Does Essentia Health St Marys - Detroit Lakes have an emergency room?

Yes. The hospital’s official website lists an emergency room at Essentia Health St Marys - Detroit Lakes (trauma center: Level III). Medicare (CMS) data does not list emergency services for it. In a medical emergency, call 911.

Where is Essentia Health St Marys - Detroit Lakes?

1027 Washington Ave, Detroit Lakes, MN 56501, in Becker County, Minnesota.

What is the phone number of Essentia Health St Marys - Detroit Lakes?

(218) 847-0888, as listed by Medicare (CMS).

What is the Medicare star rating of Essentia Health St Marys - Detroit Lakes?

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

Essentia Health St Marys - Detroit Lakes

Quick answers

Does Essentia Health St Marys - Detroit Lakes have an emergency room?: Yes. The hospital’s official website lists an emergency room at Essentia Health St Marys - Detroit Lakes (trauma center: Level III). Medicare (CMS) data does not list emergency services for it. In a medical emergency, call 911.
Where is Essentia Health St Marys - Detroit Lakes?: 1027 Washington Ave, Detroit Lakes, MN 56501, in Becker County, Minnesota.
What is the phone number of Essentia Health St Marys - Detroit Lakes?: (218) 847-0888, as listed by Medicare (CMS).
What is the Medicare star rating of Essentia Health St Marys - Detroit Lakes?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][5]

Emergency Medicine
Hospitalist Services
Birthing Center
Anesthesiology
Cardiology
Colorectal Surgery
Ear, Nose & Throat Surgery
General Surgery
Gynecologic Surgery
Orthopedic Surgery
Podiatric Surgery

Treatments^[4]

Inpatient physical therapy
Inpatient occupational therapy
Inpatient speech-language therapy
Cardiac rehabilitation
Physical therapy (inpatient)
Occupational therapy (inpatient)
Speech-language therapy (inpatient)
Dietitian (inpatient)

Procedures^[4][7]

Eye surgery
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Lung cancer screening
Imaging & radiology
Lab services

Programs and centers^[4]

Birthing Center
Fertility
Gender affirming care
Home health care
Community paramedic services
Transitional care
Hospitalist services
Spiritual care

Emergency care (hospital website)^[4][5][6]

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

Visiting and practical information

Parking	Free parking in the surface lot; ER signs off Washington Avenue, other visitors use the east door under the awning^[4]

Recognition^[4]

Joint Commission accredited

Doctors and clinicians (354)

354 doctors and other clinicians list Essentia Health St Marys - Detroit Lakes as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 330 more: the button below opens the full list.

Other emergency rooms nearby

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

Perham Health20 mi · Perham, MN · Critical Access Hospital
Mahnomen Health Center35 mi · Mahnomen, MN · Rural Emergency Hospital
St Josephs Area Health Services38 mi · Park Rapids, MN · Critical Access Hospital
Astera Health41 mi · Wadena, MN · Critical Access Hospital
Fargo VA Medical Center44 mi · Fargo, ND · Federal/VA Acute Care Hospital

Other hospitals nearby

Community Behavioral Health Hospital Fergus Falls39 mi · Fergus Falls, MN · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Essentia Health Oak Crossing0.2 mi · Detroit Lakes, MN · 5 of 5 stars
Emmanuel Nursing Home0.7 mi · Detroit Lakes, MN · 3 of 5 stars
Frazee Care Center9.0 mi · Frazee, MN · 5 of 5 stars

All nursing homes in the state →

Home health agencies

Essentia Health Home Care West1.9 mi · Detroit Lakes, MN · 4 of 5 stars
White Earth Home Health20 mi · White Earth, MN
Perham Living Home Care20 mi · Perham, MN

All home health agencies in the state →

Dialysis facilities

Sanford Dialysis Detroit Lakes1.9 mi · Detroit Lakes, MN · 3 of 5 stars
White Earth Dialysis20 mi · White Earth, MN · 3 of 5 stars

All dialysis facilities in the state →

Community care nearby

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

Clinics and urgent care

Essentia Health St. Mary's Frazee Clinic12 mi · Frazee, MN · Rural health clinic
Essentia Health St Mary's Pelican Rapids Clinic18 mi · Pelican Rapids, MN · Rural health clinic
Sanford Health Pelican Rapids Clinic18 mi · Pelican Rapids, MN · Rural health clinic

Pharmacies

Grand St Paul CVS LLC1.9 mi · Detroit Lakes, MN · Pharmacy
Sanford Clinic North1.9 mi · Detroit Lakes, MN · Pharmacy
Sanford Medical Center Fargo1.9 mi · Detroit Lakes, MN · Community/retail pharmacy

Assisted living nearby

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

Diamond Willow Assisted Living1.9 mi · Detroit Lakes, MN
Ecumen Detroit Lakes the Cottage1.9 mi · Detroit Lakes, MN
Golden Manor Corporation1.9 mi · Detroit Lakes, MN
Lincoln Park Assisted Living1.9 mi · Detroit Lakes, 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 St Marys - Detroit Lakes reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

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

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	73%National average: 72%
Would definitely recommend the hospital	71%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	81%National average: 80%
Staff “always” explained medicines before giving them	64%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	69%National average: 74%
Area around the room “always” quiet at night	66%National average: 60%
Completed surveys	428Response rate: 26%

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	0.989No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0No different from the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	8.1%
Deaths within 30 days: pneumonia patients	13.5%
Deaths within 30 days: COPD patients	8.1%
Deaths within 30 days: stroke patients	8.2%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.95No different from the national rate
Complications after hip or knee replacement	Too few cases to report

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Too few cases to report
Readmitted within 30 days: heart failure	21.8%
Readmitted within 30 days: pneumonia	16.7%
Readmitted within 30 days: COPD	19.7%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	140 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	75%National average: 65%

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

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

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

ER wait times in 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 82 common services exactly as Essentia Health St Marys - Detroit Lakes 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 →

