Code: Q4106

Description:
Description: Dermagraft, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
DERMAGRAFT 6 SQCM
Dermagraft Per 1 Sq Cm
Dermagraft Skin Sub Per Sq Cm
DERMAGRAFT PER SQ CM
DERMAGRAFT 5X7.5CM PER SQ
DERMAGRAFT 5X7.5 PER SQCM
TY TIB NP MOD PFC SIG 2 86-6022
DERMAGRFT NI-DERM-COM
TISS LIVE DERMAGRFT 5X7.5CM
Related codes:
Code: Q4100
SKIN SUBSTITUTE NOS
Code: Q4101
APLIGRAF 44 SQ CM
Code: Q4102
OASIS WND MATRX 21 SQCM
Code: Q4103
OASIS BURN MATRIX 1SQCM
Code: Q4104
INTEGRA BMWD 1SQCM
Code: Q4105
INTEGRA DRTOMNIGF 1SQCM
Code: Q4107
GRAFTJACKET 8 SQCM
Code: Q4108
INTEGRA MATRIX 25 SQCM
Code: Q4109
SKIN SUBSTITUTE TISSUEMEND PER SQ CM
Florida
Hospital Address Code Price Last Updated
Adventhealth Fish Memorial 1055 Saxon Blvd, Orange City Q4106 $59 [source] 4 years ago
Adventhealth Waterman 1000 Waterman Way, Tavares Q4106 $98 [source] 4 years ago
Florida Hospital Carrollwood 7171 N Dale Mabry Hwy, Tampa Q4106 $98 [source] 4 years ago
Adventhealth Lake Wales 410 South 11Th Street, Lake Wales Q4106 $98 [source] 4 years ago
Adventhealth Deland 701 W. Plymouth Avenue, Deland Q4106 $98 [source] 4 years ago
Florida Hospital North Pinellas 1395 S Pinellas Ave, Tarpon Springs Q4106 $98 [source] 4 years ago
Capital Regional Medical Center 2626 Capital Medical Blvd, Tallahassee Q4106 $101 [source] 4 years ago
Gulf Coast Regional Medical Center 449 W 23Rd St, Panama City Q4106 $113 [source] 4 years ago
Adventhealth Wesley Chapel 1127 Bruce B. Downs Blvd, Zephyrhills Q4106 $142 [source] 4 years ago
Adventhealth Zephyrhills 7050 Gall Blvd, Zephyrhills Q4106 $142 [source] 4 years ago
Adventhealth Dade City 13100 Fort King Rd, Dade City Q4106 $142 [source] 4 years ago
Ocala Health 1431 Sw 1St Ave, Ocala Q4106 $161 [source] 4 years ago
Adventhealth Tampa 3100 E Fletcher Ave, Tampa Q4106 $180 [source] 4 years ago
Adventist Health System/Sunbelt, Inc. 4001 W Linebaugh Ave, Tampa Q4106 $180 [source] 4 years ago
Adventhealth Ocala 1500 Sw 1St Ave, Ocala Q4106 $257 [source] 4 years ago
Adventhealth Wauchula 735 S 5Th Ave, Wauchula Q4106 $1,238 [source] 4 years ago
Adventhealth Sebring 4200 Sun N Lake Blvd, Sebring Q4106 $1,238 [source] 4 years ago
Adventhealth New Smyrna Beach 401 Palmetto St, New Smyrna Beach Q4106 $3,865 [source] 4 years ago
Doctors Hospital Of Sarasota 5731 Bee Ridge Rd, Sarasota Q4106 $4,454 [source] 4 years ago
Osceola Regional Medical Center 700 West Oak St, Kissimmee Q4106 $4,454 [source] 4 years ago
Jfk Medical Center - North Campus 2201 45Th St, West Palm Beach Q4106 $4,666 [source] 4 years ago
Palms West Hospital 13001 Southern Blvd, Loxahatchee Q4106 $4,666 [source] 4 years ago
Jfk Medical Center 5301 S Congress Ave, Lake Worth Q4106 $4,666 [source] 4 years ago
