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
Nebraska
Hospital Address Code Price Last Updated
Chi Health St. Elizabeth 555 S. 70Th St., Lincoln Q4106 $1,680 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4106 $1,680 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4106 $1,680 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4106 $1,680 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4106 $1,680 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4106 $1,680 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4106 $1,680 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4106 $1,680 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4106 $1,680 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4106 $1,680 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4106 $1,680 [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.