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
Tennessee
Hospital Address Code Price Last Updated
Riverview Regional Medical Center 158 Hospital Drive, Carthage Q4105 $10 [source] 4 years ago
Trousdale Medical Center 500 Church Street, Hartsville Q4105 $53 [source] 4 years ago
Southern Tennessee Regional Health System - Winchester 185 Hospital Road, Winchester Q4105 $76 [source] 4 years ago
Saint Thomas River Park Hospital, Llc 120 Walnut Commons Ln Ste D, Cookeville Q4105 $128 [source] 4 years ago
Ascension Saint Thomas Stones River 324 Doolittle Rd, Woodbury Q4105 $128 [source] 4 years ago
Ascension Saint Thomas Dekalb 520 W Main St, Smithville Q4105 $128 [source] 4 years ago
Saint Thomas Hickman Hospital 1518 Highway 100, Centerville Q4105 $128 [source] 4 years ago
Ascension Saint Thomas Highlands 401 Sewell Dr, Sparta Q4105 $128 [source] 4 years ago
Sumner Regional Medical Center 555 Hartsville Pike, Gallatin Q4105 $658 [source] 4 years ago
St. Jude Children's Research Hospital , Memphis Q4105 $4,819 [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.