HCPCS Q4106
Dermagraft, per square centimeter
Retired codeSkin Substitute Products29 hospitals with prices
This code is retired. Some hospitals still list it.
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Cascade Valley Hospital | $130 – $3,759 | $104 – $3,000 | $130 – $3,750 |
| EvergreenHealth Medical Center | — | $121 | $151 |
| Highline Medical Center | — | $66.70 | $218 |
| Island Hospital | $1,697 | $3,394 | $3,394 |
| Kadlec Regional Medical Center | — | — | — |
| Legacy Salmon Creek Medical Center | — | $42.25 | $65.00 |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| PeaceHealth Southwest Medical Cente | — | $50.70 | $78.00 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $2,715 | $3,878 |
| Providence Centralia Hospital | — | $4,460 | $8,578 |
| Providence Holy Family Hospital | — | $2,715 | $3,878 |
| Providence Mount Carmel Hospital | — | $2,591 | $3,701 |
| Providence Regional Medical Center Everett | — | $4,601 | $8,848 |
| Providence St Joseph Hospital | — | $2,591 | $3,701 |
| Providence St Mary Medical Center | — | $2,624 | $3,748 |
| Providence St Peter Hospital | — | $4,460 | $8,578 |
| Skagit Valley Hospital | — | $104 – $3,000 | $130 – $3,750 |
| St Anthony Hospital | — | $66.43 | $218 |
| St Clare Hospital | — | $62.96 | $218 |
| St Elizabeth Hospital | $37.13 – $45.22 | $77.18 | $218 |
| St Francis Community Hospital | — | $68.55 | $218 |
| St Joseph Medical Center | — | $72.34 | $218 |
| St Michael Medical Center | — | $96.40 | $218 |
| Swedish Edmonds Hospital | — | $2,792 | $5,816 |
| Swedish Issaquah | — | $2,792 | $5,816 |
| Swedish Medical Center | — | $2,792 | $5,816 |
| Swedish Medical Center / Cherry Hill | — | $2,792 | $5,816 |
| Virginia Mason Medical Center | — | $68.34 | $134 |
| WhidbeyHealth Medical Center | — | $161 – $321 | $161 – $321 |
Medicare (traditional) reference
CMS publishes no national amount for this code.