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
Unknown: The source file doesn't say which population this rate applies to.
| Hospital | Unknown rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Cascade Valley Hospital | — | $104 – $3,000 | $130 – $3,750 |
| EvergreenHealth Medical Center | $136 | $121 | $151 |
| Highline Medical Center | — | $66.70 | $218 |
| Island Hospital | — | $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 | — | $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.