HCPCS Q4126
Memoderm, dermaspan, tranzgraft or integuply, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products31 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $238 – $644 | — | — |
| Cascade Valley Hospital | $465 – $5,475 | $4,380 | $5,475 |
| Deaconess Medical Center | $229 – $567 | — | — |
| Harborview Medical Center | $231 – $307 | — | — |
| Island Hospital | $193 – $267 | — | — |
| Kadlec Regional Medical Center | $73.94 – $390 | $629 – $23,614 | $898 – $33,735 |
| Legacy Salmon Creek Medical Center | $98.30 – $277 | — | — |
| Mary Bridge Children's Hospital | $1,000 | — | — |
| MultiCare Auburn Medical Center | $239 – $597 | — | — |
| MultiCare Covington Medical Center | $239 – $597 | — | — |
| MultiCare Good Samaritan Hospital | $240 – $597 | — | — |
| MultiCare Valley Hospital | $229 – $566 | — | — |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | $111 – $380 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $103 – $460 | $774 – $29,145 | $1,106 – $41,635 |
| Providence Centralia Hospital | $179 – $539 | $952 – $26,527 | $1,830 – $51,014 |
| Providence Holy Family Hospital | $103 – $508 | $774 – $29,145 | $1,106 – $41,635 |
| Providence Mount Carmel Hospital | — | $734 – $27,992 | $1,049 – $39,988 |
| Providence Regional Medical Center Everett | $103 – $440 | $1,047 – $37,052 | $2,013 – $71,254 |
| Providence St Joseph Hospital | — | $734 – $27,992 | $1,049 – $39,988 |
| Providence St Mary Medical Center | $222 – $500 | $683 – $27,416 | $976 – $39,165 |
| Providence St Peter Hospital | $117 – $559 | $952 – $26,527 | $1,830 – $51,014 |
| Skagit Valley Hospital | $790 – $5,201 | $4,380 | $5,475 |
| Swedish Edmonds Hospital | $103 – $510 | $641 – $31,438 | $1,335 – $65,495 |
| Swedish Issaquah | $103 – $613 | $641 – $31,438 | $1,335 – $65,495 |
| Swedish Medical Center | $103 – $611 | $641 – $31,438 | $1,335 – $65,495 |
| Swedish Medical Center / Cherry Hill | $103 – $611 | $641 – $31,438 | $1,335 – $65,495 |
| Tacoma General Allenmore Hospital | $240 – $597 | — | — |
| University of Washington Medical Ctr | $231 – $452 | — | — |
| Wellfound Behavioral Health Hospital | $367 | — | — |
| Yakima Valley Memorial | $233 – $353 | — | — |
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 6002)
- Surgery center payment (national)
- $127