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California rates for HCPCS Q4204

XWRAP, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $4,467 · 10th–90th $1,479$8,3180%20%40%10th90th$4,467Professionalmedian $3,715 · 10th–90th $126$4,4670%50%10th90th$3,715$0.1$2.0$50.0$1.0K$20.0K$500.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $4,073.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,677.35 / $11,748.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,715.35 / $9,772.37
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $1,122.02 / $2,454.71
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $5,248.07 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $154.88
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,073.80 / $5,011.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $630.96
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,317.64 / $8,317.64 / $8,317.64
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12,302.69 / $15,848.93 / $15,848.93
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $3,715.35 / $5,370.32
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $3,388.44
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $630.96