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Integra Dermal Regeneration Template (DRT) or Omnigraft

Virginia 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?

$28.18

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $28.18 for this service. The price depends on where it is billed: about $28.18 from a physician practice, and about $28.18 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 8 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$28.18$26.92 to $81.28
FacilityA hospital or hospital-owned outpatient department$28.18$26.92 to $54.95

How much rates vary

Facilitymedian $28 · 10th to 90th $27 to $186Professionalmedian $28 · 10th to 90th $27 to $126
$20$50$100$200facility $28professional $28

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
$28.18
Typical High
$28.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$33.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$114.82
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$40.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$251.19
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$131.83
Typical High
$239.88
Medcost
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Medcost
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$28.18
Typical High
$81.28
Medcost
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$109.65
Sentara
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$31.62
Typical High
$77.62
Sentara
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$31.62
Typical High
$77.62
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$154.88
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$125.89
Typical High
$125.89

Where Virginia 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.

Virginia· 20th of 51

$28.18

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.