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Membrane Graft or Membrane Wrap

Oregon 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?

$1,202

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $1,202 for this service. The price depends on where it is billed: about $295 from a physician practice, and about $1,230 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 8 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$295$158 to $1,230
FacilityA hospital or hospital-owned outpatient department$1,230$1,202 to $1,230

How much rates vary

Facilitymedian $1,230 · 10th to 90th $1,202 to $1,660Professionalmedian $295 · 10th to 90th $126 to $1,349
$100$200$500$1K$2K$5Kfacility $1,230professional $295

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,445.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$1,659.59
Typical High
$2,089.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$151.36
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$263.03
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$1,230.27
Typical High
$1,862.09
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$251.19
Typical High
$354.81
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,230.27
Typical High
$1,348.96
Providence
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$1,288.25
Typical High
$1,949.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$125.89
Typical High
$1,698.24
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Oregon 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.

Oregon· 49th of 51

$1,202

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.