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New York rates for HCPCS Q4203

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

Facilitymedian $1,047 · 10th–90th $138$1,0960%20%40%10th90th$1,047Professionalmedian $1,047 · 10th–90th $135$1,0960%50%10th90th$1,047$100.0$500.0$2.0K$10.0K$50.0K

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
$120.23 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $165.96 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $144.54
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $537.03 / $1,258.93
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $724.44 / $851.14
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,096.48
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,096.48 / $1,096.48
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $1,122.02
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,174.90
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,096.48 / $1,096.48