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Acute Care Hospital

Holy Family Memorial

Manitowoc, Wisconsin · Manitowoc County · Emergency services listed

Summary

Holy Family Memorial is an acute care hospital in Manitowoc, Wisconsin. Medicare data lists emergency services. CMS overall star rating: 3 of 5 stars. Its official website lists 86 services, specialties and programs. Medicare lists 343 affiliated clinicians. Source: CMS Hospital General Information, data updated 2026-07-22.

What is an acute care hospital?

A general hospital for short-term care: emergencies, surgery, illness and injury. Most patients stay a few days. More about hospital types

Call(920) 320‑2011 Directions Website Medicare profile
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Exterior of Holy Family Memorial
Photo: Asher Heimermann, CC BY 3.0, via Wikimedia Commons · source · licence

Profile from official sources

Built from official Medicare (CMS) data and the hospital’s own website (checked 2026-10-31). Every service links to the page that lists it. Services change: call the hospital to confirm before you go.

In a medical emergency, call 911.

At a glance

YesEmergency services
3 of 5 stars3 of 5 stars · Medicare rating
343Doctors and clinicians
86Services listed

Quick answers

Does Holy Family Memorial have an emergency room?
Yes. Medicare (CMS) data lists emergency services at Holy Family Memorial. In a medical emergency, call 911.
Where is Holy Family Memorial?
2300 Western Ave, Manitowoc, WI 54221, in Manitowoc County, Wisconsin.
What is the phone number of Holy Family Memorial?
(920) 320-2011, as listed by Medicare (CMS).
What is the Medicare star rating of Holy Family Memorial?
3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas[4][7][8][9][10][11]

Conditions treated[7][8][9][10][12]

Treatments[4][7][8][10][11][12]

Procedures[4][7][8][9][10]

Programs and centers[7][8][9][11][12]

  • Cancer Center (Commission on Cancer accredited program)
  • Cancer Survivorship and Rehab Program
  • Heart and Vascular Center
  • Designated Heart Attack Receiving Center
  • Cardiac rehabilitation program
  • Pulmonary rehabilitation program
  • Second Opinion Program
  • 10-bed intensive care unit

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

Emergency roomYes
Open 24/7Yes
Trauma designationLevel III

Visiting and practical information

VisitingCall 920-320-2011 for visiting hours[4]
Interpreters and languagesFroedtert & MCW network offers free interpreters in person, by phone or video, around the clock, in over 150 languages (network-wide page)[6]
Patient portalMyChart

Recognition[7][11]

  • Level III Trauma Center
  • DNV Certified Acute Stroke Ready Center
  • Get With The Guidelines Rural Stroke Bronze (American Heart Association)
  • Commission on Cancer accreditation (American College of Surgeons)

Doctors and clinicians (343)

343 doctors and other clinicians list Holy Family Memorial 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

Doctors with a page on this site (343)

And 319 more: the button below opens the full list.

Other emergency rooms nearby

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

Other hospitals nearby

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

All nursing homes in the state →

Hospice providers

All hospice providers in the state →

Home health agencies

All home health agencies in the state →

Dialysis facilities

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

Clinics and urgent care

Pharmacies

Assisted living nearby

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

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 Holy Family Memorial 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 hospital4 of 5 stars
Would recommend the hospital4 of 5 stars
Nurses communicated well5 of 5 stars
Doctors communicated well4 of 5 stars
Staff explained medicines4 of 5 stars
Information about recovery at home4 of 5 stars
Room and bathroom kept clean4 of 5 stars
Quiet at night4 of 5 stars
Rated the hospital 9 or 10 out of 1071%National average: 72%
Would definitely recommend the hospital71%National average: 71%
Nurses “always” communicated well82%National average: 80%
Doctors “always” communicated well81%National average: 80%
Staff “always” explained medicines before giving them67%National average: 62%
Were given information about recovery at home91%National average: 86%
Room and bathroom “always” clean75%National average: 74%
Area around the room “always” quiet at night62%National average: 60%
Completed surveys349Response rate: 36%

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

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)Not reported to Medicare
Surgical site infections after colon surgeryNot reported to Medicare
Surgical site infections after abdominal hysterectomyNot reported to Medicare
MRSA bloodstream infectionsNot reported to Medicare
Clostridioides difficile (C. diff) intestinal infections0Better 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 patientsToo few cases to report
Deaths within 30 days: heart failure patients14.2%
Deaths within 30 days: pneumonia patients13.9%
Deaths within 30 days: COPD patients7%
Deaths within 30 days: stroke patients12.8%
Deaths within 30 days: coronary bypass surgery (CABG)Not reported to Medicare
Serious complications (patient safety indicator PSI-90)0.94No different from the national rate
Complications after hip or knee replacementToo 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 attackToo few cases to report
Readmitted within 30 days: heart failure21.1%
Readmitted within 30 days: pneumonia17.5%
Readmitted within 30 days: COPD19.9%
Readmitted within 30 days: coronary bypass surgeryNot reported to Medicare
Readmitted within 30 days: hip or knee replacementToo few cases to report

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)138 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)59%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 WisconsinBest 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 Holy Family Memorial lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

