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PuraPly XT

Pennsylvania 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$4680%50%90th$71Professionalmedian $71 · 10th–90th $71$1780%50%90th$71$100.0$500.0$2.0K$10.0K$50.0K

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
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$257.04
Typical High
$263.03
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$257.04
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$74.13
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$208.93
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$213.80