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PuraPly XT

Louisiana 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?

$115

Typical negotiated rate. In Louisiana, October 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $75.86 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$72.44 to $126
FacilityA hospital or hospital-owned outpatient department$75.86$75.86 to $75.86

How much rates vary

Facilitymedian $76 · 10th to 90th $76 to $151Professionalmedian $126 · 10th to 90th $71 to $126
$100$200facility $76professional $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
$72.44
Aetna
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$72.44
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 Louisiana
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
BCBS Louisiana
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$239.88
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$134.90

Where Louisiana 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.

Louisiana· 36th of 51

$115

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.