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
Texas
Hospital Address Code Price Last Updated
Baylor Scott & White Medical Center - Taylor 305 Mallard Ln, Taylor Q4106 $51 [source] 4 years ago
Baylor Scott & White Medical Center - Marble Falls 810 W. State Highway 71, Marble Falls Q4106 $51 [source] 4 years ago
Baylor Scott & White Medical Center - Round Rock 300 University Blvd, Sandy Q4106 $51 [source] 4 years ago
Baylor Scott & White Medical Center - College Station 700 Scott And White Dr, College Station Q4106 $54 [source] 4 years ago
Baylor Scott & White Medical Center - Lakeway 100 Medical Pkwy, Austin Q4106 $58 [source] 4 years ago
Baylor Scott & White Medical Center - Buda 5330 Overpass Rd, Buda Q4106 $58 [source] 4 years ago
Baylor Scott & White Medical Center - Brenham 700 Medical Pkwy, Brenham Q4106 $58 [source] 4 years ago
Baylor Scott & White Medical Center - Pflugerville 2600 E Pflugerville Pkwy Ste 100, Pflugerville Q4106 $58 [source] 4 years ago
Baylor Scott & White Medical Center - Irving 1901 N Macarthur Blvd, Irving Q4106 $68 [source] 4 years ago
Baylor Scott & White Emergency Center - Forney 757 E Us Highway 80 Ste 150, Forney Q4106 $68 [source] 4 years ago
Baylor Scott & White Medical Center - Centennial 12505 Lebanon Rd, Frisco Q4106 $68 [source] 4 years ago
Baylor Scott & White All Saints Medical Center - Fort Worth 1400 8Th Ave, Fort Worth Q4106 $68 [source] 4 years ago
Baylor Scott & White Emergency Hospital - Murphy 511 W Fm 544 Ste 100, Plano Q4106 $68 [source] 4 years ago
Baylor Scott & White Heart And Vascular Hospital - Dallas 621 N Hall St, Dallas Q4106 $68 [source] 4 years ago
Baylor Scott & White Emergency Hospital - Aubrey 26791 Us Highway 380 E, Aubrey Q4106 $68 [source] 4 years ago
Baylor Scott & White Medical Center - Waxahachie 2400 N Interstate 35E, Waxahachie Q4106 $68 [source] 4 years ago
Baylor Scott & White Medical Center - Lake Pointe 6800 Scenic Dr, Rowlett Q4106 $68 [source] 4 years ago
Baylor Scott & White Medical Center - Grapevine 1650 W College St, Grapevine Q4106 $71 [source] 4 years ago
Ascension Providence 6901 Medical Pkwy, Woodway Q4106 $79 [source] 4 years ago
Baylor Scott & White The Heart Hospital - Denton 2801 S Mayhill Rd, Denton Q4106 $79 [source] 4 years ago
Baylor Scott & White The Heart Hospital - Plano 1100 Allied Dr, Plano Q4106 $79 [source] 4 years ago
Baylor Scott & White Medical Center - Plano 4700 Alliance Blvd, Plano Q4106 $79 [source] 4 years ago
Baylor Scott & White Continuing Care Hospital - Temple 546 N Kegley Rd, Temple Q4106 $85 [source] 4 years ago
Northwest Texas Healthcare System 1501 S. Coulter, Amarillo Q4106 $101 [source] 4 years ago
Texas Health Huguley 11801 South Fwy, Burleson Q4106 $164 [source] 4 years ago
Palestine Regional Medical Center 2900 South Loop 256, Palestine Q4106 $199 [source] 4 years ago
Valley Baptist Medical Center 2101 Pease Street, Harlingen Q4106 $210 [source] 4 years ago
Adventhealth Rollins Brook 608 N Key Ave, Lampasas Q4106 $214 [source] 4 years ago
Medical City Frisco 5500 Frisco Square Blvd, Frisco Q4106 $243 [source] 4 years ago
St. David's Healthcare , Round Rock Q4106 $2,161 [source] 4 years ago
Texoma Medical Center 5016 South Us Highway 75, Denison Q4106 $4,240 [source] 4 years ago
Doctors Hospital Of Laredo 10700 Mcpherson Road, Laredo Q4106 $5,282 [source] 4 years ago
South Texas Health System Children’s 1102 W. Trenton Road, Edinburg Q4106 $5,413 [source] 4 years ago
South Texas Health System Mcallen 301 W. Expressway 83, Mcallen Q4106 $5,413 [source] 4 years ago
South Texas Health System Heart 1900 South D Street, Mcallen Q4106 $5,413 [source] 4 years ago
Medical City North Hills 4401 Booth Calloway Rd, North Richland Hills Q4106 $8,457 [source] 4 years ago
Adventhealth Central Texas 2201 Clear Creek Rd, Killeen Q4106 $9,029 [source] 4 years ago
Medical City Arlington 3301 Matlock Rd, Arlington Q4106 $9,051 [source] 4 years ago
Fort Duncan Regional Medical Center 3333 N. Foster Maldonado Blvd., Eagle Pass Q4106 $11,551 [source] 4 years ago
Medical City Las Colinas 6800 N Macarthur Blvd, Irving Q4106 $15,492 [source] 4 years ago
Medical City Denton 3535 S Interstate 35, Corinth Q4106 $17,213 [source] 4 years ago
Medical City Dallas 13155 Noel Rd. Suite 200, Dallas Q4106 $18,052 [source] 4 years ago
Medical City Alliance 3101 N Tarrant Pkwy, Fort Worth Q4106 $18,052 [source] 4 years ago
Medical City Lewisville 500 W Main St, Lewisville Q4106 $20,527 [source] 4 years ago
Medical City Fort Worth 900 8Th Ave, Fort Worth Q4106 $60,322 [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.