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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 July 2026.

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

$30.20

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $30.20 for this service. The price depends on where it is billed: about $126 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 8 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$126$26.92 to $209
FacilityA hospital or hospital-owned outpatient department$26.92$25.12 to $26.92

How much rates vary

Facilitymedian $27 · 10th to 90th $25 to $58Professionalmedian $126 · 10th to 90th $27 to $275
$10.0$100.0$1.0K$10.0K$100.0K$1.0Mfacility $27professional $126

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$46.77
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$257.04
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$29.51
Typical High
$141.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$239.88
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$26.92
Typical High
$29.51
Providence
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$41.69
Typical High
$245.47
Providence
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$79.43
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Oregon sits

The same service costs 3.3 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Oregon $30.20 · 15th of 51
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.