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PuraPly XT

Wisconsin rates for HCPCS Q4197

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

Rates data updated July 2026.

Facilitymedian $132 · 10th–90th $71$4900%20%10th90th$132Professionalmedian $126 · 10th–90th $71$3980%20%10th90th$126$5.0$20.0$100.0$500.0$2.0K

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
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$72.44
Typical High
$77.62
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$478.63
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$125.89
Typical High
$223.87
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$72.44
Typical High
$158.49
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$72.44
Typical High
$302.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$302.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$131.83
Typical High
$131.83
Network Health
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$75.86
Typical High
$123.03
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$72.44
Typical High
$158.49
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$446.68
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$131.83
Typical High
$660.69
Security Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$117.49
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$165.96