$ 5 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

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	$140	$89.88	$54.46 – $120.40
New patient office visit (about 30–44 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $119 America's PPO — Commercial: $108.50 BCBS MN — Medicaid: $63 BCBS PLUS PMAP PCC PRIME — Medicaid: $63 BCBS WI — Commercial: $106.40 Cigna — Commercial: $102.76 HealthEOS — Commercial: $120.40 HealthPartners — Commercial: $102.76 HealthPartners — SHP: $94.08 HealthPartners CARE PMAP — Medicaid: $54.46
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,NEW,LEVL III	$140	$89.88	$60.05 – $120.40
New patient office visit (about 30–44 minutes): 10 of 13 insurance plan rates Aetna First Health — Commercial: $119 America's PPO — Commercial: $108.50 BCBS MN — Medicaid: $93.59 BCBS PLUS PMAP PCC PRIME — Medicaid: $93.59 BCBS WI — Commercial: $106.40 HealthEOS — Commercial: $120.40 MN BCBS Commercial — BCBS MN: $103.99 Sanford HealthPlan — Commercial: $63.21 Sanford HealthPlan — Commercial-NDPERS: $60.05 Ucare — Commercial: $92.12
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office o/p new low 30 min	Not listed in the file	Not listed in the file	$145.91
New patient office visit (about 30–44 minutes): rates for 3 insurance plans BCBS MN — Medicaid: $145.91 BCBS PLUS PMAP PCC PRIME — Medicaid: $145.91 MN BCBS Commercial — BCBS MN: $145.91
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	$191	$122.62	$74.30 – $164.26
New patient office visit (about 45–59 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $162.35 America's PPO — Commercial: $148.02 BCBS MN — Medicaid: $85.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $85.95 BCBS WI — Commercial: $145.16 Cigna — Commercial: $140.19 HealthEOS — Commercial: $164.26 HealthPartners — Commercial: $140.19 HealthPartners — SHP: $128.35 HealthPartners CARE PMAP — Medicaid: $74.30
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	$191	$122.62	$81.92 – $164.26
New patient office visit (about 45–59 minutes): 10 of 13 insurance plan rates Aetna First Health — Commercial: $162.35 America's PPO — Commercial: $148.02 BCBS MN — Medicaid: $127.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $127.68 BCBS WI — Commercial: $145.16 HealthEOS — Commercial: $164.26 MN BCBS Commercial — BCBS MN: $141.87 Sanford HealthPlan — Commercial: $86.24 Sanford HealthPlan — Commercial-NDPERS: $81.92 Ucare — Commercial: $125.68
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office o/p new mod 45 min	Not listed in the file	Not listed in the file	$237.41
New patient office visit (about 45–59 minutes): rates for 3 insurance plans BCBS MN — Medicaid: $237.41 BCBS PLUS PMAP PCC PRIME — Medicaid: $237.41 MN BCBS Commercial — BCBS MN: $237.41
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	$270	$173.34	$105.03 – $232.20
New patient office visit (about 60–74 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $229.50 America's PPO — Commercial: $209.25 BCBS MN — Medicaid: $121.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $121.50 BCBS WI — Commercial: $205.20 Cigna — Commercial: $198.18 HealthEOS — Commercial: $232.20 HealthPartners — Commercial: $198.18 HealthPartners — SHP: $181.44 HealthPartners CARE PMAP — Medicaid: $105.03
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,NEW,LEVL V	$270	$173.34	$115.80 – $232.20
New patient office visit (about 60–74 minutes): 10 of 13 insurance plan rates Aetna First Health — Commercial: $229.50 America's PPO — Commercial: $209.25 BCBS MN — Medicaid: $180.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $180.50 BCBS WI — Commercial: $205.20 HealthEOS — Commercial: $232.20 MN BCBS Commercial — BCBS MN: $200.56 Sanford HealthPlan — Commercial: $121.90 Sanford HealthPlan — Commercial-NDPERS: $115.80 Ucare — Commercial: $177.66
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office o/p new hi 60 min	Not listed in the file	Not listed in the file	$322.92
New patient office visit (about 60–74 minutes): rates for 3 insurance plans BCBS MN — Medicaid: $322.92 BCBS PLUS PMAP PCC PRIME — Medicaid: $322.92 MN BCBS Commercial — BCBS MN: $322.92
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE CONSULTATION,LEVEL III	$184	$118.13	$71.58 – $158.24
Established patient office visit (about 20–29 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $156.40 America's PPO — Commercial: $142.60 BCBS MN — Medicaid: $82.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $82.80 BCBS WI — Commercial: $139.84 Cigna — Commercial: $135.06 HealthEOS — Commercial: $158.24 HealthPartners — Commercial: $135.06 HealthPartners — SHP: $123.65 HealthPartners CARE PMAP — Medicaid: $71.58
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,EST,LEVL III	$104	$66.77	$40.46 – $89.44
Established patient office visit (about 20–29 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $88.40 America's PPO — Commercial: $80.60 BCBS MN — Medicaid: $46.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $46.80 BCBS WI — Commercial: $79.04 Cigna — Commercial: $76.34 HealthEOS — Commercial: $89.44 HealthPartners — Commercial: $76.34 HealthPartners — SHP: $69.89 HealthPartners CARE PMAP — Medicaid: $40.46
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,EST,LEVL III	$104	$66.77	$44.61 – $89.44
Established patient office visit (about 20–29 minutes): 10 of 13 insurance plan rates Aetna First Health — Commercial: $88.40 America's PPO — Commercial: $80.60 BCBS MN — Medicaid: $69.52 BCBS PLUS PMAP PCC PRIME — Medicaid: $69.52 BCBS WI — Commercial: $79.04 HealthEOS — Commercial: $89.44 MN BCBS Commercial — BCBS MN: $77.25 Sanford HealthPlan — Commercial: $46.96 Sanford HealthPlan — Commercial-NDPERS: $44.61 Ucare — Commercial: $68.43
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	$147	$94.37	$57.18 – $126.42
Established patient office visit (about 30–39 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $124.95 America's PPO — Commercial: $113.92 BCBS MN — Medicaid: $66.15 BCBS PLUS PMAP PCC PRIME — Medicaid: $66.15 BCBS WI — Commercial: $111.72 Cigna — Commercial: $107.90 HealthEOS — Commercial: $126.42 HealthPartners — Commercial: $107.90 HealthPartners — SHP: $98.78 HealthPartners CARE PMAP — Medicaid: $57.18
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: OFFICE/OUTPT VISIT,EST,LEVL IV	$147	$94.37	$63.05 – $126.42
Established patient office visit (about 30–39 minutes): 10 of 13 insurance plan rates Aetna First Health — Commercial: $124.95 America's PPO — Commercial: $113.92 BCBS MN — Medicaid: $98.27 BCBS PLUS PMAP PCC PRIME — Medicaid: $98.27 BCBS WI — Commercial: $111.72 HealthEOS — Commercial: $126.42 MN BCBS Commercial — BCBS MN: $109.19 Sanford HealthPlan — Commercial: $66.37 Sanford HealthPlan — Commercial-NDPERS: $63.05 Ucare — Commercial: $96.73
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Office o/p est mod 30 min	Not listed in the file	Not listed in the file	$172.82
Established patient office visit (about 30–39 minutes): rates for 3 insurance plans BCBS MN — Medicaid: $172.82 BCBS PLUS PMAP PCC PRIME — Medicaid: $172.82 MN BCBS Commercial — BCBS MN: $172.82
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Off/op cnsltj new/est low 30	Not listed in the file	Not listed in the file	$156.68
Office consultation with a specialist (moderate): rates for 3 insurance plans BCBS MN — Medicaid: $156.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $156.68 MN BCBS Commercial — BCBS MN: $156.68
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	$198	$127.12	$77.02 – $170.28
Office consultation with a specialist (moderate to high): 10 of 25 insurance plan rates Aetna First Health — Commercial: $168.30 America's PPO — Commercial: $153.45 BCBS MN — Medicaid: $89.10 BCBS PLUS PMAP PCC PRIME — Medicaid: $89.10 BCBS WI — Commercial: $150.48 Cigna — Commercial: $145.33 HealthEOS — Commercial: $170.28 HealthPartners — Commercial: $145.33 HealthPartners — SHP: $133.06 HealthPartners CARE PMAP — Medicaid: $77.02
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Off/op cnsltj new/est mod 40	Not listed in the file	Not listed in the file	$238.60
Office consultation with a specialist (moderate to high): rates for 3 insurance plans BCBS MN — Medicaid: $238.60 BCBS PLUS PMAP PCC PRIME — Medicaid: $238.60 MN BCBS Commercial — BCBS MN: $238.60
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$166.24
Preventive checkup, new patient, age 18–39: rates for 3 insurance plans BCBS MN — Medicaid: $166.24 BCBS PLUS PMAP PCC PRIME — Medicaid: $166.24 MN BCBS Commercial — BCBS MN: $166.24
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$201.53
Preventive checkup, new patient, age 40–64: rates for 3 insurance plans BCBS MN — Medicaid: $201.53 BCBS PLUS PMAP PCC PRIME — Medicaid: $201.53 MN BCBS Commercial — BCBS MN: $201.53
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL III VISIT	$800	$513.60	$311.20 – $688
Emergency room visit (moderate): 10 of 25 insurance plan rates Aetna First Health — Commercial: $680 America's PPO — Commercial: $620 BCBS MN — Medicaid: $360 BCBS PLUS PMAP PCC PRIME — Medicaid: $360 BCBS WI — Commercial: $608 Cigna — Commercial: $587.20 HealthEOS — Commercial: $688 HealthPartners — Commercial: $587.20 HealthPartners — SHP: $537.60 HealthPartners CARE PMAP — Medicaid: $311.20
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL III VISIT	$800	$513.60	$343.12 – $688
Emergency room visit (moderate): 10 of 13 insurance plan rates Aetna First Health — Commercial: $680 America's PPO — Commercial: $620 BCBS MN — Medicaid: $534.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $534.80 BCBS WI — Commercial: $608 HealthEOS — Commercial: $688 MN BCBS Commercial — BCBS MN: $594.24 Sanford HealthPlan — Commercial: $361.20 Sanford HealthPlan — Commercial-NDPERS: $343.12 Ucare — Commercial: $526.40
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	$190.91 – $1,256.06
Emergency room visit (moderate): 10 of 34 insurance plan rates Advocare/Security Health — Medicare: $291.03 BCBS MN — Medicaid: $190.91 BCBS PLUS PMAP PCC PRIME — Medicaid: $190.91 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $291.03 Freedom Blue PPO — Medicare: $291.03 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $291.03 IMCARE MSHO PCC PRIME — Medicare: $291.03 IMCARE MSHO REF REQ — Medicare: $291.03 Itasca Med Care — Medicaid: $276.89 Medica — Commercial-FI: $1,018
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL IV VISIT	$1,338	$859	$520.48 – $1,150.68
Emergency room visit (moderately high): 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,137.30 America's PPO — Commercial: $1,036.95 BCBS MN — Medicaid: $602.10 BCBS PLUS PMAP PCC PRIME — Medicaid: $602.10 BCBS WI — Commercial: $1,016.88 Cigna — Commercial: $982.09 HealthEOS — Commercial: $1,150.68 HealthPartners — Commercial: $982.09 HealthPartners — SHP: $899.14 HealthPartners CARE PMAP — Medicaid: $520.48
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL IV VISIT	$1,338	$859	$573.87 – $1,150.68
Emergency room visit (moderately high): 10 of 13 insurance plan rates Aetna First Health — Commercial: $1,137.30 America's PPO — Commercial: $1,036.95 BCBS MN — Medicaid: $894.45 BCBS PLUS PMAP PCC PRIME — Medicaid: $894.45 BCBS WI — Commercial: $1,016.88 HealthEOS — Commercial: $1,150.68 MN BCBS Commercial — BCBS MN: $993.87 Sanford HealthPlan — Commercial: $604.11 Sanford HealthPlan — Commercial-NDPERS: $573.87 Ucare — Commercial: $880.40
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	$296.34 – $1,949.77
Emergency room visit (moderately high): 10 of 34 insurance plan rates Advocare/Security Health — Medicare: $447.57 BCBS MN — Medicaid: $296.34 BCBS PLUS PMAP PCC PRIME — Medicaid: $296.34 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $447.57 Freedom Blue PPO — Medicare: $447.57 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $447.57 IMCARE MSHO PCC PRIME — Medicare: $447.57 IMCARE MSHO REF REQ — Medicare: $447.57 Itasca Med Care — Medicaid: $425.82 Medica — Commercial-FI: $1,912
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL V VISIT	$1,863	$1,196.05	$724.71 – $1,602.18
Emergency room visit (high): 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,583.55 America's PPO — Commercial: $1,443.82 BCBS MN — Medicaid: $838.35 BCBS PLUS PMAP PCC PRIME — Medicaid: $838.35 BCBS WI — Commercial: $1,415.88 Cigna — Commercial: $1,367.44 HealthEOS — Commercial: $1,602.18 HealthPartners — Commercial: $1,367.44 HealthPartners — SHP: $1,251.94 HealthPartners CARE PMAP — Medicaid: $724.71
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: FACILITY EMERGENCY LEVEL V VISIT	$1,863	$1,196.05	$799.04 – $1,602.18
Emergency room visit (high): 10 of 13 insurance plan rates Aetna First Health — Commercial: $1,583.55 America's PPO — Commercial: $1,443.82 BCBS MN — Medicaid: $1,245.42 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,245.42 BCBS WI — Commercial: $1,415.88 HealthEOS — Commercial: $1,602.18 MN BCBS Commercial — BCBS MN: $1,383.84 Sanford HealthPlan — Commercial: $841.14 Sanford HealthPlan — Commercial-NDPERS: $799.04 Ucare — Commercial: $1,225.85
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	$429.76 – $2,827.59
Emergency room visit (high): 10 of 34 insurance plan rates Advocare/Security Health — Medicare: $644.42 BCBS MN — Medicaid: $429.76 BCBS PLUS PMAP PCC PRIME — Medicaid: $429.76 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $644.42 Freedom Blue PPO — Medicare: $644.42 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $644.42 IMCARE MSHO PCC PRIME — Medicare: $644.42 IMCARE MSHO REF REQ — Medicare: $644.42 Itasca Med Care — Medicaid: $613.10 Medica — Commercial-FI: $2,479

