Code: Q4101

Description:
Description: Apligraf, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
Apligraf 7.5 Cm
GRAFT APLIGRAF 7.5CM BOVINE COLLAGEN MATRIX HUMAN FIBROBLAST .75MM SKIN
Drsg Apligraf (free) Per Sq Cm
APLIGRAF 44CM PER SQ CM
SKIN GRAFT, APLIGRAF
APLIGRAF 44.2 PER SQCM
HC APLIGRAF PER SQ CM
APLIGRAF PER SQ CM
APLIGRAF N/MCARE 1 UNIT Q
Related codes:
Code: Q4100
SKIN SUBSTITUTE NOS
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
Illinois
Hospital Address Code Price Last Updated
Franciscan Health Olympia Fields , Olympia Fields Q4101 $32 [source] 4 years ago
Adventist Bolingbrook Hospital 500 Remington Blvd, Bolingbrook Q4101 $52 [source] 4 years ago
Presence St. Mary's Hospital 500 W Court St, Kankakee Q4101 $69 [source] 4 years ago
Alexian Brothers Medical Center 935 Beisner Rd, Elk Grove Village Q4101 $91 [source] 4 years ago
Adventist Hinsdale Hospital 120 N Oak St, Hinsdale Q4101 $93 [source] 4 years ago
Adventist Lagrange Memorial Hospital 5101 Willow Springs Rd, La Grange Q4101 $94 [source] 4 years ago
Adventist Glenoaks Hospital 701 Winthrop Ave, Glendale Heights Q4101 $94 [source] 4 years ago
St. Alexius Medical Center 1555 Barrington Road, Q4101 $94 [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.