Code: Q4107

Description:
Description: Graftjacket, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
GRAFTJACKET 25 SQCM
GRAFTJACKET 1SQCM
GRAFTJACKET 50 SQCM
GRAFTJACKET 16 SQCM
GRAFTJACKET 28 SQCM
GRAFTJACKET NOW 8SQCM
GRAFTJACKET 32 SQCM
GRAFT GRAFTJACKET ACELLULAR DERMAL MATRIX 7CMX4CMX1.5MM SKIN REGENERATIVE
GRAFT GRAFTJACKET ULTRATHICK ACELLULAR DERMAL MATRIX 7X4CM SKIN MAXIMUM
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: Q4106
DERMAGRAFT 37.5 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 Q4107 $13 [source] 4 years ago
Adventhealth Wesley Chapel 1127 Bruce B. Downs Blvd, Zephyrhills Q4107 $89 [source] 4 years ago
Adventhealth Sebring 4200 Sun N Lake Blvd, Sebring Q4107 $95 [source] 4 years ago
Adventist Health System/Sunbelt, Inc. 4001 W Linebaugh Ave, Tampa Q4107 $278 [source] 4 years ago
Adventhealth Zephyrhills 7050 Gall Blvd, Zephyrhills Q4107 $278 [source] 4 years ago
Adventhealth Wauchula 735 S 5Th Ave, Wauchula Q4107 $278 [source] 4 years ago
Florida Hospital Carrollwood 7171 N Dale Mabry Hwy, Tampa Q4107 $278 [source] 4 years ago
Adventhealth Waterman 1000 Waterman Way, Tavares Q4107 $278 [source] 4 years ago
Adventhealth Dade City 13100 Fort King Rd, Dade City Q4107 $278 [source] 4 years ago
Adventhealth Tampa 3100 E Fletcher Ave, Tampa Q4107 $278 [source] 4 years ago
Adventhealth Lake Wales 410 South 11Th Street, Lake Wales Q4107 $278 [source] 4 years ago
Adventhealth Deland 701 W. Plymouth Avenue, Deland Q4107 $278 [source] 4 years ago
Florida Hospital North Pinellas 1395 S Pinellas Ave, Tarpon Springs Q4107 $278 [source] 4 years ago
Putnam Community Medical Center 611 Zeagler Dr, Palatka Q4107 $364 [source] 4 years ago
Fort Walton Beach Medical Center 1000 Mar Walt Dr, Fort Walton Beach Q4107 $381 [source] 4 years ago
Memorial Hospital 3625 University Blvd. S, Jacksonville Q4107 $560 [source] 4 years ago
Adventhealth Ocala 1500 Sw 1St Ave, Ocala Q4107 $567 [source] 4 years ago
West Florida Hospital 8383 N Davis Hwy, Pensacola Q4107 $601 [source] 4 years ago
Orange Park Medical Center 2001 Kingsley Avenue, Orange Park Q4107 $676 [source] 4 years ago
Adventhealth Daytona Beach 301 Memorial Medical Pkwy, Daytona Beach Q4107 $942 [source] 4 years ago
North Florida Regional Medical Center 6500 W Newberry Rd, Gainesville Q4107 $1,100 [source] 4 years ago
Wellington Regional Medical Center 10101 Forest Hill Blvd., West Palm Beach Q4107 $2,897 [source] 4 years ago
Gulf Coast Regional Medical Center 449 W 23Rd St, Panama City Q4107 $3,142 [source] 4 years ago
Capital Regional Medical Center 2626 Capital Medical Blvd, Tallahassee Q4107 $5,816 [source] 4 years ago
Poinciana Medical Center 325 Cypress Pkwy, Kissimmee Q4107 $7,392 [source] 4 years ago
Manatee Healthcare System 206 Second Street East, Bradenton Q4107 $7,892 [source] 4 years ago
Lakewood Ranch Medical Center 8330 Lakewood Ranch Boulevard, Bradenton Q4107 $7,892 [source] 4 years ago
Adventhealth New Smyrna Beach 401 Palmetto St, New Smyrna Beach Q4107 $8,668 [source] 4 years ago
Adventhealth East Orlando 12301 Lake Underhill Rd Suite 219, Orlando Q4107 $9,040 [source] 4 years ago
Medical Center Of Trinity 9330 State Rd 54, New Port Richey Q4107 $9,538 [source] 4 years ago
Plantation General Hospital 401 Nw 42 Ave, Fort Lauderdale Q4107 $10,080 [source] 4 years ago
