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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 July 2026.

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

$43.65

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $43.65 for this service. The price depends on where it is billed: about $81.28 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 7 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$81.28$26.92 to $81.28
FacilityA hospital or hospital-owned outpatient department$26.92$26.92 to $81.28

How much rates vary

Facilitymedian $27 · 10th to 90th $27 to $81Professionalmedian $81 · 10th to 90th $27 to $126
$0.1$1.0$10.0$100.0facility $27professional $81

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
$26.92
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$81.28
Typical High
$87.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$223.87
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$29.51
Typical High
$64.57
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$114.82
Typical High
$251.19
Medica
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$31.62
Typical High
$81.28
Medica
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$26.30
Typical High
$95.50
Midlands
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$29.51
Typical High
$66.07
Midlands
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$208.93
Typical High
$269.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$75.86
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$114.82
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$134.90
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$26.92
Typical High
$26.92

Where Iowa 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.

Iowa $43.65 · 9th 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.