go back

Integra Dermal Regeneration Template (DRT) or Omnigraft

Idaho 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 Idaho, 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 $145 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$33.88 to $151
FacilityA hospital or hospital-owned outpatient department$145$29.51 to $158

How much rates vary

Facilitymedian $145 · 10th to 90th $19 to $191Professionalmedian $126 · 10th to 90th $30 to $204
$10$20$50$100$200facility $145professional $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
$29.51
Median
$33.88
Typical High
$33.88
BCBS Idaho
Setting
Facility
Modifier
None
Typical Low
$11.22
Median
$20.89
Typical High
$61.66
BCBS Idaho
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$151.36
BCBS Idaho
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$158.49
Median
$177.83
Typical High
$186.21
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$158.49
Typical High
$213.80
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
None
Typical Low
$26.92
Median
$33.88
Typical High
$47.86
Moda Health
Setting
Professional
Modifier
None
Typical Low
$29.51
Median
$33.88
Typical High
$223.87
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$194.98
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$151.36
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$204.17
Select Health
Setting
Facility
Modifier
None
Typical Low
$21.88
Median
$117.49
Typical High
$120.23
Select Health
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$154.88
Typical High
$213.80
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Idaho 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.

Idaho· 12th 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.