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
Hdr I192 Tx Source
Low
$141
Average
$524
Median
$451
High
$1.5k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
51 hospitals; the 90th percentile is 2.9× 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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57 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 | $641 | $641 | — | — | 194 | $641 – $641 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $349 | $349 | — | — | — | $349 – $349 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 2 | $357 | $357 | — | — | — | $357 – $357 |
| 4 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · other · both | 1 | $354 | $354 | — | — | — | $354 – $354 |
| 5 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $484 | $484 | — | — | — | $484 – $484 |
| 6 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $349 | $349 | — | — | — | $349 – $349 |
| 7 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $349 | $349 | — | — | — | $349 – $349 |
| 8 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $626 | $626 | $29 | 5% | — | $597 – $656 |
| 9 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $982 | $982 | — | — | — | $982 – $982 |
| 10 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 1 | $480 | $480 | $9 | 2% | — | $471 – $489 |
| 11 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $991 | $991 | — | — | — | $991 – $991 |
| 12 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $940 | $940 | — | — | — | $940 – $940 |
| 13 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $451 | $451 | — | — | — | $451 – $451 |
| 14 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $381 | $381 | — | — | — | $381 – $381 |
| 15 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $521 | $521 | — | — | — | $521 – $521 |
| 16 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $372 | $372 | — | — | — | $372 – $372 |
| 17 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · outpatient | 1 | $692 | $692 | — | — | — | $692 – $692 |
| 18 | MercyOne Genesis Davenport Medical Center IA 52803; 2140 53rd Avenue Bettendorf, IA facility · fee schedule · outpatient | 1 | $328 | $328 | — | — | — | $328 – $328 |
| 19 | MercyOne Genesis Davenport West Medical Center Davenport, IA facility · fee schedule · outpatient | 1 | $328 | $328 | — | — | — | $328 – $328 |
| 20 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · both | 1 | $255 | $255 | — | — | — | $255 – $255 |
| 21 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · fee schedule · outpatient | 1 | $357 | $357 | — | — | — | $357 – $357 |
| 22 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $3.8k | $3.8k | — | — | — | $3.8k – $3.8k |
| 23 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $544 | $544 | — | — | — | $544 – $544 |
| 24 | Monument Health Network Inc Spearfish, SD other · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 25 | Monument Health Network Inc Deadwood, SD percent of total billed charges · outpatientfrom % of charges | 2 | $550 | $550 | $260 | 47% | — | $290 – $810 |
← Payers reporting HCPCS C1717 · Snapshot 20261111T120946Z-9134e7f7