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	$139	$89.24	$54.07 – $119.54
Basic metabolic panel (blood test): 10 of 25 insurance plan rates Aetna First Health — Commercial: $118.15 America's PPO — Commercial: $107.72 BCBS MN — Medicaid: $62.55 BCBS PLUS PMAP PCC PRIME — Medicaid: $62.55 BCBS WI — Commercial: $105.64 Cigna — Commercial: $102.03 HealthEOS — Commercial: $119.54 HealthPartners — Commercial: $102.03 HealthPartners — SHP: $93.41 HealthPartners CARE PMAP — Medicaid: $54.07
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAB BASIC METABOLIC PANEL	$139	$89.24	$59.62 – $119.54
Basic metabolic panel (blood test): 10 of 13 insurance plan rates Aetna First Health — Commercial: $118.15 America's PPO — Commercial: $107.72 BCBS MN — Medicaid: $92.92 BCBS PLUS PMAP PCC PRIME — Medicaid: $92.92 BCBS WI — Commercial: $105.64 HealthEOS — Commercial: $119.54 MN BCBS Commercial — BCBS MN: $103.25 Sanford HealthPlan — Commercial: $62.76 Sanford HealthPlan — Commercial-NDPERS: $59.62 Ucare — Commercial: $91.46
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 – $28.68
Basic metabolic panel (blood test): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $8.46 BCBS MN — Medicaid: $8.46 BCBS PLUS PMAP PCC PRIME — Medicaid: $8.46 BCBS WI — Commercial: $16.92 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
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL	$255	$163.71	$99.20 – $219.30
Comprehensive metabolic panel (blood test): 10 of 25 insurance plan rates Aetna First Health — Commercial: $216.75 America's PPO — Commercial: $197.62 BCBS MN — Medicaid: $114.75 BCBS PLUS PMAP PCC PRIME — Medicaid: $114.75 BCBS WI — Commercial: $193.80 Cigna — Commercial: $187.17 HealthEOS — Commercial: $219.30 HealthPartners — Commercial: $187.17 HealthPartners — SHP: $171.36 HealthPartners CARE PMAP — Medicaid: $99.20
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPREHENSIVE METABOLIC PANEL	$255	$163.71	$109.37 – $219.30
Comprehensive metabolic panel (blood test): 10 of 13 insurance plan rates Aetna First Health — Commercial: $216.75 America's PPO — Commercial: $197.62 BCBS MN — Medicaid: $170.47 BCBS PLUS PMAP PCC PRIME — Medicaid: $170.47 BCBS WI — Commercial: $193.80 HealthEOS — Commercial: $219.30 MN BCBS Commercial — BCBS MN: $189.41 Sanford HealthPlan — Commercial: $115.13 Sanford HealthPlan — Commercial-NDPERS: $109.37 Ucare — Commercial: $167.79
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 – $35.80
Comprehensive metabolic panel (blood test): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $10.56 BCBS MN — Medicaid: $10.56 BCBS PLUS PMAP PCC PRIME — Medicaid: $10.56 BCBS WI — Commercial: $21.12 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
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 – $162.08
Obstetric blood test panel: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $47.81 BCBS MN — Medicaid: $47.81 BCBS PLUS PMAP PCC PRIME — Medicaid: $47.81 BCBS WI — Commercial: $95.62 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
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PROFILE	$147	$94.37	$57.18 – $126.42
Cholesterol panel (lipid panel): 10 of 25 insurance plan rates Aetna First Health — Commercial: $124.95 America's PPO — Commercial: $113.92 BCBS MN — Medicaid: $66.15 BCBS PLUS PMAP PCC PRIME — Medicaid: $66.15 BCBS WI — Commercial: $111.72 Cigna — Commercial: $107.90 HealthEOS — Commercial: $126.42 HealthPartners — Commercial: $107.90 HealthPartners — SHP: $98.78 HealthPartners CARE PMAP — Medicaid: $57.18
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LIPID PROFILE	$147	$94.37	$63.05 – $126.42
Cholesterol panel (lipid panel): 10 of 13 insurance plan rates Aetna First Health — Commercial: $124.95 America's PPO — Commercial: $113.92 BCBS MN — Medicaid: $98.27 BCBS PLUS PMAP PCC PRIME — Medicaid: $98.27 BCBS WI — Commercial: $111.72 HealthEOS — Commercial: $126.42 MN BCBS Commercial — BCBS MN: $109.19 Sanford HealthPlan — Commercial: $66.37 Sanford HealthPlan — Commercial-NDPERS: $63.05 Ucare — Commercial: $96.73
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 – $45.39
Cholesterol panel (lipid panel): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $13.39 BCBS MN — Medicaid: $13.39 BCBS PLUS PMAP PCC PRIME — Medicaid: $13.39 BCBS WI — Commercial: $26.78 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
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$140	$89.88	$54.46 – $120.40
Kidney function panel: 10 of 25 insurance plan rates Aetna First Health — Commercial: $119 America's PPO — Commercial: $108.50 BCBS MN — Medicaid: $63 BCBS PLUS PMAP PCC PRIME — Medicaid: $63 BCBS WI — Commercial: $106.40 Cigna — Commercial: $102.76 HealthEOS — Commercial: $120.40 HealthPartners — Commercial: $102.76 HealthPartners — SHP: $94.08 HealthPartners CARE PMAP — Medicaid: $54.46
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$140	$89.88	$60.05 – $120.40
Kidney function panel: 10 of 13 insurance plan rates Aetna First Health — Commercial: $119 America's PPO — Commercial: $108.50 BCBS MN — Medicaid: $93.59 BCBS PLUS PMAP PCC PRIME — Medicaid: $93.59 BCBS WI — Commercial: $106.40 HealthEOS — Commercial: $120.40 MN BCBS Commercial — BCBS MN: $103.99 Sanford HealthPlan — Commercial: $63.21 Sanford HealthPlan — Commercial-NDPERS: $60.05 Ucare — Commercial: $92.12
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 – $29.43
Kidney function panel: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $8.68 BCBS MN — Medicaid: $8.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $8.68 BCBS WI — Commercial: $17.36 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
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$170	$109.14	$66.13 – $146.20
Liver function panel: 10 of 25 insurance plan rates Aetna First Health — Commercial: $144.50 America's PPO — Commercial: $131.75 BCBS MN — Medicaid: $76.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $76.50 BCBS WI — Commercial: $129.20 Cigna — Commercial: $124.78 HealthEOS — Commercial: $146.20 HealthPartners — Commercial: $124.78 HealthPartners — SHP: $114.24 HealthPartners CARE PMAP — Medicaid: $66.13
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HEPATIC FUNCTION PANEL	$170	$109.14	$72.91 – $146.20
Liver function panel: 10 of 13 insurance plan rates Aetna First Health — Commercial: $144.50 America's PPO — Commercial: $131.75 BCBS MN — Medicaid: $113.64 BCBS PLUS PMAP PCC PRIME — Medicaid: $113.64 BCBS WI — Commercial: $129.20 HealthEOS — Commercial: $146.20 MN BCBS Commercial — BCBS MN: $126.28 Sanford HealthPlan — Commercial: $76.76 Sanford HealthPlan — Commercial-NDPERS: $72.91 Ucare — Commercial: $111.86
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 – $27.70
Liver function panel: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $8.17 BCBS MN — Medicaid: $8.17 BCBS PLUS PMAP PCC PRIME — Medicaid: $8.17 BCBS WI — Commercial: $16.34 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
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO, W/SCOPE	$53	$34.03	$20.62 – $45.58
Urine test (automated, with microscope): 10 of 25 insurance plan rates Aetna First Health — Commercial: $45.05 America's PPO — Commercial: $41.08 BCBS MN — Medicaid: $23.85 BCBS PLUS PMAP PCC PRIME — Medicaid: $23.85 BCBS WI — Commercial: $40.28 Cigna — Commercial: $38.90 HealthEOS — Commercial: $45.58 HealthPartners — Commercial: $38.90 HealthPartners — SHP: $35.62 HealthPartners CARE PMAP — Medicaid: $20.62
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO, W/SCOPE	$53	$34.03	$22.73 – $45.58
Urine test (automated, with microscope): 10 of 13 insurance plan rates Aetna First Health — Commercial: $45.05 America's PPO — Commercial: $41.08 BCBS MN — Medicaid: $35.43 BCBS PLUS PMAP PCC PRIME — Medicaid: $35.43 BCBS WI — Commercial: $40.28 HealthEOS — Commercial: $45.58 MN BCBS Commercial — BCBS MN: $39.37 Sanford HealthPlan — Commercial: $23.93 Sanford HealthPlan — Commercial-NDPERS: $22.73 Ucare — Commercial: $34.87
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 – $10.75
Urine test (automated, with microscope): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $3.17 BCBS MN — Medicaid: $3.17 BCBS PLUS PMAP PCC PRIME — Medicaid: $3.17 BCBS WI — Commercial: $6.34 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
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	$28	$17.98	$10.89 – $24.08
Urine test (manual, without microscope): 10 of 25 insurance plan rates Aetna First Health — Commercial: $23.80 America's PPO — Commercial: $21.70 BCBS MN — Medicaid: $12.60 BCBS PLUS PMAP PCC PRIME — Medicaid: $12.60 BCBS WI — Commercial: $21.28 Cigna — Commercial: $20.55 HealthEOS — Commercial: $24.08 HealthPartners — Commercial: $20.55 HealthPartners — SHP: $18.82 HealthPartners CARE PMAP — Medicaid: $10.89
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE	$28	$17.98	$12.01 – $24.08
Urine test (manual, without microscope): 10 of 13 insurance plan rates Aetna First Health — Commercial: $23.80 America's PPO — Commercial: $21.70 BCBS MN — Medicaid: $18.72 BCBS PLUS PMAP PCC PRIME — Medicaid: $18.72 BCBS WI — Commercial: $21.28 HealthEOS — Commercial: $24.08 MN BCBS Commercial — BCBS MN: $20.80 Sanford HealthPlan — Commercial: $12.64 Sanford HealthPlan — Commercial-NDPERS: $12.01 Ucare — Commercial: $18.42
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 – $11.80
Urine test (manual, without microscope): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $3.48 BCBS MN — Medicaid: $3.48 BCBS PLUS PMAP PCC PRIME — Medicaid: $3.48 BCBS WI — Commercial: $6.96 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
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO W/O SCOPE	$53	$34.03	$20.62 – $45.58
Urine test (automated, without microscope): 10 of 25 insurance plan rates Aetna First Health — Commercial: $45.05 America's PPO — Commercial: $41.08 BCBS MN — Medicaid: $23.85 BCBS PLUS PMAP PCC PRIME — Medicaid: $23.85 BCBS WI — Commercial: $40.28 Cigna — Commercial: $38.90 HealthEOS — Commercial: $45.58 HealthPartners — Commercial: $38.90 HealthPartners — SHP: $35.62 HealthPartners CARE PMAP — Medicaid: $20.62
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: URINALYSIS, AUTO W/O SCOPE	$53	$34.03	$22.73 – $45.58
Urine test (automated, without microscope): 10 of 13 insurance plan rates Aetna First Health — Commercial: $45.05 America's PPO — Commercial: $41.08 BCBS MN — Medicaid: $35.43 BCBS PLUS PMAP PCC PRIME — Medicaid: $35.43 BCBS WI — Commercial: $40.28 HealthEOS — Commercial: $45.58 MN BCBS Commercial — BCBS MN: $39.37 Sanford HealthPlan — Commercial: $23.93 Sanford HealthPlan — Commercial-NDPERS: $22.73 Ucare — Commercial: $34.87
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/o scope	Not listed in the file	Not listed in the file	$2.25 – $7.63
Urine test (automated, without microscope): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $2.25 BCBS MN — Medicaid: $2.25 BCBS PLUS PMAP PCC PRIME — Medicaid: $2.25 BCBS WI — Commercial: $4.50 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2.25 Freedom Blue PPO — Medicare: $2.25 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $2.25 IMCARE MSHO PCC PRIME — Medicare: $2.25 IMCARE MSHO REF REQ — Medicare: $2.25 Itasca Med Care — Medicaid: $2.25
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAB PSA SCREENING	$115	$73.83	$44.74 – $98.90
PSA (prostate specific antigen) blood test: 10 of 25 insurance plan rates Aetna First Health — Commercial: $97.75 America's PPO — Commercial: $89.12 BCBS MN — Medicaid: $51.75 BCBS PLUS PMAP PCC PRIME — Medicaid: $51.75 BCBS WI — Commercial: $87.40 Cigna — Commercial: $84.41 HealthEOS — Commercial: $98.90 HealthPartners — Commercial: $84.41 HealthPartners — SHP: $77.28 HealthPartners CARE PMAP — Medicaid: $44.74
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL	$162	$104	$63.02 – $139.32
PSA (prostate specific antigen) blood test: 10 of 25 insurance plan rates Aetna First Health — Commercial: $137.70 America's PPO — Commercial: $125.55 BCBS MN — Medicaid: $72.90 BCBS PLUS PMAP PCC PRIME — Medicaid: $72.90 BCBS WI — Commercial: $123.12 Cigna — Commercial: $118.91 HealthEOS — Commercial: $139.32 HealthPartners — Commercial: $118.91 HealthPartners — SHP: $108.86 HealthPartners CARE PMAP — Medicaid: $63.02
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: LAB PSA SCREENING	$115	$73.83	$49.32 – $98.90
PSA (prostate specific antigen) blood test: 10 of 13 insurance plan rates Aetna First Health — Commercial: $97.75 America's PPO — Commercial: $89.12 BCBS MN — Medicaid: $76.88 BCBS PLUS PMAP PCC PRIME — Medicaid: $76.88 BCBS WI — Commercial: $87.40 HealthEOS — Commercial: $98.90 MN BCBS Commercial — BCBS MN: $85.42 Sanford HealthPlan — Commercial: $51.92 Sanford HealthPlan — Commercial-NDPERS: $49.32 Ucare — Commercial: $75.67
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE	$214	$137.39	$83.25 – $184.04
Thyroid stimulating hormone (TSH) test: 10 of 25 insurance plan rates Aetna First Health — Commercial: $181.90 America's PPO — Commercial: $165.85 BCBS MN — Medicaid: $96.30 BCBS PLUS PMAP PCC PRIME — Medicaid: $96.30 BCBS WI — Commercial: $162.64 Cigna — Commercial: $157.08 HealthEOS — Commercial: $184.04 HealthPartners — Commercial: $157.08 HealthPartners — SHP: $143.81 HealthPartners CARE PMAP — Medicaid: $83.25
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: ASSAY THYROID STIM HORMONE	$214	$137.39	$91.78 – $184.04
Thyroid stimulating hormone (TSH) test: 10 of 13 insurance plan rates Aetna First Health — Commercial: $181.90 America's PPO — Commercial: $165.85 BCBS MN — Medicaid: $143.06 BCBS PLUS PMAP PCC PRIME — Medicaid: $143.06 BCBS WI — Commercial: $162.64 HealthEOS — Commercial: $184.04 MN BCBS Commercial — BCBS MN: $158.96 Sanford HealthPlan — Commercial: $96.62 Sanford HealthPlan — Commercial-NDPERS: $91.78 Ucare — Commercial: $140.81
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 – $56.95
Thyroid stimulating hormone (TSH) test: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $16.80 BCBS MN — Medicaid: $16.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $16.80 BCBS WI — Commercial: $33.60 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
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	$170	$109.14	$66.13 – $146.20
Complete blood count (CBC) with differential: 10 of 25 insurance plan rates Aetna First Health — Commercial: $144.50 America's PPO — Commercial: $131.75 BCBS MN — Medicaid: $76.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $76.50 BCBS WI — Commercial: $129.20 Cigna — Commercial: $124.78 HealthEOS — Commercial: $146.20 HealthPartners — Commercial: $124.78 HealthPartners — SHP: $114.24 HealthPartners CARE PMAP — Medicaid: $66.13
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPLETE CBC W/AUTO DIFF WBC	$170	$109.14	$72.91 – $146.20
Complete blood count (CBC) with differential: 10 of 13 insurance plan rates Aetna First Health — Commercial: $144.50 America's PPO — Commercial: $131.75 BCBS MN — Medicaid: $113.64 BCBS PLUS PMAP PCC PRIME — Medicaid: $113.64 BCBS WI — Commercial: $129.20 HealthEOS — Commercial: $146.20 MN BCBS Commercial — BCBS MN: $126.28 Sanford HealthPlan — Commercial: $76.76 Sanford HealthPlan — Commercial-NDPERS: $72.91 Ucare — Commercial: $111.86
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 – $26.34
Complete blood count (CBC) with differential: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $7.77 BCBS MN — Medicaid: $7.77 BCBS PLUS PMAP PCC PRIME — Medicaid: $7.77 BCBS WI — Commercial: $15.54 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
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED	$101	$64.84	$39.29 – $86.86
Complete blood count (CBC), automated: 10 of 25 insurance plan rates Aetna First Health — Commercial: $85.85 America's PPO — Commercial: $78.28 BCBS MN — Medicaid: $45.45 BCBS PLUS PMAP PCC PRIME — Medicaid: $45.45 BCBS WI — Commercial: $76.76 Cigna — Commercial: $74.13 HealthEOS — Commercial: $86.86 HealthPartners — Commercial: $74.13 HealthPartners — SHP: $67.87 HealthPartners CARE PMAP — Medicaid: $39.29
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COMPLETE CBC AUTOMATED	$101	$64.84	$43.32 – $86.86
Complete blood count (CBC), automated: 10 of 13 insurance plan rates Aetna First Health — Commercial: $85.85 America's PPO — Commercial: $78.28 BCBS MN — Medicaid: $67.52 BCBS PLUS PMAP PCC PRIME — Medicaid: $67.52 BCBS WI — Commercial: $76.76 HealthEOS — Commercial: $86.86 MN BCBS Commercial — BCBS MN: $75.02 Sanford HealthPlan — Commercial: $45.60 Sanford HealthPlan — Commercial-NDPERS: $43.32 Ucare — Commercial: $66.46
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 – $21.93
Complete blood count (CBC), automated: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $6.47 BCBS MN — Medicaid: $6.47 BCBS PLUS PMAP PCC PRIME — Medicaid: $6.47 BCBS WI — Commercial: $12.94 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
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME (PT/INR)	$65	$41.73	$25.28 – $55.90
Blood clotting time test (prothrombin time, PT): 10 of 25 insurance plan rates Aetna First Health — Commercial: $55.25 America's PPO — Commercial: $50.38 BCBS MN — Medicaid: $29.25 BCBS PLUS PMAP PCC PRIME — Medicaid: $29.25 BCBS WI — Commercial: $49.40 Cigna — Commercial: $47.71 HealthEOS — Commercial: $55.90 HealthPartners — Commercial: $47.71 HealthPartners — SHP: $43.68 HealthPartners CARE PMAP — Medicaid: $25.28
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PROTHROMBIN TIME (PT/INR)	$65	$41.73	$27.88 – $55.90
Blood clotting time test (prothrombin time, PT): 10 of 13 insurance plan rates Aetna First Health — Commercial: $55.25 America's PPO — Commercial: $50.38 BCBS MN — Medicaid: $43.45 BCBS PLUS PMAP PCC PRIME — Medicaid: $43.45 BCBS WI — Commercial: $49.40 HealthEOS — Commercial: $55.90 MN BCBS Commercial — BCBS MN: $48.28 Sanford HealthPlan — Commercial: $29.35 Sanford HealthPlan — Commercial-NDPERS: $27.88 Ucare — Commercial: $42.77
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin time	Not listed in the file	Not listed in the file	$4.29 – $14.54
Blood clotting time test (prothrombin time, PT): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $4.29 BCBS MN — Medicaid: $4.29 BCBS PLUS PMAP PCC PRIME — Medicaid: $4.29 BCBS WI — Commercial: $8.58 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $4.29 Freedom Blue PPO — Medicare: $4.29 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $4.29 IMCARE MSHO PCC PRIME — Medicare: $4.29 IMCARE MSHO REF REQ — Medicare: $4.29 Itasca Med Care — Medicaid: $4.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL	$103	$66.13	$40.07 – $88.58
Blood clotting test (partial thromboplastin time, PTT): 10 of 25 insurance plan rates Aetna First Health — Commercial: $87.55 America's PPO — Commercial: $79.82 BCBS MN — Medicaid: $46.35 BCBS PLUS PMAP PCC PRIME — Medicaid: $46.35 BCBS WI — Commercial: $78.28 Cigna — Commercial: $75.60 HealthEOS — Commercial: $88.58 HealthPartners — Commercial: $75.60 HealthPartners — SHP: $69.22 HealthPartners CARE PMAP — Medicaid: $40.07
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THROMBOPLASTIN TIME PARTIAL	$103	$66.13	$44.18 – $88.58
Blood clotting test (partial thromboplastin time, PTT): 10 of 13 insurance plan rates Aetna First Health — Commercial: $87.55 America's PPO — Commercial: $79.82 BCBS MN — Medicaid: $68.86 BCBS PLUS PMAP PCC PRIME — Medicaid: $68.86 BCBS WI — Commercial: $78.28 HealthEOS — Commercial: $88.58 MN BCBS Commercial — BCBS MN: $76.51 Sanford HealthPlan — Commercial: $46.50 Sanford HealthPlan — Commercial-NDPERS: $44.18 Ucare — Commercial: $67.77
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 – $20.37
Blood clotting test (partial thromboplastin time, PTT): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $6.01 BCBS MN — Medicaid: $6.01 BCBS PLUS PMAP PCC PRIME — Medicaid: $6.01 BCBS WI — Commercial: $12.02 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

