Code: Q4121

Description:
Description: Theraskin, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
THERASKIN 13SQCM
THERASKIN 39SQCM
THERASKIN 18SQCM
THERASKIN 13 SQ CM
THERASKIN LG 2X3IN 102TSL
GRAFT THERASKIN 13 SQ CM (101TSS)
GRAFT THERASKIN 39 SQ CM (102TSL)
GRAFT SKIN 2X1IN THERASKIN CRYOPRESERVE MESH ALLOGRAFT
GRAFT SKIN 3X2IN THERASKIN 1.5:1 LARGE MESH ALLOGRAFT CRYOPRESERVE
Related codes:
Code: Q4120
Code: Q4122
DERMACELLAWMPORO 1SQCM
Code: Q4123
ALLOSKIN RT 1SQCM
Code: Q4124
OASIS TRI MATRIX 35SQCM
Code: Q4125
ARTHROFLX 12SQCM .5M THK
Code: Q4126
DERMASPAN 25 SQ CM
Code: Q4127
Description: Talymed, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Code: Q4128
FLEXALLOPMATR HD 1SQCM
Indiana
Hospital Address Code Price Last Updated
Ascension St. Vincent Warrick 1116 Millis Ave, Boonville Q4121 $101 [source] 4 years ago
Ascension St. Vincent Hospital 2001 W 86Th St, Indianapolis Q4121 $101 [source] 4 years ago
Ascension Medical Group St. Vincent 301 Henry St, North Vernon Q4121 $101 [source] 4 years ago
Ascension St. Vincent Evansville 3700 Washington Ave, Evansville Q4121 $101 [source] 4 years ago
Ascension St. Vincent Williamsport 412 N Monroe St, Williamsport Q4121 $101 [source] 4 years ago
St Vincent Salem Hospital Inc 911 N Shelby St, Salem Q4121 $101 [source] 4 years ago
St. Vincent Mercy Hospital 1331 S A St, Elwood Q4121 $101 [source] 4 years ago
Ascension St. Vincent Dunn 1600 23Rd St, Bedford Q4121 $101 [source] 4 years ago
Ascension St. Vincent Randolph 473 E Greenville Ave, Winchester Q4121 $101 [source] 4 years ago
Ascension St. Vincent Carmel 13500 N Meridian St, Carmel Q4121 $101 [source] 4 years ago
Ascension St. Vincent Anderson 2015 Jackson St, Anderson Q4121 $101 [source] 4 years ago
Ascension St. Vincent Heart Center 10580 N Meridian St, Indianapolis Q4121 $101 [source] 4 years ago
Franciscan Health Indianapolis , Indianapolis Q4121 $342 [source] 4 years ago
Terre Haute Regional Hospital 3901 S 7Th St, Terre Haute Q4121 $5,530 [source] 4 years ago
St. Vincent Clay Hospital, Inc 1206 E National Ave, Brazil Q4121 $6,012 [source] 4 years ago
Ascension St Vincent Fishers 13861 Olio Road, Q4121 $6,012 [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.