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
Tennessee
Hospital Address Code Price Last Updated
Southern Tennessee Regional Health System - Pulaski 1265 East College Street, Pulaski Q4106 $1 [source] 4 years ago
Riverview Regional Medical Center 158 Hospital Drive, Carthage Q4106 $43 [source] 4 years ago
Saint Thomas River Park Hospital, Llc 120 Walnut Commons Ln Ste D, Cookeville Q4106 $69 [source] 4 years ago
Ascension Saint Thomas Stones River 324 Doolittle Rd, Woodbury Q4106 $69 [source] 4 years ago
Ascension Saint Thomas Dekalb 520 W Main St, Smithville Q4106 $69 [source] 4 years ago
Ascension Saint Thomas Highlands 401 Sewell Dr, Sparta Q4106 $69 [source] 4 years ago
Saint Thomas Hickman Hospital 1518 Highway 100, Centerville Q4106 $69 [source] 4 years ago
Sumner Regional Medical Center 555 Hartsville Pike, Gallatin Q4106 $117 [source] 4 years ago
Trousdale Medical Center 500 Church Street, Hartsville Q4106 $227 [source] 4 years ago
Southern Tennessee Regional Health System - Winchester 185 Hospital Road, Winchester Q4106 $317 [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.