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
North Carolina
Hospital Address Code Price Last Updated
Atrium Health University 8800 N. Tryon St. , Charlotte Q4107 $117 [source] 4 years ago
Carolinas Medical Center 1000 Blythe Blvd. , Charlotte Q4107 $118 [source] 4 years ago
Atrium Health Lincoln 433 Mcalister Road , Lincolnton Q4107 $118 [source] 4 years ago
Atrium Health Mercy 2001 Vail Ave. , Charlotte Q4107 $123 [source] 4 years ago
Atrium Health Pineville 10628 Park Road , Charlotte Q4107 $127 [source] 4 years ago
Atrium Health Cabarrus 920 Church Street North , Concord Q4107 $128 [source] 4 years ago
Atrium Health Union 600 Hospital Drive , Monroe Q4107 $144 [source] 4 years ago
Atrium Health Cleveland 201 E. Grover St. , Shelby Q4107 $168 [source] 4 years ago
Atrium Health Stanly 301 Yadkin St. , Albemarle Q4107 $179 [source] 4 years ago
Atrium Health Anson 2301 Us Hwy 74 W. , Wadesboro Q4107 $191 [source] 4 years ago
Harris Regional Hospital 68 Hospital Road, Sylva Q4107 $353 [source] 4 years ago
Adventhealth Hendersonville 100 Hospital Dr, Hendersonville Q4107 $1,841 [source] 4 years ago
Carepartners Outpatient Rehab 1 Doctors Dr, Asheville Q4107 $13,970 [source] 4 years ago
Carepartners Rehabilitation Hospital 68 Sweeten Creek Rd, Asheville Q4107 $16,071 [source] 4 years ago
Blue Ridge Regional Hospital 125 Hospital Dr, Spruce Pine Q4107 $17,357 [source] 4 years ago
Angel Medical Center 120 Riverview St, Franklin Q4107 $17,357 [source] 4 years ago
Mcdowell Hospital , Marion Q4107 $18,509 [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.