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Alaska rates for HCPCS Q4196

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

Facilitymedian $178 · 10th–90th $100$4470%10%20%10th90th$178Professionalmedian $107 · 10th–90th $100$3800%50%10th90th$107$100.0$200.0$500.0$1.0K$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
$3,630.78 / $3,890.45 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $102.33 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $158.49 / $269.15
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $295.12 / $489.78
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $288.40 / $446.68
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $223.87 / $245.47
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $151.36 / $223.87
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $125.89 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $316.23