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South Carolina rates for HCPCS Q4204

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

Facilitymedian $3,890 · 10th–90th $182–$5,1290%20%10th90th$3,890Professionalmedian $3,715 · 10th–90th $126–$3,8900%50%10th90th$3,715$50.0$200.0$1.0K$5.0K

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
$3,890.45 / $5,128.61 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $3,715.35 / $3,981.07
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $165.96 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $3,801.89 / $6,606.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $4,786.30
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $125.89 / $2,951.21