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
Other government program: TRICARE, VA, Indian Health Service, workers' compensation, or another public program.
| Hospital | Other government program rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | — | — |
| Cascade Valley Hospital | — | $4,380 | $5,475 |
| Deaconess Medical Center | — | — | — |
| Harborview Medical Center | — | — | — |
| Island Hospital | $149 – $156 | — | — |
| Kadlec Regional Medical Center | — | $629 – $23,614 | $898 – $33,735 |
| Legacy Salmon Creek Medical Center | — | — | — |
| Mary Bridge Children's Hospital | — | — | — |
| MultiCare Auburn Medical Center | — | — | — |
| MultiCare Covington Medical Center | — | — | — |
| MultiCare Good Samaritan Hospital | — | — | — |
| MultiCare Valley Hospital | — | — | — |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $774 – $29,145 | $1,106 – $41,635 |
| Providence Centralia Hospital | — | $952 – $26,527 | $1,830 – $51,014 |
| Providence Holy Family Hospital | — | $774 – $29,145 | $1,106 – $41,635 |
| Providence Mount Carmel Hospital | — | $734 – $27,992 | $1,049 – $39,988 |
| Providence Regional Medical Center Everett | — | $1,047 – $37,052 | $2,013 – $71,254 |
| Providence St Joseph Hospital | — | $734 – $27,992 | $1,049 – $39,988 |
| Providence St Mary Medical Center | — | $683 – $27,416 | $976 – $39,165 |
| Providence St Peter Hospital | — | $952 – $26,527 | $1,830 – $51,014 |
| Skagit Valley Hospital | — | $4,380 | $5,475 |
| Swedish Edmonds Hospital | — | $641 – $31,438 | $1,335 – $65,495 |
| Swedish Issaquah | — | $641 – $31,438 | $1,335 – $65,495 |
| Swedish Medical Center | — | $641 – $31,438 | $1,335 – $65,495 |
| Swedish Medical Center / Cherry Hill | — | $641 – $31,438 | $1,335 – $65,495 |
| Tacoma General Allenmore Hospital | — | — | — |
| University of Washington Medical Ctr | — | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | — | — | — |
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