Does SSM Health St Agnes Hospital-Fond Du Lac have an emergency room?

Yes. Medicare (CMS) data lists emergency services at SSM Health St Agnes Hospital-Fond Du Lac. In a medical emergency, call 911.

Where is SSM Health St Agnes Hospital-Fond Du Lac?

430 E Division St, Fond Du Lac, WI 54935, in Fond Du Lac County, Wisconsin.

What is the phone number of SSM Health St Agnes Hospital-Fond Du Lac?

(920) 929-2300, as listed by Medicare (CMS).

What is the Medicare star rating of SSM Health St Agnes Hospital-Fond Du Lac?

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

SSM Health St Agnes Hospital-Fond Du Lac

Quick answers

Does SSM Health St Agnes Hospital-Fond Du Lac have an emergency room?: Yes. Medicare (CMS) data lists emergency services at SSM Health St Agnes Hospital-Fond Du Lac. In a medical emergency, call 911.
Where is SSM Health St Agnes Hospital-Fond Du Lac?: 430 E Division St, Fond Du Lac, WI 54935, in Fond Du Lac County, Wisconsin.
What is the phone number of SSM Health St Agnes Hospital-Fond Du Lac?: (920) 929-2300, as listed by Medicare (CMS).
What is the Medicare star rating of SSM Health St Agnes Hospital-Fond Du Lac?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^{[4][5][6][7][8][9][10]}

Conditions treated^[5][8]

Balance and gait disorders
Multiple sclerosis
Orthopedic injuries
Parkinson's disease
Stroke
Psychological and addictive concerns

Treatments^[4][8]

Physical therapy
Occupational therapy
Speech therapy
Pre- and post-operative therapy programs
Emergency care

Procedures^[6]

Angiography
Catheterization
CT scan
3-Tesla MRI
Nuclear medicine imaging
Ultrasound
X-ray
Mammogram

Programs and centers^[5][8][11]

Sports and Spine Center
Behavioral Health
Samaritan Clinic

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Open visiting hours; some specialized units may have specific hours, so check at the nurses station^[12]
Parking	Visitors and patients use Lot 2; ER patients use Lot 4 by the ER entrance; clinic patients use Lot 1; handicap access in Lot 6^[12]

Doctors and clinicians (378)

378 doctors and other clinicians list SSM Health St Agnes Hospital-Fond Du Lac as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 354 more: the button below opens the full list.

Other emergency rooms nearby

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

Fond Du Lac County Acute Psych Unit0.2 mi · Fond Du Lac, WI · Psychiatric Hospital
Waupun Memorial Hospital19 mi · Waupun, WI · Critical Access Hospital
Aurora Medical Ctr Oshkosh19 mi · Oshkosh, WI · Acute Care Hospital
Ripon Medical Center20 mi · Ripon, WI · Critical Access Hospital
Ascension Calumet Hospital22 mi · Chilton, WI · Critical Access Hospital

Other hospitals nearby

Winnebago Mental Health Institute21 mi · Winnebago, WI · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

Avina on Division0.2 mi · Fond du Lac, WI · 1 of 5 stars
Harbor Haven Health & Rehabilitation0.2 mi · Fond du Lac, WI · 5 of 5 stars
St Francis Home0.2 mi · Fond du Lac, WI · 3 of 5 stars

All nursing homes in the state →

Hospice providers

Generations Hospice0.2 mi · Fond Du Lac, WI · 4 of 5 stars
Heartland Hospice Fond Du Lac4.1 mi · Fond Du Lac, WI · 4 of 5 stars
SSM Health at Home Hospice4.1 mi · Fond Du Lac, WI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

SSM Health at Home Home Health - Fond Du Lac4.1 mi · Fond Du Lac, WI
Evergreen at Home13 mi · Oshkosh, WI
Calumet County HHC Agency21 mi · Chilton, WI · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

Fond Du Lac Dialysis Ctr0.2 mi · Fond Du Lac, WI · 3 of 5 stars
DaVita Fond Du Lac Dialysis4.1 mi · Fond Du Lac, WI · 2 of 5 stars
DaVita Oshkosh West Dialysis13 mi · Oshkosh, WI · 4 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

ThedaCare Oshkosh Surgery Center13 mi · Oshkosh, WI
Ambulatory Surgical Ctr19 mi · Oshkosh, WI

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Partnership Dental City Center Oshkosh17 mi · Oshkosh, WI · Community health center
LCHC @ Elkhart-Glenbeulah ES/MS21 mi · Elkhart Lake, WI · Community health center
LCHC @ Elkhart-Glenbeulah High21 mi · Elkhart Lake, WI · Community health center

