Code: Q4100

Description:
Description: Skin substitute, not otherwise specified
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
GRAFT SKIN KIT SPLIT THK
GRAFT SKN CRYO 75 SQ CM
GRAFT TIS ACTISHLD 4X4CM
GFT SKN MSH CRYO 464SQCM
GRFT SKN 2:1 MSH 800SQCM
SKIN SUBSTITUE NOS
PATCH DURAMATRIX-ONLAY COLLAGEN MATRIX 2X2IN DURAL CONFORMABLE RESORBABLE
PATCH DURAMATRIX-ONLAY COLLAGEN MATRIX 1X1IN DURAL CONFORMABLE RESORBABLE
PATCH DUREPAIR BOVINE COLLAGEN MATRIX 3X1IN DURAL RESORBABLE DURAPLASTY
Related codes:
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: Q4106
DERMAGRAFT 37.5 SQCM
Code: Q4107
GRAFTJACKET 8 SQCM
Code: Q4108
INTEGRA MATRIX 25 SQCM
Code: Q4109
SKIN SUBSTITUTE TISSUEMEND PER SQ CM
Nebraska
Hospital Address Code Price Last Updated
Chi Health St. Elizabeth 555 S. 70Th St., Lincoln Q4100 $10,800 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4100 $10,800 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4100 $10,800 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4100 $10,800 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4100 $10,800 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4100 $10,800 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4100 $10,800 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4100 $17,380 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4100 $17,380 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4100 $17,380 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4100 $17,380 [source] 4 years ago

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.