Derma-Gide skin substitute, per square centimeter

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Derma-gide, 1 sq cm

Payers reporting HCPCS Q4203

Payer pricing summary

Low

Average

$396

Median

$291

High

$1.4k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	431	$296	$392	$352	90%	—	$48 – $1.9k
2	Cigna fee schedule · outpatient · +8 other terms	287	$578	$1.6k	$2.0k	123%	—	$101 – $7.5k
3	Aetna fee schedule · outpatient · +9 other terms	244	$149	$412	$736	179%	—	$69 – $4.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	202	$130	$320	$858	268%	—	$0 – $14.4k
5	Humana fee schedule · outpatient · +8 other terms	187	$291	$235	$163	69%	—	$48 – $1.1k
6	Molina fee schedule · outpatient · +6 other terms	80	$201	$342	$399	117%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +3 other terms	61	$300	$266	$313	118%	—	$48 – $1.5k
8	Anthem facility · fee schedule · outpatient · +5 other terms	57	$180	$442	$705	160%	—	$48 – $3.8k
9	WellCare fee schedule · outpatient · +6 other terms	52	$140	$151	$45	30%	—	$115 – $300
10	Kaiser fee schedule · outpatient · +4 other terms	41	$207	$275	$188	68%	—	$125 – $1000
11	Ambetter fee schedule · outpatient · +4 other terms	38	$248	$300	$148	49%	—	$162 – $822
12	Devoted fee schedule · outpatient · +3 other terms	36	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
15	Regence professional · fee schedule · outpatient · +4 other terms	20	$222	$219	$15	7%	—	$153 – $222
16	Healthpartners fee schedule · outpatient · +1 other terms	19	$358	$352	$38	11%	—	$131 – $366
17	Oscar facility · fee schedule · outpatient · +1 other terms	19	$234	$458	$404	88%	—	$175 – $1.1k
18	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$1.4k	$1.5k	$1.2k	78%	—	$64 – $3.7k
19	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
20	Highmark fee schedule · outpatient · +4 other terms	16	$372	$417	$317	76%	—	$127 – $3.4k
21	Wellmark fee schedule · both · +1 other terms	14	$300	$316	$90	29%	—	$300 – $871
22	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$309	$290	$26	9%	—	$256 – $309
23	Bcbs Nj fee schedule · outpatient	11	$459	$471	$326	69%	—	$300 – $1.1k
24	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
25	Medica fee schedule · outpatient · +4 other terms	10	$420	$423	$106	25%	—	$254 – $542

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