Clinics and urgent care

American Current Care P.A.13 mi · Oshkosh, WI · Urgent care center
Urgent Care Physicians, Ltd.13 mi · Oshkosh, WI · Urgent care center

Pharmacies

Agnesian Healthcare Inc0.2 mi · Fond Du Lac, WI · Community/retail pharmacy
Agnesian Healthcare Inc0.2 mi · Fond Du Lac, WI · Community/retail pharmacy
Agnesian Healthcare Inc0.2 mi · Fond Du Lac, WI · Community/retail pharmacy

Assisted living nearby

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

Adelaide Place0.2 mi · Fond Du Lac, WI
Arc Fond Du Lac0.2 mi · Fond Du Lac, WI
Edenbrook Meadows Assisted Living LLC0.2 mi · Fond Du Lac, WI
Franklin House0.2 mi · Fond Du Lac, WI

About the Medicare star rating

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

Medicare quality data

What SSM Health St Agnes Hospital-Fond Du Lac reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

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

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	2 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	72%National average: 72%
Would definitely recommend the hospital	66%National average: 71%
Nurses “always” communicated well	81%National average: 80%
Doctors “always” communicated well	78%National average: 80%
Staff “always” explained medicines before giving them	62%National average: 62%
Were given information about recovery at home	90%National average: 86%
Room and bathroom “always” clean	75%National average: 74%
Area around the room “always” quiet at night	65%National average: 60%
Completed surveys	582Response 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)	0.977No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0No different from the national benchmark
Surgical site infections after colon surgery	0No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.29Better than the national benchmark

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

Complications and deaths

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

Deaths within 30 days: heart attack patients	10.8%
Deaths within 30 days: heart failure patients	15.5%
Deaths within 30 days: pneumonia patients	16.2%
Deaths within 30 days: COPD patients	9.3%
Deaths within 30 days: stroke patients	9.8%
Deaths within 30 days: coronary bypass surgery (CABG)	1.9%
Serious complications (patient safety indicator PSI-90)	1.06No different from the national rate
Complications after hip or knee replacement	3.9%

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	14.8%
Readmitted within 30 days: heart failure	21%
Readmitted within 30 days: pneumonia	16.2%
Readmitted within 30 days: COPD	19.4%
Readmitted within 30 days: coronary bypass surgery	12.4%
Readmitted within 30 days: hip or knee replacement	5.5%

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

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	150 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)	69%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 Wisconsin Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as SSM Health St Agnes Hospital-Fond Du Lac lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Faclty Op New Level 3	$404	$222.20	Not listed in the file
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Faclty Op New Level 4	$473	$260.15	Not listed in the file
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Faclty Op New Level 5	$538	$295.90	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office Outpt Visit Est Level 3	$340	$187	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Faclty Op Est Pt Level 3	$340	$187	Not listed in the file
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Cardiac Rehab Visit Level 3	$219	$120.45	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Office Outpt Visit Est Level 4	$383	$210.65	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Faclty Op Est Pt Level 4	$383	$210.65	Not listed in the file
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Cardiac Rehab Visit Level 4	$328	$180.40	Not listed in the file
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$202.50 – $521.11
Emergency room visit (moderate): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $270 DOC — Government: $521.11 MOLINA — Medicare Managed Care Plan: $202.50 Wellcare — Medicare Managed Care Plan: $275.40
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Emergent Level Iii	$990	$544.50	Not listed in the file
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Hospital (facility) fee In the file: Hp Emergency Dept Visit Level 3	$436	$239.80	Not listed in the file
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$309.54 – $796.55
Emergency room visit (moderately high): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $412.72 DOC — Government: $796.55 MOLINA — Medicare Managed Care Plan: $309.54 Wellcare — Medicare Managed Care Plan: $420.97
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Emergent Level Iv	$1,841.64	$1,012.90	Not listed in the file
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Emergency Dept Visit Level 4	$1,841.64	$1,012.90	Not listed in the file
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit	Not listed in the file	Not listed in the file	$441.78 – $1,136.86
Emergency room visit (high): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $589.05 DOC — Government: $1,136.86 MOLINA — Medicare Managed Care Plan: $441.78 Wellcare — Medicare Managed Care Plan: $600.83
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Emergent Level V	$2,574	$1,415.70	Not listed in the file
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Exam Sexual Assault	$1,755	$965.25	Not listed in the file

