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XWRAP

New York rates for HCPCS Q4204

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

Rates data updated July 2026.

How much does XWRAP cost?

$3,715

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $3,715 for this service. The price depends on where it is billed: about $3,715 from a physician practice, and about $3,715 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$3,715$2,455 to $3,715
FacilityA hospital or hospital-owned outpatient department$3,715$200 to $3,715

How much rates vary

Facilitymedian $3,715 · 10th to 90th $138 to $3,802Professionalmedian $3,715 · 10th to 90th $126 to $4,074
$200$500$1K$2K$5K$10K$20Kfacility $3,715professional $3,715

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$3,715.35
Typical High
$3,715.35
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,890.45
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$3,715.35
Typical High
$3,715.35
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$165.96
Typical High
$3,630.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$537.03
Typical High
$4,365.16
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$2,884.03
Typical High
$3,090.30
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,801.89
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,801.89
Typical High
$3,801.89
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$4,786.30
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$4,168.69
Median
$7,079.46
Typical High
$7,079.46
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$3,090.30
Typical High
$5,623.41
Univera
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$4,073.80
Univera
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,801.89
Typical High
$3,801.89

Where New York sits

The same service costs 16.2 times more in Kansas than in Minnesota. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New York· 22nd of 51

$3,715

KS $3,802MN $234

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.