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PuraPly

South Dakota rates for HCPCS Q4195

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

Rates data updated July 2026.

Facilitymedian $107 · 10th–90th $98$1860%20%40%10th90th$107Professionalmedian $102 · 10th–90th $98$1740%20%10th90th$102$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
$97.72
Median
$97.72
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$134.90
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$128.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$181.97
Typical High
$204.17
Medica
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$107.15
Typical High
$776.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$128.82
Typical High
$128.82
Midlands
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$204.17
Midlands
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72