Code: Q4108

Description:
Description: Integra matrix, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
INTEGRA MATRIX 125 SQCM
INTEGRA MATRIX 1SQCM
INTEGRA MATRIX 250 SQCM
DRESSING MATRIX 2X2IN
INTEGRA MATRIX WOUND DRESSING, PER SQ CM, 10 X 12.5CM 1 PACK DOMESTIC
INTEGRA MATRIX WOUND DRESSING, PER SQ CM, 10 X 25CM 1 PACK DOMESTIC
INTEGRA MATRIX WOUND DRESSING, PER SQ CM, 20 X 25CM 1 PACK DOMESTIC
INTEGRA MATRIX WOUND DRESSING, PER SQ CM, 5 X 5CM 1 PACK DOMESTIC
INTEGRA WOUND MATRIX (THIN), PER SQ CM, 10 X 12.5CM 1 PACK DOMESTIC
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: Q4106
DERMAGRAFT 37.5 SQCM
Code: Q4107
GRAFTJACKET 8 SQCM
Code: Q4109
SKIN SUBSTITUTE TISSUEMEND PER SQ CM
Massachusetts
Hospital Address Code Price Last Updated
Mclean Hospital 115 Mill St, Belmont Q4108 $42 [source] 4 years ago
Newton Wellesley Hospital 2014 Washington St, Newton Lower Falls Q4108 $152 [source] 4 years ago
Martha's Vineyard Hospital One Hospital Road, Oak Bluffs Q4108 $183 [source] 4 years ago
Spaulding Hospital Cambridge 1575 Cambridge St, Cambridge Q4108 $183 [source] 4 years ago
Cooley Dickinson Health Care 30 Locust St, Northampton Q4108 $183 [source] 4 years ago
Massachusetts Eye And Ear 243 Charles St, Boston Q4108 $4,770 [source] 4 years ago
Brigham & Womens Hospital, Inc. 75 Francis St, Boston Q4108 $6,375 [source] 4 years ago
North Shore Medical Center Hospital 81 Highland Ave, Salem Q4108 $18,456 [source] 4 years ago
Brigham & Women Faulkner Hospital 1153 Centre St, Jamaica Plain Q4108 $18,456 [source] 4 years ago
Spaulding Rehab Hospital Boston 300 1St Ave, Charlestown Q4108 $18,456 [source] 4 years ago
Massachusetts General Hospital 55 Fruit St, Boston Q4108 $23,070 [source] 4 years ago
Spaulding Rehab Hospital Cape Cod 311 Service Rd, East Sandwich Q4108 $23,070 [source] 4 years ago
Nantucket Cottage Hospital 57 Prospect St, Nantucket Q4108 $23,070 [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.