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
facility
Low
$10
Average
$250
Median
$213
High
$947
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
47 hospitals; the 90th percentile is 31.5× 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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69 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 | Sanford USD Medical Center Sioux Falls, SD other · outpatient | 1 | $460 | $460 | — | — | 1–10 | $460 – $460 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $449 | $449 | — | — | — | $449 – $449 |
| 3 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 3 | $419 | $419 | — | — | — | $419 – $419 |
| 4 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $947 | $947 | — | — | — | $947 – $947 |
| 5 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $947 | $947 | — | — | — | $947 – $947 |
| 6 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $25 | $25 | $10 | 39% | — | $15 – $34 |
| 7 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $449 | $449 | — | — | — | $449 – $449 |
| 8 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 3 | $419 | $419 | — | — | — | $419 – $419 |
| 9 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 3 | $419 | $419 | — | — | — | $419 – $419 |
| 10 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $592 | $592 | — | — | — | $592 – $592 |
| 11 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 3 | $419 | $419 | — | — | — | $419 – $419 |
| 12 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 1 | $17 | $171 | $225 | 131% | — | $7 – $489 |
| 13 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $19 | $19 | $7 | 39% | — | $12 – $27 |
| 14 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $53 | $53 | $20 | 39% | — | $32 – $73 |
| 15 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $14 | $14 | $5 | 39% | — | $9 – $19 |
| 16 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $24 | $24 | $10 | 39% | — | $15 – $34 |
| 17 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $18 | $18 | $7 | 39% | — | $11 – $26 |
| 18 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $19 | $19 | $8 | 39% | — | $12 – $27 |
| 19 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $26 | $26 | $10 | 39% | — | $16 – $37 |
| 20 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $15 | $15 | $6 | 39% | — | $9 – $21 |
| 21 | Mishawaka Medical Center Mishawaka, IN facility · fee schedule · both | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 22 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $14 | $14 | $5 | 39% | — | $8 – $19 |
| 23 | Nazareth Hospital Philadelphia, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $53 | $53 | $20 | 39% | — | $32 – $73 |
| 24 | Northwest Iowa Hospital Corporation Sioux City, IA case rate · outpatient | 1 | $449 | $449 | — | — | — | $449 – $449 |
| 25 | Northwest Iowa Hospital Corporation Sioux City, IA fee schedule · both | 3 | $419 | $419 | — | — | — | $419 – $419 |
← Payers reporting HCPCS L3906 · Snapshot 20261111T120946Z-9134e7f7