Does Aspirus Divine Savior Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Aspirus Divine Savior Hospital. In a medical emergency, call 911.

Where is Aspirus Divine Savior Hospital?

2817 New Pinery Road, Portage, WI 53901, in Columbia County, Wisconsin.

What is the phone number of Aspirus Divine Savior Hospital?

(608) 742-4131, as listed by Medicare (CMS).

What is the Medicare star rating of Aspirus Divine Savior Hospital?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Aspirus Divine Savior Hospital — Portage, WI

Quick answers

Does Aspirus Divine Savior Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Aspirus Divine Savior Hospital. In a medical emergency, call 911.
Where is Aspirus Divine Savior Hospital?: 2817 New Pinery Road, Portage, WI 53901, in Columbia County, Wisconsin.
What is the phone number of Aspirus Divine Savior Hospital?: (608) 742-4131, as listed by Medicare (CMS).
What is the Medicare star rating of Aspirus Divine Savior Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Cardiovascular Disease
Clinical Nutrition
Emergency Medicine
Family Medicine
Hospital Medicine
Infectious Disease
Nurse Anesthesia
Obstetrics & Gynecology
Orthopaedic Surgery
Pathology
Pediatrics
Physical Medicine & Rehabilitation
Podiatry
Psychology, Mental Health
Pulmonary Disease
Radiology

Treatments^[4]

Physical Therapy
Occupational Therapy
Speech-Language Pathology
Athletic Training

Programs and centers^[4][5][6]

Sexual Assault Treatment (SANE Program)
Emergency Department
Birthing Center
Urgent Care
Walk-In Medicine

Emergency care (hospital website)^[4][5]

Emergency room	Yes
Open 24/7	Yes

Doctors and clinicians (169)

169 doctors and other clinicians list Aspirus Divine Savior Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 145 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

SSM Health St Clare Hospital - Baraboo14 mi · Baraboo, WI · Acute Care Hospital
Sauk Prairie Hospital23 mi · Prairie Du Sac, WI · Acute Care Hospital
Reedsburg Area Medical Center26 mi · Reedsburg, WI · Critical Access Hospital
Columbus Community Hospital27 mi · Columbus, WI · Critical Access Hospital
Marshfield Medical Center - Beaver Dam (MMC-BD)33 mi · Beaver Dam, WI · Acute Care Hospital

Other hospitals nearby

UW Health Rehabilitation Hospital30 mi · Madison, WI · Inpatient Rehabilitation Hospital
Mendota Mental Health Institute30 mi · Madison, WI · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Columbia Health Care Center9.2 mi · Wyocena, WI · 5 of 5 stars
Complete Care at Jefferson Meadows LLC14 mi · Baraboo, WI · 2 of 5 stars
Wisconsin Dells Health Services15 mi · Wisconsin Dells, WI · 4 of 5 stars

All nursing homes in the state →

Hospice providers

SSM Health at Home Hospice14 mi · Baraboo, WI · 3 of 5 stars
St Croix Hospice Baraboo14 mi · Baraboo, WI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Aveanna Home Health14 mi · Baraboo, WI

All home health agencies in the state →

Dialysis facilities

Aspirus Divine Savior Hospital Dialysis0.8 mi · Portage, WI · 1 of 5 stars
Fresenius Medical Care - Baraboo14 mi · Baraboo, WI · 2 of 5 stars
DaVita Lake Delton Dialysis16 mi · Wisconsin Dells, WI · 3 of 5 stars

All dialysis facilities in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Clinics and urgent care

Aspirus Portage Clinic0.8 mi · Portage, WI · Rural health clinic
Delton Family Medical Center16 mi · Wisconsin Dells, WI · Rural health clinic
Aspirus Oxford Clinic16 mi · Oxford, WI · Rural health clinic

Pharmacies

Divine Savior Healthcare, Inc.0.8 mi · Portage, WI · Pharmacy
Wal-Mart Stores East LP0.8 mi · Portage, WI · Community/retail pharmacy
Walgreen Co0.8 mi · Portage, WI · Pharmacy

Assisted living nearby

Licensed homes from the official state licence list, by straight-line distance.

Aspirus Tivoli Community0.8 mi · Portage, WI
Hamilton Park Place0.8 mi · Portage, WI
Lake Place Group Home0.8 mi · Portage, WI
Our House Portage Assisted Care0.8 mi · Portage, WI

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Aspirus Divine Savior Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	2 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	3 of 5 stars
Rated the hospital 9 or 10 out of 10	63%National average: 72%
Would definitely recommend the hospital	58%National average: 71%
Nurses “always” communicated well	75%National average: 80%
Doctors “always” communicated well	73%National average: 80%
Staff “always” explained medicines before giving them	51%National average: 62%
Were given information about recovery at home	82%National average: 86%
Room and bathroom “always” clean	79%National average: 74%
Area around the room “always” quiet at night	50%National average: 60%
Completed surveys	169Response rate: 22%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0No different from the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	15.3%
Deaths within 30 days: pneumonia patients	13.6%
Deaths within 30 days: COPD patients	8.8%
Deaths within 30 days: stroke patients	11.9%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.96No different from the national rate
Complications after hip or knee replacement	Too few cases to report

