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
Wisconsin
Hospital Address Code Price Last Updated
Howard Young Medical Center Inc Of Woodruff Wisconsin 240 Maple Street, Woodruff Q4108 $23 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4108 $68 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4108 $96 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4108 $100 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4108 $100 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4108 $100 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4108 $100 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4108 $100 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4108 $124 [source] 4 years ago
Watertown Regional Medical Center 125 Hospital Drive, Watertown Q4108 $3,215 [source] 4 years ago
Aspirus Stevens Point Hospital 5409 Vern Holmes Dr, Q4108 $7,503 [source] 4 years ago
Aspirus Wausau Hospital 333 Pine Ridge Blvd, Wausau Q4108 $7,503 [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.