Puraply XT skin graft substitute, per square centimeter

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC Implant Graft Purified Collagen Matrix Phmb Antimicrobial Extra Fenestrated Puraply 25cm 515-071 Puraplyam Xt-Com4.91x4.91ef

Payers reporting HCPCS Q4197

Payer pricing summary

Low

$45

Average

$849

Median

$236

High

$17.9k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +22 other terms	460	$192	$187	$141	76%	1–10	$1 – $3.4k
2	Cigna fee schedule · outpatient · +17 other terms	302	$140	$303	$665	220%	—	$57 – $7.3k
3	Aetna fee schedule · outpatient · +21 other terms	259	$133	$278	$493	177%	—	$69 – $2.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +17 other terms	214	$169	$337	$804	239%	—	$1 – $14.4k
5	Humana fee schedule · outpatient · +19 other terms	192	$116	$123	$82	67%	—	$48 – $699
6	Molina fee schedule · outpatient · +16 other terms	84	$184	$229	$341	149%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +18 other terms	68	$122	$162	$139	86%	—	$48 – $1.2k
8	Caresource fee schedule · outpatient · +10 other terms	63	$100	$106	$80	75%	—	$48 – $712
9	WellCare fee schedule · outpatient · +14 other terms	52	$135	$192	$448	233%	—	$74 – $3.5k
10	Ambetter fee schedule · outpatient · +10 other terms	48	$234	$251	$73	29%	—	$67 – $406
11	Kaiser fee schedule · outpatient · +8 other terms	44	$207	$426	$888	209%	—	$125 – $5.2k
12	Devoted fee schedule · outpatient · +7 other terms	36	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +8 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient	30	$150	$155	$48	31%	—	$114 – $564
15	Medicare fee schedule · outpatient · +6 other terms	23	$125	$126	$5	4%	—	$123 – $139
16	Oscar facility · fee schedule · outpatient · +8 other terms	21	$182	$164	$52	31%	—	$88 – $234
17	Regence professional · fee schedule · outpatient · +6 other terms	21	$178	$173	$18	10%	—	$95 – $178
18	Healthpartners fee schedule · outpatient · +8 other terms	19	$87	$88	$8	9%	—	$85 – $131
19	Medical Mutual facility · fee schedule · outpatient · +4 other terms	19	$142	$172	$75	43%	—	$64 – $468
20	Highmark fee schedule · outpatient · +8 other terms	17	$91	$150	$337	224%	—	$84 – $3.4k
21	Wellmark fee schedule · outpatient · +5 other terms	15	$74	$73	$1	1%	—	$71 – $74
22	Aetna Better Health fee schedule · outpatient · +8 other terms	12	$125	$134	$12	9%	—	$125 – $152
23	Bcbs Nj fee schedule · outpatient · +2 other terms	11	$73	$73	$0	0%	—	$73 – $73
24	Medica fee schedule · outpatient · +12 other terms	11	$246	$249	$66	26%	—	$100 – $322
25	Tricare fee schedule · outpatient · +6 other terms	11	$113	$118	$10	8%	—	$113 – $148

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