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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 October 2026.

How much does PuraPly XT cost?

$126

Typical negotiated rate. In Pennsylvania, 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 $224 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$70.79 to $224
FacilityA hospital or hospital-owned outpatient department$224$178 to $339

How much rates vary

Facilitymedian $224 · 10th to 90th $126 to $490Professionalmedian $126 · 10th to 90th $71 to $251
$100$500$2K$10K$50Kfacility $224professional $126

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$35.48
Median
$35.48
Typical High
$35.48
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$218.78
Median
$251.19
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$251.19
Typical High
$251.19
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$213.80
Typical High
$489.78
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$151.36
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$218.78
Typical High
$257.04
Geisinger
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$177.83
Typical High
$269.15
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$35.48
Median
$35.48
Typical High
$35.48
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$100.00
Typical High
$602.56
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$173.78
Median
$208.93
Typical High
$309.03
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$165.96

Where Pennsylvania 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.

Pennsylvania· 32nd 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.