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Too few cases to report
Readmitted within 30 days: heart failure	22.8%
Readmitted within 30 days: pneumonia	17.3%
Readmitted within 30 days: COPD	19.8%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	153 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	89%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Wisconsin Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 87 common services exactly as Aspirus Divine Savior Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/outpatient visit new	Not listed in the file	Not listed in the file	$63.61 – $300
New patient office visit (about 30–44 minutes): 10 of 44 insurance plan rates Aetna — Medicare Advantage Esa: $182 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $163.15 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $155.37 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $155.38 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $259.29 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $191.93 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $104.07 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $84.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $104.07 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $64.07
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$315	$204.75	Not listed in the file
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/Outpatient New Low Mdm	$396	$257.40	Not listed in the file
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/outpatient visit new	Not listed in the file	Not listed in the file	$110.94 – $514
New patient office visit (about 45–59 minutes): 10 of 45 insurance plan rates Aetna — Medicare Advantage Esa: $290.21 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $306.82 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $314.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $299.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $312.68 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $155.82 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $134.45 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $132.14 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $131.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $113.16
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$540	$351	Not listed in the file
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/Outpatient New Moderate Mdm	$541	$351.65	Not listed in the file
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/outpatient visit new	Not listed in the file	Not listed in the file	$146.41 – $630.85
New patient office visit (about 60–74 minutes): 10 of 26 insurance plan rates Aetna — Medicare Advantage Esa: $286.44 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $513.23 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $369.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $513.23 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $207.79 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $155.02 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $149.34 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $363.69 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $473.09 Dean Health Plan — Dean Health Plan Commercial Hmo: $431.35
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$706	$458.90	Not listed in the file
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/Outpatient New High Mdm	$750	$487.50	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/outpatient visit est	Not listed in the file	Not listed in the file	$51.65 – $263.79
Established patient office visit (about 20–29 minutes): 10 of 48 insurance plan rates Aetna — Medicare Advantage Esa: $125 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $154.95 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $124.39 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $145.22 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $143.96 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $157.72 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $83.21 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $67.90 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $73.70 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $84.88
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$243	$157.95	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/Outpatient Established Low Mdm	$268	$174.20	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: Office/outpatient visit est	Not listed in the file	Not listed in the file	$75.87 – $338.18
Established patient office visit (about 30–39 minutes): 10 of 48 insurance plan rates Aetna — Medicare Advantage Esa: $278.91 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $227.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $218.57 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $205.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $255.04 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $226.10 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $104.68 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $101.26 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $119.38 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $119.38
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$344	$223.60	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/Outpatient Established Mod Mdm	$399	$259.35	Not listed in the file
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: Office consultation	Not listed in the file	Not listed in the file	$76.42 – $446.16
Office consultation with a specialist (moderate): rates for 7 insurance plans Dean Health Plan — Dean Health Plan Commercial Hmo: $229.33 Dean Health Plan — Dean Health Plan Commercial Pos: $228.36 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $86.25 Multiplan, Inc — Aetna Health Plan Ppo Networks: $446.16 Quartz Health Solutions, Inc. — Quartz Wisconsin Medicaid Plans: $76.42 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $278.76 United Healthcare Of Wisconsin, Inc. — United Healthcare Wisconsin Medicaid Plans: $76.42
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$496	$322.40	Not listed in the file
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/OP Consltj New/Est Pt Low Mdm 30 Minutes	$308	$200.20	Not listed in the file
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: Office consultation	Not listed in the file	Not listed in the file	$329.44
Office consultation with a specialist (moderate to high): rates for 1 insurance plan The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $329.44
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$795	$516.75	Not listed in the file
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Office/OP Consltj New/Est Pt Mod Mdm 40 Minutes	$493	$320.45	Not listed in the file
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$86.78 – $362.43
Preventive checkup, new patient, age 18–39: 10 of 20 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $362.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $328.73 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $362.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $88.52 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $300.69 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $357.28 Dean Health Plan — Dean Health Plan Commercial Hmo: $264.33 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $88.52 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $88.52 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $253.75
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$426	$276.90	Not listed in the file
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$100.03 – $472.32
Preventive checkup, new patient, age 40–64: 10 of 18 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $419.48 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $399.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $356.56 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $102.03 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $364.39 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $454.96 Dean Health Plan — Dean Health Plan Commercial Hmo: $305.05 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $102.03 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $307.50 Multiplan, Inc — Aetna Health Plan Ppo Networks: $472.32
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$517	$336.05	Not listed in the file
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Hospital (facility) fee In the file: Pro Preventive Visit, New, Age 40-64	$517	$336.05	Not listed in the file
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$32.35 – $363.89
Emergency room visit (moderate): 10 of 45 insurance plan rates Aetna — Medicare Advantage Esa: $351.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $258.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $247.26 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $247.46 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $247.46 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $64.28 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $54.95 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $56.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $63.01 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $33
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$265.15 – $1,988.64
Emergency room visit (moderate): 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $265.15 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,988.64 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $270.45 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $278.41 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT LOW MDM	$399	$259.35	Not listed in the file
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$41.89 – $612.86
Emergency room visit (moderately high): 10 of 46 insurance plan rates Aetna — Medicare Advantage Esa: $484.71 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $470.31 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $440.31 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $399.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $419.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $419.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $92.93 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $94.36 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $95.36 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $94.20
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$405.30 – $3,039.75
Emergency room visit (moderately high): 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $405.30 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $3,039.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $413.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $425.57 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT MODERATE MDM	$672	$436.80	Not listed in the file
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$79.42 – $878.99
Emergency room visit (high): 10 of 43 insurance plan rates Aetna — Medicare Advantage Esa: $724.98 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $716.04 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $492.90 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $579.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $608.65 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $716.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $155.28 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $145.49 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $141.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $158.38
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$578.46 – $4,338.44
Emergency room visit (high): 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $578.46 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $4,338.44 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $590.03 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $607.38 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: EMERGENCY DEPARTMENT VISIT HIGH MDM	$949	$616.85	Not listed in the file

