go back

PuraPly XT

Maine rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $145 · 10th–90th $145$3630%50%90th$145Professionalmedian $71 · 10th–90th $71$1260%50%90th$71$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$74.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$125.89
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$85.11
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$125.89