go back

Ohio 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
$3.00 / $3.00 / $3.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $4.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.51 / $59,702.01 / $59,702.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.51 / $66.51 / $66.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00