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
North Carolina
Hospital Address Code Price Last Updated
Cone Health Moses Cone Hospital 1121 North Church St Entrance A, Greensboro Q4106 $46 [source] 4 years ago
Atrium Health University 8800 N. Tryon St. , Charlotte Q4106 $65 [source] 4 years ago
Carolinas Medical Center 1000 Blythe Blvd. , Charlotte Q4106 $65 [source] 4 years ago
Atrium Health Lincoln 433 Mcalister Road , Lincolnton Q4106 $65 [source] 4 years ago
Atrium Health Mercy 2001 Vail Ave. , Charlotte Q4106 $68 [source] 4 years ago
Atrium Health Pineville 10628 Park Road , Charlotte Q4106 $70 [source] 4 years ago
Atrium Health Cabarrus 920 Church Street North , Concord Q4106 $71 [source] 4 years ago
Atrium Health Union 600 Hospital Drive , Monroe Q4106 $79 [source] 4 years ago
Atrium Health Cleveland 201 E. Grover St. , Shelby Q4106 $93 [source] 4 years ago
Atrium Health Stanly 301 Yadkin St. , Albemarle Q4106 $98 [source] 4 years ago
Atrium Health Anson 2301 Us Hwy 74 W. , Wadesboro Q4106 $105 [source] 4 years ago
Cone Health Alamance Regional Medical Center 1240 Huffman Mill Rd, Burlington Q4106 $131 [source] 4 years ago
Cone Health Penn Nursing Center 618 S Main St, Reidsville Q4106 $131 [source] 4 years ago
Cone Health Wesley Long Hospital 2400 W Friendly Ave, Greensboro Q4106 $131 [source] 4 years ago
Moses Cone Hospital 1131D N Church St, Greensboro Q4106 $131 [source] 4 years ago
Cone Health Behavioral Health Hospital 700 Walter Reed Dr, Greensboro Q4106 $131 [source] 4 years ago
Adventhealth Hendersonville 100 Hospital Dr, Hendersonville Q4106 $150 [source] 4 years ago
Wilson Medical Center 1705 Tarboro Street Sw, Wilson Q4106 $176 [source] 4 years ago
Carepartners Rehabilitation Hospital 68 Sweeten Creek Rd, Asheville Q4106 $7,213 [source] 4 years ago
Mcdowell Hospital , Marion Q4106 $7,790 [source] 4 years ago
Blue Ridge Regional Hospital 125 Hospital Dr, Spruce Pine Q4106 $7,790 [source] 4 years ago
Angel Medical Center 120 Riverview St, Franklin Q4106 $7,790 [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.