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Integra Dermal Regeneration Template (DRT) or Omnigraft

New Jersey 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?

$26.92

Typical negotiated rate. In New Jersey, October 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 $288 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$26.92$26.92 to $126
FacilityA hospital or hospital-owned outpatient department$288$158 to $14,454

How much rates vary

Facilitymedian $288 · 10th to 90th $110 to $21,878Professionalmedian $27 · 10th to 90th $23 to $126
$100$1K$10Kfacility $288professional $27

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
$26.92
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Cigna
Setting
Facility
Modifier
None
Typical Low
$40.74
Median
$165.96
Typical High
$257.04
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$162.18
Horizon BCBS
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$13,489.63
Typical High
$26,915.35
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$23.44
Median
$23.44
Typical High
$147.91
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$141.25

Where New Jersey 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.

New Jersey· 50th of 51

$26.92

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.