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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 October 2026.

How much does PuraPly XT cost?

$126

Typical negotiated rate. In Oklahoma, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $102 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$75.86 to $158
FacilityA hospital or hospital-owned outpatient department$102$75.86 to $331

How much rates vary

Facilitymedian $102 · 10th to 90th $76 to $363Professionalmedian $126 · 10th to 90th $71 to $162
$100$200$500facility $102professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Aetna
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
BCBS Oklahoma
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
BCBS Oklahoma
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$158.49
Typical High
$162.18
Cigna
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$331.13
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$81.28
Typical High
$346.74
Medica
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$457.09
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$125.89
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.59
Median
$7.59
Typical High
$7.59

Where Oklahoma sits

The same service costs 3.6 times more in Wyoming than in Indiana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Oklahoma· 19th of 51

$126

WY $257IN $70.79

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.