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Nonsheet Skin Substitute, FDA-Cleared, Unclassified

New Hampshire 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 October 2026.

How much does Nonsheet Skin Substitute, FDA-Cleared, Unclassified cost?

$126

Typical negotiated rate. In New Hampshire, October 2026.

Insurers have agreed to pay about $126 for this service. Most negotiated rates run $102 to $141.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $126 · 10th to 90th $93 to $229
$100$200$500professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
None
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$190.55
Typical High
$354.81
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$46.77
Median
$46.77
Typical High
$46.77
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$9.33
Median
$9.33
Typical High
$9.33

Where New Hampshire sits

The same service costs 83.2 times more in North Dakota than in Kansas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New Hampshire· 13th of 51

$126

ND $251KS $3.02

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.