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Nebraska rates for HCPCS Q4204

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

Facilitymedian $3,802 · 10th–90th $209–$6,7610%10%20%10th90th$3,802Professionalmedian $3,715 · 10th–90th $3,715–$4,2660%50%90th$3,715$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$128.82 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $4,265.80
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,801.89 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,981.07 / $4,168.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $208.93 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $3,019.95 / $4,570.88
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,570.88 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $3,801.89 / $4,168.69
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $4,265.80 / $4,570.88
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $9,332.54 / $9,332.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $3,548.13 / $7,762.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $141.25 / $2,951.21