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
Michigan
Hospital Address Code Price Last Updated
William Beaumont Hospital 468 Cadieux Rd, Grosse Pointe Q4104 $16 [source] 4 years ago
William Beaumont Hospital 10000 Telegraph Rd, Taylor Q4104 $16 [source] 4 years ago
William Beaumont Hospital 3555 W 13 Mile Rd, Royal Oak Q4104 $16 [source] 4 years ago
Beaumont Special Radiological Procedures 3601 W Thirteen Mile Rd, Royal Oak Q4104 $47 [source] 4 years ago
William Beaumont Hospital 44201 Dequindre, Troy Q4104 $47 [source] 4 years ago
William Beaumont Hospital 1026 Eleven Mile Road, Royal Oak Q4104 $47 [source] 4 years ago
Beaumont Ashn, Llc 1919 Technology Dr Ste B, Troy Q4104 $47 [source] 4 years ago
Beaumont Orthopaedic Center 3535 W 13 Mile Road, Royal Oak Q4104 $47 [source] 4 years ago
Beaumont Health System 3601 W. 13 Mile Rd, Royal Oak Q4104 $47 [source] 4 years ago
William Beaumont Hospital 5150 Coolidge Hwy, Royal Oak Q4104 $47 [source] 4 years ago
Botsford Continuing Care Corporation 21450 Archwood Cir, Farmington Q4104 $47 [source] 4 years ago
Botsford General Hospital 28050 Grand River Ave, Farmington Q4104 $47 [source] 4 years ago
William Beaumont Hospital 4949 Coolidge Hwy, Royal Oak Q4104 $47 [source] 4 years ago
William Beaumont Hospital 3535 W 13 Mile Rd, Royal Oak Q4104 $47 [source] 4 years ago
William Beaumont Hospital 44201 Dequindre Rd, Troy Q4104 $47 [source] 4 years ago
William Beaumont Hospital 3601 W 13 Mile Rd, Royal Oak Q4104 $47 [source] 4 years ago
Karmanos Cancer Institute 4100 John R St, Detroit Q4104 $109 [source] 4 years ago
Mclaren Greater Lansing 401 W Greenlawn Ave, Lansing Q4104 $567 [source] 4 years ago
Mclaren Central Michigan 1221 South Dr, Mount Pleasant Q4104 $607 [source] 4 years ago
St. John Providence 28000 Dequindre Rd, Warren Q4104 $2,798 [source] 4 years ago
Ascension Providence Rochester Hospital 1101 W University Dr, Rochester Q4104 $3,212 [source] 4 years ago
Midmichigan Medical Center Alpena , Alpena Q4104 $3,781 [source] 4 years ago
Providence Hospital And Medical Centers 16001 W 9 Mile Rd, Southfield Q4104 $4,866 [source] 4 years ago
St. John Macomb Oakland Hospital-Warren Campus 11800 E 12 Mile Rd, Warren Q4104 $5,459 [source] 4 years ago
Mclaren Lapeer Region 1375 N Main St, Lapeer Q4104 $7,155 [source] 4 years ago
Up Health System – Marquette 580 West College Avenue, Marquette Q4104 $12,574 [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 §180.