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HCPCS V2790

Amniotic membrane for surgical reconstruction, per procedure

Current code34 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—$1,667 – $7,488$4,168 – $18,720
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
Harborview Medical CenterSeattleFile dated 2026-04-01—$556 – $14,812$794 – $21,160
Highline Medical CenterBurienFile dated 2026-02-28—$4,877 – $5,246$15,972 – $17,178
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$799 – $5,988$1,141 – $8,554
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
PeaceHealth Southwest Medical CenteVancouver—$1,683$2,590
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$973 – $8,138$1,390 – $11,626
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$1,498 – $13,606$2,880 – $26,166
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$973 – $8,138$1,390 – $11,626
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$927 – $7,784$1,324 – $11,120
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$1,634 – $11,079$3,142 – $21,306
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$927 – $7,784$1,324 – $11,120
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$1,011 – $7,022$1,444 – $10,031
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$1,209 – $13,606$2,325 – $26,166
Seattle Children's HospitalSeattle$841 – $4,06412 plans$3,273 – $12,500$3,273 – $12,500
St Anthony HospitalGig HarborFile dated 2026-02-28—$4,858 – $5,225$15,972 – $17,178
St Clare HospitalLakewoodFile dated 2026-02-28—$4,604 – $4,952$15,972 – $17,178
St Elizabeth HospitalEnumclawFile dated 2026-02-28$2,715 – $3,5565 plans$5,644 – $6,070$15,972 – $17,178
St Francis Community HospitalFederal WayFile dated 2026-02-28—$5,012 – $5,391$15,972 – $17,178
St Joseph Medical CenterTacomaFile dated 2026-02-28—$5,290 – $5,689$15,972 – $17,178
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$7,049 – $7,582$15,972 – $17,178
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$991 – $7,857$2,064 – $16,368
Swedish IssaquahIssaquahFile dated 2026-04-01—$991 – $7,857$2,064 – $16,368
Swedish Medical CenterSeattleFile dated 2026-04-01—$991 – $7,857$2,064 – $16,368
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$991 – $7,857$2,064 – $16,368
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$1,667 – $7,488$4,168 – $18,720
University of Washington Medical CtrSeattleFile dated 2026-04-01—$485 – $13,166$693 – $18,808
Virginia Mason Medical CenterSeattle—$663 – $10,200$1,300 – $20,000
Yakima Valley MemorialYakimaFile dated 2026-08-27—$691 – $4,269$1,728 – $10,672

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

CMS publishes no national amount for this code.