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Membrane Graft or Membrane Wrap

Tennessee 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 Tennessee, 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 $224 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 5 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$224$151 to $3,162

How much rates vary

Facilitymedian $224 · 10th to 90th $129 to $3,162Professionalmedian $1,230 · 10th to 90th $126 to $1,479
$100$200$500$1K$2K$5Kfacility $224professional $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
$2,187.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,288.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,621.81
Typical High
$1,621.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,162.28
Typical High
$3,162.28
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$4,073.80
Median
$5,248.07
Typical High
$5,248.07
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$125.89

Where Tennessee 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.

Tennessee· 22nd 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.