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Metabolic panel total ca	Not listed in the file	Not listed in the file	$8.46 – $63.45
Basic metabolic panel (blood test): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $8.46 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $50.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $8.63 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $57.05 Dean Health Plan — Dean Health Plan Commercial Hmo: $57.05 Dean Health Plan — Dean Health Plan Commercial Pos: $57.05 Dean Health Plan — Dean Health Plan Commercial Ppo: $57.05 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $8.88 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $44.42 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $44.42
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Doctor (professional) fee In the file: BASIC METABOLIC PANEL CALCIUM TOTAL	$142	$92.30	Not listed in the file
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Metabolic Panel Total Ca	$142	$92.30	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$10.56 – $79.20
Comprehensive metabolic panel (blood test): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $10.56 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $63.36 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $10.77 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $71.23 Dean Health Plan — Dean Health Plan Commercial Hmo: $71.23 Dean Health Plan — Dean Health Plan Commercial Pos: $71.23 Dean Health Plan — Dean Health Plan Commercial Ppo: $71.23 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $11.09 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $55.44 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $55.44
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPREHENSIVE METABOLIC PANEL	$175	$113.75	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Comprehen Metabolic Panel	$175	$113.75	Not listed in the file
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$41.20 – $358.58
Obstetric blood test panel: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $47.81 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $286.86 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $48.77 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $321.91 Dean Health Plan — Dean Health Plan Commercial Hmo: $321.91 Dean Health Plan — Dean Health Plan Commercial Pos: $321.91 Dean Health Plan — Dean Health Plan Commercial Ppo: $321.91 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $50.20 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $251 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $251
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee In the file: OBSTETRIC PANEL	$487	$316.55	Not listed in the file
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Obstetric Panel	$487	$316.55	Not listed in the file
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$13.39 – $100.42
Cholesterol panel (lipid panel): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $13.39 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $80.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $13.66 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $90.32 Dean Health Plan — Dean Health Plan Commercial Hmo: $90.32 Dean Health Plan — Dean Health Plan Commercial Pos: $90.32 Dean Health Plan — Dean Health Plan Commercial Ppo: $90.32 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $14.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $70.30 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $70.30
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Doctor (professional) fee In the file: LIPID PANEL	$165	$107.25	Not listed in the file
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Lipid Panel	$165	$107.25	Not listed in the file
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$8.68 – $65.10
Kidney function panel: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $8.68 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $52.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $8.85 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $58.58 Dean Health Plan — Dean Health Plan Commercial Hmo: $58.58 Dean Health Plan — Dean Health Plan Commercial Pos: $58.58 Dean Health Plan — Dean Health Plan Commercial Ppo: $58.58 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $9.11 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $45.57 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $45.57
Kidney function panel CPT 80069 · Inpatient or outpatient · Doctor (professional) fee In the file: RENAL FUNCTION PANEL	$158	$102.70	Not listed in the file
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Renal Function Panel	$158	$102.70	Not listed in the file
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$8.17 – $61.28
Liver function panel: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $8.17 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $49.02 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $8.33 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $55.07 Dean Health Plan — Dean Health Plan Commercial Hmo: $55.07 Dean Health Plan — Dean Health Plan Commercial Pos: $55.07 Dean Health Plan — Dean Health Plan Commercial Ppo: $55.07 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $8.58 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $42.89 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $42.89
Liver function panel CPT 80076 · Inpatient or outpatient · Doctor (professional) fee In the file: HEPATIC FUNCTION PANEL	$157	$102.05	Not listed in the file
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Hepatic Function Panel	$157	$102.05	Not listed in the file
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$3.17 – $23.78
Urine test (automated, with microscope): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $3.17 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $19.02 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3.23 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $21.36 Dean Health Plan — Dean Health Plan Commercial Hmo: $21.36 Dean Health Plan — Dean Health Plan Commercial Pos: $21.36 Dean Health Plan — Dean Health Plan Commercial Ppo: $21.36 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3.33 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $16.64 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $16.64
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Doctor (professional) fee In the file: URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$62	$40.30	Not listed in the file
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: Urine Macro and Microscopic Beaker1	$62	$40.30	Not listed in the file
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis nonauto w/o scope	Not listed in the file	Not listed in the file	$3.48 – $26.10
Urine test (manual, without microscope): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $3.48 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $20.88 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3.55 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $17.25 Dean Health Plan — Dean Health Plan Commercial Hmo: $17.25 Dean Health Plan — Dean Health Plan Commercial Pos: $17.25 Dean Health Plan — Dean Health Plan Commercial Ppo: $17.25 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3.65 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $18.27 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $18.27
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Doctor (professional) fee In the file: Urinalysis nonauto w/o scope	Not listed in the file	Not listed in the file	$10.40 – $16.51
Urine test (manual, without microscope): rates for 4 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $14.91 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $16.51 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $10.40 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $10.71
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Doctor (professional) fee In the file: URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$47	$30.55	Not listed in the file
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/o scope	Not listed in the file	Not listed in the file	$2.25 – $16.88
Urine test (automated, without microscope): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $2.25 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $13.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $2.30 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $15.13 Dean Health Plan — Dean Health Plan Commercial Hmo: $15.13 Dean Health Plan — Dean Health Plan Commercial Pos: $15.13 Dean Health Plan — Dean Health Plan Commercial Ppo: $15.13 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $2.36 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $11.81 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $11.81
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Doctor (professional) fee In the file: Urinalysis auto w/o scope	Not listed in the file	Not listed in the file	$2.30 – $44.16
Urine test (automated, without microscope): 10 of 19 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $9.64 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $9.19 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $9.19 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $9.65 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $12.69 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $40.48 Dean Health Plan — Dean Health Plan Commercial Hmo: $15.52 Dean Health Plan — Dean Health Plan Commercial Pos: $15.52 Dean Health Plan — Dean Health Plan Commercial Ppo: $15.52 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $2.30
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Doctor (professional) fee In the file: URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$47	$30.55	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay of psa total	Not listed in the file	Not listed in the file	$18.39 – $137.92
PSA (prostate specific antigen) blood test: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $18.39 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $110.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $18.76 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $124.03 Dean Health Plan — Dean Health Plan Commercial Hmo: $124.03 Dean Health Plan — Dean Health Plan Commercial Pos: $124.03 Dean Health Plan — Dean Health Plan Commercial Ppo: $124.03 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $19.31 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $96.55 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $96.55
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Doctor (professional) fee In the file: ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$182	$118.30	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Assay of Psa, Total	$182	$118.30	Not listed in the file
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$16.80 – $126
Thyroid stimulating hormone (TSH) test: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $16.80 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $100.80 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $17.14 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $113.35 Dean Health Plan — Dean Health Plan Commercial Hmo: $113.35 Dean Health Plan — Dean Health Plan Commercial Pos: $113.35 Dean Health Plan — Dean Health Plan Commercial Ppo: $113.35 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $17.64 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $88.20 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $88.20
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Doctor (professional) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$61.17
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $61.17
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Doctor (professional) fee In the file: ASSAY OF THYROID STIMULATING HORMONE TSH	$173	$112.45	Not listed in the file
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$7.77 – $58.28
Complete blood count (CBC) with differential: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $7.77 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $46.62 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $7.93 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $52.45 Dean Health Plan — Dean Health Plan Commercial Hmo: $52.45 Dean Health Plan — Dean Health Plan Commercial Pos: $52.45 Dean Health Plan — Dean Health Plan Commercial Ppo: $52.45 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $8.16 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $40.79 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $40.79
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Doctor (professional) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$28.30
Complete blood count (CBC) with differential: rates for 1 insurance plan Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $28.30
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Doctor (professional) fee In the file: BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$123	$79.95	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$6.47 – $48.52
Complete blood count (CBC), automated: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $6.47 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $38.82 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $6.60 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $43.65 Dean Health Plan — Dean Health Plan Commercial Hmo: $43.65 Dean Health Plan — Dean Health Plan Commercial Pos: $43.65 Dean Health Plan — Dean Health Plan Commercial Ppo: $43.65 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $6.79 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $33.97 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $33.97
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Doctor (professional) fee In the file: BLOOD COUNT COMPLETE AUTOMATED	$94	$61.10	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Complete Cbc, Automated	$94	$61.10	Not listed in the file
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin time	Not listed in the file	Not listed in the file	$4.29 – $32.18
Blood clotting time test (prothrombin time, PT): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $4.29 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $25.74 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $4.38 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $26.55 Dean Health Plan — Dean Health Plan Commercial Hmo: $26.55 Dean Health Plan — Dean Health Plan Commercial Pos: $26.55 Dean Health Plan — Dean Health Plan Commercial Ppo: $26.55 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $4.50 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $22.52 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $22.52
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Doctor (professional) fee In the file: PROTHROMBIN TIME	$71	$46.15	Not listed in the file
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: Prothrombin Time Beaker1	$71	$46.15	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$6.01 – $45.08
Blood clotting test (partial thromboplastin time, PTT): 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $6.01 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $36.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $6.13 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $40.49 Dean Health Plan — Dean Health Plan Commercial Hmo: $40.49 Dean Health Plan — Dean Health Plan Commercial Pos: $40.49 Dean Health Plan — Dean Health Plan Commercial Ppo: $40.49 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $6.31 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $31.55 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $31.55
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Doctor (professional) fee In the file: THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$100	$65	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Ptt, Partial Thromboplastin Beaker1	$100	$65	Not listed in the file

