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PuraPly XT

Massachusetts rates for HCPCS Q4197

PuraPly XT, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

Facilitymedian $141 · 10th–90th $71$7080%20%10th90th$141Professionalmedian $71 · 10th–90th $71$1510%50%90th$71$100.0$500.0$2.0K$10.0K$50.0K

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
$177.83
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$269.15
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$177.83
Typical High
$6,918.31
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$125.89
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$125.89
Typical High
$158.49