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PuraPly XT

New Hampshire rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $85 · 10th–90th $71$2690%20%10th90th$85Professionalmedian $71 · 10th–90th $71$1320%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
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$85.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$338.84
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
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$125.89
Typical High
$125.89
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$83.18
Typical High
$144.54