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
Nebraska
Hospital Address Code Price Last Updated
Chi Health St. Elizabeth 555 S. 70Th St., Lincoln Q4104 $6,510 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4104 $6,510 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4104 $6,510 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4104 $6,510 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4104 $6,510 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4104 $6,510 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4104 $6,510 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4104 $6,510 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4104 $6,510 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4104 $6,510 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4104 $6,510 [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.