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	Not listed in the file	Not listed in the file	$73.57 – $484.03
CT scan of the head or brain, without contrast: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $111.77 BCBS MN — Medicaid: $73.57 BCBS PLUS PMAP PCC PRIME — Medicaid: $73.57 BCBS WI — Commercial: $212.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $111.77 Freedom Blue PPO — Medicare: $111.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $111.77 IMCARE MSHO PCC PRIME — Medicare: $111.77 IMCARE MSHO REF REQ — Medicare: $111.77 Itasca Med Care — Medicaid: $106.34
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT HEAD/BRAIN W/O DYE	$1,811	$1,162.66	$704.48 – $1,557.46
CT scan of the head or brain, without contrast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,539.35 America's PPO — Commercial: $1,403.52 BCBS MN — Medicaid: $814.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $814.95 BCBS WI — Commercial: $1,376.36 Cigna — Commercial: $1,329.27 HealthEOS — Commercial: $1,557.46 HealthPartners — Commercial: $1,329.27 HealthPartners — SHP: $1,216.99 HealthPartners CARE PMAP — Medicaid: $704.48
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT HEAD/BRAIN W/O DYE	$1,811	$1,162.66	$776.74 – $1,557.46
CT scan of the head or brain, without contrast: 10 of 13 insurance plan rates Aetna First Health — Commercial: $1,539.35 America's PPO — Commercial: $1,403.52 BCBS MN — Medicaid: $1,210.65 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,210.65 BCBS WI — Commercial: $1,376.36 HealthEOS — Commercial: $1,557.46 MN BCBS Commercial — BCBS MN: $1,345.21 Sanford HealthPlan — Commercial: $817.67 Sanford HealthPlan — Commercial-NDPERS: $776.74 Ucare — Commercial: $1,191.64
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	$257.31 – $1,692.97
MRI of the brain, before and after contrast: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $375.37 BCBS MN — Medicaid: $257.31 BCBS PLUS PMAP PCC PRIME — Medicaid: $257.31 BCBS WI — Commercial: $714.26 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $375.37 Freedom Blue PPO — Medicare: $375.37 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $375.37 IMCARE MSHO PCC PRIME — Medicare: $375.37 IMCARE MSHO REF REQ — Medicare: $375.37 Itasca Med Care — Medicaid: $357.13
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN W & WO CONTRAST	$4,150	$2,664.30	$1,614.35 – $3,569
MRI of the brain, before and after contrast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $3,527.50 America's PPO — Commercial: $3,216.25 BCBS MN — Medicaid: $1,867.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,867.50 BCBS WI — Commercial: $3,154 Cigna — Commercial: $3,046.10 HealthEOS — Commercial: $3,569 HealthPartners — Commercial: $3,046.10 HealthPartners — SHP: $2,788.80 HealthPartners CARE PMAP — Medicaid: $1,614.35
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN W & WO CONTRAST	$4,150	$2,664.30	$1,779.94 – $3,569
MRI of the brain, before and after contrast: 10 of 13 insurance plan rates Aetna First Health — Commercial: $3,527.50 America's PPO — Commercial: $3,216.25 BCBS MN — Medicaid: $2,774.28 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,774.28 BCBS WI — Commercial: $3,154 HealthEOS — Commercial: $3,569 MN BCBS Commercial — BCBS MN: $3,082.62 Sanford HealthPlan — Commercial: $1,873.72 Sanford HealthPlan — Commercial-NDPERS: $1,779.94 Ucare — Commercial: $2,730.70
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	$60.80 – $400.03
Chest X-ray, 2 views: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $92.54 BCBS MN — Medicaid: $60.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $60.80 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $92.54 Freedom Blue PPO — Medicare: $92.54 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $92.54 IMCARE MSHO PCC PRIME — Medicare: $92.54 IMCARE MSHO REF REQ — Medicare: $92.54 Itasca Med Care — Medicaid: $88.05 MEDICA ADVANTAGE SOLUTIONS — Medicare: $92.54
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS	$385	$247.17	$149.77 – $331.10
Chest X-ray, 2 views: 10 of 25 insurance plan rates Aetna First Health — Commercial: $327.25 America's PPO — Commercial: $298.38 BCBS MN — Medicaid: $173.25 BCBS PLUS PMAP PCC PRIME — Medicaid: $173.25 BCBS WI — Commercial: $292.60 Cigna — Commercial: $282.59 HealthEOS — Commercial: $331.10 HealthPartners — Commercial: $282.59 HealthPartners — SHP: $258.72 HealthPartners CARE PMAP — Medicaid: $149.77
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS	$385	$247.17	$165.13 – $331.10
Chest X-ray, 2 views: 10 of 13 insurance plan rates Aetna First Health — Commercial: $327.25 America's PPO — Commercial: $298.38 BCBS MN — Medicaid: $257.37 BCBS PLUS PMAP PCC PRIME — Medicaid: $257.37 BCBS WI — Commercial: $292.60 HealthEOS — Commercial: $331.10 MN BCBS Commercial — BCBS MN: $285.98 Sanford HealthPlan — Commercial: $173.83 Sanford HealthPlan — Commercial-NDPERS: $165.13 Ucare — Commercial: $253.33
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	$73.57 – $484.03
X-ray of the lower spine, at least 4 views: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $111.77 BCBS MN — Medicaid: $73.57 BCBS PLUS PMAP PCC PRIME — Medicaid: $73.57 BCBS WI — Commercial: $212.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $111.77 Freedom Blue PPO — Medicare: $111.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $111.77 IMCARE MSHO PCC PRIME — Medicare: $111.77 IMCARE MSHO REF REQ — Medicare: $111.77 Itasca Med Care — Medicaid: $106.34
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: XRAY LUMBOSACRAL MINIMUM 4 VWS	$294	$188.75	$114.37 – $252.84
X-ray of the lower spine, at least 4 views: 10 of 25 insurance plan rates Aetna First Health — Commercial: $249.90 America's PPO — Commercial: $227.85 BCBS MN — Medicaid: $132.30 BCBS PLUS PMAP PCC PRIME — Medicaid: $132.30 BCBS WI — Commercial: $223.44 Cigna — Commercial: $215.80 HealthEOS — Commercial: $252.84 HealthPartners — Commercial: $215.80 HealthPartners — SHP: $197.57 HealthPartners CARE PMAP — Medicaid: $114.37
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	$163.95 – $1,078.69
MRI of the lower back (lumbar spine), without contrast: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $254.07 BCBS MN — Medicaid: $163.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $163.95 BCBS WI — Commercial: $483.44 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $254.07 Freedom Blue PPO — Medicare: $254.07 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $254.07 IMCARE MSHO PCC PRIME — Medicare: $254.07 IMCARE MSHO REF REQ — Medicare: $254.07 Itasca Med Care — Medicaid: $241.72
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI L SPINE WO CONTRAST	$2,886	$1,852.81	$1,122.65 – $2,481.96
MRI of the lower back (lumbar spine), without contrast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,453.10 America's PPO — Commercial: $2,236.65 BCBS MN — Medicaid: $1,298.70 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,298.70 BCBS WI — Commercial: $2,193.36 Cigna — Commercial: $2,118.32 HealthEOS — Commercial: $2,481.96 HealthPartners — Commercial: $2,118.32 HealthPartners — SHP: $1,939.39 HealthPartners CARE PMAP — Medicaid: $1,122.65
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI L SPINE WO CONTRAST	$2,886	$1,852.81	$1,237.81 – $2,481.96
MRI of the lower back (lumbar spine), without contrast: 10 of 13 insurance plan rates Aetna First Health — Commercial: $2,453.10 America's PPO — Commercial: $2,236.65 BCBS MN — Medicaid: $1,929.29 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,929.29 BCBS WI — Commercial: $2,193.36 HealthEOS — Commercial: $2,481.96 MN BCBS Commercial — BCBS MN: $2,143.72 Sanford HealthPlan — Commercial: $1,303.03 Sanford HealthPlan — Commercial-NDPERS: $1,237.81 Ucare — Commercial: $1,898.99
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	$122.93 – $808.82
CT scan of the pelvis, with contrast: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $187.11 BCBS MN — Medicaid: $122.93 BCBS PLUS PMAP PCC PRIME — Medicaid: $122.93 BCBS WI — Commercial: $356.04 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $187.11 Freedom Blue PPO — Medicare: $187.11 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $187.11 IMCARE MSHO PCC PRIME — Medicare: $187.11 IMCARE MSHO REF REQ — Medicare: $187.11 Itasca Med Care — Medicaid: $178.02
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W/DYE	$1,966	$1,262.17	$764.77 – $1,690.76
CT scan of the pelvis, with contrast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,671.10 America's PPO — Commercial: $1,523.65 BCBS MN — Medicaid: $884.70 BCBS PLUS PMAP PCC PRIME — Medicaid: $884.70 BCBS WI — Commercial: $1,494.16 Cigna — Commercial: $1,443.04 HealthEOS — Commercial: $1,690.76 HealthPartners — Commercial: $1,443.04 HealthPartners — SHP: $1,321.15 HealthPartners CARE PMAP — Medicaid: $764.77
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT PELVIS W/DYE	$1,966	$1,262.17	$843.22 – $1,690.76
CT scan of the pelvis, with contrast: 10 of 13 insurance plan rates Aetna First Health — Commercial: $1,671.10 America's PPO — Commercial: $1,523.65 BCBS MN — Medicaid: $1,314.27 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,314.27 BCBS WI — Commercial: $1,494.16 HealthEOS — Commercial: $1,690.76 MN BCBS Commercial — BCBS MN: $1,460.34 Sanford HealthPlan — Commercial: $887.65 Sanford HealthPlan — Commercial-NDPERS: $843.22 Ucare — Commercial: $1,293.63
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	$163.95 – $1,078.69
MRI of a leg joint (such as the knee), without contrast: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $254.07 BCBS MN — Medicaid: $163.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $163.95 BCBS WI — Commercial: $483.44 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $254.07 Freedom Blue PPO — Medicare: $254.07 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $254.07 IMCARE MSHO PCC PRIME — Medicare: $254.07 IMCARE MSHO REF REQ — Medicare: $254.07 Itasca Med Care — Medicaid: $241.72
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI LOW EXT JNT WO/CONT TC	$3,009	$1,931.78	$1,170.50 – $2,587.74
MRI of a leg joint (such as the knee), without contrast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,557.65 America's PPO — Commercial: $2,331.98 BCBS MN — Medicaid: $1,354.05 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,354.05 BCBS WI — Commercial: $2,286.84 Cigna — Commercial: $2,208.61 HealthEOS — Commercial: $2,587.74 HealthPartners — Commercial: $2,208.61 HealthPartners — SHP: $2,022.05 HealthPartners CARE PMAP — Medicaid: $1,170.50
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: MRI LOW EXT JNT WO/CONT TC	$3,009	$1,931.78	$1,290.56 – $2,587.74
MRI of a leg joint (such as the knee), without contrast: 10 of 13 insurance plan rates Aetna First Health — Commercial: $2,557.65 America's PPO — Commercial: $2,331.98 BCBS MN — Medicaid: $2,011.52 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,011.52 BCBS WI — Commercial: $2,286.84 HealthEOS — Commercial: $2,587.74 MN BCBS Commercial — BCBS MN: $2,235.09 Sanford HealthPlan — Commercial: $1,358.56 Sanford HealthPlan — Commercial-NDPERS: $1,290.56 Ucare — Commercial: $1,979.92
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	$257.31 – $1,692.97
CT scan of the abdomen and pelvis, with contrast: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $375.37 BCBS MN — Medicaid: $257.31 BCBS PLUS PMAP PCC PRIME — Medicaid: $257.31 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $375.37 Freedom Blue PPO — Medicare: $375.37 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $375.37 IMCARE MSHO PCC PRIME — Medicare: $375.37 IMCARE MSHO REF REQ — Medicare: $375.37 Itasca Med Care — Medicaid: $357.13 MEDICA ADVANTAGE SOLUTIONS — Medicare: $375.37
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT ABDOMEN&PELVIS W/CONTRAST	$3,907	$2,508.29	$1,519.82 – $3,360.02
CT scan of the abdomen and pelvis, with contrast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $3,320.95 America's PPO — Commercial: $3,027.92 BCBS MN — Medicaid: $1,758.15 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,758.15 BCBS WI — Commercial: $2,969.32 Cigna — Commercial: $2,867.74 HealthEOS — Commercial: $3,360.02 HealthPartners — Commercial: $2,867.74 HealthPartners — SHP: $2,625.50 HealthPartners CARE PMAP — Medicaid: $1,519.82
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: CT ABDOMEN&PELVIS W/CONTRAST	$3,907	$2,508.29	$1,675.71 – $3,360.02
CT scan of the abdomen and pelvis, with contrast: 10 of 13 insurance plan rates Aetna First Health — Commercial: $3,320.95 America's PPO — Commercial: $3,027.92 BCBS MN — Medicaid: $2,611.83 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,611.83 BCBS WI — Commercial: $2,969.32 HealthEOS — Commercial: $3,360.02 MN BCBS Commercial — BCBS MN: $2,902.12 Sanford HealthPlan — Commercial: $1,764.01 Sanford HealthPlan — Commercial-NDPERS: $1,675.71 Ucare — Commercial: $2,570.81
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	$73.57 – $484.03
Ultrasound of the abdomen, complete: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $111.77 BCBS MN — Medicaid: $73.57 BCBS PLUS PMAP PCC PRIME — Medicaid: $73.57 BCBS WI — Commercial: $212.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $111.77 Freedom Blue PPO — Medicare: $111.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $111.77 IMCARE MSHO PCC PRIME — Medicare: $111.77 IMCARE MSHO REF REQ — Medicare: $111.77 Itasca Med Care — Medicaid: $106.34
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US ABDOMEN TC	$976	$626.59	$379.66 – $839.36
Ultrasound of the abdomen, complete: 10 of 25 insurance plan rates Aetna First Health — Commercial: $829.60 America's PPO — Commercial: $756.40 BCBS MN — Medicaid: $439.20 BCBS PLUS PMAP PCC PRIME — Medicaid: $439.20 BCBS WI — Commercial: $741.76 Cigna — Commercial: $716.38 HealthEOS — Commercial: $839.36 HealthPartners — Commercial: $716.38 HealthPartners — SHP: $655.87 HealthPartners CARE PMAP — Medicaid: $379.66
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	$73.57 – $484.03
Pregnancy ultrasound (after the first trimester): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $111.77 BCBS MN — Medicaid: $73.57 BCBS PLUS PMAP PCC PRIME — Medicaid: $73.57 BCBS WI — Commercial: $212.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $111.77 Freedom Blue PPO — Medicare: $111.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $111.77 IMCARE MSHO PCC PRIME — Medicare: $111.77 IMCARE MSHO REF REQ — Medicare: $111.77 Itasca Med Care — Medicaid: $106.34
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US,PREG. UTERUS,FETAL/MAT.EVAL.,>1ST TRIM.(>/= 14 WKS 0 DYS),TRANSABD;SINGLE/FIRST GEST., TECH	$766	$491.77	$297.97 – $658.76
Pregnancy ultrasound (after the first trimester): 10 of 25 insurance plan rates Aetna First Health — Commercial: $651.10 America's PPO — Commercial: $593.65 BCBS MN — Medicaid: $344.70 BCBS PLUS PMAP PCC PRIME — Medicaid: $344.70 BCBS WI — Commercial: $582.16 Cigna — Commercial: $562.24 HealthEOS — Commercial: $658.76 HealthPartners — Commercial: $562.24 HealthPartners — SHP: $514.75 HealthPartners CARE PMAP — Medicaid: $297.97
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	$73.57 – $484.03
Transvaginal ultrasound: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $111.77 BCBS MN — Medicaid: $73.57 BCBS PLUS PMAP PCC PRIME — Medicaid: $73.57 BCBS WI — Commercial: $212.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $111.77 Freedom Blue PPO — Medicare: $111.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $111.77 IMCARE MSHO PCC PRIME — Medicare: $111.77 IMCARE MSHO REF REQ — Medicare: $111.77 Itasca Med Care — Medicaid: $106.34
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US TRANSVAGINAL TC	$606	$389.05	$235.73 – $521.16
Transvaginal ultrasound: 10 of 25 insurance plan rates Aetna First Health — Commercial: $515.10 America's PPO — Commercial: $469.65 BCBS MN — Medicaid: $272.70 BCBS PLUS PMAP PCC PRIME — Medicaid: $272.70 BCBS WI — Commercial: $460.56 Cigna — Commercial: $444.80 HealthEOS — Commercial: $521.16 HealthPartners — Commercial: $444.80 HealthPartners — SHP: $407.23 HealthPartners CARE PMAP — Medicaid: $235.73
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee · modifier TC In the file: US TRANSVAGINAL TC	$606	$389.05	$259.91 – $521.16
Transvaginal ultrasound: 10 of 13 insurance plan rates Aetna First Health — Commercial: $515.10 America's PPO — Commercial: $469.65 BCBS MN — Medicaid: $405.11 BCBS PLUS PMAP PCC PRIME — Medicaid: $405.11 BCBS WI — Commercial: $460.56 HealthEOS — Commercial: $521.16 MN BCBS Commercial — BCBS MN: $450.14 Sanford HealthPlan — Commercial: $273.61 Sanford HealthPlan — Commercial-NDPERS: $259.91 Ucare — Commercial: $398.75
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 – $256.31
Diagnostic mammogram, one breast: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $122.93 BCBS MN — Medicaid: $247.18 BCBS PLUS PMAP PCC PRIME — Medicaid: $247.18 BCBS WI — Commercial: $208 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $122.93 Freedom Blue PPO — Medicare: $122.93 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $122.93 IMCARE MSHO PCC PRIME — Medicare: $122.93 IMCARE MSHO REF REQ — Medicare: $122.93 Itasca Med Care — Medicaid: $86.73
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF	$443	$284.41	$172.33 – $380.98
Diagnostic mammogram, one breast: 10 of 25 insurance plan rates Aetna First Health — Commercial: $376.55 America's PPO — Commercial: $343.32 BCBS MN — Medicaid: $199.35 BCBS PLUS PMAP PCC PRIME — Medicaid: $199.35 BCBS WI — Commercial: $336.68 Cigna — Commercial: $325.16 HealthEOS — Commercial: $380.98 HealthPartners — Commercial: $325.16 HealthPartners — SHP: $297.70 HealthPartners CARE PMAP — Medicaid: $172.33
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 – $323.74
Diagnostic mammogram, both breasts: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $155.27 BCBS MN — Medicaid: $312.92 BCBS PLUS PMAP PCC PRIME — Medicaid: $312.92 BCBS WI — Commercial: $208 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $155.27 Freedom Blue PPO — Medicare: $155.27 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $155.27 IMCARE MSHO PCC PRIME — Medicare: $155.27 IMCARE MSHO REF REQ — Medicare: $155.27 Itasca Med Care — Medicaid: $110.60
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF	$464	$297.89	$180.50 – $399.04
Diagnostic mammogram, both breasts: 10 of 25 insurance plan rates Aetna First Health — Commercial: $394.40 America's PPO — Commercial: $359.60 BCBS MN — Medicaid: $208.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $208.80 BCBS WI — Commercial: $352.64 Cigna — Commercial: $340.58 HealthEOS — Commercial: $399.04 HealthPartners — Commercial: $340.58 HealthPartners — SHP: $311.81 HealthPartners CARE PMAP — Medicaid: $180.50
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 – $262.42
Screening mammogram, both breasts: 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $125.86 BCBS MN — Medicaid: $252.44 BCBS PLUS PMAP PCC PRIME — Medicaid: $252.44 BCBS WI — Commercial: $208 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $125.86 Freedom Blue PPO — Medicare: $125.86 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $125.86 IMCARE MSHO PCC PRIME — Medicare: $125.86 IMCARE MSHO REF REQ — Medicare: $125.86 Itasca Med Care — Medicaid: $91.61
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF	$450	$288.90	$175.05 – $387
Screening mammogram, both breasts: 10 of 25 insurance plan rates Aetna First Health — Commercial: $382.50 America's PPO — Commercial: $348.75 BCBS MN — Medicaid: $202.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $202.50 BCBS WI — Commercial: $342 Cigna — Commercial: $330.30 HealthEOS — Commercial: $387 HealthPartners — Commercial: $330.30 HealthPartners — SHP: $302.40 HealthPartners CARE PMAP — Medicaid: $175.05