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

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

Office and emergency visits

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW LOW 30 MIN Not listed in the file Not listed in the file $103.31 – $111.57
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $105.37
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $103.31
  • Community Care Incorporated — Medicare Advantage: $103.31
  • Health Partners — Medicare Advantage: $103.31
  • Humana — Medicare Advantage: $103.31
  • ICare — Medicare Advantage: $103.31
  • Molina — Marketplace Plans: $111.57
  • Molina — Medicare Advantage: $103.31
  • Network Health Plan — Medicare Advantage: $103.31
  • Security Health Plan — Medicare Advantage: $103.31
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE O/P NEW MOD 45 MIN Not listed in the file Not listed in the file $155.08 – $167.49
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $158.18
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $155.08
  • Community Care Incorporated — Medicare Advantage: $155.08
  • Health Partners — Medicare Advantage: $155.08
  • Humana — Medicare Advantage: $155.08
  • ICare — Medicare Advantage: $155.08
  • Molina — Marketplace Plans: $167.49
  • Molina — Medicare Advantage: $155.08
  • Network Health Plan — Medicare Advantage: $155.08
  • Security Health Plan — Medicare Advantage: $155.08
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEW PATIENT, FACILITY E&M LEVEL 5 $567 $311.85 $204.46 – $498.96
New patient office visit (about 60–74 minutes): 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $208.55
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $204.46
  • Aspirus — Marketplace Plans: $453.60
  • Chorus Community Health Plan — Marketplace Plans: $364.58
  • Cigna — All Contracted Commercial Plans: $408.24
  • Community Care Incorporated — Medicare Advantage: $204.46
  • Dean Health Plan — All Plans: $283.50
  • First Health Network — All Contracted Commercial Plans: $498.96
  • Health Partners — All Contracted Commercial Plans: $368.55
  • Health Partners — Medicare Advantage: $204.46
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NEW PATIENT, FACILITY E&M LEVEL 5 $567 $311.85 $340.20 – $498.96
New patient office visit (about 60–74 minutes): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $453.60
  • Cigna — All Contracted Commercial Plans: $408.24
  • First Health Network — All Contracted Commercial Plans: $498.96
  • HealthEos — All Contracted Commercial Plans: $453.60
  • HealthSmart — All Contracted Commercial Plans: $470.61
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $453.60
  • Preferred One — All Contracted Commercial Plans: $453.60
  • Security Health Plan — All Contracted Commercial Plans: $453.60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $340.20
  • Trilogy — All Contracted Commercial Plans: $374.22
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 3 $180 $99 $84.91 – $158.40
Established patient office visit (about 20–29 minutes): 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $86.61
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $84.91
  • Aspirus — Marketplace Plans: $144
  • Chorus Community Health Plan — Marketplace Plans: $115.74
  • Cigna — All Contracted Commercial Plans: $129.60
  • Community Care Incorporated — Medicare Advantage: $84.91
  • Dean Health Plan — All Plans: $90
  • First Health Network — All Contracted Commercial Plans: $158.40
  • Health Partners — All Contracted Commercial Plans: $117
  • Health Partners — Medicare Advantage: $84.91
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHARMACIST, FACILITY E&M LEVEL 3 $180 $99 $84.91 – $158.40
Established patient office visit (about 20–29 minutes): 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $86.61
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $84.91
  • Aspirus — Marketplace Plans: $144
  • Chorus Community Health Plan — Marketplace Plans: $115.74
  • Cigna — All Contracted Commercial Plans: $129.60
  • Community Care Incorporated — Medicare Advantage: $84.91
  • Dean Health Plan — All Plans: $90
  • First Health Network — All Contracted Commercial Plans: $158.40
  • Health Partners — All Contracted Commercial Plans: $117
  • Health Partners — Medicare Advantage: $84.91
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 3 $180 $99 $108 – $158.40
Established patient office visit (about 20–29 minutes): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $144
  • Cigna — All Contracted Commercial Plans: $129.60
  • First Health Network — All Contracted Commercial Plans: $158.40
  • HealthEos — All Contracted Commercial Plans: $144
  • HealthSmart — All Contracted Commercial Plans: $149.40
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $144
  • Preferred One — All Contracted Commercial Plans: $144
  • Security Health Plan — All Contracted Commercial Plans: $144
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $108
  • Trilogy — All Contracted Commercial Plans: $118.80
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 4 $234 $128.70 $117 – $205.92
Established patient office visit (about 30–39 minutes): 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $121.82
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $119.43
  • Aspirus — Marketplace Plans: $187.20
  • Chorus Community Health Plan — Marketplace Plans: $150.46
  • Cigna — All Contracted Commercial Plans: $168.48
  • Community Care Incorporated — Medicare Advantage: $119.43
  • Dean Health Plan — All Plans: $117
  • First Health Network — All Contracted Commercial Plans: $205.92
  • Health Partners — All Contracted Commercial Plans: $152.10
  • Health Partners — Medicare Advantage: $119.43
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHARMACIST, FACILITY E&M LEVEL 4 $234 $128.70 $117 – $205.92
Established patient office visit (about 30–39 minutes): 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $121.82
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $119.43
  • Aspirus — Marketplace Plans: $187.20
  • Chorus Community Health Plan — Marketplace Plans: $150.46
  • Cigna — All Contracted Commercial Plans: $168.48
  • Community Care Incorporated — Medicare Advantage: $119.43
  • Dean Health Plan — All Plans: $117
  • First Health Network — All Contracted Commercial Plans: $205.92
  • Health Partners — All Contracted Commercial Plans: $152.10
  • Health Partners — Medicare Advantage: $119.43
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FACILITY E&M LEVEL 4 $234 $128.70 $140.40 – $205.92
Established patient office visit (about 30–39 minutes): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $187.20
  • Cigna — All Contracted Commercial Plans: $168.48
  • First Health Network — All Contracted Commercial Plans: $205.92
  • HealthEos — All Contracted Commercial Plans: $187.20
  • HealthSmart — All Contracted Commercial Plans: $194.22
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $187.20
  • Preferred One — All Contracted Commercial Plans: $187.20
  • Security Health Plan — All Contracted Commercial Plans: $187.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $140.40
  • Trilogy — All Contracted Commercial Plans: $154.44
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST LOW 30 Not listed in the file Not listed in the file $104.70 – $113.08
Office consultation with a specialist (moderate): 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $106.80
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $104.70
  • Community Care Incorporated — Medicare Advantage: $104.70
  • Health Partners — Medicare Advantage: $104.70
  • Humana — Medicare Advantage: $104.70
  • ICare — Medicare Advantage: $104.70
  • Molina — Marketplace Plans: $113.08
  • Molina — Medicare Advantage: $104.70
  • Network Health Plan — Medicare Advantage: $104.70
  • Security Health Plan — Medicare Advantage: $104.70
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFF/OP CNSLTJ NEW/EST MOD 40 Not listed in the file Not listed in the file $149.40 – $161.35
Office consultation with a specialist (moderate to high): 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $152.39
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $149.40
  • Community Care Incorporated — Medicare Advantage: $149.40
  • Health Partners — Medicare Advantage: $149.40
  • Humana — Medicare Advantage: $149.40
  • ICare — Medicare Advantage: $149.40
  • Molina — Marketplace Plans: $161.35
  • Molina — Medicare Advantage: $149.40
  • Network Health Plan — Medicare Advantage: $149.40
  • Security Health Plan — Medicare Advantage: $149.40
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 18-39 Not listed in the file Not listed in the file $120.77 – $130.43
Preventive checkup, new patient, age 18–39: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $123.18
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $120.77
  • Community Care Incorporated — Medicare Advantage: $120.77
  • Health Partners — Medicare Advantage: $120.77
  • Humana — Medicare Advantage: $120.77
  • ICare — Medicare Advantage: $120.77
  • Molina — Marketplace Plans: $130.43
  • Molina — Medicare Advantage: $120.77
  • Network Health Plan — Medicare Advantage: $120.77
  • Security Health Plan — Medicare Advantage: $120.77
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREV VISIT NEW AGE 40-64 Not listed in the file Not listed in the file $139.19 – $150.33
Preventive checkup, new patient, age 40–64: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $141.98
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $139.19
  • Community Care Incorporated — Medicare Advantage: $139.19
  • Health Partners — Medicare Advantage: $139.19
  • Humana — Medicare Advantage: $139.19
  • ICare — Medicare Advantage: $139.19
  • Molina — Marketplace Plans: $150.33
  • Molina — Medicare Advantage: $139.19
  • Network Health Plan — Medicare Advantage: $139.19
  • Security Health Plan — Medicare Advantage: $139.19
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEVEL 3 EMERGENCY DEPARTMENT VISIT $1,100 $605 $263.35 – $4,183
Emergency room visit (moderate): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $268.62
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $263.35
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $4,183
  • Aspirus — Marketplace Plans: $880
  • Centivo — WI 1 Broad: $528
  • Centivo — WI 2 Median: $462
  • Chorus Community Health Plan — Marketplace Plans: $707.30
  • Cigna — All Contracted Commercial Plans: $792
  • Community Care Incorporated — Medicare Advantage: $263.35
  • Dean Health Plan — All Plans: $550
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LEVEL 3 EMERGENCY DEPARTMENT VISIT $1,100 $605 $660 – $968
Emergency room visit (moderate): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $880
  • Cigna — All Contracted Commercial Plans: $792
  • First Health Network — All Contracted Commercial Plans: $968
  • HealthEos — All Contracted Commercial Plans: $880
  • HealthSmart — All Contracted Commercial Plans: $913
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $880
  • Preferred One — All Contracted Commercial Plans: $880
  • Security Health Plan — All Contracted Commercial Plans: $880
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $660
  • Trilogy — All Contracted Commercial Plans: $726
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SANE EXAM - INTERMEDIATE $1,093 $601.15 $360.69 – $5,506
Emergency room visit (moderately high): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $413.10
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $405
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5,506
  • Aspirus — Marketplace Plans: $874.40
  • Centivo — WI 1 Broad: $524.64
  • Centivo — WI 2 Median: $459.06
  • Chorus Community Health Plan — Marketplace Plans: $702.80
  • Cigna — All Contracted Commercial Plans: $786.96
  • Community Care Incorporated — Medicare Advantage: $405
  • Dean Health Plan — All Plans: $546.50
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEVEL 4 EMERGENCY DEPARTMENT VISIT $1,800 $990 $405 – $5,506
Emergency room visit (moderately high): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $413.10
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $405
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5,506
  • Aspirus — Marketplace Plans: $1,440
  • Centivo — WI 1 Broad: $864
  • Centivo — WI 2 Median: $756
  • Chorus Community Health Plan — Marketplace Plans: $1,157.40
  • Cigna — All Contracted Commercial Plans: $1,296
  • Community Care Incorporated — Medicare Advantage: $405
  • Dean Health Plan — All Plans: $900
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SANE EXAM - INTERMEDIATE $1,093 $601.15 $655.80 – $961.84
Emergency room visit (moderately high): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $874.40
  • Cigna — All Contracted Commercial Plans: $786.96
  • First Health Network — All Contracted Commercial Plans: $961.84
  • HealthEos — All Contracted Commercial Plans: $874.40
  • HealthSmart — All Contracted Commercial Plans: $907.19
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $874.40
  • Preferred One — All Contracted Commercial Plans: $874.40
  • Security Health Plan — All Contracted Commercial Plans: $874.40
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $655.80
  • Trilogy — All Contracted Commercial Plans: $721.38
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEVEL 5 EMERGENCY DEPARTMENT VISIT $2,500 $1,375 $583.12 – $6,052
Emergency room visit (high): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $594.78
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $583.12
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5,714
  • Aspirus — Marketplace Plans: $2,000
  • Centivo — WI 1 Broad: $1,200
  • Centivo — WI 2 Median: $1,050
  • Chorus Community Health Plan — Marketplace Plans: $1,607.50
  • Cigna — All Contracted Commercial Plans: $1,800
  • Community Care Incorporated — Medicare Advantage: $583.12
  • Dean Health Plan — All Plans: $1,250
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SANE EXAM - COMPREHENSIVE $1,120 $616 $369.60 – $6,052
Emergency room visit (high): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $594.78
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $583.12
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5,714
  • Aspirus — Marketplace Plans: $896
  • Centivo — WI 1 Broad: $537.60
  • Centivo — WI 2 Median: $470.40
  • Chorus Community Health Plan — Marketplace Plans: $720.16
  • Cigna — All Contracted Commercial Plans: $806.40
  • Community Care Incorporated — Medicare Advantage: $583.12
  • Dean Health Plan — All Plans: $560
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SANE EXAM - COMPREHENSIVE $1,120 $616 $672 – $985.60
Emergency room visit (high): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $896
  • Cigna — All Contracted Commercial Plans: $806.40
  • First Health Network — All Contracted Commercial Plans: $985.60
  • HealthEos — All Contracted Commercial Plans: $896
  • HealthSmart — All Contracted Commercial Plans: $929.60
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $896
  • Preferred One — All Contracted Commercial Plans: $896
  • Security Health Plan — All Contracted Commercial Plans: $896
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $672
  • Trilogy — All Contracted Commercial Plans: $739.20

