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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 October 2026.

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

$110

Typical negotiated rate. In Missouri, October 2026.

Insurers have agreed to pay about $110 for this service. The price depends on where it is billed: about $110 from a physician practice, and about $145 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$110$97.72 to $126
FacilityA hospital or hospital-owned outpatient department$145$81.28 to $209

How much rates vary

Facilitymedian $145 · 10th to 90th $27 to $257Professionalmedian $110 · 10th to 90th $26 to $135
$20$50$100$200facility $145professional $110

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
$26.92
Median
$26.92
Typical High
$81.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$27.54
Typical High
$32.36
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$109.65
Typical High
$134.90
BCBS Kansas City
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$138.04
Typical High
$177.83
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$190.55
Typical High
$269.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$23.99
Median
$72.44
Typical High
$134.90
Medica
Setting
Professional
Modifier
None
Typical Low
$23.44
Median
$26.30
Typical High
$134.90
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$144.54

Where Missouri 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.

Missouri· 22nd of 51

$110

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.