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PuraPly XT

Nebraska rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $115 · 10th–90th $71$2290%10%20%10th90th$115Professionalmedian $71 · 10th–90th $71$1260%50%90th$71$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
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$100.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$75.86
Typical High
$79.43
BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$89.13
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$109.65
Typical High
$141.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$213.80
Midlands
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$109.65
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$309.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$109.65
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$257.04