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XWRAP

South Carolina rates for HCPCS Q4204

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

Rates data updated July 2026.

How much does XWRAP cost?

$3,715

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $3,715 for this service. The price depends on where it is billed: about $3,715 from a physician practice, and about $3,890 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$3,715$457 to $3,890
FacilityA hospital or hospital-owned outpatient department$3,890$1,738 to $4,266

How much rates vary

Facilitymedian $3,890 · 10th to 90th $182 to $5,129Professionalmedian $3,715 · 10th to 90th $126 to $3,890
$100$200$500$1K$2K$5K$10Kfacility $3,890professional $3,715

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$5,128.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$3,715.35
Typical High
$3,981.07
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$3,019.95
Typical High
$3,019.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$3,019.95
Typical High
$3,801.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$3,801.89
Typical High
$6,606.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$125.89

Where South Carolina sits

The same service costs 16.2 times more in Kansas than in Minnesota. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Carolina· 32nd of 51

$3,715

KS $3,802MN $234

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.