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$25.01
Electrocardiogram (ECG/EKG) with reading: rates for 3 insurance plans BCBS MN — Medicaid: $25.01 BCBS PLUS PMAP PCC PRIME — Medicaid: $25.01 MN BCBS Commercial — BCBS MN: $25.01
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	$2,180.23 – $14,344.79
Left heart catheterization (diagnostic): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $3,380.71 BCBS MN — Medicaid: $2,180.23 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,180.23 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $3,380.71 Freedom Blue PPO — Medicare: $3,380.71 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $3,380.71 IMCARE MSHO PCC PRIME — Medicare: $3,380.71 IMCARE MSHO REF REQ — Medicare: $3,380.71 Itasca Med Care — Medicaid: $3,216.42 MEDICA ADVANTAGE SOLUTIONS — Medicare: $3,380.71
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	$4,996.80 – $32,876.30
Heart rhythm study (electrophysiology evaluation): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $7,975.70 BCBS MN — Medicaid: $4,996.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $4,996.80 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $7,975.70 Freedom Blue PPO — Medicare: $7,975.70 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $7,975.70 IMCARE MSHO PCC PRIME — Medicare: $7,975.70 IMCARE MSHO REF REQ — Medicare: $7,975.70 Itasca Med Care — Medicaid: $7,588.10 MEDICA ADVANTAGE SOLUTIONS — Medicare: $7,975.70
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	$15,890.90 – $104,553.72
Heart rhythm study with ablation for atrial fibrillation: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $25,785.40 BCBS MN — Medicaid: $15,890.90 BCBS PLUS PMAP PCC PRIME — Medicaid: $15,890.90 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $25,785.40 Freedom Blue PPO — Medicare: $25,785.40 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $25,785.40 IMCARE MSHO PCC PRIME — Medicare: $25,785.40 IMCARE MSHO REF REQ — Medicare: $25,785.40 Itasca Med Care — Medicaid: $24,532.30 MEDICA ADVANTAGE SOLUTIONS — Medicare: $25,785.40
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	$699.55 – $4,602.67
Sleep study (overnight, in a sleep lab): 10 of 29 insurance plan rates Advocare/Security Health — Medicare: $1,069.36 BCBS MN — Medicaid: $699.55 BCBS PLUS PMAP PCC PRIME — Medicaid: $699.55 BCBS WI — Commercial: $2,793 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,069.36 Freedom Blue PPO — Medicare: $1,069.36 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $1,069.36 IMCARE MSHO PCC PRIME — Medicare: $1,069.36 IMCARE MSHO REF REQ — Medicare: $1,069.36 Itasca Med Care — Medicaid: $1,017.39
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: POLYSOMNOGRAPHY, 4 OR MORE	$3,922	$2,517.92	$1,525.66 – $3,372.92
Sleep study (overnight, in a sleep lab): 10 of 25 insurance plan rates Aetna First Health — Commercial: $3,333.70 America's PPO — Commercial: $3,039.55 BCBS MN — Medicaid: $1,764.90 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,764.90 BCBS WI — Commercial: $2,980.72 Cigna — Commercial: $2,878.75 HealthEOS — Commercial: $3,372.92 HealthPartners — Commercial: $2,878.75 HealthPartners — SHP: $2,635.58 HealthPartners CARE PMAP — Medicaid: $1,525.66

