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Nonsheet Skin Substitute, FDA-Cleared, Unclassified

Idaho rates for HCPCS A4100

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

Rates data updated July 2026.

Facilitymedian $123 · 10th–90th $72$2570%20%10th90th$123Professionalmedian $117 · 10th–90th $58$2240%10%10th90th$117$5.0$10.0$20.0$50.0$100.0$200.0

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
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$107.15
Typical High
$181.97
BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$190.55
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$147.91
Typical High
$269.15
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$223.87
Typical High
$257.04
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$190.55
Typical High
$239.88
Select Health
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$158.49
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88