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
North Carolina
Hospital Address Code Price Last Updated
Harris Regional Hospital 68 Hospital Road, Sylva Q4104 $6,240 [source] 4 years ago
Atrium Health University 8800 N. Tryon St. , Charlotte Q4104 $7,844 [source] 4 years ago
Atrium Health Mercy 2001 Vail Ave. , Charlotte Q4104 $8,222 [source] 4 years ago
Atrium Health Pineville 10628 Park Road , Charlotte Q4104 $8,521 [source] 4 years ago
Atrium Health Cabarrus 920 Church Street North , Concord Q4104 $8,584 [source] 4 years ago
Atrium Health Union 600 Hospital Drive , Monroe Q4104 $9,639 [source] 4 years ago
Atrium Health Cleveland 201 E. Grover St. , Shelby Q4104 $11,261 [source] 4 years ago
Atrium Health Stanly 301 Yadkin St. , Albemarle Q4104 $11,939 [source] 4 years ago
Atrium Health Anson 2301 Us Hwy 74 W. , Wadesboro Q4104 $12,742 [source] 4 years ago
Cone Health Alamance Regional Medical Center 1240 Huffman Mill Rd, Burlington Q4104 $14,172 [source] 4 years ago
Cone Health Moses Cone Hospital 1121 North Church St Entrance A, Greensboro Q4104 $21,421 [source] 4 years ago
Carolinas Medical Center 1000 Blythe Blvd. , Charlotte Q4104 $32,483 [source] 4 years ago
Atrium Health Lincoln 433 Mcalister Road , Lincolnton Q4104 $32,483 [source] 4 years ago
Carepartners Rehabilitation Hospital 68 Sweeten Creek Rd, Asheville Q4104 $34,789 [source] 4 years ago
Mcdowell Hospital , Marion Q4104 $37,571 [source] 4 years ago
Blue Ridge Regional Hospital 125 Hospital Dr, Spruce Pine Q4104 $37,571 [source] 4 years ago
Angel Medical Center 120 Riverview St, Franklin Q4104 $37,571 [source] 4 years ago
Cone Health Wesley Long Hospital 2400 W Friendly Ave, Greensboro Q4104 $61,204 [source] 4 years ago
Cone Health Penn Nursing Center 618 S Main St, Reidsville Q4104 $61,204 [source] 4 years ago
Cone Health Behavioral Health Hospital 700 Walter Reed Dr, Greensboro Q4104 $61,204 [source] 4 years ago
Moses Cone Hospital 1131D N Church St, Greensboro Q4104 $61,204 [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.