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
Michigan
Hospital Address Code Price Last Updated
Mclaren Greater Lansing 401 W Greenlawn Ave, Lansing Q4117 $39 [source] 4 years ago
Mclaren Central Michigan 1221 South Dr, Mount Pleasant Q4117 $42 [source] 4 years ago
Mclaren Flint 401 S Ballenger Hwy, Flint Q4117 $43 [source] 4 years ago
Mclaren Lapeer Region 1375 N Main St, Lapeer Q4117 $49 [source] 4 years ago
Mclaren Bay Region 1900 Columbus Ave, Bay City Q4117 $50 [source] 4 years ago
Mclaren Bay Special Care Hospital 3250 E Midland Rd Suite 1, Bay City Q4117 $50 [source] 4 years ago
St. John Providence 28000 Dequindre Rd, Warren Q4117 $68 [source] 4 years ago
Ascension Providence Rochester Hospital 1101 W University Dr, Rochester Q4117 $78 [source] 4 years ago
Providence Hospital And Medical Centers 16001 W 9 Mile Rd, Southfield Q4117 $119 [source] 4 years ago
St. John Macomb Oakland Hospital-Warren Campus 11800 E 12 Mile Rd, Warren Q4117 $133 [source] 4 years ago
Up Health System – Marquette 580 West College Avenue, Marquette Q4117 $329 [source] 4 years ago
Karmanos Cancer Institute 4100 John R St, Detroit Q4117 $2,563 [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 §180.