Cleveland Clinic Florida - Weston 2950 Cleveland Clinic Boulevard, Fort Lauderdale Q4107 $10,260 [source] 4 years ago
Largo Medical Center 201 14Th St Sw, Largo Q4107 $10,437 [source] 4 years ago
Central Florida Regional Hospital 1401 West Seminole Blvd, Sanford Q4107 $10,437 [source] 4 years ago
Osceola Regional Medical Center 700 West Oak St, Kissimmee Q4107 $12,647 [source] 4 years ago
Rmc Bayonet Point (Level Ii Trauma Center) 14000 Fivay Rd, Hudson Q4107 $12,965 [source] 4 years ago
Memorial Hospital Of Tampa 2901 W. Swann Avenue, Tampa Q4107 $12,965 [source] 4 years ago
Englewood Community Hospital 700 Medical Blvd, Englewood Q4107 $12,965 [source] 4 years ago
Fawcett Memorial Hospital 21298 Olean Blvd, Port Charlotte Q4107 $13,045 [source] 4 years ago
St. Petersburg General Hospital 6500 38Th Ave N, Saint Petersburg Q4107 $13,045 [source] 4 years ago
Ocala Health 1431 Sw 1St Ave, Ocala Q4107 $13,136 [source] 4 years ago
Blake Medical Center 2020 59Th St West, Bradenton Q4107 $13,572 [source] 4 years ago
Doctors Hospital Of Sarasota 5731 Bee Ridge Rd, Sarasota Q4107 $13,572 [source] 4 years ago
Brandon Regional Hospital 119 Oakfield Dr, Brandon Q4107 $13,875 [source] 4 years ago
Oak Hill Hospital 11375 Cortez Blvd, Brooksville Q4107 $13,875 [source] 4 years ago
Northside Hospital 6000 49Th St North, Saint Petersburg Q4107 $14,292 [source] 4 years ago
Jfk Medical Center 5301 S Congress Ave, Lake Worth Q4107 $15,876 [source] 4 years ago
South Bay Hospital 4016 Sun City Center Blvd, Sun City Center Q4107 $15,903 [source] 4 years ago
Adventhealth Celebration 400 Celebration Place Attn: Pharmacare Center Pharmacy , Kissimmee Q4107 $16,437 [source] 4 years ago
Adventhealth Kissimmee 2501 N. Orange Ave, Orlando Q4107 $16,437 [source] 4 years ago
Adventist Health System-Sunbelt Inc 2100 Ocoee Apopka Rd, Apopka Q4107 $16,437 [source] 4 years ago
Adventhealth Winter Park 3099 Aloma Ave, Winter Park Q4107 $16,437 [source] 4 years ago
Adventhealth South Overland Park 10987 Sheldon Rd Ste 100, Tampa Q4107 $16,437 [source] 4 years ago
Highlands Regional Medical Center 3600 South Highlands Ave, Sebring Q4107 $16,660 [source] 4 years ago
Florida Oncology Network Pa 7727 Lake Underhill Rd, Orlando Q4107 $20,690 [source] 4 years ago
Westside Regional Medical Center 8201 W Broward Blvd, Fort Lauderdale Q4107 $21,812 [source] 4 years ago
Aventura Hospital & Medical Center 20900 Biscayne Blvd, Miami Q4107 $21,812 [source] 4 years ago
St. Lucie Medical Center 1800 Se Tiffany Ave, Port Saint Lucie Q4107 $23,415 [source] 4 years ago
Northwest Medical Center 2801 North State Rd 7, Pompano Beach Q4107 $25,060 [source] 4 years ago
Mercy Miami Hospital 3663 S Miami Ave, Miami Q4107 $25,060 [source] 4 years ago
University Hospital & Medical Center 7201 North University Dr, Fort Lauderdale Q4107 $25,970 [source] 4 years ago
Kendall Regional Medical Center 11750 Sw 40 St, Miami Q4107 $26,950 [source] 4 years ago
Jfk Medical Center - North Campus 2201 45Th St, West Palm Beach Q4107 $27,762 [source] 4 years ago
Palms West Hospital 13001 Southern Blvd, Loxahatchee Q4107 $31,325 [source] 4 years ago
Lawnwood Medical Center & Heart Institute 1700 S 23Rd St, Fort Pierce Q4107 $31,325 [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.