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Nebraska rates for HCPCS Q4197

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

Facilitymedian $107 · 10th–90th $71–$2240%10%20%10th90th$107Professionalmedian $71 · 10th–90th $71–$980%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $83.18
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $75.86 / $79.43
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $208.93 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $93.33 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $141.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $213.80
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $85.11 / $109.65
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $109.65 / $177.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $102.33 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $141.25