HCPCS Q4205

Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)

Current codeSkin Substitute Products28 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.

Prices for HCPCS Q4205 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Virginia Mason Medical CenterSeattle	—	$259 – $564	$508 – $1,105

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 6002)
Surgery center payment (national): $127