HCPCS Q4289
Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products26 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 | $7,505 – $10,251 | $3,752 – $4,824 | $9,381 – $12,060 |
| Deaconess Medical Center | $6,661 – $8,804 | $3,752 – $4,824 | $9,381 – $12,060 |
| Mary Bridge Children's Hospital | $6,135 – $9,648 | $3,752 – $4,824 | $9,381 – $12,060 |
| MultiCare Auburn Medical Center | $5,535 – $8,804 | $3,752 – $4,824 | $9,381 – $12,060 |
| MultiCare Covington Medical Center | $5,535 – $8,804 | $3,752 – $4,824 | $9,381 – $12,060 |
| MultiCare Good Samaritan Hospital | $5,535 – $8,804 | $3,752 – $4,824 | $9,381 – $12,060 |
| MultiCare Valley Hospital | $6,754 – $8,683 | $3,752 – $4,824 | $9,381 – $12,060 |
| Tacoma General Allenmore Hospital | $5,535 – $8,804 | $3,752 – $4,824 | $9,381 – $12,060 |
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