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
North Carolina
Hospital Address Code Price Last Updated
Atrium Health University 8800 N. Tryon St. , Charlotte Q4105 $117 [source] 4 years ago
Atrium Health Mercy 2001 Vail Ave. , Charlotte Q4105 $123 [source] 4 years ago
Atrium Health Pineville 10628 Park Road , Charlotte Q4105 $127 [source] 4 years ago
Atrium Health Cabarrus 920 Church Street North , Concord Q4105 $128 [source] 4 years ago
Atrium Health Union 600 Hospital Drive , Monroe Q4105 $144 [source] 4 years ago
Atrium Health Cleveland 201 E. Grover St. , Shelby Q4105 $168 [source] 4 years ago
Atrium Health Stanly 301 Yadkin St. , Albemarle Q4105 $178 [source] 4 years ago
Atrium Health Anson 2301 Us Hwy 74 W. , Wadesboro Q4105 $190 [source] 4 years ago
Carolinas Medical Center 1000 Blythe Blvd. , Charlotte Q4105 $238 [source] 4 years ago
Atrium Health Lincoln 433 Mcalister Road , Lincolnton Q4105 $238 [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.