Does Childrens Hospital of Wisconsin Fox Valley have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Childrens Hospital of Wisconsin Fox Valley. In a medical emergency, call 911.

Where is Childrens Hospital of Wisconsin Fox Valley?

130 Second St, Neenah, WI 54956, in Winnebago County, Wisconsin.

What is the phone number of Childrens Hospital of Wisconsin Fox Valley?

(920) 969-7900, as listed by Medicare (CMS).

What is the Medicare star rating of Childrens Hospital of Wisconsin Fox Valley?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Childrens Hospital of Wisconsin Fox Valley

Quick answers

Does Childrens Hospital of Wisconsin Fox Valley have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Childrens Hospital of Wisconsin Fox Valley. In a medical emergency, call 911.
Where is Childrens Hospital of Wisconsin Fox Valley?: 130 Second St, Neenah, WI 54956, in Winnebago County, Wisconsin.
What is the phone number of Childrens Hospital of Wisconsin Fox Valley?: (920) 969-7900, as listed by Medicare (CMS).
What is the Medicare star rating of Childrens Hospital of Wisconsin Fox Valley?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[4][5]

Pediatrics
Neonatology
Pediatrics (inpatient)
Pediatric hospital medicine
Neonatal intensive care
Occupational therapy (NICU)
Physical therapy (NICU)
Child life
Social work

Treatments^[4]

IV infusion (short stay procedures room)
Critical care for premature and critically ill newborns
Inpatient pediatric care
Occupational and physical therapy for infant growth and development

Programs and centers^[4][5][7]

Level III Neonatal Intensive Care Unit (NICU)
Pediatric inpatient unit
Short stay procedures room for IV infusion
Neonatal transport program
NICU transport program
Child life program
Social work services for families
Level III Neonatal Intensive Care Unit (NICU), 22 beds
Pediatric inpatient unit (20 beds)
Procedure room for treating children away from their hospital room
Pediatrician specially trained in hospital care on site 24/7
Neonatologists available 24/7
Pediatric specialist consultation from Milwaukee campus
Parent CPR training (NICU)
NICU rooms for parents to practice caring for baby before discharge
Hospital playroom
Interpreter and language services

Visiting and practical information

Visiting	Up to 4 visitors of any age at bedside (2 in Fox Valley NICU); visitor list up to 6 people^[5][6]
Parking	Visitors park in any lot marked VP and enter through the Children's Wisconsin doors^[4]
Interpreters and languages	Free face-to-face, phone and video interpreters for patient families, available 24/7; qualified medical interpreters only^[7]
Patient portal	MyChart

Other emergency rooms nearby

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

Thedacare Regional Med Ctr - Neenah0.0 mi · Neenah, WI · Acute Care Hospital
Ascension NE Wisconsin - St Elizabeth Campus7.6 mi · Appleton, WI · Acute Care Hospital
Thedacare Regional Medical Center - Appleton Inc9.3 mi · Appleton, WI · Acute Care Hospital
Aurora Medical Ctr Oshkosh11 mi · Oshkosh, WI · Acute Care Hospital
Thedacare Medical Center - New London17 mi · New London, WI · Critical Access Hospital

Other hospitals nearby

Winnebago Mental Health Institute7.4 mi · Winnebago, 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

Oakridge Gardens Nur Ctr, Inc6.7 mi · Menasha, WI · 5 of 5 stars
Peabody Manor6.7 mi · Appleton, WI · 2 of 5 stars
Brewster Village7.3 mi · Appleton, WI · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Compassus Neenah0.0 mi · Neenah, WI · 3 of 5 stars
Thedacare at Home9.2 mi · Appleton, WI · 4 of 5 stars
Moments Hospice of Appleton12 mi · Appleton, WI · 3 of 5 stars

All hospice providers in the state →

Home health agencies

Ascension at Home0.0 mi · Neenah, WI
PRN Home Health and Therapy, LLC9.2 mi · Appleton, WI · 4 of 5 stars
Thedacare at Home9.2 mi · Appleton, WI · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC - Neenah0.0 mi · Neenah, WI · 3 of 5 stars
FMC Dialysis - Appleton6.1 mi · Appleton, WI · 3 of 5 stars
Fresenius Medical Care Oshkosh12 mi · Oshkosh, WI · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Advanced Spine Center of Wisconsin0.0 mi · Neenah, WI
Orthopedic Surgery Center of the Fox Valley, LLC0.0 mi · Neenah, WI
Wisconsin Institute of Surgical Excellence LLC0.0 mi · Neenah, WI

All outpatient surgery centers 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.