Lab tests

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC METABOLIC PANEL TOTAL CA $75 $41.25 $8.46 – $66
Basic metabolic panel (blood test): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $8.63
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $8.46
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $11
  • Aspirus — Marketplace Plans: $60
  • Centivo — WI 1 Broad: $34.50
  • Centivo — WI 2 Median: $30
  • Chorus Community Health Plan — Marketplace Plans: $24.25
  • Cigna — All Contracted Commercial Plans: $54
  • Community Care Incorporated — Medicare Advantage: $8.46
  • Dean Health Plan — All Plans: $37.50
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC METABOLIC PANEL TOTAL CA $75 $41.25 $45 – $66
Basic metabolic panel (blood test): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $60
  • Cigna — All Contracted Commercial Plans: $54
  • First Health Network — All Contracted Commercial Plans: $66
  • HealthEos — All Contracted Commercial Plans: $60
  • HealthSmart — All Contracted Commercial Plans: $62.25
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $60
  • Preferred One — All Contracted Commercial Plans: $60
  • Security Health Plan — All Contracted Commercial Plans: $60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $45
  • Trilogy — All Contracted Commercial Plans: $49.50
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHEN METABOLIC PANEL $100 $55 $10.56 – $88
Comprehensive metabolic panel (blood test): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $10.77
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $10.56
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $13.73
  • Aspirus — Marketplace Plans: $80
  • Centivo — WI 1 Broad: $46
  • Centivo — WI 2 Median: $40
  • Chorus Community Health Plan — Marketplace Plans: $30.29
  • Cigna — All Contracted Commercial Plans: $72
  • Community Care Incorporated — Medicare Advantage: $10.56
  • Dean Health Plan — All Plans: $50
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHEN METABOLIC PANEL $100 $55 $60 – $88
Comprehensive metabolic panel (blood test): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $80
  • Cigna — All Contracted Commercial Plans: $72
  • First Health Network — All Contracted Commercial Plans: $88
  • HealthEos — All Contracted Commercial Plans: $80
  • HealthSmart — All Contracted Commercial Plans: $83
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $80
  • Preferred One — All Contracted Commercial Plans: $80
  • Security Health Plan — All Contracted Commercial Plans: $80
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $60
  • Trilogy — All Contracted Commercial Plans: $66
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL $271 $149.05 $47.81 – $238.48
Obstetric blood test panel: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $48.77
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $47.81
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $62.15
  • Aspirus — Marketplace Plans: $216.80
  • Centivo — WI 1 Broad: $124.66
  • Centivo — WI 2 Median: $108.40
  • Chorus Community Health Plan — Marketplace Plans: $137.03
  • Cigna — All Contracted Commercial Plans: $195.12
  • Community Care Incorporated — Medicare Advantage: $47.81
  • Dean Health Plan — All Plans: $135.50
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL $271 $149.05 $162.60 – $238.48
Obstetric blood test panel: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $216.80
  • Cigna — All Contracted Commercial Plans: $195.12
  • First Health Network — All Contracted Commercial Plans: $238.48
  • HealthEos — All Contracted Commercial Plans: $216.80
  • HealthSmart — All Contracted Commercial Plans: $224.93
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $216.80
  • Preferred One — All Contracted Commercial Plans: $216.80
  • Security Health Plan — All Contracted Commercial Plans: $216.80
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $162.60
  • Trilogy — All Contracted Commercial Plans: $178.86
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL $135 $74.25 $13.39 – $118.80
Cholesterol panel (lipid panel): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $13.66
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $13.39
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $17.41
  • Aspirus — Marketplace Plans: $108
  • Centivo — WI 1 Broad: $62.10
  • Centivo — WI 2 Median: $54
  • Chorus Community Health Plan — Marketplace Plans: $38.39
  • Cigna — All Contracted Commercial Plans: $97.20
  • Community Care Incorporated — Medicare Advantage: $13.39
  • Dean Health Plan — All Plans: $67.50
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL (NMR) $100 $55 $13.39 – $88
Cholesterol panel (lipid panel): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $13.66
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $13.39
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $17.41
  • Aspirus — Marketplace Plans: $80
  • Centivo — WI 1 Broad: $46
  • Centivo — WI 2 Median: $40
  • Chorus Community Health Plan — Marketplace Plans: $38.39
  • Cigna — All Contracted Commercial Plans: $72
  • Community Care Incorporated — Medicare Advantage: $13.39
  • Dean Health Plan — All Plans: $50
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LIPID PANEL $135 $74.25 $81 – $118.80
Cholesterol panel (lipid panel): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $108
  • Cigna — All Contracted Commercial Plans: $97.20
  • First Health Network — All Contracted Commercial Plans: $118.80
  • HealthEos — All Contracted Commercial Plans: $108
  • HealthSmart — All Contracted Commercial Plans: $112.05
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $108
  • Preferred One — All Contracted Commercial Plans: $108
  • Security Health Plan — All Contracted Commercial Plans: $108
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $81
  • Trilogy — All Contracted Commercial Plans: $89.10
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL $83 $45.65 $8.68 – $73.04
Kidney function panel: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $8.85
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $8.68
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $11.28
  • Aspirus — Marketplace Plans: $66.40
  • Centivo — WI 1 Broad: $38.18
  • Centivo — WI 2 Median: $33.20
  • Chorus Community Health Plan — Marketplace Plans: $24.90
  • Cigna — All Contracted Commercial Plans: $59.76
  • Community Care Incorporated — Medicare Advantage: $8.68
  • Dean Health Plan — All Plans: $41.50
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL $83 $45.65 $49.80 – $73.04
Kidney function panel: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $66.40
  • Cigna — All Contracted Commercial Plans: $59.76
  • First Health Network — All Contracted Commercial Plans: $73.04
  • HealthEos — All Contracted Commercial Plans: $66.40
  • HealthSmart — All Contracted Commercial Plans: $68.89
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $66.40
  • Preferred One — All Contracted Commercial Plans: $66.40
  • Security Health Plan — All Contracted Commercial Plans: $66.40
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $49.80
  • Trilogy — All Contracted Commercial Plans: $54.78
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL $72 $39.60 $8.17 – $63.36
Liver function panel: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $8.33
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $8.17
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $10.62
  • Aspirus — Marketplace Plans: $57.60
  • Centivo — WI 1 Broad: $33.12
  • Centivo — WI 2 Median: $28.80
  • Chorus Community Health Plan — Marketplace Plans: $23.42
  • Cigna — All Contracted Commercial Plans: $51.84
  • Community Care Incorporated — Medicare Advantage: $8.17
  • Dean Health Plan — All Plans: $36
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL $72 $39.60 $43.20 – $63.36
Liver function panel: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $57.60
  • Cigna — All Contracted Commercial Plans: $51.84
  • First Health Network — All Contracted Commercial Plans: $63.36
  • HealthEos — All Contracted Commercial Plans: $57.60
  • HealthSmart — All Contracted Commercial Plans: $59.76
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $57.60
  • Preferred One — All Contracted Commercial Plans: $57.60
  • Security Health Plan — All Contracted Commercial Plans: $57.60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $43.20
  • Trilogy — All Contracted Commercial Plans: $47.52
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W SCOPE $33 $18.15 $3.17 – $29.04
Urine test (automated, with microscope): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $3.23
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3.17
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $4.12
  • Aspirus — Marketplace Plans: $26.40
  • Centivo — WI 1 Broad: $15.18
  • Centivo — WI 2 Median: $13.20
  • Chorus Community Health Plan — Marketplace Plans: $9.08
  • Cigna — All Contracted Commercial Plans: $23.76
  • Community Care Incorporated — Medicare Advantage: $3.17
  • Dean Health Plan — All Plans: $16.50
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS AUTO W SCOPE $33 $18.15 $19.80 – $29.04
Urine test (automated, with microscope): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $26.40
  • Cigna — All Contracted Commercial Plans: $23.76
  • First Health Network — All Contracted Commercial Plans: $29.04
  • HealthEos — All Contracted Commercial Plans: $26.40
  • HealthSmart — All Contracted Commercial Plans: $27.39
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $26.40
  • Preferred One — All Contracted Commercial Plans: $26.40
  • Security Health Plan — All Contracted Commercial Plans: $26.40
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $19.80
  • Trilogy — All Contracted Commercial Plans: $21.78
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS NONAUTO W/O SCOPE Not listed in the file Not listed in the file $3.48 – $8.98
Urine test (manual, without microscope): 10 of 19 insurance plan rates
  • Allwell — Medicare Advantage: $3.55
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3.48
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $4.52
  • Chorus Community Health Plan — Marketplace Plans: $8.98
  • Community Care Incorporated — Medicare Advantage: $3.48
  • Health Partners — Medicare Advantage: $3.48
  • Health Payment Systems — All Contracted Commercial Plans: $8.70
  • Humana — Medicare Advantage: $3.48
  • ICare — Medicare Advantage: $3.48
  • Molina — Marketplace Plans: $3.76
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS SPECIFIC GRAVITY $25 $13.75 $2.25 – $22
Urine test (automated, without microscope): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $2.30
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2.25
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $2.93
  • Aspirus — Marketplace Plans: $20
  • Centivo — WI 1 Broad: $11.50
  • Centivo — WI 2 Median: $10
  • Chorus Community Health Plan — Marketplace Plans: $6.42
  • Cigna — All Contracted Commercial Plans: $18
  • Community Care Incorporated — Medicare Advantage: $2.25
  • Dean Health Plan — All Plans: $12.50
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS DIPSTICK $55 $30.25 $2.25 – $48.40
Urine test (automated, without microscope): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $2.30
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2.25
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $2.93
  • Aspirus — Marketplace Plans: $44
