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Wisconsin rates for HCPCS Q4196

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

Facilitymedian $141 · 10th–90th $100$5500%20%10th90th$141Professionalmedian $105 · 10th–90th $100$2400%50%10th90th$105$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
$104.71 / $104.71 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $102.33 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $141.25 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $229.09 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $134.90 / $204.17
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $223.87
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $102.33 / $549.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $251.19
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
$109.65 / $109.65 / $112.20
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $112.20 / $177.83
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $251.19 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $549.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $467.74
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $134.90 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $125.89 / $151.36