Does Community Memorial Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Community Memorial Hospital. In a medical emergency, call 911.

Where is Community Memorial Hospital?

W180 N8085 Town Hall Rd, Menomonee Falls, WI 53051, in Waukesha County, Wisconsin.

What is the phone number of Community Memorial Hospital?

(262) 251-1000, as listed by Medicare (CMS).

What is the Medicare star rating of Community Memorial Hospital?

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

Community Memorial Hospital — Menomonee Falls, WI

Quick answers

Does Community Memorial Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Community Memorial Hospital. In a medical emergency, call 911.
Where is Community Memorial Hospital?: W180 N8085 Town Hall Rd, Menomonee Falls, WI 53051, in Waukesha County, Wisconsin.
What is the phone number of Community Memorial Hospital?: (262) 251-1000, as listed by Medicare (CMS).
What is the Medicare star rating of Community Memorial Hospital?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][5][7]

Arrhythmia care
Cancer care
Digestive & gastrointestinal
Emergency care
Endocrinology
Heart and vascular
Orthopaedics
Mental health services
Palliative care
Imaging services (radiology)
Rehabilitation and therapy
Surgical services
Urology

Conditions treated^[4][5][7]

Stroke
Benign blood diseases

Treatments^[4][5]

Infusion clinic
Sexual assault treatment (SANE nurse)
Trauma care

Procedures^[4]

Programs and centers^[7]

Cancer Center (Froedtert & MCW Cancer Network)

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

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level III
Stroke designation	Certified Advanced Primary Stroke Center (Joint Commission)

Visiting and practical information

Parking	Free valet parking at the main entrance, Monday to Friday, 6 a.m. to 6 p.m^[4]
Interpreters and languages	Free interpreters in person, by phone or video, around the clock; onsite Hmong, Russian and Spanish; over 150 languages via services. This is a network-wide page^[6]

Recognition^[5]

Level III Trauma Center
Advanced Primary Stroke Center (Joint Commission)

Doctors and clinicians (815)

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

Main specialties

And 791 more: the button below opens the full list.

Other emergency rooms nearby

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

Ascension Wisconsin Hosp Menomonee Falls Campus2.5 mi · Menomonee Falls, WI · Acute Care Hospital
Froedtert Memorial Lutheran Hospital10 mi · Milwaukee, WI · Acute Care Hospital
Ascension SE Wisconsin Hospital10 mi · Milwaukee, WI · Acute Care Hospital
Childrens Hospital of Wisconsin10 mi · Milwaukee, WI · Children's Hospital
Waukesha Memorial Hospital12 mi · Waukesha, WI · Acute Care Hospital

Other hospitals nearby

Aurora Psychiatric Hospital10 mi · Wauwatosa, WI · Psychiatric Hospital
Waukesha County Mental Health Ctr11 mi · Waukesha, 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

Lindengrove Menomonee Falls1.6 mi · Menomonee Falls, WI · 1 of 5 stars
Menomonee Falls Health Services1.6 mi · Menomonee Falls, WI · 2 of 5 stars
Complete Care at Germantown4.2 mi · Germantown, WI · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Horizon Homecare and Hospice4.7 mi · Milwaukee, WI · 3 of 5 stars
Vitas Healthcare Corp Midwest4.7 mi · Milwaukee, WI · 3 of 5 stars
Preceptor Hospice4.8 mi · Germantown, WI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Horizon Home Care and Hospice4.7 mi · Milwaukee, WI · 4 of 5 stars
Preceptor Home Health4.8 mi · Germantown, WI
Regal Home Health Services5.7 mi · Milwaukee, WI · 2 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Menomonee Falls Dialysis0.7 mi · Menomonee Falls, WI · 3 of 5 stars
DaVita Mequon Road Dialysis4.8 mi · Germantown, WI · 5 of 5 stars
DaVita West Appleton Dialysis5.7 mi · Milwaukee, WI · 4 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.

Menomonee Falls Asc0.7 mi · Menomonee Falls, WI
Aurora Healthcare - Germantown4.8 mi · Germantown, WI
SAAK Ambulatory Surgery Center LLC7.3 mi · Brookfield, 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

Isaac Coggs Heritage Health Ctr6.8 mi · Milwaukee, WI · Community health center
Hmong American Peace Academy7.2 mi · Milwaukee, WI · Community health center
WellPoint Care Network7.6 mi · Milwaukee, WI · Community health center

Clinics and urgent care

American Current Care P.A.4.7 mi · Milwaukee, WI · Urgent care center
American Current Care P.A.4.7 mi · Milwaukee, WI · Urgent care center
Pic Wisconsin SC7.3 mi · Brookfield, WI · Urgent care center

Pharmacies

Aurora Pharmacy Inc0.7 mi · Menomonee Falls, WI · Community/retail pharmacy
Aurora Pharmacy, Inc.0.7 mi · Menomonee Falls, WI · Pharmacy
Community Memorial Hospital of Menomonee Falls, Inc.0.7 mi · Menomonee Falls, WI · Community/retail pharmacy

Assisted living nearby

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

Dickson Hollow0.7 mi · Menomonee Falls, WI
Elite Adult Family Home's-Hartfel House0.7 mi · Menomonee Falls, WI
Grace Commons II0.7 mi · Menomonee Falls, WI
Grace Commons III0.7 mi · Menomonee Falls, 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 Community Memorial Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

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

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	2 of 5 stars
Quiet at night	3 of 5 stars
Rated the hospital 9 or 10 out of 10	69%National average: 72%
Would definitely recommend the hospital	70%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	79%National average: 80%
Staff “always” explained medicines before giving them	64%National average: 62%
Were given information about recovery at home	87%National average: 86%
Room and bathroom “always” clean	63%National average: 74%
Area around the room “always” quiet at night	50%National average: 60%
Completed surveys	777Response rate: 35%

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)	0No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.488No different from the national benchmark
Surgical site infections after colon surgery	1.63No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.226Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	10.8%
Deaths within 30 days: heart failure patients	11.9%
Deaths within 30 days: pneumonia patients	13.9%
Deaths within 30 days: COPD patients	7.3%
Deaths within 30 days: stroke patients	10.5%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.85No different from the national rate
Complications after hip or knee replacement	3.6%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	13.2%
Readmitted within 30 days: heart failure	21.1%
Readmitted within 30 days: pneumonia	16.9%
Readmitted within 30 days: COPD	20.8%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	5.5%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	219 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	56%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in Menomonee Falls Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Community Memorial Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$103.31 – $106.41
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $105.37 Allwell — Medicare Advantage: $103.31 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.31 Care Wisconsin/MyChoice — Medicare Advantage: $106.41 Community Care — Medicare Advantage: $103.31 Health Partners — Medicare Advantage: $103.31 Humana — Medicare Advantage: $103.31 ICare — Medicare Advantage: $103.31 Network Health Plan — Medicare Advantage: $103.31 Security Health Plan — Medicare Advantage: $103.31
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$155.08 – $159.73
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $158.18 Allwell — Medicare Advantage: $155.08 Anthem Blue Cross Blue Shield — Medicare Advantage: $155.08 Care Wisconsin/MyChoice — Medicare Advantage: $159.73 Community Care — Medicare Advantage: $155.08 Health Partners — Medicare Advantage: $155.08 Humana — Medicare Advantage: $155.08 ICare — Medicare Advantage: $155.08 Network Health Plan — Medicare Advantage: $155.08 Security Health Plan — Medicare Advantage: $155.08
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$204.46 – $210.59
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $208.55 Allwell — Medicare Advantage: $204.46 Anthem Blue Cross Blue Shield — Medicare Advantage: $204.46 Care Wisconsin/MyChoice — Medicare Advantage: $210.59 Community Care — Medicare Advantage: $204.46 Health Partners — Medicare Advantage: $204.46 Humana — Medicare Advantage: $204.46 ICare — Medicare Advantage: $204.46 Network Health Plan — Medicare Advantage: $204.46 Security Health Plan — Medicare Advantage: $204.46
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 3	$179	$98.45	$38 – $161.10
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates Aetna — All Contracted Commercial Plans: $125.30 Aetna — Medicare Advantage: $86.61 Allwell — Medicare Advantage: $84.91 Americas Choice — PPO: $155.73 Anthem Blue Cross Blue Shield — Medicare Advantage: $84.91 Aspirus — All Contracted Commercial Plans: $143.20 Care Wisconsin/MyChoice — Medicare Advantage: $87.46 Common Ground — All Contracted Commercial Plans: $107.40 Community Care — Medicare Advantage: $84.91 Federated Mutual — All Contracted Commercial Plans: $155.73
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHARMACIST, FACILITY E&M LEVEL 3	$179	$98.45	$38 – $161.10
Established patient office visit (about 20–29 minutes): 10 of 30 insurance plan rates Aetna — All Contracted Commercial Plans: $125.30 Aetna — Medicare Advantage: $86.61 Allwell — Medicare Advantage: $84.91 Americas Choice — PPO: $155.73 Anthem Blue Cross Blue Shield — Medicare Advantage: $84.91 Aspirus — All Contracted Commercial Plans: $143.20 Care Wisconsin/MyChoice — Medicare Advantage: $87.46 Common Ground — All Contracted Commercial Plans: $107.40 Community Care — Medicare Advantage: $84.91 Federated Mutual — All Contracted Commercial Plans: $155.73
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 3	$179	$98.45	$107.40 – $161.10
Established patient office visit (about 20–29 minutes): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $125.30 Americas Choice — PPO: $155.73 Aspirus — All Contracted Commercial Plans: $143.20 Common Ground — All Contracted Commercial Plans: $107.40 Federated Mutual — All Contracted Commercial Plans: $155.73 First Health Network — All Contracted Commercial Plans: $157.52 Health Payment Systems — All Contracted Commercial Plans: $124.51 HealthEos — All Contracted Commercial Plans: $155.73 HealthSmart — All Contracted Commercial Plans: $161.10 IBSI Passport — All Contracted Commercial Plans: $144.99
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHARMACIST, FACILITY E&M LEVEL 4	$232	$127.60	$38 – $208.80
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates Aetna — All Contracted Commercial Plans: $162.40 Aetna — Medicare Advantage: $121.82 Allwell — Medicare Advantage: $119.43 Americas Choice — PPO: $201.84 Anthem Blue Cross Blue Shield — Medicare Advantage: $119.43 Aspirus — All Contracted Commercial Plans: $185.60 Care Wisconsin/MyChoice — Medicare Advantage: $123.01 Common Ground — All Contracted Commercial Plans: $139.20 Community Care — Medicare Advantage: $119.43 Federated Mutual — All Contracted Commercial Plans: $201.84
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 4	$232	$127.60	$38 – $208.80
Established patient office visit (about 30–39 minutes): 10 of 30 insurance plan rates Aetna — All Contracted Commercial Plans: $162.40 Aetna — Medicare Advantage: $121.82 Allwell — Medicare Advantage: $119.43 Americas Choice — PPO: $201.84 Anthem Blue Cross Blue Shield — Medicare Advantage: $119.43 Aspirus — All Contracted Commercial Plans: $185.60 Care Wisconsin/MyChoice — Medicare Advantage: $123.01 Common Ground — All Contracted Commercial Plans: $139.20 Community Care — Medicare Advantage: $119.43 Federated Mutual — All Contracted Commercial Plans: $201.84
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 4	$232	$127.60	$139.20 – $208.80
Established patient office visit (about 30–39 minutes): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $162.40 Americas Choice — PPO: $201.84 Aspirus — All Contracted Commercial Plans: $185.60 Common Ground — All Contracted Commercial Plans: $139.20 Federated Mutual — All Contracted Commercial Plans: $201.84 First Health Network — All Contracted Commercial Plans: $204.16 Health Payment Systems — All Contracted Commercial Plans: $161.38 HealthEos — All Contracted Commercial Plans: $201.84 HealthSmart — All Contracted Commercial Plans: $208.80 IBSI Passport — All Contracted Commercial Plans: $187.92
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$104.70 – $107.84
Office consultation with a specialist (moderate): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $106.80 Allwell — Medicare Advantage: $104.70 Anthem Blue Cross Blue Shield — Medicare Advantage: $104.70 Care Wisconsin/MyChoice — Medicare Advantage: $107.84 Community Care — Medicare Advantage: $104.70 Health Partners — Medicare Advantage: $104.70 Humana — Medicare Advantage: $104.70 ICare — Medicare Advantage: $104.70 Network Health Plan — Medicare Advantage: $104.70 Security Health Plan — Medicare Advantage: $104.70
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$149.40 – $153.88
Office consultation with a specialist (moderate to high): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $152.39 Allwell — Medicare Advantage: $149.40 Anthem Blue Cross Blue Shield — Medicare Advantage: $149.40 Care Wisconsin/MyChoice — Medicare Advantage: $153.88 Community Care — Medicare Advantage: $149.40 Health Partners — Medicare Advantage: $149.40 Humana — Medicare Advantage: $149.40 ICare — Medicare Advantage: $149.40 Network Health Plan — Medicare Advantage: $149.40 Security Health Plan — Medicare Advantage: $149.40
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$120.77 – $124.39
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $123.18 Allwell — Medicare Advantage: $120.77 Anthem Blue Cross Blue Shield — Medicare Advantage: $120.77 Care Wisconsin/MyChoice — Medicare Advantage: $124.39 Community Care — Medicare Advantage: $120.77 Health Partners — Medicare Advantage: $120.77 Humana — Medicare Advantage: $120.77 ICare — Medicare Advantage: $120.77 Network Health Plan — Medicare Advantage: $120.77 Security Health Plan — Medicare Advantage: $120.77
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$139.19 – $143.37
Preventive checkup, new patient, age 40–64: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $141.98 Allwell — Medicare Advantage: $139.19 Anthem Blue Cross Blue Shield — Medicare Advantage: $139.19 Care Wisconsin/MyChoice — Medicare Advantage: $143.37 Community Care — Medicare Advantage: $139.19 Health Partners — Medicare Advantage: $139.19 Humana — Medicare Advantage: $139.19 ICare — Medicare Advantage: $139.19 Network Health Plan — Medicare Advantage: $139.19 Security Health Plan — Medicare Advantage: $139.19
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEVEL 3 EMERGENCY DEPARTMENT VISIT	$1,155	$635.25	$268.87 – $4,058
Emergency room visit (moderate): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $808.50 Aetna — Medicare Advantage: $274.24 Allwell — Medicare Advantage: $268.87 Americas Choice — PPO: $1,004.85 Anthem Blue Cross Blue Shield — HMO: $4,058 Anthem Blue Cross Blue Shield — Medicare Advantage: $268.87 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $981.75 Aspirus — All Contracted Commercial Plans: $924 Care Wisconsin/MyChoice — Medicare Advantage: $276.93 Centivo — WI 1 Broad: $554.40
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LEVEL 3 EMERGENCY DEPARTMENT VISIT	$1,155	$635.25	$693 – $1,039.50
Emergency room visit (moderate): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $808.50 Americas Choice — PPO: $1,004.85 Aspirus — All Contracted Commercial Plans: $924 Common Ground — All Contracted Commercial Plans: $693 Federated Mutual — All Contracted Commercial Plans: $1,004.85 First Health Network — All Contracted Commercial Plans: $1,016.40 Health Payment Systems — All Contracted Commercial Plans: $803.42 HealthEos — All Contracted Commercial Plans: $1,004.85 HealthSmart — All Contracted Commercial Plans: $1,039.50 IBSI Passport — All Contracted Commercial Plans: $935.55
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SANE EXAM - INTERMEDIATE	$1,439	$791.45	$413.48 – $5,386
Emergency room visit (moderately high): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,007.30 Aetna — Medicare Advantage: $421.75 Allwell — Medicare Advantage: $413.48 Americas Choice — PPO: $1,251.93 Anthem Blue Cross Blue Shield — HMO: $5,386 Anthem Blue Cross Blue Shield — Medicare Advantage: $413.48 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $1,223.15 Aspirus — All Contracted Commercial Plans: $1,151.20 Care Wisconsin/MyChoice — Medicare Advantage: $425.88 Centivo — WI 1 Broad: $690.72
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEVEL 4 EMERGENCY DEPARTMENT VISIT	$1,890	$1,039.50	$413.48 – $5,386
Emergency room visit (moderately high): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,323 Aetna — Medicare Advantage: $421.75 Allwell — Medicare Advantage: $413.48 Americas Choice — PPO: $1,644.30 Anthem Blue Cross Blue Shield — HMO: $5,386 Anthem Blue Cross Blue Shield — Medicare Advantage: $413.48 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $1,606.50 Aspirus — All Contracted Commercial Plans: $1,512 Care Wisconsin/MyChoice — Medicare Advantage: $425.88 Centivo — WI 1 Broad: $907.20
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LEVEL 4 EMERGENCY DEPARTMENT VISIT	$1,890	$1,039.50	$1,134 – $1,701
Emergency room visit (moderately high): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $1,323 Americas Choice — PPO: $1,644.30 Aspirus — All Contracted Commercial Plans: $1,512 Common Ground — All Contracted Commercial Plans: $1,134 Federated Mutual — All Contracted Commercial Plans: $1,644.30 First Health Network — All Contracted Commercial Plans: $1,663.20 Health Payment Systems — All Contracted Commercial Plans: $1,314.68 HealthEos — All Contracted Commercial Plans: $1,644.30 HealthSmart — All Contracted Commercial Plans: $1,701 IBSI Passport — All Contracted Commercial Plans: $1,530.90
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SANE EXAM - COMPREHENSIVE	$2,034	$1,118.70	$595.33 – $6,052
Emergency room visit (high): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,423.80 Aetna — Medicare Advantage: $607.24 Allwell — Medicare Advantage: $595.33 Americas Choice — PPO: $1,769.58 Anthem Blue Cross Blue Shield — HMO: $5,431 Anthem Blue Cross Blue Shield — Medicare Advantage: $595.33 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $1,728.90 Aspirus — All Contracted Commercial Plans: $1,627.20 Care Wisconsin/MyChoice — Medicare Advantage: $613.19 Centivo — WI 1 Broad: $976.32
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEVEL 5 EMERGENCY DEPARTMENT VISIT	$2,520	$1,386	$595.33 – $6,052
Emergency room visit (high): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,764 Aetna — Medicare Advantage: $607.24 Allwell — Medicare Advantage: $595.33 Americas Choice — PPO: $2,192.40 Anthem Blue Cross Blue Shield — HMO: $5,431 Anthem Blue Cross Blue Shield — Medicare Advantage: $595.33 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $2,142 Aspirus — All Contracted Commercial Plans: $2,016 Care Wisconsin/MyChoice — Medicare Advantage: $613.19 Centivo — WI 1 Broad: $1,209.60
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SANE EXAM - COMPREHENSIVE	$2,034	$1,118.70	$1,220.40 – $1,830.60
Emergency room visit (high): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $1,423.80 Americas Choice — PPO: $1,769.58 Aspirus — All Contracted Commercial Plans: $1,627.20 Common Ground — All Contracted Commercial Plans: $1,220.40 Federated Mutual — All Contracted Commercial Plans: $1,769.58 First Health Network — All Contracted Commercial Plans: $1,789.92 Health Payment Systems — All Contracted Commercial Plans: $1,414.85 HealthEos — All Contracted Commercial Plans: $1,769.58 HealthSmart — All Contracted Commercial Plans: $1,830.60 IBSI Passport — All Contracted Commercial Plans: $1,647.54

