Does Gundersen Lutheran Medical Center have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Gundersen Lutheran Medical Center. In a medical emergency, call 911.

Where is Gundersen Lutheran Medical Center?

1910 South Ave, La Crosse, WI 54601, in La Crosse County, Wisconsin.

What is the phone number of Gundersen Lutheran Medical Center?

(608) 782-7300, as listed by Medicare (CMS).

What is the Medicare star rating of Gundersen Lutheran Medical Center?

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

Gundersen Lutheran Medical Center

Quick answers

Does Gundersen Lutheran Medical Center have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Gundersen Lutheran Medical Center. In a medical emergency, call 911.
Where is Gundersen Lutheran Medical Center?: 1910 South Ave, La Crosse, WI 54601, in La Crosse County, Wisconsin.
What is the phone number of Gundersen Lutheran Medical Center?: (608) 782-7300, as listed by Medicare (CMS).
What is the Medicare star rating of Gundersen Lutheran Medical Center?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][6]

Emergency Medicine
Trauma Services
Imaging
Surgery (inpatient and outpatient)
Critical Care
Neuroscience
Orthopaedics
Obstetrics
Neonatal Intensive Care
Pediatrics
Pediatric Intensive Care
Oncology
Digestive Care
Gastroenterology
Nephrology
Pulmonary Medicine
Cardiology
Behavioral Health
Rehabilitation
Physical Therapy
Occupational Therapy
Speech Pathology
Nutrition Therapy

Conditions treated^[6]

Traumatic injuries
Fall injuries
Vehicle and ATV accident injuries
Motorcycle and snowmobile accident injuries
Boating and jet ski accident injuries
Hunting injuries
Violence-related injuries

Treatments^[4][6]

Emergency care
Renal dialysis
Inpatient rehabilitation
Trauma rehabilitation
Physical therapy
Occupational therapy
Speech pathology
Nutrition therapy
Virtual nursing (select units)

Procedures^[4]

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

Inpatient Behavioral Health
Level II Trauma Center
Trauma injury prevention classes
Heart Institute testing and rehab center
Neonatal ICU
Rehabilitation Unit
Virtual nursing program

Emergency care (hospital website)^[5]

Emergency room	Yes

Visiting and practical information

Parking	Free patient parking in the Green and Blue ramps and nearby lots. Free valet at the main entrance and East/Founders Buildings (weekday hours)^[7]
Interpreters and languages	Free interpreters in all languages, day or night, in person, by phone or iPad. Staff interpreters for Spanish and Hmong; ASL available^[8]
Patient portal	MyChart

Recognition^[4][6]

Level II Trauma Center
Healthgrades Outstanding Patient Experience Award (2023)

Doctors and clinicians (1,082)

1,082 doctors and other clinicians list Gundersen Lutheran Medical Center 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 1,058 more: the button below opens the full list.

Other emergency rooms nearby

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

Mayo Clinic Health System-Franciscan Medical Center Inc0.8 mi · La Crosse, WI · Acute Care Hospital
Mayo Clinic Hlth Systm Franciscan Hlthcare Sparta24 mi · Sparta, WI · Critical Access Hospital
Vernon Memorial Hospital25 mi · Viroqua, WI · Critical Access Hospital
Winona Health Services25 mi · Winona, MN · Acute Care Hospital
Veterans Memorial Hospital38 mi · Waukon, IA · Critical Access Hospital

Other hospitals nearby

Tomah Memorial Hospital39 mi · Tomah, WI · Critical Access Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Riverside0.7 mi · La Crosse, WI · 5 of 5 stars
Benedictine Manor of LaCrosse1.2 mi · La Crosse, WI · 1 of 5 stars
Bethany St Joseph Care Ctr2.3 mi · La Crosse, WI · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Gundersen Lutheran Medical Center5.4 mi · La Crosse, WI · 4 of 5 stars
St Croix Hospice La Crosse5.4 mi · La Crosse, WI · 4 of 5 stars
Winona Area Hospice Services23 mi · Winona, MN · 5 of 5 stars

All hospice providers in the state →

Home health agencies

Aveanna Home Health5.4 mi · La Crosse, WI · 5 of 5 stars

All home health agencies in the state →

Dialysis facilities

Gundersen Lutheran Renal Dialysis - La Crosse5.4 mi · La Crosse, WI
Gundersen Lutheran Renal Dialysis - Onalaska8.0 mi · Onalaska, WI · 3 of 5 stars
Mayo Clinic Dialysis - Onalaska8.0 mi · Onalaska, WI · 2 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.

Community health centers

Scenic Bluffs Health Center LAXBH0.7 mi · La Crosse, WI · Community health center
Scenic Bluffs Health Centers Inc- REACH LaCrosse1.0 mi · La Crosse, WI · Community health center
Scenic Bluffs Health Center Inc Westby MSHS22 mi · Westby, WI · Community health center

Clinics and urgent care

Gundersen Lutheran Medical Center Inc8.0 mi · Onalaska, WI · Urgent care center
Vernon Health - Westby Clinic21 mi · Westby, WI · Rural health clinic
Gundersen Lutheran Medical Center Inc23 mi · Winona, MN · Urgent care center

Pharmacies

Walgreen Co4.3 mi · La Crosse, WI · Pharmacy
Degen Berglund Inc5.4 mi · La Crosse, WI · Community/retail pharmacy
Gundersen Clinic Ltd5.4 mi · La Crosse, WI · Clinic pharmacy

Assisted living nearby

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

Brookdale Lacrosse Al5.4 mi · Lacrosse, WI
Brookdale Lacrosse MC5.4 mi · Lacrosse, WI
Care Center5.4 mi · Lacrosse, WI
Eagle Crest South CBRF5.4 mi · Lacrosse, WI

About the Medicare star rating

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

Medicare quality data

What Gundersen Lutheran Medical Center 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	5 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	2 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	77%National average: 72%
Would definitely recommend the hospital	80%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	76%National average: 80%
Staff “always” explained medicines before giving them	63%National average: 62%
Were given information about recovery at home	90%National average: 86%
Room and bathroom “always” clean	65%National average: 74%
Area around the room “always” quiet at night	63%National average: 60%
Completed surveys	420Response rate: 32%

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)	1.03No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.816No different from the national benchmark
Surgical site infections after colon surgery	0.591No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0.305No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.224Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	12.6%
Deaths within 30 days: heart failure patients	12.8%
Deaths within 30 days: pneumonia patients	13%
Deaths within 30 days: COPD patients	8.6%
Deaths within 30 days: stroke patients	12.2%
Deaths within 30 days: coronary bypass surgery (CABG)	2.6%
Serious complications (patient safety indicator PSI-90)	1.05No 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	13.3%
Readmitted within 30 days: heart failure	20.9%
Readmitted within 30 days: pneumonia	16.2%
Readmitted within 30 days: COPD	17.8%
Readmitted within 30 days: coronary bypass surgery	12%
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)	Very high (60,000 or more)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	167 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)	62%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 La Crosse Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Gundersen Lutheran Medical Center 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 →

$ 20 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 O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$146.61
New patient office visit (about 30–44 minutes): rates for 2 insurance plans BCBSMN — All Products: $146.61 BCBSMN — MHCP: $146.61
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	$235.77
New patient office visit (about 45–59 minutes): rates for 2 insurance plans BCBSMN — All Products: $235.77 BCBSMN — MHCP: $235.77
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	$320.14
New patient office visit (about 60–74 minutes): rates for 2 insurance plans BCBSMN — All Products: $320.14 BCBSMN — MHCP: $320.14
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 99213 OFFICE OUTPATIENT VISIT 20 MIN MET/EXCEEDED	$137	$54.80	$45.76 – $137
Established patient office visit (about 20–29 minutes): 10 of 46 insurance plan rates Aetna — All Products: $123.30 Aetna — Medicare Advantage: $60.28 Alliance — Comprehensive/All Products: $107.82 Alliance — Premier/All Products: $106.94 Allied National General — HMO/PPO: $116.45 Anthem — HMO/POS: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — PPO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — State Specific: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Aspirus Arise Health — All Products: $113.71 BCBSMN — All Products: $116.69
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 99213 URGENT CARE OFFICE/OUTPATIENT VISIT EST 20 MIN MET/EX	$137	$54.80	$45.76 – $137
Established patient office visit (about 20–29 minutes): 10 of 46 insurance plan rates Aetna — All Products: $123.30 Aetna — Medicare Advantage: $60.28 Alliance — Comprehensive/All Products: $107.82 Alliance — Premier/All Products: $106.94 Allied National General — HMO/PPO: $116.45 Anthem — HMO/POS: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — PPO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — State Specific: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Aspirus Arise Health — All Products: $113.71 BCBSMN — All Products: $116.69
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 99213 OFFICE OUTPATIENT VISIT 20 MIN MET/EXCEEDED	$137	$54.80	$45.76 – $137
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan Quartz — All Other Self Funded: $80.69
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 99214 OFFICE OUTPATIENT VISIT 30 MIN MET/EXCEEDED	$137	$54.80	$45.76 – $137
Established patient office visit (about 30–39 minutes): 10 of 46 insurance plan rates Aetna — All Products: $123.30 Aetna — Medicare Advantage: $60.28 Alliance — Comprehensive/All Products: $107.82 Alliance — Premier/All Products: $106.94 Allied National General — HMO/PPO: $116.45 Anthem — HMO/POS: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — PPO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — State Specific: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Aspirus Arise Health — All Products: $113.71 BCBSMN — All Products: $172.34
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 99214 URGENT CARE OFFICE/OUTPATIENT VISIT EST 30 MIN MET/EX	$137	$54.80	$45.76 – $137
Established patient office visit (about 30–39 minutes): 10 of 46 insurance plan rates Aetna — All Products: $123.30 Aetna — Medicare Advantage: $60.28 Alliance — Comprehensive/All Products: $107.82 Alliance — Premier/All Products: $106.94 Allied National General — HMO/PPO: $116.45 Anthem — HMO/POS: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — PPO: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Anthem — State Specific: $0.01 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Aspirus Arise Health — All Products: $113.71 BCBSMN — All Products: $172.34
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 99214 OFFICE OUTPATIENT VISIT 30 MIN MET/EXCEEDED	$137	$54.80	$45.76 – $137
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan Quartz — All Other Self Funded: $80.69
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	$156.78
Office consultation with a specialist (moderate): rates for 2 insurance plans BCBSMN — All Products: $156.78 BCBSMN — MHCP: $156.78
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	$239.36
Office consultation with a specialist (moderate to high): rates for 2 insurance plans BCBSMN — All Products: $239.36 BCBSMN — MHCP: $239.36
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	$166.36
Preventive checkup, new patient, age 18–39: rates for 2 insurance plans BCBSMN — All Products: $166.36 BCBSMN — MHCP: $166.36
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	$201.66
Preventive checkup, new patient, age 40–64: rates for 2 insurance plans BCBSMN — All Products: $201.66 BCBSMN — MHCP: $201.66
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	$271.85 – $289.23
Emergency room visit (moderate): 10 of 13 insurance plan rates Aetna — Medicare Advantage: $289.23 Amerigroup — Medicare Advantage: $289.23 Anthem — Medicare HMO/PPO: $289.23 BCBSMN — All Products: $535.51 BCBSMN — MHCP: $111.12 Health Partners — Medicare Advantage: $289.23 iCare — Medicare Advantage: $289.23 Medical Associates — Medicare Advantage: $289.23 Quartz — Medicare Advantage: $289.23 UCARE — Dually Eligible: $271.85
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	$422 – $443.10
Emergency room visit (moderately high): 10 of 13 insurance plan rates Aetna — Medicare Advantage: $442.11 Amerigroup — Medicare Advantage: $442.11 Anthem — Medicare HMO/PPO: $442.11 BCBSMN — All Products: $834.01 BCBSMN — MHCP: $173.06 Health Partners — Medicare Advantage: $442.11 iCare — Medicare Advantage: $442.11 Medical Associates — Medicare Advantage: $442.11 Quartz — Medicare Advantage: $442.11 UCARE — Dually Eligible: $422
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	$611.99 – $642.59
Emergency room visit (high): 10 of 13 insurance plan rates Aetna — Medicare Advantage: $630.99 Amerigroup — Medicare Advantage: $630.99 Anthem — Medicare HMO/PPO: $630.99 BCBSMN — All Products: $1,197.89 BCBSMN — MHCP: $248.57 Health Partners — Medicare Advantage: $630.99 iCare — Medicare Advantage: $630.99 Medical Associates — Medicare Advantage: $630.99 Quartz — Medicare Advantage: $630.99 UCARE — Dually Eligible: $611.99

