Does Essentia Health Holy Trinity Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Essentia Health Holy Trinity Hospital. In a medical emergency, call 911.

Where is Essentia Health Holy Trinity Hospital?

115 Second Street West, Box 157, Graceville, MN 56240, in Big Stone County, Minnesota.

What is the phone number of Essentia Health Holy Trinity Hospital?

(320) 748-7223, as listed by Medicare (CMS).

What is the Medicare star rating of Essentia Health Holy Trinity Hospital?

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

Essentia Health Holy Trinity Hospital

Quick answers

Does Essentia Health Holy Trinity Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Essentia Health Holy Trinity Hospital. In a medical emergency, call 911.
Where is Essentia Health Holy Trinity Hospital?: 115 Second Street West, Box 157, Graceville, MN 56240, in Big Stone County, Minnesota.
What is the phone number of Essentia Health Holy Trinity Hospital?: (320) 748-7223, as listed by Medicare (CMS).
What is the Medicare star rating of Essentia Health Holy Trinity Hospital?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[4][6][7]

Treatments^[4][5]

Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Mammography
Lab services
Occupational therapy (inpatient)
Physical therapy (inpatient)
Speech-language therapy (inpatient)

Programs and centers^[4]

Home health care
Transitional care

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level IV
Stroke designation	Acute Stroke Ready Hospital

Visiting and practical information

Parking	Free parking in a surface lot; hospital shares a building with Essentia Health-Graceville Clinic^[4]

Recognition^[4]

Level IV Trauma Center

Doctors and clinicians (23)

23 doctors and other clinicians list Essentia Health Holy Trinity 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

Other emergency rooms nearby

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

Ortonville Area Health Services15 mi · Ortonville, MN · Critical Access Hospital
Sanford Wheaton Medical Center17 mi · Wheaton, MN · Critical Access Hospital
Stevens Community Medical Center Inc26 mi · Morris, MN · Critical Access Hospital
Milbank Area Hospital/Avera Health26 mi · Milbank, SD · Critical Access Hospital
Coteau Des Prairies Health Care System31 mi · Sisseton, SD · Critical Access Hospital

Other hospitals nearby

Appleton Area Health32 mi · Appleton, MN · Critical Access 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

Essentia Health Grace Home0.0 mi · Graceville, MN · 5 of 5 stars
Traverse Care Center17 mi · Wheaton, MN · 4 of 5 stars
Fairway View Neighborhoods17 mi · Ortonville, MN · 3 of 5 stars

All nursing homes in the state →

Home health agencies

Essentia Health Graceville Home Health2.4 mi · Graceville, MN
Ortonville Area Health Services Home Health Agency15 mi · Ortonville, MN

All home health agencies in the state →

Dialysis facilities

Sanford Dialysis Morris24 mi · Morris, MN

All dialysis facilities in the state →

Community care nearby

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

Clinics and urgent care

Essentia Health Graceville Clinic2.4 mi · Graceville, MN · Rural health clinic
Sanford Wheaton Clinic18 mi · Wheaton, MN · Rural health clinic
Coteau Des Prairies Health Care System-Browns Valley Clinic19 mi · Browns Valley, MN · Rural health clinic

Pharmacies

Sanford Health Network2.4 mi · Graceville, MN · Community/retail pharmacy

Assisted living nearby

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

Legacy Commons Senior Living L8.4 mi · Clinton, MN

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 Essentia Health Holy Trinity 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.

Not reported to Medicare

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	Not reported to Medicare

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

Complications and deaths

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

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

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

Return visits to the hospital (readmissions)

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

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

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	131 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	Too few cases to report

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 Minnesota Best hospitals in Minnesota

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 74 common services exactly as Essentia Health Holy Trinity 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/OUTPT VISIT,NEW,LEVL III	$158	$116.76	$61.46 – $142.99
New patient office visit (about 30–44 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $97.96 Aetna First Health — Commercial: $134.30 America's PPO — Commercial: $122.45 BCBS MN — Medicaid: $137.70 BCBS ND — BCBS MN: $84.53 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $97.96 BLUE PLUS PMAP PCC PRIME — Medicaid: $137.70 Cigna — Commercial: $105.07 Freedom Blue PPO — Medicare: $97.96 HealthPartners — Commercial: $105.07
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,NEW,LEVL IV	$248	$183.27	$96.47 – $224.44
New patient office visit (about 45–59 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $153.76 Aetna First Health — Commercial: $210.80 America's PPO — Commercial: $192.20 BCBS MN — Medicaid: $216.13 BCBS ND — BCBS MN: $132.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $153.76 BLUE PLUS PMAP PCC PRIME — Medicaid: $216.13 Cigna — Commercial: $164.92 Freedom Blue PPO — Medicare: $153.76 HealthPartners — Commercial: $164.92
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,NEW,LEVL IV	$248	$183.27	$96.47 – $224.44
New patient office visit (about 45–59 minutes): 10 of 24 insurance plan rates Aetna First Health — Commercial: $210.80 America's PPO — Commercial: $192.20 BCBS MN — Medicaid: $136.40 BLUE PLUS PMAP PCC PRIME — Medicaid: $136.40 Cigna — Commercial: $164.92 HealthPartners — Commercial: $164.92 HealthPartners — SHP: $150.78 HealthPartners CARE PMAP — Medicaid: $96.47 HealthPartners PCC Prime — Commercial: $164.92 Medica — Commercial-FI: $206.09
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,NEW,LEVL V	$328	$242.39	$127.59 – $296.84
New patient office visit (about 60–74 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $203.36 Aetna First Health — Commercial: $278.80 America's PPO — Commercial: $254.20 BCBS MN — Medicaid: $285.85 BCBS ND — BCBS MN: $175.48 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $203.36 BLUE PLUS PMAP PCC PRIME — Medicaid: $285.85 Cigna — Commercial: $218.12 Freedom Blue PPO — Medicare: $203.36 HealthPartners — Commercial: $218.12
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PULMONARY REHAB EVAL	$196	$144.84	$76.24 – $177.38
Established patient office visit (about 20–29 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $121.52 Aetna First Health — Commercial: $166.60 America's PPO — Commercial: $151.90 BCBS MN — Medicaid: $170.81 BCBS ND — BCBS MN: $104.86 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $121.52 BLUE PLUS PMAP PCC PRIME — Medicaid: $170.81 Cigna — Commercial: $130.34 Freedom Blue PPO — Medicare: $121.52 HealthPartners — Commercial: $130.34
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE CONSULTATION,LEVEL III	$179	$132.28	$69.63 – $162
Established patient office visit (about 20–29 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $110.98 Aetna First Health — Commercial: $152.15 America's PPO — Commercial: $138.72 BCBS MN — Medicaid: $156 BCBS ND — BCBS MN: $95.76 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $110.98 BLUE PLUS PMAP PCC PRIME — Medicaid: $156 Cigna — Commercial: $119.04 Freedom Blue PPO — Medicare: $110.98 HealthPartners — Commercial: $119.04
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ET THERAPY, 31-45 MINUTES	$160	$118.24	$62.24 – $144.80
Established patient office visit (about 20–29 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $99.20 Aetna First Health — Commercial: $136 America's PPO — Commercial: $124 BCBS MN — Medicaid: $139.44 BCBS ND — BCBS MN: $85.60 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $99.20 BLUE PLUS PMAP PCC PRIME — Medicaid: $139.44 Cigna — Commercial: $106.40 Freedom Blue PPO — Medicare: $99.20 HealthPartners — Commercial: $106.40
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ET THERAPY, 46-90 MINUTES	$204	$150.76	$79.36 – $184.62
Established patient office visit (about 30–39 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $126.48 Aetna First Health — Commercial: $173.40 America's PPO — Commercial: $158.10 BCBS MN — Medicaid: $177.79 BCBS ND — BCBS MN: $109.14 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $126.48 BLUE PLUS PMAP PCC PRIME — Medicaid: $177.79 Cigna — Commercial: $135.66 Freedom Blue PPO — Medicare: $126.48 HealthPartners — Commercial: $135.66
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,EST,LEVL IV	$151	$111.59	$58.74 – $136.66
Established patient office visit (about 30–39 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $93.62 Aetna First Health — Commercial: $128.35 America's PPO — Commercial: $117.02 BCBS MN — Medicaid: $131.60 BCBS ND — BCBS MN: $80.79 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $93.62 BLUE PLUS PMAP PCC PRIME — Medicaid: $131.60 Cigna — Commercial: $100.42 Freedom Blue PPO — Medicare: $93.62 HealthPartners — Commercial: $100.42
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ET THERAPY, 46-90 MINUTES	$204	$150.76	$79.36 – $184.62
Established patient office visit (about 30–39 minutes): 10 of 24 insurance plan rates Aetna First Health — Commercial: $173.40 America's PPO — Commercial: $158.10 BCBS MN — Medicaid: $112.20 BLUE PLUS PMAP PCC PRIME — Medicaid: $112.20 Cigna — Commercial: $135.66 HealthPartners — Commercial: $135.66 HealthPartners — SHP: $124.03 HealthPartners CARE PMAP — Medicaid: $79.36 HealthPartners PCC Prime — Commercial: $135.66 Medica — Commercial-FI: $169.52
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTP CONSULT,LEVEL IV, MODERATE MDM >= 40 MINUTES	$256	$189.18	$99.58 – $231.68
Office consultation with a specialist (moderate to high): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $158.72 Aetna First Health — Commercial: $217.60 America's PPO — Commercial: $198.40 BCBS MN — Medicaid: $223.10 BCBS ND — BCBS MN: $136.96 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $158.72 BLUE PLUS PMAP PCC PRIME — Medicaid: $223.10 Cigna — Commercial: $170.24 Freedom Blue PPO — Medicare: $158.72 HealthPartners — Commercial: $170.24
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL III VISIT	$742	$548.34	$288.64 – $671.51
Emergency room visit (moderate): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $460.04 Aetna First Health — Commercial: $630.70 America's PPO — Commercial: $575.05 BCBS MN — Medicaid: $646.65 BCBS ND — BCBS MN: $396.97 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $460.04 BLUE PLUS PMAP PCC PRIME — Medicaid: $646.65 Cigna — Commercial: $493.43 Freedom Blue PPO — Medicare: $460.04 HealthPartners — Commercial: $493.43
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL III VISIT	$742	$548.34	$288.64 – $671.51
Emergency room visit (moderate): 10 of 24 insurance plan rates Aetna First Health — Commercial: $630.70 America's PPO — Commercial: $575.05 BCBS MN — Medicaid: $408.10 BLUE PLUS PMAP PCC PRIME — Medicaid: $408.10 Cigna — Commercial: $493.43 HealthPartners — Commercial: $493.43 HealthPartners — SHP: $451.14 HealthPartners CARE PMAP — Medicaid: $288.64 HealthPartners PCC Prime — Commercial: $493.43 Medica — Commercial-FI: $616.60
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit low mdm	Not listed in the file	Not listed in the file	$275.08 – $276.89
Emergency room visit (moderate): rates for 2 insurance plans Itasca Med Care — Medicaid: $276.89 Primewest — Medicaid: $275.08
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL IV VISIT	$1,214	$897.15	$472.25 – $1,098.67
Emergency room visit (moderately high): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $752.68 Aetna First Health — Commercial: $1,031.90 America's PPO — Commercial: $940.85 BCBS MN — Medicaid: $1,058 BCBS ND — BCBS MN: $649.49 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $752.68 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,058 Cigna — Commercial: $807.31 Freedom Blue PPO — Medicare: $752.68 HealthPartners — Commercial: $807.31
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL IV VISIT	$1,214	$897.15	$472.25 – $1,098.67
Emergency room visit (moderately high): 10 of 24 insurance plan rates Aetna First Health — Commercial: $1,031.90 America's PPO — Commercial: $940.85 BCBS MN — Medicaid: $667.70 BLUE PLUS PMAP PCC PRIME — Medicaid: $667.70 Cigna — Commercial: $807.31 HealthPartners — Commercial: $807.31 HealthPartners — SHP: $738.11 HealthPartners CARE PMAP — Medicaid: $472.25 HealthPartners PCC Prime — Commercial: $807.31 Medica — Commercial-FI: $1,008.83
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$425.82 – $427.02
Emergency room visit (moderately high): rates for 2 insurance plans Itasca Med Care — Medicaid: $425.82 Primewest — Medicaid: $427.02
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL V VISIT	$1,847	$1,364.93	$718.48 – $1,671.54
Emergency room visit (high): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,145.14 Aetna First Health — Commercial: $1,569.95 America's PPO — Commercial: $1,431.42 BCBS MN — Medicaid: $1,609.66 BCBS ND — BCBS MN: $988.15 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,145.14 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,609.66 Cigna — Commercial: $1,228.26 Freedom Blue PPO — Medicare: $1,145.14 HealthPartners — Commercial: $1,228.26
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL V VISIT	$1,847	$1,364.93	$718.48 – $1,671.54
Emergency room visit (high): 10 of 24 insurance plan rates Aetna First Health — Commercial: $1,569.95 America's PPO — Commercial: $1,431.42 BCBS MN — Medicaid: $1,015.85 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,015.85 Cigna — Commercial: $1,228.26 HealthPartners — Commercial: $1,228.26 HealthPartners — SHP: $1,122.98 HealthPartners CARE PMAP — Medicaid: $718.48 HealthPartners PCC Prime — Commercial: $1,228.26 Medica — Commercial-FI: $1,534.86
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$613.10 – $619.26
Emergency room visit (high): rates for 2 insurance plans Itasca Med Care — Medicaid: $613.10 Primewest — Medicaid: $619.26

