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Massachusetts rates for HCPCS Q4204

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

Facilitymedian $3,715 · 10th–90th $151–$7,0790%50%10th90th$3,715Professionalmedian $3,715 · 10th–90th $178–$3,9810%50%10th90th$3,715$100.0$500.0$2.0K$10.0K$50.0K

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
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,317.64 / $8,317.64 / $8,317.64
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $269.15 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $177.83 / $6,918.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,715.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,317.64 / $8,317.64 / $8,317.64
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $9,332.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,786.30 / $6,309.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $2,951.21 / $3,715.35