Avera Heart Hospital of South Dakota
AVERA HEART HOSPITAL OF SOUTH DAKOTA in Sioux Falls charges 6.5x the Medicare reimbursement rate across 41 analyzed procedures, reflecting the pricing patterns common among for-profit cardiac specialty hospitals.
Sioux Falls, SD 57108 · Acute Care Hospitals · CMS Rating: 5/5
About the analyst
Priya Iyengar leads the billing code review team at BillRazor Research. She analyzes NCCI bundling edits, DRG coding, and regional rate variation. Expertise: NCCI bundling, DRG analysis, regional pricing.
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Billing patterns — for-profit
For-profit hospitals in our dataset demonstrate distinct billing patterns, with 628 facilities showing an average markup of 7.8 times Medicare rates. These hospitals typically maintain higher charge structures across most service categories compared to non-profit and government facilities. Common patterns include substantial charges above benchmark rates for emergency services, surgical procedures, and diagnostic imaging. Patients should be aware that initial bills from for-profit hospitals often reflect chargemaster rates rather than negotiated insurance amounts. The billing structure frequently includes separate charges for facility fees, physician services, and ancillary services that may appear as multiple line items. Before receiving care, patients can request cost estimates and inquire about financial assistance programs, which are federally required at all hospital types. Understanding that insurance negotiations typically result in significantly lower actual payments than initial charges can help patients navigate the billing process more effectively when receiving care at for-profit facilities.
Pricing grade
D
High
Avg markup vs Medicare
6.54x
Charge / Medicare rate
Max markup
11.75x
Worst procedure
Procedures analyzed
41
With pricing data
Outlier procedures
0%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | 282 | $40,107 | $20,053 | — | 11.8x |
| PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | 175 | $78,961 | $39,481 | — | 10.8x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $111,426 | $55,713 | — | 9.9x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC | 322 | $103,114 | $51,557 | — | 9.3x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/ | 321 | $159,580 | $79,790 | — | 9.1x |
| EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | 039 | $53,442 | $26,721 | — | 8.8x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC | 251 | $80,570 | $40,285 | — | 8.3x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $36,849 | $18,424 | — | 8x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC | 244 | $85,936 | $42,968 | — | 8x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES O | 246 | $149,473 | $74,736 | — | 7.8x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $18,316 | $9,158 | — | 7.8x |
| OTHER VASCULAR PROCEDURES WITHOUT CC/MCC | 254 | $73,177 | $36,589 | — | 7.4x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $43,290 | $21,645 | — | 7.2x |
| OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC | 271 | $144,045 | $72,023 | — | 6.9x |
| PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC | 274 | $134,678 | $67,339 | — | 6.5x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | 243 | $93,109 | $46,555 | — | 6.5x |
| OTHER VASCULAR PROCEDURES WITH CC | 253 | $102,813 | $51,407 | — | 6.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $22,076 | $11,038 | — | 6.1x |
| AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC | 269 | $162,659 | $81,330 | — | 6.1x |
| PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC | 242 | $116,814 | $58,407 | — | 5.9x |
| MAJOR CHEST PROCEDURES WITHOUT CC/MCC | 165 | $67,869 | $33,934 | — | 5.9x |
| OTHER VASCULAR PROCEDURES WITH MCC | 252 | $124,665 | $62,333 | — | 5.9x |
| CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC | 235 | $228,913 | $114,456 | — | 5.8x |
| ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | 267 | $187,988 | $93,994 | — | 5.8x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $38,879 | $19,439 | — | 5.7x |
| OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC | 270 | $187,341 | $93,671 | — | 5.7x |
| CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC | 236 | $148,773 | $74,386 | — | 5.7x |
| CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC | 234 | $182,707 | $91,353 | — | 5.6x |
| CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC | 036 | $62,340 | $31,170 | — | 5.5x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $38,240 | $19,120 | — | 5.4x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $49,718 | $24,859 | — | 5.3x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | 286 | $69,794 | $34,897 | — | 5.3x |
| ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC | 266 | $224,184 | $112,092 | — | 5.2x |
| CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION | 220 | $178,168 | $89,084 | — | 5.1x |
| PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC | 273 | $124,355 | $62,177 | — | 5x |
| MAJOR CHEST PROCEDURES WITH CC | 164 | $77,652 | $38,826 | — | 4.8x |
| CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | 233 | $219,820 | $109,910 | — | 4.7x |
| CAROTID ARTERY STENT PROCEDURES WITH CC | 035 | $63,634 | $31,817 | — | 4.4x |
| EXTRACRANIAL PROCEDURES WITH CC | 038 | $40,570 | $20,285 | — | 4.4x |
| CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION | 219 | $215,753 | $107,877 | — | 4.3x |
| MAJOR CHEST PROCEDURES WITH MCC | 163 | $122,444 | $61,222 | — | 4x |
How AVERA HEART HOSPITAL OF SOUTH DAKOTA compares to nearby hospitals
Comparison based on average markup ratios from federal hospital pricing data (FY 2024). Chargemaster rates are gross charges — they are not what most insured patients pay. Actual costs depend on your insurance plan, negotiated rates, and coverage terms. This comparison is for informational purposes only and does not constitute medical, financial, or legal advice. Verify costs directly with your provider and insurer.
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use