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Ohio rates for HCPCS Q4195

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

Facilitymedian $115 · 10th–90th $98$2750%20%10th90th$115Professionalmedian $98 · 10th–90th $98$1480%50%90th$98$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $107.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $120.23 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $117.49 / $186.21
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $97.72
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $173.78
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $97.72
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $138.04
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $107.15 / $144.54
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $134.90 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $131.83