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Integra Dermal Regeneration Template (DRT) or Omnigraft

Oregon 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?

$126

Typical negotiated rate. In Oregon, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $29.51 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$126$60.26 to $126
FacilityA hospital or hospital-owned outpatient department$29.51$26.92 to $89.13

How much rates vary

Facilitymedian $30 · 10th to 90th $25 to $229Professionalmedian $126 · 10th to 90th $27 to $219
$50$100$200facility $30professional $126

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
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Cigna
Setting
Facility
Modifier
None
Typical Low
$46.77
Median
$223.87
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$275.42
Typical High
$346.74
Moda Health
Setting
Facility
Modifier
None
Typical Low
$13.80
Median
$38.90
Typical High
$89.13
Moda Health
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$141.25
Typical High
$275.42
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$25.12
Median
$26.92
Typical High
$56.23
Providence
Setting
Facility
Modifier
None
Typical Low
$46.77
Median
$208.93
Typical High
$288.40
Providence
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$125.89
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$204.17
Typical High
$218.78
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Oregon 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.

Oregon· 1st of 51

$126

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.