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.
Original text from hospital filings
Puraply xt 1 sq cm
Devils Lake, ND
See all hospitals reporting HCPCS Q4197 →Price type
Altru Hospital Devils Lake’s median price of $130 is 11% below the median hospital's median price ($147), higher than 35% of the 1,125 hospitals reporting HCPCS Q4197. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 10 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Medica medicaid managed care plan facility · fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 2 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 3 | Medica medicare managed care plan facility · fee schedule · outpatient | $45 | $45 | — | — | — | $45 – $45 |
| 4 | Medica all commercial plans facility · fee schedule · outpatient | $73 | $73 | — | — | — | $73 – $73 |
| 5 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $74 | $74 | — | — | — | $74 – $74 |
| 6 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $74 | $74 | — | — | — | $74 – $74 |
| 7 | Aetna medicare managed care plan facility · fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 8 | Aetna all commercial plans facility · fee schedule · outpatient | $181 | $181 | $48 | 26% | — | $134 – $229 |
| 9 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $199 | $201 | $44 | 22% | — | $148 – $255 |
| 10 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $249 | $249 | — | — | — | $249 – $249 |
Last updated: Mar 1, 2026
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