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Metabolic panel total ca	Not listed in the file	Not listed in the file	$6.34 – $17.11
Basic metabolic panel (blood test): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $8.46 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $17.11 Centivo — Broad(WI1) Other Commercial Plan: $10.58 Centivo — Median(WI2) Other Commercial Plan: $10.58 Centivo — Value(WI3) Other Commercial Plan: $10.58 DOC — Government: $16.33 MOLINA — Medicare Managed Care Plan: $6.34 The Alliance — All Commercial Plans: $14.81 UnitedHealthCare — All Commercial Plans: $8.46 Wellcare — Medicare Managed Care Plan: $8.63
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Basic Metabolic Panel (Ca Total)	$182	$100.10	Not listed in the file
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Basic Metabolic Panel Fasting	$177	$97.35	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$7.92 – $21.40
Comprehensive metabolic panel (blood test): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $10.56 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $21.40 Centivo — Broad(WI1) Other Commercial Plan: $13.20 Centivo — Median(WI2) Other Commercial Plan: $13.20 Centivo — Value(WI3) Other Commercial Plan: $13.20 DOC — Government: $20.38 MOLINA — Medicare Managed Care Plan: $7.92 The Alliance — All Commercial Plans: $18.48 UnitedHealthCare — All Commercial Plans: $10.56 Wellcare — Medicare Managed Care Plan: $10.77
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Comprehensive Metabolic Panel	$241	$132.55	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Lab Comprehensive Metabolic Pbb Bill	$241	$132.55	Not listed in the file
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$35.86 – $96.72
Obstetric blood test panel: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $47.81 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $96.72 Centivo — Broad(WI1) Other Commercial Plan: $59.76 Centivo — Median(WI2) Other Commercial Plan: $59.76 Centivo — Value(WI3) Other Commercial Plan: $59.76 DOC — Government: $92.27 MOLINA — Medicare Managed Care Plan: $35.86 The Alliance — All Commercial Plans: $83.67 UnitedHealthCare — All Commercial Plans: $47.81 Wellcare — Medicare Managed Care Plan: $48.77
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$10.04 – $27.10
Cholesterol panel (lipid panel): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $13.39 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $27.10 Centivo — Broad(WI1) Other Commercial Plan: $16.74 Centivo — Median(WI2) Other Commercial Plan: $16.74 Centivo — Value(WI3) Other Commercial Plan: $16.74 DOC — Government: $25.84 MOLINA — Medicare Managed Care Plan: $10.04 The Alliance — All Commercial Plans: $23.43 UnitedHealthCare — All Commercial Plans: $13.39 Wellcare — Medicare Managed Care Plan: $13.66
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Lipid Profile	$216	$118.80	Not listed in the file
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$6.51 – $17.57
Kidney function panel: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $8.68 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $17.57 Centivo — Broad(WI1) Other Commercial Plan: $10.85 Centivo — Median(WI2) Other Commercial Plan: $10.85 Centivo — Value(WI3) Other Commercial Plan: $10.85 DOC — Government: $16.75 MOLINA — Medicare Managed Care Plan: $6.51 The Alliance — All Commercial Plans: $15.19 UnitedHealthCare — All Commercial Plans: $8.68 Wellcare — Medicare Managed Care Plan: $8.85
Kidney function panel CPT 80069 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Renal Function Panel	$105	$57.75	Not listed in the file
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$6.13 – $16.54
Liver function panel: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $8.17 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $16.54 Centivo — Broad(WI1) Other Commercial Plan: $10.21 Centivo — Median(WI2) Other Commercial Plan: $10.21 Centivo — Value(WI3) Other Commercial Plan: $10.21 DOC — Government: $15.77 MOLINA — Medicare Managed Care Plan: $6.13 The Alliance — All Commercial Plans: $14.30 UnitedHealthCare — All Commercial Plans: $8.17 Wellcare — Medicare Managed Care Plan: $8.33
Liver function panel CPT 80076 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Hepatic Function Panel	$170	$93.50	Not listed in the file
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$2.38 – $6.41
Urine test (automated, with microscope): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $3.17 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $6.41 Centivo — Broad(WI1) Other Commercial Plan: $3.96 Centivo — Median(WI2) Other Commercial Plan: $3.96 Centivo — Value(WI3) Other Commercial Plan: $3.96 DOC — Government: $6.12 MOLINA — Medicare Managed Care Plan: $2.38 The Alliance — All Commercial Plans: $5.55 UnitedHealthCare — All Commercial Plans: $3.17 Wellcare — Medicare Managed Care Plan: $3.23
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Urinalysis Routine Auto W Microscopic	$105	$57.75	Not listed in the file
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	$2.61 – $6.72
Urine test (manual, without microscope): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $3.48 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $5.18 Centivo — Broad(WI1) Other Commercial Plan: $4.35 Centivo — Median(WI2) Other Commercial Plan: $4.35 Centivo — Value(WI3) Other Commercial Plan: $4.35 DOC — Government: $6.72 MOLINA — Medicare Managed Care Plan: $2.61 The Alliance — All Commercial Plans: $6.09 UnitedHealthCare — All Commercial Plans: $3.48 Wellcare — Medicare Managed Care Plan: $3.55
