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
Wisconsin
Hospital Address Code Price Last Updated
Howard Young Medical Center Inc Of Woodruff Wisconsin 240 Maple Street, Woodruff Q4105 $17 [source] 4 years ago
River Falls Area Hospital , River Falls Q4105 $18 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4105 $75 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4105 $75 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4105 $75 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4105 $75 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4105 $75 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4105 $77 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4105 $88 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4105 $93 [source] 4 years ago
Prairie Ridge Health 1515 Park Ave, Columbus Q4105 $3,036 [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.