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
Nebraska
Hospital Address Code Price Last Updated
Chi Health St. Elizabeth 555 S. 70Th St., Lincoln Q4121 $1,211 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4121 $1,211 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4121 $1,211 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4121 $1,211 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4121 $1,211 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4121 $1,211 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4121 $1,211 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4121 $1,211 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4121 $1,211 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4121 $1,211 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4121 $1,211 [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.