Code: Q4106

Description:
Description: Dermagraft, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
DERMAGRAFT 6 SQCM
Dermagraft Per 1 Sq Cm
Dermagraft Skin Sub Per Sq Cm
DERMAGRAFT PER SQ CM
DERMAGRAFT 5X7.5CM PER SQ
DERMAGRAFT 5X7.5 PER SQCM
TY TIB NP MOD PFC SIG 2 86-6022
DERMAGRFT NI-DERM-COM
TISS LIVE DERMAGRFT 5X7.5CM
Related codes:
Code: Q4100
SKIN SUBSTITUTE NOS
Code: Q4101
APLIGRAF 44 SQ CM
Code: Q4102
OASIS WND MATRX 21 SQCM
Code: Q4103
OASIS BURN MATRIX 1SQCM
Code: Q4104
INTEGRA BMWD 1SQCM
Code: Q4105
INTEGRA DRTOMNIGF 1SQCM
Code: Q4107
GRAFTJACKET 8 SQCM
Code: Q4108
INTEGRA MATRIX 25 SQCM
Code: Q4109
SKIN SUBSTITUTE TISSUEMEND PER SQ CM
State Average # Hospitals In Database
Minnesota (MN) $32 14
Hawaii (HI) $33 5
Rhode Island (RI) $48 1
Pennsylvania (PA) $98 2
Illinois (IL) $103 7
Tennessee (TN) $105 10
Wisconsin (WI) $109 23
Connecticut (CT) $117 8
Wyoming (WY) $121 2
Mississippi (MS) $121 3
Georgia (GA) $125 10
Alabama (AL) $143 2
Kentucky (KY) $156 6
North Dakota (ND) $164 2
New Jersey (NJ) $177 1
Ohio (OH) $178 8
Washington (WA) $185 1
South Carolina (SC) $229 3
Arizona (AZ) $271 4
Virginia (VA) $386 5
Indiana (IN) $637 23
Massachusetts (MA) $655 14
California (CA) $852 28
Missouri (MO) $933 12
New Hampshire (NH) $988 3
New York (NY) $1,084 1
Louisiana (LA) $1,151 3
Oklahoma (OK) $1,166 4
Kansas (KS) $1,443 5
Michigan (MI) $1,610 27
Iowa (IA) $1,680 3
Nebraska (NE) $1,680 11
Maine (ME) $1,787 3
North Carolina (NC) $2,212 25
District of Columbia (DC) $2,423 1
Maryland (MD) $4,775 6
Texas (TX) $4,889 50
Florida (FL) $5,450 85
Nevada (NV) $6,601 10
West Virginia (WV) $8,514 4

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 ยง180.