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
Ohio
Hospital Address Code Price Last Updated
Euclid Hospital 18901 Lakeshore Blvd., Cleveland q4104 $8,507 [source] 4 years ago
Hillcrest Hospital 6780 Mayfield Rd., Cleveland q4104 $8,507 [source] 4 years ago
South Pointe Hospital 20000 Harvard Rd., Cleveland q4104 $8,763 [source] 4 years ago
Cleveland Clinic Main Campus 9500 Euclid Ave, Cleveland q4104 $9,400 [source] 4 years ago
Medina Hospital 1000 E. Washington St., Medina q4104 $11,375 [source] 4 years ago
Akron General Lodi Hospital 225 Elyria St., Lodi q4104 $22,502 [source] 4 years ago
Marymount Hospital 12300 Mccracken Road, Cleveland q4104 $23,036 [source] 4 years ago
Akron General 1 Akron General Ave., Akron q4104 $23,177 [source] 4 years ago
Fairview Hospital 18101 Lorain Ave., Cleveland q4104 $28,677 [source] 4 years ago
Lutheran Hospital 1730 West 25Th Street, Cleveland q4104 $34,551 [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.