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PuraPly XT

Hawaii rates for HCPCS Q4197

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

Rates data updated July 2026.

Professionalmedian $71 · 10th–90th $71$1260%50%90th$71$100.0$200.0

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
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$125.89
HMSA
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$123.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$125.89
Typical High
$125.89