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
Indiana
Hospital Address Code Price Last Updated
Ascension St. Vincent Warrick 1116 Millis Ave, Boonville Q4105 $101 [source] 4 years ago
Ascension St. Vincent Hospital 2001 W 86Th St, Indianapolis Q4105 $101 [source] 4 years ago
Ascension Medical Group St. Vincent 301 Henry St, North Vernon Q4105 $101 [source] 4 years ago
Ascension St. Vincent Evansville 3700 Washington Ave, Evansville Q4105 $101 [source] 4 years ago
Ascension St. Vincent Williamsport 412 N Monroe St, Williamsport Q4105 $101 [source] 4 years ago
St Vincent Salem Hospital Inc 911 N Shelby St, Salem Q4105 $101 [source] 4 years ago
St. Vincent Mercy Hospital 1331 S A St, Elwood Q4105 $101 [source] 4 years ago
Ascension St. Vincent Dunn 1600 23Rd St, Bedford Q4105 $101 [source] 4 years ago
Ascension St. Vincent Randolph 473 E Greenville Ave, Winchester Q4105 $101 [source] 4 years ago
Ascension St. Vincent Carmel 13500 N Meridian St, Carmel Q4105 $101 [source] 4 years ago
Ascension St. Vincent Anderson 2015 Jackson St, Anderson Q4105 $101 [source] 4 years ago
Ascension St. Vincent Heart Center 10580 N Meridian St, Indianapolis Q4105 $101 [source] 4 years ago
St. Vincent Clay Hospital, Inc 1206 E National Ave, Brazil Q4105 $6,012 [source] 4 years ago
Ascension St Vincent Fishers 13861 Olio Road, Q4105 $6,012 [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.