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
DIPYRIDAMOLE 5 MG/ML INTRAVENOUS SOLUTION
Low
$4
Average
$23
Median
$4
High
$139
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
24 hospitals; the 90th percentile is 23.8× 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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38 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 | $4 | $4 | — | — | — | $4 – $4 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 3 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 4 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 5 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 6 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 7 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 8 | Grinnell Regional Medical Center Grinnell, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 9 | Mercy Fitzgerald Hospital Darby, PA facility · fee schedule · both | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 10 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 11 | Mercy Medical Center-Clinton Inc Clinton, IA facility · fee schedule · both | 2 | $19 | $19 | — | — | — | $19 – $19 |
| 12 | Meriter Hospital, Inc Madison, WI fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 13 | Nazareth Hospital Philadelphia, PA facility · fee schedule · both | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 14 | Northwest Iowa Hospital Corporation Sioux City, IA fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 15 | Northwest Iowa Hospital Corporation Sioux City, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 16 | St Joseph Mercy Ann Arbor Ypsilanti, MI facility · fee schedule · both | 1 | $94 | $94 | — | — | — | $94 – $94 |
| 17 | St Joseph Mercy Livingston Hospital | Trinity Health Medical Center - Brighton Brighton, MI facility · fee schedule · both | 1 | $96 | $96 | — | — | — | $96 – $96 |
| 18 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · both | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 19 | St Luke's Methodist Hospital Marion, IA fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 20 | St Luke's Methodist Hospital Marion, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 21 | St. Francis Hospital Inc Wilmington, DE facility · fee schedule · both | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 22 | The Finley Hospital Dubuque, IA fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 23 | The Finley Hospital Dubuque, IA fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 24 | Trinity Medical Center Rock Island, IL case rate · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 25 | Trinity Medical Center Rock Island, IL fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
← Payers reporting HCPCS J1245 · Snapshot 20261111T120946Z-9134e7f7