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PuraPly XT

Missouri rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $107 · 10th–90th $71$3470%20%10th90th$107Professionalmedian $98 · 10th–90th $71$1910%20%10th90th$98$50.0$100.0$200.0$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
$72.44
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$131.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$109.65
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$302.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$70.79
Typical High
$457.09
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$134.90