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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 July 2026.

Facilitymedian $204 · 10th–90th $71$3020%10%10th90th$204Professionalmedian $71 · 10th–90th $71$1290%50%90th$71$50.0$100.0$200.0$500.0

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
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$85.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$208.93
Typical High
$269.15
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$128.82
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$158.49
Typical High
$446.68
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$138.04