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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 October 2026.

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

$64.57

Typical negotiated rate. In Virginia, October 2026.

Insurers have agreed to pay about $64.57 for this service. The price depends on where it is billed: about $64.57 from a physician practice, and about $151 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$64.57$28.18 to $126
FacilityA hospital or hospital-owned outpatient department$151$72.44 to $240

How much rates vary

Facilitymedian $151 · 10th to 90th $27 to $316Professionalmedian $65 · 10th to 90th $26 to $126
$20$50$100$200facility $151professional $65

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
$28.18
Aetna
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$28.18
Typical High
$28.18
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
CareFirst
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Cigna
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$223.87
Typical High
$331.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$134.90
Typical High
$194.98
Medcost
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Medcost
Setting
Facility
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$42.66
Medcost
Setting
Professional
Modifier
None
Typical Low
$10.72
Median
$77.62
Typical High
$109.65
Sentara
Setting
Facility
Modifier
None
Typical Low
$26.30
Median
$72.44
Typical High
$77.62
Sentara
Setting
Professional
Modifier
None
Typical Low
$26.30
Median
$26.30
Typical High
$77.62
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$128.82

Where Virginia 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.

Virginia· 35th of 51

$64.57

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.