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: BASIC METABOLIC PNL TOTAL CA	Not listed in the file	Not listed in the file	$3.20 – $8.88
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $8.46 Alliance — Comprehensive/All Products: $128.60 Alliance — Premier/All Products: $122.17 Amerigroup — Medicare Advantage: $8.46 Anthem — Medicare HMO/PPO: $8.46 BCBSMN — All Products: $8.46 BCBSMN — MHCP: $8.46 Health Partners — Medicare Advantage: $8.46 iCare — Medicare Advantage: $8.46 Medical Associates — Dialysis Specific: $9.31
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	$3.16 – $128.60
Basic metabolic panel (blood test): rates for 10 insurance plans Amerigroup — Medicaid HMO: $3.16 Anthem — Medicaid: $3.16 Group Health Eau Claire — Medicaid HMO: $3.16 Group Health of South Central — Medicaid HMO: $3.16 ICare — Medicaid HMO: $3.20 Iowa Total Care — Medicaid: $3.16 Managed Health Service — Managed Medicaid: $3.16 Molina Health — Managed Medicaid: $3.16 Quartz — Medicaid_Badgercare: $3.16 UHC — Medicaid: $3.16
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: BASIC METABOLIC PNL TOTAL CA	Not listed in the file	Not listed in the file	$122.17 – $128.60
Basic metabolic panel (blood test): rates for 2 insurance plans Alliance — Comprehensive/All Products: $128.60 Alliance — Premier/All Products: $122.17
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	$3.20 – $11.09
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $10.56 Alliance — Comprehensive/All Products: $160.52 Alliance — Premier/All Products: $152.49 Amerigroup — Medicare Advantage: $10.56 Anthem — Medicare HMO/PPO: $10.56 BCBSMN — All Products: $10.56 BCBSMN — MHCP: $10.56 Health Partners — Medicare Advantage: $10.56 iCare — Medicare Advantage: $10.56 Medical Associates — Dialysis Specific: $11.62
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	$3.16 – $160.52
Comprehensive metabolic panel (blood test): rates for 10 insurance plans Amerigroup — Medicaid HMO: $3.16 Anthem — Medicaid: $3.16 Group Health Eau Claire — Medicaid HMO: $3.16 Group Health of South Central — Medicaid HMO: $3.16 ICare — Medicaid HMO: $3.20 Iowa Total Care — Medicaid: $3.16 Managed Health Service — Managed Medicaid: $3.16 Molina Health — Managed Medicaid: $3.16 Quartz — Medicaid_Badgercare: $3.16 UHC — Medicaid: $3.16
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$152.49 – $160.52
Comprehensive metabolic panel (blood test): rates for 2 insurance plans Alliance — Comprehensive/All Products: $160.52 Alliance — Premier/All Products: $152.49
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	$3.20 – $50.20
Obstetric blood test panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $47.81 Alliance — Comprehensive/All Products: $726.72 Alliance — Premier/All Products: $690.38 Amerigroup — Medicare Advantage: $47.81 Anthem — Medicare HMO/PPO: $47.81 BCBSMN — All Products: $47.81 BCBSMN — MHCP: $47.81 Health Partners — Medicare Advantage: $47.81 iCare — Medicare Advantage: $47.81 Medical Associates — Dialysis Specific: $52.59
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	$3.16 – $726.72
Obstetric blood test panel: rates for 10 insurance plans Amerigroup — Medicaid HMO: $3.16 Anthem — Medicaid: $3.16 Group Health Eau Claire — Medicaid HMO: $3.16 Group Health of South Central — Medicaid HMO: $3.16 ICare — Medicaid HMO: $3.20 Iowa Total Care — Medicaid: $3.16 Managed Health Service — Managed Medicaid: $3.16 Molina Health — Managed Medicaid: $3.16 Quartz — Medicaid_Badgercare: $3.16 UHC — Medicaid: $3.16
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$3.20 – $14.06
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $13.39 Alliance — Comprehensive/All Products: $203.52 Alliance — Premier/All Products: $193.34 Amerigroup — Medicare Advantage: $13.39 Anthem — Medicare HMO/PPO: $13.39 BCBSMN — All Products: $13.39 BCBSMN — MHCP: $13.39 Health Partners — Medicare Advantage: $13.39 iCare — Medicare Advantage: $13.39 Medical Associates — Dialysis Specific: $14.73
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	$3.16 – $203.52
Cholesterol panel (lipid panel): rates for 10 insurance plans Amerigroup — Medicaid HMO: $3.16 Anthem — Medicaid: $3.16 Group Health Eau Claire — Medicaid HMO: $3.16 Group Health of South Central — Medicaid HMO: $3.16 ICare — Medicaid HMO: $3.20 Iowa Total Care — Medicaid: $3.16 Managed Health Service — Managed Medicaid: $3.16 Molina Health — Managed Medicaid: $3.16 Quartz — Medicaid_Badgercare: $3.16 UHC — Medicaid: $3.16
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$193.34 – $203.52
Cholesterol panel (lipid panel): rates for 2 insurance plans Alliance — Comprehensive/All Products: $203.52 Alliance — Premier/All Products: $193.34
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	$3.20 – $9.11
Kidney function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $8.68 Alliance — Comprehensive/All Products: $131.92 Alliance — Premier/All Products: $125.32 Amerigroup — Medicare Advantage: $8.68 Anthem — Medicare HMO/PPO: $8.68 BCBSMN — All Products: $8.68 BCBSMN — MHCP: $8.68 Health Partners — Medicare Advantage: $8.68 iCare — Medicare Advantage: $8.68 Medical Associates — Dialysis Specific: $9.55
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	$3.16 – $131.92
Kidney function panel: rates for 10 insurance plans Amerigroup — Medicaid HMO: $3.16 Anthem — Medicaid: $3.16 Group Health Eau Claire — Medicaid HMO: $3.16 Group Health of South Central — Medicaid HMO: $3.16 ICare — Medicaid HMO: $3.20 Iowa Total Care — Medicaid: $3.16 Managed Health Service — Managed Medicaid: $3.16 Molina Health — Managed Medicaid: $3.16 Quartz — Medicaid_Badgercare: $3.16 UHC — Medicaid: $3.16
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$125.32 – $131.92
Kidney function panel: rates for 2 insurance plans Alliance — Comprehensive/All Products: $131.92 Alliance — Premier/All Products: $125.32
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	$3.20 – $8.58
Liver function panel: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $8.17 Alliance — Comprehensive/All Products: $124.20 Alliance — Premier/All Products: $117.99 Amerigroup — Medicare Advantage: $8.17 Anthem — Medicare HMO/PPO: $8.17 BCBSMN — All Products: $8.17 BCBSMN — MHCP: $8.17 Health Partners — Medicare Advantage: $8.17 iCare — Medicare Advantage: $8.17 Medical Associates — Dialysis Specific: $8.99
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	$3.16 – $124.20
Liver function panel: rates for 10 insurance plans Amerigroup — Medicaid HMO: $3.16 Anthem — Medicaid: $3.16 Group Health Eau Claire — Medicaid HMO: $3.16 Group Health of South Central — Medicaid HMO: $3.16 ICare — Medicaid HMO: $3.20 Iowa Total Care — Medicaid: $3.16 Managed Health Service — Managed Medicaid: $3.16 Molina Health — Managed Medicaid: $3.16 Quartz — Medicaid_Badgercare: $3.16 UHC — Medicaid: $3.16
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	$1.05 – $3.33
Urine test (automated, with microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $3.17 Alliance — Comprehensive/All Products: $48.20 Alliance — Premier/All Products: $45.79 Amerigroup — Medicare Advantage: $3.17 Anthem — Medicare HMO/PPO: $3.17 BCBSMN — All Products: $3.17 BCBSMN — MHCP: $3.17 Health Partners — Medicare Advantage: $3.17 iCare — Medicare Advantage: $3.17 Medical Associates — Dialysis Specific: $3.49
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	$1.05 – $48.20
Urine test (automated, with microscope): rates for 10 insurance plans Amerigroup — Medicaid HMO: $1.05 Anthem — Medicaid: $1.05 Group Health Eau Claire — Medicaid HMO: $1.05 Group Health of South Central — Medicaid HMO: $1.05 ICare — Medicaid HMO: $1.05 Iowa Total Care — Medicaid: $1.05 Managed Health Service — Managed Medicaid: $1.05 Molina Health — Managed Medicaid: $1.05 Quartz — Medicaid_Badgercare: $1.05 UHC — Medicaid: $1.05
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	$1.05 – $3.65
Urine test (manual, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $3.48 Alliance — Comprehensive/All Products: $52.88 Alliance — Premier/All Products: $50.24 Amerigroup — Medicare Advantage: $3.48 Anthem — Medicare HMO/PPO: $3.48 BCBSMN — All Products: $3.48 BCBSMN — MHCP: $3.48 Health Partners — Medicare Advantage: $3.48 iCare — Medicare Advantage: $3.48 Medical Associates — Dialysis Specific: $3.83
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	$1.05 – $52.88
Urine test (manual, without microscope): rates for 10 insurance plans Amerigroup — Medicaid HMO: $1.05 Anthem — Medicaid: $1.05 Group Health Eau Claire — Medicaid HMO: $1.05 Group Health of South Central — Medicaid HMO: $1.05 ICare — Medicaid HMO: $1.05 Iowa Total Care — Medicaid: $1.05 Managed Health Service — Managed Medicaid: $1.05 Molina Health — Managed Medicaid: $1.05 Quartz — Medicaid_Badgercare: $1.05 UHC — Medicaid: $1.05
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	$1.05 – $2.36
Urine test (automated, without microscope): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $2.25 Alliance — Comprehensive/All Products: $34.20 Alliance — Premier/All Products: $32.49 Amerigroup — Medicare Advantage: $2.25 Anthem — Medicare HMO/PPO: $2.25 BCBSMN — All Products: $2.25 BCBSMN — MHCP: $2.25 Health Partners — Medicare Advantage: $2.25 iCare — Medicare Advantage: $2.25 Medical Associates — Dialysis Specific: $2.48
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	$1.05 – $34.20
Urine test (automated, without microscope): rates for 10 insurance plans Amerigroup — Medicaid HMO: $1.05 Anthem — Medicaid: $1.05 Group Health Eau Claire — Medicaid HMO: $1.05 Group Health of South Central — Medicaid HMO: $1.05 ICare — Medicaid HMO: $1.05 Iowa Total Care — Medicaid: $1.05 Managed Health Service — Managed Medicaid: $1.05 Molina Health — Managed Medicaid: $1.05 Quartz — Medicaid_Badgercare: $1.05 UHC — Medicaid: $1.05
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: URINALYSIS AUTO W/O SCOPE	Not listed in the file	Not listed in the file	$32.49 – $34.20
Urine test (automated, without microscope): rates for 2 insurance plans Alliance — Comprehensive/All Products: $34.20 Alliance — Premier/All Products: $32.49
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$4.28 – $19.31
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $18.39 Alliance — Comprehensive/All Products: $279.52 Alliance — Premier/All Products: $265.54 Amerigroup — Medicare Advantage: $18.39 Anthem — Medicare HMO/PPO: $18.39 BCBSMN — All Products: $18.39 BCBSMN — MHCP: $18.39 Health Partners — Medicare Advantage: $18.39 iCare — Medicare Advantage: $18.39 Medical Associates — Dialysis Specific: $20.23
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay of psa total	Not listed in the file	Not listed in the file	$4.25 – $279.52
PSA (prostate specific antigen) blood test: rates for 10 insurance plans Amerigroup — Medicaid HMO: $4.25 Anthem — Medicaid: $4.25 Group Health Eau Claire — Medicaid HMO: $4.25 Group Health of South Central — Medicaid HMO: $4.25 ICare — Medicaid HMO: $4.28 Iowa Total Care — Medicaid: $4.25 Managed Health Service — Managed Medicaid: $4.25 Molina Health — Managed Medicaid: $4.25 Quartz — Medicaid_Badgercare: $4.25 UHC — Medicaid: $4.25
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	$4.70 – $17.64
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $16.80 Alliance — Comprehensive/All Products: $255.36 Alliance — Premier/All Products: $242.59 Amerigroup — Medicare Advantage: $16.80 Anthem — Medicare HMO/PPO: $16.80 BCBSMN — All Products: $16.80 BCBSMN — MHCP: $16.80 Health Partners — Medicare Advantage: $16.80 iCare — Medicare Advantage: $16.80 Medical Associates — Dialysis Specific: $18.48
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	$4.65 – $255.36
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans Amerigroup — Medicaid HMO: $4.65 Anthem — Medicaid: $4.65 Group Health Eau Claire — Medicaid HMO: $4.65 Group Health of South Central — Medicaid HMO: $4.65 ICare — Medicaid HMO: $4.70 Iowa Total Care — Medicaid: $4.65 Managed Health Service — Managed Medicaid: $4.65 Molina Health — Managed Medicaid: $4.65 Quartz — Medicaid_Badgercare: $4.65 UHC — Medicaid: $4.65
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: ASSAY THYROID STIM HORMONE	Not listed in the file	Not listed in the file	$242.59 – $255.36
Thyroid stimulating hormone (TSH) test: rates for 2 insurance plans Alliance — Comprehensive/All Products: $255.36 Alliance — Premier/All Products: $242.59
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	$2.11 – $8.16
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $7.77 Alliance — Comprehensive/All Products: $118.12 Alliance — Premier/All Products: $112.21 Amerigroup — Medicare Advantage: $7.77 Anthem — Medicare HMO/PPO: $7.77 BCBSMN — All Products: $7.77 BCBSMN — MHCP: $7.77 Health Partners — Medicare Advantage: $7.77 iCare — Medicare Advantage: $7.77 Medical Associates — Dialysis Specific: $8.55
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	$2.09 – $118.12
Complete blood count (CBC) with differential: rates for 10 insurance plans Amerigroup — Medicaid HMO: $2.09 Anthem — Medicaid: $2.09 Group Health Eau Claire — Medicaid HMO: $2.09 Group Health of South Central — Medicaid HMO: $2.09 ICare — Medicaid HMO: $2.11 Iowa Total Care — Medicaid: $2.09 Managed Health Service — Managed Medicaid: $2.09 Molina Health — Managed Medicaid: $2.09 Quartz — Medicaid_Badgercare: $2.09 UHC — Medicaid: $2.09
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$112.21 – $118.12
Complete blood count (CBC) with differential: rates for 2 insurance plans Alliance — Comprehensive/All Products: $118.12 Alliance — Premier/All Products: $112.21
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	$2.11 – $6.79
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Aetna — Medicare Advantage: $6.47 Alliance — Comprehensive/All Products: $98.36 Alliance — Premier/All Products: $93.44 Amerigroup — Medicare Advantage: $6.47 Anthem — Medicare HMO/PPO: $6.47 BCBSMN — All Products: $6.47 BCBSMN — MHCP: $6.47 Health Partners — Medicare Advantage: $6.47 iCare — Medicare Advantage: $6.47 Medical Associates — Dialysis Specific: $7.12
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	$2.09 – $98.36
Complete blood count (CBC), automated: rates for 10 insurance plans Amerigroup — Medicaid HMO: $2.09 Anthem — Medicaid: $2.09 Group Health Eau Claire — Medicaid HMO: $2.09 Group Health of South Central — Medicaid HMO: $2.09 ICare — Medicaid HMO: $2.11 Iowa Total Care — Medicaid: $2.09 Managed Health Service — Managed Medicaid: $2.09 Molina Health — Managed Medicaid: $2.09 Quartz — Medicaid_Badgercare: $2.09 UHC — Medicaid: $2.09
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	$1.58 – $4.50
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $4.29 Alliance — Comprehensive/All Products: $65.20 Alliance — Premier/All Products: $61.94 Amerigroup — Medicare Advantage: $4.29 Anthem — Medicare HMO/PPO: $4.29 BCBSMN — All Products: $4.29 BCBSMN — MHCP: $4.29 Health Partners — Medicare Advantage: $4.29 iCare — Medicare Advantage: $4.29 Medical Associates — Dialysis Specific: $4.72
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	$1.56 – $65.20
Blood clotting time test (prothrombin time, PT): rates for 10 insurance plans Amerigroup — Medicaid HMO: $1.56 Anthem — Medicaid: $1.56 Group Health Eau Claire — Medicaid HMO: $1.56 Group Health of South Central — Medicaid HMO: $1.56 ICare — Medicaid HMO: $1.58 Iowa Total Care — Medicaid: $1.56 Managed Health Service — Managed Medicaid: $1.56 Molina Health — Managed Medicaid: $1.56 Quartz — Medicaid_Badgercare: $1.56 UHC — Medicaid: $1.56
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier QW In the file: PROTHROMBIN TIME	Not listed in the file	Not listed in the file	$61.94 – $65.20
Blood clotting time test (prothrombin time, PT): rates for 2 insurance plans Alliance — Comprehensive/All Products: $65.20 Alliance — Premier/All Products: $61.94
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	$1.58 – $6.31
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Aetna — Medicare Advantage: $6.01 Alliance — Comprehensive/All Products: $91.36 Alliance — Premier/All Products: $86.79 Amerigroup — Medicare Advantage: $6.01 Anthem — Medicare HMO/PPO: $6.01 BCBSMN — All Products: $6.01 BCBSMN — MHCP: $6.01 Health Partners — Medicare Advantage: $6.01 iCare — Medicare Advantage: $6.01 Medical Associates — Dialysis Specific: $6.61
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	$1.56 – $91.36
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans Amerigroup — Medicaid HMO: $1.56 Anthem — Medicaid: $1.56 Group Health Eau Claire — Medicaid HMO: $1.56 Group Health of South Central — Medicaid HMO: $1.56 ICare — Medicaid HMO: $1.58 Iowa Total Care — Medicaid: $1.56 Managed Health Service — Managed Medicaid: $1.56 Molina Health — Managed Medicaid: $1.56 Quartz — Medicaid_Badgercare: $1.56 UHC — Medicaid: $1.56

