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HCPCS Q4195

Puraply, per square centimeter (add-on, list separately in addition to primary procedure)

Current codeSkin Substitute Products30 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$2,066 – $8,215$2,952 – $11,736
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$2,106 – $10,726$3,009 – $15,322
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$3,440 – $11,569$6,615 – $22,248
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$2,106 – $10,726$3,009 – $15,322
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$2,010 – $10,279$2,871 – $14,684
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$3,594 – $14,317$6,912 – $27,532
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$2,010 – $10,279$2,871 – $14,684
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$2,073 – $9,656$2,961 – $13,794
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$3,440 – $11,569$6,615 – $22,248
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$2,182 – $10,786$4,545 – $22,470
Swedish IssaquahIssaquahFile dated 2026-04-01—$247 – $10,786$514 – $22,470
Swedish Medical CenterSeattleFile dated 2026-04-01—$247 – $10,786$514 – $22,470
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$247 – $10,786$514 – $22,470
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$2,312 – $4,976$5,780 – $12,440

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

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 6001)
Surgery center payment (national)
$127