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Nonsheet Skin Substitute, FDA-Cleared, Unclassified

Wisconsin 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 $355 · 10th–90th $74$6920%10%20%10th90th$355Professionalmedian $151 · 10th–90th $68$3800%10%10th90th$151$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$74.13
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$263.03
Typical High
$446.68
Cigna
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$416.87
Typical High
$660.69
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$181.97
Medica
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$85.11
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$275.42
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$691.83
Quartz
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$660.69
Security Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Security Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$338.84
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$239.88
Typical High
$398.11