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC METABOLIC PANEL TOTAL CA	$169	$92.95	$8.46 – $152.10
Basic metabolic panel (blood test): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $118.30 Aetna — Medicare Advantage: $8.63 Allwell — Medicare Advantage: $8.46 Americas Choice — PPO: $147.03 Anthem Blue Cross Blue Shield — HMO: $11 Anthem Blue Cross Blue Shield — Medicare Advantage: $8.46 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $42.30 Aspirus — All Contracted Commercial Plans: $135.20 Care Wisconsin/MyChoice — Medicare Advantage: $8.71 Centivo — WI 1 Broad: $55.77
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC METABOLIC PANEL TOTAL CA	$169	$92.95	$101.40 – $152.10
Basic metabolic panel (blood test): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $118.30 Americas Choice — PPO: $147.03 Aspirus — All Contracted Commercial Plans: $135.20 Common Ground — All Contracted Commercial Plans: $101.40 Federated Mutual — All Contracted Commercial Plans: $147.03 First Health Network — All Contracted Commercial Plans: $148.72 Health Payment Systems — All Contracted Commercial Plans: $117.56 HealthEos — All Contracted Commercial Plans: $147.03 HealthSmart — All Contracted Commercial Plans: $152.10 IBSI Passport — All Contracted Commercial Plans: $136.89
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHEN METABOLIC PANEL	$246	$135.30	$10.56 – $221.40
Comprehensive metabolic panel (blood test): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $172.20 Aetna — Medicare Advantage: $10.77 Allwell — Medicare Advantage: $10.56 Americas Choice — PPO: $214.02 Anthem Blue Cross Blue Shield — HMO: $13.73 Anthem Blue Cross Blue Shield — Medicare Advantage: $10.56 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $52.80 Aspirus — All Contracted Commercial Plans: $196.80 Care Wisconsin/MyChoice — Medicare Advantage: $10.88 Centivo — WI 1 Broad: $81.18
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHEN METABOLIC PANEL	$246	$135.30	$147.60 – $221.40
Comprehensive metabolic panel (blood test): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $172.20 Americas Choice — PPO: $214.02 Aspirus — All Contracted Commercial Plans: $196.80 Common Ground — All Contracted Commercial Plans: $147.60 Federated Mutual — All Contracted Commercial Plans: $214.02 First Health Network — All Contracted Commercial Plans: $216.48 Health Payment Systems — All Contracted Commercial Plans: $171.12 HealthEos — All Contracted Commercial Plans: $214.02 HealthSmart — All Contracted Commercial Plans: $221.40 IBSI Passport — All Contracted Commercial Plans: $199.26
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$455.50	$250.53	$47.81 – $409.95
Obstetric blood test panel: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $318.85 Aetna — Medicare Advantage: $48.77 Allwell — Medicare Advantage: $47.81 Americas Choice — PPO: $396.29 Anthem Blue Cross Blue Shield — HMO: $62.15 Anthem Blue Cross Blue Shield — Medicare Advantage: $47.81 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $239.05 Aspirus — All Contracted Commercial Plans: $364.40 Care Wisconsin/MyChoice — Medicare Advantage: $49.24 Centivo — WI 1 Broad: $150.32
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$455.50	$250.53	$273.30 – $409.95
Obstetric blood test panel: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $318.85 Americas Choice — PPO: $396.29 Aspirus — All Contracted Commercial Plans: $364.40 Common Ground — All Contracted Commercial Plans: $273.30 Federated Mutual — All Contracted Commercial Plans: $396.29 First Health Network — All Contracted Commercial Plans: $400.84 Health Payment Systems — All Contracted Commercial Plans: $316.85 HealthEos — All Contracted Commercial Plans: $396.29 HealthSmart — All Contracted Commercial Plans: $409.95 IBSI Passport — All Contracted Commercial Plans: $368.96
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$203	$111.65	$13.39 – $182.70
Cholesterol panel (lipid panel): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $142.10 Aetna — Medicare Advantage: $13.66 Allwell — Medicare Advantage: $13.39 Americas Choice — PPO: $176.61 Anthem Blue Cross Blue Shield — HMO: $17.41 Anthem Blue Cross Blue Shield — Medicare Advantage: $13.39 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $66.95 Aspirus — All Contracted Commercial Plans: $162.40 Care Wisconsin/MyChoice — Medicare Advantage: $13.79 Centivo — WI 1 Broad: $66.99
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL (NMR)	$137	$75.35	$13.39 – $123.30
Cholesterol panel (lipid panel): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $95.90 Aetna — Medicare Advantage: $13.66 Allwell — Medicare Advantage: $13.39 Americas Choice — PPO: $119.19 Anthem Blue Cross Blue Shield — HMO: $17.41 Anthem Blue Cross Blue Shield — Medicare Advantage: $13.39 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $66.95 Aspirus — All Contracted Commercial Plans: $109.60 Care Wisconsin/MyChoice — Medicare Advantage: $13.79 Centivo — WI 1 Broad: $45.21
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LIPID PANEL (NMR)	$137	$75.35	$82.20 – $123.30
Cholesterol panel (lipid panel): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $95.90 Americas Choice — PPO: $119.19 Aspirus — All Contracted Commercial Plans: $109.60 Common Ground — All Contracted Commercial Plans: $82.20 Federated Mutual — All Contracted Commercial Plans: $119.19 First Health Network — All Contracted Commercial Plans: $120.56 Health Payment Systems — All Contracted Commercial Plans: $95.30 HealthEos — All Contracted Commercial Plans: $119.19 HealthSmart — All Contracted Commercial Plans: $123.30 IBSI Passport — All Contracted Commercial Plans: $110.97
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$172	$94.60	$8.68 – $154.80
Kidney function panel: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $120.40 Aetna — Medicare Advantage: $8.85 Allwell — Medicare Advantage: $8.68 Americas Choice — PPO: $149.64 Anthem Blue Cross Blue Shield — HMO: $11.28 Anthem Blue Cross Blue Shield — Medicare Advantage: $8.68 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $43.40 Aspirus — All Contracted Commercial Plans: $137.60 Care Wisconsin/MyChoice — Medicare Advantage: $8.94 Centivo — WI 1 Broad: $56.76
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$172	$94.60	$103.20 – $154.80
Kidney function panel: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $120.40 Americas Choice — PPO: $149.64 Aspirus — All Contracted Commercial Plans: $137.60 Common Ground — All Contracted Commercial Plans: $103.20 Federated Mutual — All Contracted Commercial Plans: $149.64 First Health Network — All Contracted Commercial Plans: $151.36 Health Payment Systems — All Contracted Commercial Plans: $119.64 HealthEos — All Contracted Commercial Plans: $149.64 HealthSmart — All Contracted Commercial Plans: $154.80 IBSI Passport — All Contracted Commercial Plans: $139.32
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$212	$116.60	$8.17 – $190.80
Liver function panel: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $148.40 Aetna — Medicare Advantage: $8.33 Allwell — Medicare Advantage: $8.17 Americas Choice — PPO: $184.44 Anthem Blue Cross Blue Shield — HMO: $10.62 Anthem Blue Cross Blue Shield — Medicare Advantage: $8.17 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $40.85 Aspirus — All Contracted Commercial Plans: $169.60 Care Wisconsin/MyChoice — Medicare Advantage: $8.42 Centivo — WI 1 Broad: $69.96
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$212	$116.60	$127.20 – $190.80
Liver function panel: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $148.40 Americas Choice — PPO: $184.44 Aspirus — All Contracted Commercial Plans: $169.60 Common Ground — All Contracted Commercial Plans: $127.20 Federated Mutual — All Contracted Commercial Plans: $184.44 First Health Network — All Contracted Commercial Plans: $186.56 Health Payment Systems — All Contracted Commercial Plans: $147.47 HealthEos — All Contracted Commercial Plans: $184.44 HealthSmart — All Contracted Commercial Plans: $190.80 IBSI Passport — All Contracted Commercial Plans: $171.72
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W SCOPE	$72	$39.60	$3.17 – $64.80
Urine test (automated, with microscope): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $50.40 Aetna — Medicare Advantage: $3.23 Allwell — Medicare Advantage: $3.17 Americas Choice — PPO: $62.64 Anthem Blue Cross Blue Shield — HMO: $4.12 Anthem Blue Cross Blue Shield — Medicare Advantage: $3.17 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $15.85 Aspirus — All Contracted Commercial Plans: $57.60 Care Wisconsin/MyChoice — Medicare Advantage: $3.27 Centivo — WI 1 Broad: $23.76
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W SCOPE	$72	$39.60	$43.20 – $64.80
Urine test (automated, with microscope): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $50.40 Americas Choice — PPO: $62.64 Aspirus — All Contracted Commercial Plans: $57.60 Common Ground — All Contracted Commercial Plans: $43.20 Federated Mutual — All Contracted Commercial Plans: $62.64 First Health Network — All Contracted Commercial Plans: $63.36 Health Payment Systems — All Contracted Commercial Plans: $50.08 HealthEos — All Contracted Commercial Plans: $62.64 HealthSmart — All Contracted Commercial Plans: $64.80 IBSI Passport — All Contracted Commercial Plans: $58.32
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$3.48 – $17.40
Urine test (manual, without microscope): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $3.55 Allwell — Medicare Advantage: $3.48 Anthem Blue Cross Blue Shield — HMO: $4.52 Anthem Blue Cross Blue Shield — Medicare Advantage: $3.48 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $17.40 Care Wisconsin/MyChoice — Medicare Advantage: $3.58 Community Care — Medicare Advantage: $3.48 Health Partners — Medicare Advantage: $3.48 Humana — Medicare Advantage: $3.48 ICare — Medicare Advantage: $3.48
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS DIPSTICK	$64	$35.20	$2.25 – $57.60
Urine test (automated, without microscope): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $44.80 Aetna — Medicare Advantage: $2.30 Allwell — Medicare Advantage: $2.25 Americas Choice — PPO: $55.68 Anthem Blue Cross Blue Shield — HMO: $2.93 Anthem Blue Cross Blue Shield — Medicare Advantage: $2.25 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $11.25 Aspirus — All Contracted Commercial Plans: $51.20 Care Wisconsin/MyChoice — Medicare Advantage: $2.32 Centivo — WI 1 Broad: $21.12
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS PH	$58	$31.90	$2.25 – $52.20
Urine test (automated, without microscope): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $40.60 Aetna — Medicare Advantage: $2.30 Allwell — Medicare Advantage: $2.25 Americas Choice — PPO: $50.46 Anthem Blue Cross Blue Shield — HMO: $2.93 Anthem Blue Cross Blue Shield — Medicare Advantage: $2.25 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $11.25 Aspirus — All Contracted Commercial Plans: $46.40 Care Wisconsin/MyChoice — Medicare Advantage: $2.32 Centivo — WI 1 Broad: $19.14
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS SPECIFIC GRAVITY	$58	$31.90	$2.25 – $52.20
Urine test (automated, without microscope): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $40.60 Aetna — Medicare Advantage: $2.30 Allwell — Medicare Advantage: $2.25 Americas Choice — PPO: $50.46 Anthem Blue Cross Blue Shield — HMO: $2.93 Anthem Blue Cross Blue Shield — Medicare Advantage: $2.25 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $11.25 Aspirus — All Contracted Commercial Plans: $46.40 Care Wisconsin/MyChoice — Medicare Advantage: $2.32 Centivo — WI 1 Broad: $19.14
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN (PSA) DX ASSAY	$188	$103.40	$18.39 – $169.20
PSA (prostate specific antigen) blood test: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $131.60 Aetna — Medicare Advantage: $18.76 Allwell — Medicare Advantage: $18.39 Americas Choice — PPO: $163.56 Anthem Blue Cross Blue Shield — HMO: $23.91 Anthem Blue Cross Blue Shield — Medicare Advantage: $18.39 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $91.95 Aspirus — All Contracted Commercial Plans: $150.40 Care Wisconsin/MyChoice — Medicare Advantage: $18.94 Centivo — WI 1 Broad: $62.04
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE HEALTH INDEX, PROSTATE SPECIFIC ANTIGEN, TOTAL	$174	$95.70	$18.39 – $156.60
PSA (prostate specific antigen) blood test: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $121.80 Aetna — Medicare Advantage: $18.76 Allwell — Medicare Advantage: $18.39 Americas Choice — PPO: $151.38 Anthem Blue Cross Blue Shield — HMO: $23.91 Anthem Blue Cross Blue Shield — Medicare Advantage: $18.39 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $91.95 Aspirus — All Contracted Commercial Plans: $139.20 Care Wisconsin/MyChoice — Medicare Advantage: $18.94 Centivo — WI 1 Broad: $57.42
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATE HEALTH INDEX, PROSTATE SPECIFIC ANTIGEN, TOTAL	$174	$95.70	$104.40 – $156.60
PSA (prostate specific antigen) blood test: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $121.80 Americas Choice — PPO: $151.38 Aspirus — All Contracted Commercial Plans: $139.20 Common Ground — All Contracted Commercial Plans: $104.40 Federated Mutual — All Contracted Commercial Plans: $151.38 First Health Network — All Contracted Commercial Plans: $153.12 Health Payment Systems — All Contracted Commercial Plans: $121.03 HealthEos — All Contracted Commercial Plans: $151.38 HealthSmart — All Contracted Commercial Plans: $156.60 IBSI Passport — All Contracted Commercial Plans: $140.94
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIM HORMONE ASSAY	$208	$114.40	$16.80 – $187.20
Thyroid stimulating hormone (TSH) test: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $145.60 Aetna — Medicare Advantage: $17.14 Allwell — Medicare Advantage: $16.80 Americas Choice — PPO: $180.96 Anthem Blue Cross Blue Shield — HMO: $21.84 Anthem Blue Cross Blue Shield — Medicare Advantage: $16.80 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $84 Aspirus — All Contracted Commercial Plans: $166.40 Care Wisconsin/MyChoice — Medicare Advantage: $17.30 Centivo — WI 1 Broad: $68.64
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TSH 3RD GENERATION	$56.50	$31.08	$16.80 – $84
Thyroid stimulating hormone (TSH) test: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $39.55 Aetna — Medicare Advantage: $17.14 Allwell — Medicare Advantage: $16.80 Americas Choice — PPO: $49.16 Anthem Blue Cross Blue Shield — HMO: $21.84 Anthem Blue Cross Blue Shield — Medicare Advantage: $16.80 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $84 Aspirus — All Contracted Commercial Plans: $45.20 Care Wisconsin/MyChoice — Medicare Advantage: $17.30 Centivo — WI 1 Broad: $18.65
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TSH 3RD GENERATION	$56.50	$31.08	$33.90 – $50.85
Thyroid stimulating hormone (TSH) test: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $39.55 Americas Choice — PPO: $49.16 Aspirus — All Contracted Commercial Plans: $45.20 Common Ground — All Contracted Commercial Plans: $33.90 Federated Mutual — All Contracted Commercial Plans: $49.16 First Health Network — All Contracted Commercial Plans: $49.72 Health Payment Systems — All Contracted Commercial Plans: $39.30 HealthEos — All Contracted Commercial Plans: $49.16 HealthSmart — All Contracted Commercial Plans: $50.85 IBSI Passport — All Contracted Commercial Plans: $45.77
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPL CBC W AUTO DIFF WBC	$138	$75.90	$7.77 – $124.20
Complete blood count (CBC) with differential: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $96.60 Aetna — Medicare Advantage: $7.93 Allwell — Medicare Advantage: $7.77 Americas Choice — PPO: $120.06 Anthem Blue Cross Blue Shield — HMO: $10.10 Anthem Blue Cross Blue Shield — Medicare Advantage: $7.77 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $38.85 Aspirus — All Contracted Commercial Plans: $110.40 Care Wisconsin/MyChoice — Medicare Advantage: $8 Centivo — WI 1 Broad: $45.54
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPL CBC W AUTO DIFF WBC	$138	$75.90	$82.80 – $124.20
Complete blood count (CBC) with differential: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $96.60 Americas Choice — PPO: $120.06 Aspirus — All Contracted Commercial Plans: $110.40 Common Ground — All Contracted Commercial Plans: $82.80 Federated Mutual — All Contracted Commercial Plans: $120.06 First Health Network — All Contracted Commercial Plans: $121.44 Health Payment Systems — All Contracted Commercial Plans: $95.99 HealthEos — All Contracted Commercial Plans: $120.06 HealthSmart — All Contracted Commercial Plans: $124.20 IBSI Passport — All Contracted Commercial Plans: $111.78
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPL CBC AUTOMATED	$85	$46.75	$6.47 – $76.50
Complete blood count (CBC), automated: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $59.50 Aetna — Medicare Advantage: $6.60 Allwell — Medicare Advantage: $6.47 Americas Choice — PPO: $73.95 Anthem Blue Cross Blue Shield — HMO: $8.41 Anthem Blue Cross Blue Shield — Medicare Advantage: $6.47 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $32.35 Aspirus — All Contracted Commercial Plans: $68 Care Wisconsin/MyChoice — Medicare Advantage: $6.66 Centivo — WI 1 Broad: $28.05
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPL CBC AUTOMATED	$85	$46.75	$51 – $76.50
Complete blood count (CBC), automated: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $59.50 Americas Choice — PPO: $73.95 Aspirus — All Contracted Commercial Plans: $68 Common Ground — All Contracted Commercial Plans: $51 Federated Mutual — All Contracted Commercial Plans: $73.95 First Health Network — All Contracted Commercial Plans: $74.80 Health Payment Systems — All Contracted Commercial Plans: $59.13 HealthEos — All Contracted Commercial Plans: $73.95 HealthSmart — All Contracted Commercial Plans: $76.50 IBSI Passport — All Contracted Commercial Plans: $68.85
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$68	$37.40	$4.29 – $61.20
Blood clotting time test (prothrombin time, PT): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $47.60 Aetna — Medicare Advantage: $4.38 Allwell — Medicare Advantage: $4.29 Americas Choice — PPO: $59.16 Anthem Blue Cross Blue Shield — HMO: $5.58 Anthem Blue Cross Blue Shield — Medicare Advantage: $4.29 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $21.45 Aspirus — All Contracted Commercial Plans: $54.40 Care Wisconsin/MyChoice — Medicare Advantage: $4.42 Centivo — WI 1 Broad: $22.44
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LA PT, PROTHROMBIN TIME (WDL)	$15	$8.25	$4.29 – $21.45
Blood clotting time test (prothrombin time, PT): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $10.50 Aetna — Medicare Advantage: $4.38 Allwell — Medicare Advantage: $4.29 Americas Choice — PPO: $13.05 Anthem Blue Cross Blue Shield — HMO: $5.58 Anthem Blue Cross Blue Shield — Medicare Advantage: $4.29 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $21.45 Aspirus — All Contracted Commercial Plans: $12 Care Wisconsin/MyChoice — Medicare Advantage: $4.42 Centivo — WI 1 Broad: $4.95
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$68	$37.40	$40.80 – $61.20
Blood clotting time test (prothrombin time, PT): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $47.60 Americas Choice — PPO: $59.16 Aspirus — All Contracted Commercial Plans: $54.40 Common Ground — All Contracted Commercial Plans: $40.80 Federated Mutual — All Contracted Commercial Plans: $59.16 First Health Network — All Contracted Commercial Plans: $59.84 Health Payment Systems — All Contracted Commercial Plans: $47.30 HealthEos — All Contracted Commercial Plans: $59.16 HealthSmart — All Contracted Commercial Plans: $61.20 IBSI Passport — All Contracted Commercial Plans: $55.08
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME (PTT)	$83	$45.65	$6.01 – $74.70
Blood clotting test (partial thromboplastin time, PTT): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $58.10 Aetna — Medicare Advantage: $6.13 Allwell — Medicare Advantage: $6.01 Americas Choice — PPO: $72.21 Anthem Blue Cross Blue Shield — HMO: $7.81 Anthem Blue Cross Blue Shield — Medicare Advantage: $6.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $30.05 Aspirus — All Contracted Commercial Plans: $66.40 Care Wisconsin/MyChoice — Medicare Advantage: $6.19 Centivo — WI 1 Broad: $27.39
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LA PTT, THROMBOPLASTIN TIME PARTIAL (WDL)	$13	$7.15	$3.90 – $30.05
Blood clotting test (partial thromboplastin time, PTT): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $9.10 Aetna — Medicare Advantage: $6.13 Allwell — Medicare Advantage: $6.01 Americas Choice — PPO: $11.31 Anthem Blue Cross Blue Shield — HMO: $7.81 Anthem Blue Cross Blue Shield — Medicare Advantage: $6.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $30.05 Aspirus — All Contracted Commercial Plans: $10.40 Care Wisconsin/MyChoice — Medicare Advantage: $6.19 Centivo — WI 1 Broad: $4.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME (PTT)	$83	$45.65	$49.80 – $74.70
Blood clotting test (partial thromboplastin time, PTT): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $58.10 Americas Choice — PPO: $72.21 Aspirus — All Contracted Commercial Plans: $66.40 Common Ground — All Contracted Commercial Plans: $49.80 Federated Mutual — All Contracted Commercial Plans: $72.21 First Health Network — All Contracted Commercial Plans: $73.04 Health Payment Systems — All Contracted Commercial Plans: $57.73 HealthEos — All Contracted Commercial Plans: $72.21 HealthSmart — All Contracted Commercial Plans: $74.70 IBSI Passport — All Contracted Commercial Plans: $67.23

