Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Xwrap 1 sq cm
Low
$8
Average
$2.4k
Median
$1.3k
High
$21.2k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
46 payers; the 90th percentile is 40.2× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +13 other terms | 430 | $296 | $2.4k | $3.3k | 136% | — | $48 – $18.3k |
| 2 | Cigna fee schedule · outpatient · +11 other terms | 260 | $4.4k | $8.5k | $9.8k | 115% | — | $119 – $96.3k |
| 3 | Aetna fee schedule · outpatient · +14 other terms | 235 | $149 | $2.1k | $4.1k | 197% | — | $69 – $29.6k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +7 other terms | 200 | $128 | $1.1k | $3.5k | 318% | — | $1 – $73.7k |
| 5 | Humana fee schedule · outpatient · +10 other terms | 182 | $2.3k | $1.4k | $1.4k | 96% | — | $48 – $3.7k |
| 6 | Molina fee schedule · outpatient · +9 other terms | 58 | $194 | $1.0k | $3.3k | 324% | — | $51 – $22.6k |
| 7 | Anthem facility · fee schedule · outpatient · +9 other terms | 54 | $177 | $1.9k | $3.0k | 155% | — | $0 – $13.3k |
| 8 | Caresource fee schedule · outpatient · +4 other terms | 49 | $191 | $1.1k | $1.7k | 156% | — | $48 – $6.4k |
| 9 | WellCare fee schedule · outpatient · +7 other terms | 48 | $140 | $482 | $934 | 194% | — | $115 – $3.2k |
| 10 | Kaiser fee schedule · outpatient · +5 other terms | 42 | $207 | $1.9k | $9.0k | 463% | — | $125 – $68.8k |
| 11 | Ambetter fee schedule · outpatient · +3 other terms | 38 | $248 | $940 | $1.8k | 193% | — | $162 – $6.0k |
| 12 | Devoted fee schedule · outpatient · +3 other terms | 34 | $125 | $125 | $8 | 6% | — | $116 – $139 |
| 13 | Optum fee schedule · outpatient · +4 other terms | 33 | $125 | $1.1k | $3.7k | 342% | — | $113 – $22.0k |
| 14 | Bcbs Tx fee schedule · outpatient | 30 | $8 | $8 | $3 | 31% | — | $6 – $30 |
| 15 | Healthpartners fee schedule · outpatient · +1 other terms | 19 | $3.6k | $3.5k | $563 | 16% | — | $131 – $3.6k |
| 16 | Oscar facility · fee schedule · outpatient · +2 other terms | 19 | $234 | $1.5k | $2.0k | 134% | — | $175 – $4.7k |
| 17 | Medical Mutual facility · fee schedule · outpatient · +3 other terms | 18 | $6.1k | $6.5k | $5.4k | 83% | — | $64 – $16.1k |
| 18 | Medicare fee schedule · outpatient · +1 other terms | 18 | $125 | $125 | — | — | — | $125 – $125 |
| 19 | Highmark fee schedule · outpatient · +5 other terms | 16 | $3.6k | $3.4k | $876 | 26% | — | $127 – $3.7k |
| 20 | Wellmark fee schedule · both · +1 other terms | 14 | $2.9k | $2.8k | $252 | 9% | — | $1.6k – $3.8k |
| 21 | Bcbs Nj fee schedule · outpatient | 11 | $3.0k | $3.1k | $408 | 13% | — | $2.8k – $3.8k |
| 22 | Tricare fee schedule · outpatient · +1 other terms | 11 | $113 | $118 | $10 | 8% | — | $113 – $148 |
| 23 | Medica fee schedule · outpatient · +4 other terms | 10 | $1.6k | $1.6k | $394 | 25% | — | $950 – $2.0k |
| 24 | Regence fee schedule · outpatient · +4 other terms | 10 | $146 | $146 | $4 | 3% | — | $140 – $156 |
| 25 | Clover fee schedule · outpatient · +2 other terms | 9 | $140 | $1.1k | $1.3k | 125% | — | $120 – $2.9k |
← Hospitals reporting HCPCS Q4204 · Snapshot 20261112T181611Z-3fa9fb76