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Integra Dermal Regeneration Template (DRT) or Omnigraft

Nebraska 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?

$30.20

Typical negotiated rate. In Nebraska, October 2026.

Insurers have agreed to pay about $30.20 for this service. The price depends on where it is billed: about $30.20 from a physician practice, and about $30.20 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$30.20$26.30 to $120
FacilityA hospital or hospital-owned outpatient department$30.20$26.92 to $30.20

How much rates vary

Facilitymedian $30 · 10th to 90th $26 to $224Professionalmedian $30 · 10th to 90th $23 to $126
$20$50$100$200facility $30professional $30

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
$26.92
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$26.92
BCBS Nebraska
Setting
Facility
Modifier
None
Typical Low
$25.70
Median
$30.20
Typical High
$30.20
BCBS Nebraska
Setting
Professional
Modifier
None
Typical Low
$28.84
Median
$30.20
Typical High
$30.20
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$208.93
Typical High
$234.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$29.51
Median
$31.62
Typical High
$158.49
Medica
Setting
Facility
Modifier
None
Typical Low
$25.12
Median
$50.12
Typical High
$134.90
Medica
Setting
Professional
Modifier
None
Typical Low
$23.44
Median
$26.30
Typical High
$120.23
Midlands
Setting
Professional
Modifier
None
Typical Low
$31.62
Median
$34.67
Typical High
$190.55
Midlands
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$208.93
Typical High
$331.13
Midlands
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$38.02
Typical High
$158.49
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$125.89

Where Nebraska 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.

Nebraska· 41st of 51

$30.20

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.