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$36.36 – $404.16
CT scan of the head or brain, without contrast: 10 of 30 insurance plan rates Aetna — Medicare Advantage Esa: $228 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $320.92 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $305.64 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $320.92 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $37.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $37.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $37.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $193.07 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $212.31 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $36.77
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$101.55 – $1,473.06
CT scan of the head or brain, without contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $101.55 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $761.61 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $103.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $624.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $624.85 Dean Health Plan — Dean Health Plan Commercial Pos: $624.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $624.85 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $106.63 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee In the file: CT HEAD/BRAIN W/O CONTRAST MATERIAL	$2,403	$1,561.95	Not listed in the file
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$338.87 – $6,069.44
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $338.87 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $2,541.54 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $345.65 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $2,435.38 Dean Health Plan — Dean Health Plan Commercial Hmo: $2,435.38 Dean Health Plan — Dean Health Plan Commercial Pos: $2,435.38 Dean Health Plan — Dean Health Plan Commercial Ppo: $2,435.38 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $355.82 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$98.83 – $1,118.76
MRI of the brain, before and after contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $621 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $826.59 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $826.59 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $100.81 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $644.90 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $571.14 Dean Health Plan — Dean Health Plan Commercial Hmo: $219.12 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $120.66 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $98.83 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $306.44
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$8,565	$5,567.25	Not listed in the file
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Doctor (professional) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$8.53 – $135.52
Chest X-ray, 2 views: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $59 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $69.31 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $66.01 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $66.01 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $69.31 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $69.31 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $9.69 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $9.69 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $9.69 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $9.69
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$84.53 – $1,473.06
Chest X-ray, 2 views: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $84.53 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $633.98 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $86.22 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $302.69 Dean Health Plan — Dean Health Plan Commercial Hmo: $302.69 Dean Health Plan — Dean Health Plan Commercial Pos: $302.69 Dean Health Plan — Dean Health Plan Commercial Ppo: $302.69 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $88.76 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Doctor (professional) fee In the file: RADIOLOGIC EXAM CHEST 2 VIEWS	$484	$314.60	Not listed in the file
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$101.55 – $1,473.06
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $101.55 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $761.61 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $103.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $449.06 Dean Health Plan — Dean Health Plan Commercial Hmo: $449.06 Dean Health Plan — Dean Health Plan Commercial Pos: $449.06 Dean Health Plan — Dean Health Plan Commercial Ppo: $449.06 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $106.63 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$11.68 – $103.11
X-ray of the lower spine, at least 4 views: rates for 8 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $11.92 Dean Health Plan — Dean Health Plan Commercial Hmo: $25.61 Dean Health Plan — Dean Health Plan Medicare Advantage: $11.92 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $103.11 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $11.68 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $35.94 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $93.54 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $11.92
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee In the file: RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$550	$357.50	Not listed in the file
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$52.25 – $851.84
MRI of the lower back (lumbar spine), without contrast: 10 of 20 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $479.67 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $52.25 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $65.32 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $417.97 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $371.33 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $851.84 Dean Health Plan — Dean Health Plan Commercial Hmo: $128.05 Dean Health Plan — Dean Health Plan Medicare Advantage: $65.32 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $75.90 First Health Group Corp — First Health National Rental Ppo Network: $124.47
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$231.76 – $3,892.72
MRI of the lower back (lumbar spine), without contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $231.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,738.21 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $236.40 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $1,456.43 Dean Health Plan — Dean Health Plan Commercial Hmo: $1,456.43 Dean Health Plan — Dean Health Plan Commercial Pos: $1,456.43 Dean Health Plan — Dean Health Plan Commercial Ppo: $1,456.43 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $243.35 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$5,504	$3,577.60	Not listed in the file
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$170.37 – $1,473.06
CT scan of the pelvis, with contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $170.37 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,277.79 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $173.78 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $1,230.23 Dean Health Plan — Dean Health Plan Commercial Hmo: $1,230.23 Dean Health Plan — Dean Health Plan Commercial Pos: $1,230.23 Dean Health Plan — Dean Health Plan Commercial Ppo: $1,230.23 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $178.89 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$51.04 – $605.70
CT scan of the pelvis, with contrast: rates for 5 insurance plans Dean Health Plan — Dean Health Plan Commercial Hmo: $605.70 Dean Health Plan — Dean Health Plan Medicare Advantage: $51.04 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $421.37 Quartz Health Solutions, Inc. — Quartz Wisconsin Medicaid Plans: $58.41 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $52.08
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee In the file: CT PELVIS W/CONTRAST MATERIAL	$4,350	$2,827.50	Not listed in the file
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Doctor (professional) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$54.12 – $777.04
MRI of a leg joint (such as the knee), without contrast: 10 of 25 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $517.29 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $492.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $59.77 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $54.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $59.77 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $59.77 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $55.20 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $339.23 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $777.04 Dean Health Plan — Dean Health Plan Commercial Hmo: $130.18
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$231.76 – $3,438.24
MRI of a leg joint (such as the knee), without contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $231.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,738.21 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $236.40 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $1,456.43 Dean Health Plan — Dean Health Plan Commercial Hmo: $1,456.43 Dean Health Plan — Dean Health Plan Commercial Pos: $1,456.43 Dean Health Plan — Dean Health Plan Commercial Ppo: $1,456.43 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $243.35 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$4,966	$3,227.90	Not listed in the file
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee In the file: Ct abd & pelv w/contrast	Not listed in the file	Not listed in the file	$64.12 – $794.04
CT scan of the abdomen and pelvis, with contrast: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $642 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $692.19 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $794.04 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $659.23 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $692.19 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $692.19 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $80.35 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $64.27 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $80.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $80.34
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelv w/contrast	Not listed in the file	Not listed in the file	$338.87 – $2,541.54
CT scan of the abdomen and pelvis, with contrast: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $338.87 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $2,541.54 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $345.65 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $1,927.53 Dean Health Plan — Dean Health Plan Commercial Hmo: $1,927.53 Dean Health Plan — Dean Health Plan Commercial Pos: $1,927.53 Dean Health Plan — Dean Health Plan Commercial Ppo: $1,927.53 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $355.82 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee In the file: CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$5,834	$3,792.10	Not listed in the file
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$101.55 – $1,473.06
Ultrasound of the abdomen, complete: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $101.55 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $761.61 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $103.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $664.86 Dean Health Plan — Dean Health Plan Commercial Hmo: $664.86 Dean Health Plan — Dean Health Plan Commercial Pos: $664.86 Dean Health Plan — Dean Health Plan Commercial Ppo: $664.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $106.63 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$34.90 – $254.44
Ultrasound of the abdomen, complete: rates for 9 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $254.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $254.44 Dean Health Plan — Dean Health Plan Commercial Hmo: $77.54 Dean Health Plan — Dean Health Plan Commercial Pos: $77.54 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $47.14 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $34.90 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $107.82 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $240.83 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $36.32
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee In the file: US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$1,456	$946.40	Not listed in the file
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Doctor (professional) fee In the file: Ob us >/= 14 wks sngl fetus	Not listed in the file	Not listed in the file	$44.22 – $401.28
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $313.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $239.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $313.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $50.19 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $255.02 Dean Health Plan — Dean Health Plan Commercial Hmo: $75.62 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $50.19 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $50.19 Healthpartners — Health Partners Commercial Ppo: $401.28 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicaid Plans: $51.67
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >/= 14 wks sngl fetus	Not listed in the file	Not listed in the file	$101.55 – $1,473.06
Pregnancy ultrasound (after the first trimester): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $101.55 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $761.61 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $103.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $664.86 Dean Health Plan — Dean Health Plan Commercial Hmo: $664.86 Dean Health Plan — Dean Health Plan Commercial Pos: $664.86 Dean Health Plan — Dean Health Plan Commercial Ppo: $664.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $106.63 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Doctor (professional) fee In the file: US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$1,186	$770.90	Not listed in the file
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$30.20 – $322.08
Transvaginal ultrasound: 10 of 27 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $207.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $207.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $217.80 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $30.67 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $30.67 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $34.94 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $173.03 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $322.08 Dean Health Plan — Dean Health Plan Commercial Hmo: $66.88 Dean Health Plan — Dean Health Plan Medicare Advantage: $30.67
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$101.55 – $1,473.06
Transvaginal ultrasound: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $101.55 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $761.61 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $103.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $664.86 Dean Health Plan — Dean Health Plan Commercial Hmo: $664.86 Dean Health Plan — Dean Health Plan Commercial Pos: $664.86 Dean Health Plan — Dean Health Plan Commercial Ppo: $664.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $106.63 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee In the file: US TRANSVAGINAL	$1,051	$683.15	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$30.77 – $254.44
Diagnostic mammogram, one breast: 10 of 17 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $254.44 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $35.59 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $35.74 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $214.49 Dean Health Plan — Dean Health Plan Commercial Hmo: $77.54 Dean Health Plan — Dean Health Plan Medicare Advantage: $35.59 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $31.39 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $174.03 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $34.90 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $36.64
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$156.45 – $524.16
Diagnostic mammogram, one breast: rates for 8 insurance plans Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $524.16 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $524.16 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $524.16 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $524.16 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $524.16 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $524.16 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Premier Pos: $524.16 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $156.45
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$948	$616.20	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$38.28 – $288.11
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $149.81 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $265.17 Dean Health Plan — Dean Health Plan Commercial Hmo: $95.32 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $39.05 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $45.20 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $132.41 Quartz Health Solutions, Inc. — Quartz Medicare Advantage Plans: $43.04 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $288.11 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $43.91 United Healthcare Of Wisconsin, Inc. — United Healthcare Wisconsin Medicaid Plans: $38.28
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$200.41 – $671.23
Diagnostic mammogram, both breasts: rates for 8 insurance plans Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $671.23 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $671.23 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $671.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $671.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $671.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $671.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Premier Pos: $671.23 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $200.41
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$1,198	$778.70	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Doctor (professional) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$29.20 – $192
Screening mammogram, both breasts: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $155.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $192 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $192 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $192 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $33.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $33.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $33.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $29.78 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $141.03 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $33.01
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$165.57 – $554.24
Screening mammogram, both breasts: rates for 8 insurance plans Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $554.24 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $554.24 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $554.24 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $554.24 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $554.24 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $554.24 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Premier Pos: $554.24 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $165.57
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Doctor (professional) fee In the file: SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$720	$468	Not listed in the file

