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Kansas 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
$5,169.00 / $5,169.00 / $5,169.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,765.98 / $5,169.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,483.15 / $3,483.15 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,740.00 / $3,850.27 / $5,552.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,774.77 / $3,774.77 / $12,996.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $5,353.60