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Washington rates for HCPCS Q4196

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

Facilitymedian $123 · 10th–90th $76$5890%10%10th90th$123Professionalmedian $107 · 10th–90th $100$1660%20%40%10th90th$107$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$112.20 / $1,905.46 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $102.33 / $125.89
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $125.89 / $165.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $125.89 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $147.91 / $380.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $128.82 / $281.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $75.86 / $158.49
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $100.00 / $114.82
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $89.13 / $169.82
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $125.89 / $165.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $125.89 / $131.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $154.88 / $295.12