  • Centivo — WI 1 Broad: $25.30
  • Centivo — WI 2 Median: $22
  • Chorus Community Health Plan — Marketplace Plans: $6.42
  • Cigna — All Contracted Commercial Plans: $39.60
  • Community Care Incorporated — Medicare Advantage: $2.25
  • Dean Health Plan — All Plans: $27.50
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS PH $29 $15.95 $2.25 – $25.52
Urine test (automated, without microscope): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $2.30
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2.25
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $2.93
  • Aspirus — Marketplace Plans: $23.20
  • Centivo — WI 1 Broad: $13.34
  • Centivo — WI 2 Median: $11.60
  • Chorus Community Health Plan — Marketplace Plans: $6.42
  • Cigna — All Contracted Commercial Plans: $20.88
  • Community Care Incorporated — Medicare Advantage: $2.25
  • Dean Health Plan — All Plans: $14.50
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN (PSA) DX ASSAY $104 $57.20 $18.39 – $91.52
PSA (prostate specific antigen) blood test: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $18.76
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $18.39
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $23.91
  • Aspirus — Marketplace Plans: $83.20
  • Centivo — WI 1 Broad: $47.84
  • Centivo — WI 2 Median: $41.60
  • Chorus Community Health Plan — Marketplace Plans: $52.73
  • Cigna — All Contracted Commercial Plans: $74.88
  • Community Care Incorporated — Medicare Advantage: $18.39
  • Dean Health Plan — All Plans: $52
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE HEALTH INDEX, PROSTATE SPECIFIC ANTIGEN, TOTAL $104 $57.20 $18.39 – $91.52
PSA (prostate specific antigen) blood test: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $18.76
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $18.39
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $23.91
  • Aspirus — Marketplace Plans: $83.20
  • Centivo — WI 1 Broad: $47.84
  • Centivo — WI 2 Median: $41.60
  • Chorus Community Health Plan — Marketplace Plans: $52.73
  • Cigna — All Contracted Commercial Plans: $74.88
  • Community Care Incorporated — Medicare Advantage: $18.39
  • Dean Health Plan — All Plans: $52
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN (PSA) DX ASSAY $104 $57.20 $62.40 – $91.52
PSA (prostate specific antigen) blood test: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $83.20
  • Cigna — All Contracted Commercial Plans: $74.88
  • First Health Network — All Contracted Commercial Plans: $91.52
  • HealthEos — All Contracted Commercial Plans: $83.20
  • HealthSmart — All Contracted Commercial Plans: $86.32
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $83.20
  • Preferred One — All Contracted Commercial Plans: $83.20
  • Security Health Plan — All Contracted Commercial Plans: $83.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $62.40
  • Trilogy — All Contracted Commercial Plans: $68.64
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIM HORMONE ASSAY $126 $69.30 $16.80 – $110.88
Thyroid stimulating hormone (TSH) test: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $17.14
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $16.80
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $21.84
  • Aspirus — Marketplace Plans: $100.80
  • Centivo — WI 1 Broad: $57.96
  • Centivo — WI 2 Median: $50.40
  • Chorus Community Health Plan — Marketplace Plans: $48.16
  • Cigna — All Contracted Commercial Plans: $90.72
  • Community Care Incorporated — Medicare Advantage: $16.80
  • Dean Health Plan — All Plans: $63
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TSH 3RD GENERATION $56.50 $31.08 $16.80 – $49.72
Thyroid stimulating hormone (TSH) test: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $17.14
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $16.80
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $21.84
  • Aspirus — Marketplace Plans: $45.20
  • Centivo — WI 1 Broad: $25.99
  • Centivo — WI 2 Median: $22.60
  • Chorus Community Health Plan — Marketplace Plans: $48.16
  • Cigna — All Contracted Commercial Plans: $40.68
  • Community Care Incorporated — Medicare Advantage: $16.80
  • Dean Health Plan — All Plans: $28.25
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THYROID STIM HORMONE ASSAY $126 $69.30 $75.60 – $110.88
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $100.80
  • Cigna — All Contracted Commercial Plans: $90.72
  • First Health Network — All Contracted Commercial Plans: $110.88
  • HealthEos — All Contracted Commercial Plans: $100.80
  • HealthSmart — All Contracted Commercial Plans: $104.58
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $100.80
  • Preferred One — All Contracted Commercial Plans: $100.80
  • Security Health Plan — All Contracted Commercial Plans: $100.80
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $75.60
  • Trilogy — All Contracted Commercial Plans: $83.16
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPL CBC W AUTO DIFF WBC $57 $31.35 $7.77 – $50.16
Complete blood count (CBC) with differential: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $7.93
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $7.77
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $10.10
  • Aspirus — Marketplace Plans: $45.60
  • Centivo — WI 1 Broad: $26.22
  • Centivo — WI 2 Median: $22.80
  • Chorus Community Health Plan — Marketplace Plans: $22.27
  • Cigna — All Contracted Commercial Plans: $41.04
  • Community Care Incorporated — Medicare Advantage: $7.77
  • Dean Health Plan — All Plans: $28.50
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPL CBC W AUTO DIFF WBC $57 $31.35 $34.20 – $50.16
Complete blood count (CBC) with differential: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $45.60
  • Cigna — All Contracted Commercial Plans: $41.04
  • First Health Network — All Contracted Commercial Plans: $50.16
  • HealthEos — All Contracted Commercial Plans: $45.60
  • HealthSmart — All Contracted Commercial Plans: $47.31
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $45.60
  • Preferred One — All Contracted Commercial Plans: $45.60
  • Security Health Plan — All Contracted Commercial Plans: $45.60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $34.20
  • Trilogy — All Contracted Commercial Plans: $37.62
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPL CBC AUTOMATED $37 $20.35 $6.47 – $32.56
Complete blood count (CBC), automated: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $6.60
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $6.47
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $8.41
  • Aspirus — Marketplace Plans: $29.60
  • Centivo — WI 1 Broad: $17.02
  • Centivo — WI 2 Median: $14.80
  • Chorus Community Health Plan — Marketplace Plans: $18.53
  • Cigna — All Contracted Commercial Plans: $26.64
  • Community Care Incorporated — Medicare Advantage: $6.47
  • Dean Health Plan — All Plans: $18.50
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPL CBC AUTOMATED $37 $20.35 $22.20 – $32.56
Complete blood count (CBC), automated: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $29.60
  • Cigna — All Contracted Commercial Plans: $26.64
  • First Health Network — All Contracted Commercial Plans: $32.56
  • HealthEos — All Contracted Commercial Plans: $29.60
  • HealthSmart — All Contracted Commercial Plans: $30.71
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $29.60
  • Preferred One — All Contracted Commercial Plans: $29.60
  • Security Health Plan — All Contracted Commercial Plans: $29.60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $22.20
  • Trilogy — All Contracted Commercial Plans: $24.42
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME $30 $16.50 $4.29 – $26.40
Blood clotting time test (prothrombin time, PT): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $4.38
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $4.29
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5.58
  • Aspirus — Marketplace Plans: $24
  • Centivo — WI 1 Broad: $13.80
  • Centivo — WI 2 Median: $12
  • Chorus Community Health Plan — Marketplace Plans: $11.28
  • Cigna — All Contracted Commercial Plans: $21.60
  • Community Care Incorporated — Medicare Advantage: $4.29
  • Dean Health Plan — All Plans: $15
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUPUS, PROTHROMBIN TIME $32 $17.60 $4.29 – $28.16
Blood clotting time test (prothrombin time, PT): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $4.38
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $4.29
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5.58
  • Aspirus — Marketplace Plans: $25.60
  • Centivo — WI 1 Broad: $14.72
  • Centivo — WI 2 Median: $12.80
  • Chorus Community Health Plan — Marketplace Plans: $11.28
  • Cigna — All Contracted Commercial Plans: $23.04
  • Community Care Incorporated — Medicare Advantage: $4.29
  • Dean Health Plan — All Plans: $16
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LA PT, PROTHROMBIN TIME (WDL) $30 $16.50 $4.29 – $26.40
Blood clotting time test (prothrombin time, PT): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $4.38
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $4.29
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $5.58
  • Aspirus — Marketplace Plans: $24
  • Centivo — WI 1 Broad: $13.80
  • Centivo — WI 2 Median: $12
  • Chorus Community Health Plan — Marketplace Plans: $11.28
  • Cigna — All Contracted Commercial Plans: $21.60
  • Community Care Incorporated — Medicare Advantage: $4.29
  • Dean Health Plan — All Plans: $15
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME (PTT) $55 $30.25 $6.01 – $48.40
Blood clotting test (partial thromboplastin time, PTT): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $6.13
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $6.01
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7.81
  • Aspirus — Marketplace Plans: $44
  • Centivo — WI 1 Broad: $25.30
  • Centivo — WI 2 Median: $22
  • Chorus Community Health Plan — Marketplace Plans: $17.20
  • Cigna — All Contracted Commercial Plans: $39.60
  • Community Care Incorporated — Medicare Advantage: $6.01
  • Dean Health Plan — All Plans: $27.50
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LA PTT, THROMBOPLASTIN TIME PARTIAL (WDL) $55 $30.25 $6.01 – $48.40
Blood clotting test (partial thromboplastin time, PTT): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $6.13
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $6.01
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7.81
  • Aspirus — Marketplace Plans: $44
  • Centivo — WI 1 Broad: $25.30
  • Centivo — WI 2 Median: $22
  • Chorus Community Health Plan — Marketplace Plans: $17.20
  • Cigna — All Contracted Commercial Plans: $39.60
  • Community Care Incorporated — Medicare Advantage: $6.01
  • Dean Health Plan — All Plans: $27.50
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME (PTT) $55 $30.25 $33 – $48.40
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $44
  • Cigna — All Contracted Commercial Plans: $39.60
  • First Health Network — All Contracted Commercial Plans: $48.40
  • HealthEos — All Contracted Commercial Plans: $44
  • HealthSmart — All Contracted Commercial Plans: $45.65
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $44
  • Preferred One — All Contracted Commercial Plans: $44
  • Security Health Plan — All Contracted Commercial Plans: $44
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $33
  • Trilogy — All Contracted Commercial Plans: $36.30

