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Virginia rates for HCPCS A4100

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

Facilitymedian $126 · 10th–90th $93–$2140%20%10th90th$126Professionalmedian $102 · 10th–90th $69–$1660%10%10th90th$102$5.0$10.0$20.0$50.0$100.0$200.0$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
$93.33 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $89.13 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $186.21
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $128.82 / $223.87
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $128.82 / $223.87