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New York rates for HCPCS Q4204

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

Facilitymedian $3,715 · 10th–90th $120$3,8020%20%40%10th90th$3,715Professionalmedian $3,715 · 10th–90th $135$4,0740%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
$120.23 / $144.54 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $165.96 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $144.54
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $537.03 / $4,365.16
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $2,454.71 / $2,884.03
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,801.89
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,801.89 / $3,801.89
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7,079.46 / $7,079.46 / $7,079.46
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $2,951.21 / $6,165.95
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $4,073.80
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,801.89 / $3,801.89