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 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT, HEAD OR BRAIN, WITHOUT CONTRAST	$2,418	$1,329.90	$103.26 – $2,176.20
CT scan of the head or brain, without contrast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,692.60 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $2,103.66 Anthem Blue Cross Blue Shield — HMO: $1,386 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $2,055.30 Aspirus — All Contracted Commercial Plans: $1,934.40 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $797.94
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT, HEAD OR BRAIN, WITHOUT CONTRAST	$2,418	$1,329.90	$1,450.80 – $2,176.20
CT scan of the head or brain, without contrast: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $1,692.60 Americas Choice — PPO: $2,103.66 Aspirus — All Contracted Commercial Plans: $1,934.40 Common Ground — All Contracted Commercial Plans: $1,450.80 Federated Mutual — All Contracted Commercial Plans: $2,103.66 First Health Network — All Contracted Commercial Plans: $2,127.84 Health Payment Systems — All Contracted Commercial Plans: $1,681.96 HealthEos — All Contracted Commercial Plans: $2,103.66 HealthSmart — All Contracted Commercial Plans: $2,176.20 IBSI Passport — All Contracted Commercial Plans: $1,958.58
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$117.37
CT scan of the head or brain, without contrast: rates for 1 insurance plan Anthem Blue Cross Blue Shield — HMO: $117.37
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI, BRAIN (INCL BRAIN STEM), W/O CONTRAST, F/B CONTRAST AND FURTHER SEQ	$6,461	$3,553.55	$346.78 – $5,814.90
MRI of the brain, before and after contrast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $4,522.70 Aetna — Medicare Advantage: $353.72 Allwell — Medicare Advantage: $346.78 Americas Choice — PPO: $5,621.07 Anthem Blue Cross Blue Shield — HMO: $2,199 Anthem Blue Cross Blue Shield — Medicare Advantage: $346.78 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $5,491.85 Aspirus — All Contracted Commercial Plans: $5,168.80 Care Wisconsin/MyChoice — Medicare Advantage: $357.18 Centivo — WI 1 Broad: $2,132.13
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI, BRAIN (INCL BRAIN STEM), W/O CONTRAST, F/B CONTRAST AND FURTHER SEQ	$6,461	$3,553.55	$3,876.60 – $5,814.90
MRI of the brain, before and after contrast: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $4,522.70 Americas Choice — PPO: $5,621.07 Aspirus — All Contracted Commercial Plans: $5,168.80 Common Ground — All Contracted Commercial Plans: $3,876.60 Federated Mutual — All Contracted Commercial Plans: $5,621.07 First Health Network — All Contracted Commercial Plans: $5,685.68 Health Payment Systems — All Contracted Commercial Plans: $4,494.27 HealthEos — All Contracted Commercial Plans: $5,621.07 HealthSmart — All Contracted Commercial Plans: $5,814.90 IBSI Passport — All Contracted Commercial Plans: $5,233.41
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, CHEST, 2 VIEWS	$413	$227.15	$39.06 – $597
Chest X-ray, 2 views: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $289.10 Aetna — Medicare Advantage: $87.21 Allwell — Medicare Advantage: $85.50 Americas Choice — PPO: $359.31 Anthem Blue Cross Blue Shield — HMO: $39.06 Anthem Blue Cross Blue Shield — Medicare Advantage: $85.50 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $351.05 Aspirus — All Contracted Commercial Plans: $330.40 Care Wisconsin/MyChoice — Medicare Advantage: $88.06 Centivo — WI 1 Broad: $136.29
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, CHEST, 2 VIEWS	$413	$227.15	$247.80 – $371.70
Chest X-ray, 2 views: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $289.10 Americas Choice — PPO: $359.31 Aspirus — All Contracted Commercial Plans: $330.40 Common Ground — All Contracted Commercial Plans: $247.80 Federated Mutual — All Contracted Commercial Plans: $359.31 First Health Network — All Contracted Commercial Plans: $363.44 Health Payment Systems — All Contracted Commercial Plans: $287.28 HealthEos — All Contracted Commercial Plans: $359.31 HealthSmart — All Contracted Commercial Plans: $371.70 IBSI Passport — All Contracted Commercial Plans: $334.53
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, SPINE, LUMBOSACRAL, MINIMUM 4 VIEWS	$796	$437.80	$65.54 – $716.40
X-ray of the lower spine, at least 4 views: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $557.20 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $692.52 Anthem Blue Cross Blue Shield — HMO: $65.54 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $676.60 Aspirus — All Contracted Commercial Plans: $636.80 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $262.68
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, SPINE, LUMBOSACRAL, MINIMUM 4 VIEWS	$796	$437.80	$477.60 – $716.40
X-ray of the lower spine, at least 4 views: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $557.20 Americas Choice — PPO: $692.52 Aspirus — All Contracted Commercial Plans: $636.80 Common Ground — All Contracted Commercial Plans: $477.60 Federated Mutual — All Contracted Commercial Plans: $692.52 First Health Network — All Contracted Commercial Plans: $700.48 Health Payment Systems — All Contracted Commercial Plans: $553.70 HealthEos — All Contracted Commercial Plans: $692.52 HealthSmart — All Contracted Commercial Plans: $716.40 IBSI Passport — All Contracted Commercial Plans: $644.76
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI, SPINAL CANAL AND CONTENTS, LUMBAR, WITHOUT CONTRAST	$4,734	$2,603.70	$234.72 – $4,260.60
MRI of the lower back (lumbar spine), without contrast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $3,313.80 Aetna — Medicare Advantage: $239.41 Allwell — Medicare Advantage: $234.72 Americas Choice — PPO: $4,118.58 Anthem Blue Cross Blue Shield — HMO: $2,199 Anthem Blue Cross Blue Shield — Medicare Advantage: $234.72 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $4,023.90 Aspirus — All Contracted Commercial Plans: $3,787.20 Care Wisconsin/MyChoice — Medicare Advantage: $241.76 Centivo — WI 1 Broad: $1,562.22
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI, SPINAL CANAL AND CONTENTS, LUMBAR, WITHOUT CONTRAST	$4,734	$2,603.70	$2,840.40 – $4,260.60
MRI of the lower back (lumbar spine), without contrast: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $3,313.80 Americas Choice — PPO: $4,118.58 Aspirus — All Contracted Commercial Plans: $3,787.20 Common Ground — All Contracted Commercial Plans: $2,840.40 Federated Mutual — All Contracted Commercial Plans: $4,118.58 First Health Network — All Contracted Commercial Plans: $4,165.92 Health Payment Systems — All Contracted Commercial Plans: $3,292.97 HealthEos — All Contracted Commercial Plans: $4,118.58 HealthSmart — All Contracted Commercial Plans: $4,260.60 IBSI Passport — All Contracted Commercial Plans: $3,834.54
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT, PELVIS, WITH CONTRAST	$3,123	$1,717.65	$172.86 – $2,810.70
CT scan of the pelvis, with contrast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $2,186.10 Aetna — Medicare Advantage: $176.32 Allwell — Medicare Advantage: $172.86 Americas Choice — PPO: $2,717.01 Anthem Blue Cross Blue Shield — HMO: $1,386 Anthem Blue Cross Blue Shield — Medicare Advantage: $172.86 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $2,654.55 Aspirus — All Contracted Commercial Plans: $2,498.40 Care Wisconsin/MyChoice — Medicare Advantage: $178.05 Centivo — WI 1 Broad: $1,030.59
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT, PELVIS, WITH CONTRAST	$3,123	$1,717.65	$1,873.80 – $2,810.70
CT scan of the pelvis, with contrast: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $2,186.10 Americas Choice — PPO: $2,717.01 Aspirus — All Contracted Commercial Plans: $2,498.40 Common Ground — All Contracted Commercial Plans: $1,873.80 Federated Mutual — All Contracted Commercial Plans: $2,717.01 First Health Network — All Contracted Commercial Plans: $2,748.24 Health Payment Systems — All Contracted Commercial Plans: $2,172.36 HealthEos — All Contracted Commercial Plans: $2,717.01 HealthSmart — All Contracted Commercial Plans: $2,810.70 IBSI Passport — All Contracted Commercial Plans: $2,529.63
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI, ANY JOINT OF LOWER EXTREMITY, WITHOUT CONTRAST	$4,560	$2,508	$234.72 – $4,104
MRI of a leg joint (such as the knee), without contrast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $3,192 Aetna — Medicare Advantage: $239.41 Allwell — Medicare Advantage: $234.72 Americas Choice — PPO: $3,967.20 Anthem Blue Cross Blue Shield — HMO: $2,199 Anthem Blue Cross Blue Shield — Medicare Advantage: $234.72 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $3,876 Aspirus — All Contracted Commercial Plans: $3,648 Care Wisconsin/MyChoice — Medicare Advantage: $241.76 Centivo — WI 1 Broad: $1,504.80
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI, ANY JOINT OF LOWER EXTREMITY, WITHOUT CONTRAST	$4,560	$2,508	$2,736 – $4,104
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates Aetna — All Contracted Commercial Plans: $3,192 Americas Choice — PPO: $3,967.20 Aspirus — All Contracted Commercial Plans: $3,648 Common Ground — All Contracted Commercial Plans: $2,736 Compsych — Behavioral Health: $3,648 Federated Mutual — All Contracted Commercial Plans: $3,967.20 First Health Network — All Contracted Commercial Plans: $4,012.80 Health Payment Systems — All Contracted Commercial Plans: $3,171.94 HealthEos — All Contracted Commercial Plans: $3,967.20 HealthSmart — All Contracted Commercial Plans: $4,104
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT, ABDOMEN AND PELVIS, WITH CONTRAST	$5,125	$2,818.75	$346.78 – $4,612.50
CT scan of the abdomen and pelvis, with contrast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $3,587.50 Aetna — Medicare Advantage: $353.72 Allwell — Medicare Advantage: $346.78 Americas Choice — PPO: $4,458.75 Anthem Blue Cross Blue Shield — HMO: $1,386 Anthem Blue Cross Blue Shield — Medicare Advantage: $346.78 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $4,356.25 Aspirus — All Contracted Commercial Plans: $4,100 Care Wisconsin/MyChoice — Medicare Advantage: $357.18 Centivo — WI 1 Broad: $1,691.25
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT, ABDOMEN AND PELVIS, WITH CONTRAST	$5,125	$2,818.75	$3,075 – $4,612.50
CT scan of the abdomen and pelvis, with contrast: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $3,587.50 Americas Choice — PPO: $4,458.75 Aspirus — All Contracted Commercial Plans: $4,100 Common Ground — All Contracted Commercial Plans: $3,075 Federated Mutual — All Contracted Commercial Plans: $4,458.75 First Health Network — All Contracted Commercial Plans: $4,510 Health Payment Systems — All Contracted Commercial Plans: $3,564.95 HealthEos — All Contracted Commercial Plans: $4,458.75 HealthSmart — All Contracted Commercial Plans: $4,612.50 IBSI Passport — All Contracted Commercial Plans: $4,151.25
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION, COMPLETE	$1,235	$679.25	$103.26 – $1,111.50
Ultrasound of the abdomen, complete: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $864.50 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $1,074.45 Anthem Blue Cross Blue Shield — HMO: $570 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $1,049.75 Aspirus — All Contracted Commercial Plans: $988 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $407.55
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION, COMPLETE	$1,235	$679.25	$741 – $1,111.50
Ultrasound of the abdomen, complete: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $864.50 Americas Choice — PPO: $1,074.45 Aspirus — All Contracted Commercial Plans: $988 Common Ground — All Contracted Commercial Plans: $741 Federated Mutual — All Contracted Commercial Plans: $1,074.45 First Health Network — All Contracted Commercial Plans: $1,086.80 Health Payment Systems — All Contracted Commercial Plans: $859.07 HealthEos — All Contracted Commercial Plans: $1,074.45 HealthSmart — All Contracted Commercial Plans: $1,111.50 IBSI Passport — All Contracted Commercial Plans: $1,000.35
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OB US, UTERUS, FETAL AND MATERNAL EVAL, MORE TH/EQL 14 WKS, SGL/1ST GEST	$1,114	$612.70	$103.26 – $1,002.60
Pregnancy ultrasound (after the first trimester): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $779.80 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $969.18 Anthem Blue Cross Blue Shield — HMO: $570 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $946.90 Aspirus — All Contracted Commercial Plans: $891.20 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $367.62
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US, PREG UTERUS, AFTER FIRST TRIMESTER, TRANSABD APPROACH, SGL/1ST GEST	$1,114	$612.70	$103.26 – $1,002.60
Pregnancy ultrasound (after the first trimester): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $779.80 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $969.18 Anthem Blue Cross Blue Shield — HMO: $570 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $946.90 Aspirus — All Contracted Commercial Plans: $891.20 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $367.62
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OB US, UTERUS, FETAL AND MATERNAL EVAL, MORE TH/EQL 14 WKS, SGL/1ST GEST	$1,114	$612.70	$668.40 – $1,002.60
Pregnancy ultrasound (after the first trimester): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $779.80 Americas Choice — PPO: $969.18 Aspirus — All Contracted Commercial Plans: $891.20 Common Ground — All Contracted Commercial Plans: $668.40 Federated Mutual — All Contracted Commercial Plans: $969.18 First Health Network — All Contracted Commercial Plans: $980.32 Health Payment Systems — All Contracted Commercial Plans: $774.90 HealthEos — All Contracted Commercial Plans: $969.18 HealthSmart — All Contracted Commercial Plans: $1,002.60 IBSI Passport — All Contracted Commercial Plans: $902.34
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NON-OB US, TRANSVAGINAL	$976	$536.80	$103.26 – $878.40
Transvaginal ultrasound: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $683.20 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $849.12 Anthem Blue Cross Blue Shield — HMO: $570 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $829.60 Aspirus — All Contracted Commercial Plans: $780.80 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $322.08
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US, TRANSVAGINAL	$976	$536.80	$103.26 – $878.40
Transvaginal ultrasound: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $683.20 Aetna — Medicare Advantage: $105.32 Allwell — Medicare Advantage: $103.26 Americas Choice — PPO: $849.12 Anthem Blue Cross Blue Shield — HMO: $570 Anthem Blue Cross Blue Shield — Medicare Advantage: $103.26 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $829.60 Aspirus — All Contracted Commercial Plans: $780.80 Care Wisconsin/MyChoice — Medicare Advantage: $106.36 Centivo — WI 1 Broad: $322.08
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NON-OB US, TRANSVAGINAL	$976	$536.80	$585.60 – $878.40
Transvaginal ultrasound: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $683.20 Americas Choice — PPO: $849.12 Aspirus — All Contracted Commercial Plans: $780.80 Common Ground — All Contracted Commercial Plans: $585.60 Federated Mutual — All Contracted Commercial Plans: $849.12 First Health Network — All Contracted Commercial Plans: $858.88 Health Payment Systems — All Contracted Commercial Plans: $678.91 HealthEos — All Contracted Commercial Plans: $849.12 HealthSmart — All Contracted Commercial Plans: $878.40 IBSI Passport — All Contracted Commercial Plans: $790.56
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UNILAT, DX MAMMOGRAPHY, INCLUDING CAD	$270	$148.50	$81 – $243
Diagnostic mammogram, one breast: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $189 Aetna — Medicare Advantage: $118.95 Allwell — Medicare Advantage: $116.61 Americas Choice — PPO: $234.90 Anthem Blue Cross Blue Shield — HMO: $181 Anthem Blue Cross Blue Shield — Medicare Advantage: $116.61 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $229.50 Aspirus — All Contracted Commercial Plans: $216 Care Wisconsin/MyChoice — Medicare Advantage: $120.11 Centivo — WI 1 Broad: $89.10
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UNILAT, DX MAMMOGRAPHY, INCLUDING CAD	$270	$148.50	$162 – $243
Diagnostic mammogram, one breast: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $189 Americas Choice — PPO: $234.90 Aspirus — All Contracted Commercial Plans: $216 Common Ground — All Contracted Commercial Plans: $162 Federated Mutual — All Contracted Commercial Plans: $234.90 First Health Network — All Contracted Commercial Plans: $237.60 Health Payment Systems — All Contracted Commercial Plans: $187.81 HealthEos — All Contracted Commercial Plans: $234.90 HealthSmart — All Contracted Commercial Plans: $243 IBSI Passport — All Contracted Commercial Plans: $218.70
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BILAT, DX MAMMOGRAPHY, INCLUDING CAD	$336	$184.80	$100.80 – $302.40
Diagnostic mammogram, both breasts: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $235.20 Aetna — Medicare Advantage: $150.16 Allwell — Medicare Advantage: $147.22 Americas Choice — PPO: $292.32 Anthem Blue Cross Blue Shield — HMO: $181 Anthem Blue Cross Blue Shield — Medicare Advantage: $147.22 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $285.60 Aspirus — All Contracted Commercial Plans: $268.80 Care Wisconsin/MyChoice — Medicare Advantage: $151.63 Centivo — WI 1 Broad: $110.88
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BILAT, DX MAMMOGRAPHY, INCLUDING CAD	$336	$184.80	$201.60 – $302.40
Diagnostic mammogram, both breasts: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $235.20 Americas Choice — PPO: $292.32 Aspirus — All Contracted Commercial Plans: $268.80 Common Ground — All Contracted Commercial Plans: $201.60 Federated Mutual — All Contracted Commercial Plans: $292.32 First Health Network — All Contracted Commercial Plans: $295.68 Health Payment Systems — All Contracted Commercial Plans: $233.72 HealthEos — All Contracted Commercial Plans: $292.32 HealthSmart — All Contracted Commercial Plans: $302.40 IBSI Passport — All Contracted Commercial Plans: $272.16
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BILAT, SCREEN MAMMOGRAPHY, INCLUDING CAD	$373	$205.15	$111.90 – $335.70
Screening mammogram, both breasts: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $261.10 Aetna — Medicare Advantage: $121.61 Allwell — Medicare Advantage: $119.22 Americas Choice — PPO: $324.51 Anthem Blue Cross Blue Shield — HMO: $181 Anthem Blue Cross Blue Shield — Medicare Advantage: $119.22 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $317.05 Aspirus — All Contracted Commercial Plans: $298.40 Care Wisconsin/MyChoice — Medicare Advantage: $122.80 Centivo — WI 1 Broad: $123.09
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BILAT, SCREEN MAMMOGRAPHY, INCLUDING CAD	$373	$205.15	$223.80 – $335.70
Screening mammogram, both breasts: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $261.10 Americas Choice — PPO: $324.51 Aspirus — All Contracted Commercial Plans: $298.40 Common Ground — All Contracted Commercial Plans: $223.80 Federated Mutual — All Contracted Commercial Plans: $324.51 First Health Network — All Contracted Commercial Plans: $328.24 Health Payment Systems — All Contracted Commercial Plans: $259.46 HealthEos — All Contracted Commercial Plans: $324.51 HealthSmart — All Contracted Commercial Plans: $335.70 IBSI Passport — All Contracted Commercial Plans: $302.13

