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
Cleveland, OH
See all hospitals reporting HCPCS Q4204 →Price type
Metrohealth System’s median price of $247 is 35% below the median hospital's median price ($381), higher than 42% of the 930 hospitals reporting HCPCS Q4204. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 8 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Caresource exchange facility · fee schedule · outpatient | $165 | $165 | — | — | — | $165 – $165 |
| 2 | Aetna cvs exchange facility · fee schedule · outpatient | $188 | $188 | — | — | — | $188 – $188 |
| 3 | Blue Cross Blue Shield anthem pathway exchange facility · fee schedule · outpatient | $256 | $256 | — | — | — | $256 – $256 |
| 4 | Blue Cross Blue Shield anthem pathway tiered exchange facility · fee schedule · outpatient | $314 | $314 | — | — | — | $314 – $314 |
| 5 | Blue Cross Blue Shield anthem all commercial plans facility · fee schedule · outpatient | $449 | $449 | — | — | — | $449 – $449 |
| 6 | Medical Mutual cle-care hmo facility · fee schedule · outpatient | $351 | $1.8k | $2.3k | 126% | — | $64 – $5.1k |
| 7 | Medical Mutual all commercial plans facility · fee schedule · outpatient | $468 | $2.4k | $3.1k | 126% | — | $85 – $6.8k |
| 8 | Cigna all commercial plans facility · fee schedule · outpatient | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
Last updated: Apr 1, 2026
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