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$7.31 – $147.50
Electrocardiogram (ECG/EKG) with reading: 10 of 12 insurance plan rates Aetna — Medicare Advantage Esa: $147.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $102.23 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $97.37 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $102.24 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $19.58 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $92.60 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $12.88 Dean Health Plan — Dean Health Plan Commercial Hmo: $28.46 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $19.58 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $7.31
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$237	$154.05	Not listed in the file
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$3,148.99 – $23,617.45
Left heart catheterization (diagnostic): 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $3,148.99 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $23,617.45 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3,211.97 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3,306.44 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $12,276.75
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee In the file: L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I	$6,399	$4,159.35	Not listed in the file
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac L Hrt Cath W/Njx L Ventriculography Img S&I	$10,499	$6,824.35	Not listed in the file
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrophysiology evaluation	Not listed in the file	Not listed in the file	$7,576.07 – $56,820.50
Heart rhythm study (electrophysiology evaluation): 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $7,576.07 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $56,820.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $7,727.59 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $7,954.87 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $13,221.32
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Compre Electrophysiologic W/O Arrhyt Induction	$5,908	$3,840.20	Not listed in the file
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION	$2,989	$1,942.85	Not listed in the file
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tx atrial fib pulm vein isol	Not listed in the file	Not listed in the file	$17,943.23 – $190,414.14
Heart rhythm study with ablation for atrial fibrillation: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $25,388.55 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $190,414.14 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $25,896.32 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $26,657.98 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $17,943.23 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $17,943.23 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $17,943.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $17,943.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $17,943.23 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $17,943.23
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	$10,012	$6,507.80	Not listed in the file
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation	$27,244	$17,708.60	Not listed in the file
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$834.12 – $6,255.92
Sleep study (overnight, in a sleep lab): 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $834.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,255.92 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $850.80 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $875.83 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $4,155.28
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee In the file: POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$6,524	$4,240.60	Not listed in the file
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Polysomnography, 4 or More	$5,244	$3,408.60	Not listed in the file

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Doctor (professional) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$20.61 – $239.68
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 24 insurance plan rates Aetna — Medicare Advantage Esa: $93.69 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $239.68 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $152.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $80.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $37.28 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $28.53 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $40.13 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $145.77 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $21.02 Dean Health Plan — Dean Health Plan Commercial Hmo: $89.95
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$28.25 – $211.88
Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans Aetna — Medicare Advantage Esa: $28.25 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $211.88 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $28.82 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $93.65 Dean Health Plan — Dean Health Plan Commercial Hmo: $93.65 Dean Health Plan — Dean Health Plan Commercial Pos: $93.65 Dean Health Plan — Dean Health Plan Commercial Ppo: $93.65 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $29.66 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicare Advantage Plans: $29.10 Wps Health Plan — Wps Statewide Ppo/Pos/Epo Plans: $59.32
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Doctor (professional) fee In the file: THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES	$149	$96.85	Not listed in the file
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$95.70 – $717.75
Physical therapy evaluation (low complexity): rates for 10 insurance plans Aetna — Medicare Advantage Esa: $95.70 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $717.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $97.61 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $317.25 Dean Health Plan — Dean Health Plan Commercial Hmo: $317.25 Dean Health Plan — Dean Health Plan Commercial Pos: $317.25 Dean Health Plan — Dean Health Plan Commercial Ppo: $317.25 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $100.49 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicare Advantage Plans: $98.57 Wps Health Plan — Wps Statewide Ppo/Pos/Epo Plans: $200.97
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Doctor (professional) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$62.66 – $216.13
Physical therapy evaluation (low complexity): rates for 10 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $216.13 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $94.03 Dean Health Plan — Dean Health Plan Commercial Hmo: $207.73 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $67.74 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $95.31 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicaid Plans: $69.73 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicaid Plans: $68.40 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $199.23 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $95.15 United Healthcare Of Wisconsin, Inc. — United Healthcare Wisconsin Medicaid Plans: $62.66
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Doctor (professional) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS	$332	$215.80	Not listed in the file
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Doctor (professional) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$66.41 – $285.33
Physical therapy evaluation (moderate complexity): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $197.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $226.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $191.94 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $95.32 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $67.74 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $254.15 Dean Health Plan — Dean Health Plan Commercial Hmo: $200.56 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $67.74 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $93.23 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicaid Plans: $69.73
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$95.70 – $717.75
Physical therapy evaluation (moderate complexity): rates for 10 insurance plans Aetna — Medicare Advantage Esa: $95.70 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $717.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $97.61 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $317.25 Dean Health Plan — Dean Health Plan Commercial Hmo: $317.25 Dean Health Plan — Dean Health Plan Commercial Pos: $317.25 Dean Health Plan — Dean Health Plan Commercial Ppo: $317.25 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $100.49 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicare Advantage Plans: $98.57 Wps Health Plan — Wps Statewide Ppo/Pos/Epo Plans: $200.97
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Doctor (professional) fee In the file: PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS	$346	$224.90	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$95.70 – $717.75
Physical therapy evaluation (high complexity): rates for 10 insurance plans Aetna — Medicare Advantage Esa: $95.70 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $717.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $97.61 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $317.25 Dean Health Plan — Dean Health Plan Commercial Hmo: $317.25 Dean Health Plan — Dean Health Plan Commercial Pos: $317.25 Dean Health Plan — Dean Health Plan Commercial Ppo: $317.25 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $100.49 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicare Advantage Plans: $98.57 Wps Health Plan — Wps Statewide Ppo/Pos/Epo Plans: $200.97
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Doctor (professional) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS	$422	$274.30	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Physical Therapy Evaluation High Complex	$422	$274.30	Not listed in the file
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 30 minutes	Not listed in the file	Not listed in the file	$172.41 – $1,473.06
Psychotherapy, 30 minutes: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $172.41 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,293.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $175.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $181.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYCHOTHERAPY W/PATIENT 30 MINUTES	$282	$183.30	Not listed in the file
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Psychotherapy W/Patient 30 Minutes	$119	$77.35	Not listed in the file
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$172.41 – $1,473.06
Psychotherapy, 45 minutes: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $172.41 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,293.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $175.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $181.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYCHOTHERAPY W/PATIENT 45 MINUTES	$375	$243.75	Not listed in the file
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Psychotherapy W/Patient 45 Minutes	$157	$102.05	Not listed in the file
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$172.41 – $1,473.06
Psychotherapy, 60 minutes: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $172.41 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,293.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $175.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $181.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: PSYCHOTHERAPY W/PATIENT 60 MINUTES	$563	$365.95	Not listed in the file
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Psychotherapy W/Patient 60 Minutes	$235	$152.75	Not listed in the file
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$172.41 – $1,473.06
Family psychotherapy, without the patient: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $172.41 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,293.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $175.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $181.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$453	$294.45	Not listed in the file
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Family Psychotherapy W/O Patient Present 50 Mins	$281	$182.65	Not listed in the file
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$172.41 – $1,473.06
Family psychotherapy, with the patient: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $172.41 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,293.05 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $175.86 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $181.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$471	$306.15	Not listed in the file
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Family Psychotherapy W/Patient Present 50 Mins	$292	$189.80	Not listed in the file
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$98.68 – $1,473.06
Group psychotherapy: 10 of 13 insurance plan rates Aetna — Medicare Advantage Esa: $98.68 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $740.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $100.65 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $103.61 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Ppo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Hmo Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Indemnity Plans: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Pos Plans: $1,473.06
Group psychotherapy CPT 90853 · Inpatient or outpatient · Doctor (professional) fee In the file: GROUP PSYCHOTHERAPY	$131	$85.15	Not listed in the file
Group psychotherapy CPT 90853 · Inpatient or outpatient · Hospital (facility) fee In the file: Grp Psyctx Pbb	$48	$31.20	Not listed in the file

