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
Michigan
Hospital Address Code Price Last Updated
Up Health System – Marquette 580 West College Avenue, Marquette Q4108 $53 [source] 4 years ago
Beaumont - Farmington Hills 28050 Grand River Ave, Farmington Q4108 $1,089 [source] 4 years ago
William Beaumont Hospital 468 Cadieux Rd, Grosse Pointe Q4108 $1,091 [source] 4 years ago
William Beaumont Hospital 44201 Dequindre Rd, Troy Q4108 $1,115 [source] 4 years ago
St. John Providence 28000 Dequindre Rd, Warren Q4108 $1,528 [source] 4 years ago
Ascension Providence Rochester Hospital 1101 W University Dr, Rochester Q4108 $1,755 [source] 4 years ago
Providence Hospital And Medical Centers 16001 W 9 Mile Rd, Southfield Q4108 $2,658 [source] 4 years ago
St. John Macomb Oakland Hospital-Warren Campus 11800 E 12 Mile Rd, Warren Q4108 $2,982 [source] 4 years ago
William Beaumont Hospital 3555 W 13 Mile Rd, Royal Oak Q4108 $5,185 [source] 4 years ago
William Beaumont Hospital 10000 Telegraph Rd, Taylor Q4108 $5,185 [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.