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PuraPly XT

Minnesota rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $186 · 10th–90th $71$2570%10%20%10th90th$186Professionalmedian $105 · 10th–90th $63$1260%20%10th90th$105$0.2$1.0$5.0$20.0$100.0$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
$177.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$109.65
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$87.10
Typical High
$95.50
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$281.84
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$102.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$158.49
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$95.50
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$257.04