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: LAB BASIC METABOLIC PANEL	$235	$173.66	$91.42 – $212.68
Basic metabolic panel (blood test): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $145.70 Aetna First Health — Commercial: $199.75 America's PPO — Commercial: $182.12 BCBS MN — Medicaid: $204.80 BCBS ND — BCBS MN: $125.72 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $145.70 BLUE PLUS PMAP PCC PRIME — Medicaid: $204.80 Cigna — Commercial: $156.28 Freedom Blue PPO — Medicare: $145.70 HealthPartners — Commercial: $156.28
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAB BASIC METABOLIC PANEL	$235	$173.66	$91.42 – $212.68
Basic metabolic panel (blood test): 10 of 24 insurance plan rates Aetna First Health — Commercial: $199.75 America's PPO — Commercial: $182.12 BCBS MN — Medicaid: $129.25 BLUE PLUS PMAP PCC PRIME — Medicaid: $129.25 Cigna — Commercial: $156.28 HealthPartners — Commercial: $156.28 HealthPartners — SHP: $142.88 HealthPartners CARE PMAP — Medicaid: $91.42 HealthPartners PCC Prime — Commercial: $156.28 Medica — Commercial-FI: $195.28
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Metabolic panel total ca	Not listed in the file	Not listed in the file	$8.46
Basic metabolic panel (blood test): 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $8.46 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $8.46 Freedom Blue PPO — Medicare: $8.46 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $8.46 IMCARE MSHO PCC PRIME — Medicare: $8.46 IMCARE MSHO REF REQ — Medicare: $8.46 Itasca Med Care — Medicaid: $8.46 MEDICA ADVANTAGE SOLUTIONS — Medicare: $8.46 MEDICA MSHO/Dual Solutions — Medicare: $8.46 MEDICA PRIME SOLUTION GROUP — Medicare: $8.46
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL	$295	$218	$114.76 – $266.98
Comprehensive metabolic panel (blood test): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $182.90 Aetna First Health — Commercial: $250.75 America's PPO — Commercial: $228.62 BCBS MN — Medicaid: $257.09 BCBS ND — BCBS MN: $157.83 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $182.90 BLUE PLUS PMAP PCC PRIME — Medicaid: $257.09 Cigna — Commercial: $196.18 Freedom Blue PPO — Medicare: $182.90 HealthPartners — Commercial: $196.18
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL	$295	$218	$114.76 – $266.98
Comprehensive metabolic panel (blood test): 10 of 24 insurance plan rates Aetna First Health — Commercial: $250.75 America's PPO — Commercial: $228.62 BCBS MN — Medicaid: $162.25 BLUE PLUS PMAP PCC PRIME — Medicaid: $162.25 Cigna — Commercial: $196.18 HealthPartners — Commercial: $196.18 HealthPartners — SHP: $179.36 HealthPartners CARE PMAP — Medicaid: $114.76 HealthPartners PCC Prime — Commercial: $196.18 Medica — Commercial-FI: $245.14
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$10.56
Comprehensive metabolic panel (blood test): 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $10.56 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $10.56 Freedom Blue PPO — Medicare: $10.56 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $10.56 IMCARE MSHO PCC PRIME — Medicare: $10.56 IMCARE MSHO REF REQ — Medicare: $10.56 Itasca Med Care — Medicaid: $10.56 MEDICA ADVANTAGE SOLUTIONS — Medicare: $10.56 MEDICA MSHO/Dual Solutions — Medicare: $10.56 MEDICA PRIME SOLUTION GROUP — Medicare: $10.56
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$47.81
Obstetric blood test panel: 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $47.81 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $47.81 Freedom Blue PPO — Medicare: $47.81 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $47.81 IMCARE MSHO PCC PRIME — Medicare: $47.81 IMCARE MSHO REF REQ — Medicare: $47.81 Itasca Med Care — Medicaid: $47.81 MEDICA ADVANTAGE SOLUTIONS — Medicare: $47.81 MEDICA MSHO/Dual Solutions — Medicare: $47.81 MEDICA PRIME SOLUTION GROUP — Medicare: $47.81
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE	$147	$108.63	$57.18 – $133.04
Cholesterol panel (lipid panel): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $91.14 Aetna First Health — Commercial: $124.95 America's PPO — Commercial: $113.92 BCBS MN — Medicaid: $128.11 BCBS ND — BCBS MN: $78.65 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $91.14 BLUE PLUS PMAP PCC PRIME — Medicaid: $128.11 Cigna — Commercial: $97.76 Freedom Blue PPO — Medicare: $91.14 HealthPartners — Commercial: $97.76
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LIPID PROFILE	$147	$108.63	$57.18 – $133.04
Cholesterol panel (lipid panel): 10 of 24 insurance plan rates Aetna First Health — Commercial: $124.95 America's PPO — Commercial: $113.92 BCBS MN — Medicaid: $80.85 BLUE PLUS PMAP PCC PRIME — Medicaid: $80.85 Cigna — Commercial: $97.76 HealthPartners — Commercial: $97.76 HealthPartners — SHP: $89.38 HealthPartners CARE PMAP — Medicaid: $57.18 HealthPartners PCC Prime — Commercial: $97.76 Medica — Commercial-FI: $122.16
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$13.39
Cholesterol panel (lipid panel): 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $13.39 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $13.39 Freedom Blue PPO — Medicare: $13.39 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $13.39 IMCARE MSHO PCC PRIME — Medicare: $13.39 IMCARE MSHO REF REQ — Medicare: $13.39 Itasca Med Care — Medicaid: $13.39 MEDICA ADVANTAGE SOLUTIONS — Medicare: $13.39 MEDICA MSHO/Dual Solutions — Medicare: $13.39 MEDICA PRIME SOLUTION GROUP — Medicare: $13.39
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$298	$220.22	$115.92 – $269.69
Kidney function panel: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $184.76 Aetna First Health — Commercial: $253.30 America's PPO — Commercial: $230.95 BCBS MN — Medicaid: $259.71 BCBS ND — BCBS MN: $159.43 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $184.76 BLUE PLUS PMAP PCC PRIME — Medicaid: $259.71 Cigna — Commercial: $198.17 Freedom Blue PPO — Medicare: $184.76 HealthPartners — Commercial: $198.17
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$298	$220.22	$115.92 – $269.69
Kidney function panel: 10 of 24 insurance plan rates Aetna First Health — Commercial: $253.30 America's PPO — Commercial: $230.95 BCBS MN — Medicaid: $163.90 BLUE PLUS PMAP PCC PRIME — Medicaid: $163.90 Cigna — Commercial: $198.17 HealthPartners — Commercial: $198.17 HealthPartners — SHP: $181.18 HealthPartners CARE PMAP — Medicaid: $115.92 HealthPartners PCC Prime — Commercial: $198.17 Medica — Commercial-FI: $247.64
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$8.68
Kidney function panel: 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $8.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $8.68 Freedom Blue PPO — Medicare: $8.68 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $8.68 IMCARE MSHO PCC PRIME — Medicare: $8.68 IMCARE MSHO REF REQ — Medicare: $8.68 Itasca Med Care — Medicaid: $8.68 MEDICA ADVANTAGE SOLUTIONS — Medicare: $8.68 MEDICA MSHO/Dual Solutions — Medicare: $8.68 MEDICA PRIME SOLUTION GROUP — Medicare: $8.68
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$174	$128.59	$67.69 – $157.47
Liver function panel: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $107.88 Aetna First Health — Commercial: $147.90 America's PPO — Commercial: $134.85 BCBS MN — Medicaid: $151.64 BCBS ND — BCBS MN: $93.09 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $107.88 BLUE PLUS PMAP PCC PRIME — Medicaid: $151.64 Cigna — Commercial: $115.71 Freedom Blue PPO — Medicare: $107.88 HealthPartners — Commercial: $115.71
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$174	$128.59	$67.69 – $157.47
Liver function panel: 10 of 24 insurance plan rates Aetna First Health — Commercial: $147.90 America's PPO — Commercial: $134.85 BCBS MN — Medicaid: $95.70 BLUE PLUS PMAP PCC PRIME — Medicaid: $95.70 Cigna — Commercial: $115.71 HealthPartners — Commercial: $115.71 HealthPartners — SHP: $105.79 HealthPartners CARE PMAP — Medicaid: $67.69 HealthPartners PCC Prime — Commercial: $115.71 Medica — Commercial-FI: $144.59
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$8.17
Liver function panel: 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $8.17 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $8.17 Freedom Blue PPO — Medicare: $8.17 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $8.17 IMCARE MSHO PCC PRIME — Medicare: $8.17 IMCARE MSHO REF REQ — Medicare: $8.17 Itasca Med Care — Medicaid: $8.17 MEDICA ADVANTAGE SOLUTIONS — Medicare: $8.17 MEDICA MSHO/Dual Solutions — Medicare: $8.17 MEDICA PRIME SOLUTION GROUP — Medicare: $8.17
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO, W/SCOPE	$77	$56.90	$29.95 – $69.68
Urine test (automated, with microscope): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $47.74 Aetna First Health — Commercial: $65.45 America's PPO — Commercial: $59.68 BCBS MN — Medicaid: $67.11 BCBS ND — BCBS MN: $41.20 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $47.74 BLUE PLUS PMAP PCC PRIME — Medicaid: $67.11 Cigna — Commercial: $51.21 Freedom Blue PPO — Medicare: $47.74 HealthPartners — Commercial: $51.21
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO, W/SCOPE	$77	$56.90	$29.95 – $69.68
Urine test (automated, with microscope): 10 of 24 insurance plan rates Aetna First Health — Commercial: $65.45 America's PPO — Commercial: $59.68 BCBS MN — Medicaid: $42.35 BLUE PLUS PMAP PCC PRIME — Medicaid: $42.35 Cigna — Commercial: $51.21 HealthPartners — Commercial: $51.21 HealthPartners — SHP: $46.82 HealthPartners CARE PMAP — Medicaid: $29.95 HealthPartners PCC Prime — Commercial: $51.21 Medica — Commercial-FI: $63.99
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$3.17
Urine test (automated, with microscope): 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $3.17 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $3.17 Freedom Blue PPO — Medicare: $3.17 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $3.17 IMCARE MSHO PCC PRIME — Medicare: $3.17 IMCARE MSHO REF REQ — Medicare: $3.17 Itasca Med Care — Medicaid: $3.17 MEDICA ADVANTAGE SOLUTIONS — Medicare: $3.17 MEDICA MSHO/Dual Solutions — Medicare: $3.17 MEDICA PRIME SOLUTION GROUP — Medicare: $3.17
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	$30	$22.17	$11.67 – $27.15
Urine test (manual, without microscope): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $18.60 Aetna First Health — Commercial: $25.50 America's PPO — Commercial: $23.25 BCBS MN — Medicaid: $26.15 BCBS ND — BCBS MN: $16.05 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $18.60 BLUE PLUS PMAP PCC PRIME — Medicaid: $26.15 Cigna — Commercial: $19.95 Freedom Blue PPO — Medicare: $18.60 HealthPartners — Commercial: $19.95
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	$30	$22.17	$11.67 – $27.15
Urine test (manual, without microscope): 10 of 24 insurance plan rates Aetna First Health — Commercial: $25.50 America's PPO — Commercial: $23.25 BCBS MN — Medicaid: $16.50 BLUE PLUS PMAP PCC PRIME — Medicaid: $16.50 Cigna — Commercial: $19.95 HealthPartners — Commercial: $19.95 HealthPartners — SHP: $18.24 HealthPartners CARE PMAP — Medicaid: $11.67 HealthPartners PCC Prime — Commercial: $19.95 Medica — Commercial-FI: $24.93
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
