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Montana rates for HCPCS Q4196

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

Facilitymedian $112 · 10th–90th $71–$3160%50%10th90th$112Professionalmedian $105 · 10th–90th $100–$1580%50%10th90th$105$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $102.33 / $158.49
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64,565.42 / $77,624.71 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $204.17
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $204.17
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $120.23 / $204.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89