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Texas rates for HCPCS Q4197

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

Facilitymedian $107 · 10th–90th $71–$3800%20%40%10th90th$107Professionalmedian $72 · 10th–90th $71–$1260%50%10th90th$72$2.0$10.0$50.0$200.0$1.0K

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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $81.28
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $316.23 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $74.13 / $213.80
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $77.62 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $69.18 / $70.79
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $75.86 / $263.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $102.33 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89