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
Wisconsin
Hospital Address Code Price Last Updated
Howard Young Medical Center Inc Of Woodruff Wisconsin 240 Maple Street, Woodruff Q4104 $17 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4104 $68 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4104 $109 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4104 $119 [source] 4 years ago
Aurora Medical Center Kenosha 10400 75Th St, Kenosha Q4104 $177 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4104 $235 [source] 4 years ago
Aurora Baycare 1160 Kepler Dr, Green Bay Q4104 $288 [source] 4 years ago
Aurora Medical Center Bay Area 3003 University Dr, Marinette Q4104 $288 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4104 $314 [source] 4 years ago
Aurora Medical Center Summit 36500 Aurora Dr, Oconomowoc Q4104 $346 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4104 $423 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4104 $428 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4104 $514 [source] 4 years ago
Aurora West Allis Medical Center 8901 W Lincoln Ave, Milwaukee Q4104 $550 [source] 4 years ago
Aspirus Stevens Point Hospital 5409 Vern Holmes Dr, Q4104 $4,000 [source] 4 years ago
Aspirus Wausau Hospital 333 Pine Ridge Blvd, Wausau Q4104 $4,000 [source] 4 years ago
Watertown Regional Medical Center 125 Hospital Drive, Watertown Q4104 $6,129 [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.