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XWRAP

Indiana rates for HCPCS Q4204

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

Rates data updated July 2026.

How much does XWRAP cost?

$3,715

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $3,715 for this service. The price depends on where it is billed: about $3,715 from a physician practice, and about $380 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$3,715$3,715 to $3,715
FacilityA hospital or hospital-owned outpatient department$380$209 to $513

How much rates vary

Facilitymedian $380 · 10th to 90th $141 to $3,715Professionalmedian $3,715 · 10th to 90th $126 to $4,074
$100$200$500$1K$2K$5Kfacility $380professional $3,715

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
$3,715.35
Median
$3,715.35
Typical High
$3,715.35
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,801.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$380.19
Typical High
$512.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,754.23
Median
$3,715.35
Typical High
$5,495.41
CareSource
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,466.84
Typical High
$6,606.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04

Where Indiana sits

The same service costs 16.2 times more in Kansas 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.

Indiana· 27th of 51

$3,715

KS $3,802MN $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.