HCPCS Q4107
Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products39 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $141 – $155 | $4,661 – $6,262 | $11,653 – $15,655 |
| Cascade Valley Hospital | $4,545 – $9,078 | $3,636 – $7,262 | $4,545 – $9,078 |
| Deaconess Medical Center | $136 – $149 | $4,661 – $6,262 | $11,653 – $15,655 |
| Harborview Medical Center | $144 – $159 | $2,992 – $9,147 | $4,275 – $13,067 |
| Highline Medical Center | — | $1,116 – $4,194 | $3,656 – $13,736 |
| Island Hospital | $149 – $157 | — | — |
| Kadlec Regional Medical Center | $139 – $166 | $2,094 – $4,606 | $2,991 – $6,580 |
| Legacy Salmon Creek Medical Center | $143 – $155 | $115 | $177 |
| Mary Bridge Children's Hospital | $142 – $157 | $4,661 – $6,262 | $11,653 – $15,655 |
| MultiCare Auburn Medical Center | $142 – $156 | $4,661 – $6,262 | $11,653 – $15,655 |
| MultiCare Covington Medical Center | $142 – $156 | $4,661 – $6,262 | $11,653 – $15,655 |
| MultiCare Good Samaritan Hospital | $142 – $157 | $4,661 – $6,262 | $11,653 – $15,655 |
| MultiCare Valley Hospital | $140 – $149 | $4,661 – $6,262 | $11,653 – $15,655 |
| Olympic Medical Center | $156 – $201 | — | — |
| Overlake Hospital Medical Center & Clinics | $145 – $150 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $139 – $166 | $2,134 – $6,202 | $3,049 – $8,860 |
| Providence Centralia Hospital | $144 – $231 | $3,486 – $10,046 | $6,703 – $19,318 |
| Providence Holy Family Hospital | $139 – $153 | $2,134 – $6,202 | $3,049 – $8,860 |
| Providence Mount Carmel Hospital | — | $2,037 – $5,925 | $2,909 – $8,464 |
| Providence Regional Medical Center Everett | $142 – $156 | $3,642 – $8,437 | $7,004 – $16,225 |
| Providence St Joseph Hospital | — | $2,037 – $5,925 | $2,909 – $8,464 |
| Providence St Mary Medical Center | $139 – $153 | $2,100 – $5,295 | $3,000 – $7,564 |
| Providence St Peter Hospital | $143 – $229 | $3,486 – $10,046 | $6,703 – $19,318 |
| Skagit Valley Hospital | — | $3,636 – $7,262 | $4,545 – $9,078 |
| St Anthony Hospital | — | $1,112 – $4,178 | $3,656 – $13,736 |
| St Clare Hospital | — | $1,054 – $3,959 | $3,656 – $13,736 |
| St Elizabeth Hospital | $658 – $3,022 | $1,292 – $4,854 | $3,656 – $13,736 |
| St Francis Community Hospital | — | $1,147 – $4,311 | $3,656 – $13,736 |
| St Joseph Medical Center | — | $1,211 – $4,549 | $3,656 – $13,736 |
| St Michael Medical Center | — | $1,613 – $6,062 | $3,656 – $13,736 |
| Swedish Edmonds Hospital | $142 – $170 | $2,211 – $5,912 | $4,606 – $12,317 |
| Swedish Issaquah | $145 – $173 | $2,211 – $5,912 | $4,606 – $12,317 |
| Swedish Medical Center | $144 – $173 | $2,211 – $5,912 | $4,606 – $12,317 |
| Swedish Medical Center / Cherry Hill | $144 – $173 | $2,211 – $5,912 | $4,606 – $12,317 |
| Tacoma General Allenmore Hospital | $142 – $157 | $4,661 – $6,262 | $11,653 – $15,655 |
| University of Washington Medical Ctr | $144 – $159 | $233 – $8,131 | $333 – $11,615 |
| Virginia Mason Medical Center | — | $18.36 – $702 | $36.00 – $1,376 |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $146 – $163 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $156 in an office; $156 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $134 in an office; $134 in a hospital or surgery center
- Hospital outpatient payment (national)
- $127 (APC 6001)
- Surgery center payment (national)
- $127