Code: Q4119

Description:
Description: Matristem wound matrix, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
CYTAL WND MTRX 1LAYER 10X15CM WS1015
CYTAL WND MTRX 2LAYER 10X15CM WSM1015
CYTAL BURN MTRX MESHED 7X10CM BMM0710
CYTAL WND MTRX 1LAYER 7X10CM WS0710
CYTAL WND MATRIX 2LAYER 7X10CM WSM0710
MATRIX SURGICAL PSMT 16X20CM
MATRIX SURGICAL PSMT 20X20CM
MATRIX SURGICAL PSMT 20X25CM
MATRIX SURGICAL PSMT 20X30CM
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: Q4117
HYALOMATRIX 100SQCM
Code: Q4118
MATRISTEM MICRO 1MG 100
Nebraska
Hospital Address Code Price Last Updated
Chi Health St. Elizabeth 555 S. 70Th St., Lincoln Q4119 $1,890 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4119 $1,890 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4119 $1,890 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4119 $1,890 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4119 $1,890 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4119 $1,890 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4119 $1,890 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4119 $1,890 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4119 $1,890 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4119 $1,890 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4119 $1,890 [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.