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Maine rates for HCPCS Q4197

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

Facilitymedian $145 · 10th–90th $145–$3630%50%90th$145Professionalmedian $71 · 10th–90th $71–$1260%50%90th$71$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $151.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $85.11
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $177.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $138.04