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
Tennessee
Hospital Address Code Price Last Updated
St. Jude Children's Research Hospital , Memphis Q4108 $45 [source] 4 years ago
Saint Thomas River Park Hospital, Llc 120 Walnut Commons Ln Ste D, Cookeville Q4108 $143 [source] 4 years ago
Ascension Saint Thomas Stones River 324 Doolittle Rd, Woodbury Q4108 $143 [source] 4 years ago
Ascension Saint Thomas Dekalb 520 W Main St, Smithville Q4108 $143 [source] 4 years ago
Saint Thomas Hickman Hospital 1518 Highway 100, Centerville Q4108 $143 [source] 4 years ago
Ascension Saint Thomas Highlands 401 Sewell Dr, Sparta Q4108 $143 [source] 4 years ago
Southern Tennessee Regional Health System - Winchester 185 Hospital Road, Winchester Q4108 $157 [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.