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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 October 2026.

How much does Integra Dermal Regeneration Template (DRT) or Omnigraft cost?

$67.61

Typical negotiated rate. In New York, October 2026.

Insurers have agreed to pay about $67.61 for this service. The price depends on where it is billed: about $67.61 from a physician practice, and about $70.79 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$67.61$67.61 to $126
FacilityA hospital or hospital-owned outpatient department$70.79$70.79 to $178

How much rates vary

Facilitymedian $71 · 10th to 90th $68 to $288Professionalmedian $68 · 10th to 90th $27 to $135
$10$20$50$100$200$500facility $71professional $68

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
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
CDPHP
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$186.21
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$138.04
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$151.36
Excellus BCBS
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$70.79
Typical High
$70.79
Excellus BCBS
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$70.79
Typical High
$70.79
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$33.11
Median
$33.11
Typical High
$147.91
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$24.55
Median
$43.65
Typical High
$43.65
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$165.96
Univera
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$70.79
Typical High
$70.79
Univera
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$70.79
Typical High
$70.79

Where New York 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 York· 34th of 51

$67.61

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.