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Pennsylvania rates for HCPCS Q4195

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

Facilitymedian $100 · 10th–90th $98$4470%20%10th90th$100Professionalmedian $98 · 10th–90th $98$1260%50%90th$98$1.0$10.0$100.0$1.0K$10.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $102.33
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $169.82 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $446.68 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $173.78 / $263.03
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $147.91 / $199.53
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $97.72
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $102.33
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $194.98 / $245.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $83.18 / $114.82
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $107.15 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $181.97