go back

Integra Dermal Regeneration Template (DRT) or Omnigraft

Iowa 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?

$28.18

Typical negotiated rate. In Iowa, October 2026.

Insurers have agreed to pay about $28.18 for this service. The price depends on where it is billed: about $28.84 from a physician practice, and about $26.92 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$28.84$26.30 to $126
FacilityA hospital or hospital-owned outpatient department$26.92$26.92 to $64.57

How much rates vary

Facilitymedian $27 · 10th to 90th $27 to $81Professionalmedian $29 · 10th to 90th $25 to $191
$20$50$100$200facility $27professional $29

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
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$25.12
Median
$25.12
Typical High
$81.28
Cigna
Setting
Facility
Modifier
None
Typical Low
$18.20
Median
$223.87
Typical High
$269.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$23.44
Median
$151.36
Typical High
$190.55
Hally Health
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$218.78
Medica
Setting
Facility
Modifier
None
Typical Low
$22.91
Median
$38.90
Typical High
$81.28
Medica
Setting
Professional
Modifier
None
Typical Low
$25.70
Median
$26.92
Typical High
$134.90
Midlands
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$190.55
Typical High
$190.55
Midlands
Setting
Facility
Modifier
None
Typical Low
$18.20
Median
$208.93
Typical High
$269.15
Midlands
Setting
Professional
Modifier
None
Typical Low
$16.98
Median
$45.71
Typical High
$95.50
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90
Wellmark
Setting
Facility
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Wellmark
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92

Where Iowa 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.

Iowa· 46th of 51

$28.18

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.