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Membrane Graft or Membrane Wrap

Hawaii 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. In Hawaii, July 2026.

Insurers have agreed to pay about $1,230 for this service. Most negotiated rates run $1,230 to $1,349.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $1,230 · 10th to 90th $182 to $1,413
$200$500$1Kprofessional $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
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,348.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$1,174.90
Typical High
$1,445.44
HMSA
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,412.54
Typical High
$1,659.59
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$1,380.38

Where Hawaii sits

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.

Hawaii· 23rd of 51

$1,230

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.