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Mississippi 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
$3,876.75 / $3,876.75 / $4,430.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,876.75 / $4,430.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $25.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,507.53 / $3,692.14 / $4,799.78