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	$104.75 – $138.07
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $110.77 Alliance — Comprehensive/All Products: $1,794.41 Alliance — Premier/All Products: $1,708.96 Amerigroup — Medicare Advantage: $110.77 Anthem — Medicare HMO/PPO: $110.77 BCBSMN — All Products: $233.59 BCBSMN — MHCP: $48.47 Health Partners — Medicare Advantage: $110.77 iCare — Medicare Advantage: $110.77 Medical Associates — Medicare Advantage: $110.77
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$48.47 – $1,794.41
CT scan of the head or brain, without contrast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $144.33 Anthem — Medicaid: $144.33 Group Health Eau Claire — Medicaid HMO: $144.33 Group Health of South Central — Medicaid HMO: $144.33 ICare — Medicaid HMO: $138.07 Iowa Total Care — Medicaid: $144.33 Managed Health Service — Managed Medicaid: $144.33 Molina Health — Managed Medicaid: $144.33 Quartz — Medicaid_Badgercare: $144.33 UHC — Medicaid: $144.33
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	$173.56 – $384.74
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $369.65 Alliance — Comprehensive/All Products: $5,988.02 Alliance — Premier/All Products: $5,702.88 Amerigroup — Medicare Advantage: $369.65 Anthem — Medicare HMO/PPO: $369.65 BCBSMN — All Products: $805.20 BCBSMN — MHCP: $167.08 Health Partners — Medicare Advantage: $369.65 iCare — Medicare Advantage: $369.65 Medical Associates — Medicare Advantage: $369.65
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	$167.08 – $5,988.02
MRI of the brain, before and after contrast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $177.62 Anthem — Medicaid: $177.62 Group Health Eau Claire — Medicaid HMO: $177.62 Group Health of South Central — Medicaid HMO: $177.62 ICare — Medicaid HMO: $173.56 Iowa Total Care — Medicaid: $177.62 Managed Health Service — Managed Medicaid: $177.62 Molina Health — Managed Medicaid: $177.62 Quartz — Medicaid_Badgercare: $177.62 UHC — Medicaid: $177.62
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	$23.94 – $92.21
Chest X-ray, 2 views: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $92.21 Alliance — Comprehensive/All Products: $1,493.69 Alliance — Premier/All Products: $1,422.56 Amerigroup — Medicare Advantage: $92.21 Anthem — Medicare HMO/PPO: $92.21 BCBSMN — All Products: $189.88 BCBSMN — MHCP: $39.40 Health Partners — Medicare Advantage: $92.21 iCare — Medicare Advantage: $92.21 Medical Associates — Medicare Advantage: $92.21
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	$24.82 – $1,493.69
Chest X-ray, 2 views: rates for 10 insurance plans Amerigroup — Medicaid HMO: $24.82 Anthem — Medicaid: $24.82 Group Health Eau Claire — Medicaid HMO: $24.82 Group Health of South Central — Medicaid HMO: $24.82 ICare — Medicaid HMO: $23.94 Iowa Total Care — Medicaid: $24.82 Managed Health Service — Managed Medicaid: $24.82 Molina Health — Managed Medicaid: $24.82 Quartz — Medicaid_Badgercare: $24.82 UHC — Medicaid: $24.82
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	$23.94 – $110.77
X-ray of the lower spine, at least 4 views: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $110.77 Alliance — Comprehensive/All Products: $1,794.41 Alliance — Premier/All Products: $1,708.96 Amerigroup — Medicare Advantage: $110.77 Anthem — Medicare HMO/PPO: $110.77 BCBSMN — All Products: $233.59 BCBSMN — MHCP: $48.47 Health Partners — Medicare Advantage: $110.77 iCare — Medicare Advantage: $110.77 Medical Associates — Medicare Advantage: $110.77
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	$24.82 – $1,794.41
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans Amerigroup — Medicaid HMO: $24.82 Anthem — Medicaid: $24.82 Group Health Eau Claire — Medicaid HMO: $24.82 Group Health of South Central — Medicaid HMO: $24.82 ICare — Medicaid HMO: $23.94 Iowa Total Care — Medicaid: $24.82 Managed Health Service — Managed Medicaid: $24.82 Molina Health — Managed Medicaid: $24.82 Quartz — Medicaid_Badgercare: $24.82 UHC — Medicaid: $24.82
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	$103.19 – $252.81
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $252.81 Alliance — Comprehensive/All Products: $4,095.34 Alliance — Premier/All Products: $3,900.32 Amerigroup — Medicare Advantage: $252.81 Anthem — Medicare HMO/PPO: $252.81 BCBSMN — All Products: $510.36 BCBSMN — MHCP: $105.90 Health Partners — Medicare Advantage: $252.81 iCare — Medicare Advantage: $252.81 Medical Associates — Medicare Advantage: $252.81
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	$105.90 – $4,095.34
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $106.82 Anthem — Medicaid: $106.82 Group Health Eau Claire — Medicaid HMO: $106.82 Group Health of South Central — Medicaid HMO: $106.82 ICare — Medicaid HMO: $103.19 Iowa Total Care — Medicaid: $106.82 Managed Health Service — Managed Medicaid: $106.82 Molina Health — Managed Medicaid: $106.82 Quartz — Medicaid_Badgercare: $106.82 UHC — Medicaid: $106.82
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	$138.07 – $185.84
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $185.84 Alliance — Comprehensive/All Products: $3,010.56 Alliance — Premier/All Products: $2,867.20 Amerigroup — Medicare Advantage: $185.84 Anthem — Medicare HMO/PPO: $185.84 BCBSMN — All Products: $394.13 BCBSMN — MHCP: $81.78 Health Partners — Medicare Advantage: $185.84 iCare — Medicare Advantage: $185.84 Medical Associates — Medicare Advantage: $185.84
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	$81.78 – $3,010.56
CT scan of the pelvis, with contrast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $144.33 Anthem — Medicaid: $144.33 Group Health Eau Claire — Medicaid HMO: $144.33 Group Health of South Central — Medicaid HMO: $144.33 ICare — Medicaid HMO: $138.07 Iowa Total Care — Medicaid: $144.33 Managed Health Service — Managed Medicaid: $144.33 Molina Health — Managed Medicaid: $144.33 Quartz — Medicaid_Badgercare: $144.33 UHC — Medicaid: $144.33
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	$103.19 – $252.81
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $252.81 Alliance — Comprehensive/All Products: $4,095.34 Alliance — Premier/All Products: $3,900.32 Amerigroup — Medicare Advantage: $252.81 Anthem — Medicare HMO/PPO: $252.81 BCBSMN — All Products: $510.36 BCBSMN — MHCP: $105.90 Health Partners — Medicare Advantage: $252.81 iCare — Medicare Advantage: $252.81 Medical Associates — Medicare Advantage: $252.81
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	$105.90 – $4,095.34
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $106.82 Anthem — Medicaid: $106.82 Group Health Eau Claire — Medicaid HMO: $106.82 Group Health of South Central — Medicaid HMO: $106.82 ICare — Medicaid HMO: $103.19 Iowa Total Care — Medicaid: $106.82 Managed Health Service — Managed Medicaid: $106.82 Molina Health — Managed Medicaid: $106.82 Quartz — Medicaid_Badgercare: $106.82 UHC — Medicaid: $106.82
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	$138.07 – $384.74
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $369.65 Alliance — Comprehensive/All Products: $5,988.02 Alliance — Premier/All Products: $5,702.88 Amerigroup — Medicare Advantage: $369.65 Anthem — Medicare HMO/PPO: $369.65 BCBSMN — All Products: $805.20 BCBSMN — MHCP: $167.08 Health Partners — Medicare Advantage: $369.65 iCare — Medicare Advantage: $369.65 Medical Associates — Medicare Advantage: $369.65
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelv w/contrast	Not listed in the file	Not listed in the file	$144.33 – $5,988.02
CT scan of the abdomen and pelvis, with contrast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $144.33 Anthem — Medicaid: $144.33 Group Health Eau Claire — Medicaid HMO: $144.33 Group Health of South Central — Medicaid HMO: $144.33 ICare — Medicaid HMO: $138.07 Iowa Total Care — Medicaid: $144.33 Managed Health Service — Managed Medicaid: $144.33 Molina Health — Managed Medicaid: $144.33 Quartz — Medicaid_Badgercare: $144.33 UHC — Medicaid: $144.33
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	$71.11 – $110.77
Ultrasound of the abdomen, complete: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $110.77 Alliance — Comprehensive/All Products: $491.33 Alliance — Premier/All Products: $427.24 Amerigroup — Medicare Advantage: $110.77 Anthem — Medicare HMO/PPO: $110.77 BCBSMN — All Products: $233.59 BCBSMN — MHCP: $48.47 Health Partners — Medicare Advantage: $110.77 iCare — Medicare Advantage: $110.77 Medical Associates — Medicare Advantage: $110.77
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	$48.47 – $491.33
Ultrasound of the abdomen, complete: rates for 10 insurance plans Amerigroup — Medicaid HMO: $73.45 Anthem — Medicaid: $73.45 Group Health Eau Claire — Medicaid HMO: $73.45 Group Health of South Central — Medicaid HMO: $73.45 ICare — Medicaid HMO: $71.11 Iowa Total Care — Medicaid: $73.45 Managed Health Service — Managed Medicaid: $73.45 Molina Health — Managed Medicaid: $73.45 Quartz — Medicaid_Badgercare: $73.45 UHC — Medicaid: $73.45
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	$43.05 – $110.77
Pregnancy ultrasound (after the first trimester): 10 of 15 insurance plan rates Aetna — Medicare Advantage: $110.77 Alliance — Comprehensive/All Products: $491.33 Alliance — Premier/All Products: $427.24 Amerigroup — Medicare Advantage: $110.77 Anthem — Medicare HMO/PPO: $110.77 BCBSMN — All Products: $233.59 BCBSMN — MHCP: $48.47 Health Partners — Medicare Advantage: $110.77 iCare — Medicare Advantage: $110.77 Medical Associates — Medicare Advantage: $110.77
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	$43.84 – $491.33
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans Amerigroup — Medicaid HMO: $43.84 Anthem — Medicaid: $43.84 Group Health Eau Claire — Medicaid HMO: $43.84 Group Health of South Central — Medicaid HMO: $43.84 ICare — Medicaid HMO: $43.05 Iowa Total Care — Medicaid: $43.84 Managed Health Service — Managed Medicaid: $43.84 Molina Health — Managed Medicaid: $43.84 Quartz — Medicaid_Badgercare: $43.84 UHC — Medicaid: $43.84
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	$46.95 – $110.77
Transvaginal ultrasound: 10 of 15 insurance plan rates Aetna — Medicare Advantage: $110.77 Alliance — Comprehensive/All Products: $491.33 Alliance — Premier/All Products: $427.24 Amerigroup — Medicare Advantage: $110.77 Anthem — Medicare HMO/PPO: $110.77 BCBSMN — All Products: $233.59 BCBSMN — MHCP: $48.47 Health Partners — Medicare Advantage: $110.77 iCare — Medicare Advantage: $110.77 Medical Associates — Medicare Advantage: $110.77
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	$48.47 – $491.33
Transvaginal ultrasound: rates for 10 insurance plans Amerigroup — Medicaid HMO: $48.71 Anthem — Medicaid: $48.71 Group Health Eau Claire — Medicaid HMO: $48.71 Group Health of South Central — Medicaid HMO: $48.71 ICare — Medicaid HMO: $46.95 Iowa Total Care — Medicaid: $48.71 Managed Health Service — Managed Medicaid: $48.71 Molina Health — Managed Medicaid: $48.71 Quartz — Medicaid_Badgercare: $48.71 UHC — Medicaid: $48.71
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	$20.16 – $168.11
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $168.11 Alliance — Premier/All Products: $495.68 Amerigroup — Medicare Advantage: $168.11 Anthem — Medicare HMO/PPO: $168.11 BCBSMN — All Products: $240.34 BCBSMN — MHCP: $240.34 Health Partners — Medicare Advantage: $168.11 iCare — Medicare Advantage: $168.11 Medical Associates — Medicare Advantage: $168.11 Quartz — Medicare Advantage: $118.52
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	$20.47 – $495.68
Diagnostic mammogram, one breast: rates for 10 insurance plans Amerigroup — Medicaid HMO: $20.47 Anthem — Medicaid: $20.47 Group Health Eau Claire — Medicaid HMO: $20.47 Group Health of South Central — Medicaid HMO: $20.47 ICare — Medicaid HMO: $20.16 Iowa Total Care — Medicaid: $20.47 Managed Health Service — Managed Medicaid: $20.47 Molina Health — Managed Medicaid: $20.47 Quartz — Medicaid_Badgercare: $20.47 UHC — Medicaid: $20.47
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$150.96
Diagnostic mammogram, one breast: rates for 1 insurance plan Alliance — Premier/All Products: $150.96
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	$20.16 – $213.08
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $213.08 Alliance — Premier/All Products: $627.92 Amerigroup — Medicare Advantage: $213.08 Anthem — Medicare HMO/PPO: $213.08 BCBSMN — All Products: $302.98 BCBSMN — MHCP: $302.98 Health Partners — Medicare Advantage: $213.08 iCare — Medicare Advantage: $213.08 Medical Associates — Medicare Advantage: $213.08 Quartz — Medicare Advantage: $150.03
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	$20.47 – $627.92
Diagnostic mammogram, both breasts: rates for 10 insurance plans Amerigroup — Medicaid HMO: $20.47 Anthem — Medicaid: $20.47 Group Health Eau Claire — Medicaid HMO: $20.47 Group Health of South Central — Medicaid HMO: $20.47 ICare — Medicaid HMO: $20.16 Iowa Total Care — Medicaid: $20.47 Managed Health Service — Managed Medicaid: $20.47 Molina Health — Managed Medicaid: $20.47 Quartz — Medicaid_Badgercare: $20.47 UHC — Medicaid: $20.47
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$185.72
Diagnostic mammogram, both breasts: rates for 1 insurance plan Alliance — Premier/All Products: $185.72
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	$20.16 – $172.34
Screening mammogram, both breasts: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $172.34 Alliance — Premier/All Products: $505.04 Amerigroup — Medicare Advantage: $172.34 Anthem — Medicare HMO/PPO: $172.34 BCBSMN — All Products: $246.09 BCBSMN — MHCP: $246.09 Health Partners — Medicare Advantage: $172.34 iCare — Medicare Advantage: $172.34 Medical Associates — Medicare Advantage: $172.34 Quartz — Medicare Advantage: $120.91
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$20.47 – $505.04
Screening mammogram, both breasts: rates for 10 insurance plans Amerigroup — Medicaid HMO: $20.47 Anthem — Medicaid: $20.47 Group Health Eau Claire — Medicaid HMO: $20.47 Group Health of South Central — Medicaid HMO: $20.47 ICare — Medicaid HMO: $20.16 Iowa Total Care — Medicaid: $20.47 Managed Health Service — Managed Medicaid: $20.47 Molina Health — Managed Medicaid: $20.47 Quartz — Medicaid_Badgercare: $20.47 UHC — Medicaid: $20.47
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$140.28
Screening mammogram, both breasts: rates for 1 insurance plan Alliance — Premier/All Products: $140.28

