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
Tennessee
Hospital Address Code Price Last Updated
Riverview Regional Medical Center 158 Hospital Drive, Carthage Q4101 $40 [source] 4 years ago
Saint Thomas Hickman Hospital 1518 Highway 100, Centerville Q4101 $66 [source] 4 years ago
Saint Thomas River Park Hospital, Llc 120 Walnut Commons Ln Ste D, Cookeville Q4101 $66 [source] 4 years ago
Ascension Saint Thomas Stones River 324 Doolittle Rd, Woodbury Q4101 $66 [source] 4 years ago
Ascension Saint Thomas Dekalb 520 W Main St, Smithville Q4101 $66 [source] 4 years ago
Ascension Saint Thomas Highlands 401 Sewell Dr, Sparta Q4101 $66 [source] 4 years ago
Sumner Regional Medical Center 555 Hartsville Pike, Gallatin Q4101 $111 [source] 4 years ago
Trousdale Medical Center 500 Church Street, Hartsville Q4101 $215 [source] 4 years ago
Southern Tennessee Regional Health System - Winchester 185 Hospital Road, Winchester Q4101 $270 [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.