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
Wisconsin
Hospital Address Code Price Last Updated
River Falls Area Hospital , River Falls Q4101 $2 [source] 4 years ago
Howard Young Medical Center Inc Of Woodruff Wisconsin 240 Maple Street, Woodruff Q4101 $39 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4101 $43 [source] 4 years ago
Aspirus Medford Hospital 135 S Gibson St, Medford Q4101 $68 [source] 4 years ago
Aspirus Stevens Point Hospital 5409 Vern Holmes Dr, Q4101 $68 [source] 4 years ago
Aspirus Wausau Hospital 333 Pine Ridge Blvd, Wausau Q4101 $68 [source] 4 years ago
Aspirus Riverview Hospital 410 Dewey St, Wisconsin Rapids Q4101 $68 [source] 4 years ago
Aspirus Divine Savior Hospital 2817 New Pinery Rd, Portage Q4101 $88 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4101 $92 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4101 $93 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4101 $110 [source] 4 years ago
Aurora Baycare 1160 Kepler Dr, Green Bay Q4101 $110 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4101 $110 [source] 4 years ago
Aurora Medical Center Of Manitowoc County 5000 Memorial Dr, Two Rivers Q4101 $110 [source] 4 years ago
Aurora Sheboygan Memorial Medical Center 2629 N 7Th St, Sheboygan Q4101 $110 [source] 4 years ago
Aurora Medical Center Summit 36500 Aurora Dr, Oconomowoc Q4101 $110 [source] 4 years ago
Aurora West Allis Medical Center 8901 W Lincoln Ave, Milwaukee Q4101 $110 [source] 4 years ago
Aurora Medical Center Bay Area 3003 University Dr, Marinette Q4101 $110 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4101 $110 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4101 $110 [source] 4 years ago
Aurora Medical Center Of Washington County 1032 E Sumner St, Hartford Q4101 $110 [source] 4 years ago
Aurora Medical Center Of Oshkosh 855 N Westhaven Dr, Oshkosh Q4101 $110 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4101 $110 [source] 4 years ago
Aurora Medical Center Kenosha 10400 75Th St, Kenosha Q4101 $110 [source] 4 years ago
Watertown Regional Medical Center 125 Hospital Drive, Watertown Q4101 $3,004 [source] 4 years ago
Prairie Ridge Health 1515 Park Ave, Columbus Q4101 $3,043 [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.