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$13.14 – $13.54
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $13.41 Allwell — Medicare Advantage: $13.14 Anthem Blue Cross Blue Shield — Medicare Advantage: $13.14 Care Wisconsin/MyChoice — Medicare Advantage: $13.54 Community Care — Medicare Advantage: $13.14 Health Partners — Medicare Advantage: $13.14 Humana — Medicare Advantage: $13.14 ICare — Medicare Advantage: $13.14 Network Health Plan — Medicare Advantage: $13.14 Security Health Plan — Medicare Advantage: $13.14
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$3,123.20 – $15,743
Left heart catheterization (diagnostic): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $3,185.66 Allwell — Medicare Advantage: $3,123.20 Anthem Blue Cross Blue Shield — HMO: $13,311 Anthem Blue Cross Blue Shield — Medicare Advantage: $3,123.20 Care Wisconsin/MyChoice — Medicare Advantage: $3,216.89 Community Care — Medicare Advantage: $3,123.20 Health Partners — Medicare Advantage: $3,123.20 Humana — Medicare Advantage: $3,123.20 ICare — Medicare Advantage: $3,123.20 Network Health Plan — ACA: $8,391.64
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPRHNSV ELECTRPHYS EVAL WO ARRHYTH INDUCT RT	$16,850	$9,267.50	$1,350 – $15,165
Heart rhythm study (electrophysiology evaluation): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $11,795 Aetna — Medicare Advantage: $7,515.56 Allwell — Medicare Advantage: $7,368.20 Americas Choice — PPO: $14,659.50 Anthem Blue Cross Blue Shield — HMO: $11,121 Anthem Blue Cross Blue Shield — Medicare Advantage: $7,368.20 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $14,322.50 Aspirus — All Contracted Commercial Plans: $13,480 Care Wisconsin/MyChoice — Medicare Advantage: $7,589.24 Centivo — WI 1 Broad: $5,560.50
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPRHNSV ELECTRPHYS EVAL WO ARRHYTH INDUCT RT	$16,850	$9,267.50	$10,110 – $15,165
Heart rhythm study (electrophysiology evaluation): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $11,795 Americas Choice — PPO: $14,659.50 Aspirus — All Contracted Commercial Plans: $13,480 Common Ground — All Contracted Commercial Plans: $10,110 Federated Mutual — All Contracted Commercial Plans: $14,659.50 First Health Network — All Contracted Commercial Plans: $14,828 Health Payment Systems — All Contracted Commercial Plans: $11,720.86 HealthEos — All Contracted Commercial Plans: $14,659.50 HealthSmart — All Contracted Commercial Plans: $15,165 IBSI Passport — All Contracted Commercial Plans: $13,648.50
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$9,706.25 – $16,779
Heart rhythm study (electrophysiology evaluation): rates for 6 insurance plans Network Health Plan — ACA: $9,706.25 Network Health Plan — All Contracted Commercial Plans: $10,784.73 Sheboygan Employers Health Network — All Contracted Commercial Plans: $12,248 United Healthcare — Choice Plus/Navigate: $13,982 United Healthcare — Nexus: $11,897 United Healthcare — Options PPO: $16,779
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPRHSV ELECTROPHYS EVAL TRNSSEPT CATH, ABLAT ATR FIB BY PULM VEIN ISOL	$38,200	$21,010	$1,350 – $34,380
Heart rhythm study with ablation for atrial fibrillation: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $26,740 Aetna — Medicare Advantage: $24,297.78 Allwell — Medicare Advantage: $23,821.35 Americas Choice — PPO: $33,234 Anthem Blue Cross Blue Shield — HMO: $18,668 Anthem Blue Cross Blue Shield — Medicare Advantage: $23,821.35 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $32,470 Aspirus — All Contracted Commercial Plans: $30,560 Care Wisconsin/MyChoice — Medicare Advantage: $24,535.99 Centivo — WI 1 Broad: $12,606
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPRHSV ELECTROPHYS EVAL TRNSSEPT CATH, ABLAT ATR FIB BY PULM VEIN ISOL	$38,200	$21,010	$22,920 – $34,380
Heart rhythm study with ablation for atrial fibrillation: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $26,740 Americas Choice — PPO: $33,234 Aspirus — All Contracted Commercial Plans: $30,560 Common Ground — All Contracted Commercial Plans: $22,920 Federated Mutual — All Contracted Commercial Plans: $33,234 First Health Network — All Contracted Commercial Plans: $33,616 Health Payment Systems — All Contracted Commercial Plans: $26,571.92 HealthEos — All Contracted Commercial Plans: $33,234 HealthSmart — All Contracted Commercial Plans: $34,380 IBSI Passport — All Contracted Commercial Plans: $30,942
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	Not listed in the file	Not listed in the file	$13,130.52 – $22,275
Heart rhythm study with ablation for atrial fibrillation: rates for 6 insurance plans Network Health Plan — ACA: $13,130.52 Network Health Plan — All Contracted Commercial Plans: $14,589.46 Sheboygan Employers Health Network — All Contracted Commercial Plans: $16,571 United Healthcare — Choice Plus/Navigate: $18,562 United Healthcare — Nexus: $15,792 United Healthcare — Options PPO: $22,275
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC POLYSOMNOGRAPHY STUDY < 6 HRS	$6,468	$3,557.40	$987.91 – $5,821.20
Sleep study (overnight, in a sleep lab): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $4,527.60 Aetna — Medicare Advantage: $1,007.66 Allwell — Medicare Advantage: $987.91 Americas Choice — PPO: $5,627.16 Anthem Blue Cross Blue Shield — HMO: $3,628 Anthem Blue Cross Blue Shield — Medicare Advantage: $987.91 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $5,497.80 Aspirus — All Contracted Commercial Plans: $5,174.40 Care Wisconsin/MyChoice — Medicare Advantage: $1,017.54 Centivo — WI 1 Broad: $2,134.44
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC POLYSOMNOGRAPHY STUDY	$6,468	$3,557.40	$987.91 – $5,821.20
Sleep study (overnight, in a sleep lab): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $4,527.60 Aetna — Medicare Advantage: $1,007.66 Allwell — Medicare Advantage: $987.91 Americas Choice — PPO: $5,627.16 Anthem Blue Cross Blue Shield — HMO: $3,628 Anthem Blue Cross Blue Shield — Medicare Advantage: $987.91 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $5,497.80 Aspirus — All Contracted Commercial Plans: $5,174.40 Care Wisconsin/MyChoice — Medicare Advantage: $1,017.54 Centivo — WI 1 Broad: $2,134.44
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC POLYSOMNOGRAPHY STUDY < 6 HRS	$6,468	$3,557.40	$3,880.80 – $5,821.20
Sleep study (overnight, in a sleep lab): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $4,527.60 Americas Choice — PPO: $5,627.16 Aspirus — All Contracted Commercial Plans: $5,174.40 Common Ground — All Contracted Commercial Plans: $3,880.80 Federated Mutual — All Contracted Commercial Plans: $5,627.16 First Health Network — All Contracted Commercial Plans: $5,691.84 Health Payment Systems — All Contracted Commercial Plans: $4,499.14 HealthEos — All Contracted Commercial Plans: $5,627.16 HealthSmart — All Contracted Commercial Plans: $5,821.20 IBSI Passport — All Contracted Commercial Plans: $5,239.08

