This information is listed for claims purposes only.
| UPC/GTIN | HCPCS Code | Brand Name | Product Description | SKU | Strength/Package Size | Billing Units |
|---|---|---|---|---|---|---|
| 860471002503 | Q4180 | Revita | Revita Intact Human Placental Membrane 15 mm | RV-0015 | 1.767 sq cm | 2 |
| 869457000304 | Q4180 | Revita | Revita Intact Human Placental Membrane 2x2 cm | RV-2020 | 4 sq cm | 4 |
| 869457000311 | Q4180 | Revita | Revita Intact Human Placental Membrane 2x3 cm | RV-2030 | 6 sq cm | 6 |
| 869457000328 | Q4180 | Revita | Revita Intact Human Placental Membrane 4x4 cm | RV-4040 | 16 sq cm | 16 |
| 869457000397 | Q4180 | Revita | Revita Intact Human Placental Membrane 2x12 cm | RV-0212 | 24 sq cm | 24 |
| 869457000335 | Q4180 | Revita | Revita Intact Human Placental Membrane 4x6 cm | RV-4060 | 24 sq cm | 24 |
| 869457000342 | Q4180 | Revita | Revita Intact Human Placental Membrane 6x6 cm | RV-6060 | 36 sq cm | 36 |
| 869457000359 | Q4180 | Revita | Revita Intact Human Placental Membrane 6x8 cm | RV-6080 | 48 sq cm | 48 |
| 850039927294 | Q4258 | Enverse | Enverse Human Placental Membrane Allograft 15 mm | EN-0015 | 1.767 sq cm | 2 |
| 860471002589 | Q4258 | Enverse | Enverse Human Placental Membrane Allograft 2x3 cm | EN-2030 | 6 sq cm | 6 |
| 850039927256 | Q4258 | Enverse | Enverse Human Placental Membrane Allograft 4x4 cm | EN-4040 | 16 sq cm | 16 |
| 850039927263 | Q4258 | Enverse | Enverse Human Placental Membrane Allograft 4x6 cm | EN-4060 | 24 sq cm | 24 |
| 850039927270 | Q4258 | Enverse | Enverse Human Placental Membrane Allograft 6x8 cm | EN-6080 | 48 sq cm | 48 |
| 850039927287 | Q4258 | Enverse | Enverse Human Placental Membrane Allograft 9x15 cm | EN-0915 | 135 sq cm | 135 |
| 860471002510 | Q4232 | Corplex | Corplex Dehydrated Human Umbilical Cord Sheet 15 mm | CX-0015 | 1.767 sq cm | 2 |
| 860471002527 | Q4232 | Corplex | Corplex Dehydrated Human Umbilical Cord Sheet 2x2 cm | CX-2020 | 4 sq cm | 4 |
| 860471002534 | Q4232 | Corplex | Corplex Dehydrated Human Umbilical Cord Sheet 2x3 cm | CX-2030 | 6 sq cm | 6 |
| 860471002541 | Q4232 | Corplex | Corplex Dehydrated Human Umbilical Cord Sheet 3x5 cm | CX-3050 | 15 sq cm | 15 |
| 860471002558 | Q4231 | Corplex P | Corplex P Dehydrated Human Umbilical Cord 1 cc | CP-0010 | 1 cc | 1 |
| 860471002565 | Q4231 | Corplex P | Corplex P Dehydrated Human Umbilical Cord 2 cc | CP-0020 | 2 cc | 2 |
| 860471002572 | Q4231 | Corplex P | Corplex P Dehydrated Human Umbilical Cord 4 cc | CP-0040 | 4 cc | 4 |
| 860471002596 | Q4229 | Cogenex | Cogenex Human Placental Membrane 2x3 cm | CG-2030 | 6 sq cm | 6 |
| 860007909801 | Q4229 | Cogenex | Cogenex Human Placental Membrane 4x4 cm | CG-4040 | 16 sq cm | 16 |
| 860007909818 | Q4229 | Cogenex | Cogenex Human Placental Membrane 6x8 cm | CG-6080 | 48 sq cm | 48 |
| 850039927317 | Q4257 | Relese | Relese Human Placental Membrane 2x3 cm | RL-2030 | 6 sq cm | 6 |
| 850039927324 | Q4257 | Relese | Relese Human Placental Membrane 4x4 cm | RL-4040 | 16 sq cm | 16 |
| 850039927331 | Q4257 | Relese | Relese Human Placental Membrane 6x8 cm | RL-6080 | 48 sq cm | 48 |
