HCPCS Q4295

Amnio tri-core amniotic, per square centimeter (add-on, list separately in addition to primary procedure)

Current codeSkin Substitute Products27 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 Q4295 by hospital
HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27———
Deaconess Medical CenterSpokaneFile dated 2026-08-27———
Harborview Medical CenterSeattleFile dated 2026-04-01———
Island HospitalAnacortes$1491 plan——
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01———
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01———
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27———
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27———
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27———
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27———
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27———
Olympic Medical CenterPort AngelesFile dated 2026-06-24———
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01———
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01———
Providence Centralia HospitalCentraliaFile dated 2026-04-01———
Providence Holy Family HospitalSpokaneFile dated 2026-04-01———
Providence Regional Medical Center EverettEverettFile dated 2026-04-01———
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01———
Providence St Peter HospitalOlympiaFile dated 2026-04-01———
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01———
Swedish IssaquahIssaquahFile dated 2026-04-01———
Swedish Medical CenterSeattleFile dated 2026-04-01———
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01———
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27———
University of Washington Medical CtrSeattleFile dated 2026-04-01———
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27———
Yakima Valley MemorialYakimaFile dated 2026-08-27———

Lowest and highest amounts each hospital lists for this code as an outpatient, 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