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PuraPly XT

California rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $89 · 10th–90th $71$4170%50%10th90th$89Professionalmedian $78 · 10th–90th $71$4170%50%10th90th$78$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
$70.79
Median
$70.79
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$512.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$89.13
Typical High
$223.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$269.15
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$1,023.29
Typical High
$1,995.26
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$72.44
Typical High
$95.50
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$169.82
Typical High
$269.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$72.44
Providence
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$251.19
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$109.65
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$234.42