go back

Maryland rates for HCPCS Q4195

PuraPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.92 / $107.92 / $107.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $113.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.06 / $105.06 / $105.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $124.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.25 / $97.94 / $190.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $103.82
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.79 / $102.79 / $128.30