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	$11.76 – $70.66
Electrocardiogram (ECG/EKG) with reading: rates for 10 insurance plans Amerigroup — Medicaid HMO: $11.76 Anthem — Medicaid: $11.76 Group Health Eau Claire — Medicaid HMO: $11.76 Group Health of South Central — Medicaid HMO: $11.76 ICare — Medicaid HMO: $11.19 Iowa Total Care — Medicaid: $11.76 Managed Health Service — Managed Medicaid: $11.76 Molina Health — Managed Medicaid: $11.76 Quartz — Medicaid_Badgercare: $11.76 UHC — Medicaid: $11.76
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	$11.76 – $70.66
Electrocardiogram (ECG/EKG) with reading: rates for 4 insurance plans Alliance — Comprehensive/All Products: $70.66 Alliance — Premier/All Products: $61.44 BCBSMN — All Products: $25.09 BCBSMN — MHCP: $25.09
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	$1,065.61 – $16,052
Left heart catheterization (diagnostic): 10 of 17 insurance plan rates Aetna — Medicare Advantage: $3,434.96 Amerigroup — Medicare Advantage: $3,434.96 Anthem — HMO/POS: $12,021 Anthem — Medicare HMO/PPO: $3,434.96 Anthem — PPO: $16,052 Anthem — State Specific: $10,901 BCBSMN — All Products: $6,465.71 BCBSMN — MHCP: $1,341.66 Health Partners — Medicare Advantage: $3,434.96 iCare — Medicare Advantage: $3,434.96
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	$1,111.19 – $6,465.71
Left heart catheterization (diagnostic): rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,111.19 Anthem — Medicaid: $1,111.19 Group Health Eau Claire — Medicaid HMO: $1,111.19 Group Health of South Central — Medicaid HMO: $1,111.19 ICare — Medicaid HMO: $1,065.61 Iowa Total Care — Medicaid: $1,111.19 Managed Health Service — Managed Medicaid: $1,111.19 Molina Health — Managed Medicaid: $1,111.19 Quartz — Medicaid_Badgercare: $1,111.19 UHC — Medicaid: $1,111.19
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	$2,935.25 – $10,544
Heart rhythm study (electrophysiology evaluation): 10 of 14 insurance plan rates Aetna — Medicare Advantage: $8,264.08 Amerigroup — Medicare Advantage: $8,264.08 Anthem — Medicare HMO/PPO: $8,264.08 BCBSMN — All Products: $14,714.43 BCBSMN — MHCP: $3,053.30 Health Partners — Medicare Advantage: $8,264.08 iCare — Medicare Advantage: $8,264.08 Medical Associates — All Products: $10,544 Medical Associates — Medicare Advantage: $8,264.08 Quartz — Medicare Advantage: $8,264.08
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrophysiology evaluation	Not listed in the file	Not listed in the file	$2,965.73 – $14,714.43
Heart rhythm study (electrophysiology evaluation): rates for 10 insurance plans Amerigroup — Medicaid HMO: $2,965.73 Anthem — Medicaid: $2,965.73 Group Health Eau Claire — Medicaid HMO: $2,965.73 Group Health of South Central — Medicaid HMO: $2,965.73 ICare — Medicaid HMO: $2,935.25 Iowa Total Care — Medicaid: $2,965.73 Managed Health Service — Managed Medicaid: $2,965.73 Molina Health — Managed Medicaid: $2,965.73 Quartz — Medicaid_Badgercare: $2,965.73 UHC — Medicaid: $2,965.73
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	$7,323.26 – $27,694.17
Heart rhythm study with ablation for atrial fibrillation: 10 of 17 insurance plan rates Aetna — Medicare Advantage: $27,694.17 Amerigroup — Medicare Advantage: $27,694.17 Anthem — HMO/POS: $20,399 Anthem — Medicare HMO/PPO: $27,694.17 Anthem — PPO: $24,968 Anthem — State Specific: $19,380 BCBSMN — All Products: $51,318.36 BCBSMN — MHCP: $10,648.77 Health Partners — Medicare Advantage: $27,694.17 iCare — Medicare Advantage: $27,694.17
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	$7,742.17 – $51,318.36
Heart rhythm study with ablation for atrial fibrillation: rates for 10 insurance plans Amerigroup — Medicaid HMO: $7,742.17 Anthem — Medicaid: $7,742.17 Group Health Eau Claire — Medicaid HMO: $7,742.17 Group Health of South Central — Medicaid HMO: $7,742.17 ICare — Medicaid HMO: $7,323.26 Iowa Total Care — Medicaid: $7,742.17 Managed Health Service — Managed Medicaid: $7,742.17 Molina Health — Managed Medicaid: $7,742.17 Quartz — Medicaid_Badgercare: $7,742.17 UHC — Medicaid: $7,742.17
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	$330.23 – $1,045.99
Sleep study (overnight, in a sleep lab): 10 of 13 insurance plan rates Aetna — Medicare Advantage: $909.87 Amerigroup — Medicare Advantage: $909.87 Anthem — Medicare HMO/PPO: $909.87 BCBSMN — All Products: $2,042.09 BCBSMN — MHCP: $423.74 Health Partners — Medicare Advantage: $909.87 iCare — Medicare Advantage: $909.87 Medical Associates — Medicare Advantage: $909.87 Quartz — Medicare Advantage: $909.87 UCARE — Dually Eligible: $996.18
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	$333.28 – $2,042.09
Sleep study (overnight, in a sleep lab): rates for 10 insurance plans Amerigroup — Medicaid HMO: $333.28 Anthem — Medicaid: $333.28 Group Health Eau Claire — Medicaid HMO: $333.28 Group Health of South Central — Medicaid HMO: $333.28 ICare — Medicaid HMO: $330.23 Iowa Total Care — Medicaid: $333.28 Managed Health Service — Managed Medicaid: $333.28 Molina Health — Managed Medicaid: $333.28 Quartz — Medicaid_Badgercare: $333.28 UHC — Medicaid: $333.28

