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PuraPly XT

New Jersey rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $263 · 10th–90th $71$19,4980%10%10th90th$263Professionalmedian $71 · 10th–90th $71$1260%50%90th$71$100.0$500.0$2.0K$10.0K

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
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$107.15
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$245.47
Typical High
$257.04
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$11,481.54
Typical High
$25,118.86
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$154.88
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$125.89
Typical High
$134.90