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
Florida
Hospital Address Code Price Last Updated
Adventhealth South Overland Park 10987 Sheldon Rd Ste 100, Tampa Q4105 $88 [source] 4 years ago
Adventhealth Wesley Chapel 1127 Bruce B. Downs Blvd, Zephyrhills Q4105 $88 [source] 4 years ago
Adventhealth Waterman 1000 Waterman Way, Tavares Q4105 $88 [source] 4 years ago
Adventhealth Ocala 1500 Sw 1St Ave, Ocala Q4105 $88 [source] 4 years ago
Adventhealth Celebration 400 Celebration Place Attn: Pharmacare Center Pharmacy , Kissimmee Q4105 $88 [source] 4 years ago
Adventhealth Fish Memorial 1055 Saxon Blvd, Orange City Q4105 $88 [source] 4 years ago
Adventhealth Kissimmee 2501 N. Orange Ave, Orlando Q4105 $88 [source] 4 years ago
Florida Hospital Carrollwood 7171 N Dale Mabry Hwy, Tampa Q4105 $88 [source] 4 years ago
Adventist Health System-Sunbelt Inc 2100 Ocoee Apopka Rd, Apopka Q4105 $88 [source] 4 years ago
Adventhealth Zephyrhills 7050 Gall Blvd, Zephyrhills Q4105 $88 [source] 4 years ago
Florida Oncology Network Pa 7727 Lake Underhill Rd, Orlando Q4105 $88 [source] 4 years ago
Adventhealth Tampa 3100 E Fletcher Ave, Tampa Q4105 $88 [source] 4 years ago
Adventhealth Wauchula 735 S 5Th Ave, Wauchula Q4105 $88 [source] 4 years ago
Adventhealth Deland 701 W. Plymouth Avenue, Deland Q4105 $88 [source] 4 years ago
Adventhealth Winter Park 3099 Aloma Ave, Winter Park Q4105 $88 [source] 4 years ago
Adventhealth Dade City 13100 Fort King Rd, Dade City Q4105 $88 [source] 4 years ago
Adventist Health System/Sunbelt, Inc. 4001 W Linebaugh Ave, Tampa Q4105 $88 [source] 4 years ago
Florida Hospital North Pinellas 1395 S Pinellas Ave, Tarpon Springs Q4105 $88 [source] 4 years ago
Adventhealth New Smyrna Beach 401 Palmetto St, New Smyrna Beach Q4105 $88 [source] 4 years ago
Adventhealth Sebring 4200 Sun N Lake Blvd, Sebring Q4105 $88 [source] 4 years ago
Adventhealth Lake Wales 410 South 11Th Street, Lake Wales Q4105 $88 [source] 4 years ago
Adventhealth East Orlando 12301 Lake Underhill Rd Suite 219, Orlando Q4105 $183 [source] 4 years ago
Manatee Healthcare System 206 Second Street East, Bradenton Q4105 $15,479 [source] 4 years ago
Lakewood Ranch Medical Center 8330 Lakewood Ranch Boulevard, Bradenton Q4105 $15,479 [source] 4 years ago
Blake Medical Center 2020 59Th St West, Bradenton Q4105 $33,744 [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.