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
Missouri
Hospital Address Code Price Last Updated
Wright Memorial Hospital 191 Iowa Blvd, Trenton Q4106 $43 [source] 4 years ago
Hedrick Medical Center 2799 N Washington St, Chillicothe Q4106 $46 [source] 4 years ago
Saint Luke’s North Hospital 5830 Nw Barry Rd, Kansas City Q4106 $46 [source] 4 years ago
Saint Luke’s Hospital 4401 Wornall Rd, Kansas City Q4106 $74 [source] 4 years ago
Saint Luke’s East Hospital 100 Ne Saint Luke's Blvd, Lees Summit Q4106 $75 [source] 4 years ago
Lee's Summit Medical Center 2100 Se Blue Parkway, Lees Summit Q4106 $154 [source] 4 years ago
Lafayette Regional Health Center 1500 State Street, Lexington Q4106 $184 [source] 4 years ago
Research Medical Center 2316 E Meyer Blvd, Kansas City Q4106 $3,413 [source] 4 years ago
Centerpoint Medical Center 19600 East 39Th Street, Independence Q4106 $3,413 [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.