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$3,803.19 – $28,523.91
Removal of breast growth (open surgery): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $3,803.19 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $28,523.91 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3,879.25 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $4,536.24 Dean Health Plan — Dean Health Plan Commercial Hmo: $4,536.24 Dean Health Plan — Dean Health Plan Commercial Pos: $4,536.24 Dean Health Plan — Dean Health Plan Commercial Ppo: $4,536.24 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3,993.35 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $12,276.75
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$305.92 – $1,234.22
Removal of breast growth (open surgery): rates for 3 insurance plans Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $373.66 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $1,234.22 United Healthcare Of Wisconsin, Inc. — United Healthcare Wisconsin Medicaid Plans: $305.92
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION	$3,312	$2,152.80	Not listed in the file
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$12,470.63 – $93,529.71
Total hip replacement: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $12,470.63 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $93,529.71 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $12,720.04 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $16,283.93 Dean Health Plan — Dean Health Plan Commercial Hmo: $16,283.93 Dean Health Plan — Dean Health Plan Commercial Pos: $16,283.93 Dean Health Plan — Dean Health Plan Commercial Ppo: $16,283.93 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $13,094.16 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $13,221.32
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$296.48 – $7,683.93
Total hip replacement: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $2,299.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $2,489.80 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $2,312.80 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $6,665.57 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $376.19 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $7,683.93 Dean Health Plan — Dean Health Plan Commercial Hmo: $1,386.19 Dean Health Plan — Dean Health Plan Commercial Pos: $2,511.97 Dean Health Plan — Dean Health Plan Medicare Advantage: $371.43 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $326.40
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT	$10,266	$6,672.90	Not listed in the file
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$261.12 – $3,611.52
Total knee replacement: 10 of 22 insurance plan rates Aetna — Medicare Advantage Esa: $328.94 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $1,069.22 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $349.73 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $340.28 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $300.58 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $277.44 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $1,956.07 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $334.60 Dean Health Plan — Dean Health Plan Commercial Hmo: $1,310.04 Dean Health Plan — Dean Health Plan Commercial Pos: $1,251.37
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$12,212.95 – $93,529.71
Total knee replacement: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $12,470.63 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $93,529.71 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $12,720.04 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $12,212.95 Dean Health Plan — Dean Health Plan Commercial Hmo: $12,212.95 Dean Health Plan — Dean Health Plan Commercial Pos: $12,212.95 Dean Health Plan — Dean Health Plan Commercial Ppo: $12,212.95 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $13,094.16 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $13,221.32
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS	$10,521	$6,838.65	Not listed in the file
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: Shoulder arthroscopy/surgery	Not listed in the file	Not listed in the file	$154.68 – $977.54
Shoulder arthroscopy: shaving of shoulder bone: rates for 5 insurance plans Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $608.88 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicaid Plans: $587.95 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $977.54 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $154.68 United Healthcare Of Wisconsin, Inc. — United Healthcare Wisconsin Medicaid Plans: $570.83
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Shoulder arthroscopy/surgery	Not listed in the file	Not listed in the file	$7,560.40
Shoulder arthroscopy: shaving of shoulder bone: rates for 4 insurance plans Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $7,560.40 Dean Health Plan — Dean Health Plan Commercial Hmo: $7,560.40 Dean Health Plan — Dean Health Plan Commercial Pos: $7,560.40 Dean Health Plan — Dean Health Plan Commercial Ppo: $7,560.40
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	$4,027	$2,617.55	Not listed in the file
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$3,178.20 – $23,836.50
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $3,178.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $23,836.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3,241.76 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $7,560.40 Dean Health Plan — Dean Health Plan Commercial Hmo: $7,560.40 Dean Health Plan — Dean Health Plan Commercial Pos: $7,560.40 Dean Health Plan — Dean Health Plan Commercial Ppo: $7,560.40 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3,337.11 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $12,276.75
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$72.10 – $3,860.56
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $3,823.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $3,641.07 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $3,860.56 Dean Health Plan — Dean Health Plan Commercial Hmo: $660.10 Dean Health Plan — Dean Health Plan Commercial Pos: $1,084.90 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $554.63 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $72.10 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $2,614.65 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $486.80 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $510.22
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: ARTHRS KNEE SURG W/MENISCECTOMY MED/LAT W/SHVG	$4,387	$2,851.55	Not listed in the file
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$5,750.12 – $43,125.92
Removal of tonsils and adenoids (under age 12): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $5,750.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $43,125.92 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $5,865.13 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $5,815.69 Dean Health Plan — Dean Health Plan Commercial Hmo: $5,815.69 Dean Health Plan — Dean Health Plan Commercial Pos: $5,815.69 Dean Health Plan — Dean Health Plan Commercial Ppo: $5,815.69 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $6,037.63 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $13,221.32
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$130.56
Removal of tonsils and adenoids (under age 12): rates for 1 insurance plan Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $130.56
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: TONSILLECTOMY & ADENOIDECTOMY <AGE 12	$2,381	$1,547.65	Not listed in the file
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$880.98 – $6,607.38
Upper GI endoscopy (diagnostic): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $880.98 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,607.38 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $898.60 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Pos: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $2,907.85 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $925.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$96 – $904.82
Upper GI endoscopy (diagnostic): rates for 8 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $870.11 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $828.68 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $904.82 Dean Health Plan — Dean Health Plan Commercial Hmo: $509.46 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $118.44 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $779.57 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $116.11 United Healthcare Of Wisconsin, Inc. — United Healthcare Wisconsin Medicaid Plans: $96
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,107	$1,369.55	Not listed in the file
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$62.19 – $2,336.64
Upper GI endoscopy with biopsy: 10 of 35 insurance plan rates Aetna — Medicare Advantage Esa: $706.25 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $422.40 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $467.46 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $1,100 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $374 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $119.94 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $115.79 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $120.99 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $113.43 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $114.24
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$880.98 – $6,607.38
Upper GI endoscopy with biopsy: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $880.98 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,607.38 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $898.60 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $925.03 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$2,434	$1,582.10	Not listed in the file
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: Diagnostic colonoscopy	Not listed in the file	Not listed in the file	$80 – $2,444.64
Colonoscopy (diagnostic): 10 of 33 insurance plan rates Aetna — Medicare Advantage Esa: $897.18 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $814 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $767 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $682 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $83.18 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $163.07 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $86.96 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $141.22 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $351.69 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $825.55
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic colonoscopy	Not listed in the file	Not listed in the file	$903.30 – $6,774.74
Colonoscopy (diagnostic): 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $903.30 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,774.74 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $921.36 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $948.46 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$2,778	$1,805.70	Not listed in the file
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$116.84 – $3,186.24
Colonoscopy with biopsy: 10 of 37 insurance plan rates Aetna — Medicare Advantage Esa: $672.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,050.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $322.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $704 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $1,422.23 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $179.86 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $153.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $134.22 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $179.86 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $211.18
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$1,162.34 – $8,717.53
Colonoscopy with biopsy: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $1,162.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $8,717.53 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $1,185.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $1,220.45 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $6,232.92 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $6,232.92
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$3,319	$2,157.35	Not listed in the file
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$97.92 – $3,580.80
Colonoscopy with removal of polyps (snare): 10 of 36 insurance plan rates Aetna — Medicare Advantage Esa: $1,823.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $792 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $1,637.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $837.80 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $1,109.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $194.83 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $228.33 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $227.40 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $115.32 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $476.76
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$1,162.34 – $8,717.53
Colonoscopy with removal of polyps (snare): 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $1,162.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $8,717.53 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $1,185.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $1,220.45 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $6,232.92 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $6,232.92
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$3,730	$2,424.50	Not listed in the file
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$1,162.34 – $8,717.53
Ultrasound of the lower bowel by endoscope: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $1,162.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $8,717.53 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $1,185.58 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $1,220.45 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $6,232.92 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $6,232.92
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Colsc Flx W/Ndsc US Xm Rctm Et Al Lmtd&Adj Strux	$3,849	$2,501.85	Not listed in the file
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$903.30 – $6,774.74
Screening colonoscopy (not high risk): 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $903.30 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,774.74 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $921.36 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $948.46 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$162.26 – $351.69
Screening colonoscopy (not high risk): rates for 9 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $165.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $165.50 Dean Health Plan — Dean Health Plan Medicare Advantage: $165.50 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $351.69 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $162.26 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $170.37 Quartz Health Solutions, Inc. — Quartz Medicare Advantage Plans: $162.26 United Healthcare Of Wisconsin, Inc. — United Healthcare Medicare Advantage Plans: $165.51 United Healthcare Of Wisconsin, Inc. — Va Community Care Network: $165.57
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: COLON CA SCRN NOT HI RSK IND	$1,990	$1,293.50	Not listed in the file
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$5,872.22 – $44,041.63
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $5,872.22 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $44,041.63 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $5,989.66 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $9,072.47 Dean Health Plan — Dean Health Plan Commercial Hmo: $9,072.47 Dean Health Plan — Dean Health Plan Commercial Pos: $9,072.47 Dean Health Plan — Dean Health Plan Commercial Ppo: $9,072.47 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $6,165.83 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $13,221.32 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $13,221.32
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$225.88 – $5,487.68
Gallbladder removal by laparoscope: 10 of 16 insurance plan rates Aetna — Medicare Advantage Esa: $3,664 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $1,699.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $241.81 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $225.88 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $5,487.68 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $630.06 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $231.48 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $274.21 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $2,371.69 Quartz Health Solutions, Inc. — Quartz Medicare Advantage Plans: $570.83
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPAROSCOPY SURG CHOLECYSTECTOMY	$6,236	$4,053.40	Not listed in the file
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$3,477.76 – $26,083.20
Groin (inguinal) hernia repair, age 5 or older: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $3,477.76 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $26,083.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3,547.31 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $5,234.12 Dean Health Plan — Dean Health Plan Commercial Hmo: $5,234.12 Dean Health Plan — Dean Health Plan Commercial Pos: $5,234.12 Dean Health Plan — Dean Health Plan Commercial Ppo: $5,234.12 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3,651.65 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $12,276.75
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$221.22 – $3,149.75
Groin (inguinal) hernia repair, age 5 or older: 10 of 11 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $3,110.10 Dean Health Plan — Dean Health Plan Commercial Hmo: $506.17 Dean Health Plan — Dean Health Plan Commercial Pos: $976.72 Dean Health Plan — Dean Health Plan Medicare Advantage: $464.02 Group Health Cooperative Of Eau Claire — Group Health Wisconsin Medicaid Hmo: $438.54 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $454.93 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $221.22 Multiplan, Inc — Aetna Health Plan Ppo Networks: $3,149.75 Security Health Plan Of Wisconsin, Inc. — Security Health Plan Wisconsin Medicare Advantage Plans: $473.36 United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: $2,676.57
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: R1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE	$4,163	$2,705.95	Not listed in the file
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: PROSTATE NEEDLE BIOPSY ANY APPROACH	$1,460	$949	Not listed in the file
Prostate biopsy CPT 55700 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Biopsy of Prostate	$2,349	$1,526.85	Not listed in the file
Prostate biopsy CPT 55700 · Inpatient or outpatient · Hospital (facility) fee In the file: Pro Biopsy of Prostate	$1,460	$949	Not listed in the file
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparo radical prostatectomy	Not listed in the file	Not listed in the file	$9,072.47 – $77,438.27
Prostate removal by laparoscope (radical prostatectomy): 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $10,325.10 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $77,438.27 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $10,531.61 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $9,072.47 Dean Health Plan — Dean Health Plan Commercial Hmo: $9,072.47 Dean Health Plan — Dean Health Plan Commercial Pos: $9,072.47 Dean Health Plan — Dean Health Plan Commercial Ppo: $9,072.47 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $10,841.36 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $17,943.23 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $17,943.23
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING	$9,908	$6,440.20	Not listed in the file
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$3,144.33 – $23,582.44
Hysteroscopy with biopsy of the uterus lining: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $3,144.33 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $23,582.44 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $3,207.21 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $4,536.24 Dean Health Plan — Dean Health Plan Commercial Hmo: $4,536.24 Dean Health Plan — Dean Health Plan Commercial Pos: $4,536.24 Dean Health Plan — Dean Health Plan Commercial Ppo: $4,536.24 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $3,301.54 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $12,276.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $12,276.75
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$181.31 – $1,501.16
Hysteroscopy with biopsy of the uterus lining: rates for 10 insurance plans Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $1,146.96 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $1,129.10 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $181.31 Dean Health Plan — Dean Health Plan Commercial Hmo: $448.90 Dean Health Plan — Dean Health Plan Commercial Pos: $509.47 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $195.84 Quartz Health Solutions, Inc. — Quartz Fully Insured And Self Insured Commercial Plans: $820.52 Quartz Health Solutions, Inc. — Quartz Medicare Advantage Plans: $620.93 The Alliance (F/K/A Employer Health Care Alliance Cooperativ — The Alliance Network Commercial Plans: $1,501.16 United Healthcare Of Wisconsin, Inc. — Va Community Care Network: $211.62
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C	$8,956	$5,821.40	Not listed in the file
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$685.65 – $5,142.34
Spinal injection, lower back (epidural), with imaging guidance: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $685.65 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $5,142.34 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $699.36 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Pos: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $2,907.85 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $719.93 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$89.18 – $545.71
Spinal injection, lower back (epidural), with imaging guidance: 10 of 14 insurance plan rates Aetna — Medicare Advantage Esa: $491.50 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $545.71 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $540.21 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $90.96 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $539.06 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $89.18 Dean Health Plan — Dean Health Plan Commercial Hmo: $192.32 Humana — Humana Medicare Ppo/Pos/Hmo Network Plans: $125.39 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicaid Plans: $199.10 Quartz Health Solutions, Inc. — Quartz Wisconsin Medicaid Plans: $189.62
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$846	$549.90	Not listed in the file
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: Inj foramen epidural l/s	Not listed in the file	Not listed in the file	$104.51 – $743.83
Nerve root injection, lower back, with imaging guidance: 10 of 24 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $637.10 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $606.77 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $664.56 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $153.67 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $157.03 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $104.68 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $153.67 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $308.75 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $688.58 Dean Health Plan — Dean Health Plan Commercial Hmo: $324.55
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj foramen epidural l/s	Not listed in the file	Not listed in the file	$859.12 – $6,443.38
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $859.12 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,443.38 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $876.30 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Pos: $2,907.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $2,907.85 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $902.07 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $4,155.28 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $4,155.28
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$1,046	$679.90	Not listed in the file
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$174.38 – $2,471.99
Carpal tunnel release: 10 of 20 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $1,177.14 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $2,471.99 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $202.15 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $404.30 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $355.74 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $1,066.14 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $2,040.54 Dean Health Plan — Dean Health Plan Commercial Hmo: $884.27 Dean Health Plan — Dean Health Plan Medicare Advantage: $411.85 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $355.74
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$1,896.75 – $14,225.59
Carpal tunnel release: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $1,896.75 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $14,225.59 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $1,934.68 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $1,991.58 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $9,442.86 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $9,442.86
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE	$2,865	$1,862.25	Not listed in the file
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$534.23 – $4,006.73
Laser treatment of clouding after cataract surgery: 10 of 17 insurance plan rates Aetna — Medicare Advantage Esa: $534.23 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $4,006.73 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $544.91 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Hmo: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Pos: $3,489.41 Dean Health Plan — Dean Health Plan Commercial Ppo: $3,489.41 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $560.94 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $1,473.06 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $1,473.06
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee In the file: POST-CATARACT LASER SURGERY	$2,963	$1,925.95	Not listed in the file
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Hospital (facility) fee In the file: Fac Post-Cataract Laser Surgery	$1,808	$1,175.20	Not listed in the file
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: Cataract surg w/iol 1 stage	Not listed in the file	Not listed in the file	$104.47 – $770
Cataract removal with lens implant: 10 of 19 insurance plan rates Aetna — Medicare Advantage Esa: $462 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $726 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $726 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $770 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $104.47 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $121.87 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $109.64 Aspirus Health Plan, Inc. — Aspirus Health Plan Medicare Advantage: $111.53 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $411.40 Dean Health Plan — Dean Health Plan Commercial Hmo: $436.69
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cataract surg w/iol 1 stage	Not listed in the file	Not listed in the file	$2,241.66 – $16,812.48
Cataract removal with lens implant: 10 of 18 insurance plan rates Aetna — Medicare Advantage Esa: $2,241.66 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $16,812.48 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $2,286.50 Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Pos: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $8,839.85 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $2,353.75 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Hmo: $9,442.86 Security Health Plan Of Wisconsin, Inc. — Security Administrative Services Pos: $9,442.86
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP	$7,113	$4,623.45	Not listed in the file

