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Nonsheet Skin Substitute, FDA-Cleared, Unclassified

Montana 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 $170 · 10th–90th $5$81,2830%10%10th90th$170Professionalmedian $76 · 10th–90th $3$1260%20%10th90th$76$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Global
Typical Low
$3.02
Median
$75.86
Typical High
$125.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Providence
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$120.23
Typical High
$281.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$125.89