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: HC TELEHEALTH THERAPEUTIC EXERCISES EACH 15 MIN_OT	$163	$89.65	$27.97 – $370
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $114.10 Aetna — Medicare Advantage: $28.53 Allwell — Medicare Advantage: $27.97 Americas Choice — PPO: $141.81 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $27.97 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $138.55 Aspirus — All Contracted Commercial Plans: $130.40 Care Wisconsin/MyChoice — Medicare Advantage: $28.81 Centivo — WI 1 Broad: $53.79
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TELEHEALTH PT, THERAPEUTIC EXERCISES, EACH 15 MIN	$163	$89.65	$27.97 – $370
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $114.10 Aetna — Medicare Advantage: $28.53 Allwell — Medicare Advantage: $27.97 Americas Choice — PPO: $141.81 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $27.97 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $138.55 Aspirus — All Contracted Commercial Plans: $130.40 Care Wisconsin/MyChoice — Medicare Advantage: $28.81 Centivo — WI 1 Broad: $53.79
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OT, THERAPEUTIC EXERCISES, EACH 15 MIN	$163	$89.65	$27.97 – $370
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $114.10 Aetna — Medicare Advantage: $28.53 Allwell — Medicare Advantage: $27.97 Americas Choice — PPO: $141.81 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $27.97 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $138.55 Aspirus — All Contracted Commercial Plans: $130.40 Care Wisconsin/MyChoice — Medicare Advantage: $28.81 Centivo — WI 1 Broad: $53.79
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, LOW COMPLEXITY	$414	$227.70	$95.13 – $372.60
Physical therapy evaluation (low complexity): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $289.80 Aetna — Medicare Advantage: $97.03 Allwell — Medicare Advantage: $95.13 Americas Choice — PPO: $360.18 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $351.90 Aspirus — All Contracted Commercial Plans: $331.20 Care Wisconsin/MyChoice — Medicare Advantage: $97.98 Centivo — WI 1 Broad: $136.62
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TELEHEALTH PHYSICAL THERAPY EVALUATION, LOW COMPLEXITY	$363	$199.65	$95.13 – $370
Physical therapy evaluation (low complexity): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $254.10 Aetna — Medicare Advantage: $97.03 Allwell — Medicare Advantage: $95.13 Americas Choice — PPO: $315.81 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $308.55 Aspirus — All Contracted Commercial Plans: $290.40 Care Wisconsin/MyChoice — Medicare Advantage: $97.98 Centivo — WI 1 Broad: $119.79
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TELEHEALTH PHYSICAL THERAPY EVALUATION, LOW COMPLEXITY	$363	$199.65	$217.80 – $326.70
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $254.10 Americas Choice — PPO: $315.81 Aspirus — All Contracted Commercial Plans: $290.40 Common Ground — All Contracted Commercial Plans: $217.80 Federated Mutual — All Contracted Commercial Plans: $315.81 First Health Network — All Contracted Commercial Plans: $319.44 Health Payment Systems — All Contracted Commercial Plans: $252.50 HealthEos — All Contracted Commercial Plans: $315.81 HealthSmart — All Contracted Commercial Plans: $326.70 IBSI Passport — All Contracted Commercial Plans: $294.03
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TELEHEALTH PHYSICAL THERAPY EVALUATION, MODERATE COMPLEXITY	$421	$231.55	$95.13 – $378.90
Physical therapy evaluation (moderate complexity): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $294.70 Aetna — Medicare Advantage: $97.03 Allwell — Medicare Advantage: $95.13 Americas Choice — PPO: $366.27 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $357.85 Aspirus — All Contracted Commercial Plans: $336.80 Care Wisconsin/MyChoice — Medicare Advantage: $97.98 Centivo — WI 1 Broad: $138.93
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, MODERATE COMPLEXITY	$469	$257.95	$95.13 – $422.10
Physical therapy evaluation (moderate complexity): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $328.30 Aetna — Medicare Advantage: $97.03 Allwell — Medicare Advantage: $95.13 Americas Choice — PPO: $408.03 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $398.65 Aspirus — All Contracted Commercial Plans: $375.20 Care Wisconsin/MyChoice — Medicare Advantage: $97.98 Centivo — WI 1 Broad: $154.77
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, MODERATE COMPLEXITY	$469	$257.95	$281.40 – $422.10
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $328.30 Americas Choice — PPO: $408.03 Aspirus — All Contracted Commercial Plans: $375.20 Common Ground — All Contracted Commercial Plans: $281.40 Federated Mutual — All Contracted Commercial Plans: $408.03 First Health Network — All Contracted Commercial Plans: $412.72 Health Payment Systems — All Contracted Commercial Plans: $326.24 HealthEos — All Contracted Commercial Plans: $408.03 HealthSmart — All Contracted Commercial Plans: $422.10 IBSI Passport — All Contracted Commercial Plans: $379.89
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, HIGH COMPLEXITY	$545	$299.75	$95.13 – $490.50
Physical therapy evaluation (high complexity): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $381.50 Aetna — Medicare Advantage: $97.03 Allwell — Medicare Advantage: $95.13 Americas Choice — PPO: $474.15 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $463.25 Aspirus — All Contracted Commercial Plans: $436 Care Wisconsin/MyChoice — Medicare Advantage: $97.98 Centivo — WI 1 Broad: $179.85
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TELEHEALTH PHYSICAL THERAPY EVALUATION, HIGH COMPLEXITY	$515	$283.25	$95.13 – $463.50
Physical therapy evaluation (high complexity): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $360.50 Aetna — Medicare Advantage: $97.03 Allwell — Medicare Advantage: $95.13 Americas Choice — PPO: $448.05 Anthem Blue Cross Blue Shield — HMO: $329 Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $437.75 Aspirus — All Contracted Commercial Plans: $412 Care Wisconsin/MyChoice — Medicare Advantage: $97.98 Centivo — WI 1 Broad: $169.95
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TELEHEALTH PHYSICAL THERAPY EVALUATION, HIGH COMPLEXITY	$515	$283.25	$309 – $463.50
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $360.50 Americas Choice — PPO: $448.05 Aspirus — All Contracted Commercial Plans: $412 Common Ground — All Contracted Commercial Plans: $309 Federated Mutual — All Contracted Commercial Plans: $448.05 First Health Network — All Contracted Commercial Plans: $453.20 Health Payment Systems — All Contracted Commercial Plans: $358.23 HealthEos — All Contracted Commercial Plans: $448.05 HealthSmart — All Contracted Commercial Plans: $463.50 IBSI Passport — All Contracted Commercial Plans: $417.15
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCHOTHERAPY, 30 MINUTES WITH PATIENT	$259	$142.45	$77.70 – $233.10
Psychotherapy, 30 minutes: 10 of 42 insurance plan rates Aetna — All Contracted Commercial Plans: $181.30 Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Americas Choice — PPO: $225.33 Anthem Blue Cross Blue Shield — HMO: $170.94 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $220.15 Aspirus — All Contracted Commercial Plans: $207.20 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Centivo — WI 1 Broad: $85.47
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AODA PSYCHOTHERAPY, 30 MINUTES WITH PATIENT	$181	$99.55	$54.30 – $162.90
Psychotherapy, 30 minutes: 10 of 42 insurance plan rates Aetna — All Contracted Commercial Plans: $126.70 Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Americas Choice — PPO: $157.47 Anthem Blue Cross Blue Shield — HMO: $119.46 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $153.85 Aspirus — All Contracted Commercial Plans: $144.80 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Centivo — WI 1 Broad: $59.73
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYCHOTHERAPY, 30 MINUTES WITH PATIENT	$259	$142.45	$155.40 – $233.10
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $181.30 Americas Choice — PPO: $225.33 Aspirus — All Contracted Commercial Plans: $207.20 Common Ground — All Contracted Commercial Plans: $155.40 Federated Mutual — All Contracted Commercial Plans: $225.33 First Health Network — All Contracted Commercial Plans: $227.92 Health Payment Systems — All Contracted Commercial Plans: $180.16 HealthEos — All Contracted Commercial Plans: $225.33 HealthSmart — All Contracted Commercial Plans: $233.10 IBSI Passport — All Contracted Commercial Plans: $209.79
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCHOTHERAPY, 45 MINUTES WITH PATIENT	$204	$112.20	$61.20 – $183.60
Psychotherapy, 45 minutes: 10 of 42 insurance plan rates Aetna — All Contracted Commercial Plans: $142.80 Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Americas Choice — PPO: $177.48 Anthem Blue Cross Blue Shield — HMO: $134.64 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $173.40 Aspirus — All Contracted Commercial Plans: $163.20 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Centivo — WI 1 Broad: $67.32
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AODA PSYCHOTHERAPY, 45 MINUTES WITH PATIENT	$204	$112.20	$61.20 – $183.60
Psychotherapy, 45 minutes: 10 of 42 insurance plan rates Aetna — All Contracted Commercial Plans: $142.80 Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Americas Choice — PPO: $177.48 Anthem Blue Cross Blue Shield — HMO: $134.64 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $173.40 Aspirus — All Contracted Commercial Plans: $163.20 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Centivo — WI 1 Broad: $67.32
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AODA PSYCHOTHERAPY, 45 MINUTES WITH PATIENT	$204	$112.20	$122.40 – $183.60
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $142.80 Americas Choice — PPO: $177.48 Aspirus — All Contracted Commercial Plans: $163.20 Common Ground — All Contracted Commercial Plans: $122.40 Federated Mutual — All Contracted Commercial Plans: $177.48 First Health Network — All Contracted Commercial Plans: $179.52 Health Payment Systems — All Contracted Commercial Plans: $141.90 HealthEos — All Contracted Commercial Plans: $177.48 HealthSmart — All Contracted Commercial Plans: $183.60 IBSI Passport — All Contracted Commercial Plans: $165.24
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYCHOTHERAPY, 60 MINUTES WITH PATIENT	$381	$209.55	$114.30 – $342.90
Psychotherapy, 60 minutes: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $266.70 Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Americas Choice — PPO: $331.47 Anthem Blue Cross Blue Shield — HMO: $251.46 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $323.85 Aspirus — All Contracted Commercial Plans: $304.80 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Centivo — WI 1 Broad: $125.73
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AODA PSYCHOTHERAPY, 60 MINUTES WITH PATIENT	$259	$142.45	$77.70 – $233.10
Psychotherapy, 60 minutes: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $181.30 Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Americas Choice — PPO: $225.33 Anthem Blue Cross Blue Shield — HMO: $170.94 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $220.15 Aspirus — All Contracted Commercial Plans: $207.20 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Centivo — WI 1 Broad: $85.47
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AODA PSYCHOTHERAPY, 60 MINUTES WITH PATIENT	$259	$142.45	$155.40 – $233.10
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $181.30 Americas Choice — PPO: $225.33 Aspirus — All Contracted Commercial Plans: $207.20 Common Ground — All Contracted Commercial Plans: $155.40 Federated Mutual — All Contracted Commercial Plans: $225.33 First Health Network — All Contracted Commercial Plans: $227.92 Health Payment Systems — All Contracted Commercial Plans: $180.16 HealthEos — All Contracted Commercial Plans: $225.33 HealthSmart — All Contracted Commercial Plans: $233.10 IBSI Passport — All Contracted Commercial Plans: $209.79
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$156.01 – $160.69
Family psychotherapy, without the patient: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Community Care — Medicare Advantage: $156.01 Health Partners — Medicare Advantage: $156.01 Humana — Medicare Advantage: $156.01 ICare — Medicare Advantage: $156.01 Network Health Plan — Medicare Advantage: $156.01 Security Health Plan — Medicare Advantage: $156.01
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$128 – $160.69
Family psychotherapy, with the patient: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $159.13 Allwell — Medicare Advantage: $156.01 Anthem Blue Cross Blue Shield — Medicare Advantage: $156.01 Care Wisconsin/MyChoice — Medicare Advantage: $160.69 Community Care — Medicare Advantage: $156.01 Compsych — Behavioral Health: $128 Health Partners — Medicare Advantage: $156.01 Humana — Medicare Advantage: $156.01 ICare — Medicare Advantage: $156.01 Network Health Plan — Medicare Advantage: $156.01
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC GROUP PSYCHOTHERAPY	$437	$240.35	$89.35 – $474
Group psychotherapy: 10 of 43 insurance plan rates Aetna — All Contracted Commercial Plans: $305.90 Aetna — Medicare Advantage: $91.62 Allwell — Medicare Advantage: $89.82 Americas Choice — PPO: $380.19 Anthem Blue Cross Blue Shield — HMO: $460 Anthem Blue Cross Blue Shield — Medicare Advantage: $89.82 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $371.45 Aspirus — All Contracted Commercial Plans: $349.60 Care Wisconsin/MyChoice — Medicare Advantage: $92.51 Centivo — WI 1 Broad: $144.21
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INTENSIVE OUTPATIENT PROGRAM, GROUP PSYCHOTHERAPY	$267	$146.85	$80.10 – $474
Group psychotherapy: 10 of 43 insurance plan rates Aetna — All Contracted Commercial Plans: $186.90 Aetna — Medicare Advantage: $91.62 Allwell — Medicare Advantage: $89.82 Americas Choice — PPO: $232.29 Anthem Blue Cross Blue Shield — HMO: $460 Anthem Blue Cross Blue Shield — Medicare Advantage: $89.82 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $226.95 Aspirus — All Contracted Commercial Plans: $213.60 Care Wisconsin/MyChoice — Medicare Advantage: $92.51 Centivo — WI 1 Broad: $88.11
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AODA GROUP PSYCHOTHERAPY 90 MIN_MS	$437	$240.35	$89.35 – $393.30
Group psychotherapy: 10 of 43 insurance plan rates Aetna — All Contracted Commercial Plans: $305.90 Aetna — Medicare Advantage: $91.62 Allwell — Medicare Advantage: $89.82 Americas Choice — PPO: $380.19 Anthem Blue Cross Blue Shield — HMO: $288.42 Anthem Blue Cross Blue Shield — Medicare Advantage: $89.82 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $371.45 Aspirus — All Contracted Commercial Plans: $349.60 Care Wisconsin/MyChoice — Medicare Advantage: $92.51 Centivo — WI 1 Broad: $144.21

