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
Dosimetry Calculation Basic
Low
$58
Average
$275
Median
$151
High
$969
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
61 hospitals; the 90th percentile is 7.0× 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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113 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 | $745 | $745 | — | — | 816 | $745 – $745 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · other · both | 1 | $129 | $129 | — | — | 85 | $129 – $129 |
| 3 | Spencer Municipal Hospital Spencer, IA fee schedule · outpatient | 2 | $716 | $716 | $34 | 5% | 80 | $682 – $750 |
| 4 | Avera St. Luke's Aberdeen, SD outpatient | 1 | $685 | $685 | — | — | 30 | $685 – $685 |
| 5 | Avera St. Luke's Aberdeen, SD case rate · outpatient | 1 | $685 | $685 | — | — | 30 | $685 – $685 |
| 6 | Mercy Health Services-Iowa Corp. Mason City, IA facility · other · both | 1 | $143 | $143 | — | — | 27 | $143 – $143 |
| 7 | Avera St. Mary's Hospital Pierre, SD outpatient | 1 | $761 | $761 | — | — | 22 | $761 – $761 |
| 8 | Avera St. Mary's Hospital Pierre, SD case rate · outpatient | 1 | $761 | $761 | — | — | 22 | $761 – $761 |
| 9 | Sanford USD Medical Center Sioux Falls, SD other · outpatient | 1 | $277 | $277 | — | — | 18 | $277 – $277 |
| 10 | Mercy Medical Center-Clinton Inc Clinton, IA facility · other · both | 1 | $142 | $142 | — | — | 1–10 | $142 – $142 |
| 11 | Spencer Municipal Hospital Spencer, IA case rate · both | 1 | $126 | $126 | — | — | 1–10 | $126 – $126 |
| 12 | Spencer Municipal Hospital Spencer, IA case rate · outpatient | 1 | $126 | $126 | — | — | 1–10 | $126 – $126 |
| 13 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 14 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 4 | $64 | $76 | $35 | 46% | — | $31 – $146 |
| 15 | Avera Queen of Peace Mitchell, SD fee schedule · both | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 16 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 2 | $137 | $137 | — | — | — | $137 – $137 |
| 17 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · inpatient | 3 | $67 | $85 | $38 | 45% | — | $31 – $146 |
| 18 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 3 | $67 | $85 | $38 | 45% | — | $31 – $146 |
| 19 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 20 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 4 | $64 | $76 | $35 | 46% | — | $31 – $146 |
| 21 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 4 | $64 | $76 | $35 | 46% | — | $31 – $146 |
| 22 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 2 | $137 | $137 | — | — | — | $137 – $137 |
| 23 | Covenant Medical Center Inc Waterloo, IA facility · other · both | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 24 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 3 | $67 | $85 | $38 | 45% | — | $31 – $146 |
| 25 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 3 | $67 | $85 | $38 | 45% | — | $31 – $146 |
← Payers reporting CPT 77300 · Snapshot 20261111T120946Z-9134e7f7