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Integra Dermal Regeneration Template (DRT) or Omnigraft

New York 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?

$27.54

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $27.54 for this service. The price depends on where it is billed: about $27.54 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 9 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$27.54$26.30 to $67.61
FacilityA hospital or hospital-owned outpatient department$26.92$26.92 to $126

How much rates vary

Facilitymedian $27 · 10th to 90th $27 to $174Professionalmedian $28 · 10th to 90th $25 to $91
$100$1K$10Kfacility $27professional $28

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. 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
$28.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$63.10
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$144.54
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$162.18
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$28.18
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$28.18
Typical High
$28.18
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$43.65
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$26.30
Typical High
$125.89
Univera
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$29.51
Univera
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$28.18
Typical High
$28.18

Where New York 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.

New York· 26th of 51

$27.54

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.