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Integra Dermal Regeneration Template (DRT) or Omnigraft

South Carolina 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?

$117

Typical negotiated rate. In South Carolina, October 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $117 from a physician practice, and about $151 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$117$38.90 to $126
FacilityA hospital or hospital-owned outpatient department$151$83.18 to $224

How much rates vary

Facilitymedian $151 · 10th to 90th $44 to $302Professionalmedian $117 · 10th to 90th $28 to $148
$20$50$100$200facility $151professional $117

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
$28.18
Median
$28.18
Typical High
$28.18
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$28.18
Typical High
$28.18
BCBS South Carolina
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$67.61
Typical High
$83.18
BCBS South Carolina
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$117.49
Typical High
$147.91
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$177.83
Typical High
$309.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
None
Typical Low
$15.85
Median
$30.90
Typical High
$100.00
Medcost
Setting
Professional
Modifier
None
Typical Low
$10.72
Median
$13.18
Typical High
$81.28
Molina
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$87.10
United
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
5 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$5.37
Median
$6.61
Typical High
$22.91
Medcost
Setting
Professional
Modifier
80 · Assistant surgeon
Typical Low
$2.14
Median
$2.63
Typical High
$9.33
Medcost
Setting
Professional
Modifier
81 · Minimal assistant surgeon
Typical Low
$1.51
Median
$1.82
Typical High
$6.46
Medcost
Setting
Professional
Modifier
82 · Assistant surgeon, no resident
Typical Low
$1.51
Median
$1.82
Typical High
$6.46
Medcost
Setting
Professional
Modifier
AS · PA/NP assist
Typical Low
$1.51
Median
$1.82
Typical High
$6.46

Where South Carolina 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.

South Carolina· 19th of 51

$117

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.