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PuraPly XT

Maine 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?

$126

Typical negotiated rate. In Maine, October 2026.

Insurers have agreed to pay about $126 for this service. Most negotiated rates run $74.13 to $126.

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.

How much rates vary

Facilitymedian $145 · 10th to 90th $145 to $363Professionalmedian $126 · 10th to 90th $71 to $158
$100$200facility $145professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$37.15
Median
$37.15
Typical High
$37.15
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$10.96
Median
$10.96
Typical High
$10.96
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.41
Median
$7.41
Typical High
$7.41
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$125.89
Typical High
$173.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$107.15
Typical High
$177.83
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$37.15
Median
$37.15
Typical High
$37.15
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$10.96
Median
$10.96
Typical High
$10.96
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.41
Median
$7.41
Typical High
$7.41
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$190.55

Where Maine 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.

Maine· 28th of 51

$126

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.