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PuraPly

Washington 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 $87$3470%20%10th90th$107Professionalmedian $107 · 10th–90th $98$1480%20%10th90th$107$50.0$100.0$200.0$500.0$1.0K

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
$107.15
Median
$107.15
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$123.03
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$131.83
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$151.36
Typical High
$457.09
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$144.54
Typical High
$213.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$60.26
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$97.72
Typical High
$97.72
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$91.20
Typical High
$169.82
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$131.83
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$131.83
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$154.88
Typical High
$295.12