go back

Ohio rates for HCPCS Q4203

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

Facilitymedian $1,000 · 10th–90th $102$1,2300%50%10th90th$1,000Professionalmedian $1,047 · 10th–90th $135$1,3490%50%10th90th$1,047$0.1$0.5$5.0$50.0$500.0$5.0K

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
$1,047.13 / $1,047.13 / $1,230.27
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
$186.21 / $1,096.48 / $1,819.70
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,047.13
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $117.49 / $1,318.26
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $302.00