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PuraPly XT

Washington rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $126 · 10th–90th $71$4790%20%10th90th$126Professionalmedian $78 · 10th–90th $71$1510%50%10th90th$78$50.0$100.0$200.0$500.0$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
$77.62
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$147.91
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$169.82
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$346.74
Typical High
$588.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$275.42
Typical High
$346.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$50.12
Typical High
$60.26
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$89.13
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$251.19
Typical High
$251.19
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$107.15
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
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
$154.88
Typical High
$295.12