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PuraPly XT

Illinois 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?

$126

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $204 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$70.79 to $126
FacilityA hospital or hospital-owned outpatient department$204$182 to $245

How much rates vary

Facilitymedian $204 · 10th to 90th $158 to $282Professionalmedian $126 · 10th to 90th $71 to $135
$50$100$200$500facility $204professional $126

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
Facility
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$117.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$35.48
Median
$35.48
Typical High
$36.31
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$14.13
Median
$14.13
Typical High
$14.45
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$10.72
Median
$10.72
Typical High
$10.96
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.08
Median
$7.08
Typical High
$7.24
BCBS
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$204.17
Typical High
$275.42
BCBS
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$128.82
Typical High
$128.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$257.04
Typical High
$302.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Hally Health
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$89.13
Typical High
$398.11
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$169.82

Where Illinois 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.

Illinois· 20th of 51

$126

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.