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	$87.95	$53.29 – $117.82
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 25 insurance plan rates Aetna First Health — Commercial: $116.45 America's PPO — Commercial: $106.18 BCBS MN — Medicaid: $61.65 BCBS PLUS PMAP PCC PRIME — Medicaid: $61.65 BCBS WI — Commercial: $104.12 Cigna — Commercial: $100.56 HealthEOS — Commercial: $117.82 HealthPartners — Commercial: $100.56 HealthPartners — SHP: $92.06 HealthPartners CARE PMAP — Medicaid: $53.29
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: THERAPEUTIC EXERCISES	$137	$87.95	$58.76 – $117.82
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 13 insurance plan rates Aetna First Health — Commercial: $116.45 America's PPO — Commercial: $106.18 BCBS MN — Medicaid: $91.58 BCBS PLUS PMAP PCC PRIME — Medicaid: $91.58 BCBS WI — Commercial: $104.12 HealthEOS — Commercial: $117.82 MN BCBS Commercial — BCBS MN: $101.76 Sanford HealthPlan — Commercial: $61.86 Sanford HealthPlan — Commercial-NDPERS: $58.76 Ucare — Commercial: $90.15
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 – $60.28
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $28.91 BCBS MN — Medicaid: $38.66 BCBS PLUS PMAP PCC PRIME — Medicaid: $38.66 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $28.91 Freedom Blue PPO — Medicare: $28.91 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $28.91 IMCARE MSHO PCC PRIME — Medicare: $28.91 IMCARE MSHO REF REQ — Medicare: $28.91 Itasca Med Care — Medicaid: $28.85 MEDICA ADVANTAGE SOLUTIONS — Medicare: $28.91
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEX	$228	$146.38	$88.69 – $196.08
Physical therapy evaluation (low complexity): 10 of 25 insurance plan rates Aetna First Health — Commercial: $193.80 America's PPO — Commercial: $176.70 BCBS MN — Medicaid: $102.60 BCBS PLUS PMAP PCC PRIME — Medicaid: $102.60 BCBS WI — Commercial: $173.28 Cigna — Commercial: $167.35 HealthEOS — Commercial: $196.08 HealthPartners — Commercial: $167.35 HealthPartners — SHP: $153.22 HealthPartners CARE PMAP — Medicaid: $88.69
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION LOW COMPLEX	$228	$146.38	$97.79 – $196.08
Physical therapy evaluation (low complexity): 10 of 13 insurance plan rates Aetna First Health — Commercial: $193.80 America's PPO — Commercial: $176.70 BCBS MN — Medicaid: $152.42 BCBS PLUS PMAP PCC PRIME — Medicaid: $152.42 BCBS WI — Commercial: $173.28 HealthEOS — Commercial: $196.08 MN BCBS Commercial — BCBS MN: $169.36 Sanford HealthPlan — Commercial: $102.94 Sanford HealthPlan — Commercial-NDPERS: $97.79 Ucare — Commercial: $150.02
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 – $204.91
Physical therapy evaluation (low complexity): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $98.28 BCBS MN — Medicaid: $132.23 BCBS PLUS PMAP PCC PRIME — Medicaid: $132.23 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $98.28 Freedom Blue PPO — Medicare: $98.28 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $98.28 IMCARE MSHO PCC PRIME — Medicare: $98.28 IMCARE MSHO REF REQ — Medicare: $98.28 Itasca Med Care — Medicaid: $98.08 MEDICA ADVANTAGE SOLUTIONS — Medicare: $98.28
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MOD COMPLEX	$249	$159.86	$96.86 – $214.14
Physical therapy evaluation (moderate complexity): 10 of 25 insurance plan rates Aetna First Health — Commercial: $211.65 America's PPO — Commercial: $192.98 BCBS MN — Medicaid: $112.05 BCBS PLUS PMAP PCC PRIME — Medicaid: $112.05 BCBS WI — Commercial: $189.24 Cigna — Commercial: $182.77 HealthEOS — Commercial: $214.14 HealthPartners — Commercial: $182.77 HealthPartners — SHP: $167.33 HealthPartners CARE PMAP — Medicaid: $96.86
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION MOD COMPLEX	$249	$159.86	$106.80 – $214.14
Physical therapy evaluation (moderate complexity): 10 of 13 insurance plan rates Aetna First Health — Commercial: $211.65 America's PPO — Commercial: $192.98 BCBS MN — Medicaid: $166.46 BCBS PLUS PMAP PCC PRIME — Medicaid: $166.46 BCBS WI — Commercial: $189.24 HealthEOS — Commercial: $214.14 MN BCBS Commercial — BCBS MN: $184.96 Sanford HealthPlan — Commercial: $112.42 Sanford HealthPlan — Commercial-NDPERS: $106.80 Ucare — Commercial: $163.84
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 – $204.91
Physical therapy evaluation (moderate complexity): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $98.28 BCBS MN — Medicaid: $132.23 BCBS PLUS PMAP PCC PRIME — Medicaid: $132.23 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $98.28 Freedom Blue PPO — Medicare: $98.28 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $98.28 IMCARE MSHO PCC PRIME — Medicare: $98.28 IMCARE MSHO REF REQ — Medicare: $98.28 Itasca Med Care — Medicaid: $98.08 MEDICA ADVANTAGE SOLUTIONS — Medicare: $98.28
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEX	$271	$173.98	$105.42 – $233.06
Physical therapy evaluation (high complexity): 10 of 25 insurance plan rates Aetna First Health — Commercial: $230.35 America's PPO — Commercial: $210.02 BCBS MN — Medicaid: $121.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $121.95 BCBS WI — Commercial: $205.96 Cigna — Commercial: $198.91 HealthEOS — Commercial: $233.06 HealthPartners — Commercial: $198.91 HealthPartners — SHP: $182.11 HealthPartners CARE PMAP — Medicaid: $105.42
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: PHYSICAL THERAPY EVALUATION HIGH COMPLEX	$271	$173.98	$116.23 – $233.06
Physical therapy evaluation (high complexity): 10 of 13 insurance plan rates Aetna First Health — Commercial: $230.35 America's PPO — Commercial: $210.02 BCBS MN — Medicaid: $181.16 BCBS PLUS PMAP PCC PRIME — Medicaid: $181.16 BCBS WI — Commercial: $205.96 HealthEOS — Commercial: $233.06 MN BCBS Commercial — BCBS MN: $201.30 Sanford HealthPlan — Commercial: $122.36 Sanford HealthPlan — Commercial-NDPERS: $116.23 Ucare — Commercial: $178.32
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 – $204.91
Physical therapy evaluation (high complexity): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $98.28 BCBS MN — Medicaid: $132.23 BCBS PLUS PMAP PCC PRIME — Medicaid: $132.23 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $98.28 Freedom Blue PPO — Medicare: $98.28 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $98.28 IMCARE MSHO PCC PRIME — Medicare: $98.28 IMCARE MSHO REF REQ — Medicare: $98.28 Itasca Med Care — Medicaid: $98.08 MEDICA ADVANTAGE SOLUTIONS — Medicare: $98.28
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	$106.68 – $701.88
Psychotherapy, 30 minutes: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $168.88 BCBS MN — Medicaid: $106.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $106.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $168.88 Freedom Blue PPO — Medicare: $168.88 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $168.88 IMCARE MSHO PCC PRIME — Medicare: $168.88 IMCARE MSHO REF REQ — Medicare: $168.88 Itasca Med Care — Medicaid: $160.67 MEDICA ADVANTAGE SOLUTIONS — Medicare: $168.88
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	$106.68 – $701.88
Psychotherapy, 45 minutes: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $168.88 BCBS MN — Medicaid: $106.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $106.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $168.88 Freedom Blue PPO — Medicare: $168.88 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $168.88 IMCARE MSHO PCC PRIME — Medicare: $168.88 IMCARE MSHO REF REQ — Medicare: $168.88 Itasca Med Care — Medicaid: $160.67 MEDICA ADVANTAGE SOLUTIONS — Medicare: $168.88
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY, 60 MINUTES	$250	$160.50	$97.25 – $215
Psychotherapy, 60 minutes: 10 of 25 insurance plan rates Aetna First Health — Commercial: $212.50 America's PPO — Commercial: $193.75 BCBS MN — Medicaid: $112.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $112.50 BCBS WI — Commercial: $190 Cigna — Commercial: $183.50 HealthEOS — Commercial: $215 HealthPartners — Commercial: $183.50 HealthPartners — SHP: $168 HealthPartners CARE PMAP — Medicaid: $97.25
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	$106.68 – $701.88
Psychotherapy, 60 minutes: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $168.88 BCBS MN — Medicaid: $106.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $106.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $168.88 Freedom Blue PPO — Medicare: $168.88 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $168.88 IMCARE MSHO PCC PRIME — Medicare: $168.88 IMCARE MSHO REF REQ — Medicare: $168.88 Itasca Med Care — Medicaid: $160.67 MEDICA ADVANTAGE SOLUTIONS — Medicare: $168.88
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	$106.68 – $701.88
Family psychotherapy, without the patient: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $168.88 BCBS MN — Medicaid: $106.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $106.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $168.88 Freedom Blue PPO — Medicare: $168.88 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $168.88 IMCARE MSHO PCC PRIME — Medicare: $168.88 IMCARE MSHO REF REQ — Medicare: $168.88 Itasca Med Care — Medicaid: $160.67 MEDICA ADVANTAGE SOLUTIONS — Medicare: $168.88
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	$106.68 – $701.88
Family psychotherapy, with the patient: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $168.88 BCBS MN — Medicaid: $106.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $106.68 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $168.88 Freedom Blue PPO — Medicare: $168.88 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $168.88 IMCARE MSHO PCC PRIME — Medicare: $168.88 IMCARE MSHO REF REQ — Medicare: $168.88 Itasca Med Care — Medicaid: $160.67 MEDICA ADVANTAGE SOLUTIONS — Medicare: $168.88
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	$59.63 – $392.36
Group psychotherapy: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $97.23 BCBS MN — Medicaid: $59.63 BCBS PLUS PMAP PCC PRIME — Medicaid: $59.63 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $97.23 Freedom Blue PPO — Medicare: $97.23 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $97.23 IMCARE MSHO PCC PRIME — Medicare: $97.23 IMCARE MSHO REF REQ — Medicare: $97.23 Itasca Med Care — Medicaid: $92.50 MEDICA ADVANTAGE SOLUTIONS — Medicare: $97.23

