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Missouri rates for HCPCS Q4197

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

Facilitymedian $102 · 10th–90th $71–$3160%20%10th90th$102Professionalmedian $72 · 10th–90th $71–$1410%50%10th90th$72$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $72.44 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $83.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $109.65 / $199.53
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $144.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $100.00 / $302.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $70.79 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $102.33 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $125.89