $28 · 10th–90th $27$1260%20%40%10th90th$28$2.0$5.0$10.0$20.0$50.0$100.0$200.0

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
$28.18
Median
$28.18
Typical High
$32.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$32.36
BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$14.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$128.82