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THERAPEUTIC EXERCISES	Not listed in the file	Not listed in the file	$15.21 – $37.31
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $37.31 Alliance — Comprehensive/All Products: $133.68 Amerigroup — Medicare Advantage: $37.31 Anthem — Medicare HMO/PPO: $37.31 BCBSMN — All Products: $37.83 BCBSMN — MHCP: $37.83 Health Partners — Medicare Advantage: $37.31 iCare — Medicare Advantage: $37.31 Medical Associates — Medicare Advantage: $37.31 Quartz — Medicare Advantage: $28.25
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	$15.39 – $133.68
Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans Amerigroup — Medicaid HMO: $15.39 Anthem — Medicaid: $15.39 Group Health Eau Claire — Medicaid HMO: $15.39 Group Health of South Central — Medicaid HMO: $15.39 ICare — Medicaid HMO: $15.21 Iowa Total Care — Medicaid: $15.39 Managed Health Service — Managed Medicaid: $15.39 Molina Health — Managed Medicaid: $15.39 Quartz — Medicaid_Badgercare: $15.39 UHC — Medicaid: $15.39
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$95.70 – $126.43
Physical therapy evaluation (low complexity): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $126.43 Alliance — Comprehensive/All Products: $450.16 Amerigroup — Medicare Advantage: $126.43 Anthem — Medicare HMO/PPO: $126.43 BCBSMN — All Products: $128.97 BCBSMN — MHCP: $128.97 Health Partners — Medicare Advantage: $126.43 iCare — Medicare Advantage: $126.43 Medical Associates — Medicare Advantage: $126.43 Quartz — Medicare Advantage: $95.70
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	$109.40 – $450.16
Physical therapy evaluation (low complexity): rates for 10 insurance plans Amerigroup — Medicaid HMO: $109.40 Anthem — Medicaid: $109.40 Group Health Eau Claire — Medicaid HMO: $109.40 Group Health of South Central — Medicaid HMO: $109.40 ICare — Medicaid HMO: $100.33 Iowa Total Care — Medicaid: $109.40 Managed Health Service — Managed Medicaid: $109.40 Molina Health — Managed Medicaid: $109.40 Quartz — Medicaid_Badgercare: $109.40 UHC — Medicaid: $109.40
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$95.70 – $126.43
Physical therapy evaluation (moderate complexity): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $126.43 Alliance — Comprehensive/All Products: $450.16 Amerigroup — Medicare Advantage: $126.43 Anthem — Medicare HMO/PPO: $126.43 BCBSMN — All Products: $128.97 BCBSMN — MHCP: $128.97 Health Partners — Medicare Advantage: $126.43 iCare — Medicare Advantage: $126.43 Medical Associates — Medicare Advantage: $126.43 Quartz — Medicare Advantage: $95.70
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	$109.40 – $450.16
Physical therapy evaluation (moderate complexity): rates for 10 insurance plans Amerigroup — Medicaid HMO: $109.40 Anthem — Medicaid: $109.40 Group Health Eau Claire — Medicaid HMO: $109.40 Group Health of South Central — Medicaid HMO: $109.40 ICare — Medicaid HMO: $100.33 Iowa Total Care — Medicaid: $109.40 Managed Health Service — Managed Medicaid: $109.40 Molina Health — Managed Medicaid: $109.40 Quartz — Medicaid_Badgercare: $109.40 UHC — Medicaid: $109.40
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$95.70 – $126.43
Physical therapy evaluation (high complexity): 10 of 11 insurance plan rates Aetna — Medicare Advantage: $126.43 Alliance — Comprehensive/All Products: $450.16 Amerigroup — Medicare Advantage: $126.43 Anthem — Medicare HMO/PPO: $126.43 BCBSMN — All Products: $128.97 BCBSMN — MHCP: $128.97 Health Partners — Medicare Advantage: $126.43 iCare — Medicare Advantage: $126.43 Medical Associates — Medicare Advantage: $126.43 Quartz — Medicare Advantage: $95.70
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	$109.40 – $450.16
Physical therapy evaluation (high complexity): rates for 10 insurance plans Amerigroup — Medicaid HMO: $109.40 Anthem — Medicaid: $109.40 Group Health Eau Claire — Medicaid HMO: $109.40 Group Health of South Central — Medicaid HMO: $109.40 ICare — Medicaid HMO: $100.33 Iowa Total Care — Medicaid: $109.40 Managed Health Service — Managed Medicaid: $109.40 Molina Health — Managed Medicaid: $109.40 Quartz — Medicaid_Badgercare: $109.40 UHC — Medicaid: $109.40
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 90832 PSYCHOTHERAPY 30 MIN MNTL	$131	$52.40	$55.89 – $188.06
Psychotherapy, 30 minutes: 10 of 60 insurance plan rates Aetna — All Products: $117.90 Aetna — Medicare Advantage: $188.06 Alliance — Comprehensive/All Products: $103.10 Alliance — Premier/All Products: $102.26 Allied National General — HMO/PPO: $111.35 Amerigroup — Medicaid HMO: $54.45 Amerigroup — Medicare Advantage: $188.06 Anthem — HMO/POS: $103.49 Anthem — Medicaid: $54.45 Anthem — Medicare HMO/PPO: $188.06
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 90832 PSYCHOTHERAPY 30 MIN MNTL	$131	$52.40	$43.75 – $127.07
Psychotherapy, 30 minutes: rates for 1 insurance plan Quartz — All Other Self Funded: $77.16
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 90834 PSYCHOTHERAPY 45 MIN MNTL	$297	$118.80	$62.88 – $188.06
Psychotherapy, 45 minutes: 10 of 60 insurance plan rates Aetna — All Products: $267.30 Aetna — Medicare Advantage: $188.06 Alliance — Comprehensive/All Products: $233.74 Alliance — Premier/All Products: $231.84 Allied National General — HMO/PPO: $252.45 Amerigroup — Medicaid HMO: $60.37 Amerigroup — Medicare Advantage: $188.06 Anthem — HMO/POS: $234.63 Anthem — Medicaid: $60.37 Anthem — Medicare HMO/PPO: $188.06
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 90834 PSYCHOTHERAPY 45 MIN MNTL	$297	$118.80	$99.20 – $288.09
Psychotherapy, 45 minutes: rates for 1 insurance plan Quartz — All Other Self Funded: $174.93
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 90837 PSYCHOTHERAPY 60 MIN MNTL	$260	$104	$62.88 – $188.06
Psychotherapy, 60 minutes: 10 of 60 insurance plan rates Aetna — All Products: $234 Aetna — Medicare Advantage: $188.06 Alliance — Comprehensive/All Products: $204.62 Alliance — Premier/All Products: $202.96 Allied National General — HMO/PPO: $221 Amerigroup — Medicaid HMO: $60.37 Amerigroup — Medicare Advantage: $188.06 Anthem — HMO/POS: $205.40 Anthem — Medicaid: $60.37 Anthem — Medicare HMO/PPO: $188.06
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 90837 PSYCHOTHERAPY 60 MIN MNTL	$260	$104	$86.84 – $252.20
Psychotherapy, 60 minutes: rates for 1 insurance plan Quartz — All Other Self Funded: $153.14
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 90846 FAM PSYCHOTHERAPY W/O PATIENT, 50 MIN	$287	$114.80	$66.72 – $188.06
Family psychotherapy, without the patient: 10 of 60 insurance plan rates Aetna — All Products: $258.30 Aetna — Medicare Advantage: $188.06 Alliance — Comprehensive/All Products: $225.87 Alliance — Premier/All Products: $224.03 Allied National General — HMO/PPO: $243.95 Amerigroup — Medicaid HMO: $71.85 Amerigroup — Medicare Advantage: $188.06 Anthem — HMO/POS: $226.73 Anthem — Medicaid: $71.85 Anthem — Medicare HMO/PPO: $188.06
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 90846 FAM PSYCHOTHERAPY W/O PATIENT, 50 MIN	$287	$114.80	$95.86 – $278.39
Family psychotherapy, without the patient: rates for 1 insurance plan Quartz — All Other Self Funded: $169.04
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 90847 FAMILY PSYCHOTHERAPY W/PT PRESENT, 50 MIN	$283	$113.20	$66.72 – $188.06
Family psychotherapy, with the patient: 10 of 60 insurance plan rates Aetna — All Products: $254.70 Aetna — Medicare Advantage: $188.06 Alliance — Comprehensive/All Products: $222.72 Alliance — Premier/All Products: $220.91 Allied National General — HMO/PPO: $240.55 Amerigroup — Medicaid HMO: $71.85 Amerigroup — Medicare Advantage: $188.06 Anthem — HMO/POS: $223.57 Anthem — Medicaid: $71.85 Anthem — Medicare HMO/PPO: $188.06
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 90847 FAMILY PSYCHOTHERAPY W/PT PRESENT, 50 MIN	$283	$113.20	$94.52 – $274.51
Family psychotherapy, with the patient: rates for 1 insurance plan Quartz — All Other Self Funded: $166.69
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 90853 GROUP PSYCHOTHERAPY	$142	$56.80	$84.93 – $108.46
Group psychotherapy: 10 of 60 insurance plan rates Aetna — All Products: $127.80 Aetna — Medicare Advantage: $107.64 Alliance — Comprehensive/All Products: $111.75 Alliance — Premier/All Products: $110.85 Allied National General — HMO/PPO: $120.70 Amerigroup — Medicaid HMO: $106.64 Amerigroup — Medicare Advantage: $107.64 Anthem — HMO/POS: $112.18 Anthem — Medicaid: $106.64 Anthem — Medicare HMO/PPO: $107.64
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 90853 GROUP PSYCHOTHERAPY	$142	$56.80	$47.43 – $137.74
Group psychotherapy: rates for 1 insurance plan Quartz — All Other Self Funded: $83.64

