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Integra Dermal Regeneration Template (DRT) or Omnigraft

Minnesota 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?

$89.13

Typical negotiated rate. In Minnesota, July 2026.

Insurers have agreed to pay about $89.13 for this service. The price depends on where it is billed: about $102 from a physician practice, and about $58.88 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 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$102$23.99 to $126
FacilityA hospital or hospital-owned outpatient department$58.88$27.54 to $75.86

How much rates vary

Facilitymedian $59 · 10th to 90th $23 to $257Professionalmedian $102 · 10th to 90th $20 to $126
$20$50$100$200facility $59professional $102

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
$26.92
Typical High
$26.92
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$30.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$42.66
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$63.10
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$27.54
Typical High
$30.20
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$60.26
Typical High
$89.13
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$23.44
Typical High
$32.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$26.30
Typical High
$57.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$26.30
Typical High
$47.86
United
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$125.89
Typical High
$239.88

Where Minnesota 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.

Minnesota· 1st of 51

$89.13

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.