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Kentucky rates for HCPCS A4100

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $85.11 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $4.57 / $144.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,904.51 / $51,286.14 / $56,234.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46,773.51 / $48,977.88 / $51,286.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $112.20 / $162.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $112.20 / $162.18