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PuraPly XT

Texas rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $107 · 10th–90th $71$3550%20%10th90th$107Professionalmedian $72 · 10th–90th $71$1260%50%10th90th$72$2.0$10.0$50.0$200.0$1.0K

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$295.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Christus
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$120.23
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$316.23
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$72.44
Typical High
$213.80
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$234.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$69.18
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$75.86
Typical High
$263.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$120.23
Typical High
$169.82