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PuraPly XT

Oregon rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $71 · 10th–90th $71$1350%50%90th$71Professionalmedian $126 · 10th–90th $71$2950%20%10th90th$126$100.0$500.0$2.0K$10.0K$50.0K$200.0K$1.0M

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$144.54
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$257.04
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$91.20
Typical High
$263.03
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$245.47
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$95.50
Providence
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$281.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$125.89
Typical High
$199.53
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89