Community health centers

Partnership Community Health Center - Medical and Behavioral Care5.9 mi · Appleton, WI · Community health center
Partnership Community Health Center - Appleton Dental5.9 mi · Appleton, WI · Community health center
Partnership Dental City Center Oshkosh12 mi · Oshkosh, WI · Community health center

Clinics and urgent care

American Current Care P.A.6.1 mi · Appleton, WI · Urgent care center
Urgent Care Physcians, Ltd9.2 mi · Appleton, WI · Urgent care center
Children's Health System12 mi · Appleton, WI · Urgent care center

Pharmacies

Accurabenefits, LLC0.0 mi · Neenah, WI · Pharmacy
Neenah Hometown Pharmacy LLC0.0 mi · Neenah, WI · Community/retail pharmacy
Roundys Supermarkets Inc0.0 mi · Neenah, WI · Community/retail pharmacy

Assisted living nearby

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

Adava Care of Irish Road0.0 mi · Neenah, WI
Adava Care of Neenah I0.0 mi · Neenah, WI
Adava Care of Neenah II0.0 mi · Neenah, WI
Alten Haus Edelweiss0.0 mi · Neenah, 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 Childrens Hospital of Wisconsin Fox Valley 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.

Not reported to Medicare

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	Not reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

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	Not reported to Medicare
Deaths within 30 days: heart failure patients	Not reported to Medicare
Deaths within 30 days: pneumonia patients	Not reported to Medicare
Deaths within 30 days: COPD patients	Not reported to Medicare
Deaths within 30 days: stroke patients	Not reported to Medicare
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Not reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026.

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	Not reported to Medicare
Readmitted within 30 days: heart failure	Not reported to Medicare
Readmitted within 30 days: pneumonia	Not reported to Medicare
Readmitted within 30 days: COPD	Not reported to Medicare
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.

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.

Average (median) time patients spent in the emergency room before leaving (OP-18b)	Not reported to Medicare
Patients who left the emergency room before being seen (OP-22)	Not reported to Medicare
Sepsis patients who got all the recommended early care (SEP-1)	Not reported to Medicare

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026.

