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
Michigan
Hospital Address Code Price Last Updated
Aspirus Keweenaw Hospital 205 Osceola Street, Calumet Q4106 $78 [source] 4 years ago
Mclaren Lapeer Region 1375 N Main St, Lapeer Q4106 $159 [source] 4 years ago
Oakwood Healthcare, Inc. 10000 Telegraph Rd, Taylor Q4106 $209 [source] 4 years ago
Oakwood Healthcare, Inc. 5450 Fort St, Trenton Q4106 $209 [source] 4 years ago
Oakwood Healthcare, Inc. 33155 Annapolis St, Wayne Q4106 $209 [source] 4 years ago
Oakwood Health Promotions, Inc. 16391 Rotunda Dr, Dearborn Q4106 $209 [source] 4 years ago
Oakwood Healthcare, Inc. 18101 Oakwood Blvd, Dearborn Q4106 $209 [source] 4 years ago
William Beaumont Hospital 18181 Oakwood Blvd, Dearborn Q4106 $209 [source] 4 years ago
Oakwood Healthcare Inc Beaumont Service Center, Q4106 $209 [source] 4 years ago
Midmichigan Medical Center Alpena , Alpena Q4106 $1,376 [source] 4 years ago
Mclaren Flint 401 S Ballenger Hwy, Flint Q4106 $2,426 [source] 4 years ago
St. John Providence 28000 Dequindre Rd, Warren Q4106 $5,089 [source] 4 years ago
Ascension Providence Rochester Hospital 1101 W University Dr, Rochester Q4106 $5,843 [source] 4 years ago
Up Health System – Marquette 580 West College Avenue, Marquette Q4106 $6,171 [source] 4 years ago
Providence Hospital And Medical Centers 16001 W 9 Mile Rd, Southfield Q4106 $8,851 [source] 4 years ago
St. John Macomb Oakland Hospital-Warren Campus 11800 E 12 Mile Rd, Warren Q4106 $9,930 [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 §180.