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PuraPly XT

North Dakota rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $71 · 10th–90th $71$1200%50%90th$71Professionalmedian $71 · 10th–90th $60$870%50%10th90th$71$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
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$66.07
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$134.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$93.33
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$131.83
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$79.43
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$239.88