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
HC Topical Fluoride Varnish Appl
Low
$14
Average
$406
Median
$19
High
$5.8k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
25 hospitals; the 90th percentile is 60.3× 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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31 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 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 2 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $62 | $62 | — | — | — | $62 – $62 |
| 3 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $62 | $62 | — | — | — | $62 – $62 |
| 4 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 5 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 6 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 7 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $328 | $328 | $15 | 5% | — | $313 – $343 |
| 8 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · both | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 9 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · inpatient | 1 | $362 | $362 | — | — | — | $362 – $362 |
| 10 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · per diem · inpatient | 1 | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 11 | MercyOne Genesis DeWitt Medical Center DeWitt, IA facility · per diem · inpatient | 2 | $1.8k | $1.8k | $876 | 49% | — | $928 – $2.7k |
| 12 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · inpatient | 1 | $134 | $134 | — | — | — | $134 – $134 |
| 13 | Meriter Hospital, Inc Madison, WI percent of total billed charges · bothfrom % of charges | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 14 | Northwest Iowa Hospital Corporation Sioux City, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 15 | Plymouth Medical Center Plymouth, IN facility · other · outpatient | 1 | $5.8k | $5.8k | — | — | — | $5.8k – $5.8k |
| 16 | St Josephs Hospital Health Center Syracuse, NY professional · fee schedule · both | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 17 | St Luke's Methodist Hospital Marion, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 18 | St Mary Mercy Livonia Livonia, MI professional · fee schedule · inpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 20 | The Finley Hospital Dubuque, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 21 | Trinity Medical Center Rock Island, IL case rate · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 22 | Trinity Medical Center Rock Island, IL fee schedule · both | 2 | $18 | $19 | $2 | 9% | — | $18 – $22 |
| 23 | Trinity Medical Center Bettendorf, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 24 | Trinity Regional Medical Center Fort Dodge, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
| 25 | Unity Healthcare Muscatine, IA fee schedule · both | 3 | $18 | $19 | $1 | 8% | — | $18 – $21 |
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