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Integra Dermal Regeneration Template (DRT) or Omnigraft

North Dakota 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?

$58.88

Typical negotiated rate. In North Dakota, July 2026.

Insurers have agreed to pay about $58.88 for this service. The price depends on where it is billed: about $60.26 from a physician practice, and about $26.92 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 5 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$60.26$26.92 to $70.79
FacilityA hospital or hospital-owned outpatient department$26.92$26.92 to $26.92

How much rates vary

Facilitymedian $27 · 10th to 90th $26 to $44Professionalmedian $60 · 10th to 90th $27 to $79
$20$50$100facility $27professional $60

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
$50.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$61.66
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$37.15
Typical High
$42.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$29.51
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$30.20
Typical High
$48.98
Medica
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$26.30
Typical High
$29.51
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$125.89
Typical High
$239.88

Where North Dakota 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.

North Dakota· 7th of 51

$58.88

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.