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Arizona rates for HCPCS A4100

Nonsheet form skin substitute, FDA-cleared as a device, not otherwise specified (list in addition to primary procedure)

Facilitymedian $240 · 10th–90th $3–$8510%5%10th90th$240Professionalmedian $95 · 10th–90th $65–$1290%10%10th90th$95$5.0$20.0$100.0$500.0

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
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $93.33 / $123.03
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $275.42 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $245.47 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.02 / $3.31 / $6.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $134.90 / $190.55