Code: Q4125

Description:
Description: Arthroflex, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
ARTHROFLEX 28 SQ CM 1THK
ARTHROFLEX 28 SQ CM 2THK
ARTHROFLEX 45 SQ CM
ARTHROFLEX 40X70MM 3THK
ARTHROFLEX 1 SQ CM
GRAFT ARTHROFLEX FLEXIGRAFT DERMIS 35X35X1.26-1.75MM SOFT TISSUE PATCH
GRAFT ARTHROFLEX FLEXIGRAFT DERMIS 40X70X1.26-1.75MM SOFT TISSUE PATCH
GRAFT DERMIS 70X40X2MM SOFT TISSUE DECELLULARIZED LATEX FREE
GRAFT ARTHROFLEX THK.76-1.25MM DECELLULARIZED DERMIS 70X40MM SOFT TISSUE
Related codes:
Code: Q4120
Code: Q4121
THERASKIN 6SQCM
Code: Q4122
DERMACELLAWMPORO 1SQCM
Code: Q4123
ALLOSKIN RT 1SQCM
Code: Q4124
OASIS TRI MATRIX 35SQCM
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 Q4125 $3,695 [source] 4 years ago
Chi Health Good Samaritan 10 E 31St St, Kearney Q4125 $3,695 [source] 4 years ago
Chi Health Lakeside 17201 Wright St, Omaha Q4125 $3,695 [source] 4 years ago
Chi Health Schuyler 1721 Colfax St, Schuyler Q4125 $3,695 [source] 4 years ago
Chi Health Midlands 11111 S 84Th St, Papillion Q4125 $3,695 [source] 4 years ago
Chi Health Plainview 704 N 3Rd St, Plainview Q4125 $3,695 [source] 4 years ago
Chi Health St. Mary 1301 Grundman Blvd, Nebraska City Q4125 $3,695 [source] 4 years ago
Chi Health Creighton University Medical Center - Bergan Mercy 7500 Mercy Rd, Omaha Q4125 $3,695 [source] 4 years ago
Chi Health Immanuel 7101 Newport Ave, Omaha Q4125 $3,695 [source] 4 years ago
Chi Health St. Francis 2116 W Faidley Ave, Grand Island Q4125 $3,695 [source] 4 years ago
Chi Health Nebraska Heart 7500 So. 91St St., Lincoln Q4125 $3,695 [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.