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: HC EXC CYST, FIBROADENOMA, ABERR BRST TISS, DUCT/NIP/AREOLAR LES,1/MORE LES	$10,737	$5,905.35	$3,221.10 – $9,663.30
Removal of breast growth (open surgery): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $7,515.90 Aetna — Medicare Advantage: $3,792.67 Allwell — Medicare Advantage: $3,718.31 Americas Choice — PPO: $9,341.19 Anthem Blue Cross Blue Shield — HMO: $8,592 Anthem Blue Cross Blue Shield — Medicare Advantage: $3,718.31 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $9,126.45 Aspirus — All Contracted Commercial Plans: $8,589.60 Care Wisconsin/MyChoice — Medicare Advantage: $3,829.86 Centivo — WI 1 Broad: $3,543.21
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EXC CYST, FIBROADENOMA, ABERR BRST TISS, DUCT/NIP/AREOLAR LES,1/MORE LES	$10,737	$5,905.35	$6,442.20 – $9,663.30
Removal of breast growth (open surgery): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $7,515.90 Americas Choice — PPO: $9,341.19 Aspirus — All Contracted Commercial Plans: $8,589.60 Common Ground — All Contracted Commercial Plans: $6,442.20 Federated Mutual — All Contracted Commercial Plans: $9,341.19 First Health Network — All Contracted Commercial Plans: $9,448.56 Health Payment Systems — All Contracted Commercial Plans: $7,468.66 HealthEos — All Contracted Commercial Plans: $9,341.19 HealthSmart — All Contracted Commercial Plans: $9,663.30 IBSI Passport — All Contracted Commercial Plans: $8,696.97
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	$5,216.73 – $8,783
Removal of breast growth (open surgery): rates for 6 insurance plans Network Health Plan — ACA: $5,216.73 Network Health Plan — All Contracted Commercial Plans: $5,796.37 Sheboygan Employers Health Network — All Contracted Commercial Plans: $6,052 United Healthcare — Choice Plus/Navigate: $7,318 United Healthcare — Nexus: $6,227 United Healthcare — Options PPO: $8,783
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	$11,645.84 – $19,754
Total hip replacement: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $12,743.82 Allwell — Medicare Advantage: $12,493.94 Anthem Blue Cross Blue Shield — HMO: $17,495 Anthem Blue Cross Blue Shield — Medicare Advantage: $12,493.94 Care Wisconsin/MyChoice — Medicare Advantage: $12,868.76 Community Care — Medicare Advantage: $12,493.94 Health Partners — Medicare Advantage: $12,493.94 Humana — Medicare Advantage: $12,493.94 ICare — Medicare Advantage: $12,493.94 Network Health Plan — ACA: $11,645.84
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	$11,645.84 – $19,754
Total knee replacement: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $12,743.82 Allwell — Medicare Advantage: $12,493.94 Anthem Blue Cross Blue Shield — HMO: $19,217 Anthem Blue Cross Blue Shield — Medicare Advantage: $12,493.94 Care Wisconsin/MyChoice — Medicare Advantage: $12,868.76 Community Care — Medicare Advantage: $12,493.94 Health Partners — Medicare Advantage: $12,493.94 Humana — Medicare Advantage: $12,493.94 ICare — Medicare Advantage: $12,493.94 Network Health Plan — ACA: $11,645.84
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$151.65 – $3,457
Shoulder arthroscopy: shaving of shoulder bone: 10 of 17 insurance plan rates Aetna — Medicare Advantage: $154.68 Allwell — Medicare Advantage: $151.65 Anthem Blue Cross Blue Shield — Medicare Advantage: $151.65 Care Wisconsin/MyChoice — Medicare Advantage: $156.20 Community Care — Medicare Advantage: $151.65 Health Partners — Medicare Advantage: $151.65 Humana — Medicare Advantage: $151.65 ICare — Medicare Advantage: $151.65 Network Health Plan — ACA: $834.68 Network Health Plan — All Contracted Commercial Plans: $927.42
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$3,150.58 – $13,918
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $3,213.59 Allwell — Medicare Advantage: $3,150.58 Anthem Blue Cross Blue Shield — HMO: $8,592 Anthem Blue Cross Blue Shield — Medicare Advantage: $3,150.58 Care Wisconsin/MyChoice — Medicare Advantage: $3,245.10 Community Care — Medicare Advantage: $3,150.58 Health Partners — Medicare Advantage: $3,150.58 Humana — Medicare Advantage: $3,150.58 ICare — Medicare Advantage: $3,150.58 Network Health Plan — ACA: $8,242.44
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$5,216.73 – $13,468
Removal of tonsils and adenoids (under age 12): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $5,859.11 Allwell — Medicare Advantage: $5,744.22 Anthem Blue Cross Blue Shield — HMO: $13,468 Anthem Blue Cross Blue Shield — Medicare Advantage: $5,744.22 Care Wisconsin/MyChoice — Medicare Advantage: $5,916.55 Community Care — Medicare Advantage: $5,744.22 Health Partners — Medicare Advantage: $5,744.22 Humana — Medicare Advantage: $5,744.22 ICare — Medicare Advantage: $5,744.22 Network Health Plan — ACA: $5,216.73
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,651	$1,458.05	$795.30 – $4,258
Upper GI endoscopy (diagnostic): 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,855.70 Aetna — Medicare Advantage: $928.60 Allwell — Medicare Advantage: $910.39 Americas Choice — PPO: $2,306.37 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $910.39 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $2,253.35 Aspirus — All Contracted Commercial Plans: $2,120.80 Care Wisconsin/MyChoice — Medicare Advantage: $937.70 Centivo — WI 1 Broad: $874.83
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$2,651	$1,458.05	$1,590.60 – $2,385.90
Upper GI endoscopy (diagnostic): 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $1,855.70 Americas Choice — PPO: $2,306.37 Aspirus — All Contracted Commercial Plans: $2,120.80 Common Ground — All Contracted Commercial Plans: $1,590.60 Federated Mutual — All Contracted Commercial Plans: $2,306.37 First Health Network — All Contracted Commercial Plans: $2,332.88 Health Payment Systems — All Contracted Commercial Plans: $1,844.04 HealthEos — All Contracted Commercial Plans: $2,306.37 HealthSmart — All Contracted Commercial Plans: $2,385.90 IBSI Passport — All Contracted Commercial Plans: $2,147.31
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$3,893.77 – $6,312
Upper GI endoscopy (diagnostic): rates for 6 insurance plans Network Health Plan — ACA: $3,893.77 Network Health Plan — All Contracted Commercial Plans: $4,326.41 Sheboygan Employers Health Network — All Contracted Commercial Plans: $4,611 United Healthcare — Choice Plus/Navigate: $5,261 United Healthcare — Nexus: $4,476 United Healthcare — Options PPO: $6,312
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$910.39 – $6,312
Upper GI endoscopy with biopsy: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $928.60 Allwell — Medicare Advantage: $910.39 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $910.39 Care Wisconsin/MyChoice — Medicare Advantage: $937.70 Community Care — Medicare Advantage: $910.39 Health Partners — Medicare Advantage: $910.39 Humana — Medicare Advantage: $910.39 ICare — Medicare Advantage: $910.39 Network Health Plan — ACA: $3,893.77
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	$885.29 – $6,312
Colonoscopy (diagnostic): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $902.99 Allwell — Medicare Advantage: $885.29 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $885.29 Care Wisconsin/MyChoice — Medicare Advantage: $911.85 Community Care — Medicare Advantage: $885.29 Health Partners — Medicare Advantage: $885.29 Humana — Medicare Advantage: $885.29 ICare — Medicare Advantage: $885.29 Network Health Plan — ACA: $3,893.77
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$1,144.91 – $6,312
Colonoscopy with biopsy: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $1,167.81 Allwell — Medicare Advantage: $1,144.91 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $1,144.91 Care Wisconsin/MyChoice — Medicare Advantage: $1,179.26 Community Care — Medicare Advantage: $1,144.91 Health Partners — Medicare Advantage: $1,144.91 Humana — Medicare Advantage: $1,144.91 ICare — Medicare Advantage: $1,144.91 Network Health Plan — ACA: $3,893.77
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$1,144.91 – $6,312
Colonoscopy with removal of polyps (snare): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $1,167.81 Allwell — Medicare Advantage: $1,144.91 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $1,144.91 Care Wisconsin/MyChoice — Medicare Advantage: $1,179.26 Community Care — Medicare Advantage: $1,144.91 Health Partners — Medicare Advantage: $1,144.91 Humana — Medicare Advantage: $1,144.91 ICare — Medicare Advantage: $1,144.91 Network Health Plan — ACA: $3,893.77
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$1,144.91 – $6,312
Ultrasound of the lower bowel by endoscope: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $1,167.81 Allwell — Medicare Advantage: $1,144.91 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $1,144.91 Care Wisconsin/MyChoice — Medicare Advantage: $1,179.26 Community Care — Medicare Advantage: $1,144.91 Health Partners — Medicare Advantage: $1,144.91 Humana — Medicare Advantage: $1,144.91 ICare — Medicare Advantage: $1,144.91 Network Health Plan — ACA: $3,893.77
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$885.29 – $4,793
Screening colonoscopy (not high risk): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $902.99 Allwell — Medicare Advantage: $885.29 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $885.29 Care Wisconsin/MyChoice — Medicare Advantage: $911.85 Community Care — Medicare Advantage: $885.29 Health Partners — Medicare Advantage: $885.29 Humana — Medicare Advantage: $885.29 ICare — Medicare Advantage: $885.29 Network Health Plan — ACA: $2,931.80
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$5,665.28 – $16,779
Gallbladder removal by laparoscope: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $5,778.59 Allwell — Medicare Advantage: $5,665.28 Anthem Blue Cross Blue Shield — HMO: $16,224 Anthem Blue Cross Blue Shield — Medicare Advantage: $5,665.28 Care Wisconsin/MyChoice — Medicare Advantage: $5,835.24 Community Care — Medicare Advantage: $5,665.28 Health Partners — Medicare Advantage: $5,665.28 Humana — Medicare Advantage: $5,665.28 ICare — Medicare Advantage: $5,665.28 Network Health Plan — ACA: $9,706.25
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$3,426.79 – $13,918
Groin (inguinal) hernia repair, age 5 or older: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $3,495.32 Allwell — Medicare Advantage: $3,426.79 Anthem Blue Cross Blue Shield — HMO: $8,592 Anthem Blue Cross Blue Shield — Medicare Advantage: $3,426.79 Care Wisconsin/MyChoice — Medicare Advantage: $3,529.59 Community Care — Medicare Advantage: $3,426.79 Health Partners — Medicare Advantage: $3,426.79 Humana — Medicare Advantage: $3,426.79 ICare — Medicare Advantage: $3,426.79 Network Health Plan — ACA: $8,242.44
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE BX	$3,901	$2,145.55	$1,170.30 – $5,498
Prostate biopsy: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $2,730.70 Aetna — Medicare Advantage: $2,028.93 Allwell — Medicare Advantage: $1,989.14 Americas Choice — PPO: $3,393.87 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $1,989.14 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $3,315.85 Aspirus — All Contracted Commercial Plans: $3,120.80 Care Wisconsin/MyChoice — Medicare Advantage: $2,048.82 Centivo — WI 1 Broad: $1,287.33
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATE BX	$3,901	$2,145.55	$2,340.60 – $3,510.90
Prostate biopsy: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $2,730.70 Americas Choice — PPO: $3,393.87 Aspirus — All Contracted Commercial Plans: $3,120.80 Common Ground — All Contracted Commercial Plans: $2,340.60 Federated Mutual — All Contracted Commercial Plans: $3,393.87 First Health Network — All Contracted Commercial Plans: $3,432.88 Health Payment Systems — All Contracted Commercial Plans: $2,713.54 HealthEos — All Contracted Commercial Plans: $3,393.87 HealthSmart — All Contracted Commercial Plans: $3,510.90 IBSI Passport — All Contracted Commercial Plans: $3,159.81
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Surgery	Not listed in the file	Not listed in the file	$3,893.77 – $6,312
Prostate biopsy: rates for 6 insurance plans Network Health Plan — ACA: $3,893.77 Network Health Plan — All Contracted Commercial Plans: $4,326.41 Sheboygan Employers Health Network — All Contracted Commercial Plans: $4,611 United Healthcare — Choice Plus/Navigate: $5,261 United Healthcare — Nexus: $4,476 United Healthcare — Options PPO: $6,312
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$10,109.50 – $19,754
Prostate removal by laparoscope (radical prostatectomy): 10 of 18 insurance plan rates Aetna — Medicare Advantage: $10,311.69 Allwell — Medicare Advantage: $10,109.50 Anthem Blue Cross Blue Shield — HMO: $19,217 Anthem Blue Cross Blue Shield — Medicare Advantage: $10,109.50 Care Wisconsin/MyChoice — Medicare Advantage: $10,412.79 Community Care — Medicare Advantage: $10,109.50 Health Partners — Medicare Advantage: $10,109.50 Humana — Medicare Advantage: $10,109.50 ICare — Medicare Advantage: $10,109.50 Network Health Plan — ACA: $11,645.84
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$3,087.39 – $8,783
Hysteroscopy with biopsy of the uterus lining: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $3,149.13 Allwell — Medicare Advantage: $3,087.39 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $3,087.39 Care Wisconsin/MyChoice — Medicare Advantage: $3,180.01 Community Care — Medicare Advantage: $3,087.39 Health Partners — Medicare Advantage: $3,087.39 Humana — Medicare Advantage: $3,087.39 ICare — Medicare Advantage: $3,087.39 Network Health Plan — ACA: $5,216.73
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ DX/THER SUBST, INTERLAMINAR, LUMBAR/SACRAL, W/ IMAG GUID	$1,968	$1,082.40	$590.40 – $4,258
Spinal injection, lower back (epidural), with imaging guidance: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $1,377.60 Aetna — Medicare Advantage: $685.90 Allwell — Medicare Advantage: $672.45 Americas Choice — PPO: $1,712.16 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $672.45 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $1,672.80 Aspirus — All Contracted Commercial Plans: $1,574.40 Care Wisconsin/MyChoice — Medicare Advantage: $692.62 Centivo — WI 1 Broad: $649.44
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ DX/THER SUBST, INTERLAMINAR, LUMBAR/SACRAL, W/ IMAG GUID	$1,968	$1,082.40	$1,180.80 – $1,771.20
Spinal injection, lower back (epidural), with imaging guidance: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $1,377.60 Americas Choice — PPO: $1,712.16 Aspirus — All Contracted Commercial Plans: $1,574.40 Common Ground — All Contracted Commercial Plans: $1,180.80 Federated Mutual — All Contracted Commercial Plans: $1,712.16 First Health Network — All Contracted Commercial Plans: $1,731.84 Health Payment Systems — All Contracted Commercial Plans: $1,368.94 HealthEos — All Contracted Commercial Plans: $1,712.16 HealthSmart — All Contracted Commercial Plans: $1,771.20 IBSI Passport — All Contracted Commercial Plans: $1,594.08
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$2,931.80 – $4,793
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans Network Health Plan — ACA: $2,931.80 Network Health Plan — All Contracted Commercial Plans: $3,257.56 Sheboygan Employers Health Network — All Contracted Commercial Plans: $3,457 United Healthcare — Choice Plus/Navigate: $3,995 United Healthcare — Nexus: $3,399 United Healthcare — Options PPO: $4,793
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ(S), ANES AGENT/STEROID, TFE, W/ IMG GUID, L-S, SINGLE LEVEL	$3,068	$1,687.40	$864.49 – $4,258
Nerve root injection, lower back, with imaging guidance: 10 of 41 insurance plan rates Aetna — All Contracted Commercial Plans: $2,147.60 Aetna — Medicare Advantage: $881.78 Allwell — Medicare Advantage: $864.49 Americas Choice — PPO: $2,669.16 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $864.49 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $2,607.80 Aspirus — All Contracted Commercial Plans: $2,454.40 Care Wisconsin/MyChoice — Medicare Advantage: $890.42 Centivo — WI 1 Broad: $1,012.44
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ(S), ANES AGENT/STEROID, TFE, W/ IMG GUID, L-S, SINGLE LEVEL	$3,068	$1,687.40	$1,840.80 – $2,761.20
Nerve root injection, lower back, with imaging guidance: 10 of 14 insurance plan rates Aetna — All Contracted Commercial Plans: $2,147.60 Americas Choice — PPO: $2,669.16 Aspirus — All Contracted Commercial Plans: $2,454.40 Common Ground — All Contracted Commercial Plans: $1,840.80 Federated Mutual — All Contracted Commercial Plans: $2,669.16 First Health Network — All Contracted Commercial Plans: $2,699.84 Health Payment Systems — All Contracted Commercial Plans: $2,134.10 HealthEos — All Contracted Commercial Plans: $2,669.16 HealthSmart — All Contracted Commercial Plans: $2,761.20 IBSI Passport — All Contracted Commercial Plans: $2,485.08
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$2,931.80 – $4,793
Nerve root injection, lower back, with imaging guidance: rates for 6 insurance plans Network Health Plan — ACA: $2,931.80 Network Health Plan — All Contracted Commercial Plans: $3,257.56 Sheboygan Employers Health Network — All Contracted Commercial Plans: $3,457 United Healthcare — Choice Plus/Navigate: $3,995 United Healthcare — Nexus: $3,399 United Healthcare — Options PPO: $4,793
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$1,896.18 – $8,783
Carpal tunnel release: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $1,934.10 Allwell — Medicare Advantage: $1,896.18 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $1,896.18 Care Wisconsin/MyChoice — Medicare Advantage: $1,953.06 Community Care — Medicare Advantage: $1,896.18 Health Partners — Medicare Advantage: $1,896.18 Humana — Medicare Advantage: $1,896.18 ICare — Medicare Advantage: $1,896.18 Network Health Plan — ACA: $5,216.73
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	$532.70 – $4,793
Laser treatment of clouding after cataract surgery: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $543.36 Allwell — Medicare Advantage: $532.70 Anthem Blue Cross Blue Shield — HMO: $4,258 Anthem Blue Cross Blue Shield — Medicare Advantage: $532.70 Care Wisconsin/MyChoice — Medicare Advantage: $548.68 Community Care — Medicare Advantage: $532.70 Health Partners — Medicare Advantage: $532.70 Humana — Medicare Advantage: $532.70 ICare — Medicare Advantage: $532.70 Network Health Plan — ACA: $2,931.80
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$2,214.63 – $8,783
Cataract removal with lens implant: 10 of 18 insurance plan rates Aetna — Medicare Advantage: $2,258.93 Allwell — Medicare Advantage: $2,214.63 Anthem Blue Cross Blue Shield — HMO: $5,498 Anthem Blue Cross Blue Shield — Medicare Advantage: $2,214.63 Care Wisconsin/MyChoice — Medicare Advantage: $2,281.07 Community Care — Medicare Advantage: $2,214.63 Health Partners — Medicare Advantage: $2,214.63 Humana — Medicare Advantage: $2,214.63 ICare — Medicare Advantage: $2,214.63 Network Health Plan — ACA: $5,216.73

