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
Texas
Hospital Address Code Price Last Updated
Ascension Providence 6901 Medical Pkwy, Woodway Q4104 $70 [source] 4 years ago
Texoma Medical Center 5016 South Us Highway 75, Denison Q4104 $78 [source] 4 years ago
Adventhealth Central Texas 2201 Clear Creek Rd, Killeen Q4104 $153 [source] 4 years ago
Adventhealth Rollins Brook 608 N Key Ave, Lampasas Q4104 $153 [source] 4 years ago
Texas Health Huguley 11801 South Fwy, Burleson Q4104 $1,364 [source] 4 years ago
Woman's Hospital Of Texas 7600 Fannin, Houston Q4104 $1,510 [source] 4 years ago
Rio Grande Regional Hospital 101 East Ridge Road, Mcallen Q4104 $1,736 [source] 4 years ago
Medical City Fort Worth 900 8Th Ave, Fort Worth Q4104 $3,079 [source] 4 years ago
Baylor Scott & White Medical Center - Round Rock 300 University Blvd, Sandy Q4104 $5,850 [source] 4 years ago
Baylor Scott & White Medical Center - Marble Falls 810 W. State Highway 71, Marble Falls Q4104 $5,850 [source] 4 years ago
Baylor Scott & White Medical Center - Taylor 305 Mallard Ln, Taylor Q4104 $5,850 [source] 4 years ago
Baylor Scott & White Medical Center - College Station 700 Scott And White Dr, College Station Q4104 $6,240 [source] 4 years ago
Baylor Scott & White Medical Center - Lakeway 100 Medical Pkwy, Austin Q4104 $6,630 [source] 4 years ago
Baylor Scott & White Medical Center - Buda 5330 Overpass Rd, Buda Q4104 $6,630 [source] 4 years ago
Baylor Scott & White Medical Center - Brenham 700 Medical Pkwy, Brenham Q4104 $6,630 [source] 4 years ago
Baylor Scott & White Medical Center - Pflugerville 2600 E Pflugerville Pkwy Ste 100, Pflugerville Q4104 $6,630 [source] 4 years ago
South Texas Health System Heart 1900 South D Street, Mcallen Q4104 $7,100 [source] 4 years ago
South Texas Health System Mcallen 301 W. Expressway 83, Mcallen Q4104 $7,100 [source] 4 years ago
South Texas Health System Children’s 1102 W. Trenton Road, Edinburg Q4104 $7,100 [source] 4 years ago
Texas Children's Hospital 6621 Fannin St Houston, Houston Q4104 $7,360 [source] 4 years ago
Baylor Scott & White Emergency Hospital - Murphy 511 W Fm 544 Ste 100, Plano Q4104 $7,800 [source] 4 years ago
Baylor Scott & White All Saints Medical Center - Fort Worth 1400 8Th Ave, Fort Worth Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Heart And Vascular Hospital - Dallas 621 N Hall St, Dallas Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Medical Center - Centennial 12505 Lebanon Rd, Frisco Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Emergency Center - Forney 757 E Us Highway 80 Ste 150, Forney Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Medical Center - Irving 1901 N Macarthur Blvd, Irving Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Emergency Hospital - Aubrey 26791 Us Highway 380 E, Aubrey Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Medical Center - Waxahachie 2400 N Interstate 35E, Waxahachie Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Medical Center - Lake Pointe 6800 Scenic Dr, Rowlett Q4104 $7,800 [source] 4 years ago
Baylor Scott & White Medical Center - Grapevine 1650 W College St, Grapevine Q4104 $8,190 [source] 4 years ago
Fort Duncan Regional Medical Center 3333 N. Foster Maldonado Blvd., Eagle Pass Q4104 $8,205 [source] 4 years ago
Doctors Hospital Of Laredo 10700 Mcpherson Road, Laredo Q4104 $8,220 [source] 4 years ago
Baylor Scott & White Medical Center - Plano 4700 Alliance Blvd, Plano Q4104 $9,100 [source] 4 years ago
Baylor Scott & White The Heart Hospital - Denton 2801 S Mayhill Rd, Denton Q4104 $9,100 [source] 4 years ago
Baylor Scott & White The Heart Hospital - Plano 1100 Allied Dr, Plano Q4104 $9,100 [source] 4 years ago
Baylor Scott & White Continuing Care Hospital - Temple 546 N Kegley Rd, Temple Q4104 $9,750 [source] 4 years ago
Northwest Texas Healthcare System 1501 S. Coulter, Amarillo Q4104 $9,850 [source] 4 years ago
Medical City Arlington 3301 Matlock Rd, Arlington Q4104 $10,891 [source] 4 years ago
Hca Houston Healthcare 3737 Buffalo Speedway Suite 140, Houston Q4104 $14,034 [source] 4 years ago
Corpus Christi Medical Center 7101 South Padre Island Dr, Corpus Christi Q4104 $34,831 [source] 4 years ago
Medical City Denton 3535 S Interstate 35, Corinth Q4104 $39,423 [source] 4 years ago
Medical City North Hills 4401 Booth Calloway Rd, North Richland Hills Q4104 $40,112 [source] 4 years ago
Medical City Las Colinas 6800 N Macarthur Blvd, Irving Q4104 $44,883 [source] 4 years ago
Medical City Alliance 3101 N Tarrant Pkwy, Fort Worth Q4104 $45,273 [source] 4 years ago
Medical City Frisco 5500 Frisco Square Blvd, Frisco Q4104 $90,918 [source] 4 years ago
Medical City Dallas 13155 Noel Rd. Suite 200, Dallas Q4104 $148,907 [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.