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: EXCISE BREAST CYST	$4,639	$2,978.24	$1,804.57 – $3,989.54
Removal of breast growth (open surgery): 10 of 25 insurance plan rates Aetna First Health — Commercial: $3,943.15 America's PPO — Commercial: $3,595.22 BCBS MN — Medicaid: $2,087.55 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,087.55 BCBS WI — Commercial: $3,525.64 Cigna — Commercial: $3,405.03 HealthEOS — Commercial: $3,989.54 HealthPartners — Commercial: $3,405.03 HealthPartners — SHP: $3,117.41 HealthPartners CARE PMAP — Medicaid: $1,804.57
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: EXCISE BREAST CYST	$4,639	$2,978.24	$1,989.67 – $3,989.54
Removal of breast growth (open surgery): 10 of 13 insurance plan rates Aetna First Health — Commercial: $3,943.15 America's PPO — Commercial: $3,595.22 BCBS MN — Medicaid: $3,101.17 BCBS PLUS PMAP PCC PRIME — Medicaid: $3,101.17 BCBS WI — Commercial: $3,525.64 HealthEOS — Commercial: $3,989.54 MN BCBS Commercial — BCBS MN: $3,445.85 Sanford HealthPlan — Commercial: $2,094.51 Sanford HealthPlan — Commercial-NDPERS: $1,989.67 Ucare — Commercial: $3,052.46
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	$2,550.35 – $16,779.93
Removal of breast growth (open surgery): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $4,024.88 BCBS MN — Medicaid: $2,550.35 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,550.35 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $4,024.88 Freedom Blue PPO — Medicare: $4,024.88 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $4,024.88 IMCARE MSHO PCC PRIME — Medicare: $4,024.88 IMCARE MSHO REF REQ — Medicare: $4,024.88 Itasca Med Care — Medicaid: $3,829.28 MEDICA ADVANTAGE SOLUTIONS — Medicare: $4,024.88
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	$8,805.84 – $57,937.77
Total hip replacement: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $13,524.05 BCBS MN — Medicaid: $8,805.84 BCBS PLUS PMAP PCC PRIME — Medicaid: $8,805.84 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $13,524.05 Freedom Blue PPO — Medicare: $13,524.05 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $13,524.05 IMCARE MSHO PCC PRIME — Medicare: $13,524.05 IMCARE MSHO REF REQ — Medicare: $13,524.05 Itasca Med Care — Medicaid: $12,866.82 MEDICA ADVANTAGE SOLUTIONS — Medicare: $13,524.05
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	$8,805.84 – $57,937.77
Total knee replacement: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $13,524.05 BCBS MN — Medicaid: $8,805.84 BCBS PLUS PMAP PCC PRIME — Medicaid: $8,805.84 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $13,524.05 Freedom Blue PPO — Medicare: $13,524.05 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $13,524.05 IMCARE MSHO PCC PRIME — Medicare: $13,524.05 IMCARE MSHO REF REQ — Medicare: $13,524.05 Itasca Med Care — Medicaid: $12,866.82 MEDICA ADVANTAGE SOLUTIONS — Medicare: $13,524.05
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$1 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Shoulder arthroscopy: shaving of shoulder bone: rates for 3 insurance plans BCBS MN — Medicaid: $1 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCBS PLUS PMAP PCC PRIME — Medicaid: $1 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) MN BCBS Commercial — BCBS MN: $1 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
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	$2,165.70 – $14,249.16
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $3,410.34 BCBS MN — Medicaid: $2,165.70 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,165.70 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $3,410.34 Freedom Blue PPO — Medicare: $3,410.34 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $3,410.34 IMCARE MSHO PCC PRIME — Medicare: $3,410.34 IMCARE MSHO REF REQ — Medicare: $3,410.34 Itasca Med Care — Medicaid: $3,244.61 MEDICA ADVANTAGE SOLUTIONS — Medicare: $3,410.34
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	$3,918.24 – $25,779.92
Removal of tonsils and adenoids (under age 12): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $6,217.83 BCBS MN — Medicaid: $3,918.24 BCBS PLUS PMAP PCC PRIME — Medicaid: $3,918.24 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $6,217.83 Freedom Blue PPO — Medicare: $6,217.83 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $6,217.83 IMCARE MSHO PCC PRIME — Medicare: $6,217.83 IMCARE MSHO REF REQ — Medicare: $6,217.83 Itasca Med Care — Medicaid: $5,915.66 MEDICA ADVANTAGE SOLUTIONS — Medicare: $6,217.83
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,DIAGNOSIS	$2,349	$1,508.06	$913.76 – $2,020.14
Upper GI endoscopy (diagnostic): 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,996.65 America's PPO — Commercial: $1,820.48 BCBS MN — Medicaid: $1,057.05 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,057.05 BCBS WI — Commercial: $1,785.24 Cigna — Commercial: $1,724.17 HealthEOS — Commercial: $2,020.14 HealthPartners — Commercial: $1,724.17 HealthPartners — SHP: $1,578.53 HealthPartners CARE PMAP — Medicaid: $913.76
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,DIAGNOSIS	$2,349	$1,508.06	$1,007.49 – $2,020.14
Upper GI endoscopy (diagnostic): 10 of 13 insurance plan rates Aetna First Health — Commercial: $1,996.65 America's PPO — Commercial: $1,820.48 BCBS MN — Medicaid: $1,570.31 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,570.31 BCBS WI — Commercial: $1,785.24 HealthEOS — Commercial: $2,020.14 MN BCBS Commercial — BCBS MN: $1,744.84 Sanford HealthPlan — Commercial: $1,060.57 Sanford HealthPlan — Commercial-NDPERS: $1,007.49 Ucare — Commercial: $1,545.64
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	$606.51 – $1,660.22
Upper GI endoscopy (diagnostic): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $985.45 BCBS MN — Medicaid: $606.51 BCBS PLUS PMAP PCC PRIME — Medicaid: $606.51 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $985.45 Freedom Blue PPO — Medicare: $985.45 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $985.45 IMCARE MSHO PCC PRIME — Medicare: $985.45 IMCARE MSHO REF REQ — Medicare: $985.45 Itasca Med Care — Medicaid: $937.56 MEDICA ADVANTAGE SOLUTIONS — Medicare: $985.45
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,BIOPSY	$3,096	$1,987.63	$1,204.34 – $2,662.56
Upper GI endoscopy with biopsy: 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,631.60 America's PPO — Commercial: $2,399.40 BCBS MN — Medicaid: $1,393.20 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,393.20 BCBS WI — Commercial: $2,352.96 Cigna — Commercial: $2,272.46 HealthEOS — Commercial: $2,662.56 HealthPartners — Commercial: $2,272.46 HealthPartners — SHP: $2,080.51 HealthPartners CARE PMAP — Medicaid: $1,204.34
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,BIOPSY	$3,096	$1,987.63	$1,327.87 – $2,662.56
Upper GI endoscopy with biopsy: 10 of 13 insurance plan rates Aetna First Health — Commercial: $2,631.60 America's PPO — Commercial: $2,399.40 BCBS MN — Medicaid: $2,069.68 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,069.68 BCBS WI — Commercial: $2,352.96 HealthEOS — Commercial: $2,662.56 MN BCBS Commercial — BCBS MN: $2,299.71 Sanford HealthPlan — Commercial: $1,397.84 Sanford HealthPlan — Commercial-NDPERS: $1,327.87 Ucare — Commercial: $2,037.17
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	$606.51 – $1,660.22
Upper GI endoscopy with biopsy: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $985.45 BCBS MN — Medicaid: $606.51 BCBS PLUS PMAP PCC PRIME — Medicaid: $606.51 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $985.45 Freedom Blue PPO — Medicare: $985.45 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $985.45 IMCARE MSHO PCC PRIME — Medicare: $985.45 IMCARE MSHO REF REQ — Medicare: $985.45 Itasca Med Care — Medicaid: $937.56 MEDICA ADVANTAGE SOLUTIONS — Medicare: $985.45
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,FLEX,DIAGNOSTIC	$2,827	$1,814.93	$1,099.70 – $2,431.22
Colonoscopy (diagnostic): 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,402.95 America's PPO — Commercial: $2,190.93 BCBS MN — Medicaid: $1,272.15 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,272.15 BCBS WI — Commercial: $2,148.52 Cigna — Commercial: $2,075.02 HealthEOS — Commercial: $2,431.22 HealthPartners — Commercial: $2,075.02 HealthPartners — SHP: $1,899.74 HealthPartners CARE PMAP — Medicaid: $1,099.70
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY,FLEX,DIAGNOSTIC	$2,827	$1,814.93	$1,212.50 – $2,431.22
Colonoscopy (diagnostic): 10 of 13 insurance plan rates Aetna First Health — Commercial: $2,402.95 America's PPO — Commercial: $2,190.93 BCBS MN — Medicaid: $1,889.85 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,889.85 BCBS WI — Commercial: $2,148.52 HealthEOS — Commercial: $2,431.22 MN BCBS Commercial — BCBS MN: $2,099.90 Sanford HealthPlan — Commercial: $1,276.39 Sanford HealthPlan — Commercial-NDPERS: $1,212.50 Ucare — Commercial: $1,860.17
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	$611.50 – $1,614.45
Colonoscopy (diagnostic): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $958.28 BCBS MN — Medicaid: $611.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $611.50 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $958.28 Freedom Blue PPO — Medicare: $958.28 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $958.28 IMCARE MSHO PCC PRIME — Medicare: $958.28 IMCARE MSHO REF REQ — Medicare: $958.28 Itasca Med Care — Medicaid: $911.71 MEDICA ADVANTAGE SOLUTIONS — Medicare: $958.28
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,BIOPSY	$3,064	$1,967.09	$1,191.90 – $2,635.04
Colonoscopy with biopsy: 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,604.40 America's PPO — Commercial: $2,374.60 BCBS MN — Medicaid: $1,378.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,378.80 BCBS WI — Commercial: $2,328.64 Cigna — Commercial: $2,248.98 HealthEOS — Commercial: $2,635.04 HealthPartners — Commercial: $2,248.98 HealthPartners — SHP: $2,059.01 HealthPartners CARE PMAP — Medicaid: $1,191.90
Colonoscopy with biopsy CPT 45380 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY,BIOPSY	$3,064	$1,967.09	$1,314.15 – $2,635.04
Colonoscopy with biopsy: 10 of 13 insurance plan rates Aetna First Health — Commercial: $2,604.40 America's PPO — Commercial: $2,374.60 BCBS MN — Medicaid: $2,048.28 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,048.28 BCBS WI — Commercial: $2,328.64 HealthEOS — Commercial: $2,635.04 MN BCBS Commercial — BCBS MN: $2,275.94 Sanford HealthPlan — Commercial: $1,383.40 Sanford HealthPlan — Commercial-NDPERS: $1,314.15 Ucare — Commercial: $2,016.11
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	$789.56 – $2,087.91
Colonoscopy with biopsy: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $1,239.31 BCBS MN — Medicaid: $789.56 BCBS PLUS PMAP PCC PRIME — Medicaid: $789.56 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,239.31 Freedom Blue PPO — Medicare: $1,239.31 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $1,239.31 IMCARE MSHO PCC PRIME — Medicare: $1,239.31 IMCARE MSHO REF REQ — Medicare: $1,239.31 Itasca Med Care — Medicaid: $1,179.08 MEDICA ADVANTAGE SOLUTIONS — Medicare: $1,239.31
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,REMV LESN,SNARE	$3,342	$2,145.56	$1,300.04 – $2,874.12
Colonoscopy with removal of polyps (snare): 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,840.70 America's PPO — Commercial: $2,590.05 BCBS MN — Medicaid: $1,503.90 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,503.90 BCBS WI — Commercial: $2,539.92 Cigna — Commercial: $2,453.03 HealthEOS — Commercial: $2,874.12 HealthPartners — Commercial: $2,453.03 HealthPartners — SHP: $2,245.82 HealthPartners CARE PMAP — Medicaid: $1,300.04
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY,REMV LESN,SNARE	$3,342	$2,145.56	$1,433.38 – $2,874.12
Colonoscopy with removal of polyps (snare): 10 of 13 insurance plan rates Aetna First Health — Commercial: $2,840.70 America's PPO — Commercial: $2,590.05 BCBS MN — Medicaid: $2,234.13 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,234.13 BCBS WI — Commercial: $2,539.92 HealthEOS — Commercial: $2,874.12 MN BCBS Commercial — BCBS MN: $2,482.44 Sanford HealthPlan — Commercial: $1,508.91 Sanford HealthPlan — Commercial-NDPERS: $1,433.38 Ucare — Commercial: $2,199.04
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	$789.56 – $2,087.91
Colonoscopy with removal of polyps (snare): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $1,239.31 BCBS MN — Medicaid: $789.56 BCBS PLUS PMAP PCC PRIME — Medicaid: $789.56 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,239.31 Freedom Blue PPO — Medicare: $1,239.31 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $1,239.31 IMCARE MSHO PCC PRIME — Medicare: $1,239.31 IMCARE MSHO REF REQ — Medicare: $1,239.31 Itasca Med Care — Medicaid: $1,179.08 MEDICA ADVANTAGE SOLUTIONS — Medicare: $1,239.31
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	$789.56 – $5,194.88
Ultrasound of the lower bowel by endoscope: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $1,239.31 BCBS MN — Medicaid: $789.56 BCBS PLUS PMAP PCC PRIME — Medicaid: $789.56 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $1,239.31 Freedom Blue PPO — Medicare: $1,239.31 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $1,239.31 IMCARE MSHO PCC PRIME — Medicare: $1,239.31 IMCARE MSHO REF REQ — Medicare: $1,239.31 Itasca Med Care — Medicaid: $1,179.08 MEDICA ADVANTAGE SOLUTIONS — Medicare: $1,239.31
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY,SCREEN PREV	$2,243	$1,440.01	$872.53 – $1,928.98
Screening colonoscopy (not high risk): 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,906.55 America's PPO — Commercial: $1,738.32 BCBS MN — Medicaid: $1,009.35 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,009.35 BCBS WI — Commercial: $1,704.68 Cigna — Commercial: $1,646.36 HealthEOS — Commercial: $1,928.98 HealthPartners — Commercial: $1,646.36 HealthPartners — SHP: $1,507.30 HealthPartners CARE PMAP — Medicaid: $872.53
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: COLONOSCOPY,SCREEN PREV	$2,243	$1,440.01	$962.02 – $1,928.98
Screening colonoscopy (not high risk): 10 of 13 insurance plan rates Aetna First Health — Commercial: $1,906.55 America's PPO — Commercial: $1,738.32 BCBS MN — Medicaid: $1,499.45 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,499.45 BCBS WI — Commercial: $1,704.68 HealthEOS — Commercial: $1,928.98 MN BCBS Commercial — BCBS MN: $1,666.10 Sanford HealthPlan — Commercial: $1,012.71 Sanford HealthPlan — Commercial-NDPERS: $962.02 Ucare — Commercial: $1,475.89
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	$611.50 – $4,023.38
Screening colonoscopy (not high risk): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $958.28 BCBS MN — Medicaid: $611.50 BCBS PLUS PMAP PCC PRIME — Medicaid: $611.50 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $958.28 Freedom Blue PPO — Medicare: $958.28 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $958.28 IMCARE MSHO PCC PRIME — Medicare: $958.28 IMCARE MSHO REF REQ — Medicare: $958.28 Itasca Med Care — Medicaid: $911.71 MEDICA ADVANTAGE SOLUTIONS — Medicare: $958.28
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	$3,860.56 – $25,400.48
Gallbladder removal by laparoscope: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $6,132.38 BCBS MN — Medicaid: $3,860.56 BCBS PLUS PMAP PCC PRIME — Medicaid: $3,860.56 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $6,132.38 Freedom Blue PPO — Medicare: $6,132.38 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $6,132.38 IMCARE MSHO PCC PRIME — Medicare: $6,132.38 IMCARE MSHO REF REQ — Medicare: $6,132.38 Itasca Med Care — Medicaid: $5,834.36 MEDICA ADVANTAGE SOLUTIONS — Medicare: $6,132.38
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	$2,314.79 – $15,230.09
Groin (inguinal) hernia repair, age 5 or older: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $3,709.32 BCBS MN — Medicaid: $2,314.79 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,314.79 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $3,709.32 Freedom Blue PPO — Medicare: $3,709.32 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $3,709.32 IMCARE MSHO PCC PRIME — Medicare: $3,709.32 IMCARE MSHO REF REQ — Medicare: $3,709.32 Itasca Med Care — Medicaid: $3,529.06 MEDICA ADVANTAGE SOLUTIONS — Medicare: $3,709.32
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BX OF PROSTATE,NEEDLE/PUNCH(T)	$2,625	$1,685.25	$1,021.12 – $2,257.50
Prostate biopsy: 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,231.25 America's PPO — Commercial: $2,034.38 BCBS MN — Medicaid: $1,181.25 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,181.25 BCBS WI — Commercial: $1,995 Cigna — Commercial: $1,926.75 HealthEOS — Commercial: $2,257.50 HealthPartners — Commercial: $1,926.75 HealthPartners — SHP: $1,764 HealthPartners CARE PMAP — Medicaid: $1,021.12
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	$1,362.80 – $8,966.49
Prostate biopsy: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $2,153.14 BCBS MN — Medicaid: $1,362.80 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,362.80 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,153.14 Freedom Blue PPO — Medicare: $2,153.14 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $2,153.14 IMCARE MSHO PCC PRIME — Medicare: $2,153.14 IMCARE MSHO REF REQ — Medicare: $2,153.14 Itasca Med Care — Medicaid: $2,048.51 MEDICA ADVANTAGE SOLUTIONS — Medicare: $2,153.14
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	$6,887.31 – $45,314.84
Prostate removal by laparoscope (radical prostatectomy): 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $10,943.02 BCBS MN — Medicaid: $6,887.31 BCBS PLUS PMAP PCC PRIME — Medicaid: $6,887.31 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $10,943.02 Freedom Blue PPO — Medicare: $10,943.02 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $10,943.02 IMCARE MSHO PCC PRIME — Medicare: $10,943.02 IMCARE MSHO REF REQ — Medicare: $10,943.02 Itasca Med Care — Medicaid: $10,411.22 MEDICA ADVANTAGE SOLUTIONS — Medicare: $10,943.02
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY,W/ENDO BX	$3,248	$2,085.22	$1,263.47 – $2,793.28
Hysteroscopy with biopsy of the uterus lining: 10 of 25 insurance plan rates Aetna First Health — Commercial: $2,760.80 America's PPO — Commercial: $2,517.20 BCBS MN — Medicaid: $1,461.60 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,461.60 BCBS WI — Commercial: $2,468.48 Cigna — Commercial: $2,384.03 HealthEOS — Commercial: $2,793.28 HealthPartners — Commercial: $2,384.03 HealthPartners — SHP: $2,182.66 HealthPartners CARE PMAP — Medicaid: $1,263.47
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	$2,091.79 – $13,762.87
Hysteroscopy with biopsy of the uterus lining: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $3,341.93 BCBS MN — Medicaid: $2,091.79 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,091.79 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $3,341.93 Freedom Blue PPO — Medicare: $3,341.93 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $3,341.93 IMCARE MSHO PCC PRIME — Medicare: $3,341.93 IMCARE MSHO REF REQ — Medicare: $3,341.93 Itasca Med Care — Medicaid: $3,179.53 MEDICA ADVANTAGE SOLUTIONS — Medicare: $3,341.93
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	$1,891	$1,214.02	$735.60 – $1,626.26
Spinal injection, lower back (epidural), with imaging guidance: 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,607.35 America's PPO — Commercial: $1,465.52 BCBS MN — Medicaid: $850.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $850.95 BCBS WI — Commercial: $1,437.16 Cigna — Commercial: $1,387.99 HealthEOS — Commercial: $1,626.26 HealthPartners — Commercial: $1,387.99 HealthPartners — SHP: $1,270.75 HealthPartners CARE PMAP — Medicaid: $735.60
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	$462.70 – $3,044.29
Spinal injection, lower back (epidural), with imaging guidance: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $727.90 BCBS MN — Medicaid: $462.70 BCBS PLUS PMAP PCC PRIME — Medicaid: $462.70 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $727.90 Freedom Blue PPO — Medicare: $727.90 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $727.90 IMCARE MSHO PCC PRIME — Medicare: $727.90 IMCARE MSHO REF REQ — Medicare: $727.90 Itasca Med Care — Medicaid: $692.52 MEDICA ADVANTAGE SOLUTIONS — Medicare: $727.90
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)	$1,931	$1,239.70	$751.16 – $1,660.66
Nerve root injection, lower back, with imaging guidance: 10 of 25 insurance plan rates Aetna First Health — Commercial: $1,641.35 America's PPO — Commercial: $1,496.52 BCBS MN — Medicaid: $868.95 BCBS PLUS PMAP PCC PRIME — Medicaid: $868.95 BCBS WI — Commercial: $1,467.56 Cigna — Commercial: $1,417.35 HealthEOS — Commercial: $1,660.66 HealthPartners — Commercial: $1,417.35 HealthPartners — SHP: $1,297.63 HealthPartners CARE PMAP — Medicaid: $751.16
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	$609.85 – $4,012.48
Nerve root injection, lower back, with imaging guidance: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $935.77 BCBS MN — Medicaid: $609.85 BCBS PLUS PMAP PCC PRIME — Medicaid: $609.85 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $935.77 Freedom Blue PPO — Medicare: $935.77 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $935.77 IMCARE MSHO PCC PRIME — Medicare: $935.77 IMCARE MSHO REF REQ — Medicare: $935.77 Itasca Med Care — Medicaid: $890.29 MEDICA ADVANTAGE SOLUTIONS — Medicare: $935.77
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	$1,291.84 – $8,499.63
Carpal tunnel release: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $2,052.52 BCBS MN — Medicaid: $1,291.84 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,291.84 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,052.52 Freedom Blue PPO — Medicare: $2,052.52 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $2,052.52 IMCARE MSHO PCC PRIME — Medicare: $2,052.52 IMCARE MSHO REF REQ — Medicare: $2,052.52 Itasca Med Care — Medicaid: $1,952.77 MEDICA ADVANTAGE SOLUTIONS — Medicare: $2,052.52
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	$388.91 – $2,558.83
Laser treatment of clouding after cataract surgery: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $576.63 BCBS MN — Medicaid: $388.91 BCBS PLUS PMAP PCC PRIME — Medicaid: $388.91 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $576.63 Freedom Blue PPO — Medicare: $576.63 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $576.63 IMCARE MSHO PCC PRIME — Medicare: $576.63 IMCARE MSHO REF REQ — Medicare: $576.63 Itasca Med Care — Medicaid: $548.60 MEDICA ADVANTAGE SOLUTIONS — Medicare: $576.63
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	$1,559.20 – $10,258.73
Cataract removal with lens implant: 10 of 28 insurance plan rates Advocare/Security Health — Medicare: $2,397.23 BCBS MN — Medicaid: $1,559.20 BCBS PLUS PMAP PCC PRIME — Medicaid: $1,559.20 BLUE CROSS MEDICARE ADVANTAGE CORE — Medicare: $2,397.23 Freedom Blue PPO — Medicare: $2,397.23 HEALTHPARTNERS CARE MSHO / MCR ADV — Medicare: $2,397.23 IMCARE MSHO PCC PRIME — Medicare: $2,397.23 IMCARE MSHO REF REQ — Medicare: $2,397.23 Itasca Med Care — Medicaid: $2,280.73 MEDICA ADVANTAGE SOLUTIONS — Medicare: $2,397.23

