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PuraPly

Wisconsin rates for HCPCS Q4195

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

Rates data updated July 2026.

Facilitymedian $174 · 10th–90th $98$7080%10%20%10th90th$174Professionalmedian $112 · 10th–90th $83$3160%20%10th90th$112$5.0$20.0$100.0$500.0$2.0K

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
$100.00
Median
$100.00
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$100.00
Typical High
$107.15
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$112.20
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$288.40
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$128.82
Typical High
$245.47
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$213.80
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$112.20
Typical High
$776.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$776.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$223.87
Typical High
$223.87
Network Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$107.15
Typical High
$173.78
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$213.80
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$245.47
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$131.83
Typical High
$660.69
Security Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$131.83
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$162.18