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 68 common services exactly as Childrens Hospital of Wisconsin Fox Valley 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 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES	$490	$269.50	$74.38 – $465.50
New patient office visit (about 30–44 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $367.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $416.50 AETNA Health — Cofinity: $441 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $126.45 America's PPO — AMERICAS PPO MAYO: $426.30 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $254.20 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $81.82 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $352.80 Centivo — All Commercial Centivo plans: $357.70 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $78.84
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · both In the file: PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$490	$269.50	$74.38 – $465.50
New patient office visit (about 30–44 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $367.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $416.50 AETNA Health — Cofinity: $441 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $126.45 America's PPO — AMERICAS PPO MAYO: $426.30 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $254.20 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $81.82 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $352.80 Centivo — All Commercial Centivo plans: $357.70 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $78.84
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES	$734	$403.70	$110.94 – $697.30
New patient office visit (about 45–59 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $550.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $623.90 AETNA Health — Cofinity: $660.60 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $188.62 America's PPO — AMERICAS PPO MAYO: $638.58 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $388.03 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $122.03 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $528.48 Centivo — All Commercial Centivo plans: $535.82 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $117.60
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · both In the file: PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$734	$403.70	$110.94 – $697.30
New patient office visit (about 45–59 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $550.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $623.90 AETNA Health — Cofinity: $660.60 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $188.62 America's PPO — AMERICAS PPO MAYO: $638.58 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $388.03 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $122.03 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $528.48 Centivo — All Commercial Centivo plans: $535.82 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $117.60
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES	$970	$533.50	$146.41 – $921.50
New patient office visit (about 60–74 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $727.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $824.50 AETNA Health — Cofinity: $873 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $248.93 America's PPO — AMERICAS PPO MAYO: $843.90 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $487.54 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $161.05 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $698.40 Centivo — All Commercial Centivo plans: $708.10 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $155.19
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · both In the file: PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$970	$533.50	$146.41 – $921.50
New patient office visit (about 60–74 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $727.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $824.50 AETNA Health — Cofinity: $873 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $248.93 America's PPO — AMERICAS PPO MAYO: $843.90 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $487.54 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $161.05 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $698.40 Centivo — All Commercial Centivo plans: $708.10 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $155.19
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN	$387	$212.85	$60.42 – $367.65
Established patient office visit (about 20–29 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $290.25 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $328.95 AETNA Health — Cofinity: $348.30 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $102.74 America's PPO — AMERICAS PPO MAYO: $336.69 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $171.45 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $66.46 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $278.64 Centivo — All Commercial Centivo plans: $282.51 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $64.05
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · both In the file: PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$387	$212.85	$60.42 – $367.65
Established patient office visit (about 20–29 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $290.25 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $328.95 AETNA Health — Cofinity: $348.30 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $102.74 America's PPO — AMERICAS PPO MAYO: $336.69 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $171.45 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $66.46 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $278.64 Centivo — All Commercial Centivo plans: $282.51 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $64.05
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN	$520	$286	$85.58 – $494
Established patient office visit (about 30–39 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $390 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $442 AETNA Health — Cofinity: $468 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $145.50 America's PPO — AMERICAS PPO MAYO: $452.40 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $254.53 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $94.14 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $374.40 Centivo — All Commercial Centivo plans: $379.60 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $90.71
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · both In the file: PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$520	$286	$85.58 – $494
Established patient office visit (about 30–39 minutes): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $390 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $442 AETNA Health — Cofinity: $468 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $145.50 America's PPO — AMERICAS PPO MAYO: $452.40 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $254.53 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $94.14 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $374.40 Centivo — All Commercial Centivo plans: $379.60 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $90.71
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$547	$300.85	$76.42 – $519.65
Office consultation with a specialist (moderate): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $410.25 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $464.95 AETNA Health — Cofinity: $492.30 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $154.48 America's PPO — AMERICAS PPO MAYO: $475.89 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $293.57 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $84.06 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $393.84 Centivo — All Commercial Centivo plans: $399.31 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $81.01
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$758	$416.90	$109.24 – $720.10
Office consultation with a specialist (moderate to high): 10 of 42 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $568.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $644.30 AETNA Health — Cofinity: $682.20 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $220.85 America's PPO — AMERICAS PPO MAYO: $659.46 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $436.45 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $120.16 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $545.76 Centivo — All Commercial Centivo plans: $553.34 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS: $115.79
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL III	$332.25	$182.74	$232.58 – $315.64
Emergency room visit (moderate): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $255.83 America's PPO — AMERICAS PPO MAYO: $289.06 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $315.64 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $299.03 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $249.19 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $299.03 Centivo — All Commercial Centivo plans: $259.16 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $299.03 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $249.19 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $282.41
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL III	$332.25	$182.74	$1,845 – $1,905
Emergency room visit (moderate): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $292.38 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $1,845 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $1,845 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $1,905
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL III	$332.25	$182.74	$232.58 – $315.64
Emergency room visit (moderate): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $295.70 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $259.16 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $259.16
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL IV	$565.25	$310.89	$395.68 – $536.99
Emergency room visit (moderately high): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $435.24 America's PPO — AMERICAS PPO MAYO: $491.77 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $536.99 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $508.73 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $423.94 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $508.73 Centivo — All Commercial Centivo plans: $440.90 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $508.73 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $423.94 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $480.46
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL IV	$565.25	$310.89	$3,881 – $4,005
Emergency room visit (moderately high): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $497.42 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $3,881 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $3,881 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $4,005
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL IV	$565.25	$310.89	$395.68 – $536.99
Emergency room visit (moderately high): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $503.07 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $440.90 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $440.90
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL V	$1,614	$887.70	$1,129.80 – $1,533.30
Emergency room visit (high): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $1,242.78 America's PPO — AMERICAS PPO MAYO: $1,404.18 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $1,533.30 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $1,452.60 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $1,210.50 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $1,452.60 Centivo — All Commercial Centivo plans: $1,258.92 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $1,452.60 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $1,210.50 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $1,371.90
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL V	$1,614	$887.70	$3,881 – $4,005
Emergency room visit (high): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $1,420.32 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $3,881 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $3,881 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $4,005
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV EMERGENCY DEPT VISIT LEVEL V	$1,614	$887.70	$1,129.80 – $1,533.30
Emergency room visit (high): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $1,436.46 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $1,258.92 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $1,258.92

