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
HB Rpr S/N/a/Gen/Trk12.6-20.0cm
Low
$42
Average
$356
Median
$278
High
$2.2k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
77 hospitals; the 90th percentile is 7.1× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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152 hospital rates
iThe hospitals that file a Wellmark rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Avera McKennan Hospital Sioux Falls, SD case rate · outpatient | 2 | $205 | $205 | — | — | 2–20 | $205 – $205 |
| 2 | Lakes Regional Hospital Spirit Lake, IA case rate · outpatient | 2 | $754 | $754 | — | — | 2–20 | $754 – $754 |
| 3 | Monument Health Network Inc Deadwood, SD percent of total billed charges · outpatientfrom % of charges | 2 | $647 | $647 | $306 | 47% | 2–20 | $341 – $953 |
| 4 | Monument Health Network Inc Sturgis, SD percent of total billed charges · outpatientfrom % of charges | 2 | $595 | $595 | $312 | 53% | 2–20 | $282 – $907 |
| 5 | Osceola Regional Health Center Sibley, IA case rate · outpatient | 2 | $329 | $329 | — | — | 2–20 | $329 – $329 |
| 6 | Avera St. Benedicts Parkston, SD outpatient | 1 | $264 | $264 | — | — | 1–10 | $264 – $264 |
| 7 | Avera St. Benedicts Parkston, SD percent of total billed charges · outpatientfrom % of charges | 1 | $246 | $246 | — | — | 1–10 | $246 – $246 |
| 8 | Sanford Aberdeen Medical Center Aberdeen, SD other · outpatient | 1 | $475 | $475 | — | — | 1–10 | $475 – $475 |
| 9 | Sanford Chamberlain Medical Center Chamberlain, SD percent of total billed charges · outpatientfrom % of charges | 2 | $455 | $455 | $183 | 40% | 1–10 | $272 – $637 |
| 10 | Sanford USD Medical Center Sioux Falls, SD other · outpatient | 1 | $743 | $743 | — | — | 1–10 | $743 – $743 |
| 11 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient | 2 | $296 | $296 | $3 | 1% | — | $293 – $299 |
| 12 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $282 | $282 | $3 | 1% | — | $279 – $284 |
| 13 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $376 | $376 | — | — | — | $376 – $376 |
| 14 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 4 | $167 | $154 | $42 | 27% | — | $85 – $197 |
| 15 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 16 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 17 | Avera Behavioral Health Hospital Sioux Falls, SD fee schedule · both | 2 | $205 | $205 | — | — | — | $205 – $205 |
| 18 | Avera Creighton Hospital Creighton, NE percent of total billed charges · bothfrom % of charges | 1 | $360 | $360 | — | — | — | $360 – $360 |
| 19 | Avera Creighton Hospital Creighton, NE percent of total billed charges · inpatientfrom % of charges | 1 | $474 | $474 | — | — | — | $474 – $474 |
| 20 | Avera Creighton Hospital Creighton, NE percent of total billed charges · outpatientfrom % of charges | 1 | $474 | $474 | — | — | — | $474 – $474 |
| 21 | Avera DeSmet De Smet, SD fee schedule · both | 1 | $205 | $205 | — | — | — | $205 – $205 |
| 22 | Avera DeSmet De Smet, SD percent of total billed charges · inpatientfrom % of charges | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 23 | Avera DeSmet De Smet, SD percent of total billed charges · outpatientfrom % of charges | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 24 | Avera Holy Family Hospital Estherville, IA fee schedule · both | 2 | $182 | $182 | $15 | 8% | — | $167 – $197 |
| 25 | Avera Holy Family Hospital Estherville, IA percent of total billed charges · inpatientfrom % of charges | 2 | $220 | $220 | — | — | — | $220 – $220 |
← Payers reporting CPT 12005 · Snapshot 20261111T120946Z-9134e7f7