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PuraPly XT

Alaska rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $132 · 10th–90th $71$3630%20%10th90th$132Professionalmedian $158 · 10th–90th $71$4170%20%10th90th$158$100.0$200.0$500.0$1.0K$2.0K

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
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$112.20
Typical High
$331.13
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$302.00
Typical High
$512.86
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$416.87
Typical High
$660.69
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$331.13
Typical High
$363.08
Providence
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$112.20
Typical High
$331.13
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$190.55
Typical High
$380.19