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$1,149.32 – $6,807.70
Vaginal delivery, with care before and after: 10 of 16 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $6,554.91 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $6,242.78 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $6,554.92 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $1,172.31 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $4,229.62 Dean Health Plan — Dean Health Plan Commercial Hmo: $5,415.29 Dean Health Plan — Dean Health Plan Commercial Pos: $4,332.23 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $1,172.31 Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: $4,270.94 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicaid Plans: $1,206.79
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$8,839.85
Vaginal delivery, with care before and after: rates for 4 insurance plans Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Pos: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $8,839.85
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM	$7,524	$4,890.60	Not listed in the file
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$1,149.32 – $7,966.62
Cesarean delivery (C-section), with care before and after: 10 of 12 insurance plan rates Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $7,173.10 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $5,549.85 Anthem Blue Cross Blue Shield Wisconsin — Anthem Wisconsin Medicaid Plans: $1,396.27 Aspirus Health Plan, Inc. — Aspirus Health Plan Hmo/Pos: $5,533.27 Cigna — Cigna Ppo And Open Access Plus Benefit Plans: $6,283.87 Dean Health Plan — Dean Health Plan Commercial Pos: $5,695.88 Dean Health Plan — Dean Health Plan Wisconsin Medicaid Plans: $1,172.31 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicaid Plans: $1,206.79 Managed Health Services Insurance Corp. — Managed Health Wisconsin Medicare Advantage Plans: $2,379.08 Quartz Health Solutions, Inc. — Quartz Wisconsin Medicaid Plans: $1,149.32
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$8,839.85
Cesarean delivery (C-section), with care before and after: rates for 4 insurance plans Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Pos: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $8,839.85
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM	$8,912	$5,792.80	Not listed in the file
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$8,839.85
Vaginal delivery after a previous C-section, with care before and after: rates for 4 insurance plans Dean Health Plan — Dean Health Plan Commercial Aso Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Hmo: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Pos: $8,839.85 Dean Health Plan — Dean Health Plan Commercial Ppo: $8,839.85
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB	$8,530	$5,544.50	Not listed in the file