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: HCHG 19120 EXCISION CYST BREAST	$5,713	$2,285.20	$571.19 – $16,052
Removal of breast growth (open surgery): 10 of 60 insurance plan rates Aetna — All Products: $5,141.70 Aetna — Medicare Advantage: $4,148.57 Alliance — Comprehensive/All Products: $4,496.13 Alliance — Premier/All Products: $4,459.57 Allied National General — HMO/PPO: $4,856.05 Amerigroup — Medicaid HMO: $599.65 Amerigroup — Medicare Advantage: $4,148.57 Anthem — HMO/POS: $12,021 Anthem — Medicaid: $599.65 Anthem — Medicare HMO/PPO: $4,148.57
Removal of breast growth (open surgery) CPT 19120 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 19120 EXCISION CYST BREAST	$5,713	$2,285.20	$1,908.14 – $5,541.61
Removal of breast growth (open surgery): rates for 1 insurance plan Quartz — All Other Self Funded: $3,364.96
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$2,338.56 – $11,269.97
Removal of breast growth (open surgery): rates for 2 insurance plans BCBSMN — All Products: $11,269.97 BCBSMN — MHCP: $2,338.56
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	$4,060.18 – $27,825
Total hip replacement: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $13,603.13 Alliance — Comprehensive/All Products: $60,337.10 Alliance — Premier/All Products: $52,467.04 Amerigroup — Medicare Advantage: $13,603.13 Anthem — HMO/POS: $20,837 Anthem — Medicare HMO/PPO: $13,603.13 Anthem — PPO: $27,825 Anthem — State Specific: $18,896 BCBSMN — All Products: $28,516.58 BCBSMN — MHCP: $5,917.30
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	$4,156.30 – $60,337.10
Total hip replacement: rates for 10 insurance plans Amerigroup — Medicaid HMO: $4,156.30 Anthem — Medicaid: $4,156.30 Group Health Eau Claire — Medicaid HMO: $4,156.30 Group Health of South Central — Medicaid HMO: $4,156.30 ICare — Medicaid HMO: $4,060.18 Iowa Total Care — Medicaid: $4,156.30 Managed Health Service — Managed Medicaid: $4,156.30 Molina Health — Managed Medicaid: $4,156.30 Quartz — Medicaid_Badgercare: $4,156.30 UHC — Medicaid: $4,156.30
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$8,875.96 – $42,774.87
Total hip replacement: rates for 2 insurance plans BCBSMN — All Products: $42,774.87 BCBSMN — MHCP: $8,875.96
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	$4,060.18 – $29,959
Total knee replacement: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $13,603.13 Alliance — Comprehensive/All Products: $60,337.10 Alliance — Premier/All Products: $52,467.04 Amerigroup — Medicare Advantage: $13,603.13 Anthem — HMO/POS: $22,439 Anthem — Medicare HMO/PPO: $13,603.13 Anthem — PPO: $29,959 Anthem — State Specific: $20,349 BCBSMN — All Products: $28,516.58 BCBSMN — MHCP: $5,917.30
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	$4,156.30 – $60,337.10
Total knee replacement: rates for 10 insurance plans Amerigroup — Medicaid HMO: $4,156.30 Anthem — Medicaid: $4,156.30 Group Health Eau Claire — Medicaid HMO: $4,156.30 Group Health of South Central — Medicaid HMO: $4,156.30 ICare — Medicaid HMO: $4,060.18 Iowa Total Care — Medicaid: $4,156.30 Managed Health Service — Managed Medicaid: $4,156.30 Molina Health — Managed Medicaid: $4,156.30 Quartz — Medicaid_Badgercare: $4,156.30 UHC — Medicaid: $4,156.30
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$8,875.96 – $42,774.87
Total knee replacement: rates for 2 insurance plans BCBSMN — All Products: $42,774.87 BCBSMN — MHCP: $8,875.96
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.) – $962.88
Shoulder arthroscopy: shaving of shoulder bone: rates for 10 insurance plans Amerigroup — Medicaid HMO: $962.88 Anthem — Medicaid: $962.88 Group Health Eau Claire — Medicaid HMO: $962.88 Group Health of South Central — Medicaid HMO: $962.88 ICare — Medicaid HMO: $934.72 Iowa Total Care — Medicaid: $962.88 Managed Health Service — Managed Medicaid: $962.88 Molina Health — Managed Medicaid: $962.88 Quartz — Medicaid_Badgercare: $962.88 UHC — Medicaid: $962.88
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.) – $962.88
Shoulder arthroscopy: shaving of shoulder bone: rates for 3 insurance plans BCBSMN — All Products: $1 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCBSMN — MHCP: $1 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Medical Associates — All Products: $991
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$1.50 (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 2 insurance plans BCBSMN — All Products: $1.50 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) BCBSMN — MHCP: $1.50 (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: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$934.72 – $16,052
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $3,466.82 Alliance — Comprehensive/All Products: $15,377.20 Alliance — Premier/All Products: $13,371.48 Amerigroup — Medicare Advantage: $3,466.82 Anthem — HMO/POS: $12,021 Anthem — Medicare HMO/PPO: $3,466.82 Anthem — PPO: $16,052 Anthem — State Specific: $10,901 BCBSMN — All Products: $6,505.49 BCBSMN — MHCP: $1,349.92
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	$962.88 – $15,377.20
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 10 insurance plans Amerigroup — Medicaid HMO: $962.88 Anthem — Medicaid: $962.88 Group Health Eau Claire — Medicaid HMO: $962.88 Group Health of South Central — Medicaid HMO: $962.88 ICare — Medicaid HMO: $934.72 Iowa Total Care — Medicaid: $962.88 Managed Health Service — Managed Medicaid: $962.88 Molina Health — Managed Medicaid: $962.88 Quartz — Medicaid_Badgercare: $962.88 UHC — Medicaid: $962.88
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$2,024.87 – $9,758.24
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 2 insurance plans BCBSMN — All Products: $9,758.24 BCBSMN — MHCP: $2,024.87
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	$929.44 – $20,984
Removal of tonsils and adenoids (under age 12): 10 of 17 insurance plan rates Aetna — Medicare Advantage: $6,272.31 Amerigroup — Medicare Advantage: $6,272.31 Anthem — HMO/POS: $17,486 Anthem — Medicare HMO/PPO: $6,272.31 Anthem — PPO: $20,984 Anthem — State Specific: $16,052 BCBSMN — All Products: $11,669.85 BCBSMN — MHCP: $2,421.54 Health Partners — Medicare Advantage: $6,272.31 iCare — Medicare Advantage: $6,272.31
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	$948.86 – $11,669.85
Removal of tonsils and adenoids (under age 12): rates for 10 insurance plans Amerigroup — Medicaid HMO: $948.86 Anthem — Medicaid: $948.86 Group Health Eau Claire — Medicaid HMO: $948.86 Group Health of South Central — Medicaid HMO: $948.86 ICare — Medicaid HMO: $929.44 Iowa Total Care — Medicaid: $948.86 Managed Health Service — Managed Medicaid: $948.86 Molina Health — Managed Medicaid: $948.86 Quartz — Medicaid_Badgercare: $948.86 UHC — Medicaid: $948.86
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	$432.56 – $7,135
Upper GI endoscopy (diagnostic): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $960.99 Alliance — Comprehensive/All Products: $4,262.50 Alliance — Premier/All Products: $3,706.52 Amerigroup — Medicare Advantage: $960.99 Anthem — HMO/POS: $5,830 Anthem — Medicare HMO/PPO: $960.99 Anthem — PPO: $7,135 Anthem — State Specific: $5,537 BCBSMN — All Products: $1,804.15 BCBSMN — MHCP: $374.37
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	$374.37 – $4,262.50
Upper GI endoscopy (diagnostic): rates for 10 insurance plans Amerigroup — Medicaid HMO: $452.72 Anthem — Medicaid: $452.72 Group Health Eau Claire — Medicaid HMO: $452.72 Group Health of South Central — Medicaid HMO: $452.72 ICare — Medicaid HMO: $432.56 Iowa Total Care — Medicaid: $452.72 Managed Health Service — Managed Medicaid: $452.72 Molina Health — Managed Medicaid: $452.72 Quartz — Medicaid_Badgercare: $452.72 UHC — Medicaid: $452.72
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	$432.56 – $7,135
Upper GI endoscopy with biopsy: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $960.99 Alliance — Comprehensive/All Products: $4,262.50 Alliance — Premier/All Products: $3,706.52 Amerigroup — Medicare Advantage: $960.99 Anthem — HMO/POS: $5,830 Anthem — Medicare HMO/PPO: $960.99 Anthem — PPO: $7,135 Anthem — State Specific: $5,537 BCBSMN — All Products: $1,804.15 BCBSMN — MHCP: $374.37
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	$374.37 – $4,262.50
Upper GI endoscopy with biopsy: rates for 10 insurance plans Amerigroup — Medicaid HMO: $452.72 Anthem — Medicaid: $452.72 Group Health Eau Claire — Medicaid HMO: $452.72 Group Health of South Central — Medicaid HMO: $452.72 ICare — Medicaid HMO: $432.56 Iowa Total Care — Medicaid: $452.72 Managed Health Service — Managed Medicaid: $452.72 Molina Health — Managed Medicaid: $452.72 Quartz — Medicaid_Badgercare: $452.72 UHC — Medicaid: $452.72
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	$429.85 – $7,135
Colonoscopy (diagnostic): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $985.33 Alliance — Comprehensive/All Products: $4,370.46 Alliance — Premier/All Products: $3,800.40 Amerigroup — Medicare Advantage: $985.33 Anthem — HMO/POS: $5,830 Anthem — Medicare HMO/PPO: $985.33 Anthem — PPO: $7,135 Anthem — State Specific: $5,537 BCBSMN — All Products: $1,816.24 BCBSMN — MHCP: $376.88
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	$376.88 – $4,370.46
Colonoscopy (diagnostic): rates for 10 insurance plans Amerigroup — Medicaid HMO: $444.28 Anthem — Medicaid: $444.28 Group Health Eau Claire — Medicaid HMO: $444.28 Group Health of South Central — Medicaid HMO: $444.28 ICare — Medicaid HMO: $429.85 Iowa Total Care — Medicaid: $444.28 Managed Health Service — Managed Medicaid: $444.28 Molina Health — Managed Medicaid: $444.28 Quartz — Medicaid_Badgercare: $444.28 UHC — Medicaid: $444.28
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	$429.85 – $9,365
Colonoscopy with biopsy: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $1,267.89 Alliance — Comprehensive/All Products: $5,623.78 Alliance — Premier/All Products: $4,890.24 Amerigroup — Medicare Advantage: $1,267.89 Anthem — HMO/POS: $7,506 Anthem — Medicare HMO/PPO: $1,267.89 Anthem — PPO: $9,365 Anthem — State Specific: $6,991 BCBSMN — All Products: $2,366.70 BCBSMN — MHCP: $491.10
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	$444.28 – $5,623.78
Colonoscopy with biopsy: rates for 10 insurance plans Amerigroup — Medicaid HMO: $444.28 Anthem — Medicaid: $444.28 Group Health Eau Claire — Medicaid HMO: $444.28 Group Health of South Central — Medicaid HMO: $444.28 ICare — Medicaid HMO: $429.85 Iowa Total Care — Medicaid: $444.28 Managed Health Service — Managed Medicaid: $444.28 Molina Health — Managed Medicaid: $444.28 Quartz — Medicaid_Badgercare: $444.28 UHC — Medicaid: $444.28
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	$429.85 – $9,365
Colonoscopy with removal of polyps (snare): 10 of 19 insurance plan rates Aetna — Medicare Advantage: $1,267.89 Alliance — Comprehensive/All Products: $5,623.78 Alliance — Premier/All Products: $4,890.24 Amerigroup — Medicare Advantage: $1,267.89 Anthem — HMO/POS: $7,506 Anthem — Medicare HMO/PPO: $1,267.89 Anthem — PPO: $9,365 Anthem — State Specific: $6,991 BCBSMN — All Products: $2,366.70 BCBSMN — MHCP: $491.10
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	$444.28 – $5,623.78
Colonoscopy with removal of polyps (snare): rates for 10 insurance plans Amerigroup — Medicaid HMO: $444.28 Anthem — Medicaid: $444.28 Group Health Eau Claire — Medicaid HMO: $444.28 Group Health of South Central — Medicaid HMO: $444.28 ICare — Medicaid HMO: $429.85 Iowa Total Care — Medicaid: $444.28 Managed Health Service — Managed Medicaid: $444.28 Molina Health — Managed Medicaid: $444.28 Quartz — Medicaid_Badgercare: $444.28 UHC — Medicaid: $444.28
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	$429.85 – $9,365
Ultrasound of the lower bowel by endoscope: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $1,267.89 Alliance — Comprehensive/All Products: $5,623.78 Alliance — Premier/All Products: $4,890.24 Amerigroup — Medicare Advantage: $1,267.89 Anthem — HMO/POS: $7,506 Anthem — Medicare HMO/PPO: $1,267.89 Anthem — PPO: $9,365 Anthem — State Specific: $6,991 BCBSMN — All Products: $2,366.70 BCBSMN — MHCP: $491.10
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	$444.28 – $5,623.78
Ultrasound of the lower bowel by endoscope: rates for 10 insurance plans Amerigroup — Medicaid HMO: $444.28 Anthem — Medicaid: $444.28 Group Health Eau Claire — Medicaid HMO: $444.28 Group Health of South Central — Medicaid HMO: $444.28 ICare — Medicaid HMO: $429.85 Iowa Total Care — Medicaid: $444.28 Managed Health Service — Managed Medicaid: $444.28 Molina Health — Managed Medicaid: $444.28 Quartz — Medicaid_Badgercare: $444.28 UHC — Medicaid: $444.28
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG G0121P COLORECTAL CANCER SCREENING; COLONOSCOPY (PT NOT MEE	$1,925	$770	$642.95 – $1,867.25
Screening colonoscopy (not high risk): 10 of 60 insurance plan rates Aetna — All Products: $1,732.50 Aetna — Medicare Advantage: $985.33 Alliance — Comprehensive/All Products: $1,828.75 Alliance — Premier/All Products: $1,540 Allied National General — HMO/PPO: $1,636.25 Amerigroup — Medicaid HMO: $444.28 Amerigroup — Medicare Advantage: $985.33 Anthem — HMO/POS: $5,830 Anthem — Medicaid: $444.28 Anthem — Medicare HMO/PPO: $985.33
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG G0121P COLORECTAL CANCER SCREENING; COLONOSCOPY (PT NOT MEE	$1,925	$770	$642.95 – $1,867.25
Screening colonoscopy (not high risk): rates for 1 insurance plan Quartz — All Other Self Funded: $1,133.83
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	$1,565.56 – $27,180
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates Aetna — Medicare Advantage: $6,405.49 Amerigroup — Medicare Advantage: $6,405.49 Anthem — HMO/POS: $20,356 Anthem — Medicare HMO/PPO: $6,405.49 Anthem — PPO: $27,180 Anthem — State Specific: $18,460 BCBSMN — All Products: $11,391.15 BCBSMN — MHCP: $2,363.71 Health Partners — Medicare Advantage: $6,405.49 iCare — Medicare Advantage: $6,405.49
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	$1,674 – $11,391.15
Gallbladder removal by laparoscope: rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,674 Anthem — Medicaid: $1,674 Group Health Eau Claire — Medicaid HMO: $1,674 Group Health of South Central — Medicaid HMO: $1,674 ICare — Medicaid HMO: $1,565.56 Iowa Total Care — Medicaid: $1,674 Managed Health Service — Managed Medicaid: $1,674 Molina Health — Managed Medicaid: $1,674 Quartz — Medicaid_Badgercare: $1,674 UHC — Medicaid: $1,674
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	$1,576.39 – $16,052
Groin (inguinal) hernia repair, age 5 or older: 10 of 17 insurance plan rates Aetna — Medicare Advantage: $3,793.59 Amerigroup — Medicare Advantage: $3,793.59 Anthem — HMO/POS: $12,021 Anthem — Medicare HMO/PPO: $3,793.59 Anthem — PPO: $16,052 Anthem — State Specific: $10,901 BCBSMN — All Products: $7,740.89 BCBSMN — MHCP: $1,606.27 Health Partners — Medicare Advantage: $3,793.59 iCare — Medicare Advantage: $3,793.59
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	$1,606.27 – $7,740.89
Groin (inguinal) hernia repair, age 5 or older: rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,745.04 Anthem — Medicaid: $1,745.04 Group Health Eau Claire — Medicaid HMO: $1,745.04 Group Health of South Central — Medicaid HMO: $1,745.04 ICare — Medicaid HMO: $1,576.39 Iowa Total Care — Medicaid: $1,745.04 Managed Health Service — Managed Medicaid: $1,745.04 Molina Health — Managed Medicaid: $1,745.04 Quartz — Medicaid_Badgercare: $1,745.04 UHC — Medicaid: $1,745.04
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$2,409.40 – $11,611.34
Groin (inguinal) hernia repair, age 5 or older: rates for 2 insurance plans BCBSMN — All Products: $11,611.34 BCBSMN — MHCP: $2,409.40
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	$766.30 – $4,053.84
Prostate biopsy: rates for 10 insurance plans Amerigroup — Medicaid HMO: $766.30 Anthem — Medicaid: $766.30 Group Health Eau Claire — Medicaid HMO: $766.30 Group Health of South Central — Medicaid HMO: $766.30 ICare — Medicaid HMO: $738.72 Iowa Total Care — Medicaid: $766.30 Managed Health Service — Managed Medicaid: $766.30 Molina Health — Managed Medicaid: $766.30 Quartz — Medicaid_Badgercare: $766.30 UHC — Medicaid: $766.30
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	$738.72 – $9,365
Prostate biopsy: rates for 9 insurance plans Anthem — HMO/POS: $7,506 Anthem — PPO: $9,365 Anthem — State Specific: $6,991 BCBSMN — All Products: $4,053.84 BCBSMN — MHCP: $841.19 Medical Associates — All Products: $3,135 UCARE — Dually Eligible: $1,940.66 UCARE — MSHO/Minnesota Special Needs: $2,037.69 UCARE — Non-Dually Eligible: $1,940.66
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	$1,947.46 – $29,959
Prostate removal by laparoscope (radical prostatectomy): 10 of 17 insurance plan rates Aetna — Medicare Advantage: $11,262.76 Amerigroup — Medicare Advantage: $11,262.76 Anthem — HMO/POS: $22,439 Anthem — Medicare HMO/PPO: $11,262.76 Anthem — PPO: $29,959 Anthem — State Specific: $20,349 BCBSMN — All Products: $19,860.29 BCBSMN — MHCP: $4,121.09 Health Partners — Medicare Advantage: $11,262.76 iCare — Medicare Advantage: $11,262.76
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	$2,121.50 – $19,860.29
Prostate removal by laparoscope (radical prostatectomy): rates for 10 insurance plans Amerigroup — Medicaid HMO: $2,121.50 Anthem — Medicaid: $2,121.50 Group Health Eau Claire — Medicaid HMO: $2,121.50 Group Health of South Central — Medicaid HMO: $2,121.50 ICare — Medicaid HMO: $1,947.46 Iowa Total Care — Medicaid: $2,121.50 Managed Health Service — Managed Medicaid: $2,121.50 Molina Health — Managed Medicaid: $2,121.50 Quartz — Medicaid_Badgercare: $2,121.50 UHC — Medicaid: $2,121.50
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	$1,020.91 – $9,365
Hysteroscopy with biopsy of the uterus lining: 10 of 17 insurance plan rates Aetna — Medicare Advantage: $3,429.87 Amerigroup — Medicare Advantage: $3,429.87 Anthem — HMO/POS: $7,506 Anthem — Medicare HMO/PPO: $3,429.87 Anthem — PPO: $9,365 Anthem — State Specific: $6,991 BCBSMN — All Products: $6,179.37 BCBSMN — MHCP: $1,282.24 Health Partners — Medicare Advantage: $3,429.87 iCare — Medicare Advantage: $3,429.87
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	$1,091.33 – $6,179.37
Hysteroscopy with biopsy of the uterus lining: rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,091.33 Anthem — Medicaid: $1,091.33 Group Health Eau Claire — Medicaid HMO: $1,091.33 Group Health of South Central — Medicaid HMO: $1,091.33 ICare — Medicaid HMO: $1,020.91 Iowa Total Care — Medicaid: $1,091.33 Managed Health Service — Managed Medicaid: $1,091.33 Molina Health — Managed Medicaid: $1,091.33 Quartz — Medicaid_Badgercare: $1,091.33 UHC — Medicaid: $1,091.33
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 62323 PR INJ DIAG/THER SUBSTANCE W/CATH PLC, EPID/SUBARACH,	$1,182	$472.80	$394.79 – $1,146.54
Spinal injection, lower back (epidural), with imaging guidance: 10 of 60 insurance plan rates Aetna — All Products: $1,063.80 Aetna — Medicare Advantage: $747.91 Alliance — Comprehensive/All Products: $930.23 Alliance — Premier/All Products: $922.67 Allied National General — HMO/PPO: $1,004.70 Amerigroup — Medicaid HMO: $337.09 Amerigroup — Medicare Advantage: $747.91 Anthem — HMO/POS: $5,830 Anthem — Medicaid: $337.09 Anthem — Medicare HMO/PPO: $747.91
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 62323 PR INJ DIAG/THER SUBSTANCE W/CATH PLC, EPID/SUBARACH,	$1,182	$472.80	$394.79 – $1,146.54
Spinal injection, lower back (epidural), with imaging guidance: rates for 1 insurance plan Quartz — All Other Self Funded: $696.20
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	$328.50 – $7,135
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates Aetna — Medicare Advantage: $937.14 Amerigroup — Medicare Advantage: $937.14 Anthem — HMO/POS: $5,830 Anthem — Medicare HMO/PPO: $937.14 Anthem — PPO: $7,135 Anthem — State Specific: $5,537 BCBSMN — All Products: $1,862.44 BCBSMN — MHCP: $386.46 Health Partners — Medicare Advantage: $937.14 iCare — Medicare Advantage: $937.14
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	$337.09 – $1,862.44
Nerve root injection, lower back, with imaging guidance: rates for 10 insurance plans Amerigroup — Medicaid HMO: $337.09 Anthem — Medicaid: $337.09 Group Health Eau Claire — Medicaid HMO: $337.09 Group Health of South Central — Medicaid HMO: $337.09 ICare — Medicaid HMO: $328.50 Iowa Total Care — Medicaid: $337.09 Managed Health Service — Managed Medicaid: $337.09 Molina Health — Managed Medicaid: $337.09 Quartz — Medicaid_Badgercare: $337.09 UHC — Medicaid: $337.09
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$579.70 – $2,793.66
Nerve root injection, lower back, with imaging guidance: rates for 2 insurance plans BCBSMN — All Products: $2,793.66 BCBSMN — MHCP: $579.70
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 64721 REVISE NERVE AT WRIST	$5,372	$2,148.80	$586.16 – $9,741.74
Carpal tunnel release: 10 of 60 insurance plan rates Aetna — All Products: $4,834.80 Aetna — Medicare Advantage: $2,069 Alliance — Comprehensive/All Products: $9,741.74 Alliance — Premier/All Products: $3,990.04 Allied National General — HMO/PPO: $4,566.20 Amerigroup — Medicaid HMO: $613.69 Amerigroup — Medicare Advantage: $2,069 Anthem — HMO/POS: $7,506 Anthem — Medicaid: $613.69 Anthem — Medicare HMO/PPO: $2,069
Carpal tunnel release CPT 64721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 64721 REVISE NERVE AT WRIST	$5,372	$2,148.80	$1,794.25 – $5,210.84
Carpal tunnel release: rates for 1 insurance plan Quartz — All Other Self Funded: $3,164.11
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$1,222.76 – $5,892.72
Carpal tunnel release: rates for 2 insurance plans BCBSMN — All Products: $5,892.72 BCBSMN — MHCP: $1,222.76
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCHG 66821 YAG LASER SURGERY	$1,166	$466.40	$247.69 – $7,135
Laser treatment of clouding after cataract surgery: 10 of 60 insurance plan rates Aetna — All Products: $1,049.40 Aetna — Medicare Advantage: $582.75 Alliance — Comprehensive/All Products: $917.64 Alliance — Premier/All Products: $910.18 Allied National General — HMO/PPO: $991.10 Amerigroup — Medicaid HMO: $258.30 Amerigroup — Medicare Advantage: $582.75 Anthem — HMO/POS: $5,830 Anthem — Medicaid: $258.30 Anthem — Medicare HMO/PPO: $582.75
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCHG 66821 YAG LASER SURGERY	$1,166	$466.40	$389.44 – $1,131.02
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan Quartz — All Other Self Funded: $686.77
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$361.06 – $1,740.01
Laser treatment of clouding after cataract surgery: rates for 2 insurance plans BCBSMN — All Products: $1,740.01 BCBSMN — MHCP: $361.06
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	$744.04 – $9,365
Cataract removal with lens implant: 10 of 19 insurance plan rates Aetna — Medicare Advantage: $2,445.24 Alliance — Comprehensive/All Products: $10,845.93 Alliance — Premier/All Products: $9,431.24 Amerigroup — Medicare Advantage: $2,445.24 Anthem — HMO/POS: $7,506 Anthem — Medicare HMO/PPO: $2,445.24 Anthem — PPO: $9,365 Anthem — State Specific: $6,991 BCBSMN — All Products: $4,719.46 BCBSMN — MHCP: $979.31
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	$775.99 – $10,845.93
Cataract removal with lens implant: rates for 10 insurance plans Amerigroup — Medicaid HMO: $775.99 Anthem — Medicaid: $775.99 Group Health Eau Claire — Medicaid HMO: $775.99 Group Health of South Central — Medicaid HMO: $775.99 ICare — Medicaid HMO: $744.04 Iowa Total Care — Medicaid: $775.99 Managed Health Service — Managed Medicaid: $775.99 Molina Health — Managed Medicaid: $775.99 Quartz — Medicaid_Badgercare: $775.99 UHC — Medicaid: $775.99
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 50 In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$1,468.96 – $7,079.18
Cataract removal with lens implant: rates for 2 insurance plans BCBSMN — All Products: $7,079.18 BCBSMN — MHCP: $1,468.96

