Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
GRAFT BONE FLEX 2.5CM X 5CM GRAFTON-COST PER SQ CM
Troy, NY
See all hospitals reporting HCPCS Q4205 →Price type
Samaritan Hospital’s median price of $4 is 99% below the median hospital's median price ($336), higher than 3% of the 988 hospitals reporting HCPCS Q4205. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 12 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges | $2 | $2 | — | — | — | $2 – $2 |
| 2 | UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges | $2 | $2 | — | — | — | $2 – $2 |
| 3 | Anthem empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $4 | $4 | — | — | — | $4 – $4 |
| 4 | Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $4 | $4 | — | — | — | $4 – $4 |
| 5 | UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $4 | $4 | — | — | — | $4 – $4 |
| 6 | Wellmark empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $4 | $4 | — | — | — | $4 – $4 |
| 7 | First Health first health facility · percent of total billed charges · bothfrom % of charges | $4 | $4 | — | — | — | $4 – $4 |
| 8 | Cigna cigna facility · percent of total billed charges · bothfrom % of charges | $5 | $5 | — | — | — | $5 – $5 |
| 9 | MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges | $5 | $5 | — | — | — | $5 – $5 |
| 10 | MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges | $5 | $5 | — | — | — | $5 – $5 |
| 11 | Phcs multiplan facility · percent of total billed charges · bothfrom % of charges | $5 | $5 | — | — | — | $5 – $5 |
| 12 | UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges | $5 | $5 | — | — | — | $5 – $5 |
Last updated: Mar 31, 2026
See Skin graft membrane, per square centimeter pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.