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PuraPly

South Carolina rates for HCPCS Q4195

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

Rates data updated July 2026.

Facilitymedian $138 · 10th–90th $98$2400%10%20%10th90th$138Professionalmedian $100 · 10th–90th $87$1260%20%10th90th$100$50.0$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
$102.33
Median
$102.33
Typical High
$138.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$97.72
Typical High
$107.15
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$169.82
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$117.49
Typical High
$229.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$125.89