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	$2,101.95 – $8,592
Vaginal delivery, with care before and after: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $2,143.99 Allwell — Medicare Advantage: $2,101.95 Anthem Blue Cross Blue Shield — HMO: $8,592 Anthem Blue Cross Blue Shield — Medicare Advantage: $2,101.95 Care Wisconsin/MyChoice — Medicare Advantage: $2,165 Community Care — Medicare Advantage: $2,101.95 Health Partners — Medicare Advantage: $2,101.95 Humana — Medicare Advantage: $2,101.95 ICare — Medicare Advantage: $2,101.95 Network Health Plan — Medicare Advantage: $2,101.95
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	$2,312.03 – $8,592
Cesarean delivery (C-section), with care before and after: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $2,358.27 Allwell — Medicare Advantage: $2,312.03 Anthem Blue Cross Blue Shield — HMO: $8,592 Anthem Blue Cross Blue Shield — Medicare Advantage: $2,312.03 Care Wisconsin/MyChoice — Medicare Advantage: $2,381.39 Community Care — Medicare Advantage: $2,312.03 Health Partners — Medicare Advantage: $2,312.03 Humana — Medicare Advantage: $2,312.03 ICare — Medicare Advantage: $2,312.03 Network Health Plan — Medicare Advantage: $2,312.03
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	$2,177.41 – $8,592
Vaginal delivery after a previous C-section, with care before and after: 10 of 12 insurance plan rates Aetna — Medicare Advantage: $2,220.96 Allwell — Medicare Advantage: $2,177.41 Anthem Blue Cross Blue Shield — HMO: $8,592 Anthem Blue Cross Blue Shield — Medicare Advantage: $2,177.41 Care Wisconsin/MyChoice — Medicare Advantage: $2,242.74 Community Care — Medicare Advantage: $2,177.41 Health Partners — Medicare Advantage: $2,177.41 Humana — Medicare Advantage: $2,177.41 ICare — Medicare Advantage: $2,177.41 Network Health Plan — Medicare Advantage: $2,177.41

