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
Maryland
Hospital Address Code Price Last Updated
Northwest Hospital Center 5401 Old Court Rd, Randallstown Q4106 $27 [source] 4 years ago
Atlantic General Hospital Corp 9733 Healthway Dr, Berlin Q4106 $39 [source] 4 years ago
Carroll Hospital Center 200 Memorial Ave, Westminster Q4106 $62 [source] 4 years ago
The Good Samaritan Hospital 5601 Loch Raven Blvd, Baltimore Q4106 $6,488 [source] 4 years ago
The Union Memorial Hospital 201 E University Pkwy, Baltimore Q4106 $10,400 [source] 4 years ago
Harbor Hospital 3001 S Hanover St, Brooklyn Q4106 $11,634 [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.