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Membrane Graft or Membrane Wrap

Montana 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?

$1,318

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $1,318 for this service. The price depends on where it is billed: about $1,318 from a physician practice, and about $1,318 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$1,318$1,230 to $1,349
FacilityA hospital or hospital-owned outpatient department$1,318$1,259 to $1,698

How much rates vary

Facilitymedian $1,318 · 10th to 90th $1,202 to $4,467Professionalmedian $1,318 · 10th to 90th $126 to $1,862
$100$1K$10K$100Kfacility $1,318professional $1,318

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
$1,348.96
Typical High
$1,548.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$1,202.26
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$1,202.26
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$2,884.03
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$2,884.03
Providence
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$1,230.27
Typical High
$1,819.70
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$125.89
Typical High
$1,445.44
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana 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.

Montana· 1st of 51

$1,318

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.