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/o scope	Not listed in the file	Not listed in the file	$1.69 – $4.55
Urine test (automated, without microscope): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $2.25 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $4.55 Centivo — Broad(WI1) Other Commercial Plan: $2.81 Centivo — Median(WI2) Other Commercial Plan: $2.81 Centivo — Value(WI3) Other Commercial Plan: $2.81 DOC — Government: $4.34 MOLINA — Medicare Managed Care Plan: $1.69 The Alliance — All Commercial Plans: $3.94 UnitedHealthCare — All Commercial Plans: $2.25 Wellcare — Medicare Managed Care Plan: $2.30
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Urinalysis Dipstick Auto	$45	$24.75	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay of psa total	Not listed in the file	Not listed in the file	$13.79 – $37.22
PSA (prostate specific antigen) blood test: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $18.39 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $37.22 Centivo — Broad(WI1) Other Commercial Plan: $22.99 Centivo — Median(WI2) Other Commercial Plan: $22.99 Centivo — Value(WI3) Other Commercial Plan: $22.99 DOC — Government: $35.49 MOLINA — Medicare Managed Care Plan: $13.79 The Alliance — All Commercial Plans: $32.18 UnitedHealthCare — All Commercial Plans: $18.39 Wellcare — Medicare Managed Care Plan: $18.76
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Psa Total Refer	$225	$123.75	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Prostate Specific Antigen Diag	$218	$119.90	Not listed in the file
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$12.60 – $34.01
Thyroid stimulating hormone (TSH) test: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $16.80 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $34.01 Centivo — Broad(WI1) Other Commercial Plan: $21 Centivo — Median(WI2) Other Commercial Plan: $21 Centivo — Value(WI3) Other Commercial Plan: $21 DOC — Government: $32.42 MOLINA — Medicare Managed Care Plan: $12.60 The Alliance — All Commercial Plans: $29.40 UnitedHealthCare — All Commercial Plans: $16.80 Wellcare — Medicare Managed Care Plan: $17.14
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Tsh	$252	$138.60	Not listed in the file
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Tsh Neonatal	$252	$138.60	Not listed in the file
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc w/auto diff wbc	Not listed in the file	Not listed in the file	$5.83 – $15.72
Complete blood count (CBC) with differential: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $7.77 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $15.72 Centivo — Broad(WI1) Other Commercial Plan: $9.71 Centivo — Median(WI2) Other Commercial Plan: $9.71 Centivo — Value(WI3) Other Commercial Plan: $9.71 DOC — Government: $15 MOLINA — Medicare Managed Care Plan: $5.83 The Alliance — All Commercial Plans: $13.60 UnitedHealthCare — All Commercial Plans: $7.77 Wellcare — Medicare Managed Care Plan: $7.93
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Cbc W Auto Differential	$137	$75.35	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$4.85 – $13.08
Complete blood count (CBC), automated: rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $6.47 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $13.08 Centivo — Broad(WI1) Other Commercial Plan: $8.09 Centivo — Median(WI2) Other Commercial Plan: $8.09 Centivo — Value(WI3) Other Commercial Plan: $8.09 DOC — Government: $12.49 MOLINA — Medicare Managed Care Plan: $4.85 The Alliance — All Commercial Plans: $11.32 UnitedHealthCare — All Commercial Plans: $6.47 Wellcare — Medicare Managed Care Plan: $6.60
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Cbc W/O Auto Differential	$108	$59.40	Not listed in the file
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin time	Not listed in the file	Not listed in the file	$3.22 – $8.28
Blood clotting time test (prothrombin time, PT): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $4.29 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $7.94 Centivo — Broad(WI1) Other Commercial Plan: $5.36 Centivo — Median(WI2) Other Commercial Plan: $5.36 Centivo — Value(WI3) Other Commercial Plan: $5.36 DOC — Government: $8.28 MOLINA — Medicare Managed Care Plan: $3.22 The Alliance — All Commercial Plans: $7.51 UnitedHealthCare — All Commercial Plans: $4.29 Wellcare — Medicare Managed Care Plan: $4.38
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Pt Poct	$57	$31.35	Not listed in the file
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Pt-Inr	$57	$31.35	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$4.51 – $12.16
Blood clotting test (partial thromboplastin time, PTT): rates for 10 insurance plans BCBS — Anthem Medicare Managed Care Plan: $6.01 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $12.16 Centivo — Broad(WI1) Other Commercial Plan: $7.51 Centivo — Median(WI2) Other Commercial Plan: $7.51 Centivo — Value(WI3) Other Commercial Plan: $7.51 DOC — Government: $11.60 MOLINA — Medicare Managed Care Plan: $4.51 The Alliance — All Commercial Plans: $10.52 UnitedHealthCare — All Commercial Plans: $6.01 Wellcare — Medicare Managed Care Plan: $6.13
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Ptt Inhibitor I	$36	$19.80	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Hospital (facility) fee In the file: Lchg Ptt	$36	$19.80	Not listed in the file

