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Integra Dermal Regeneration Template (DRT) or Omnigraft

Washington, DC 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.

Facilitymedian $27 · 10th–90th $27$2630%50%90th$27Professionalmedian $27 · 10th–90th $27$1260%50%90th$27$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

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
$28.18
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$35.48
Typical High
$69.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$263.03
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$107.15
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$125.89
Typical High
$158.49