Urine test (manual, without microscope): 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $3.48 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $3.48 Freedom Blue PPO — Medicare: $3.48 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $3.48 IMCARE MSHO PCC PRIME — Medicare: $3.48 IMCARE MSHO REF REQ — Medicare: $3.48 Itasca Med Care — Medicaid: $3.48 MEDICA ADVANTAGE SOLUTIONS — Medicare: $3.48 MEDICA MSHO/Dual Solutions — Medicare: $3.48 MEDICA PRIME SOLUTION GROUP — Medicare: $3.48
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO W/O SCOPE QW	$49	$36.21	$19.06 – $44.34
Urine test (automated, without microscope): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $30.38 Aetna First Health — Commercial: $41.65 America's PPO — Commercial: $37.98 BCBS MN — Medicaid: $42.70 BCBS ND — BCBS MN: $26.22 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $30.38 BLUE PLUS PMAP PCC PRIME — Medicaid: $42.70 Cigna — Commercial: $32.58 Freedom Blue PPO — Medicare: $30.38 HealthPartners — Commercial: $32.58
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO W/O SCOPE	$50	$36.95	$19.45 – $45.25
Urine test (automated, without microscope): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $31 Aetna First Health — Commercial: $42.50 America's PPO — Commercial: $38.75 BCBS MN — Medicaid: $43.58 BCBS ND — BCBS MN: $26.75 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $31 BLUE PLUS PMAP PCC PRIME — Medicaid: $43.58 Cigna — Commercial: $33.25 Freedom Blue PPO — Medicare: $31 HealthPartners — Commercial: $33.25
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO W/O SCOPE	$50	$36.95	$19.45 – $45.25
Urine test (automated, without microscope): 10 of 24 insurance plan rates Aetna First Health — Commercial: $42.50 America's PPO — Commercial: $38.75 BCBS MN — Medicaid: $27.50 BLUE PLUS PMAP PCC PRIME — Medicaid: $27.50 Cigna — Commercial: $33.25 HealthPartners — Commercial: $33.25 HealthPartners — SHP: $30.40 HealthPartners CARE PMAP — Medicaid: $19.45 HealthPartners PCC Prime — Commercial: $33.25 Medica — Commercial-FI: $41.55
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAB PSA SCREENING	$152	$112.33	$59.13 – $137.56
PSA (prostate specific antigen) blood test: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $94.24 Aetna First Health — Commercial: $129.20 America's PPO — Commercial: $117.80 BCBS MN — Medicaid: $132.47 BCBS ND — BCBS MN: $81.32 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $94.24 BLUE PLUS PMAP PCC PRIME — Medicaid: $132.47 Cigna — Commercial: $101.08 Freedom Blue PPO — Medicare: $94.24 HealthPartners — Commercial: $101.08
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL	$162	$119.72	$63.02 – $146.61
PSA (prostate specific antigen) blood test: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $100.44 Aetna First Health — Commercial: $137.70 America's PPO — Commercial: $125.55 BCBS MN — Medicaid: $141.18 BCBS ND — BCBS MN: $86.67 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $100.44 BLUE PLUS PMAP PCC PRIME — Medicaid: $141.18 Cigna — Commercial: $107.73 Freedom Blue PPO — Medicare: $100.44 HealthPartners — Commercial: $107.73
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAB PSA SCREENING	$152	$112.33	$59.13 – $137.56
PSA (prostate specific antigen) blood test: 10 of 24 insurance plan rates Aetna First Health — Commercial: $129.20 America's PPO — Commercial: $117.80 BCBS MN — Medicaid: $83.60 BLUE PLUS PMAP PCC PRIME — Medicaid: $83.60 Cigna — Commercial: $101.08 HealthPartners — Commercial: $101.08 HealthPartners — SHP: $92.42 HealthPartners CARE PMAP — Medicaid: $59.13 HealthPartners PCC Prime — Commercial: $101.08 Medica — Commercial-FI: $126.31
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE	$145	$107.16	$56.40 – $131.22
Thyroid stimulating hormone (TSH) test: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $89.90 Aetna First Health — Commercial: $123.25 America's PPO — Commercial: $112.38 BCBS MN — Medicaid: $126.37 BCBS ND — BCBS MN: $77.58 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $89.90 BLUE PLUS PMAP PCC PRIME — Medicaid: $126.37 Cigna — Commercial: $96.43 Freedom Blue PPO — Medicare: $89.90 HealthPartners — Commercial: $96.43
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE	$145	$107.16	$56.40 – $131.22
Thyroid stimulating hormone (TSH) test: 10 of 24 insurance plan rates Aetna First Health — Commercial: $123.25 America's PPO — Commercial: $112.38 BCBS MN — Medicaid: $79.75 BLUE PLUS PMAP PCC PRIME — Medicaid: $79.75 Cigna — Commercial: $96.43 HealthPartners — Commercial: $96.43 HealthPartners — SHP: $88.16 HealthPartners CARE PMAP — Medicaid: $56.40 HealthPartners PCC Prime — Commercial: $96.43 Medica — Commercial-FI: $120.49
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$16.80
Thyroid stimulating hormone (TSH) test: 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $16.80 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $16.80 Freedom Blue PPO — Medicare: $16.80 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $16.80 IMCARE MSHO PCC PRIME — Medicare: $16.80 IMCARE MSHO REF REQ — Medicare: $16.80 Itasca Med Care — Medicaid: $16.80 MEDICA ADVANTAGE SOLUTIONS — Medicare: $16.80 MEDICA MSHO/Dual Solutions — Medicare: $16.80 MEDICA PRIME SOLUTION GROUP — Medicare: $16.80
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	$165	$121.94	$64.18 – $149.33
Complete blood count (CBC) with differential: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $102.30 Aetna First Health — Commercial: $140.25 America's PPO — Commercial: $127.88 BCBS MN — Medicaid: $143.80 BCBS ND — BCBS MN: $88.28 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $102.30 BLUE PLUS PMAP PCC PRIME — Medicaid: $143.80 Cigna — Commercial: $109.72 Freedom Blue PPO — Medicare: $102.30 HealthPartners — Commercial: $109.72
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	$165	$121.94	$64.18 – $149.33
Complete blood count (CBC) with differential: 10 of 24 insurance plan rates Aetna First Health — Commercial: $140.25 America's PPO — Commercial: $127.88 BCBS MN — Medicaid: $90.75 BLUE PLUS PMAP PCC PRIME — Medicaid: $90.75 Cigna — Commercial: $109.72 HealthPartners — Commercial: $109.72 HealthPartners — SHP: $100.32 HealthPartners CARE PMAP — Medicaid: $64.18 HealthPartners PCC Prime — Commercial: $109.72 Medica — Commercial-FI: $137.11
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$7.77
Complete blood count (CBC) with differential: 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $7.77 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $7.77 Freedom Blue PPO — Medicare: $7.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $7.77 IMCARE MSHO PCC PRIME — Medicare: $7.77 IMCARE MSHO REF REQ — Medicare: $7.77 Itasca Med Care — Medicaid: $7.77 MEDICA ADVANTAGE SOLUTIONS — Medicare: $7.77 MEDICA MSHO/Dual Solutions — Medicare: $7.77 MEDICA PRIME SOLUTION GROUP — Medicare: $7.77
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED	$157	$116.02	$61.07 – $142.08
Complete blood count (CBC), automated: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $97.34 Aetna First Health — Commercial: $133.45 America's PPO — Commercial: $121.68 BCBS MN — Medicaid: $136.83 BCBS ND — BCBS MN: $84 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $97.34 BLUE PLUS PMAP PCC PRIME — Medicaid: $136.83 Cigna — Commercial: $104.40 Freedom Blue PPO — Medicare: $97.34 HealthPartners — Commercial: $104.40
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED	$157	$116.02	$61.07 – $142.08
Complete blood count (CBC), automated: 10 of 24 insurance plan rates Aetna First Health — Commercial: $133.45 America's PPO — Commercial: $121.68 BCBS MN — Medicaid: $86.35 BLUE PLUS PMAP PCC PRIME — Medicaid: $86.35 Cigna — Commercial: $104.40 HealthPartners — Commercial: $104.40 HealthPartners — SHP: $95.46 HealthPartners CARE PMAP — Medicaid: $61.07 HealthPartners PCC Prime — Commercial: $104.40 Medica — Commercial-FI: $130.47
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$6.47
Complete blood count (CBC), automated: 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $6.47 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $6.47 Freedom Blue PPO — Medicare: $6.47 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $6.47 IMCARE MSHO PCC PRIME — Medicare: $6.47 IMCARE MSHO REF REQ — Medicare: $6.47 Itasca Med Care — Medicaid: $6.47 MEDICA ADVANTAGE SOLUTIONS — Medicare: $6.47 MEDICA MSHO/Dual Solutions — Medicare: $6.47 MEDICA PRIME SOLUTION GROUP — Medicare: $6.47
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME (PT/INR)	$65	$48.04	$25.28 – $58.82
Blood clotting time test (prothrombin time, PT): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $40.30 Aetna First Health — Commercial: $55.25 America's PPO — Commercial: $50.38 BCBS MN — Medicaid: $56.65 BCBS ND — BCBS MN: $34.78 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $40.30 BLUE PLUS PMAP PCC PRIME — Medicaid: $56.65 Cigna — Commercial: $43.22 Freedom Blue PPO — Medicare: $40.30 HealthPartners — Commercial: $43.22
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME (PT/INR) QW	$65	$48.04	$25.28 – $58.82
Blood clotting time test (prothrombin time, PT): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $40.30 Aetna First Health — Commercial: $55.25 America's PPO — Commercial: $50.38 BCBS MN — Medicaid: $56.65 BCBS ND — BCBS MN: $34.78 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $40.30 BLUE PLUS PMAP PCC PRIME — Medicaid: $56.65 Cigna — Commercial: $43.22 Freedom Blue PPO — Medicare: $40.30 HealthPartners — Commercial: $43.22
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME (PT/INR)	$65	$48.04	$25.28 – $58.82
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates Aetna First Health — Commercial: $55.25 America's PPO — Commercial: $50.38 BCBS MN — Medicaid: $35.75 BLUE PLUS PMAP PCC PRIME — Medicaid: $35.75 Cigna — Commercial: $43.22 HealthPartners — Commercial: $43.22 HealthPartners — SHP: $39.52 HealthPartners CARE PMAP — Medicaid: $25.28 HealthPartners PCC Prime — Commercial: $43.22 Medica — Commercial-FI: $54.02
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL	$103	$76.12	$40.07 – $93.22
Blood clotting test (partial thromboplastin time, PTT): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $63.86 Aetna First Health — Commercial: $87.55 America's PPO — Commercial: $79.82 BCBS MN — Medicaid: $89.76 BCBS ND — BCBS MN: $55.10 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $63.86 BLUE PLUS PMAP PCC PRIME — Medicaid: $89.76 Cigna — Commercial: $68.50 Freedom Blue PPO — Medicare: $63.86 HealthPartners — Commercial: $68.50
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL	$103	$76.12	$40.07 – $93.22
Blood clotting test (partial thromboplastin time, PTT): 10 of 24 insurance plan rates Aetna First Health — Commercial: $87.55 America's PPO — Commercial: $79.82 BCBS MN — Medicaid: $56.65 BLUE PLUS PMAP PCC PRIME — Medicaid: $56.65 Cigna — Commercial: $68.50 HealthPartners — Commercial: $68.50 HealthPartners — SHP: $62.62 HealthPartners CARE PMAP — Medicaid: $40.07 HealthPartners PCC Prime — Commercial: $68.50 Medica — Commercial-FI: $85.59
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$6.01
Blood clotting test (partial thromboplastin time, PTT): 10 of 23 insurance plan rates Advocare/Security Health — Medicare: $6.01 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $6.01 Freedom Blue PPO — Medicare: $6.01 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $6.01 IMCARE MSHO PCC PRIME — Medicare: $6.01 IMCARE MSHO REF REQ — Medicare: $6.01 Itasca Med Care — Medicaid: $6.01 MEDICA ADVANTAGE SOLUTIONS — Medicare: $6.01 MEDICA MSHO/Dual Solutions — Medicare: $6.01 MEDICA PRIME SOLUTION GROUP — Medicare: $6.01

