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

Michigan

Hospital	Address	Code	Price	Last Updated
Up Health System – Marquette	580 West College Avenue, Marquette	Q4105	$28 [source]	4 years ago
St. John Providence	28000 Dequindre Rd, Warren	Q4105	$2,917 [source]	4 years ago
Ascension Providence Rochester Hospital	1101 W University Dr, Rochester	Q4105	$3,349 [source]	4 years ago
Providence Hospital And Medical Centers	16001 W 9 Mile Rd, Southfield	Q4105	$5,073 [source]	4 years ago
St. John Macomb Oakland Hospital-Warren Campus	11800 E 12 Mile Rd, Warren	Q4105	$5,691 [source]	4 years ago
Mclaren Flint	401 S Ballenger Hwy, Flint	Q4105	$7,493 [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 §180.