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Minnesota rates for HCPCS Q4204

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

Facilitymedian $4,365 · 10th–90th $2,951–$9,7720%20%10th90th$4,365Professionalmedian $126 · 10th–90th $107–$3,7150%20%10th90th$126$0.2$2.0$20.0$200.0$2.0K$20.0K

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 / $3,981.07
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,365.16 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $125.89 / $2,691.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $8,912.51 / $12,302.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,388.44 / $3,890.45
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,570.88 / $8,912.51 / $11,481.54
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,019.95 / $3,801.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $3,801.89 / $6,606.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,801.89 / $5,011.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $3,090.30