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: CT HEAD/BRAIN W/O DYE	$1,703	$1,258.52	$662.47 – $1,541.22
CT scan of the head or brain, without contrast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,055.86 Aetna First Health — Commercial: $1,447.55 America's PPO — Commercial: $1,319.82 BCBS MN — Medicaid: $1,484.16 BCBS ND — BCBS MN: $911.10 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,055.86 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,484.16 Cigna — Commercial: $1,132.50 Freedom Blue PPO — Medicare: $1,055.86 HealthPartners — Commercial: $1,132.50
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT HEAD/BRAIN W/O DYE	$1,703	$1,258.52	$662.47 – $1,541.22
CT scan of the head or brain, without contrast: 10 of 24 insurance plan rates Aetna First Health — Commercial: $1,447.55 America's PPO — Commercial: $1,319.82 BCBS MN — Medicaid: $936.65 BLUE PLUS PMAP PCC PRIME — Medicaid: $936.65 Cigna — Commercial: $1,132.50 HealthPartners — Commercial: $1,132.50 HealthPartners — SHP: $1,035.42 HealthPartners CARE PMAP — Medicaid: $662.47 HealthPartners PCC Prime — Commercial: $1,132.50 Medica — Commercial-FI: $1,415.19
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	$106 – $106.34
CT scan of the head or brain, without contrast: rates for 2 insurance plans Itasca Med Care — Medicaid: $106.34 Primewest — Medicaid: $106
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI BRAIN W & WO CONTRAST	$3,926	$2,901.31	$1,527.21 – $3,553.03
MRI of the brain, before and after contrast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $2,434.12 Aetna First Health — Commercial: $3,337.10 America's PPO — Commercial: $3,042.65 BCBS MN — Medicaid: $3,421.51 BCBS ND — BCBS MN: $2,100.41 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,434.12 BLUE PLUS PMAP PCC PRIME — Medicaid: $3,421.51 Cigna — Commercial: $2,610.79 Freedom Blue PPO — Medicare: $2,434.12 HealthPartners — Commercial: $2,610.79
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI BRAIN W & WO CONTRAST	$3,926	$2,901.31	$1,527.21 – $3,553.03
MRI of the brain, before and after contrast: 10 of 24 insurance plan rates Aetna First Health — Commercial: $3,337.10 America's PPO — Commercial: $3,042.65 BCBS MN — Medicaid: $2,159.30 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,159.30 Cigna — Commercial: $2,610.79 HealthPartners — Commercial: $2,610.79 HealthPartners — SHP: $2,387.01 HealthPartners CARE PMAP — Medicaid: $1,527.21 HealthPartners PCC Prime — Commercial: $2,610.79 Medica — Commercial-FI: $3,262.51
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$357.13 – $370.77
MRI of the brain, before and after contrast: rates for 2 insurance plans Itasca Med Care — Medicaid: $357.13 Primewest — Medicaid: $370.77
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY EXAM CHEST 2 VIEWS	$313	$231.31	$121.76 – $283.26
Chest X-ray, 2 views: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $194.06 Aetna First Health — Commercial: $266.05 America's PPO — Commercial: $242.58 BCBS MN — Medicaid: $272.78 BCBS ND — BCBS MN: $167.46 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $194.06 BLUE PLUS PMAP PCC PRIME — Medicaid: $272.78 Cigna — Commercial: $208.14 Freedom Blue PPO — Medicare: $194.06 HealthPartners — Commercial: $208.14
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: X-RAY EXAM CHEST 2 VIEWS	$313	$231.31	$121.76 – $283.26
Chest X-ray, 2 views: 10 of 24 insurance plan rates Aetna First Health — Commercial: $266.05 America's PPO — Commercial: $242.58 BCBS MN — Medicaid: $172.15 BLUE PLUS PMAP PCC PRIME — Medicaid: $172.15 Cigna — Commercial: $208.14 HealthPartners — Commercial: $208.14 HealthPartners — SHP: $190.30 HealthPartners CARE PMAP — Medicaid: $121.76 HealthPartners PCC Prime — Commercial: $208.14 Medica — Commercial-FI: $260.10
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$87.61 – $88.05
Chest X-ray, 2 views: rates for 2 insurance plans Itasca Med Care — Medicaid: $88.05 Primewest — Medicaid: $87.61
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XRAY LUMBOSACRAL MINIMUM 4 VWS	$465	$343.64	$180.89 – $420.82
X-ray of the lower spine, at least 4 views: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $288.30 Aetna First Health — Commercial: $395.25 America's PPO — Commercial: $360.38 BCBS MN — Medicaid: $405.25 BCBS ND — BCBS MN: $248.78 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $288.30 BLUE PLUS PMAP PCC PRIME — Medicaid: $405.25 Cigna — Commercial: $309.23 Freedom Blue PPO — Medicare: $288.30 HealthPartners — Commercial: $309.23
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$106 – $106.34
X-ray of the lower spine, at least 4 views: rates for 2 insurance plans Itasca Med Care — Medicaid: $106.34 Primewest — Medicaid: $106
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI L SPINE WO CONTRAST	$2,832	$2,092.85	$1,101.65 – $2,562.96
MRI of the lower back (lumbar spine), without contrast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,755.84 Aetna First Health — Commercial: $2,407.20 America's PPO — Commercial: $2,194.80 BCBS MN — Medicaid: $2,468.09 BCBS ND — BCBS MN: $1,515.12 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,755.84 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,468.09 Cigna — Commercial: $1,883.28 Freedom Blue PPO — Medicare: $1,755.84 HealthPartners — Commercial: $1,883.28
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MRI L SPINE WO CONTRAST	$2,832	$2,092.85	$1,101.65 – $2,562.96
MRI of the lower back (lumbar spine), without contrast: 10 of 24 insurance plan rates Aetna First Health — Commercial: $2,407.20 America's PPO — Commercial: $2,194.80 BCBS MN — Medicaid: $1,557.60 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,557.60 Cigna — Commercial: $1,883.28 HealthPartners — Commercial: $1,883.28 HealthPartners — SHP: $1,721.86 HealthPartners CARE PMAP — Medicaid: $1,101.65 HealthPartners PCC Prime — Commercial: $1,883.28 Medica — Commercial-FI: $2,353.39
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$236.24 – $241.72
MRI of the lower back (lumbar spine), without contrast: rates for 2 insurance plans Itasca Med Care — Medicaid: $241.72 Primewest — Medicaid: $236.24
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT PELVIS W/DYE	$1,989	$1,469.87	$773.72 – $1,800.04
CT scan of the pelvis, with contrast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,233.18 Aetna First Health — Commercial: $1,690.65 America's PPO — Commercial: $1,541.48 BCBS MN — Medicaid: $1,733.41 BCBS ND — BCBS MN: $1,064.12 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,233.18 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,733.41 Cigna — Commercial: $1,322.69 Freedom Blue PPO — Medicare: $1,233.18 HealthPartners — Commercial: $1,322.69
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT PELVIS W/DYE	$1,989	$1,469.87	$773.72 – $1,800.04
CT scan of the pelvis, with contrast: 10 of 24 insurance plan rates Aetna First Health — Commercial: $1,690.65 America's PPO — Commercial: $1,541.48 BCBS MN — Medicaid: $1,093.95 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,093.95 Cigna — Commercial: $1,322.69 HealthPartners — Commercial: $1,322.69 HealthPartners — SHP: $1,209.31 HealthPartners CARE PMAP — Medicaid: $773.72 HealthPartners PCC Prime — Commercial: $1,322.69 Medica — Commercial-FI: $1,652.86
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$177.14 – $178.02
