Puraply skin substitute wound covering, per square centimeter

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Puraply 1 sq cm

Payers reporting HCPCS Q4195

Payer pricing summary

Low

$80

Average

$939

Median

$327

High

$6.1k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +22 other terms	473	$210	$336	$1.3k	394%	—	$1 – $23.0k
2	Cigna fee schedule · outpatient · +21 other terms	292	$204	$1.2k	$3.8k	315%	—	$72 – $27.2k
3	Aetna fee schedule · outpatient · +24 other terms	261	$132	$279	$1.3k	481%	—	$20 – $15.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +20 other terms	237	$169	$421	$1.6k	382%	—	$1 – $25.4k
5	Humana fee schedule · outpatient · +19 other terms	197	$116	$122	$39	32%	—	$1 – $360
6	Molina fee schedule · outpatient · +17 other terms	95	$192	$192	$288	150%	—	$1 – $3.4k
7	Anthem facility · fee schedule · outpatient · +16 other terms	76	$155	$184	$116	63%	—	$48 – $1.2k
8	Caresource fee schedule · outpatient · +10 other terms	64	$112	$114	$58	51%	—	$1 – $270
9	Kaiser fee schedule · outpatient · +14 other terms	61	$258	$2.4k	$5.1k	210%	—	$71 – $23.6k
10	Ambetter facility · fee schedule · outpatient · +11 other terms	59	$212	$232	$44	19%	—	$103 – $331
11	WellCare fee schedule · outpatient · +15 other terms	54	$135	$135	$19	14%	—	$67 – $171
12	Devoted facility · fee schedule · outpatient · +8 other terms	43	$118	$123	$8	7%	—	$111 – $143
13	Tricare facility · fee schedule · outpatient · +6 other terms	37	$127	$130	$20	15%	—	$71 – $257
14	Optum fee schedule · outpatient · +10 other terms	32	$125	$170	$89	52%	—	$113 – $459
15	Highmark facility · fee schedule · outpatient · +10 other terms	31	$117	$144	$69	48%	—	$47 – $401
16	Bcbs Tx fee schedule · outpatient · +3 other terms	30	$150	$155	$48	31%	—	$114 – $564
17	Oscar facility · fee schedule · outpatient · +10 other terms	28	$188	$179	$32	18%	—	$134 – $234
18	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
19	Medcost percent of total billed charges · bothfrom % of charges · +2 other terms	25	$221	$381	$576	151%	—	$208 – $6.3k
20	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	24	$131	$131	$31	24%	—	$39 – $372
21	Clover facility · fee schedule · outpatient · +5 other terms	22	$134	$129	$9	7%	—	$113 – $139
22	Medicare fee schedule · outpatient · +9 other terms	22	$125	$125	$4	3%	—	$123 – $139
23	MultiPlan fee schedule · inpatient · +13 other terms	22	$14.3k	$12.0k	$9.2k	76%	—	$165 – $30.3k
24	Regence professional · fee schedule · outpatient · +5 other terms	21	$71	$79	$19	24%	—	$71 – $153
25	Healthpartners fee schedule · outpatient · +5 other terms	19	$123	$123	$3	2%	—	$120 – $131

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