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
facility
The 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.
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131 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient | 2 | $267.30 | $263.40 – $271.20 |
| 2 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $253.94 | $250.23 – $257.64 |
| 3 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $186.87 | $186.87 – $186.87 |
| 4 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 4 | $182.56 | $101.25 – $233.00 |
| 5 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $831.68 | $831.68 – $831.68 |
| 6 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $831.68 | $831.68 – $831.68 |
| 7 | Avera Behavioral Health Hospital Sioux Falls, SD fee schedule · both | 2 | $242.30 | $242.30 – $242.30 |
| 8 | Avera Creighton Hospital Creighton, NE percent of total billed charges · bothfrom % of charges | 1 | $594.08 | $594.08 – $594.08 |
| 9 | Avera Creighton Hospital Creighton, NE percent of total billed charges · inpatientfrom % of charges | 1 | $192.70 | $192.70 – $192.70 |
| 10 | Avera Creighton Hospital Creighton, NE percent of total billed charges · outpatientfrom % of charges | 1 | $192.70 | $192.70 – $192.70 |
| 11 | Avera Gregory Hospital Gregory, SD fee schedule · both | 1 | $242.30 | $242.30 – $242.30 |
| 12 | Avera Gregory Hospital Gregory, SD percent of total billed charges · inpatientfrom % of charges | 1 | $153.12 | $153.12 – $153.12 |
| 13 | Avera Gregory Hospital Gregory, SD percent of total billed charges · outpatientfrom % of charges | 1 | $153.12 | $153.12 – $153.12 |
| 14 | Avera Holy Family Hospital Estherville, IA fee schedule · both | 2 | $215.50 | $198.00 – $233.00 |
| 15 | Avera Holy Family Hospital Estherville, IA percent of total billed charges · inpatientfrom % of charges | 2 | $166.32 | $166.32 – $166.32 |
| 16 | Avera McKennan Hospital Sioux Falls, SD fee schedule · both | 2 | $242.30 | $242.30 – $242.30 |
| 17 | Avera Queen of Peace Mitchell, SD fee schedule · both | 1 | $242.30 | $242.30 – $242.30 |
| 18 | Avera Sacred Heart Hospital Yankton, SD fee schedule · both | 1 | $242.30 | $242.30 – $242.30 |
| 19 | Avera Sacred Heart Hospital Yankton, SD percent of total billed charges · inpatientfrom % of charges | 1 | $153.12 | $153.12 – $153.12 |
| 20 | Avera Sacred Heart Hospital Yankton, SD percent of total billed charges · outpatientfrom % of charges | 1 | $153.12 | $153.12 – $153.12 |
| 21 | Avera Specialty Hospital Sioux Falls, SD fee schedule · both | 2 | $242.30 | $242.30 – $242.30 |
| 22 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $189.16 | $189.16 – $189.16 |
| 23 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 4 | $182.56 | $101.25 – $233.00 |
| 24 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 4 | $182.56 | $101.25 – $233.00 |
| 25 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $189.16 | $189.16 – $189.16 |
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