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
Wisconsin
Hospital Address Code Price Last Updated
River Falls Area Hospital , River Falls Q4106 $28 [source] 4 years ago
Aspirus Divine Savior Hospital 2817 New Pinery Rd, Portage Q4106 $45 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4106 $46 [source] 4 years ago
Howard Young Medical Center Inc Of Woodruff Wisconsin 240 Maple Street, Woodruff Q4106 $47 [source] 4 years ago
Prairie Ridge Health 1515 Park Ave, Columbus Q4106 $65 [source] 4 years ago
Aspirus Wausau Hospital 333 Pine Ridge Blvd, Wausau Q4106 $78 [source] 4 years ago
Aspirus Stevens Point Hospital 5409 Vern Holmes Dr, Q4106 $78 [source] 4 years ago
Aspirus Riverview Hospital 410 Dewey St, Wisconsin Rapids Q4106 $78 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4106 $98 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4106 $99 [source] 4 years ago
Aurora Medical Center Of Oshkosh 855 N Westhaven Dr, Oshkosh Q4106 $145 [source] 4 years ago
Aurora Medical Center Of Washington County 1032 E Sumner St, Hartford Q4106 $145 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4106 $145 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4106 $145 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4106 $145 [source] 4 years ago
Aurora Medical Center Bay Area 3003 University Dr, Marinette Q4106 $145 [source] 4 years ago
Aurora Medical Center Summit 36500 Aurora Dr, Oconomowoc Q4106 $145 [source] 4 years ago
Aurora Medical Center Of Manitowoc County 5000 Memorial Dr, Two Rivers Q4106 $145 [source] 4 years ago
Aurora Baycare 1160 Kepler Dr, Green Bay Q4106 $145 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4106 $145 [source] 4 years ago
Aurora Medical Center Kenosha 10400 75Th St, Kenosha Q4106 $145 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4106 $145 [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.