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$77.56 – $250.56
CT scan of the head or brain, without contrast: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $103.41 BCBS — Blue Access PPO: $250.56 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $241.91 BCBS — Blue Traditional Traditional: $250.56 DOC — Government: $199.58 MOLINA — Medicare Managed Care Plan: $77.56 Wellcare — Medicare Managed Care Plan: $105.48
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ct Head Non Contrast	$2,500	$1,375	Not listed in the file
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri brain stem w/o & w/dye	Not listed in the file	Not listed in the file	$258.81 – $901.10
MRI of the brain, before and after contrast: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $345.07 BCBS — Blue Access PPO: $901.10 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $869.97 BCBS — Blue Traditional Traditional: $901.10 DOC — Government: $665.99 MOLINA — Medicare Managed Care Plan: $258.81 Wellcare — Medicare Managed Care Plan: $351.98
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mri Brain With & Without Contrast	$3,352	$1,843.60	Not listed in the file
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$64.56 – $166.13
Chest X-ray, 2 views: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $86.08 BCBS — Blue Access PPO: $67.02 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $64.74 BCBS — Blue Traditional Traditional: $67.02 DOC — Government: $166.13 MOLINA — Medicare Managed Care Plan: $64.56 Wellcare — Medicare Managed Care Plan: $87.80
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Xray Chest 2 Views	$475	$261.25	Not listed in the file
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$77.56 – $199.58
X-ray of the lower spine, at least 4 views: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $103.41 BCBS — Blue Access PPO: $112.73 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $108.83 BCBS — Blue Traditional Traditional: $112.73 DOC — Government: $199.58 MOLINA — Medicare Managed Care Plan: $77.56 Wellcare — Medicare Managed Care Plan: $105.48
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Lumbar Spine 4+ Vw	$553	$304.15	Not listed in the file
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$177 – $507.77
MRI of the lower back (lumbar spine), without contrast: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $236 BCBS — Blue Access PPO: $507.77 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $490.24 BCBS — Blue Traditional Traditional: $507.77 DOC — Government: $455.49 MOLINA — Medicare Managed Care Plan: $177 Wellcare — Medicare Managed Care Plan: $240.72
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mri Spine Lumbar Non Contrast	$4,104	$2,257.20	Not listed in the file
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$130.12 – $575.46
CT scan of the pelvis, with contrast: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $173.49 BCBS — Blue Access PPO: $575.46 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $555.58 BCBS — Blue Traditional Traditional: $575.46 DOC — Government: $334.84 MOLINA — Medicare Managed Care Plan: $130.12 Wellcare — Medicare Managed Care Plan: $176.96
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ct Pelvis With Iv Contrast	$2,833	$1,558.15	Not listed in the file
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$177 – $577.41
MRI of a leg joint (such as the knee), without contrast: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $236 BCBS — Blue Access PPO: $577.41 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $557.47 BCBS — Blue Traditional Traditional: $577.41 DOC — Government: $455.49 MOLINA — Medicare Managed Care Plan: $177 Wellcare — Medicare Managed Care Plan: $240.72
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mri Lower Ext Any Joint Non Contrast	$4,176	$2,296.80	Not listed in the file
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelv w/contrast	Not listed in the file	Not listed in the file	$258.81 – $755.13
CT scan of the abdomen and pelvis, with contrast: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $345.07 BCBS — Blue Access PPO: $755.13 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $729.06 BCBS — Blue Traditional Traditional: $755.13 DOC — Government: $665.99 MOLINA — Medicare Managed Care Plan: $258.81 Wellcare — Medicare Managed Care Plan: $351.98
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ct Abdomen Pelvis W Contrast	$3,115	$1,713.25	Not listed in the file
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$77.56 – $285.01
Ultrasound of the abdomen, complete: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $103.41 BCBS — Blue Access PPO: $285.01 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $275.17 BCBS — Blue Traditional Traditional: $285.01 DOC — Government: $199.58 MOLINA — Medicare Managed Care Plan: $77.56 Wellcare — Medicare Managed Care Plan: $105.48
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Us Abdomen Complete	$1,226	$674.30	Not listed in the file
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >/= 14 wks sngl fetus	Not listed in the file	Not listed in the file	$77.56 – $317.01
Pregnancy ultrasound (after the first trimester): rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $103.41 BCBS — Blue Access PPO: $317.01 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $306.06 BCBS — Blue Traditional Traditional: $317.01 DOC — Government: $199.58 MOLINA — Medicare Managed Care Plan: $77.56 Wellcare — Medicare Managed Care Plan: $105.48
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Us Ob 14+ Wks Single Gest	$729	$400.95	Not listed in the file
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Us Ob >=14 Wks Single Gest	$838	$460.90	Not listed in the file
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$77.56 – $302.25
Transvaginal ultrasound: rates for 7 insurance plans BCBS — Anthem Medicare Managed Care Plan: $103.41 BCBS — Blue Access PPO: $302.25 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $291.80 BCBS — Blue Traditional Traditional: $302.25 DOC — Government: $199.58 MOLINA — Medicare Managed Care Plan: $77.56 Wellcare — Medicare Managed Care Plan: $105.48
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Us Transvaginal Non Ob	$744	$409.20	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$114.41
Diagnostic mammogram, one breast: rates for 1 insurance plan BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $114.41
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mamm Dx Unilateral Includes Cad/Ai	$363	$199.65	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$61.76 – $158.92
Diagnostic mammogram, one breast: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $82.34 DOC — Government: $158.92 MOLINA — Medicare Managed Care Plan: $61.76 Wellcare — Medicare Managed Care Plan: $83.99
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$146.40
Diagnostic mammogram, both breasts: rates for 1 insurance plan BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $146.40
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mamm Dx Bilateral Includes Cad/Ai	$726	$399.30	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$79.11 – $203.58
Diagnostic mammogram, both breasts: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $105.48 DOC — Government: $203.58 MOLINA — Medicare Managed Care Plan: $79.11 Wellcare — Medicare Managed Care Plan: $107.59
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Scr mammo bi incl cad	Not listed in the file	Not listed in the file	$120.90
Screening mammogram, both breasts: rates for 1 insurance plan BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $120.90
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mamm Screen Bilat Includes Cad/Ai	$395	$217.25	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Mamm Screen Unilat Includes Cad/Ai	$198	$108.90	Not listed in the file

