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Nonsheet Skin Substitute, FDA-Cleared, Unclassified

South Dakota 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 $8 · 10th–90th $3$2450%10%20%10th90th$8Professionalmedian $102 · 10th–90th $3$1820%20%10th90th$102$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$87.10
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$181.97
Medica
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$5.13
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$263.03
Typical High
$275.42