Code: Q4105

Description:

Description: Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)

Other Descriptions:

INTEGRA DRT 810 SQCM

DRSNG COLLAGEN HELICOLL 2X4 HC2X4

INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 10 X 25CM 1 PACK DOMESTIC

OMNIGRAFT AND DISPOSABLE STAPLER KIT, PER SQ CM, 4 X 4CM

OMNIGRAFT AND DISPOSABLE STAPLER KIT, PER SQ CM, 7 X 7CM

INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 10 X 12.5CM 1 PACK DOMESTIC

INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 20 X 25CM 1 PACK DOMESTIC

INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 5 X 5CM 1 PACK DOMESTIC

INTEGRA DRT/INTEGRA OMNIGR DRML RGN MTX P SQ CM

Related codes:

SKIN SUBSTITUTE NOS

APLIGRAF 44 SQ CM

OASIS WND MATRX 21 SQCM

OASIS BURN MATRIX 1SQCM

INTEGRA BMWD 1SQCM

DERMAGRAFT 37.5 SQCM

GRAFTJACKET 8 SQCM

INTEGRA MATRIX 25 SQCM

SKIN SUBSTITUTE TISSUEMEND PER SQ CM

State	Average	# Hospitals In Database
Oklahoma (OK)	$24	1
Hawaii (HI)	$30	5
Illinois (IL)	$31	7
Minnesota (MN)	$33	14
Alabama (AL)	$78	1
Kentucky (KY)	$109	2
North Carolina (NC)	$165	10
Virginia (VA)	$189	2
Missouri (MO)	$201	3
South Carolina (SC)	$270	1
Washington (WA)	$300	1
Kansas (KS)	$301	6
Wisconsin (WI)	$316	12
Tennessee (TN)	$625	10
Mississippi (MS)	$939	2
Indiana (IN)	$946	14
Nebraska (NE)	$1,035	11
Iowa (IA)	$1,035	3
California (CA)	$1,243	23
New Jersey (NJ)	$1,555	1
Florida (FL)	$2,612	45
Michigan (MI)	$4,092	6
Massachusetts (MA)	$6,555	14
District of Columbia (DC)	$6,616	1
Georgia (GA)	$8,085	2
New York (NY)	$9,573	2
Nevada (NV)	$9,663	6
Texas (TX)	$17,959	13
New Hampshire (NH)	$23,070	1
Maryland (MD)	$28,590	3
West Virginia (WV)	$39,013	2

ChargemasterDB by Joseph Paul Cohen
A database of US hospital prices based on data made available by the Centers for Medicare & Medicaid Services (CMS), HHS price transparancy rule 45 CFR §180.