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PuraPly XT

Virginia rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $178 · 10th–90th $71$3470%10%20%10th90th$178Professionalmedian $126 · 10th–90th $71$3020%20%40%10th90th$126$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$74.13
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$426.58
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$251.19
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$275.42
Medcost
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$79.43
Typical High
$302.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$281.84
Sentara
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$199.53
Typical High
$912.01
Sentara
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$199.53
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90