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
Illinois
Hospital Address Code Price Last Updated
Adventist Bolingbrook Hospital 500 Remington Blvd, Bolingbrook Q4106 $64 [source] 4 years ago
Presence St. Mary's Hospital 500 W Court St, Kankakee Q4106 $85 [source] 4 years ago
Alexian Brothers Medical Center 935 Beisner Rd, Elk Grove Village Q4106 $111 [source] 4 years ago
Adventist Hinsdale Hospital 120 N Oak St, Hinsdale Q4106 $114 [source] 4 years ago
Adventist Lagrange Memorial Hospital 5101 Willow Springs Rd, La Grange Q4106 $115 [source] 4 years ago
Adventist Glenoaks Hospital 701 Winthrop Ave, Glendale Heights Q4106 $115 [source] 4 years ago
St. Alexius Medical Center 1555 Barrington Road, Q4106 $116 [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.