Code: Q4114

Description:
Description: Integra flowable wound matrix, injectable, 1 cc
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
INTEGRA FLW WM 1CC
SEALR WOUND MATRIX FLO 3 ML FWD301
INTEGRA FLOWABLE WOUND MATRIX, PER 1ML, 3 ML
INTEGRA FLOWABLE WOUND MATRIX INJECTABLE 1 CC
Related codes:
Code: Q4110
PRIMATRIX 64 SQCM
Code: Q4111
GAMMAGRAFT 12 SQCM
Code: Q4112
CYMETRA ALLOGRFT 1 CC
Code: Q4113
GRAFTJACKET XPRESS 1CC
Code: Q4115
GRAFT SOFT TISSUE FROZEN CADAVER
Code: Q4116
ALLODERM 1SQCM
Code: Q4117
HYALOMATRIX 100SQCM
Code: Q4118
MATRISTEM MICRO 1MG 100
Code: Q4119
Wisconsin
Hospital Address Code Price Last Updated
River Falls Area Hospital , River Falls Q4114 $34 [source] 4 years ago
Howard Young Medical Center Inc Of Woodruff Wisconsin 240 Maple Street, Woodruff Q4114 $1,077 [source] 4 years ago
Watertown Regional Medical Center 125 Hospital Drive, Watertown Q4114 $2,226 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4114 $2,875 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4114 $2,980 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4114 $2,980 [source] 4 years ago
Aurora Medical Center Of Oshkosh 855 N Westhaven Dr, Oshkosh Q4114 $2,980 [source] 4 years ago
Aurora West Allis Medical Center 8901 W Lincoln Ave, Milwaukee Q4114 $2,980 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4114 $2,980 [source] 4 years ago
Aurora Medical Center Summit 36500 Aurora Dr, Oconomowoc Q4114 $2,980 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4114 $2,980 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4114 $2,980 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4114 $4,733 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4114 $4,812 [source] 4 years ago
Aspirus Stevens Point Hospital 5409 Vern Holmes Dr, Q4114 $8,351 [source] 4 years ago
Aspirus Wausau Hospital 333 Pine Ridge Blvd, Wausau Q4114 $8,351 [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.