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	Not listed in the file	Not listed in the file	$69,818.18 – $223,263.06
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $69,818.18 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $223,263.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $203,844.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $203,844.20 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $223,263.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $223,263.06 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $71,214.54 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $71,214.54 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $71,214.54 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $71,214.54
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Spinal Fusion Except Cervical Without Mcc	Not listed in the file	Not listed in the file	Not listed in the file
Spinal fusion (not neck), without major complications: rates for 5 insurance plans Cigna — Cigna Ppo And Open Access Plus Benefit Plans: 74.8% (a percentage in the contract, not a dollar amount) Group Health Cooperative Of South Central Wisconsin — Group Health Cooperative Commercial Hmo: 72.2% (a percentage in the contract, not a dollar amount) Multiplan, Inc — Aetna Health Plan Ppo Networks: 96% (a percentage in the contract, not a dollar amount) Multiplan, Inc — Health Eos Ppos Network Plans: 80% (a percentage in the contract, not a dollar amount) United Healthcare Of Wisconsin, Inc. — United Healthcare Hmo/Ppo/Pos/Epo Networks: 84% (a percentage in the contract, not a dollar amount)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	Not listed in the file	Not listed in the file	$14,407.92 – $44,021.36
Hip or knee replacement (major joint of the leg), without major complications: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $14,407.92 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $44,021.36 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $40,192.49 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $40,192.49 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $44,021.36 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $44,021.36 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $14,696.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $14,696.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $14,696.08 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $14,696.08
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cervical Spinal Fusion Without Cc/Mcc	Not listed in the file	Not listed in the file	$18,022.96 – $55,715.35
Neck (cervical) spinal fusion, without complications: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $18,022.96 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $55,715.35 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $50,869.37 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $50,869.37 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $55,715.35 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $55,715.35 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $18,383.42 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $18,383.42 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $18,383.42 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $18,383.42
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc	Not listed in the file	Not listed in the file	$9,552.58 – $28,315.26
Uterus and ovary surgery (not for cancer), without complications: 10 of 38 insurance plan rates Aetna — Medicare Advantage Esa: $9,552.58 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Access Ppo: $28,315.26 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Hmo: $25,852.47 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Preferred Pos: $25,852.47 Anthem Blue Cross Blue Shield Wisconsin — Anthem Blue Traditional Network: $28,315.26 Anthem Blue Cross Blue Shield Wisconsin — Anthem Federal Employee Program: $28,315.26 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Access Ppo: $9,743.63 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Dual Hmo Snp: $9,743.63 Anthem Blue Cross Blue Shield Wisconsin — Anthem Mediblue Plus Hmo: $9,743.63 Anthem Blue Cross Blue Shield Wisconsin — Anthem Medicare Advantage Plans: $9,743.63

Source: Aspirus Divine Savior Hospital’s standard charges file (aspirus.org, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the price transparency link on the hospital’s website (aspirus.org), because the hospital has no cms-hpt.txt file; both are required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	2817 New Pinery Road, Portage, WI 53901
County	Columbia County
State	Wisconsin
Phone	(608) 742‑4131
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	520041
Name in Medicare records	ASPIRUS DIVINE SAVIOR HOSPITAL
Profile level	Medicare data + hospital website
Official website	locations.aspirus.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Aspirus Divine Savior Hospital — locations.aspirus.org
Aspirus Divine Savior Hospital - Emergency Department — locations.aspirus.org
Aspirus Divine Savior Hospital - Birthing Center — locations.aspirus.org

Aspirus Divine Savior Hospital

Summary

Profile from official sources

At a glance