Code: Q4117

Description:
Description: Hyalomatrix, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
HYALOMATRIX 1SQCM
HYALOMATRIX 200SQCM
HYALOMATRIX 25SQCM
DRSNG HYALOMATRIX WND PER SQ CM (18X20CM)
DRESSING HYALOMATRIX 2.5X2.5CM
HYALOMATRIX NON SIL 10X20CM (PER 1 CM)
HYALOMATRIX NON SIL 10X10CM (PER 1 CM)
HYALOMATRIX 10 SQCM
HYALOMATRIX 5.0 SQCM
Related codes:
Code: Q4110
PRIMATRIX 64 SQCM
Code: Q4111
GAMMAGRAFT 12 SQCM
Code: Q4112
CYMETRA ALLOGRFT 1 CC
Code: Q4113
GRAFTJACKET XPRESS 1CC
Code: Q4114
INTEGRA WOUND MATRX 1 CC
Code: Q4115
GRAFT SOFT TISSUE FROZEN CADAVER
Code: Q4116
ALLODERM 1SQCM
Code: Q4118
MATRISTEM MICRO 1MG 100
Code: Q4119
Indiana
Hospital Address Code Price Last Updated
Franciscan Health Michigan City , Michigan City Q4117 $7 [source] 4 years ago
Ascension St. Vincent Warrick 1116 Millis Ave, Boonville Q4117 $101 [source] 4 years ago
Ascension St. Vincent Hospital 2001 W 86Th St, Indianapolis Q4117 $101 [source] 4 years ago
Ascension Medical Group St. Vincent 301 Henry St, North Vernon Q4117 $101 [source] 4 years ago
Ascension St. Vincent Evansville 3700 Washington Ave, Evansville Q4117 $101 [source] 4 years ago
Ascension St. Vincent Williamsport 412 N Monroe St, Williamsport Q4117 $101 [source] 4 years ago
St Vincent Salem Hospital Inc 911 N Shelby St, Salem Q4117 $101 [source] 4 years ago
St. Vincent Mercy Hospital 1331 S A St, Elwood Q4117 $101 [source] 4 years ago
Ascension St. Vincent Dunn 1600 23Rd St, Bedford Q4117 $101 [source] 4 years ago
Ascension St. Vincent Randolph 473 E Greenville Ave, Winchester Q4117 $101 [source] 4 years ago
Ascension St. Vincent Carmel 13500 N Meridian St, Carmel Q4117 $101 [source] 4 years ago
Ascension St. Vincent Anderson 2015 Jackson St, Anderson Q4117 $101 [source] 4 years ago
Ascension St. Vincent Heart Center 10580 N Meridian St, Indianapolis Q4117 $101 [source] 4 years ago
St. Vincent Clay Hospital, Inc 1206 E National Ave, Brazil Q4117 $6,012 [source] 4 years ago
Ascension St Vincent Fishers 13861 Olio Road, Q4117 $6,012 [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.