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$2,091.79 – $13,762.87
Vaginal delivery, with care before and after: rates for 3 insurance plans BCBS MN — Medicaid: $2,091.79 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,091.79 MN BCBS Commercial — BCBS MN: $13,762.87
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$5,615.34
Cesarean delivery (C-section), with care before and after: rates for 3 insurance plans BCBS MN — Medicaid: $5,615.34 BCBS PLUS PMAP PCC PRIME — Medicaid: $5,615.34 MN BCBS Commercial — BCBS MN: $5,615.34
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$2,091.79 – $13,762.87
Vaginal delivery after a previous C-section, with care before and after: rates for 3 insurance plans BCBS MN — Medicaid: $2,091.79 BCBS PLUS PMAP PCC PRIME — Medicaid: $2,091.79 MN BCBS Commercial — BCBS MN: $13,762.87

Source: Essentia Health St Marys - Detroit Lakes’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	Acute Care Hospital
Address	1027 Washington Ave, Detroit Lakes, MN 56501
County	Becker County
State	Minnesota
Phone	(218) 847‑0888
Emergency services	Yes
Ownership	Voluntary non-profit - Church
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	240101
Name in Medicare records	ESSENTIA HEALTH ST MARYS - DETROIT LAKES
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(218) 847‑5611^[4]
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 St. Mary's-Detroit Lakes — essentiahealth.org
Emergency Medicine - Essentia Health St. Mary's-Detroit Lakes — essentiahealth.org
Trauma Centers | Essentia Health — essentiahealth.org
Lab Services - Essentia Health St. Mary's-Detroit Lakes | Essentia Health — essentiahealth.org