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
TEE w or w/o fol w/cont, mon
Low
$551
Average
$1.1k
Median
$771
High
$2.8k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
23 hospitals; the 90th percentile is 3.4× 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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28 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 case rate · outpatient | 1 | $743 | $743 | — | — | — | $743 – $743 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 2 | $801 | $801 | — | — | — | $801 – $801 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · other · both | 1 | $749 | $749 | — | — | — | $749 – $749 |
| 4 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $752 | $752 | — | — | — | $752 – $752 |
| 5 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $752 | $752 | — | — | — | $752 – $752 |
| 6 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $1.1k | $1.1k | $53 | 5% | — | $1.1k – $1.2k |
| 7 | Mercy Fitzgerald Hospital Darby, PA facility · fee schedule · both | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 8 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 9 | MercyOne Genesis Davenport Medical Center IA 52803; 2140 53rd Avenue Bettendorf, IA facility · fee schedule · outpatient | 1 | $756 | $756 | — | — | — | $756 – $756 |
| 10 | MercyOne Genesis Davenport West Medical Center Davenport, IA facility · fee schedule · outpatient | 1 | $756 | $756 | — | — | — | $756 – $756 |
| 11 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · outpatient | 1 | $462 | $462 | — | — | — | $462 – $462 |
| 12 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · fee schedule · outpatient | 1 | $824 | $824 | — | — | — | $824 – $824 |
| 13 | Mount Carmel East Reynoldsburg, OH facility · other · both | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 14 | Mount Carmel Grove City Grove City, OH facility · other · both | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 15 | Mount Carmel St Ann's Lewis Center, OH facility · other · both | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 16 | Northwest Iowa Hospital Corporation Sioux City, IA case rate · outpatient | 1 | $785 | $785 | — | — | — | $785 – $785 |
| 17 | Samaritan Hospital Troy, NY facility · other · both | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 18 | Samaritan Hospital Troy, NY facility · percent of total billed charges · bothfrom % of charges | 2 | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 19 | St Luke's Methodist Hospital Marion, IA case rate · outpatient | 1 | $747 | $747 | — | — | — | $747 – $747 |
| 20 | St Mary Medical Center Langhorne, PA facility · fee schedule · both | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 21 | The Finley Hospital Dubuque, IA case rate · outpatient | 1 | $771 | $771 | — | — | — | $771 – $771 |
| 22 | Trinity Medical Center Rock Island, IL case rate · outpatient | 1 | $840 | $840 | — | — | — | $840 – $840 |
| 23 | Trinity Medical Center Rock Island, IL percent of total billed charges · outpatientfrom % of charges | 1 | $869 | $869 | — | — | — | $869 – $869 |
| 24 | Trinity Medical Center Bettendorf, IA case rate · outpatient | 1 | $743 | $743 | — | — | — | $743 – $743 |
| 25 | Trinity Regional Medical Center Fort Dodge, IA case rate · outpatient | 1 | $743 | $743 | — | — | — | $743 – $743 |
← Payers reporting HCPCS C8927 · Snapshot 20261112T181611Z-3fa9fb76