Code: Q4126

Description:
Description: Memoderm, dermaspan, tranzgraft or integuply, per square centimeter
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
MEMODERM 25 SQ CM
MEMODERM 32 SQ CM
MEMODERM 50 SQ CM
DERMASPAN 25SQCM
MEMODDERMTRZINT 1SQCM
DERMASPAN 0.8-1.4 5X5CM
DERMASPAN 4X8CM 0.70MM
DERMASPAN 0.9-1.99 5X10CM
DERMASPAN 0.9-1.99 6X12CM
Related codes:
Code: Q4120
Code: Q4121
THERASKIN 6SQCM
Code: Q4122
DERMACELLAWMPORO 1SQCM
Code: Q4123
ALLOSKIN RT 1SQCM
Code: Q4124
OASIS TRI MATRIX 35SQCM
Code: Q4125
ARTHROFLX 12SQCM .5M THK
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 Q4126 $101 [source] 4 years ago
Ascension St. Vincent Hospital 2001 W 86Th St, Indianapolis Q4126 $101 [source] 4 years ago
Ascension Medical Group St. Vincent 301 Henry St, North Vernon Q4126 $101 [source] 4 years ago
Ascension St. Vincent Evansville 3700 Washington Ave, Evansville Q4126 $101 [source] 4 years ago
Ascension St. Vincent Williamsport 412 N Monroe St, Williamsport Q4126 $101 [source] 4 years ago
St Vincent Salem Hospital Inc 911 N Shelby St, Salem Q4126 $101 [source] 4 years ago
St. Vincent Mercy Hospital 1331 S A St, Elwood Q4126 $101 [source] 4 years ago
Ascension St. Vincent Dunn 1600 23Rd St, Bedford Q4126 $101 [source] 4 years ago
Ascension St. Vincent Randolph 473 E Greenville Ave, Winchester Q4126 $101 [source] 4 years ago
Ascension St. Vincent Carmel 13500 N Meridian St, Carmel Q4126 $101 [source] 4 years ago
Ascension St. Vincent Anderson 2015 Jackson St, Anderson Q4126 $101 [source] 4 years ago
Ascension St. Vincent Heart Center 10580 N Meridian St, Indianapolis Q4126 $101 [source] 4 years ago
Terre Haute Regional Hospital 3901 S 7Th St, Terre Haute Q4126 $630 [source] 4 years ago
St. Vincent Clay Hospital, Inc 1206 E National Ave, Brazil Q4126 $6,012 [source] 4 years ago
Ascension St Vincent Fishers 13861 Olio Road, Q4126 $6,012 [source] 4 years ago
Franciscan Health Indianapolis , Indianapolis Q4126 $13,826 [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.