CT scan of the pelvis, with contrast: rates for 2 insurance plans Itasca Med Care — Medicaid: $178.02 Primewest — Medicaid: $177.14
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI LOW EXT JNT WO/CONT TC	$2,847	$2,103.93	$1,107.48 – $2,576.54
MRI of a leg joint (such as the knee), without contrast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,765.14 Aetna First Health — Commercial: $2,419.95 America's PPO — Commercial: $2,206.43 BCBS MN — Medicaid: $2,481.16 BCBS ND — BCBS MN: $1,523.14 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,765.14 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,481.16 Cigna — Commercial: $1,893.26 Freedom Blue PPO — Medicare: $1,765.14 HealthPartners — Commercial: $1,893.26
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$236.24 – $241.72
MRI of a leg joint (such as the knee), without contrast: rates for 2 insurance plans Itasca Med Care — Medicaid: $241.72 Primewest — Medicaid: $236.24
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABDOMEN&PELVIS W/CONTRAST	$3,421	$2,528.12	$1,330.77 – $3,096
CT scan of the abdomen and pelvis, with contrast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $2,121.02 Aetna First Health — Commercial: $2,907.85 America's PPO — Commercial: $2,651.28 BCBS MN — Medicaid: $2,981.40 BCBS ND — BCBS MN: $1,830.24 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,121.02 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,981.40 Cigna — Commercial: $2,274.96 Freedom Blue PPO — Medicare: $2,121.02 HealthPartners — Commercial: $2,274.96
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CT ABDOMEN&PELVIS W/CONTRAST	$3,421	$2,528.12	$1,330.77 – $3,096
CT scan of the abdomen and pelvis, with contrast: 10 of 24 insurance plan rates Aetna First Health — Commercial: $2,907.85 America's PPO — Commercial: $2,651.28 BCBS MN — Medicaid: $1,881.55 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,881.55 Cigna — Commercial: $2,274.96 HealthPartners — Commercial: $2,274.96 HealthPartners — SHP: $2,079.97 HealthPartners CARE PMAP — Medicaid: $1,330.77 HealthPartners PCC Prime — Commercial: $2,274.96 Medica — Commercial-FI: $2,842.85
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelvis w/contrast	Not listed in the file	Not listed in the file	$357.13 – $370.77
CT scan of the abdomen and pelvis, with contrast: rates for 2 insurance plans Itasca Med Care — Medicaid: $357.13 Primewest — Medicaid: $370.77
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US ABDOMEN TC	$827	$611.15	$321.70 – $748.44
Ultrasound of the abdomen, complete: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $512.74 Aetna First Health — Commercial: $702.95 America's PPO — Commercial: $640.93 BCBS MN — Medicaid: $720.73 BCBS ND — BCBS MN: $442.45 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $512.74 BLUE PLUS PMAP PCC PRIME — Medicaid: $720.73 Cigna — Commercial: $549.96 Freedom Blue PPO — Medicare: $512.74 HealthPartners — Commercial: $549.96
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: US ABDOMEN TC	$827	$611.15	$321.70 – $748.44
Ultrasound of the abdomen, complete: 10 of 24 insurance plan rates Aetna First Health — Commercial: $702.95 America's PPO — Commercial: $640.93 BCBS MN — Medicaid: $454.85 BLUE PLUS PMAP PCC PRIME — Medicaid: $454.85 Cigna — Commercial: $549.96 HealthPartners — Commercial: $549.96 HealthPartners — SHP: $502.82 HealthPartners CARE PMAP — Medicaid: $321.70 HealthPartners PCC Prime — Commercial: $549.96 Medica — Commercial-FI: $687.24
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$106 – $106.34
Ultrasound of the abdomen, complete: rates for 2 insurance plans Itasca Med Care — Medicaid: $106.34 Primewest — Medicaid: $106
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US,PREG. UTERUS,FETAL/MAT.EVAL.,>1ST TRIM.(>/= 14 WKS 0 DYS),TRANSABD;SINGLE/FIRST GEST., TECH	$680	$502.52	$264.52 – $615.40
Pregnancy ultrasound (after the first trimester): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $421.60 Aetna First Health — Commercial: $578 America's PPO — Commercial: $527 BCBS MN — Medicaid: $592.62 BCBS ND — BCBS MN: $363.80 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $421.60 BLUE PLUS PMAP PCC PRIME — Medicaid: $592.62 Cigna — Commercial: $452.20 Freedom Blue PPO — Medicare: $421.60 HealthPartners — Commercial: $452.20
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >= 14 wks sngl fetus	Not listed in the file	Not listed in the file	$106 – $106.34
Pregnancy ultrasound (after the first trimester): rates for 2 insurance plans Itasca Med Care — Medicaid: $106.34 Primewest — Medicaid: $106
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US TRANSVAGINAL TC	$565	$417.54	$219.78 – $511.32
Transvaginal ultrasound: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $350.30 Aetna First Health — Commercial: $480.25 America's PPO — Commercial: $437.88 BCBS MN — Medicaid: $492.40 BCBS ND — BCBS MN: $302.28 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $350.30 BLUE PLUS PMAP PCC PRIME — Medicaid: $492.40 Cigna — Commercial: $375.72 Freedom Blue PPO — Medicare: $350.30 HealthPartners — Commercial: $375.72
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$106 – $106.34
Transvaginal ultrasound: rates for 2 insurance plans Itasca Med Care — Medicaid: $106.34 Primewest — Medicaid: $106
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF	$443	$327.38	$172.33 – $400.92
Diagnostic mammogram, one breast: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $274.66 Aetna First Health — Commercial: $376.55 America's PPO — Commercial: $343.32 BCBS MN — Medicaid: $386.07 BCBS ND — BCBS MN: $237.01 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $274.66 BLUE PLUS PMAP PCC PRIME — Medicaid: $386.07 Cigna — Commercial: $294.60 Freedom Blue PPO — Medicare: $274.66 HealthPartners — Commercial: $294.60
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$86.73 – $89.15
Diagnostic mammogram, one breast: rates for 2 insurance plans Itasca Med Care — Medicaid: $86.73 Primewest — Medicaid: $89.15
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF	$541	$399.80	$210.45 – $489.60
Diagnostic mammogram, both breasts: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $335.42 Aetna First Health — Commercial: $459.85 America's PPO — Commercial: $419.28 BCBS MN — Medicaid: $471.48 BCBS ND — BCBS MN: $289.44 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $335.42 BLUE PLUS PMAP PCC PRIME — Medicaid: $471.48 Cigna — Commercial: $359.77 Freedom Blue PPO — Medicare: $335.42 HealthPartners — Commercial: $359.77
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$110.60 – $114.16
Diagnostic mammogram, both breasts: rates for 2 insurance plans Itasca Med Care — Medicaid: $110.60 Primewest — Medicaid: $114.16
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF	$457	$337.72	$177.77 – $413.58
Screening mammogram, both breasts: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $283.34 Aetna First Health — Commercial: $388.45 America's PPO — Commercial: $354.18 BCBS MN — Medicaid: $398.28 BCBS ND — BCBS MN: $244.50 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $283.34 BLUE PLUS PMAP PCC PRIME — Medicaid: $398.28 Cigna — Commercial: $303.91 Freedom Blue PPO — Medicare: $283.34 HealthPartners — Commercial: $303.91
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$91.61 – $94.27
Screening mammogram, both breasts: rates for 2 insurance plans Itasca Med Care — Medicaid: $91.61 Primewest — Medicaid: $94.27

