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Wisconsin rates for HCPCS Q4204

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

Facilitymedian $3,802 · 10th–90th $2,951$8,3180%20%40%10th90th$3,802Professionalmedian $3,715 · 10th–90th $170$5,0120%50%10th90th$3,715$5.0$20.0$100.0$500.0$2.0K$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
$3,801.89 / $3,801.89 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $4,073.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $7,079.46 / $11,748.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $6,165.95 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $3,801.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,801.89 / $8,317.64
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $3,890.45 / $8,317.64
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $3,801.89 / $7,943.28
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $275.42 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,801.89 / $10,232.93
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,801.89 / $15,848.93
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,011.87 / $5,011.87 / $6,165.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $2,951.21 / $6,918.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $2,951.21