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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 July 2026.

Facilitymedian $93 · 10th–90th $93$1320%50%90th$93Professionalmedian $141 · 10th–90th $83$2950%10%10th90th$141$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$93.33
Typical High
$112.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$213.80
Typical High
$323.59
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$354.81
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$2,884.03
Median
$2,884.03
Typical High
$3,981.07