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California rates for HCPCS Q4203

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

Facilitymedian $1,288 · 10th–90th $1,047$3,0900%50%10th90th$1,288Professionalmedian $1,047 · 10th–90th $126$1,2300%50%10th90th$1,047$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
$912.01 / $1,047.13 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,047.13 / $1,148.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,318.26 / $3,311.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,047.13 / $2,398.83
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $1,096.48 / $2,344.23
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $154.88
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $1,047.13 / $1,412.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $269.15
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $4,466.84 / $4,466.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $1,047.13 / $1,513.56
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $371.54
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $208.93 / $309.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $302.00