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
Tennessee
Hospital Address Code Price Last Updated
Southern Tennessee Regional Health System - Winchester 185 Hospital Road, Winchester Q4104 $131 [source] 4 years ago
Saint Thomas River Park Hospital, Llc 120 Walnut Commons Ln Ste D, Cookeville Q4104 $157 [source] 4 years ago
Ascension Saint Thomas Stones River 324 Doolittle Rd, Woodbury Q4104 $157 [source] 4 years ago
Ascension Saint Thomas Dekalb 520 W Main St, Smithville Q4104 $157 [source] 4 years ago
Saint Thomas Hickman Hospital 1518 Highway 100, Centerville Q4104 $157 [source] 4 years ago
Ascension Saint Thomas Highlands 401 Sewell Dr, Sparta Q4104 $157 [source] 4 years ago
St. Jude Children's Research Hospital , Memphis Q4104 $2,517 [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.