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PuraPly

Montana rates for HCPCS Q4195

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

Rates data updated July 2026.

Facilitymedian $115 · 10th–90th $76$2040%10%20%10th90th$115Professionalmedian $107 · 10th–90th $98$1260%20%10th90th$107$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$107.15
Typical High
$114.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$186.21
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$186.21
Providence
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$114.82
Typical High
$204.17
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$114.82
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89