Blake Medical Center 2020 59Th St West, Bradenton Q4106 $5,402 [source] 4 years ago
Rmc Bayonet Point (Level Ii Trauma Center) 14000 Fivay Rd, Hudson Q4106 $5,402 [source] 4 years ago
Lakewood Ranch Medical Center 8330 Lakewood Ranch Boulevard, Bradenton Q4106 $6,955 [source] 4 years ago
Manatee Healthcare System 206 Second Street East, Bradenton Q4106 $6,955 [source] 4 years ago
Wellington Regional Medical Center 10101 Forest Hill Blvd., West Palm Beach Q4106 $7,434 [source] 4 years ago
Adventhealth East Orlando 12301 Lake Underhill Rd Suite 219, Orlando Q4106 $7,930 [source] 4 years ago
St. Lucie Medical Center 1800 Se Tiffany Ave, Port Saint Lucie Q4106 $8,225 [source] 4 years ago
Aventura Hospital & Medical Center 20900 Biscayne Blvd, Miami Q4106 $8,925 [source] 4 years ago
Poinciana Medical Center 325 Cypress Pkwy, Kissimmee Q4106 $9,140 [source] 4 years ago
Oak Hill Hospital 11375 Cortez Blvd, Brooksville Q4106 $9,144 [source] 4 years ago
Brandon Regional Hospital 119 Oakfield Dr, Brandon Q4106 $9,144 [source] 4 years ago
Largo Medical Center 201 14Th St Sw, Largo Q4106 $9,144 [source] 4 years ago
St. Petersburg General Hospital 6500 38Th Ave N, Saint Petersburg Q4106 $9,144 [source] 4 years ago
Englewood Community Hospital 700 Medical Blvd, Englewood Q4106 $9,144 [source] 4 years ago
Fawcett Memorial Hospital 21298 Olean Blvd, Port Charlotte Q4106 $9,144 [source] 4 years ago
South Bay Hospital 4016 Sun City Center Blvd, Sun City Center Q4106 $9,144 [source] 4 years ago
Northside Hospital 6000 49Th St North, Saint Petersburg Q4106 $9,144 [source] 4 years ago
University Hospital & Medical Center 7201 North University Dr, Fort Lauderdale Q4106 $9,534 [source] 4 years ago
Raulerson Hospital 1796 Hwy 441 North, Okeechobee Q4106 $9,800 [source] 4 years ago
Westside Regional Medical Center 8201 W Broward Blvd, Fort Lauderdale Q4106 $9,800 [source] 4 years ago
Kendall Regional Medical Center 11750 Sw 40 St, Miami Q4106 $12,250 [source] 4 years ago
Palms Of Pasadena Hospital 1501 Pasadena Ave, Saint Petersburg Q4106 $13,704 [source] 4 years ago
Adventhealth Kissimmee 2501 N. Orange Ave, Orlando Q4106 $14,417 [source] 4 years ago
Adventhealth Celebration 400 Celebration Place Attn: Pharmacare Center Pharmacy , Kissimmee Q4106 $14,417 [source] 4 years ago
Adventist Health System-Sunbelt Inc 2100 Ocoee Apopka Rd, Apopka Q4106 $14,417 [source] 4 years ago
Florida Oncology Network Pa 7727 Lake Underhill Rd, Orlando Q4106 $14,417 [source] 4 years ago
Adventhealth South Overland Park 10987 Sheldon Rd Ste 100, Tampa Q4106 $14,417 [source] 4 years ago
Adventhealth Winter Park 3099 Aloma Ave, Winter Park Q4106 $14,417 [source] 4 years ago
Lawnwood Medical Center & Heart Institute 1700 S 23Rd St, Fort Pierce Q4106 $22,352 [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.