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Membrane Graft or Membrane Wrap

Nationwide rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

How much does Membrane Graft or Membrane Wrap cost?

$1,230

Typical negotiated rate. Nationwide, July 2026.

Insurers have agreed to pay about $1,230 for this service. The price depends on where it is billed: about $1,230 from a physician practice, and about $1,288 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 61 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1,230$407 to $1,259
FacilityA hospital or hospital-owned outpatient department$1,288$1,096 to $1,698

How much rates vary

Facilitymedian $1,288 · 10th to 90th $145 to $2,754Professionalmedian $1,230 · 10th to 90th $126 to $1,445
$10$100$1K$10Kfacility $1,288professional $1,230

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,445.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,348.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,548.82
Typical High
$3,890.45
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$1,230.27
Typical High
$1,949.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$2,187.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$1,174.90
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$1,318.26

What it costs in each state

The same service costs 5.6 times more in Montana than in Minnesota. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Touch or drag across the chart to see any state's rate.

MT $1,318MN $234

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.