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PuraPly

New Hampshire rates for HCPCS Q4195

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

Rates data updated July 2026.

Facilitymedian $117 · 10th–90th $98$2950%20%10th90th$117Professionalmedian $98 · 10th–90th $98$1410%50%90th$98$100.0$200.0$500.0

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
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$117.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$125.89
Typical High
$125.89
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$162.18