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
Texas
Hospital Address Code Price Last Updated
Texas Health Huguley 11801 South Fwy, Burleson Q4105 $88 [source] 4 years ago
Adventhealth Central Texas 2201 Clear Creek Rd, Killeen Q4105 $88 [source] 4 years ago
Adventhealth Rollins Brook 608 N Key Ave, Lampasas Q4105 $88 [source] 4 years ago
Ascension Providence 6901 Medical Pkwy, Woodway Q4105 $90 [source] 4 years ago
South Texas Health System Children’s 1102 W. Trenton Road, Edinburg Q4105 $3,990 [source] 4 years ago
South Texas Health System Heart 1900 South D Street, Mcallen Q4105 $3,990 [source] 4 years ago
South Texas Health System Mcallen 301 W. Expressway 83, Mcallen Q4105 $3,990 [source] 4 years ago
Northwest Texas Healthcare System 1501 S. Coulter, Amarillo Q4105 $7,386 [source] 4 years ago
Medical City Denton 3535 S Interstate 35, Corinth Q4105 $21,433 [source] 4 years ago
Rio Grande Regional Hospital 101 East Ridge Road, Mcallen Q4105 $46,168 [source] 4 years ago
Medical City Frisco 5500 Frisco Square Blvd, Frisco Q4105 $96,000 [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.