Code: Q4105

Description:
Description: Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
INTEGRA DRT 810 SQCM
DRSNG COLLAGEN HELICOLL 2X4 HC2X4
INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 10 X 25CM 1 PACK DOMESTIC
OMNIGRAFT AND DISPOSABLE STAPLER KIT, PER SQ CM, 4 X 4CM
OMNIGRAFT AND DISPOSABLE STAPLER KIT, PER SQ CM, 7 X 7CM
INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 10 X 12.5CM 1 PACK DOMESTIC
INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 20 X 25CM 1 PACK DOMESTIC
INTEGRA DERMAL REGENERATION TEMPLATE-TS, PER SQ CM, 5 X 5CM 1 PACK DOMESTIC
INTEGRA DRT/INTEGRA OMNIGR DRML RGN MTX P SQ CM
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: Q4104
INTEGRA BMWD 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
California
Hospital Address Code Price Last Updated
South Sacramento Medical Center 6600 Bruceville Rd, Sacramento Q4105 $495 [source] 4 years ago
South San Francisco Medical Center 1200 El Camino Real, South San Francisco Q4105 $495 [source] 4 years ago
Oakland Medical Center 3600 Broadway, Woodland Hills Q4105 $495 [source] 4 years ago
Sacramento Medical Center 2025 Morse Ave, Sacramento Q4105 $495 [source] 4 years ago
Kaiser Foundation Hospitals 4501 Sand Creek Road, Antioch Q4105 $495 [source] 4 years ago
Modesto Medical Center 4601 Dale Rd, Modesto Q4105 $495 [source] 4 years ago
Vacaville Medical Center 1 Quality Dr, Vacaville Q4105 $495 [source] 4 years ago
San Leandro Medical Center 2500 Merced St, San Leandro Q4105 $495 [source] 4 years ago
Walnut Creek Medical Center 1425 S Main St, Walnut Creek Q4105 $495 [source] 4 years ago
Santa Clara Medical Center 700 Lawrence Expy, Santa Clara Q4105 $495 [source] 4 years ago
Richmond Medical Center 901 Nevin Ave, Richmond Q4105 $495 [source] 4 years ago
Santa Rosa Medical Center 401 Bicentennial Way, American Canyon Q4105 $495 [source] 4 years ago
Redwood City Medical Center 1100 Veterans Blvd, Redwood City Q4105 $495 [source] 4 years ago
Vallejo Medical Center 975 Sereno Dr, Vallejo Q4105 $495 [source] 4 years ago
San Rafael Medical Center 99 Montecillo Rd, San Rafael Q4105 $495 [source] 4 years ago
San Francisco Medical Center 2525 Geary Blvd, San Francisco Q4105 $495 [source] 4 years ago
Fresno Medical Center 39400 Paseo Padre Pkwy, Fresno Q4105 $495 [source] 4 years ago
Roseville Medical Center 1600 Eureka Rd, Roseville Q4105 $495 [source] 4 years ago
San Jose Medical Center 250 Hospital Pkwy, San Jose Q4105 $495 [source] 4 years ago
West Hills Hospital 7300 Medical Center Dr, West Hills Q4105 $4,105 [source] 4 years ago
Temecula Valley Hospital 31700 Temecula Parkway, Temecula Q4105 $10,488 [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.