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PuraPly

Pennsylvania rates for HCPCS Q4195

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $16$4470%10%20%10th90th$100Professionalmedian $100 · 10th–90th $98$1260%20%40%10th90th$100$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$15.85
Median
$97.72
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$102.33
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$169.82
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$173.78
Typical High
$263.03
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$144.54
Typical High
$204.17
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$15.85
Median
$100.00
Typical High
$100.00
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$102.33
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$83.18
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$181.97