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
Texas
Hospital Address Code Price Last Updated
Medical City Weatherford 713 E Anderson St, Weatherford Q4126 $798 [source] 4 years ago
Medical City North Hills 4401 Booth Calloway Rd, North Richland Hills Q4126 $1,242 [source] 4 years ago
Northwest Texas Healthcare System 1501 S. Coulter, Amarillo Q4126 $1,999 [source] 4 years ago
Medical City Fort Worth 900 8Th Ave, Fort Worth Q4126 $2,054 [source] 4 years ago
Doctors Hospital Of Laredo 10700 Mcpherson Road, Laredo Q4126 $2,357 [source] 4 years ago
South Texas Health System Children’s 1102 W. Trenton Road, Edinburg Q4126 $2,375 [source] 4 years ago
South Texas Health System Heart 1900 South D Street, Mcallen Q4126 $2,375 [source] 4 years ago
South Texas Health System Mcallen 301 W. Expressway 83, Mcallen Q4126 $2,375 [source] 4 years ago
Medical City Arlington 3301 Matlock Rd, Arlington Q4126 $2,498 [source] 4 years ago
Texoma Medical Center 5016 South Us Highway 75, Denison Q4126 $3,224 [source] 4 years ago
Rio Grande Regional Hospital 101 East Ridge Road, Mcallen Q4126 $19,555 [source] 4 years ago
Medical City Frisco 5500 Frisco Square Blvd, Frisco Q4126 $29,376 [source] 4 years ago
Medical City Denton 3535 S Interstate 35, Corinth Q4126 $36,087 [source] 4 years ago
Texas Health Huguley 11801 South Fwy, Burleson Q4126 $40,728 [source] 4 years ago
Medical City Healthcare 13155 Noel Rd. Suite 200, Dallas Q4126 $47,495 [source] 4 years ago
Medical City Alliance 3101 N Tarrant Pkwy, Fort Worth Q4126 $47,495 [source] 4 years ago
Medical City Las Colinas 6800 N Macarthur Blvd, Irving Q4126 $48,456 [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 §180.