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 July 2026.

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

$27.54

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $27.54 for this service. The price depends on where it is billed: about $27.54 from a physician practice, and about $40.74 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 6 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$27.54$26.92 to $120
FacilityA hospital or hospital-owned outpatient department$40.74$27.54 to $102

How much rates vary

Facilitymedian $41 · 10th to 90th $28 to $126Professionalmedian $28 · 10th to 90th $24 to $126
$20$50$100$200facility $41professional $28

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
$27.54
Median
$27.54
Typical High
$27.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$28.18
BCBS
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$79.43
Typical High
$79.43
BCBS
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$125.89
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$85.11
Typical High
$229.09
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$85.11
Typical High
$138.04
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$125.89
Typical High
$125.89

Where Michigan 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.

Michigan· 27th of 51

$27.54

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.