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$2,404.97 – $16,106
Left heart catheterization (diagnostic): 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $3,206.62 BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589 Centivo — Broad(WI1) Other Commercial Plan: $16,106 Centivo — Median(WI2) Other Commercial Plan: $16,106 Centivo — Value(WI3) Other Commercial Plan: $16,106 DOC — Government: $6,188.79 MOLINA — Medicare Managed Care Plan: $2,404.97 Network Health Plan — HMO/POS: $15,691
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Electrophysiology evaluation	Not listed in the file	Not listed in the file	$5,786.04 – $18,364
Heart rhythm study (electrophysiology evaluation): rates for 8 insurance plans BCBS — Anthem Medicare Managed Care Plan: $7,714.72 Centivo — Broad(WI1) Other Commercial Plan: $18,364 Centivo — Median(WI2) Other Commercial Plan: $18,364 Centivo — Value(WI3) Other Commercial Plan: $18,364 DOC — Government: $14,889.41 MOLINA — Medicare Managed Care Plan: $5,786.04 Network Health Plan — HMO/POS: $17,314 Wellcare — Medicare Managed Care Plan: $7,869.01
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ep Eval W/O Induction Right A/V	$16,486	$9,067.30	Not listed in the file
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tx atrial fib pulm vein isol	Not listed in the file	Not listed in the file	$19,389.90 – $49,896.68
Heart rhythm study with ablation for atrial fibrillation: rates for 8 insurance plans BCBS — Anthem Medicare Managed Care Plan: $25,853.20 Centivo — Broad(WI1) Other Commercial Plan: $43,643 Centivo — Median(WI2) Other Commercial Plan: $43,643 Centivo — Value(WI3) Other Commercial Plan: $43,643 DOC — Government: $49,896.68 MOLINA — Medicare Managed Care Plan: $19,389.90 Network Health Plan — HMO/POS: $41,120 Wellcare — Medicare Managed Care Plan: $26,370.26
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ep Eval Ablation Afib By Pulm Vein Iso	$46,413	$25,527.15	Not listed in the file
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$637.04 – $1,639.32
Sleep study (overnight, in a sleep lab): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $849.39 DOC — Government: $1,639.32 MOLINA — Medicare Managed Care Plan: $637.04 Wellcare — Medicare Managed Care Plan: $866.38
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Polysomn 4 Or More Less Than 6 Hrs	$5,844	$3,214.20	Not listed in the file
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Polysomn 4 Or More >=6Yrs	$7,129	$3,920.95	Not listed in the file

