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Integra Dermal Regeneration Template (DRT) or Omnigraft

Ohio 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?

$42.66

Typical negotiated rate. In Ohio, October 2026.

Insurers have agreed to pay about $42.66 for this service. The price depends on where it is billed: about $37.15 from a physician practice, and about $166 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$37.15$26.92 to $126
FacilityA hospital or hospital-owned outpatient department$166$141 to $269

How much rates vary

Facilitymedian $166 · 10th to 90th $126 to $363Professionalmedian $37 · 10th to 90th $27 to $126
$50$100$200facility $166professional $37

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
$398.11
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$141.25
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$22.91
Median
$26.92
Typical High
$74.13
CareSource
Setting
Facility
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
CareSource
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$36.31
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$194.98
Typical High
$389.05
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medical Mutual of Ohio
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$316.23
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$97.72
Typical High
$131.83
SummaCare
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$123.03
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$125.89
Typical High
$151.36

Where Ohio 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.

Ohio· 38th of 51

$42.66

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.