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South Carolina rates for HCPCS Q4203

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

Facilitymedian $1,096 · 10th–90th $182$1,4790%20%10th90th$1,096Professionalmedian $1,047 · 10th–90th $126$1,0960%50%10th90th$1,047$50.0$100.0$200.0$500.0$1.0K$2.0K$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
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,479.11
Typical High
$1,479.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$1,047.13
Typical High
$1,148.15
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$165.96
Typical High
$1,096.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$1,096.48
Typical High
$1,819.70
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$302.00