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Washington rates for HCPCS Q4197

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

Facilitymedian $170 · 10th–90th $71$5620%20%10th90th$170Professionalmedian $74 · 10th–90th $71$1510%50%10th90th$74$50.0$100.0$200.0$500.0$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
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $131.83
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $169.82 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $346.74 / $588.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $275.42 / $346.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $50.12 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $89.13
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $251.19 / $251.19
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $107.15 / $107.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $125.89 / $141.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $102.33 / $102.33
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
$134.90 / $154.88 / $295.12