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
Massachusetts
Hospital Address Code Price Last Updated
Brigham & Women Faulkner Hospital 1153 Centre St, Jamaica Plain Q4106 $99 [source] 4 years ago
Spaulding Rehab Hospital Boston 300 1St Ave, Charlestown Q4106 $99 [source] 4 years ago
Newton Wellesley Hospital 2014 Washington St, Newton Lower Falls Q4106 $99 [source] 4 years ago
Spaulding Hospital Cambridge 1575 Cambridge St, Cambridge Q4106 $115 [source] 4 years ago
Massachusetts General Hospital 55 Fruit St, Boston Q4106 $115 [source] 4 years ago
Spaulding Rehab Hospital Cape Cod 311 Service Rd, East Sandwich Q4106 $115 [source] 4 years ago
Cooley Dickinson Health Care 30 Locust St, Northampton Q4106 $115 [source] 4 years ago
Nantucket Cottage Hospital 57 Prospect St, Nantucket Q4106 $115 [source] 4 years ago
Massachusetts Eye And Ear 243 Charles St, Boston Q4106 $115 [source] 4 years ago
Martha's Vineyard Hospital One Hospital Road, Oak Bluffs Q4106 $1,873 [source] 4 years ago
North Shore Medical Center Hospital 81 Highland Ave, Salem Q4106 $1,873 [source] 4 years ago
Mclean Hospital 115 Mill St, Belmont Q4106 $1,873 [source] 4 years ago
Brigham & Womens Hospital, Inc. 75 Francis St, Boston Q4106 $1,873 [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.