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	$75,915.85 – $305,996.20
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 27 insurance plan rates Aetna — Medicare Advantage: $77,434.17 Allwell — Medicare Advantage: $75,915.85 Anthem Blue Cross Blue Shield — HMO: $223,840.25 Anthem Blue Cross Blue Shield — Medicare Advantage: $75,915.85 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $305,996.20 Care Wisconsin/MyChoice — Medicare Advantage: $78,193.33 Centivo — WI 1 Broad: $220,699.97 Centivo — WI 2 Median: $182,361.17 Chorus Community Health Plan — All Contracted Commercial Plans: $179,123.07 Cigna — All Contracted Commercial Plans: $266,825.87
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	$15,564.54 – $60,334.06
Hip or knee replacement (major joint of the leg), without major complications: 10 of 27 insurance plan rates Aetna — Medicare Advantage: $15,875.83 Allwell — Medicare Advantage: $15,564.54 Anthem Blue Cross Blue Shield — HMO: $44,135.16 Anthem Blue Cross Blue Shield — Medicare Advantage: $15,564.54 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $60,334.06 Care Wisconsin/MyChoice — Medicare Advantage: $16,031.48 Centivo — WI 1 Broad: $43,515.98 Centivo — WI 2 Median: $35,956.62 Chorus Community Health Plan — All Contracted Commercial Plans: $35,318.16 Cigna — All Contracted Commercial Plans: $52,610.75
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	$19,501.95 – $76,361.42
Neck (cervical) spinal fusion, without complications: 10 of 27 insurance plan rates Aetna — Medicare Advantage: $19,891.99 Allwell — Medicare Advantage: $19,501.95 Anthem Blue Cross Blue Shield — HMO: $55,859.39 Anthem Blue Cross Blue Shield — Medicare Advantage: $19,501.95 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $76,361.42 Care Wisconsin/MyChoice — Medicare Advantage: $20,087.01 Centivo — WI 1 Broad: $55,075.73 Centivo — WI 2 Median: $45,508.27 Chorus Community Health Plan — All Contracted Commercial Plans: $44,700.20 Cigna — All Contracted Commercial Plans: $66,586.46
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	$10,276.24 – $38,807.86
Uterus and ovary surgery (not for cancer), without complications: 10 of 27 insurance plan rates Aetna — Medicare Advantage: $10,481.76 Allwell — Medicare Advantage: $10,276.24 Anthem Blue Cross Blue Shield — HMO: $28,388.46 Anthem Blue Cross Blue Shield — Medicare Advantage: $10,276.24 Anthem Blue Cross Blue Shield (Healthlink) — PPO: $38,807.86 Care Wisconsin/MyChoice — Medicare Advantage: $10,584.53 Centivo — WI 1 Broad: $27,990.19 Centivo — WI 2 Median: $23,127.89 Chorus Community Health Plan — All Contracted Commercial Plans: $22,717.22 Cigna — All Contracted Commercial Plans: $33,840.09

Source: Community Memorial Hospital’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on December 31, 2025; 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	Acute Care Hospital
Address	W180 N8085 Town Hall Rd, Menomonee Falls, WI 53051
County	Waukesha County
State	Wisconsin
Phone	(262) 251‑1000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
CMS Certification Number	520103
Name in Medicare records	COMMUNITY MEMORIAL HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Froedtert Menomonee Falls Hospital
Official website	froedtert.com
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

Numbers match the citations above. Checked 2026-10-31.

Froedtert Menomonee Falls Hospital | Froedtert & MCW — froedtert.com
Froedtert Menomonee Falls Hospital Emergency Department | Froedtert & MCW — froedtert.com
Interpreting & Language Support — froedtert.com
Cancer Center at Froedtert Menomonee Falls Hospital | Froedtert & MCW — froedtert.com

Community Memorial Hospital

Summary

Profile from official sources

At a glance