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
Ohio
Hospital Address Code Price Last Updated
Euclid Hospital 18901 Lakeshore Blvd., Cleveland Q4107 $5,814 [source] 4 years ago
South Pointe Hospital 20000 Harvard Rd., Cleveland Q4107 $5,814 [source] 4 years ago
Cleveland Clinic Main Campus 9500 Euclid Ave, Cleveland Q4107 $6,840 [source] 4 years ago
Hillcrest Hospital 6780 Mayfield Rd., Cleveland Q4107 $6,840 [source] 4 years ago
Marymount Hospital 12300 Mccracken Road, Cleveland Q4107 $6,842 [source] 4 years ago
Medina Hospital 1000 E. Washington St., Medina Q4107 $7,375 [source] 4 years ago
Lutheran Hospital 1730 West 25Th Street, Cleveland Q4107 $8,721 [source] 4 years ago
Fairview Hospital 18101 Lorain Ave., Cleveland Q4107 $8,721 [source] 4 years ago
Akron General Lodi Hospital 225 Elyria St., Lodi Q4107 $18,092 [source] 4 years ago
Akron General 1 Akron General Ave., Akron Q4107 $18,092 [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.