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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 July 2026.

Facilitymedian $66 · 10th–90th $66$660%50%$66Professionalmedian $102 · 10th–90th $66$1820%10%20%10th90th$102$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
$66.07
Median
$66.07
Typical High
$66.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$95.50
Typical High
$128.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$190.55
Select Health
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Select Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$204.17
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$208.93
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$239.88