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV BASIC METABOLIC PANEL	$284.50	$156.48	$199.15 – $270.28
Basic metabolic panel (blood test): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $219.07 America's PPO — AMERICAS PPO MAYO: $247.52 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $270.28 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $256.05 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $213.38 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $256.05 Centivo — All Commercial Centivo plans: $221.91 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $256.05 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $213.38 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $241.83
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV BASIC METABOLIC PANEL	$284.50	$156.48	$199.15 – $270.28
Basic metabolic panel (blood test): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $250.36 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $170.70 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $170.70 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $216.50
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV BASIC METABOLIC PANEL	$284.50	$156.48	$199.15 – $270.28
Basic metabolic panel (blood test): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $253.21 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $221.91 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $221.91
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV COMPREHENSIVE METABOLIC PANEL	$95.25	$52.39	$66.68 – $90.49
Comprehensive metabolic panel (blood test): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $73.34 America's PPO — AMERICAS PPO MAYO: $82.87 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $90.49 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $85.73 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $71.44 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $85.73 Centivo — All Commercial Centivo plans: $74.30 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $85.73 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $71.44 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $80.96
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV COMPREHENSIVE METABOLIC PANEL	$95.25	$52.39	$66.68 – $90.49
Comprehensive metabolic panel (blood test): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $83.82 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $57.15 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $57.15 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $72.49
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV COMPREHENSIVE METABOLIC PANEL	$95.25	$52.39	$66.68 – $90.49
Comprehensive metabolic panel (blood test): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $84.77 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $74.30 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $74.30
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	$19.03 – $23.79
Obstetric blood test panel: rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $21.88 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $19.41 ICare — WI Medicaid I Care - CFV: $23.79 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $20.74 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $20.74 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $19.03 My Choice Wisconsin — WI MEDICAID TRILOGY: $21.31 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $19.03
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV LIPID PANEL	$201.75	$110.96	$141.23 – $191.66
Cholesterol panel (lipid panel): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $155.35 America's PPO — AMERICAS PPO MAYO: $175.52 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $191.66 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $181.58 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $151.31 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $181.58 Centivo — All Commercial Centivo plans: $157.37 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $181.58 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $151.31 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $171.49
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV LIPID PANEL	$201.75	$110.96	$141.23 – $191.66
Cholesterol panel (lipid panel): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $177.54 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $121.05 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $121.05 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $153.53
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV LIPID PANEL	$201.75	$110.96	$141.23 – $191.66
Cholesterol panel (lipid panel): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $179.56 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $157.37 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $157.37
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION P	Not listed in the file	Not listed in the file	$8.68 – $10.85
Kidney function panel: rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $9.98 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $8.85 ICare — WI Medicaid I Care - CFV: $10.85 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $9.46 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $9.46 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $8.68 My Choice Wisconsin — WI MEDICAID TRILOGY: $9.72 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $8.68
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV HEPATIC PANEL	$212.50	$116.88	$148.75 – $201.88
Liver function panel: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $163.63 America's PPO — AMERICAS PPO MAYO: $184.88 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $201.88 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $191.25 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $159.38 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $191.25 Centivo — All Commercial Centivo plans: $165.75 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $191.25 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $159.38 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $180.63
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV HEPATIC PANEL	$212.50	$116.88	$148.75 – $201.88
Liver function panel: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $187 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $127.50 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $127.50 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $161.71
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV HEPATIC PANEL	$212.50	$116.88	$148.75 – $201.88
Liver function panel: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $189.13 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $165.75 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $165.75
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV URINALYSIS AUTO W MICRO	$61.75	$33.96	$43.23 – $58.66
Urine test (automated, with microscope): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $47.55 America's PPO — AMERICAS PPO MAYO: $53.72 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $58.66 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $55.58 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $46.31 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $55.58 Centivo — All Commercial Centivo plans: $48.17 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $55.58 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $46.31 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $52.49
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV URINALYSIS AUTO W MICRO	$61.75	$33.96	$43.23 – $58.66
Urine test (automated, with microscope): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $54.34 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $37.05 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $37.05 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $46.99
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV URINALYSIS AUTO W MICRO	$61.75	$33.96	$43.23 – $58.66
Urine test (automated, with microscope): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $54.96 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $48.17 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $48.17
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV URINALYSIS DIP ONLY NONAUTO	$18.25	$10.04	$12.78 – $17.34
Urine test (manual, without microscope): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $14.05 America's PPO — AMERICAS PPO MAYO: $15.88 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $17.34 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $16.43 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $13.69 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $16.43 Centivo — All Commercial Centivo plans: $14.24 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $16.43 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $13.69 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $15.51
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: CHG URINALYSIS NONAUTO W/O SCOPE	$42	$23.10	$3.48 – $39.90
Urine test (manual, without microscope): 10 of 39 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $31.50 AETNA Health — AETNA PROHEALTH CARE EMPLOYEE PLAN: $35.70 AETNA Health — Cofinity: $37.80 AETNA Health — Commercial AETNA PPO, EPO, POS, and HMO Plans: $5.53 America's PPO — AMERICAS PPO MAYO: $36.54 Anthem Blue Cross Blue Shield — Anthem HIX/PPO/POS/HMO/EPO/Standard/Traditional/Indemnity pl: $31.50 Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $3.83 Aspirus Health Plan — ASPIRUS HEALTH PLAN CONTRACTED: $30.24 Centivo — All Commercial Centivo plans: $30.66 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $37.80
