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Membrane Graft or Membrane Wrap

Missouri 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 Missouri, 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$126 to $1,259
FacilityA hospital or hospital-owned outpatient department$1,288$282 to $1,778

How much rates vary

Facilitymedian $1,288 · 10th to 90th $102 to $2,344Professionalmedian $1,230 · 10th to 90th $110 to $1,585
$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
$1,230.27
Median
$1,288.25
Typical High
$1,778.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,258.93
Typical High
$2,290.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$120.23
Typical High
$1,548.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,513.56
Typical High
$3,388.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,202.26
Typical High
$5,128.61
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$177.83

Where Missouri 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.

Missouri· 21st 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.