Code: Q4104

Description:
Description: Integra bilayer matrix wound dressing (bmwd), per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
INTEGRA BMWD 500 SQ CM
DRESSING BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE 5X4IN BIOLOGICAL
DRESSING BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE 2X2IN BIOLOGICAL
DRESSING BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE MESH 2X2IN WOUND
Dressing,wound,bilayer,bmw4101
DRESSING BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE 10X4IN BIOLOGICAL
DRESSING BOVINE COLLAGEN GLYCOSAMINOGLYCAN POLYSILOXANE 10X8IN BIOLOGICAL
INTEGRA 2LAYR MTRX SQ C
INTEGRA BILAYER MATRIX WOUND DRESSING, PER SQ CM, 10 X 12.5CM 1 PACK
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: 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
California
Hospital Address Code Price Last Updated
Kentfield Hospital 1125 Sir Francis Drake Blvd., Greenbrae Q4104 $106 [source] 4 years ago
Richmond Medical Center 901 Nevin Ave, Richmond Q4104 $396 [source] 4 years ago
South San Francisco Medical Center 1200 El Camino Real, South San Francisco Q4104 $396 [source] 4 years ago
Oakland Medical Center 3600 Broadway, Woodland Hills Q4104 $396 [source] 4 years ago
Sacramento Medical Center 2025 Morse Ave, Sacramento Q4104 $396 [source] 4 years ago
Kaiser Foundation Hospitals 4501 Sand Creek Road, Antioch Q4104 $396 [source] 4 years ago
Modesto Medical Center 4601 Dale Rd, Modesto Q4104 $396 [source] 4 years ago
Vacaville Medical Center 1 Quality Dr, Vacaville Q4104 $396 [source] 4 years ago
San Leandro Medical Center 2500 Merced St, San Leandro Q4104 $396 [source] 4 years ago
Walnut Creek Medical Center 1425 S Main St, Walnut Creek Q4104 $396 [source] 4 years ago
Santa Clara Medical Center 700 Lawrence Expy, Santa Clara Q4104 $396 [source] 4 years ago
South Sacramento Medical Center 6600 Bruceville Rd, Sacramento Q4104 $396 [source] 4 years ago
Santa Rosa Medical Center 401 Bicentennial Way, American Canyon Q4104 $396 [source] 4 years ago
Redwood City Medical Center 1100 Veterans Blvd, Redwood City Q4104 $396 [source] 4 years ago
Vallejo Medical Center 975 Sereno Dr, Vallejo Q4104 $396 [source] 4 years ago
San Jose Medical Center 250 Hospital Pkwy, San Jose Q4104 $396 [source] 4 years ago
Roseville Medical Center 1600 Eureka Rd, Roseville Q4104 $396 [source] 4 years ago
Fresno Medical Center 39400 Paseo Padre Pkwy, Fresno Q4104 $396 [source] 4 years ago
San Francisco Medical Center 2525 Geary Blvd, San Francisco Q4104 $396 [source] 4 years ago
San Rafael Medical Center 99 Montecillo Rd, San Rafael Q4104 $396 [source] 4 years ago
Riverside Community Hospital 4445 Magnolia Ave, Riverside Q4104 $1,127 [source] 4 years ago
Palmdale Regional Medical Center 38600 Medical Center Drive, Palmdale Q4104 $2,605 [source] 4 years ago
Inland Valley Medical Center 36485 Inland Valley Drive, Wildomar Q4104 $3,038 [source] 4 years ago
Rancho Springs Medical Center 25500 Medical Center Drive, Murrieta Q4104 $3,038 [source] 4 years ago
Temecula Valley Hospital 31700 Temecula Parkway, Temecula Q4104 $6,982 [source] 4 years ago
Corona Regional Medical Center 800 S. Main Street, Corona Q4104 $7,688 [source] 4 years ago
Sutter Santa Rosa Regional Hospital 30 Mark West Springs Rd, Santa Rosa Q4104 $13,123 [source] 4 years ago
Sutter Solano Medical Center 300 Hospital Dr, Vallejo Q4104 $14,028 [source] 4 years ago
Sutter Roseville Medical Center 1 Medical Plaza Dr, Roseville Q4104 $14,254 [source] 4 years ago
Mills-Peninsula Medical Center 1501 Trousdale Dr, Burlingame Q4104 $15,385 [source] 4 years ago
Sutter Medical Center Of Sacramento 2825 Capitol Avenue, Sacramento Q4104 $21,735 [source] 4 years ago
Sutter Medical Center, Sacramento 2825 Capitol Ave, Sacramento Q4104 $21,735 [source] 4 years ago
California Pacific Medical Center - Van Ness Campus 1101 Van Ness Ave, San Francisco Q4104 $23,115 [source] 4 years ago
Novato Community Hospital 180 Rowland Way, Novato Q4104 $30,933 [source] 4 years ago
Sutter Maternity And Surgery Center Of Santa Cruz 2900 Chanticleer Avenue, Santa Cruz Q4104 $34,078 [source] 4 years ago
California Pacific Medical Center - Mission Bernal Campus 3555 Cesar Chavez, San Francisco Q4104 $35,127 [source] 4 years ago
California Pacific Medical Center - Davies Campus 45 Castro St, San Francisco Q4104 $35,127 [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.