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Therapeutic exercises	Not listed in the file	Not listed in the file	$21.19 – $54.52
Physical therapy: therapeutic exercise (each 15 minutes): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $28.25 DOC — Government: $54.52 MOLINA — Medicare Managed Care Plan: $21.19 Wellcare — Medicare Managed Care Plan: $28.82
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ther Exercise Ea 15 Min Pt	$125	$68.75	Not listed in the file
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ther Exercise Ea 15 Min Ot	$125	$68.75	Not listed in the file
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$71.78 – $184.70
Physical therapy evaluation (low complexity): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $95.70 DOC — Government: $184.70 MOLINA — Medicare Managed Care Plan: $71.78 Wellcare — Medicare Managed Care Plan: $97.61
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval Low Complexity 1 Rvu	$205	$112.75	Not listed in the file
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval Low Complexity 2 Rvu	$205	$112.75	Not listed in the file
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval mod complex 30 min	Not listed in the file	Not listed in the file	$71.78 – $184.70
Physical therapy evaluation (moderate complexity): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $95.70 DOC — Government: $184.70 MOLINA — Medicare Managed Care Plan: $71.78 Wellcare — Medicare Managed Care Plan: $97.61
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval Mod Complexity 2 Rvu	$244	$134.20	Not listed in the file
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval Mod Complexity 3 Rvu	$244	$134.20	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$71.78 – $184.70
Physical therapy evaluation (high complexity): rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $95.70 DOC — Government: $184.70 MOLINA — Medicare Managed Care Plan: $71.78 Wellcare — Medicare Managed Care Plan: $97.61
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval High Complexity 3 Rvu	$282	$155.10	Not listed in the file
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Pt Eval High Complexity 4 Rvu	$282	$155.10	Not listed in the file
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	$131.67 – $338.84
Psychotherapy, 30 minutes: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $175.56 DOC — Government: $338.84 MOLINA — Medicare Managed Care Plan: $131.67 Wellcare — Medicare Managed Care Plan: $179.07
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Psychotherapy W Pt 30 Min Gl	$168	$92.40	Not listed in the file
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Psychotherapy W Pt 30 Min	$186	$102.30	Not listed in the file
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	$131.67 – $338.84
Psychotherapy, 45 minutes: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $175.56 DOC — Government: $338.84 MOLINA — Medicare Managed Care Plan: $131.67 Wellcare — Medicare Managed Care Plan: $179.07
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Psychotherapy W Pt 45 Min Gl	$507	$278.85	Not listed in the file
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Op Psychotherapy W Pt 45 Min	$186	$102.30	Not listed in the file
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	$131.67 – $338.84
Psychotherapy, 60 minutes: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $175.56 DOC — Government: $338.84 MOLINA — Medicare Managed Care Plan: $131.67 Wellcare — Medicare Managed Care Plan: $179.07
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Op Psychotherapy W Pt 60 Min	$165	$90.75	Not listed in the file
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Psychotherapy W Pt 60 Min Gl	$631	$347.05	Not listed in the file
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	$131.67 – $338.84
Family psychotherapy, without the patient: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $175.56 DOC — Government: $338.84 MOLINA — Medicare Managed Care Plan: $131.67 Wellcare — Medicare Managed Care Plan: $179.07
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Op Family Psychotherapy Wo Pt 50Min	$238	$130.90	Not listed in the file
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Family Psychotherapy Wo Pt 50 Min	$217	$119.35	Not listed in the file
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	$131.67 – $338.84
Family psychotherapy, with the patient: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $175.56 DOC — Government: $338.84 MOLINA — Medicare Managed Care Plan: $131.67 Wellcare — Medicare Managed Care Plan: $179.07
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Family Psychotherapy W Pt 50 Min	$216	$118.80	Not listed in the file
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Op Family Psychotherapy W Pt 50 Min	$238	$130.90	Not listed in the file
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	$75.36 – $193.93
Group psychotherapy: rates for 4 insurance plans BCBS — Anthem Medicare Managed Care Plan: $100.48 DOC — Government: $193.93 MOLINA — Medicare Managed Care Plan: $75.36 Wellcare — Medicare Managed Care Plan: $102.49
Group psychotherapy CPT 90853 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Op Group Therapy Day Rate	$226	$124.30	Not listed in the file
Group psychotherapy CPT 90853 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Iop Group Psychotherapy Session	$207	$113.85	Not listed in the file

