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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 July 2026.

Facilitymedian $245 · 10th–90th $71$5130%10%10th90th$245Professionalmedian $71 · 10th–90th $71$1260%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
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$74.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$275.42
Typical High
$512.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$123.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04