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT, HEAD OR BRAIN, WITHOUT CONTRAST $1,854 $1,019.70 $101.14 – $1,631.52
CT scan of the head or brain, without contrast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $103.16
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $101.14
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,470
  • Aspirus — Marketplace Plans: $1,483.20
  • Centivo — WI 1 Broad: $852.84
  • Centivo — WI 2 Median: $741.60
  • Chorus Community Health Plan — Marketplace Plans: $1,192.12
  • Cigna — All Contracted Commercial Plans: $1,334.88
  • Community Care Incorporated — Medicare Advantage: $101.14
  • Dean Health Plan — All Plans: $927
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT, HEAD OR BRAIN, WITHOUT CONTRAST $1,854 $1,019.70 $1,112.40 – $1,631.52
CT scan of the head or brain, without contrast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $1,483.20
  • Cigna — All Contracted Commercial Plans: $1,334.88
  • First Health Network — All Contracted Commercial Plans: $1,631.52
  • HealthEos — All Contracted Commercial Plans: $1,483.20
  • HealthSmart — All Contracted Commercial Plans: $1,538.82
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $1,483.20
  • Preferred One — All Contracted Commercial Plans: $1,483.20
  • Security Health Plan — All Contracted Commercial Plans: $1,483.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $1,112.40
  • Trilogy — All Contracted Commercial Plans: $1,223.64
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT HEAD/BRAIN W/O DYE Not listed in the file Not listed in the file $117.37
CT scan of the head or brain, without contrast: rates for 1 insurance plan
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $117.37
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI, BRAIN (INCL BRAIN STEM), W/O CONTRAST, F/B CONTRAST AND FURTHER SEQ $4,500 $2,475 $339.67 – $3,960
MRI of the brain, before and after contrast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $346.46
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $339.67
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $2,364
  • Aspirus — Marketplace Plans: $3,600
  • Centivo — WI 1 Broad: $2,070
  • Centivo — WI 2 Median: $1,800
  • Chorus Community Health Plan — Marketplace Plans: $2,893.50
  • Cigna — All Contracted Commercial Plans: $3,240
  • Community Care Incorporated — Medicare Advantage: $339.67
  • Dean Health Plan — All Plans: $2,250
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI, BRAIN (INCL BRAIN STEM), W/O CONTRAST, F/B CONTRAST AND FURTHER SEQ $4,500 $2,475 $2,700 – $3,960
MRI of the brain, before and after contrast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $3,600
  • Cigna — All Contracted Commercial Plans: $3,240
  • First Health Network — All Contracted Commercial Plans: $3,960
  • HealthEos — All Contracted Commercial Plans: $3,600
  • HealthSmart — All Contracted Commercial Plans: $3,735
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $3,600
  • Preferred One — All Contracted Commercial Plans: $3,600
  • Security Health Plan — All Contracted Commercial Plans: $3,600
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $2,700
  • Trilogy — All Contracted Commercial Plans: $2,970
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, CHEST, 2 VIEWS $244 $134.20 $39.06 – $597
Chest X-ray, 2 views: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $85.42
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $83.74
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $39.06
  • Aspirus — Marketplace Plans: $195.20
  • Centivo — WI 1 Broad: $112.24
  • Centivo — WI 2 Median: $97.60
  • Chorus Community Health Plan — Marketplace Plans: $156.89
  • Cigna — All Contracted Commercial Plans: $175.68
  • Community Care Incorporated — Medicare Advantage: $83.74
  • Dean Health Plan — All Plans: $122
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, CHEST, 2 VIEWS $244 $134.20 $146.40 – $214.72
Chest X-ray, 2 views: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $195.20
  • Cigna — All Contracted Commercial Plans: $175.68
  • First Health Network — All Contracted Commercial Plans: $214.72
  • HealthEos — All Contracted Commercial Plans: $195.20
  • HealthSmart — All Contracted Commercial Plans: $202.52
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $195.20
  • Preferred One — All Contracted Commercial Plans: $195.20
  • Security Health Plan — All Contracted Commercial Plans: $195.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $146.40
  • Trilogy — All Contracted Commercial Plans: $161.04
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, SPINE, LUMBOSACRAL, MINIMUM 4 VIEWS $519 $285.45 $65.54 – $597
X-ray of the lower spine, at least 4 views: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $103.16
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $101.14
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $65.54
  • Aspirus — Marketplace Plans: $415.20
  • Centivo — WI 1 Broad: $238.74
  • Centivo — WI 2 Median: $207.60
  • Chorus Community Health Plan — Marketplace Plans: $333.72
  • Cigna — All Contracted Commercial Plans: $373.68
  • Community Care Incorporated — Medicare Advantage: $101.14
  • Dean Health Plan — All Plans: $259.50
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC X-RAY EXAM, SPINE, LUMBOSACRAL, MINIMUM 4 VIEWS $519 $285.45 $311.40 – $456.72
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $415.20
  • Cigna — All Contracted Commercial Plans: $373.68
  • First Health Network — All Contracted Commercial Plans: $456.72
  • HealthEos — All Contracted Commercial Plans: $415.20
  • HealthSmart — All Contracted Commercial Plans: $430.77
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $415.20
  • Preferred One — All Contracted Commercial Plans: $415.20
  • Security Health Plan — All Contracted Commercial Plans: $415.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $311.40
  • Trilogy — All Contracted Commercial Plans: $342.54
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI, SPINAL CANAL AND CONTENTS, LUMBAR, WITHOUT CONTRAST $3,000 $1,650 $229.90 – $2,640
MRI of the lower back (lumbar spine), without contrast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $234.50
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $229.90
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $2,364
  • Aspirus — Marketplace Plans: $2,400
  • Centivo — WI 1 Broad: $1,380
  • Centivo — WI 2 Median: $1,200
  • Chorus Community Health Plan — Marketplace Plans: $1,929
  • Cigna — All Contracted Commercial Plans: $2,160
  • Community Care Incorporated — Medicare Advantage: $229.90
  • Dean Health Plan — All Plans: $1,500
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI, SPINAL CANAL AND CONTENTS, LUMBAR, WITHOUT CONTRAST $3,000 $1,650 $1,800 – $2,640
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $2,400
  • Cigna — All Contracted Commercial Plans: $2,160
  • First Health Network — All Contracted Commercial Plans: $2,640
  • HealthEos — All Contracted Commercial Plans: $2,400
  • HealthSmart — All Contracted Commercial Plans: $2,490
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $2,400
  • Preferred One — All Contracted Commercial Plans: $2,400
  • Security Health Plan — All Contracted Commercial Plans: $2,400
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $1,800
  • Trilogy — All Contracted Commercial Plans: $1,980
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT, PELVIS, WITH CONTRAST $3,090 $1,699.50 $169.31 – $2,719.20
CT scan of the pelvis, with contrast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $172.70
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $169.31
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,470
  • Aspirus — Marketplace Plans: $2,472
  • Centivo — WI 1 Broad: $1,421.40
  • Centivo — WI 2 Median: $1,236
  • Chorus Community Health Plan — Marketplace Plans: $1,986.87
  • Cigna — All Contracted Commercial Plans: $2,224.80
  • Community Care Incorporated — Medicare Advantage: $169.31
  • Dean Health Plan — All Plans: $1,545
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT, PELVIS, WITH CONTRAST $3,090 $1,699.50 $1,854 – $2,719.20
CT scan of the pelvis, with contrast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $2,472
  • Cigna — All Contracted Commercial Plans: $2,224.80
  • First Health Network — All Contracted Commercial Plans: $2,719.20
  • HealthEos — All Contracted Commercial Plans: $2,472
  • HealthSmart — All Contracted Commercial Plans: $2,564.70
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $2,472
  • Preferred One — All Contracted Commercial Plans: $2,472
  • Security Health Plan — All Contracted Commercial Plans: $2,472
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $1,854
  • Trilogy — All Contracted Commercial Plans: $2,039.40
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI, ANY JOINT OF LOWER EXTREMITY, WITHOUT CONTRAST $4,400 $2,420 $229.90 – $3,872
MRI of a leg joint (such as the knee), without contrast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $234.50
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $229.90
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $2,364
  • Aspirus — Marketplace Plans: $3,520
  • Centivo — WI 1 Broad: $2,024
  • Centivo — WI 2 Median: $1,760
  • Chorus Community Health Plan — Marketplace Plans: $2,829.20
  • Cigna — All Contracted Commercial Plans: $3,168
  • Community Care Incorporated — Medicare Advantage: $229.90
  • Dean Health Plan — All Plans: $2,200
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI, ANY JOINT OF LOWER EXTREMITY, WITHOUT CONTRAST $4,400 $2,420 $2,640 – $3,872
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $3,520
  • Cigna — All Contracted Commercial Plans: $3,168
  • First Health Network — All Contracted Commercial Plans: $3,872
  • HealthEos — All Contracted Commercial Plans: $3,520
  • HealthSmart — All Contracted Commercial Plans: $3,652
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $3,520
  • Preferred One — All Contracted Commercial Plans: $3,520
  • Security Health Plan — All Contracted Commercial Plans: $3,520
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $2,640
  • Trilogy — All Contracted Commercial Plans: $2,904
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT, ABDOMEN AND PELVIS, WITH CONTRAST $3,502 $1,926.10 $339.67 – $3,081.76
CT scan of the abdomen and pelvis, with contrast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $346.46
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $339.67
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,470
  • Aspirus — Marketplace Plans: $2,801.60
  • Centivo — WI 1 Broad: $1,610.92
  • Centivo — WI 2 Median: $1,400.80
  • Chorus Community Health Plan — Marketplace Plans: $2,251.79
  • Cigna — All Contracted Commercial Plans: $2,521.44
  • Community Care Incorporated — Medicare Advantage: $339.67
  • Dean Health Plan — All Plans: $1,751
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT, ABDOMEN AND PELVIS, WITH CONTRAST $3,502 $1,926.10 $2,101.20 – $3,081.76
CT scan of the abdomen and pelvis, with contrast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $2,801.60
  • Cigna — All Contracted Commercial Plans: $2,521.44
  • First Health Network — All Contracted Commercial Plans: $3,081.76
  • HealthEos — All Contracted Commercial Plans: $2,801.60
  • HealthSmart — All Contracted Commercial Plans: $2,906.66
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $2,801.60
  • Preferred One — All Contracted Commercial Plans: $2,801.60
  • Security Health Plan — All Contracted Commercial Plans: $2,801.60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $2,101.20
  • Trilogy — All Contracted Commercial Plans: $2,311.32
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION, COMPLETE $887 $487.85 $101.14 – $780.56
Ultrasound of the abdomen, complete: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $103.16
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $101.14
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $579
  • Aspirus — Marketplace Plans: $709.60
  • Centivo — WI 1 Broad: $408.02
  • Centivo — WI 2 Median: $354.80
  • Chorus Community Health Plan — Marketplace Plans: $570.34
  • Cigna — All Contracted Commercial Plans: $638.64
  • Community Care Incorporated — Medicare Advantage: $101.14
  • Dean Health Plan — All Plans: $443.50
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION, COMPLETE $887 $487.85 $532.20 – $780.56
Ultrasound of the abdomen, complete: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $709.60
  • Cigna — All Contracted Commercial Plans: $638.64
  • First Health Network — All Contracted Commercial Plans: $780.56
  • HealthEos — All Contracted Commercial Plans: $709.60
  • HealthSmart — All Contracted Commercial Plans: $736.21
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $709.60
  • Preferred One — All Contracted Commercial Plans: $709.60
  • Security Health Plan — All Contracted Commercial Plans: $709.60
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $532.20
  • Trilogy — All Contracted Commercial Plans: $585.42
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OB US, UTERUS, FETAL AND MATERNAL EVAL, MORE TH/EQL 14 WKS, SGL/1ST GEST $1,211 $666.05 $101.14 – $1,065.68
Pregnancy ultrasound (after the first trimester): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $103.16
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $101.14
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $579
  • Aspirus — Marketplace Plans: $968.80
  • Centivo — WI 1 Broad: $557.06
  • Centivo — WI 2 Median: $484.40
  • Chorus Community Health Plan — Marketplace Plans: $778.67
  • Cigna — All Contracted Commercial Plans: $871.92
  • Community Care Incorporated — Medicare Advantage: $101.14
  • Dean Health Plan — All Plans: $605.50
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OB US, UTERUS, FETAL AND MATERNAL EVAL, MORE TH/EQL 14 WKS, SGL/1ST GEST $1,211 $666.05 $726.60 – $1,065.68
Pregnancy ultrasound (after the first trimester): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $968.80
  • Cigna — All Contracted Commercial Plans: $871.92
  • First Health Network — All Contracted Commercial Plans: $1,065.68
  • HealthEos — All Contracted Commercial Plans: $968.80
  • HealthSmart — All Contracted Commercial Plans: $1,005.13
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $968.80
  • Preferred One — All Contracted Commercial Plans: $968.80
  • Security Health Plan — All Contracted Commercial Plans: $968.80
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $726.60
  • Trilogy — All Contracted Commercial Plans: $799.26
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NON-OB US, TRANSVAGINAL $990 $544.50 $101.14 – $871.20
Transvaginal ultrasound: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $103.16
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $101.14
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $579
  • Aspirus — Marketplace Plans: $792
  • Centivo — WI 1 Broad: $455.40
  • Centivo — WI 2 Median: $396
  • Chorus Community Health Plan — Marketplace Plans: $636.57
  • Cigna — All Contracted Commercial Plans: $712.80
  • Community Care Incorporated — Medicare Advantage: $101.14
  • Dean Health Plan — All Plans: $495
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC NON-OB US, TRANSVAGINAL $990 $544.50 $594 – $871.20
Transvaginal ultrasound: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $792
  • Cigna — All Contracted Commercial Plans: $712.80
  • First Health Network — All Contracted Commercial Plans: $871.20
  • HealthEos — All Contracted Commercial Plans: $792
  • HealthSmart — All Contracted Commercial Plans: $821.70
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $792
  • Preferred One — All Contracted Commercial Plans: $792
  • Security Health Plan — All Contracted Commercial Plans: $792
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $594
  • Trilogy — All Contracted Commercial Plans: $653.40
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UNILAT, DX MAMMOGRAPHY, INCLUDING CAD $335 $184.25 $110.55 – $294.80
Diagnostic mammogram, one breast: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $118.95
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $116.61
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $182
  • Aspirus — Marketplace Plans: $268
  • Centivo — WI 1 Broad: $154.10
  • Centivo — WI 2 Median: $134
  • Chorus Community Health Plan — Marketplace Plans: $215.41
  • Cigna — All Contracted Commercial Plans: $241.20
  • Community Care Incorporated — Medicare Advantage: $116.61
  • Dean Health Plan — All Plans: $167.50
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UNILAT, DX MAMMOGRAPHY, INCLUDING CAD $335 $184.25 $201 – $294.80
Diagnostic mammogram, one breast: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $268
  • Cigna — All Contracted Commercial Plans: $241.20
  • First Health Network — All Contracted Commercial Plans: $294.80
  • HealthEos — All Contracted Commercial Plans: $268
  • HealthSmart — All Contracted Commercial Plans: $278.05
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $268
  • Preferred One — All Contracted Commercial Plans: $268
  • Security Health Plan — All Contracted Commercial Plans: $268
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $201
  • Trilogy — All Contracted Commercial Plans: $221.10
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BILAT, DX MAMMOGRAPHY, INCLUDING CAD $583 $320.65 $126 – $513.04
Diagnostic mammogram, both breasts: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $150.16
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $147.22
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $182
  • Aspirus — Marketplace Plans: $466.40
  • Centivo — WI 1 Broad: $268.18
  • Centivo — WI 2 Median: $233.20
  • Chorus Community Health Plan — Marketplace Plans: $374.87
  • Cigna — All Contracted Commercial Plans: $419.76
  • Community Care Incorporated — Medicare Advantage: $147.22
  • Dean Health Plan — All Plans: $291.50
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BILAT, DX MAMMOGRAPHY, INCLUDING CAD $583 $320.65 $349.80 – $513.04
Diagnostic mammogram, both breasts: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $466.40
  • Cigna — All Contracted Commercial Plans: $419.76
  • First Health Network — All Contracted Commercial Plans: $513.04
  • HealthEos — All Contracted Commercial Plans: $466.40
  • HealthSmart — All Contracted Commercial Plans: $483.89
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $466.40
  • Preferred One — All Contracted Commercial Plans: $466.40
  • Security Health Plan — All Contracted Commercial Plans: $466.40
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $349.80
  • Trilogy — All Contracted Commercial Plans: $384.78
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BILAT, SCREEN MAMMOGRAPHY, INCLUDING CAD $480 $264 $119.22 – $422.40
Screening mammogram, both breasts: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $121.61
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $119.22
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $182
  • Aspirus — Marketplace Plans: $384
  • Centivo — WI 1 Broad: $220.80
  • Centivo — WI 2 Median: $192
  • Chorus Community Health Plan — Marketplace Plans: $308.64
  • Cigna — All Contracted Commercial Plans: $345.60
  • Community Care Incorporated — Medicare Advantage: $119.22
  • Dean Health Plan — All Plans: $240
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BILAT, SCREEN MAMMOGRAPHY, INCLUDING CAD $480 $264 $288 – $422.40
Screening mammogram, both breasts: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $384
  • Cigna — All Contracted Commercial Plans: $345.60
  • First Health Network — All Contracted Commercial Plans: $422.40
  • HealthEos — All Contracted Commercial Plans: $384
  • HealthSmart — All Contracted Commercial Plans: $398.40
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $384
  • Preferred One — All Contracted Commercial Plans: $384
  • Security Health Plan — All Contracted Commercial Plans: $384
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $288
  • Trilogy — All Contracted Commercial Plans: $316.80

