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
Revoshield+ amnio, per sq cm
Devils Lake, ND
See all hospitals reporting HCPCS Q4289 →Price type
Altru Hospital Devils Lake’s median price of $443 is 56% above the median hospital's median price ($283), higher than 55% of the 837 hospitals reporting HCPCS Q4289. 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 | Aetna medicare managed care plan facility · fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 2 | Aetna all commercial plans facility · fee schedule · outpatient | $181 | $181 | $48 | 26% | — | $134 – $229 |
| 3 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $249 | $249 | — | — | — | $249 – $249 |
| 4 | Medica medicaid managed care plan facility · fee schedule · outpatient | $632 | $632 | — | — | — | $632 – $632 |
| 5 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $632 | $632 | — | — | — | $632 – $632 |
| 6 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $199 | $745 | $808 | 108% | — | $148 – $1.9k |
| 7 | Medica medicare managed care plan facility · fee schedule · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 8 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 9 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 10 | Medica all commercial plans facility · fee schedule · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
Last updated: Mar 1, 2026
See Amniotic membrane wound covering, per square centimeter pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.