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PuraPly XT

Oklahoma rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $76 · 10th–90th $76$3310%50%90th$76Professionalmedian $120 · 10th–90th $71$1620%20%10th90th$120$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
$75.86
Median
$75.86
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$75.86
BCBS
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$147.91
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$331.13
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$81.28
Typical High
$331.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$457.09
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89