Heart tests and sleep study

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM COMPLETE Not listed in the file Not listed in the file $13.14 – $14.19
Electrocardiogram (ECG/EKG) with reading: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $13.41
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $13.14
  • Community Care Incorporated — Medicare Advantage: $13.14
  • Health Partners — Medicare Advantage: $13.14
  • Humana — Medicare Advantage: $13.14
  • ICare — Medicare Advantage: $13.14
  • Molina — Marketplace Plans: $14.19
  • Molina — Medicare Advantage: $13.14
  • Network Health Plan — Medicare Advantage: $13.14
  • Security Health Plan — Medicare Advantage: $13.14
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LEFT HRT CATH W/VENTRCLGRPHY Not listed in the file Not listed in the file $3,059.13 – $15,743
Left heart catheterization (diagnostic): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $3,120.31
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3,059.13
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $3,059.13
  • Health Partners — Medicare Advantage: $3,059.13
  • Humana — Medicare Advantage: $3,059.13
  • ICare — Medicare Advantage: $3,059.13
  • Molina — Marketplace Plans: $3,303.86
  • Molina — Medicare Advantage: $3,059.13
  • Network Health Plan — ACA: $8,391.64
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPREHENSIVE EP EVALUATION Not listed in the file Not listed in the file $7,217.04 – $16,779
Heart rhythm study (electrophysiology evaluation): 10 of 17 insurance plan rates
  • Allwell — Medicare Advantage: $7,361.38
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $7,217.04
  • Community Care Incorporated — Medicare Advantage: $7,217.04
  • Health Partners — Medicare Advantage: $7,217.04
  • Humana — Medicare Advantage: $7,217.04
  • ICare — Medicare Advantage: $7,217.04
  • Molina — Marketplace Plans: $7,794.41
  • Molina — Medicare Advantage: $7,217.04
  • Network Health Plan — ACA: $9,706.25
  • Network Health Plan — HMO: $10,784.73
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 $14,849.60 – $25,199.28
Heart rhythm study with ablation for atrial fibrillation: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $23,799.32
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $23,332.67
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $14,782
  • Community Care Incorporated — Medicare Advantage: $23,332.67
  • Health Partners — Medicare Advantage: $23,332.67
  • Humana — Medicare Advantage: $23,332.67
  • ICare — Medicare Advantage: $23,332.67
  • Molina — Marketplace Plans: $25,199.28
  • Molina — Medicare Advantage: $23,332.67
  • Network Health Plan — ACA: $13,130.52
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC POLYSOMNOGRAPHY STUDY $5,254 $2,889.70 $478 – $4,623.52
Sleep study (overnight, in a sleep lab): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $986.99
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $967.64
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,311
  • Aspirus — Marketplace Plans: $4,203.20
  • Centivo — WI 1 Broad: $2,416.84
  • Centivo — WI 2 Median: $2,101.60
  • Chorus Community Health Plan — Marketplace Plans: $3,378.32
  • Cigna — All Contracted Commercial Plans: $3,782.88
  • Community Care Incorporated — Medicare Advantage: $967.64
  • Dean Health Plan — All Plans: $2,627
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC POLYSOMNOGRAPHY STUDY $5,254 $2,889.70 $3,152.40 – $4,623.52
Sleep study (overnight, in a sleep lab): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $4,203.20
  • Cigna — All Contracted Commercial Plans: $3,782.88
  • First Health Network — All Contracted Commercial Plans: $4,623.52
  • HealthEos — All Contracted Commercial Plans: $4,203.20
  • HealthSmart — All Contracted Commercial Plans: $4,360.82
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $4,203.20
  • Preferred One — All Contracted Commercial Plans: $4,203.20
  • Security Health Plan — All Contracted Commercial Plans: $4,203.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $3,152.40
  • Trilogy — All Contracted Commercial Plans: $3,467.64

Physical therapy and mental health

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OT, THERAPEUTIC EXERCISES, EACH 15 MIN $190 $104.50 $27.97 – $370
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $28.53
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $27.97
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $248
  • Aspirus — Marketplace Plans: $152
  • Centivo — WI 1 Broad: $87.40
  • Centivo — WI 2 Median: $76
  • Chorus Community Health Plan — Marketplace Plans: $122.17
  • Cigna — All Contracted Commercial Plans: $136.80
  • Community Care Incorporated — Medicare Advantage: $27.97
  • Dean Health Plan — All Plans: $95
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT, THERAPEUTIC EXERCISES, EACH 15 MIN $190 $104.50 $27.97 – $370
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $28.53
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $27.97
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $248
  • Aspirus — Marketplace Plans: $152
  • Centivo — WI 1 Broad: $87.40
  • Centivo — WI 2 Median: $76
  • Chorus Community Health Plan — Marketplace Plans: $122.17
  • Cigna — All Contracted Commercial Plans: $136.80
  • Community Care Incorporated — Medicare Advantage: $27.97
  • Dean Health Plan — All Plans: $95
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OT, THERAPEUTIC EXERCISES, EACH 15 MIN $190 $104.50 $114 – $167.20
Physical therapy: therapeutic exercise (each 15 minutes): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $152
  • Cigna — All Contracted Commercial Plans: $136.80
  • First Health Network — All Contracted Commercial Plans: $167.20
  • HealthEos — All Contracted Commercial Plans: $152
  • HealthSmart — All Contracted Commercial Plans: $157.70
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $152
  • Preferred One — All Contracted Commercial Plans: $152
  • Security Health Plan — All Contracted Commercial Plans: $152
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $114
  • Trilogy — All Contracted Commercial Plans: $125.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, LOW COMPLEXITY $313 $172.15 $95.13 – $370
Physical therapy evaluation (low complexity): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $97.03
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $248
  • Aspirus — Marketplace Plans: $250.40
  • Centivo — WI 1 Broad: $143.98
  • Centivo — WI 2 Median: $125.20
  • Chorus Community Health Plan — Marketplace Plans: $201.26
  • Cigna — All Contracted Commercial Plans: $225.36
  • Community Care Incorporated — Medicare Advantage: $95.13
  • Dean Health Plan — All Plans: $156.50
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, LOW COMPLEXITY $313 $172.15 $187.80 – $275.44
Physical therapy evaluation (low complexity): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $250.40
  • Cigna — All Contracted Commercial Plans: $225.36
  • First Health Network — All Contracted Commercial Plans: $275.44
  • HealthEos — All Contracted Commercial Plans: $250.40
  • HealthSmart — All Contracted Commercial Plans: $259.79
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $250.40
  • Preferred One — All Contracted Commercial Plans: $250.40
  • Security Health Plan — All Contracted Commercial Plans: $250.40
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $187.80
  • Trilogy — All Contracted Commercial Plans: $206.58
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, MODERATE COMPLEXITY $375 $206.25 $95.13 – $370
Physical therapy evaluation (moderate complexity): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $97.03
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $248
  • Aspirus — Marketplace Plans: $300
  • Centivo — WI 1 Broad: $172.50
  • Centivo — WI 2 Median: $150
  • Chorus Community Health Plan — Marketplace Plans: $241.13
  • Cigna — All Contracted Commercial Plans: $270
  • Community Care Incorporated — Medicare Advantage: $95.13
  • Dean Health Plan — All Plans: $187.50
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, MODERATE COMPLEXITY $375 $206.25 $225 – $330
Physical therapy evaluation (moderate complexity): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $300
  • Cigna — All Contracted Commercial Plans: $270
  • First Health Network — All Contracted Commercial Plans: $330
  • HealthEos — All Contracted Commercial Plans: $300
  • HealthSmart — All Contracted Commercial Plans: $311.25
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $300
  • Preferred One — All Contracted Commercial Plans: $300
  • Security Health Plan — All Contracted Commercial Plans: $300
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $225
  • Trilogy — All Contracted Commercial Plans: $247.50
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, HIGH COMPLEXITY $481 $264.55 $95.13 – $423.28
Physical therapy evaluation (high complexity): 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $97.03
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $95.13
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $248
  • Aspirus — Marketplace Plans: $384.80
  • Centivo — WI 1 Broad: $221.26
  • Centivo — WI 2 Median: $192.40
  • Chorus Community Health Plan — Marketplace Plans: $309.28
  • Cigna — All Contracted Commercial Plans: $346.32
  • Community Care Incorporated — Medicare Advantage: $95.13
  • Dean Health Plan — All Plans: $240.50
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PHYSICAL THERAPY EVALUATION, HIGH COMPLEXITY $481 $264.55 $288.60 – $423.28
Physical therapy evaluation (high complexity): rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $384.80
  • Cigna — All Contracted Commercial Plans: $346.32
  • First Health Network — All Contracted Commercial Plans: $423.28
  • HealthEos — All Contracted Commercial Plans: $384.80
  • HealthSmart — All Contracted Commercial Plans: $399.23
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $384.80
  • Preferred One — All Contracted Commercial Plans: $384.80
  • Security Health Plan — All Contracted Commercial Plans: $384.80
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $288.60
  • Trilogy — All Contracted Commercial Plans: $317.46
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 30 MINUTES Not listed in the file Not listed in the file $152.81 – $165.04
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $155.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $152.81
  • Community Care Incorporated — Medicare Advantage: $152.81
  • Health Partners — Medicare Advantage: $152.81
  • Humana — Medicare Advantage: $152.81
  • ICare — Medicare Advantage: $152.81
  • Molina — Marketplace Plans: $165.04
  • Molina — Medicare Advantage: $152.81
  • Network Health Plan — Medicare Advantage: $152.81
  • Security Health Plan — Medicare Advantage: $152.81
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 45 MINUTES Not listed in the file Not listed in the file $152.81 – $165.04
Psychotherapy, 45 minutes: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $155.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $152.81
  • Community Care Incorporated — Medicare Advantage: $152.81
  • Health Partners — Medicare Advantage: $152.81
  • Humana — Medicare Advantage: $152.81
  • ICare — Medicare Advantage: $152.81
  • Molina — Marketplace Plans: $165.04
  • Molina — Medicare Advantage: $152.81
  • Network Health Plan — Medicare Advantage: $152.81
  • Security Health Plan — Medicare Advantage: $152.81
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYTX W PT 60 MINUTES Not listed in the file Not listed in the file $152.81 – $165.04
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $155.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $152.81
  • Community Care Incorporated — Medicare Advantage: $152.81
  • Health Partners — Medicare Advantage: $152.81
  • Humana — Medicare Advantage: $152.81
  • ICare — Medicare Advantage: $152.81
  • Molina — Marketplace Plans: $165.04
  • Molina — Medicare Advantage: $152.81
  • Network Health Plan — Medicare Advantage: $152.81
  • Security Health Plan — Medicare Advantage: $152.81
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/O PT 50 MIN Not listed in the file Not listed in the file $152.81 – $165.04
Family psychotherapy, without the patient: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $155.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $152.81
  • Community Care Incorporated — Medicare Advantage: $152.81
  • Health Partners — Medicare Advantage: $152.81
  • Humana — Medicare Advantage: $152.81
  • ICare — Medicare Advantage: $152.81
  • Molina — Marketplace Plans: $165.04
  • Molina — Medicare Advantage: $152.81
  • Network Health Plan — Medicare Advantage: $152.81
  • Security Health Plan — Medicare Advantage: $152.81
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYTX W/PT 50 MIN Not listed in the file Not listed in the file $152.81 – $165.04
Family psychotherapy, with the patient: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $155.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $152.81
  • Community Care Incorporated — Medicare Advantage: $152.81
  • Health Partners — Medicare Advantage: $152.81
  • Humana — Medicare Advantage: $152.81
  • ICare — Medicare Advantage: $152.81
  • Molina — Marketplace Plans: $165.04
  • Molina — Medicare Advantage: $152.81
  • Network Health Plan — Medicare Advantage: $152.81
  • Security Health Plan — Medicare Advantage: $152.81
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY Not listed in the file Not listed in the file $87.98 – $95.01
Group psychotherapy: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $89.74
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $87.98
  • Community Care Incorporated — Medicare Advantage: $87.98
  • Health Partners — Medicare Advantage: $87.98
  • Humana — Medicare Advantage: $87.98
  • ICare — Medicare Advantage: $87.98
  • Molina — Marketplace Plans: $95.01
  • Molina — Medicare Advantage: $87.98
  • Network Health Plan — Medicare Advantage: $87.98
  • Security Health Plan — Medicare Advantage: $87.98

