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Wisconsin rates for HCPCS A4100

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

Facilitymedian $74 · 10th–90th $65–$1000%50%10th90th$74Professionalmedian $107 · 10th–90th $66–$2880%10%20%10th90th$107$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $91.20 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $257.04 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $147.91 / $181.97
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $288.40 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $100.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $190.55 / $338.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $239.88 / $398.11