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
Nebraska
Hospital Address Code Price Last Updated
Chi Health St. Elizabeth 555 S. 70Th St., Lincoln Q4105 $1,035 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4105 $1,035 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4105 $1,035 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4105 $1,035 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4105 $1,035 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4105 $1,035 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4105 $1,035 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4105 $1,035 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4105 $1,035 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4105 $1,035 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4105 $1,035 [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.