Procedures and surgery

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION Not listed in the file Not listed in the file $3,642.03 – $8,783
Removal of breast growth (open surgery): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $3,714.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3,642.03
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $3,642.03
  • Health Partners — Medicare Advantage: $3,642.03
  • Humana — Medicare Advantage: $3,642.03
  • ICare — Medicare Advantage: $3,642.03
  • Molina — Marketplace Plans: $3,933.39
  • Molina — Medicare Advantage: $3,642.03
  • Network Health Plan — ACA: $5,216.73
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY Not listed in the file Not listed in the file $12,237.63 – $19,754
Total hip replacement: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $12,482.39
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $12,237.63
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $13,007
  • Community Care Incorporated — Medicare Advantage: $12,237.63
  • Health Partners — Medicare Advantage: $12,237.63
  • Humana — Medicare Advantage: $12,237.63
  • ICare — Medicare Advantage: $12,237.63
  • Molina — Marketplace Plans: $13,216.64
  • Molina — Medicare Advantage: $12,237.63
  • Network Health Plan — ACA: $11,645.84
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY Not listed in the file Not listed in the file $12,237.63 – $19,754
Total knee replacement: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $12,482.39
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $12,237.63
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $13,007
  • Community Care Incorporated — Medicare Advantage: $12,237.63
  • Health Partners — Medicare Advantage: $12,237.63
  • Humana — Medicare Advantage: $12,237.63
  • ICare — Medicare Advantage: $12,237.63
  • Molina — Marketplace Plans: $13,216.64
  • Molina — Medicare Advantage: $12,237.63
  • Network Health Plan — ACA: $11,645.84
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION Not listed in the file Not listed in the file $151.65 – $1,449
Shoulder arthroscopy: shaving of shoulder bone: 10 of 17 insurance plan rates
  • Allwell — Medicare Advantage: $154.68
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $151.65
  • Community Care Incorporated — Medicare Advantage: $151.65
  • Health Partners — Medicare Advantage: $151.65
  • Humana — Medicare Advantage: $151.65
  • ICare — Medicare Advantage: $151.65
  • Molina — Marketplace Plans: $163.78
  • Molina — Medicare Advantage: $151.65
  • Network Health Plan — ACA: $834.68
  • Network Health Plan — HMO: $927.42
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L Not listed in the file Not listed in the file $3,085.95 – $13,918
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $3,147.67
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3,085.95
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $3,085.95
  • Health Partners — Medicare Advantage: $3,085.95
  • Humana — Medicare Advantage: $3,085.95
  • ICare — Medicare Advantage: $3,085.95
  • Molina — Marketplace Plans: $3,332.82
  • Molina — Medicare Advantage: $3,085.95
  • Network Health Plan — ACA: $8,242.44
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS Not listed in the file Not listed in the file $5,626.38 – $8,783
Removal of tonsils and adenoids (under age 12): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $5,738.91
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $5,626.38
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,760
  • Community Care Incorporated — Medicare Advantage: $5,626.38
  • Health Partners — Medicare Advantage: $5,626.38
  • Humana — Medicare Advantage: $5,626.38
  • ICare — Medicare Advantage: $5,626.38
  • Molina — Marketplace Plans: $6,076.49
  • Molina — Medicare Advantage: $5,626.38
  • Network Health Plan — ACA: $5,216.73
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 $891.71 – $6,312
Upper GI endoscopy (diagnostic): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $909.55
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $891.71
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Community Care Incorporated — Medicare Advantage: $891.71
  • Health Partners — Medicare Advantage: $891.71
  • Humana — Medicare Advantage: $891.71
  • ICare — Medicare Advantage: $891.71
  • Molina — Marketplace Plans: $963.05
  • Molina — Medicare Advantage: $891.71
  • Network Health Plan — ACA: $3,893.77
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 $891.71 – $6,312
Upper GI endoscopy with biopsy: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $909.55
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $891.71
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Community Care Incorporated — Medicare Advantage: $891.71
  • Health Partners — Medicare Advantage: $891.71
  • Humana — Medicare Advantage: $891.71
  • ICare — Medicare Advantage: $891.71
  • Molina — Marketplace Plans: $963.05
  • Molina — Medicare Advantage: $891.71
  • Network Health Plan — ACA: $3,893.77
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY Not listed in the file Not listed in the file $867.13 – $6,312
Colonoscopy (diagnostic): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $884.47
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $867.13
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Community Care Incorporated — Medicare Advantage: $867.13
  • Health Partners — Medicare Advantage: $867.13
  • Humana — Medicare Advantage: $867.13
  • ICare — Medicare Advantage: $867.13
  • Molina — Marketplace Plans: $936.50
  • Molina — Medicare Advantage: $867.13
  • Network Health Plan — ACA: $3,893.77
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY Not listed in the file Not listed in the file $1,121.42 – $6,312
Colonoscopy with biopsy: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $1,143.85
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $1,121.42
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Community Care Incorporated — Medicare Advantage: $1,121.42
  • Health Partners — Medicare Advantage: $1,121.42
  • Humana — Medicare Advantage: $1,121.42
  • ICare — Medicare Advantage: $1,121.42
  • Molina — Marketplace Plans: $1,211.14
  • Molina — Medicare Advantage: $1,121.42
  • Network Health Plan — ACA: $3,893.77
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/LESION REMOVAL Not listed in the file Not listed in the file $1,121.42 – $6,312
Colonoscopy with removal of polyps (snare): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $1,143.85
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $1,121.42
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Community Care Incorporated — Medicare Advantage: $1,121.42
  • Health Partners — Medicare Advantage: $1,121.42
  • Humana — Medicare Advantage: $1,121.42
  • ICare — Medicare Advantage: $1,121.42
  • Molina — Marketplace Plans: $1,211.14
  • Molina — Medicare Advantage: $1,121.42
  • Network Health Plan — ACA: $3,893.77
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US Not listed in the file Not listed in the file $1,121.42 – $6,312
Ultrasound of the lower bowel by endoscope: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $1,143.85
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $1,121.42
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Community Care Incorporated — Medicare Advantage: $1,121.42
  • Health Partners — Medicare Advantage: $1,121.42
  • Humana — Medicare Advantage: $1,121.42
  • ICare — Medicare Advantage: $1,121.42
  • Molina — Marketplace Plans: $1,211.14
  • Molina — Medicare Advantage: $1,121.42
  • Network Health Plan — ACA: $3,893.77
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind Not listed in the file Not listed in the file $867.13 – $4,793
Screening colonoscopy (not high risk): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $884.47
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $867.13
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Community Care Incorporated — Medicare Advantage: $867.13
  • Health Partners — Medicare Advantage: $867.13
  • Humana — Medicare Advantage: $867.13
  • ICare — Medicare Advantage: $867.13
  • Molina — Marketplace Plans: $936.50
  • Molina — Medicare Advantage: $867.13
  • Network Health Plan — ACA: $2,931.80
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPAROSCOPIC CHOLECYSTECTOMY Not listed in the file Not listed in the file $5,549.06 – $16,779
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates
  • Allwell — Medicare Advantage: $5,660.04
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $5,549.06
  • Community Care Incorporated — Medicare Advantage: $5,549.06
  • Health Partners — Medicare Advantage: $5,549.06
  • Humana — Medicare Advantage: $5,549.06
  • ICare — Medicare Advantage: $5,549.06
  • Molina — Marketplace Plans: $5,992.98
  • Molina — Medicare Advantage: $5,549.06
  • Network Health Plan — ACA: $9,706.25
  • Network Health Plan — HMO: $10,784.73
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR Not listed in the file Not listed in the file $3,356.49 – $13,918
Groin (inguinal) hernia repair, age 5 or older: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $3,423.62
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3,356.49
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $3,356.49
  • Health Partners — Medicare Advantage: $3,356.49
  • Humana — Medicare Advantage: $3,356.49
  • ICare — Medicare Advantage: $3,356.49
  • Molina — Marketplace Plans: $3,625.01
  • Molina — Medicare Advantage: $3,356.49
  • Network Health Plan — ACA: $8,242.44
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: APC Not listed in the file Not listed in the file $1,948.34 – $6,312
Prostate biopsy: 10 of 11 insurance plan rates
  • Allwell — Medicare Advantage: $1,987.30
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $1,948.34
  • Community Care Incorporated — Medicare Advantage: $1,948.34
  • Health Partners — Medicare Advantage: $1,948.34
  • Humana — Medicare Advantage: $1,948.34
  • ICare — Medicare Advantage: $1,948.34
  • Molina — Marketplace Plans: $2,104.20
  • Molina — Medicare Advantage: $1,948.34
  • Network Health Plan — Medicare Advantage: $1,948.34
  • Security Health Plan — Medicare Advantage: $1,948.34
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Surgery Not listed in the file Not listed in the file $3,370 – $4,326.41
Prostate biopsy: rates for 7 insurance plans
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Network Health Plan — ACA: $3,893.77
  • Network Health Plan — HMO: $4,326.41
  • United Healthcare — Manitowoc Schools: $4,208.80
  • United Healthcare — Nexus: $4,475
  • United Healthcare Choice/Navigate — APA: $5,261
  • United Healthcare Options — PPO: $6,312
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD Not listed in the file Not listed in the file $9,902.11 – $19,754
Prostate removal by laparoscope (radical prostatectomy): 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $10,100.15
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $9,902.11
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $13,007
  • Community Care Incorporated — Medicare Advantage: $9,902.11
  • Health Partners — Medicare Advantage: $9,902.11
  • Humana — Medicare Advantage: $9,902.11
  • ICare — Medicare Advantage: $9,902.11
  • Molina — Marketplace Plans: $10,694.28
  • Molina — Medicare Advantage: $9,902.11
  • Network Health Plan — ACA: $11,645.84
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY Not listed in the file Not listed in the file $3,024.05 – $8,783
Hysteroscopy with biopsy of the uterus lining: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $3,084.53
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $3,024.05
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Community Care Incorporated — Medicare Advantage: $3,024.05
  • Health Partners — Medicare Advantage: $3,024.05
  • Humana — Medicare Advantage: $3,024.05
  • ICare — Medicare Advantage: $3,024.05
  • Molina — Marketplace Plans: $3,265.98
  • Molina — Medicare Advantage: $3,024.05
  • Network Health Plan — ACA: $5,216.73
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ DX/THER SUBST, INTERLAMINAR, LUMBAR/SACRAL, W/ IMAG GUID $1,949 $1,071.95 $643.17 – $4,793
Spinal injection, lower back (epidural), with imaging guidance: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $671.83
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $658.66
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,149.91
  • Aspirus — Marketplace Plans: $1,559.20
  • Centivo — WI 1 Broad: $896.54
  • Centivo — WI 2 Median: $779.60
  • Chorus Community Health Plan — Marketplace Plans: $1,253.21
  • Cigna — All Contracted Commercial Plans: $1,403.28
  • Community Care Incorporated — Medicare Advantage: $658.66
  • Dean Health Plan — All Plans: $974.50
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ DX/THER SUBST, INTERLAMINAR, LUMBAR/SACRAL, W/ IMAG GUID $1,949 $1,071.95 $1,169.40 – $1,715.12
Spinal injection, lower back (epidural), with imaging guidance: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $1,559.20
  • Cigna — All Contracted Commercial Plans: $1,403.28
  • First Health Network — All Contracted Commercial Plans: $1,715.12
  • HealthEos — All Contracted Commercial Plans: $1,559.20
  • HealthSmart — All Contracted Commercial Plans: $1,617.67
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $1,559.20
  • Preferred One — All Contracted Commercial Plans: $1,559.20
  • Security Health Plan — All Contracted Commercial Plans: $1,559.20
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $1,169.40
  • Trilogy — All Contracted Commercial Plans: $1,286.34
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX INTERLAMINAR LMBR/SAC Not listed in the file Not listed in the file $1,241 – $3,257.56
Spinal injection, lower back (epidural), with imaging guidance: rates for 3 insurance plans
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Network Health Plan — ACA: $2,931.80
  • Network Health Plan — HMO: $3,257.56
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ(S), ANES AGENT/STEROID, TFE, W/ IMG GUID, L-S, SINGLE LEVEL $2,773 $1,525.15 $846.75 – $4,793
Nerve root injection, lower back, with imaging guidance: 10 of 36 insurance plan rates
  • Allwell — Medicare Advantage: $863.69
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $846.75
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,636.07
  • Aspirus — Marketplace Plans: $2,218.40
  • Centivo — WI 1 Broad: $1,275.58
  • Centivo — WI 2 Median: $1,109.20
  • Chorus Community Health Plan — Marketplace Plans: $1,783.04
  • Cigna — All Contracted Commercial Plans: $1,996.56
  • Community Care Incorporated — Medicare Advantage: $846.75
  • Dean Health Plan — All Plans: $1,386.50
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ(S), ANES AGENT/STEROID, TFE, W/ IMG GUID, L-S, SINGLE LEVEL $2,773 $1,525.15 $1,663.80 – $2,440.24
Nerve root injection, lower back, with imaging guidance: rates for 10 insurance plans
  • Aspirus — Marketplace Plans: $2,218.40
  • Cigna — All Contracted Commercial Plans: $1,996.56
  • First Health Network — All Contracted Commercial Plans: $2,440.24
  • HealthEos — All Contracted Commercial Plans: $2,218.40
  • HealthSmart — All Contracted Commercial Plans: $2,301.59
  • Multiplan/Private Healthcare Systems — All Contracted Commercial Plans: $2,218.40
  • Preferred One — All Contracted Commercial Plans: $2,218.40
  • Security Health Plan — All Contracted Commercial Plans: $2,218.40
  • Sheboygan Employers Health Network — All Contracted Commercial Plans: $1,663.80
  • Trilogy — All Contracted Commercial Plans: $1,830.18
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 $1,241 – $3,257.56
Nerve root injection, lower back, with imaging guidance: rates for 3 insurance plans
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Network Health Plan — ACA: $2,931.80
  • Network Health Plan — HMO: $3,257.56
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY Not listed in the file Not listed in the file $1,857.28 – $8,783
Carpal tunnel release: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $1,894.43
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $1,857.28
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Community Care Incorporated — Medicare Advantage: $1,857.28
  • Health Partners — Medicare Advantage: $1,857.28
  • Humana — Medicare Advantage: $1,857.28
  • ICare — Medicare Advantage: $1,857.28
  • Molina — Marketplace Plans: $2,005.86
  • Molina — Medicare Advantage: $1,857.28
  • Network Health Plan — ACA: $5,216.73
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY Not listed in the file Not listed in the file $521.77 – $4,793
Laser treatment of clouding after cataract surgery: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $532.21
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $521.77
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $1,241
  • Community Care Incorporated — Medicare Advantage: $521.77
  • Health Partners — Medicare Advantage: $521.77
  • Humana — Medicare Advantage: $521.77
  • ICare — Medicare Advantage: $521.77
  • Molina — Marketplace Plans: $563.52
  • Molina — Medicare Advantage: $521.77
  • Network Health Plan — ACA: $2,931.80
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP Not listed in the file Not listed in the file $2,169.20 – $8,783
Cataract removal with lens implant: 10 of 18 insurance plan rates
  • Allwell — Medicare Advantage: $2,212.59
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2,169.20
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $3,370
  • Community Care Incorporated — Medicare Advantage: $2,169.20
  • Health Partners — Medicare Advantage: $2,169.20
  • Humana — Medicare Advantage: $2,169.20
  • ICare — Medicare Advantage: $2,169.20
  • Molina — Marketplace Plans: $2,342.74
  • Molina — Medicare Advantage: $2,169.20
  • Network Health Plan — ACA: $5,216.73