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV URINALYSIS DIP ONLY NONAUTO	$18.25	$10.04	$12.78 – $17.34
Urine test (manual, without microscope): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $16.06 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $10.95 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $10.95 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $13.89
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV URINALYSIS DIP ONLY AUTO	$18	$9.90	$12.60 – $17.10
Urine test (automated, without microscope): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $13.86 America's PPO — AMERICAS PPO MAYO: $15.66 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $17.10 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $16.20 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $13.50 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $16.20 Centivo — All Commercial Centivo plans: $14.04 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $16.20 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $13.50 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $15.30
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV URINALYSIS DIP ONLY AUTO	$18	$9.90	$12.60 – $17.10
Urine test (automated, without microscope): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $15.84 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $10.80 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $10.80 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $13.70
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV URINALYSIS DIP ONLY AUTO	$18	$9.90	$12.60 – $17.10
Urine test (automated, without microscope): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $16.02 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $14.04 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $14.04
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PROSTAT	Not listed in the file	Not listed in the file	$18.39 – $22.99
PSA (prostate specific antigen) blood test: rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $21.15 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $18.76 ICare — WI Medicaid I Care - CFV: $22.99 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $20.05 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $20.05 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $18.39 My Choice Wisconsin — WI MEDICAID TRILOGY: $20.60 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $18.39
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV THYROID STIMULATING HORMONE (TSH)	$190.75	$104.91	$133.53 – $181.21
Thyroid stimulating hormone (TSH) test: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $146.88 America's PPO — AMERICAS PPO MAYO: $165.95 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $181.21 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $171.68 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $143.06 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $171.68 Centivo — All Commercial Centivo plans: $148.79 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $171.68 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $143.06 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $162.14
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV THYROID STIMULATING HORMONE (TSH)	$190.75	$104.91	$133.53 – $181.21
Thyroid stimulating hormone (TSH) test: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $167.86 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $114.45 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $114.45 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $145.16
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV THYROID STIMULATING HORMONE (TSH)	$190.75	$104.91	$133.53 – $181.21
Thyroid stimulating hormone (TSH) test: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $169.77 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $148.79 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $148.79
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV COMPLETE BLOOD CT W DIFF	$103.50	$56.93	$72.45 – $98.33
Complete blood count (CBC) with differential: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $79.70 America's PPO — AMERICAS PPO MAYO: $90.05 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $98.33 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $93.15 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $77.63 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $93.15 Centivo — All Commercial Centivo plans: $80.73 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $93.15 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $77.63 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $87.98
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV COMPLETE BLOOD CT W DIFF	$103.50	$56.93	$72.45 – $98.33
Complete blood count (CBC) with differential: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $91.08 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $62.10 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $62.10 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $78.76
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV COMPLETE BLOOD CT W DIFF	$103.50	$56.93	$72.45 – $98.33
Complete blood count (CBC) with differential: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $92.12 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $80.73 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $80.73
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV COMPLETE BLOOD CT NO DIFF	$87.25	$47.99	$61.08 – $82.89
Complete blood count (CBC), automated: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $67.18 America's PPO — AMERICAS PPO MAYO: $75.91 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $82.89 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $78.53 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $65.44 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $78.53 Centivo — All Commercial Centivo plans: $68.06 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $78.53 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $65.44 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $74.16
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV COMPLETE BLOOD CT NO DIFF	$87.25	$47.99	$61.08 – $82.89
Complete blood count (CBC), automated: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $76.78 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $52.35 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $52.35 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $66.40
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV COMPLETE BLOOD CT NO DIFF	$87.25	$47.99	$61.08 – $82.89
Complete blood count (CBC), automated: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $77.65 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $68.06 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $68.06
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV PROTHROMBIN TIME	$50.25	$27.64	$35.18 – $47.74
Blood clotting time test (prothrombin time, PT): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $38.69 America's PPO — AMERICAS PPO MAYO: $43.72 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $47.74 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $45.23 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $37.69 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $45.23 Centivo — All Commercial Centivo plans: $39.20 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $45.23 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $37.69 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $42.71
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV PROTHROMBIN TIME	$50.25	$27.64	$35.18 – $47.74
Blood clotting time test (prothrombin time, PT): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $44.22 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $30.15 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $30.15 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $38.24
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV PROTHROMBIN TIME	$50.25	$27.64	$35.18 – $47.74
Blood clotting time test (prothrombin time, PT): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $44.72 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $39.20 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $39.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV PARTIAL THROMBOPLASTIN TIME	$87.25	$47.99	$61.08 – $82.89
Blood clotting test (partial thromboplastin time, PTT): 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $67.18 America's PPO — AMERICAS PPO MAYO: $75.91 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $82.89 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $78.53 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $65.44 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $78.53 Centivo — All Commercial Centivo plans: $68.06 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $78.53 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $65.44 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $74.16
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV PARTIAL THROMBOPLASTIN TIME	$87.25	$47.99	$61.08 – $82.89
Blood clotting test (partial thromboplastin time, PTT): rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $76.78 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $52.35 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $52.35 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $66.40
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV PARTIAL THROMBOPLASTIN TIME	$87.25	$47.99	$61.08 – $82.89
Blood clotting test (partial thromboplastin time, PTT): rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $77.65 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $68.06 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $68.06

