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Wisconsin rates for HCPCS Q4195

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

Facilitymedian $151 · 10th–90th $98$5130%20%10th90th$151Professionalmedian $100 · 10th–90th $98$2190%20%10th90th$100$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $107.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $112.20 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $190.55 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $128.82 / $245.47
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $213.80
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $112.20 / $776.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $776.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $223.87 / $223.87
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $107.15 / $173.78
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $234.42 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $512.86
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $467.74
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $131.83 / $162.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $144.54