Pregnancy and childbirth

ServiceHospital chargeCash priceInsurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE Not listed in the file Not listed in the file $2,101.95 – $2,270.10
Vaginal delivery, with care before and after: 10 of 12 insurance plan rates
  • Allwell — Medicare Advantage: $2,143.99
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2,101.95
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $2,101.95
  • Health Partners — Medicare Advantage: $2,101.95
  • Humana — Medicare Advantage: $2,101.95
  • ICare — Medicare Advantage: $2,101.95
  • Molina — Marketplace Plans: $2,270.10
  • Molina — Medicare Advantage: $2,101.95
  • Network Health Plan — Medicare Advantage: $2,101.95
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY Not listed in the file Not listed in the file $2,312.03 – $2,497
Cesarean delivery (C-section), with care before and after: 10 of 12 insurance plan rates
  • Allwell — Medicare Advantage: $2,358.27
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2,312.03
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $2,312.03
  • Health Partners — Medicare Advantage: $2,312.03
  • Humana — Medicare Advantage: $2,312.03
  • ICare — Medicare Advantage: $2,312.03
  • Molina — Marketplace Plans: $2,497
  • Molina — Medicare Advantage: $2,312.03
  • Network Health Plan — Medicare Advantage: $2,312.03
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY Not listed in the file Not listed in the file $2,177.41 – $2,351.61
Vaginal delivery after a previous C-section, with care before and after: 10 of 12 insurance plan rates
  • Allwell — Medicare Advantage: $2,220.96
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $2,177.41
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $7,271
  • Community Care Incorporated — Medicare Advantage: $2,177.41
  • Health Partners — Medicare Advantage: $2,177.41
  • Humana — Medicare Advantage: $2,177.41
  • ICare — Medicare Advantage: $2,177.41
  • Molina — Marketplace Plans: $2,351.61
  • Molina — Medicare Advantage: $2,177.41
  • Network Health Plan — Medicare Advantage: $2,177.41

Hospital stays (whole stay, MS-DRG)

ServiceHospital chargeCash priceInsurance 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 $68,473.95 – $288,240.42
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $69,843.43
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $68,473.95
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $172,216.41
  • Centivo — WI 1 Broad: $220,699.97
  • Centivo — WI 2 Median: $182,361.17
  • Chorus Community Health Plan — Marketplace Plans: $134,542.85
  • Community Care Incorporated — Medicare Advantage: $68,473.95
  • Dean Health Plan — All Plans: $170,257.41
  • Health Partners — All Contracted Commercial Plans: $199,314.77
  • Health Partners — Medicare Advantage: $68,473.95
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 $13,501.19 – $56,833.11
Hip or knee replacement (major joint of the leg), without major complications: 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $13,771.21
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $13,501.19
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $33,956.36
  • Centivo — WI 1 Broad: $43,515.98
  • Centivo — WI 2 Median: $35,956.62
  • Chorus Community Health Plan — Marketplace Plans: $26,528.16
  • Community Care Incorporated — Medicare Advantage: $13,501.19
  • Dean Health Plan — All Plans: $33,570.09
  • Health Partners — All Contracted Commercial Plans: $39,299.41
  • Health Partners — Medicare Advantage: $13,501.19
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 $17,087.69 – $71,930.46
Neck (cervical) spinal fusion, without complications: 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $17,429.44
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $17,087.69
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $42,976.65
  • Centivo — WI 1 Broad: $55,075.73
  • Centivo — WI 2 Median: $45,508.27
  • Chorus Community Health Plan — Marketplace Plans: $33,575.20
  • Community Care Incorporated — Medicare Advantage: $17,087.69
  • Dean Health Plan — All Plans: $42,487.77
  • Health Partners — All Contracted Commercial Plans: $49,739.05
  • Health Partners — Medicare Advantage: $17,087.69
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 $8,684.19 – $36,555.98
Uterus and ovary surgery (not for cancer), without complications: 10 of 26 insurance plan rates
  • Allwell — Medicare Advantage: $8,857.87
  • Anthem Blue Cross Blue Shield — Medicare Advantage: $8,684.19
  • Anthem Blue Cross Blue Shield (Healthlink) — HMO/PPO: $21,841.28
  • Centivo — WI 1 Broad: $27,990.19
  • Centivo — WI 2 Median: $23,127.89
  • Chorus Community Health Plan — Marketplace Plans: $17,063.35
  • Community Care Incorporated — Medicare Advantage: $8,684.19
  • Dean Health Plan — All Plans: $21,592.83
  • Health Partners — All Contracted Commercial Plans: $25,278.02
  • Health Partners — Medicare Advantage: $8,684.19

Source: Holy Family Memorial’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on December 31, 2025; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital typeAcute Care Hospital
Address2300 Western Ave, Manitowoc, WI 54221
CountyManitowoc County
StateWisconsin
Phone(920) 320‑2011
Emergency servicesYes
OwnershipVoluntary non-profit - Other
Medicare overall rating3 of 5 stars
CMS Certification Number520107
Name in Medicare recordsHOLY FAMILY MEMORIAL
Profile levelMedicare data + hospital website
Name on the hospital’s websiteFroedtert Holy Family Memorial Hospital
Official websitefroedtert.com
CorrectionsReport an error or suggest an update →

Sources

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

From the hospital’s website

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

  1. Froedtert Holy Family Memorial Hospital | Froedtert & MCW — froedtert.com
  2. Froedtert Holy Family Memorial Hospital Emergency Department | Froedtert & MCW — froedtert.com
  3. Interpreting & Language Support — froedtert.com
  4. Emergency Services | Holy Family Memorial — hfmhealth.org
  5. Heart and Vascular | Holy Family Memorial — hfmhealth.org
  6. General Surgery | Holy Family Memorial — hfmhealth.org
  7. Women's Health | Holy Family Memorial — hfmhealth.org
  8. Cancer Center | Holy Family Memorial — hfmhealth.org
  9. Rehabilitation and Therapy Services | Holy Family Memorial — hfmhealth.org