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$3,141.61 – $3,216.42
Left heart catheterization (diagnostic): rates for 2 insurance plans Itasca Med Care — Medicaid: $3,216.42 Primewest — Medicaid: $3,141.61
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	$7,200.15 – $7,588.10
Heart rhythm study (electrophysiology evaluation): rates for 2 insurance plans Itasca Med Care — Medicaid: $7,588.10 Primewest — Medicaid: $7,200.15
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TX ATRIAL FIB PULM VEIN ISOL	$18,139	$13,404.72	$7,056.07 – $16,415.80
Heart rhythm study with ablation for atrial fibrillation: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $11,246.18 Aetna First Health — Commercial: $15,418.15 America's PPO — Commercial: $14,057.72 BCBS MN — Medicaid: $15,808.14 BCBS ND — BCBS MN: $9,704.36 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $11,246.18 BLUE PLUS PMAP PCC PRIME — Medicaid: $15,808.14 Cigna — Commercial: $12,062.44 Freedom Blue PPO — Medicare: $11,246.18 HealthPartners — Commercial: $12,062.44
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: TX ATRIAL FIB PULM VEIN ISOL	$18,139	$13,404.72	$7,056.07 – $16,415.80
Heart rhythm study with ablation for atrial fibrillation: 10 of 24 insurance plan rates Aetna First Health — Commercial: $15,418.15 America's PPO — Commercial: $14,057.72 BCBS MN — Medicaid: $9,976.45 BLUE PLUS PMAP PCC PRIME — Medicaid: $9,976.45 Cigna — Commercial: $12,062.44 HealthPartners — Commercial: $12,062.44 HealthPartners — SHP: $11,028.51 HealthPartners CARE PMAP — Medicaid: $7,056.07 HealthPartners PCC Prime — Commercial: $12,062.44 Medica — Commercial-FI: $15,073.51
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	$22,898.03 – $24,532.30
Heart rhythm study with ablation for atrial fibrillation: rates for 2 insurance plans Itasca Med Care — Medicaid: $24,532.30 Primewest — Medicaid: $22,898.03
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOMNOGRAPHY, 4 OR MORE	$4,814	$3,557.55	$1,872.65 – $4,356.67
Sleep study (overnight, in a sleep lab): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $2,984.68 Aetna First Health — Commercial: $4,091.90 America's PPO — Commercial: $3,730.85 BCBS MN — Medicaid: $4,195.40 BCBS ND — BCBS MN: $2,575.49 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,984.68 BLUE PLUS PMAP PCC PRIME — Medicaid: $4,195.40 Cigna — Commercial: $3,201.31 Freedom Blue PPO — Medicare: $2,984.68 HealthPartners — Commercial: $3,201.31
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$1,008.02 – $1,017.39
Sleep study (overnight, in a sleep lab): rates for 2 insurance plans Itasca Med Care — Medicaid: $1,017.39 Primewest — Medicaid: $1,008.02

