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
Wisconsin
Hospital Address Code Price Last Updated
River Falls Area Hospital , River Falls Q4121 $22 [source] 4 years ago
Ascension Calumet Hospital 614 Memorial Dr, Chilton Q4121 $60 [source] 4 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q4121 $110 [source] 4 years ago
Aurora Sheboygan Memorial Medical Center 2629 N 7Th St, Sheboygan Q4121 $110 [source] 4 years ago
Aurora Lakeland Medical Center W3930 County Road Nn, Elkhorn Q4121 $110 [source] 4 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q4121 $110 [source] 4 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q4121 $110 [source] 4 years ago
Aurora Baycare 1160 Kepler Dr, Green Bay Q4121 $110 [source] 4 years ago
Aurora Medical Center Of Manitowoc County 5000 Memorial Dr, Two Rivers Q4121 $110 [source] 4 years ago
Aurora Medical Center Summit 36500 Aurora Dr, Oconomowoc Q4121 $110 [source] 4 years ago
Aurora Medical Center Bay Area 3003 University Dr, Marinette Q4121 $110 [source] 4 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q4121 $110 [source] 4 years ago
Aurora West Allis Medical Center 8901 W Lincoln Ave, Milwaukee Q4121 $110 [source] 4 years ago
Aurora Medical Center Of Washington County 1032 E Sumner St, Hartford Q4121 $110 [source] 4 years ago
Aurora Medical Center Of Oshkosh 855 N Westhaven Dr, Oshkosh Q4121 $110 [source] 4 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q4121 $110 [source] 4 years ago
Aurora Medical Center Kenosha 10400 75Th St, Kenosha Q4121 $110 [source] 4 years ago
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q4121 $122 [source] 4 years ago
Orthopaedic Hospital Of Wisconsin 475 W River Woods Pkwy, Milwaukee Q4121 $124 [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.