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 · Hospital (facility) fee In the file: HBC FV CT HEAD WO CONTRAST	$1,127	$619.85	$788.90 – $1,070.65
CT scan of the head or brain, without contrast: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $867.79 America's PPO — AMERICAS PPO MAYO: $980.49 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $1,070.65 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $1,014.30 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $845.25 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $1,014.30 Centivo — All Commercial Centivo plans: $879.06 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $1,014.30 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $845.25 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $957.95
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV CT HEAD WO CONTRAST	$1,127	$619.85	$788.90 – $1,070.65
CT scan of the head or brain, without contrast: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $991.76 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $879.06 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $879.06 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $857.65
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV CT HEAD WO CONTRAST	$1,127	$619.85	$788.90 – $1,070.65
CT scan of the head or brain, without contrast: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $1,003.03 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $879.06 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $879.06
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV MRI BRAIN WO AND W CONTRAST	$3,544	$1,949.20	$2,480.80 – $3,366.80
MRI of the brain, before and after contrast: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $2,728.88 America's PPO — AMERICAS PPO MAYO: $3,083.28 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $3,366.80 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $3,189.60 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $2,658 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $3,189.60 Centivo — All Commercial Centivo plans: $2,764.32 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $3,189.60 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $2,658 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $3,012.40
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV MRI BRAIN WO AND W CONTRAST	$3,544	$1,949.20	$2,480.80 – $3,366.80
MRI of the brain, before and after contrast: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $3,154.16 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $2,764.32 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $2,764.32
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV MRI BRAIN WO AND W CONTRAST	$3,544	$1,949.20	$2,480.80 – $3,366.80
MRI of the brain, before and after contrast: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $3,118.72 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $2,764.32 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $2,764.32
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV RADIOLOGIC EXAM CHEST 2 VIEWS	$248.25	$136.54	$173.78 – $235.84
Chest X-ray, 2 views: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $191.15 America's PPO — AMERICAS PPO MAYO: $215.98 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $235.84 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $223.43 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $186.19 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $223.43 Centivo — All Commercial Centivo plans: $193.64 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $223.43 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $186.19 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $211.01
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV RADIOLOGIC EXAM CHEST 2 VIEWS	$248.25	$136.54	$173.78 – $235.84
Chest X-ray, 2 views: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $218.46 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $193.64 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $193.64 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $188.92
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV RADIOLOGIC EXAM CHEST 2 VIEWS	$248.25	$136.54	$173.78 – $235.84
Chest X-ray, 2 views: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $220.94 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $193.64 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $193.64
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV CT SCAN OF PELVIS CONTRAST	$2,130.75	$1,171.91	$1,491.53 – $2,024.21
CT scan of the pelvis, with contrast: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $1,640.68 America's PPO — AMERICAS PPO MAYO: $1,853.75 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $2,024.21 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $1,917.68 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $1,598.06 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $1,917.68 Centivo — All Commercial Centivo plans: $1,661.99 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $1,917.68 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $1,598.06 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $1,811.14
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV CT SCAN OF PELVIS CONTRAST	$2,130.75	$1,171.91	$1,491.53 – $2,024.21
CT scan of the pelvis, with contrast: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $1,875.06 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $1,661.99 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $1,661.99 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $1,621.50
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV CT SCAN OF PELVIS CONTRAST	$2,130.75	$1,171.91	$1,491.53 – $2,024.21
CT scan of the pelvis, with contrast: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $1,896.37 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $1,661.99 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $1,661.99
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV CT ABDOMEN & PELVIS W CONTRAST	$3,648.75	$2,006.81	$2,554.13 – $3,466.31
CT scan of the abdomen and pelvis, with contrast: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $2,809.54 America's PPO — AMERICAS PPO MAYO: $3,174.41 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $3,466.31 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $3,283.88 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $2,736.56 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $3,283.88 Centivo — All Commercial Centivo plans: $2,846.03 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $3,283.88 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $2,736.56 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $3,101.44
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV CT ABDOMEN & PELVIS W CONTRAST	$3,648.75	$2,006.81	$2,554.13 – $3,466.31
CT scan of the abdomen and pelvis, with contrast: rates for 4 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $3,210.90 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $2,846.03 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $2,846.03 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $2,776.70
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV CT ABDOMEN & PELVIS W CONTRAST	$3,648.75	$2,006.81	$2,554.13 – $3,466.31
CT scan of the abdomen and pelvis, with contrast: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $3,247.39 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $2,846.03 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $2,846.03
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Hospital (facility) fee In the file: HBC FV US ABDOMEN COMPLETE	$722.50	$397.38	$505.75 – $686.38
Ultrasound of the abdomen, complete: 10 of 41 insurance plan rates Advocate Aurora Healthcare — All Aurora Healthcare employee plans: $556.33 America's PPO — AMERICAS PPO MAYO: $628.58 Anthem Blue Cross Blue Shield — Anthem Indemnity/Traditional/Standard-Blue Traditional plans: $686.38 Anthem Blue Cross Blue Shield — PPO-Blue Access/Blue Card PPO plans: $650.25 Aspirus Health Plan — All Contracted Commercial ASPIRUS HEALTH plans: $541.88 Bellin Thedacare — PREMIUM HEALTHCARE BELLIN THEDACARE: $650.25 Centivo — All Commercial Centivo plans: $563.55 CIGNA Healthcare — All Commercial CIGNA HMO/POS/EPO/PPO plans: $650.25 Common Ground Healthcare Cooperative — COMMON GROUND ENVISION NETWORK: $541.88 Common Ground Healthcare Cooperative — COMMON GROUND TRILOGY: $614.13
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HBC FV US ABDOMEN COMPLETE	$722.50	$397.38	$505.75 – $686.38
Ultrasound of the abdomen, complete: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $643.03 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $563.55 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $563.55
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV US ABDOMEN COMPLETE	$722.50	$397.38	$505.75 – $686.38
Ultrasound of the abdomen, complete: rates for 3 insurance plans AETNA Health — All Commercial AETNA HMO/POS/EPO/PPO plans: $635.80 Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $563.55 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $563.55

