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
Massachusetts
Hospital Address Code Price Last Updated
Spaulding Rehab Hospital Boston 300 1St Ave, Charlestown Q4105 $45 [source] 4 years ago
Spaulding Rehab Hospital Cape Cod 311 Service Rd, East Sandwich Q4105 $46 [source] 4 years ago
Mclean Hospital 115 Mill St, Belmont Q4105 $56 [source] 4 years ago
Massachusetts Eye And Ear 243 Charles St, Boston Q4105 $56 [source] 4 years ago
Massachusetts General Hospital 55 Fruit St, Boston Q4105 $201 [source] 4 years ago
Brigham & Womens Hospital, Inc. 75 Francis St, Boston Q4105 $6,711 [source] 4 years ago
Martha's Vineyard Hospital One Hospital Road, Oak Bluffs Q4105 $6,987 [source] 4 years ago
Newton Wellesley Hospital 2014 Washington St, Newton Lower Falls Q4105 $6,987 [source] 4 years ago
Cooley Dickinson Health Care 30 Locust St, Northampton Q4105 $9,704 [source] 4 years ago
North Shore Medical Center Hospital 81 Highland Ave, Salem Q4105 $9,704 [source] 4 years ago
Nantucket Cottage Hospital 57 Prospect St, Nantucket Q4105 $9,704 [source] 4 years ago
Brigham & Women Faulkner Hospital 1153 Centre St, Jamaica Plain Q4105 $18,456 [source] 4 years ago
Spaulding Hospital Cambridge 1575 Cambridge St, Cambridge Q4105 $23,070 [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.