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 Ref T3, Total
Low
$8
Average
$64
Median
$43
High
$300
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
121 hospitals; the 90th percentile is 9.7× 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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198 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 Holy Family Hospital Estherville, IA case rate · outpatient | 2 | $26 | $26 | — | — | 290 | $26 – $26 |
| 2 | Spencer Municipal Hospital Spencer, IA fee schedule · outpatient | 3 | $47 | $38 | $17 | 44% | 98 | $14 – $52 |
| 3 | Grundy County Memorial Hospital Grundy Center, IA facility · other · outpatient | 2 | $25 | $25 | $1 | 5% | 61 | $24 – $26 |
| 4 | Sioux Center Health Sioux Center, IA case rate · outpatient | 2 | $27 | $27 | — | — | 32 | $27 – $27 |
| 5 | Lakes Regional Hospital Spirit Lake, IA case rate · outpatient | 2 | $26 | $26 | — | — | 22 | $26 – $26 |
| 6 | Avera McKennan Hospital Sioux Falls, SD case rate · outpatient | 2 | $12 | $12 | — | — | 2–20 | $12 – $12 |
| 7 | Osceola Regional Health Center Sibley, IA case rate · outpatient | 2 | $24 | $24 | — | — | 2–20 | $24 – $24 |
| 8 | Pella Regional Health Center Pella, IA other · outpatient | 2 | $25 | $25 | $1 | 2% | 2–20 | $25 – $26 |
| 9 | Regional Health Services of Howard County Cresco, IA case rate · outpatient | 2 | $27 | $27 | — | — | 2–20 | $27 – $27 |
| 10 | Avera Creighton Hospital Creighton, NE outpatient | 1 | $14 | $14 | — | — | 1–10 | $14 – $14 |
| 11 | Avera Creighton Hospital Creighton, NE percent of total billed charges · outpatientfrom % of charges | 1 | $168 | $168 | — | — | 1–10 | $168 – $168 |
| 12 | Avera Flandreau Hospital Flandreau, SD outpatient | 1 | $146 | $146 | — | — | 1–10 | $146 – $146 |
| 13 | Avera Flandreau Hospital Flandreau, SD percent of total billed charges · outpatientfrom % of charges | 1 | $149 | $149 | — | — | 1–10 | $149 – $149 |
| 14 | Avera Hand County Hospital Miller, SD outpatient | 1 | $159 | $159 | — | — | 1–10 | $159 – $159 |
| 15 | Avera Hand County Hospital Miller, SD percent of total billed charges · outpatientfrom % of charges | 1 | $159 | $159 | — | — | 1–10 | $159 – $159 |
| 16 | Avera Missouri River Health Center Gettysburg, SD outpatient | 1 | $136 | $136 | — | — | 1–10 | $136 – $136 |
| 17 | Avera Missouri River Health Center Gettysburg, SD percent of total billed charges · outpatientfrom % of charges | 1 | $136 | $136 | — | — | 1–10 | $136 – $136 |
| 18 | Avera Queen of Peace Mitchell, SD outpatient | 1 | $30 | $30 | — | — | 1–10 | $30 – $30 |
| 19 | Avera Queen of Peace Mitchell, SD case rate · outpatient | 1 | $30 | $30 | — | — | 1–10 | $30 – $30 |
| 20 | Avera St. Anthony's Hospital O'Neill, NE inpatient | 1 | $285 | $285 | — | — | 1–10 | $285 – $285 |
| 21 | Avera St. Anthony's Hospital O'Neill, NE outpatient | 1 | $300 | $300 | — | — | 1–10 | $300 – $300 |
| 22 | Avera St. Anthony's Hospital O'Neill, NE percent of total billed charges · inpatientfrom % of charges | 1 | $299 | $299 | — | — | 1–10 | $299 – $299 |
| 23 | Avera St. Anthony's Hospital O'Neill, NE percent of total billed charges · outpatientfrom % of charges | 1 | $299 | $299 | — | — | 1–10 | $299 – $299 |
| 24 | Avera St. Benedicts Parkston, SD outpatient | 1 | $119 | $119 | — | — | 1–10 | $119 – $119 |
| 25 | Avera St. Benedicts Parkston, SD percent of total billed charges · outpatientfrom % of charges | 1 | $77 | $77 | — | — | 1–10 | $77 – $77 |
← Payers reporting CPT 84480 · Snapshot 20261111T120946Z-9134e7f7