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$11,290 – $13,913
Left heart catheterization (diagnostic): rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $13,913
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	$11,941 – $18,060
Heart rhythm study (electrophysiology evaluation): rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $18,060
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	Not listed in the file	Not listed in the file	$14,056 – $37,141
Heart rhythm study with ablation for atrial fibrillation: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $37,141

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$31.38 – $39.23
Physical therapy: therapeutic exercise (each 15 minutes): rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $36.09 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $32.01 ICare — WI Medicaid I Care - CFV: $39.23 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $34.20 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $34.20 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $31.38 My Choice Wisconsin — WI MEDICAID TRILOGY: $35.15 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $31.38
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	$62.66 – $78.33
Physical therapy evaluation (low complexity): rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $72.06 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $63.91 ICare — WI Medicaid I Care - CFV: $78.33 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $68.30 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $68.30 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $62.66 My Choice Wisconsin — WI MEDICAID TRILOGY: $70.18 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $62.66
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	$62.66 – $78.33
Physical therapy evaluation (moderate complexity): rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $72.06 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $63.91 ICare — WI Medicaid I Care - CFV: $78.33 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $68.30 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $68.30 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $62.66 My Choice Wisconsin — WI MEDICAID TRILOGY: $70.18 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $62.66
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	$62.66 – $78.33
Physical therapy evaluation (high complexity): rates for 8 insurance plans Anthem Blue Cross Blue Shield — WI MEDICAID ANTHEM: $72.06 Chorus Community Health Plan — WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP): $63.91 ICare — WI Medicaid I Care - CFV: $78.33 Managed Health Services — WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH: $68.30 Molina Healthcare of Wisconsin — WI MEDICAID MOLINA HEALTHCARE: $68.30 My Choice Wisconsin — WI MEDICAID MYCHOICE WI-CARE WI: $62.66 My Choice Wisconsin — WI MEDICAID TRILOGY: $70.18 United Healthcare Insurance Company — WI MEDICAID UHC COMMUNITY PLAN: $62.66

