GRAFT SKIN APLIGRAF 44 SQ CM ALLOGRAFT VENOUS LEG DIABETIC FOOT ULCER

Payers reporting HCPCS Q4101

Payer pricing summary

Low

Average

$766

Median

$474

High

$6.4k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +31 other terms	553	$130	$219	$536	245%	2–20	$1 – $7.4k
2	Blue Cross Blue Shield fee schedule · outpatient · +30 other terms	314	$121	$227	$747	330%	1–10	$0 – $8.6k
3	Cigna fee schedule · outpatient · +27 other terms	401	$72	$318	$1.1k	336%	—	$1 – $11.2k
4	Aetna fee schedule · outpatient · +32 other terms	320	$124	$549	$1.3k	246%	—	$1 – $8.9k
5	Humana fee schedule · outpatient · +28 other terms	266	$101	$148	$318	214%	—	$1 – $3.4k
6	Molina fee schedule · outpatient · +26 other terms	116	$124	$279	$789	282%	—	$1 – $6.8k
7	Anthem fee schedule · outpatient · +27 other terms	107	$95	$141	$522	371%	—	$2 – $7.5k
8	Kaiser fee schedule · outpatient · +20 other terms	72	$269	$1.3k	$2.2k	169%	—	$30 – $9.8k
9	MultiPlan fee schedule · outpatient · +22 other terms	70	$2.9k	$3.4k	$3.6k	106%	—	$48 – $13.4k
10	Caresource fee schedule · outpatient · +15 other terms	69	$52	$153	$176	114%	—	$1 – $524
11	Ambetter facility · fee schedule · outpatient · +18 other terms	65	$212	$227	$52	23%	—	$30 – $331
12	WellCare fee schedule · outpatient · +19 other terms	59	$127	$117	$44	37%	—	$12 – $171
13	Tricare facility · fee schedule · outpatient · +13 other terms	53	$127	$272	$1.1k	403%	—	$40 – $10.0k
14	Devoted facility · fee schedule · outpatient · +15 other terms	47	$118	$124	$10	8%	—	$111 – $143
15	Medcost percent of total billed charges · bothfrom % of charges · +6 other terms	43	$112	$262	$1.2k	472%	—	$34 – $11.2k
16	Highmark facility · fee schedule · outpatient · +15 other terms	41	$86	$117	$88	75%	—	$30 – $454
17	Optum fee schedule · outpatient · +20 other terms	39	$125	$319	$677	212%	—	$34 – $3.5k
18	Oscar facility · fee schedule · outpatient · +14 other terms	33	$143	$186	$265	142%	—	$32 – $1.4k
19	First Health fee schedule · outpatient · +19 other terms	31	$4.8k	$4.3k	$3.0k	70%	—	$66 – $9.4k
20	Bcbs Tx fee schedule · outpatient · +3 other terms	27	$151	$141	$42	30%	—	$55 – $233
21	Medica fee schedule · outpatient · +18 other terms	27	$65	$407	$956	235%	—	$32 – $3.4k
22	Amerihealth Caritas other · outpatient · +11 other terms	25	$1.1k	$1.4k	$927	66%	—	$23 – $4.8k
23	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
24	Bcbs La fee schedule · outpatient · +3 other terms	25	$34	$34	$0	0%	—	$33 – $34
25	Medicare facility · fee schedule · outpatient · +13 other terms	25	$128	$128	$27	21%	—	$19 – $156

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← Hospitals reporting HCPCS Q4101 · Snapshot 20261111T120946Z-9134e7f7