Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
XWRAP 4X4 2087X-2714
Gilbert, AZ
See all hospitals reporting HCPCS Q4204 →Price type
Dignity Health’s median price of $5.5k is 1345% above the median hospital's median price ($381), higher than 91% of the 926 hospitals reporting HCPCS Q4204. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 17 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare commercial|dignityhealthemployee fee schedule · outpatient | $3.3k | $3.3k | $437 | 13% | — | $2.9k – $3.8k |
| 2 | UnitedHealthcare medicaid|all plans fee schedule · outpatient | $3.3k | $3.3k | $437 | 13% | — | $2.9k – $3.8k |
| 3 | Cigna commercial|exchange fee schedule · outpatient | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 4 | Cigna commercial|localplus surefit fee schedule · outpatient | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 5 | Aetna commercial|all other plans fee schedule · outpatient | $4.1k | $4.1k | $531 | 13% | — | $3.5k – $4.6k |
| 6 | Aetna commercial|hmo fee schedule · outpatient | $4.1k | $4.1k | $531 | 13% | — | $3.5k – $4.6k |
| 7 | Aetna commercial|ppo fee schedule · outpatient | $4.1k | $4.1k | $531 | 13% | — | $3.5k – $4.6k |
| 8 | Cigna commercial|all other plans fee schedule · outpatient | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 9 | Cigna commercial|ppo fee schedule · outpatient | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 10 | Blue Cross Blue Shield commercial|maricopafocus fee schedule · outpatient | $5.9k | $5.9k | — | — | — | $5.9k – $5.9k |
| 11 | Blue Cross Blue Shield commercial|neighborhood fee schedule · outpatient | $5.9k | $5.9k | — | — | — | $5.9k – $5.9k |
| 12 | Blue Cross Blue Shield commercial|all other plans fee schedule · outpatient | $7.9k | $7.9k | — | — | — | $7.9k – $7.9k |
| 13 | Blue Cross Blue Shield commercial|workers comp fee schedule · outpatient | $11.7k | $11.7k | — | — | — | $11.7k – $11.7k |
| 14 | First Health commercial|all plans fee schedule · inpatient | $12.9k | $12.9k | $1.7k | 13% | — | $11.2k – $14.6k |
| 15 | First Health commercial|all plans fee schedule · outpatient | $12.9k | $12.9k | $1.7k | 13% | — | $11.2k – $14.6k |
| 16 | MultiPlan commercial|all plans fee schedule · inpatient | $18.4k | $18.4k | $2.4k | 13% | — | $16.0k – $20.8k |
| 17 | MultiPlan commercial|all plans fee schedule · outpatient | $18.4k | $18.4k | $2.4k | 13% | — | $16.0k – $20.8k |
Last updated: Feb 28, 2026
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