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Integra Dermal Regeneration Template (DRT) or Omnigraft

Missouri 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?

$50.12

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $50.12 for this service. The price depends on where it is billed: about $45.71 from a physician practice, and about $72.44 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$45.71$26.92 to $120
FacilityA hospital or hospital-owned outpatient department$72.44$27.54 to $102

How much rates vary

Facilitymedian $72 · 10th to 90th $27 to $158Professionalmedian $46 · 10th to 90th $27 to $132
$20$50$100$200facility $72professional $46

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
$27.54
Typical High
$87.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$81.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$97.72
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$36.31
Typical High
$81.28
Medica
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$26.30
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$125.89
Typical High
$125.89

Where Missouri 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.

Missouri· 8th of 51

$50.12

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.