HCPCS Q4101
Apligraf, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products43 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $141 – $155 | $3,418 | $8,545 |
| Cascade Valley Hospital | $1,564 – $4,035 | $144 – $3,228 | $180 – $4,035 |
| Deaconess Medical Center | $136 – $149 | $3,418 | $8,545 |
| EvergreenHealth Medical Center | — | $134 | $168 |
| EvergreenHealth Monroe | — | $134 | $168 |
| Harborview Medical Center | $144 – $159 | $4,176 | $5,966 |
| Highline Medical Center | — | $73.67 – $2,764 | $241 – $9,051 |
| Island Hospital | $149 – $157 | $388 – $3,494 | $388 – $3,494 |
| Kadlec Regional Medical Center | $139 – $166 | $2,695 | $3,851 |
| Legacy Salmon Creek Medical Center | $143 – $155 | — | — |
| Mary Bridge Children's Hospital | $142 – $157 | $3,418 | $8,545 |
| MultiCare Auburn Medical Center | $142 – $156 | $3,418 | $8,545 |
| MultiCare Covington Medical Center | $142 – $156 | $3,418 | $8,545 |
| MultiCare Good Samaritan Hospital | $142 – $157 | $3,418 | $8,545 |
| MultiCare Valley Hospital | $140 – $149 | $3,418 | $8,545 |
| Olympic Medical Center | $156 – $201 | — | — |
| Overlake Hospital Medical Center & Clinics | $145 – $150 | — | — |
| PeaceHealth Southwest Medical Cente | $127 – $146 | $44.20 – $1,945 | $68.00 – $2,992 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $139 – $166 | $2,917 | $4,167 |
| Providence Centralia Hospital | $144 – $231 | $4,787 | $9,206 |
| Providence Holy Family Hospital | $139 – $153 | $2,917 | $4,167 |
| Providence Mount Carmel Hospital | — | $2,785 | $3,978 |
| Providence Regional Medical Center Everett | $142 – $156 | $4,893 | $9,410 |
| Providence St Joseph Hospital | — | $2,785 | $3,978 |
| Providence St Mary Medical Center | $139 – $153 | $2,767 | $3,953 |
| Providence St Peter Hospital | $143 – $229 | $4,787 | $9,206 |
| Skagit Valley Hospital | — | $144 – $3,228 | $180 – $4,035 |
| St Anthony Hospital | — | $73.37 – $2,753 | $241 – $9,051 |
| St Clare Hospital | — | $69.54 – $2,609 | $241 – $9,051 |
| St Elizabeth Hospital | $43.43 – $1,991 | $85.25 – $3,198 | $241 – $9,051 |
| St Francis Community Hospital | — | $75.71 – $2,840 | $241 – $9,051 |
| St Joseph Medical Center | — | $79.90 – $2,998 | $241 – $9,051 |
| St Michael Medical Center | — | $106 – $3,994 | $241 – $9,051 |
| Swedish Edmonds Hospital | $142 – $170 | $2,968 | $6,184 |
| Swedish Issaquah | $145 – $173 | $67.46 – $2,968 | $141 – $6,184 |
| Swedish Medical Center | $144 – $173 | $67.46 – $2,968 | $141 – $6,184 |
| Swedish Medical Center / Cherry Hill | $144 – $173 | $67.46 – $2,968 | $141 – $6,184 |
| Tacoma General Allenmore Hospital | $142 – $157 | $3,418 | $8,545 |
| University of Washington Medical Ctr | $144 – $159 | $83.94 – $3,712 | $120 – $5,303 |
| Virginia Mason Medical Center | — | $60.18 | $118 |
| Wellfound Behavioral Health Hospital | — | — | — |
| WhidbeyHealth Medical Center | — | $151 – $508 | $151 – $508 |
| Yakima Valley Memorial | $146 – $163 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $156 in an office; $156 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $134 in an office; $134 in a hospital or surgery center
- Hospital outpatient payment (national)
- $127 (APC 6000)
- Surgery center payment (national)
- $127