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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 October 2026.

How much does PuraPly XT cost?

$87.10

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $87.10 for this service. Most negotiated rates run $87.10 to $107.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $87 · 10th to 90th $87 to $158
$100$200professional $87

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
$70.79
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
HMSA
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$107.15
Typical High
$107.15
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$165.96
Typical High
$204.17
United
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$87.10
Typical High
$125.89
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$213.80

Where Hawaii sits

The same service costs 3.6 times more in Wyoming than in Indiana. 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.

Hawaii· 42nd of 51

$87.10

WY $257IN $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.