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
Georgia
Hospital Address Code Price Last Updated
Murray Medical Center, Inc. 104 Hospital Dr, Chatsworth Q4107 $278 [source] 4 years ago
Adventist Health System Georgia, Inc 170 Curtis Pkwy Ne, Calhoun Q4107 $278 [source] 4 years ago
Adventhealth Gordon 105 Willowbrook Way Se, Calhoun Q4107 $278 [source] 4 years ago
Murray County Memorial Hospital Authority 707 Old Dalton Ellijay Rd, Chatsworth Q4107 $278 [source] 4 years ago
Adventist Health System Georgia Inc 1035 Red Bud Rd Ne, Calhoun Q4107 $278 [source] 4 years ago
Coliseum Health System 350 Hospital Dr, Macon Q4107 $374 [source] 4 years ago
Doctors Hospital Of Augusta 3651 Wheeler Rd, Augusta Q4107 $546 [source] 4 years ago
Wellstar Atlanta Medical Center 303 Parkway Dr Ne, Atlanta, Georgia, Atlanta Q4107 $713 [source] 4 years ago
Memorial Satilla Health 1900 Tebeau St, Waycross Q4107 $835 [source] 4 years ago
Cartersville Medical Center 960 Joe Frank Harris Pkwy, Cartersville Q4107 $1,030 [source] 4 years ago
Memorial Health 4700 Waters Avenue, Savannah Q4107 $1,240 [source] 4 years ago
Redmond Regional Medical Center 501 Redmond Rd, Rome Q4107 $1,522 [source] 4 years ago
Eastside Medical Center 1700 Medical Way, Snellville Q4107 $1,564 [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.