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PuraPly AM

Utah rates for HCPCS Q4196

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

Rates data updated July 2026.

How much does PuraPly AM cost?

$117

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $117 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$112$100 to $126
FacilityA hospital or hospital-owned outpatient department$117$117 to $120

How much rates vary

Facilitymedian $117 · 10th to 90th $117 to $151Professionalmedian $112 · 10th to 90th $100 to $155
$100$200$500facility $117professional $112

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$112.20
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$151.36
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$81.28
Typical High
$104.71
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$70.79
Typical High
$151.36
Select Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$120.23
Typical High
$154.88
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Utah sits

The same service costs 1.9 times more in Alaska than in Vermont. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 8th of 51

$117

AK $186VT $100

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.