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THERAPEUTIC EXERCISES	$137	$101.24	$53.29 – $123.98
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $84.94 Aetna First Health — Commercial: $116.45 America's PPO — Commercial: $106.18 BCBS MN — Medicaid: $119.40 BCBS ND — BCBS MN: $73.30 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $84.94 BLUE PLUS PMAP PCC PRIME — Medicaid: $119.40 Cigna — Commercial: $91.10 Freedom Blue PPO — Medicare: $84.94 HealthPartners — Commercial: $91.10
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THERAPEUTIC EXERCISES	$137	$101.24	$53.29 – $123.98
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 24 insurance plan rates Aetna First Health — Commercial: $116.45 America's PPO — Commercial: $106.18 BCBS MN — Medicaid: $75.35 BLUE PLUS PMAP PCC PRIME — Medicaid: $75.35 Cigna — Commercial: $91.10 HealthPartners — Commercial: $91.10 HealthPartners — SHP: $83.30 HealthPartners CARE PMAP — Medicaid: $53.29 HealthPartners PCC Prime — Commercial: $91.10 Medica — Commercial-FI: $113.85
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$28.85 – $29.41
Physical therapy: therapeutic exercise (each 15 minutes): rates for 2 insurance plans Itasca Med Care — Medicaid: $28.85 Primewest — Medicaid: $29.41
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEX	$228	$168.49	$88.69 – $206.34
Physical therapy evaluation (low complexity): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $141.36 Aetna First Health — Commercial: $193.80 America's PPO — Commercial: $176.70 BCBS MN — Medicaid: $198.70 BCBS ND — BCBS MN: $121.98 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $141.36 BLUE PLUS PMAP PCC PRIME — Medicaid: $198.70 Cigna — Commercial: $151.62 Freedom Blue PPO — Medicare: $141.36 HealthPartners — Commercial: $151.62
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEX	$228	$168.49	$88.69 – $206.34
Physical therapy evaluation (low complexity): 10 of 24 insurance plan rates Aetna First Health — Commercial: $193.80 America's PPO — Commercial: $176.70 BCBS MN — Medicaid: $125.40 BLUE PLUS PMAP PCC PRIME — Medicaid: $125.40 Cigna — Commercial: $151.62 HealthPartners — Commercial: $151.62 HealthPartners — SHP: $138.62 HealthPartners CARE PMAP — Medicaid: $88.69 HealthPartners PCC Prime — Commercial: $151.62 Medica — Commercial-FI: $189.47
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$98.08 – $100.45
Physical therapy evaluation (low complexity): rates for 2 insurance plans Itasca Med Care — Medicaid: $98.08 Primewest — Medicaid: $100.45
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MOD COMPLEX	$249	$184.01	$96.86 – $225.34
Physical therapy evaluation (moderate complexity): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $154.38 Aetna First Health — Commercial: $211.65 America's PPO — Commercial: $192.98 BCBS MN — Medicaid: $217 BCBS ND — BCBS MN: $133.22 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $154.38 BLUE PLUS PMAP PCC PRIME — Medicaid: $217 Cigna — Commercial: $165.58 Freedom Blue PPO — Medicare: $154.38 HealthPartners — Commercial: $165.58
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MOD COMPLEX	$249	$184.01	$96.86 – $225.34
Physical therapy evaluation (moderate complexity): 10 of 24 insurance plan rates Aetna First Health — Commercial: $211.65 America's PPO — Commercial: $192.98 BCBS MN — Medicaid: $136.95 BLUE PLUS PMAP PCC PRIME — Medicaid: $136.95 Cigna — Commercial: $165.58 HealthPartners — Commercial: $165.58 HealthPartners — SHP: $151.39 HealthPartners CARE PMAP — Medicaid: $96.86 HealthPartners PCC Prime — Commercial: $165.58 Medica — Commercial-FI: $206.92
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$98.08 – $100.45
Physical therapy evaluation (moderate complexity): rates for 2 insurance plans Itasca Med Care — Medicaid: $98.08 Primewest — Medicaid: $100.45
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEX	$271	$200.27	$105.42 – $245.26
Physical therapy evaluation (high complexity): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $168.02 Aetna First Health — Commercial: $230.35 America's PPO — Commercial: $210.02 BCBS MN — Medicaid: $236.18 BCBS ND — BCBS MN: $144.99 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $168.02 BLUE PLUS PMAP PCC PRIME — Medicaid: $236.18 Cigna — Commercial: $180.22 Freedom Blue PPO — Medicare: $168.02 HealthPartners — Commercial: $180.22
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEX	$271	$200.27	$105.42 – $245.26
Physical therapy evaluation (high complexity): 10 of 24 insurance plan rates Aetna First Health — Commercial: $230.35 America's PPO — Commercial: $210.02 BCBS MN — Medicaid: $149.05 BLUE PLUS PMAP PCC PRIME — Medicaid: $149.05 Cigna — Commercial: $180.22 HealthPartners — Commercial: $180.22 HealthPartners — SHP: $164.77 HealthPartners CARE PMAP — Medicaid: $105.42 HealthPartners PCC Prime — Commercial: $180.22 Medica — Commercial-FI: $225.20
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$98.08 – $100.45
Physical therapy evaluation (high complexity): rates for 2 insurance plans Itasca Med Care — Medicaid: $98.08 Primewest — Medicaid: $100.45
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 30 minutes	Not listed in the file	Not listed in the file	$153.72 – $160.67
Psychotherapy, 30 minutes: rates for 2 insurance plans Itasca Med Care — Medicaid: $160.67 Primewest — Medicaid: $153.72
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$153.72 – $160.67
Psychotherapy, 45 minutes: rates for 2 insurance plans Itasca Med Care — Medicaid: $160.67 Primewest — Medicaid: $153.72
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$153.72 – $160.67
Psychotherapy, 60 minutes: rates for 2 insurance plans Itasca Med Care — Medicaid: $160.67 Primewest — Medicaid: $153.72
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	$153.72 – $160.67
Family psychotherapy, without the patient: rates for 2 insurance plans Itasca Med Care — Medicaid: $160.67 Primewest — Medicaid: $153.72
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	$153.72 – $160.67
Family psychotherapy, with the patient: rates for 2 insurance plans Itasca Med Care — Medicaid: $160.67 Primewest — Medicaid: $153.72
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$85.94 – $92.50
Group psychotherapy: rates for 2 insurance plans Itasca Med Care — Medicaid: $92.50 Primewest — Medicaid: $85.94

