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
Michigan
Hospital Address Code Price Last Updated
William Beaumont Hospital 468 Cadieux Rd, Grosse Pointe Q4121 $35 [source] 4 years ago
William Beaumont Hospital 5450 Fort St, Trenton Q4121 $35 [source] 4 years ago
Beaumont Wayne 33155 Annapolis St, Wayne Q4121 $36 [source] 4 years ago
William Beaumont Hospital 18181 Oakwood Blvd, Dearborn Q4121 $36 [source] 4 years ago
St. John Providence 28000 Dequindre Rd, Warren Q4121 $48 [source] 4 years ago
Ascension Providence Rochester Hospital 1101 W University Dr, Rochester Q4121 $56 [source] 4 years ago
Providence Hospital And Medical Centers 16001 W 9 Mile Rd, Southfield Q4121 $84 [source] 4 years ago
St. John Macomb Oakland Hospital-Warren Campus 11800 E 12 Mile Rd, Warren Q4121 $95 [source] 4 years ago
Beaumont Special Radiological Procedures 3601 W Thirteen Mile Rd, Royal Oak Q4121 $98 [source] 4 years ago
William Beaumont Hospital 44201 Dequindre, Troy Q4121 $98 [source] 4 years ago
William Beaumont Hospital 1026 Eleven Mile Road, Royal Oak Q4121 $98 [source] 4 years ago
Beaumont Ashn, Llc 1919 Technology Dr Ste B, Troy Q4121 $98 [source] 4 years ago
Beaumont Orthopaedic Center 3535 W 13 Mile Road, Royal Oak Q4121 $98 [source] 4 years ago
Beaumont Health System 3601 W. 13 Mile Rd, Royal Oak Q4121 $98 [source] 4 years ago
William Beaumont Hospital 5150 Coolidge Hwy, Royal Oak Q4121 $98 [source] 4 years ago
William Beaumont Hospital 4949 Coolidge Hwy, Royal Oak Q4121 $98 [source] 4 years ago
William Beaumont Hospital 3535 W 13 Mile Rd, Royal Oak Q4121 $98 [source] 4 years ago
William Beaumont Hospital 44201 Dequindre Rd, Troy Q4121 $98 [source] 4 years ago
William Beaumont Hospital 3601 W 13 Mile Rd, Royal Oak Q4121 $98 [source] 4 years ago
Mclaren Greater Lansing 401 W Greenlawn Ave, Lansing Q4121 $107 [source] 4 years ago
Mclaren Central Michigan 1221 South Dr, Mount Pleasant Q4121 $150 [source] 4 years ago
Mclaren Port Huron 1221 Pine Grove Ave, Port Huron Q4121 $169 [source] 4 years ago
Mclaren Macomb 1000 Harrington St, Mount Clemens Q4121 $507 [source] 4 years ago
Midmichigan Medical Center Gladwin , Gladwin Q4121 $1,668 [source] 4 years ago
William Beaumont Hospital 3555 W 13 Mile Rd, Royal Oak Q4121 $1,793 [source] 4 years ago
William Beaumont Hospital 10000 Telegraph Rd, Taylor Q4121 $1,793 [source] 4 years ago
Mclaren Lapeer Region 1375 N Main St, Lapeer Q4121 $1,796 [source] 4 years ago
Mclaren Flint 401 S Ballenger Hwy, Flint Q4121 $2,031 [source] 4 years ago
Botsford Continuing Care Corporation 21450 Archwood Cir, Farmington Q4121 $5,178 [source] 4 years ago
Botsford General Hospital 28050 Grand River Ave, Farmington Q4121 $5,178 [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.