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Membrane Graft or Membrane Wrap

Michigan 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 Michigan, 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 6 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$162 to $1,288
FacilityA hospital or hospital-owned outpatient department$1,288$126 to $1,288

How much rates vary

Facilitymedian $1,288 · 10th to 90th $102 to $1,778Professionalmedian $1,230 · 10th to 90th $120 to $1,288
$100$200$500$1K$2K$5Kfacility $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
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,288.25
BCBS
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$120.23
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$1,148.15
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$1,778.28
Typical High
$4,786.30
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$1,288.25
Typical High
$2,290.87
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$1,096.48
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$1,698.24
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90

Where Michigan 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.

Michigan· 45th 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.