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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 July 2026.

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

$33.88

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $33.88 for this service. The price depends on where it is billed: about $33.88 from a physician practice, and about $33.88 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$33.88$26.92 to $126
FacilityA hospital or hospital-owned outpatient department$33.88$25.70 to $112

How much rates vary

Facilitymedian $34 · 10th to 90th $14 to $141Professionalmedian $34 · 10th to 90th $27 to $219
$10$20$50$100$200facility $34professional $34

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
$50.12
BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.22
Median
$20.89
Typical High
$61.66
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$30.90
Typical High
$89.13
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$218.78
Typical High
$251.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$77.62
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$151.36
Select Health
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$117.49
Typical High
$302.00
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$147.91
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Idaho sits

The same service costs 3.3 times more in Minnesota than in West Virginia. 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· 11th of 51

$33.88

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.