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
PT RE-EVAL EST PLAN OF CARE
Low
$55
Average
$150
Median
$128
High
$599
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
122 hospitals; the 90th percentile is 4.1× 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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202 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 | Lakes Regional Hospital Spirit Lake, IA case rate · outpatient | 2 | $64 | $64 | — | — | 346 | $64 – $64 |
| 2 | Avera Holy Family Hospital Estherville, IA case rate · outpatient | 2 | $247 | $247 | — | — | 160 | $247 – $247 |
| 3 | Osceola Regional Health Center Sibley, IA case rate · outpatient | 2 | $231 | $231 | — | — | 44 | $231 – $231 |
| 4 | Spencer Municipal Hospital Spencer, IA fee schedule · outpatient | 3 | $226 | $180 | $82 | 46% | 43–52 | $64 – $249 |
| 5 | Sioux Center Health Sioux Center, IA case rate · outpatient | 2 | $127 | $127 | — | — | 40 | $127 – $127 |
| 6 | Regional Health Services of Howard County Cresco, IA case rate · outpatient | 2 | $177 | $177 | — | — | 34 | $177 – $177 |
| 7 | Monument Health Network Inc Custer, SD percent of total billed charges · outpatientfrom % of charges | 2 | $138 | $138 | $77 | 56% | 28 | $61 – $215 |
| 8 | Sanford USD Medical Center Sioux Falls, SD other · outpatient | 1 | $236 | $236 | — | — | 21 | $236 – $236 |
| 9 | Avera Sacred Heart Hospital Yankton, SD outpatient | 1 | $67 | $67 | — | — | 14 | $67 – $67 |
| 10 | Avera Sacred Heart Hospital Yankton, SD percent of total billed charges · outpatientfrom % of charges | 1 | $168 | $168 | — | — | 14 | $168 – $168 |
| 11 | Avera Behavioral Health Hospital Sioux Falls, SD case rate · outpatient | 2 | $67 | $67 | — | — | 2–20 | $67 – $67 |
| 12 | Avera McKennan Hospital Sioux Falls, SD case rate · outpatient | 2 | $240 | $240 | — | — | 2–20 | $240 – $240 |
| 13 | Avera Merrill Pioneer Rock Rapids, IA case rate · outpatient | 2 | $258 | $258 | — | — | 2–20 | $258 – $258 |
| 14 | Avera Specialty Hospital Sioux Falls, SD case rate · outpatient | 2 | $67 | $67 | — | — | 2–20 | $67 – $67 |
| 15 | Monument Health Network Inc Sturgis, SD percent of total billed charges · outpatientfrom % of charges | 2 | $124 | $124 | $65 | 53% | 2–20 | $59 – $189 |
| 16 | Pella Regional Health Center Pella, IA other · outpatient | 2 | $208 | $208 | $0 | 0% | 2–20 | $208 – $208 |
| 17 | Sanford Sheldon Medical Center Sheldon, IA other · outpatient | 2 | $183 | $183 | $61 | 33% | 2–20 | $122 – $244 |
| 18 | Sioux Center Health Sioux Center, IA case rate · inpatient | 2 | $127 | $127 | — | — | 2–20 | $127 – $127 |
| 19 | Avera Dell Rapids Hospital Dell Rapids, SD outpatient | 1 | $210 | $210 | — | — | 1–10 | $210 – $210 |
| 20 | Avera Dell Rapids Hospital Dell Rapids, SD percent of total billed charges · outpatientfrom % of charges | 1 | $210 | $210 | — | — | 1–10 | $210 – $210 |
| 21 | Avera Flandreau Hospital Flandreau, SD outpatient | 1 | $172 | $172 | — | — | 1–10 | $172 – $172 |
| 22 | Avera Flandreau Hospital Flandreau, SD percent of total billed charges · outpatientfrom % of charges | 1 | $172 | $172 | — | — | 1–10 | $172 – $172 |
| 23 | Avera Gregory Hospital Gregory, SD outpatient | 1 | $226 | $226 | — | — | 1–10 | $226 – $226 |
| 24 | Avera Gregory Hospital Gregory, SD percent of total billed charges · outpatientfrom % of charges | 1 | $168 | $168 | — | — | 1–10 | $168 – $168 |
| 25 | Avera Hand County Hospital Miller, SD outpatient | 1 | $250 | $250 | — | — | 1–10 | $250 – $250 |
← Payers reporting CPT 97164 · Snapshot 20261111T120946Z-9134e7f7