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PuraPly XT

Arizona rates for HCPCS Q4197

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

Rates data updated October 2026.

How much does PuraPly XT cost?

$112

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $107 from a physician practice, and about $145 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$107$77.62 to $126
FacilityA hospital or hospital-owned outpatient department$145$67.61 to $224

How much rates vary

Facilitymedian $145 · 10th to 90th $49 to $302Professionalmedian $107 · 10th to 90th $71 to $263
$50$100$200$500facility $145professional $107

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$38.90
Median
$38.90
Typical High
$38.90
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$15.49
Median
$15.49
Typical High
$15.49
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$11.48
Median
$11.75
Typical High
$11.75
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.76
Median
$7.76
Typical High
$7.76
BCBS
Setting
Facility
Modifier
None
Typical Low
$48.98
Median
$117.49
Typical High
$309.03
BCBS
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$100.00
Typical High
$223.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$223.87
Typical High
$239.88
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$85.11
Typical High
$302.00
Medica
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$457.09
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona sits

The same service costs 3.6 times more in Wyoming than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Arizona· 38th of 51

$112

WY $257KY $70.79

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.