go back

Integra Dermal Regeneration Template (DRT) or Omnigraft

Hawaii 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?

$38.90

Typical negotiated rate. In Hawaii, July 2026.

Insurers have agreed to pay about $38.90 for this service. Most negotiated rates run $26.92 to $46.77.

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.

How much rates vary

Professionalmedian $39 · 10th to 90th $27 to $56
$20.0$50.0$100.0$200.0professional $39

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
Professional
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$29.51
Cigna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$38.02
Typical High
$125.89
HMSA
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$44.67
Typical High
$52.48
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$125.89
Typical High
$125.89

Where Hawaii sits

The same service costs 3.3 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Hawaii $38.90 · 10th of 51
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.