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	$1,060.22 – $6,179.37
Vaginal delivery, with care before and after: rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,060.22 Anthem — Medicaid: $1,060.22 Group Health Eau Claire — Medicaid HMO: $1,060.22 Group Health of South Central — Medicaid HMO: $1,060.22 ICare — Medicaid HMO: $1,032.11 Iowa Total Care — Medicaid: $1,060.22 Managed Health Service — Managed Medicaid: $1,060.22 Molina Health — Managed Medicaid: $1,060.22 Quartz — Medicaid_Badgercare: $1,060.22 UHC — Medicaid: $1,060.22
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	$1,032.11 – $16,052
Vaginal delivery, with care before and after: rates for 5 insurance plans Anthem — HMO/POS: $12,021 Anthem — PPO: $16,052 Anthem — State Specific: $10,901 BCBSMN — All Products: $6,179.37 BCBSMN — MHCP: $1,282.24
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	$1,172.47 – $5,477.12
Cesarean delivery (C-section), with care before and after: rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,172.47 Anthem — Medicaid: $1,172.47 Group Health Eau Claire — Medicaid HMO: $1,172.47 Group Health of South Central — Medicaid HMO: $1,172.47 ICare — Medicaid HMO: $1,141.40 Iowa Total Care — Medicaid: $1,172.47 Managed Health Service — Managed Medicaid: $1,172.47 Molina Health — Managed Medicaid: $1,172.47 Quartz — Medicaid_Badgercare: $1,172.47 UHC — Medicaid: $1,172.47
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	$1,141.40 – $16,052
Cesarean delivery (C-section), with care before and after: rates for 5 insurance plans Anthem — HMO/POS: $12,021 Anthem — PPO: $16,052 Anthem — State Specific: $10,901 BCBSMN — All Products: $5,477.12 BCBSMN — MHCP: $5,477.12
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	$1,060.22 – $6,179.37
Vaginal delivery after a previous C-section, with care before and after: rates for 10 insurance plans Amerigroup — Medicaid HMO: $1,060.22 Anthem — Medicaid: $1,060.22 Group Health Eau Claire — Medicaid HMO: $1,060.22 Group Health of South Central — Medicaid HMO: $1,060.22 ICare — Medicaid HMO: $1,032.11 Iowa Total Care — Medicaid: $1,060.22 Managed Health Service — Managed Medicaid: $1,060.22 Molina Health — Managed Medicaid: $1,060.22 Quartz — Medicaid_Badgercare: $1,060.22 UHC — Medicaid: $1,060.22
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	$1,032.11 – $16,052
Vaginal delivery after a previous C-section, with care before and after: rates for 5 insurance plans Anthem — HMO/POS: $12,021 Anthem — PPO: $16,052 Anthem — State Specific: $10,901 BCBSMN — All Products: $6,179.37 BCBSMN — MHCP: $1,282.24

