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PuraPly XT

South Dakota 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$1700%50%90th$71Professionalmedian $74 · 10th–90th $71$2570%50%10th90th$74$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
$70.79
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$85.11
Typical High
$93.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$120.23
Typical High
$302.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$457.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$89.13
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79