Code: Q4106

Description:
Description: Dermagraft, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
DERMAGRAFT 6 SQCM
Dermagraft Per 1 Sq Cm
Dermagraft Skin Sub Per Sq Cm
DERMAGRAFT PER SQ CM
DERMAGRAFT 5X7.5CM PER SQ
DERMAGRAFT 5X7.5 PER SQCM
TY TIB NP MOD PFC SIG 2 86-6022
DERMAGRFT NI-DERM-COM
TISS LIVE DERMAGRFT 5X7.5CM
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: Q4105
INTEGRA DRTOMNIGF 1SQCM
Code: Q4107
GRAFTJACKET 8 SQCM
Code: Q4108
INTEGRA MATRIX 25 SQCM
Code: Q4109
SKIN SUBSTITUTE TISSUEMEND PER SQ CM
California
Hospital Address Code Price Last Updated
Kentfield Hospital 1125 Sir Francis Drake Blvd., Greenbrae Q4106 $71 [source] 4 years ago
Roseville Medical Center 1600 Eureka Rd, Roseville Q4106 $151 [source] 4 years ago
South San Francisco Medical Center 1200 El Camino Real, South San Francisco Q4106 $151 [source] 4 years ago
Oakland Medical Center 3600 Broadway, Woodland Hills Q4106 $151 [source] 4 years ago
Sacramento Medical Center 2025 Morse Ave, Sacramento Q4106 $151 [source] 4 years ago
Kaiser Foundation Hospitals 4501 Sand Creek Road, Antioch Q4106 $151 [source] 4 years ago
Modesto Medical Center 4601 Dale Rd, Modesto Q4106 $151 [source] 4 years ago
Vacaville Medical Center 1 Quality Dr, Vacaville Q4106 $151 [source] 4 years ago
San Leandro Medical Center 2500 Merced St, San Leandro Q4106 $151 [source] 4 years ago
Walnut Creek Medical Center 1425 S Main St, Walnut Creek Q4106 $151 [source] 4 years ago
Santa Clara Medical Center 700 Lawrence Expy, Santa Clara Q4106 $151 [source] 4 years ago
South Sacramento Medical Center 6600 Bruceville Rd, Sacramento Q4106 $151 [source] 4 years ago
Richmond Medical Center 901 Nevin Ave, Richmond Q4106 $151 [source] 4 years ago
Santa Rosa Medical Center 401 Bicentennial Way, American Canyon Q4106 $151 [source] 4 years ago
Redwood City Medical Center 1100 Veterans Blvd, Redwood City Q4106 $151 [source] 4 years ago
Vallejo Medical Center 975 Sereno Dr, Vallejo Q4106 $151 [source] 4 years ago
San Rafael Medical Center 99 Montecillo Rd, San Rafael Q4106 $151 [source] 4 years ago
San Francisco Medical Center 2525 Geary Blvd, San Francisco Q4106 $151 [source] 4 years ago
Fresno Medical Center 39400 Paseo Padre Pkwy, Fresno Q4106 $151 [source] 4 years ago
San Jose Medical Center 250 Hospital Pkwy, San Jose Q4106 $151 [source] 4 years ago
Fountain Valley Regional Hospital 17100 Euclid At Warner, Fountain Valley Q4106 $232 [source] 4 years ago
Temecula Valley Hospital 31700 Temecula Parkway, Temecula Q4106 $2,623 [source] 4 years ago
Inland Valley Medical Center 36485 Inland Valley Drive, Wildomar Q4106 $3,038 [source] 4 years ago
Rancho Springs Medical Center 25500 Medical Center Drive, Murrieta Q4106 $3,038 [source] 4 years ago
Palmdale Regional Medical Center 38600 Medical Center Drive, Palmdale Q4106 $3,080 [source] 4 years ago
Sutter Delta Medical Center 3901 Lone Tree Way, Antioch Q4106 $4,350 [source] 4 years ago
Corona Regional Medical Center 800 S. Main Street, Corona Q4106 $4,407 [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.