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
Nevada
Hospital Address Code Price Last Updated
Southern Hills Hospital & Medical Center 9300 W Sunset Rd, Las Vegas Q4107 $1,381 [source] 4 years ago
Sunrise Hospital & Medical Center 3186 S Maryland Pkwy, Las Vegas Q4107 $1,846 [source] 4 years ago
Mountainview Hospital 3100 N Tenaya Way, Las Vegas Q4107 $2,391 [source] 4 years ago
Desert View Regional Medical Center 360 S Lola Ln, Pahrump Q4107 $2,935 [source] 4 years ago
Summerlin Hospital Medical Center 657 Town Center Dr, Las Vegas Q4107 $7,267 [source] 4 years ago
Northern Nevada Medical Center 2375 E Prater Way, Sparks Q4107 $8,183 [source] 4 years ago
Valley Hospital Medical Center 620 Shadow Lane, Las Vegas Q4107 $9,052 [source] 4 years ago
Spring Valley Medical Center 5400 S Rainbow Blvd, Las Vegas Q4107 $12,043 [source] 4 years ago
Henderson Hospital 1050 West Galleria Drive, Henderson Q4107 $15,198 [source] 4 years ago
Centennial Hills Hospital Medical Center 6900 N Durango Drive, Las Vegas Q4107 $15,198 [source] 4 years ago
Desert Springs Hospital 2075 E Flamingo Rd, Las Vegas Q4107 $15,701 [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.