HCPCS Q4105
Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products38 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $238 – $644 | — | — |
| Cascade Valley Hospital | $35.48 – $540 | $480 | $600 |
| Deaconess Medical Center | $229 – $567 | — | — |
| Harborview Medical Center | $231 – $307 | $37.84 – $33,671 | $54.05 – $48,102 |
| Highline Medical Center | $57.97 – $33,478 | $6,611 – $11,358 | $21,650 – $37,197 |
| Island Hospital | $193 – $1,912 | $1,458 – $2,013 | $1,458 – $2,013 |
| Kadlec Regional Medical Center | $37.60 – $390 | $2,039 – $4,279 | $2,913 – $6,113 |
| Legacy Salmon Creek Medical Center | $42.44 – $277 | $345 | $531 |
| Mary Bridge Children's Hospital | $1,000 | — | — |
| MultiCare Auburn Medical Center | $239 – $597 | — | — |
| MultiCare Covington Medical Center | $239 – $597 | — | — |
| MultiCare Good Samaritan Hospital | $240 – $597 | — | — |
| MultiCare Valley Hospital | $229 – $566 | — | — |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | $56.32 – $380 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $28.62 – $460 | $2,079 – $5,762 | $2,970 – $8,231 |
| Providence Centralia Hospital | $83.92 – $539 | $3,395 – $9,332 | $6,528 – $17,947 |
| Providence Holy Family Hospital | $28.62 – $508 | $2,079 – $5,762 | $2,970 – $8,231 |
| Providence Mount Carmel Hospital | — | $1,983 – $5,504 | $2,833 – $7,863 |
| Providence Regional Medical Center Everett | $28.62 – $440 | $3,547 – $7,838 | $6,821 – $15,073 |
| Providence St Joseph Hospital | — | $1,983 – $5,504 | $2,833 – $7,863 |
| Providence St Mary Medical Center | $66.60 – $408 | $2,046 – $4,919 | $2,922 – $7,027 |
| Providence St Peter Hospital | $42.98 – $559 | $3,395 – $9,332 | $6,528 – $17,947 |
| Skagit Valley Hospital | $86.58 – $570 | $480 | $600 |
| St Anthony Hospital | $48.37 – $27,898 | $6,585 – $11,314 | $21,650 – $37,197 |
| St Clare Hospital | $48.37 – $27,898 | $6,241 – $10,722 | $21,650 – $37,197 |
| St Elizabeth Hospital | $53.75 – $33,478 | $7,651 – $13,144 | $21,650 – $37,197 |
| St Francis Community Hospital | $48.37 – $27,898 | $6,794 – $11,673 | $21,650 – $37,197 |
| St Joseph Medical Center | $48.37 – $27,898 | $7,171 – $12,320 | $21,650 – $37,197 |
| St Michael Medical Center | $46.98 – $33,478 | $9,555 – $16,417 | $21,650 – $37,197 |
| Swedish Edmonds Hospital | $28.62 – $510 | $2,153 – $5,492 | $4,485 – $11,442 |
| Swedish Issaquah | $28.62 – $613 | $2,153 – $5,492 | $4,485 – $11,442 |
| Swedish Medical Center | $28.62 – $611 | $2,153 – $5,492 | $4,485 – $11,442 |
| Swedish Medical Center / Cherry Hill | $28.62 – $611 | $2,153 – $5,492 | $4,485 – $11,442 |
| Tacoma General Allenmore Hospital | $240 – $597 | — | — |
| University of Washington Medical Ctr | $231 – $452 | $3,180 – $30,171 | $4,543 – $43,101 |
| Wellfound Behavioral Health Hospital | $367 | — | — |
| Yakima Valley Memorial | $233 – $353 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $156 in an office; $156 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $134 in an office; $134 in a hospital or surgery center
- Hospital outpatient payment (national)
- $127 (APC 6000)
- Surgery center payment (national)
- $127