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
Connecticut
Hospital Address Code Price Last Updated
Hartford Hospital 80 Seymour St, Hartford Q4106 $68 [source] 4 years ago
The Hospital Of Central Connecticut 100 Grand St, Emergency Department, New Britain Q4106 $68 [source] 4 years ago
William W Backus Hospital 326 Washington St, Norwich Q4106 $68 [source] 4 years ago
Lawrence And Memorial Hospital 365 Montauk Ave, New London Q4106 $87 [source] 4 years ago
Yale New Haven Hospital 20 York St, New Haven Q4106 $132 [source] 4 years ago
Norwalk Hospital 40 Prospect Ave, Norwalk Q4106 $156 [source] 4 years ago
Danbury Hospital 24 Hospital Ave, Danbury Q4106 $168 [source] 4 years ago
St Vincent's Medical Center 2600 Park Ave, Unit 1M, Bridgeport Q4106 $193 [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.