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$3,674.93 – $3,829.28
Removal of breast growth (open surgery): rates for 2 insurance plans Itasca Med Care — Medicaid: $3,829.28 Primewest — Medicaid: $3,674.93
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$12,688.80 – $12,866.82
Total hip replacement: rates for 2 insurance plans Itasca Med Care — Medicaid: $12,866.82 Primewest — Medicaid: $12,688.80
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$12,688.80 – $12,866.82
Total knee replacement: rates for 2 insurance plans Itasca Med Care — Medicaid: $12,866.82 Primewest — Medicaid: $12,688.80
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$3,120.67 – $3,244.61
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 2 insurance plans Itasca Med Care — Medicaid: $3,244.61 Primewest — Medicaid: $3,120.67
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	$5,645.99 – $5,915.66
Removal of tonsils and adenoids (under age 12): rates for 2 insurance plans Itasca Med Care — Medicaid: $5,915.66 Primewest — Medicaid: $5,645.99
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,DIAGNOSIS	$2,967	$2,192.61	$1,154.16 – $2,685.14
Upper GI endoscopy (diagnostic): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,839.54 Aetna First Health — Commercial: $2,521.95 America's PPO — Commercial: $2,299.43 BCBS MN — Medicaid: $2,585.74 BCBS ND — BCBS MN: $1,587.34 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,839.54 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,585.74 Cigna — Commercial: $1,973.06 Freedom Blue PPO — Medicare: $1,839.54 HealthPartners — Commercial: $1,973.06
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	$873.95 – $937.56
Upper GI endoscopy (diagnostic): rates for 2 insurance plans Itasca Med Care — Medicaid: $937.56 Primewest — Medicaid: $873.95
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,BIOPSY	$3,095	$2,287.20	$1,203.96 – $2,800.98
Upper GI endoscopy with biopsy: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,918.90 Aetna First Health — Commercial: $2,630.75 America's PPO — Commercial: $2,398.62 BCBS MN — Medicaid: $2,697.29 BCBS ND — BCBS MN: $1,655.82 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,918.90 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,697.29 Cigna — Commercial: $2,058.18 Freedom Blue PPO — Medicare: $1,918.90 HealthPartners — Commercial: $2,058.18
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,BIOPSY	$3,095	$2,287.20	$1,203.96 – $2,800.98
Upper GI endoscopy with biopsy: 10 of 24 insurance plan rates Aetna First Health — Commercial: $2,630.75 America's PPO — Commercial: $2,398.62 BCBS MN — Medicaid: $1,702.25 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,702.25 Cigna — Commercial: $2,058.18 HealthPartners — Commercial: $2,058.18 HealthPartners — SHP: $1,881.76 HealthPartners CARE PMAP — Medicaid: $1,203.96 HealthPartners PCC Prime — Commercial: $2,058.18 Medica — Commercial-FI: $2,571.94
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	$873.95 – $937.56
Upper GI endoscopy with biopsy: rates for 2 insurance plans Itasca Med Care — Medicaid: $937.56 Primewest — Medicaid: $873.95
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,FLEX,DIAGNOSTIC	$2,827	$2,089.15	$1,099.70 – $2,558.44
Colonoscopy (diagnostic): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,752.74 Aetna First Health — Commercial: $2,402.95 America's PPO — Commercial: $2,190.93 BCBS MN — Medicaid: $2,463.73 BCBS ND — BCBS MN: $1,512.45 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,752.74 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,463.73 Cigna — Commercial: $1,879.96 Freedom Blue PPO — Medicare: $1,752.74 HealthPartners — Commercial: $1,879.96
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY,FLEX,DIAGNOSTIC	$2,827	$2,089.15	$1,099.70 – $2,558.44
Colonoscopy (diagnostic): 10 of 24 insurance plan rates Aetna First Health — Commercial: $2,402.95 America's PPO — Commercial: $2,190.93 BCBS MN — Medicaid: $1,554.85 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,554.85 Cigna — Commercial: $1,879.96 HealthPartners — Commercial: $1,879.96 HealthPartners — SHP: $1,718.82 HealthPartners CARE PMAP — Medicaid: $1,099.70 HealthPartners PCC Prime — Commercial: $1,879.96 Medica — Commercial-FI: $2,349.24
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	$881.16 – $911.71
Colonoscopy (diagnostic): rates for 2 insurance plans Itasca Med Care — Medicaid: $911.71 Primewest — Medicaid: $881.16
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,BIOPSY	$3,064	$2,264.30	$1,191.90 – $2,772.92
Colonoscopy with biopsy: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,899.68 Aetna First Health — Commercial: $2,604.40 America's PPO — Commercial: $2,374.60 BCBS MN — Medicaid: $2,670.28 BCBS ND — BCBS MN: $1,639.24 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,899.68 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,670.28 Cigna — Commercial: $2,037.56 Freedom Blue PPO — Medicare: $1,899.68 HealthPartners — Commercial: $2,037.56
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	$1,137.72 – $1,179.08
Colonoscopy with biopsy: rates for 2 insurance plans Itasca Med Care — Medicaid: $1,179.08 Primewest — Medicaid: $1,137.72
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,REMV LESN,SNARE	$3,341	$2,469	$1,299.65 – $3,023.60
Colonoscopy with removal of polyps (snare): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $2,071.42 Aetna First Health — Commercial: $2,839.85 America's PPO — Commercial: $2,589.28 BCBS MN — Medicaid: $2,911.68 BCBS ND — BCBS MN: $1,787.44 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,071.42 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,911.68 Cigna — Commercial: $2,221.77 Freedom Blue PPO — Medicare: $2,071.42 HealthPartners — Commercial: $2,221.77
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	$1,137.72 – $1,179.08
Colonoscopy with removal of polyps (snare): rates for 2 insurance plans Itasca Med Care — Medicaid: $1,179.08 Primewest — Medicaid: $1,137.72
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	$1,137.72 – $1,179.08
Ultrasound of the lower bowel by endoscope: rates for 2 insurance plans Itasca Med Care — Medicaid: $1,179.08 Primewest — Medicaid: $1,137.72
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,SCREEN PREV	$2,839	$2,098.02	$1,104.37 – $2,569.30
Screening colonoscopy (not high risk): 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,760.18 Aetna First Health — Commercial: $2,413.15 America's PPO — Commercial: $2,200.22 BCBS MN — Medicaid: $2,474.19 BCBS ND — BCBS MN: $1,518.86 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,760.18 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,474.19 Cigna — Commercial: $1,887.94 Freedom Blue PPO — Medicare: $1,760.18 HealthPartners — Commercial: $1,887.94
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	$881.16 – $911.71
Screening colonoscopy (not high risk): rates for 2 insurance plans Itasca Med Care — Medicaid: $911.71 Primewest — Medicaid: $881.16
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	$5,562.90 – $5,834.36
Gallbladder removal by laparoscope: rates for 2 insurance plans Itasca Med Care — Medicaid: $5,834.36 Primewest — Medicaid: $5,562.90
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	$3,335.50 – $3,529.06
Groin (inguinal) hernia repair, age 5 or older: rates for 2 insurance plans Itasca Med Care — Medicaid: $3,529.06 Primewest — Medicaid: $3,335.50
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy of prostate	Not listed in the file	Not listed in the file	$1,963.71 – $2,048.51
Prostate biopsy: rates for 2 insurance plans Itasca Med Care — Medicaid: $2,048.51 Primewest — Medicaid: $1,963.71
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	$9,924.28 – $10,411.22
Prostate removal by laparoscope (radical prostatectomy): rates for 2 insurance plans Itasca Med Care — Medicaid: $10,411.22 Primewest — Medicaid: $9,924.28
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	$3,014.16 – $3,179.53
Hysteroscopy with biopsy of the uterus lining: rates for 2 insurance plans Itasca Med Care — Medicaid: $3,179.53 Primewest — Medicaid: $3,014.16
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ LUMBAR/SACRAL WITH IMAGE GUIDANCE	$1,890	$1,396.71	$735.21 – $1,710.45
Spinal injection, lower back (epidural), with imaging guidance: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,171.80 Aetna First Health — Commercial: $1,606.50 America's PPO — Commercial: $1,464.75 BCBS MN — Medicaid: $1,647.14 BCBS ND — BCBS MN: $1,011.15 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,171.80 BLUE PLUS PMAP PCC PRIME — Medicaid: $1,647.14 Cigna — Commercial: $1,256.85 Freedom Blue PPO — Medicare: $1,171.80 HealthPartners — Commercial: $1,256.85
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	$666.72 – $692.52
Spinal injection, lower back (epidural), with imaging guidance: rates for 2 insurance plans Itasca Med Care — Medicaid: $692.52 Primewest — Medicaid: $666.72
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: INJ,FORAMEN,L/S,1 LEVEL(T)	$2,303	$1,701.92	$895.87 – $2,084.22
Nerve root injection, lower back, with imaging guidance: 10 of 46 insurance plan rates Advocare/Security Health — Medicare: $1,427.86 Aetna First Health — Commercial: $1,957.55 America's PPO — Commercial: $1,784.82 BCBS MN — Medicaid: $2,007.06 BCBS ND — BCBS MN: $1,232.10 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,427.86 BLUE PLUS PMAP PCC PRIME — Medicaid: $2,007.06 Cigna — Commercial: $1,531.50 Freedom Blue PPO — Medicare: $1,427.86 HealthPartners — Commercial: $1,531.50
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	$878.76 – $890.29
Nerve root injection, lower back, with imaging guidance: rates for 2 insurance plans Itasca Med Care — Medicaid: $890.29 Primewest — Medicaid: $878.76
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	$1,861.48 – $1,952.77
Carpal tunnel release: rates for 2 insurance plans Itasca Med Care — Medicaid: $1,952.77 Primewest — Medicaid: $1,861.48
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	$548.60 – $560.41
Laser treatment of clouding after cataract surgery: rates for 2 insurance plans Itasca Med Care — Medicaid: $548.60 Primewest — Medicaid: $560.41
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	$2,246.73 – $2,280.73
Cataract removal with lens implant: rates for 2 insurance plans Itasca Med Care — Medicaid: $2,280.73 Primewest — Medicaid: $2,246.73

Source: Essentia Health Holy Trinity Hospital’s standard charges file (essentiahealth.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Critical Access Hospital
Address	115 Second Street West, Box 157, Graceville, MN 56240
County	Big Stone County
State	Minnesota
Phone	(320) 748‑7223
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	Not rated by CMS
CMS Certification Number	241321
Name in Medicare records	ESSENTIA HEALTH HOLY TRINITY HOSPITAL
Profile level	Medicare data + hospital website
Name on the hospital’s website	Essentia Health-Holy Trinity Hospital (Graceville)
Official website	essentiahealth.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Essentia Health-Holy Trinity Hospital (Graceville) — essentiahealth.org
Lab Services - Essentia Health-Holy Trinity Hospital (Graceville) | Essentia Health — essentiahealth.org
Emergency Medicine - Essentia Health-Holy Trinity Hospital (Graceville) | Essentia Health — essentiahealth.org
Imaging & Radiology - Essentia Health-Holy Trinity Hospital (Graceville) | Essentia Health — essentiahealth.org