go back

Alabama rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,951.21 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $2,630.27 / $2,951.21