go back

Minnesota rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,802.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $4,360.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.82 / $3,661.53 / $3,774.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,572.25 / $8,402.20 / $11,810.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,076.06 / $3,258.79 / $3,867.91
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,060.80 / $7,700.09 / $10,642.54
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,045.60 / $3,045.60 / $3,471.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,774.77 / $3,774.77 / $8,318.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,774.77 / $3,774.77 / $8,658.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $6,693.11