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PuraPly XT

Indiana 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?

$70.79

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $70.79 for this service. The price depends on where it is billed: about $70.79 from a physician practice, and about $191 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$70.79$70.79 to $126
FacilityA hospital or hospital-owned outpatient department$191$141 to $309

How much rates vary

Facilitymedian $191 · 10th to 90th $126 to $676Professionalmedian $71 · 10th to 90th $71 to $126
$100$200$500$1K$2Kfacility $191professional $71

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
$70.79
Aetna
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$117.49
CareSource
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$107.15
Typical High
$141.25
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$616.60
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$371.54
Typical High
$2,089.30
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$190.55
Typical High
$257.04
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$218.78
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$35.48
Median
$35.48
Typical High
$35.48
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.08
Median
$7.08
Typical High
$7.08

Where Indiana 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.

Indiana· 50th of 51

$70.79

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.