go back

Integra Dermal Regeneration Template (DRT) or Omnigraft

Michigan 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?

$29.51

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $29.51 for this service. The price depends on where it is billed: about $28.18 from a physician practice, and about $2,512 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$28.18$27.54 to $126
FacilityA hospital or hospital-owned outpatient department$2,512$2,399 to $3,802

How much rates vary

Facilitymedian $2,512 · 10th to 90th $79 to $5,623Professionalmedian $28 · 10th to 90th $24 to $126
$100$1K$10Kfacility $2,512professional $28

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
$27.54
Median
$28.18
Typical High
$28.18
Aetna
Setting
Professional
Modifier
None
Typical Low
$27.54
Median
$27.54
Typical High
$28.18
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$2,398.83
Median
$2,691.53
Typical High
$6,165.95
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$21.88
Median
$107.15
Typical High
$125.89
Cigna
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$12.88
Typical High
$125.89
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$40.74
Median
$79.43
Typical High
$134.90
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$27.54
Typical High
$35.48
Priority Health
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$12.88
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90

Where Michigan 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.

Michigan· 43rd of 51

$29.51

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.