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PuraPly XT

Tennessee 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 Tennessee, October 2026.

Insurers have agreed to pay about $126 for this service. Most negotiated rates run $105 to $288.

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.

How much rates vary

Facilitymedian $158 · 10th to 90th $141 to $224Professionalmedian $126 · 10th to 90th $71 to $661
$100$200$500$1Kfacility $158professional $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
BCBS Tennessee
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Facility
Modifier
None
Typical Low
$141.25
Median
$158.49
Typical High
$223.87
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$660.69
Median
$1,096.48
Typical High
$1,096.48
United
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$125.89
Typical High
$125.89

Where Tennessee 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.

Tennessee· 30th 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.