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	$8,006 – $10,500
Removal of breast growth (open surgery): rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $10,500
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$8,006 – $10,500
Removal of breast growth (open surgery): rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $8,894 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $8,006
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	$13,774 – $25,306
Total hip replacement: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $25,306
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$13,774 – $25,306
Total hip replacement: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $13,958 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $13,774
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	$13,774 – $25,306
Total knee replacement: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $25,306
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$14,056 – $37,141
Total knee replacement: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $15,055 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $14,056
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	Not listed in the file	Not listed in the file	$3,990
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $3,990
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS	Not listed in the file	Not listed in the file	$5,749 – $7,350
Shoulder arthroscopy: shaving of shoulder bone: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749
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	$10,196 – $11,655
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $11,655
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$8,006 – $10,500
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $8,894 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $8,006
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HBC FV REMOVE TONSILS ADENOIDS <12 YR	$6,357	$3,496.35	$4,449.90 – $6,039.15
Removal of tonsils and adenoids (under age 12): rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $4,837.68
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	$8,006 – $10,500
Removal of tonsils and adenoids (under age 12): rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $10,948 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $10,196 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $10,500
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPR GI ENDOSCOPY DIAGNOSIS	Not listed in the file	Not listed in the file	$6,842 – $8,190
Upper GI endoscopy (diagnostic): rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $8,190
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY BIOPSY	Not listed in the file	Not listed in the file	$6,842 – $8,190
Upper GI endoscopy with biopsy: rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $8,190
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	$6,842 – $8,190
Colonoscopy (diagnostic): rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $8,190
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	$6,842 – $8,190
Colonoscopy with biopsy: rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $8,190
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LESION REMOVAL COLONOSCOPY	Not listed in the file	Not listed in the file	$6,842 – $8,190
Colonoscopy with removal of polyps (snare): rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $8,190
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	$6,842 – $8,190
Ultrasound of the lower bowel by endoscope: rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $8,190
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLOREC CNCR SCR;COLNSCPY NO HI RSK	Not listed in the file	Not listed in the file	$5,749 – $7,350
Screening colonoscopy (not high risk): rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $7,350
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	$11,941 – $18,060
Gallbladder removal by laparoscope: rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $11,838 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $11,290 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $18,060
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	$10,196 – $11,655
Groin (inguinal) hernia repair, age 5 or older: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $11,655
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$8,006 – $10,500
Groin (inguinal) hernia repair, age 5 or older: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $8,894 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $8,006
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$6,842 – $8,190
Prostate biopsy: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842
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	$14,056 – $37,141
Prostate removal by laparoscope (radical prostatectomy): rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $15,055 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $14,056
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING	Not listed in the file	Not listed in the file	$13,774 – $25,306
Prostate removal by laparoscope (radical prostatectomy): rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $25,306
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	$8,006 – $10,500
Hysteroscopy with biopsy of the uterus lining: rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $10,500
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	Not listed in the file	Not listed in the file	$5,749 – $7,350
Spinal injection, lower back (epidural), with imaging guidance: rates for 3 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749 United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $7,350
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	Not listed in the file	Not listed in the file	$5,749 – $7,350
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $7,350
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	Not listed in the file	Not listed in the file	$5,749 – $7,350
Nerve root injection, lower back, with imaging guidance: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749
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	$8,006 – $10,500
Carpal tunnel release: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $10,500
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$6,842 – $8,190
Carpal tunnel release: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842
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	$5,749 – $7,350
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $7,350
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$5,749 – $7,350
Laser treatment of clouding after cataract surgery: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $6,159 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $5,749
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	$8,006 – $10,500
Cataract removal with lens implant: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $10,500
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: CATARACT SURG W/IOL 1 STAGE	Not listed in the file	Not listed in the file	$6,842 – $8,190
Cataract removal with lens implant: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $7,870 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $6,842

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$8,006 – $10,500
Vaginal delivery, with care before and after: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $8,894 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $8,006
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	$8,006 – $10,500
Cesarean delivery (C-section), with care before and after: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $8,894 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $8,006
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	$8,006 – $10,500
Vaginal delivery after a previous C-section, with care before and after: rates for 2 insurance plans Anthem Blue Cross Blue Shield — HMO/EPO/POS - Blue Preferred/Blue Preferred POS plans: $8,894 Anthem Blue Cross Blue Shield — State Specific/Exchange-Blue Priority WI/X-WI plans: $8,006

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	$202,006
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $202,006
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	$58,532.47
Hip or knee replacement (major joint of the leg), without major complications: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $58,532.47
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	$74,081.25
Neck (cervical) spinal fusion, without complications: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $74,081.25
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	$37,649.04
Uterus and ovary surgery (not for cancer), without complications: rates for 1 insurance plan United Healthcare Insurance Company — All UHC Commercial HMO/POS/PPO Plans: $37,649.04

Source: Childrens Hospital of Wisconsin Fox Valley’s standard charges file (7pgcgohua4yc5gik.public.blob.vercel-storage.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 24, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as 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	Children's Hospital
Address	130 Second St, Neenah, WI 54956
County	Winnebago County
State	Wisconsin
Phone	(920) 969‑7900
Emergency services	Yes
Ownership	Voluntary non-profit - Other
Medicare overall rating	Not rated by CMS
CMS Certification Number	523302
Name in Medicare records	CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY
Profile level	Medicare data + hospital website
Name on the hospital’s website	Fox Valley Hospital
Official website	childrenswi.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 ZIP code areas (Gazetteer) — approximate position (center of the ZIP code area) used for distances

From the hospital’s website

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

Fox Valley Hospital-Children's Wisconsin — childrenswi.org
Fox Valley | Children's Wisconsin — childrenswi.org
Visitor Guidelines | Children's Wisconsin — childrenswi.org
Language services | Children's Wisconsin — childrenswi.org