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Membrane Graft or Membrane Wrap

Pennsylvania 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 Pennsylvania, 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 $1,230 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 7 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$1,230 to $1,259
FacilityA hospital or hospital-owned outpatient department$1,230$1,175 to $1,259

How much rates vary

Facilitymedian $1,230 · 10th to 90th $214 to $1,380Professionalmedian $1,230 · 10th to 90th $126 to $1,349
$200$1K$5K$20Kfacility $1,230professional $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
$1,230.27
Typical High
$1,258.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,288.25
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,380.38
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$275.42
Typical High
$1,412.54
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$158.49
Typical High
$223.87
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,258.93
Typical High
$1,258.93
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,288.25
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$1,318.26

Where Pennsylvania 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.

Pennsylvania· 27th 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.