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Virginia rates for HCPCS Q4204

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

Facilitymedian $3,715 · 10th–90th $1,288–$6,0260%20%10th90th$3,715Professionalmedian $3,715 · 10th–90th $457–$3,8900%50%10th90th$3,715$2.0$10.0$50.0$200.0$1.0K$5.0K$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 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,715.35 / $3,890.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $4,897.79
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $173.78 / $3,467.37
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,715.35 / $6,165.95
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $3,388.44 / $3,388.44
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,235.94 / $6,760.83
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,235.94 / $6,760.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $4,786.30 / $6,309.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $2,951.21