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
Texas
Hospital Address Code Price Last Updated
Ascension Providence 6901 Medical Pkwy, Woodway Q4108 $67 [source] 4 years ago
Texas Health Huguley 11801 South Fwy, Burleson Q4108 $96 [source] 4 years ago
Adventhealth Central Texas 2201 Clear Creek Rd, Killeen Q4108 $96 [source] 4 years ago
Adventhealth Rollins Brook 608 N Key Ave, Lampasas Q4108 $96 [source] 4 years ago
Medical City Arlington 3301 Matlock Rd, Arlington Q4108 $1,201 [source] 4 years ago
Medical City Dallas 13155 Noel Rd. Suite 200, Dallas Q4108 $39,882 [source] 4 years ago
Medical City Alliance 3101 N Tarrant Pkwy, Fort Worth Q4108 $39,882 [source] 4 years ago
Medical City Frisco 5500 Frisco Square Blvd, Frisco Q4108 $47,561 [source] 4 years ago
Medical City North Hills 4401 Booth Calloway Rd, North Richland Hills Q4108 $59,841 [source] 4 years ago
Medical City Denton 3535 S Interstate 35, Corinth Q4108 $70,988 [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.