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PuraPly

Ohio 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 $98$3160%20%10th90th$115Professionalmedian $100 · 10th–90th $98$1550%20%40%10th90th$100$0.1$0.2$1.0$5.0$20.0$100.0$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
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$107.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$120.23
Typical High
$131.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$117.49
Typical High
$186.21
CareSource
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
CareSource
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$269.15
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$269.15
Typical High
$389.05
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Molina
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$141.25
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$134.90
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90