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Nonsheet Skin Substitute, FDA-Cleared, Unclassified

Utah 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?

$123

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $123 for this service. Most negotiated rates run $66.07 to $145.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $66 · 10th to 90th $66 to $66Professionalmedian $123 · 10th to 90th $66 to $151
$50$100$200facility $66professional $123

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Aetna
Setting
Professional
Modifier
None
Typical Low
$66.07
Median
$66.07
Typical High
$69.18
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$33.11
Median
$33.11
Typical High
$34.67
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$13.18
Median
$13.18
Typical High
$13.80
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$9.77
Median
$9.77
Typical High
$10.47
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$6.61
Median
$6.61
Typical High
$6.92
Cigna
Setting
Professional
Modifier
None
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$44.67
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$131.83
Typical High
$151.36
Select Health
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Select Health
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$194.98
Typical High
$239.88
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$239.88
Typical High
$302.00
United
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54

Where Utah 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.

Utah· 16th of 51

$123

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.