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$79,041.55 – $223,282.63
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 44 insurance plan rates Aetna — Medicare Advantage: $86,440.64 Alliance — Comprehensive/All Products: $185,100.36 Alliance — Premier/All Products: $173,214.26 Amerigroup — Medicare Advantage: $86,440.64 Anthem — HMO/POS: $209,664.97 Anthem — Medicare HMO/PPO: $86,440.64 Anthem — PPO: $223,282.63 Anthem — State Specific: $194,325.54 Health Partners — Medicare Advantage: $86,440.64 iCare — Medicare Advantage: $86,440.64
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Major joint replacement or reattachment of lower extremity w/o MCC	Not listed in the file	Not listed in the file	$15,796.79 – $44,025.21
Hip or knee replacement (major joint of the leg), without major complications: 10 of 33 insurance plan rates Alliance — Comprehensive/All Products: $36,496.72 Alliance — Premier/All Products: $34,153.10 Anthem — HMO/POS: $41,340.18 Anthem — PPO: $44,025.21 Anthem — State Specific: $38,315.67 Medical Associates — All Products: $19,047.89 Quartz — All Products: $19,514.68 Quartz — Fully Insured: $17,880.90 Quartz — Level Funded: $27,969.05 Quartz — Self Funded: $18,087.30
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$15,796.79 – $44,025.21
Hip or knee replacement (major joint of the leg), without major complications: 10 of 11 insurance plan rates Aetna — Medicare Advantage: $17,959.06 Amerigroup — Medicare Advantage: $17,959.06 Anthem — Medicare HMO/PPO: $17,959.06 Health Partners — Medicare Advantage: $17,959.06 iCare — Medicare Advantage: $17,959.06 Medical Associates — Medicare Advantage: $17,959.06 Quartz — Medicare Advantage: $17,959.06 UCARE — Dually Eligible: $15,796.79 UCARE — MSHO/Minnesota Special Needs: $16,586.63 UCARE — Non-Dually Eligible: $15,796.79
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$20,476.52 – $55,720.23
Neck (cervical) spinal fusion, without complications: 10 of 44 insurance plan rates Aetna — Medicare Advantage: $22,426.90 Alliance — Comprehensive/All Products: $46,191.84 Alliance — Premier/All Products: $43,225.66 Amerigroup — Medicare Advantage: $22,426.90 Anthem — HMO/POS: $52,321.94 Anthem — Medicare HMO/PPO: $22,426.90 Anthem — PPO: $55,720.23 Anthem — State Specific: $48,493.98 Health Partners — Medicare Advantage: $22,426.90 iCare — Medicare Advantage: $22,426.90
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$9,978.84 – $28,317.74
Uterus and ovary surgery (not for cancer), without complications: 10 of 44 insurance plan rates Aetna — Medicare Advantage: $11,958.35 Alliance — Comprehensive/All Products: $23,475.28 Alliance — Premier/All Products: $21,967.83 Amerigroup — Medicare Advantage: $11,958.35 Anthem — HMO/POS: $26,590.68 Anthem — Medicare HMO/PPO: $11,958.35 Anthem — PPO: $28,317.74 Anthem — State Specific: $24,645.26 Health Partners — Medicare Advantage: $11,958.35 iCare — Medicare Advantage: $11,958.35

Source: Gundersen Lutheran Medical Center’s standard charges file (bellin-ghs.pt.panaceainc.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on June 27, 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	1910 South Ave, La Crosse, WI 54601
County	La Crosse County
State	Wisconsin
Phone	(608) 782‑7300
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	520087
Name in Medicare records	GUNDERSEN LUTHERAN MEDICAL CENTER
Profile level	Medicare data + hospital website
Official website	gundersenhealth.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.

Gundersen Lutheran Medical Center | Gundersen Health System — gundersenhealth.org
Gundersen La Crosse Campus | Gundersen Health System — gundersenhealth.org
Trauma Services — gundersenhealth.org
La Crosse Campus Parking | Gundersen Health System — gundersenhealth.org
Interpreter Services | Gundersen Health System — gundersenhealth.org