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$2,904.59 – $7,791
Removal of breast growth (open surgery): 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $3,872.79 BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589 Centivo — Broad(WI1) Other Commercial Plan: $7,529 Centivo — Median(WI2) Other Commercial Plan: $7,529 Centivo — Value(WI3) Other Commercial Plan: $7,529 DOC — Government: $7,474.49 MOLINA — Medicare Managed Care Plan: $2,904.59 Network Health Plan — HMO/POS: $7,791
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	$6,779 – $27,583
Total hip replacement: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $12,698.86 BCBS — Blue Access PPO: $8,333 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $6,779 BCBS — Blue Traditional Traditional: $8,333 Centivo — Broad(WI1) Other Commercial Plan: $26,827 Centivo — Median(WI2) Other Commercial Plan: $26,827 Centivo — Value(WI3) Other Commercial Plan: $26,827 DOC — Government: $24,508.80 FABOH — All Commercial Plans: $11,502 MOLINA — Medicare Managed Care Plan: $9,524.15
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	$7,609 – $27,583
Total knee replacement: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $12,698.86 BCBS — Blue Access PPO: $9,356 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $7,609 BCBS — Blue Traditional Traditional: $9,356 Centivo — Broad(WI1) Other Commercial Plan: $26,827 Centivo — Median(WI2) Other Commercial Plan: $26,827 Centivo — Value(WI3) Other Commercial Plan: $26,827 DOC — Government: $24,508.80 FABOH — All Commercial Plans: $10,165 MOLINA — Medicare Managed Care Plan: $9,524.15
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Shoulder arthroscopy/surgery	Not listed in the file	Not listed in the file	$1,887 – $8,265
Shoulder arthroscopy: shaving of shoulder bone: rates for 8 insurance plans BCBS — Blue Access PPO: $6,822 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $5,512 BCBS — Blue Traditional Traditional: $6,822 Centivo — Broad(WI1) Other Commercial Plan: $1,887 Centivo — Median(WI2) Other Commercial Plan: $1,887 Centivo — Value(WI3) Other Commercial Plan: $1,887 FABOH — All Commercial Plans: $8,265 Network Health Plan — HMO/POS: $2,334
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Knee arthroscopy/surgery	Not listed in the file	Not listed in the file	$2,427.27 – $8,770
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $3,236.37 BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589 Centivo — Broad(WI1) Other Commercial Plan: $8,770 Centivo — Median(WI2) Other Commercial Plan: $8,770 Centivo — Value(WI3) Other Commercial Plan: $8,770 DOC — Government: $6,246.19 FABOH — All Commercial Plans: $5,067 MOLINA — Medicare Managed Care Plan: $2,427.27
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	$4,226 – $11,300.84
Removal of tonsils and adenoids (under age 12): 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $5,855.36 BCBS — Blue Access PPO: $5,441 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $4,428 BCBS — Blue Traditional Traditional: $5,441 Centivo — Broad(WI1) Other Commercial Plan: $7,529 Centivo — Median(WI2) Other Commercial Plan: $7,529 Centivo — Value(WI3) Other Commercial Plan: $7,529 DOC — Government: $11,300.84 FABOH — All Commercial Plans: $4,226 MOLINA — Medicare Managed Care Plan: $4,391.52
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	$672.83 – $4,761
Upper GI endoscopy (diagnostic): 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $897.11 BCBS — Blue Access PPO: $3,335 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $2,654 BCBS — Blue Traditional Traditional: $3,335 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 DOC — Government: $1,731.42 FABOH — All Commercial Plans: $1,484 MOLINA — Medicare Managed Care Plan: $672.83
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Egd Flex Transoral Dx	$657	$361.35	Not listed in the file
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	$672.83 – $4,761
Upper GI endoscopy with biopsy: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $897.11 BCBS — Blue Access PPO: $3,335 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $2,654 BCBS — Blue Traditional Traditional: $3,335 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 DOC — Government: $1,731.42 FABOH — All Commercial Plans: $1,484 MOLINA — Medicare Managed Care Plan: $672.83
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	$689.87 – $4,761
Colonoscopy (diagnostic): 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $919.83 BCBS — Blue Access PPO: $3,335 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $2,654 BCBS — Blue Traditional Traditional: $3,335 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 DOC — Government: $1,775.27 FABOH — All Commercial Plans: $1,543 MOLINA — Medicare Managed Care Plan: $689.87
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	$887.71 – $4,761
Colonoscopy with biopsy: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $1,183.61 BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 DOC — Government: $2,284.37 FABOH — All Commercial Plans: $1,543 MOLINA — Medicare Managed Care Plan: $887.71
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	$887.71 – $4,761
Colonoscopy with removal of polyps (snare): 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $1,183.61 BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 DOC — Government: $2,284.37 FABOH — All Commercial Plans: $1,543 MOLINA — Medicare Managed Care Plan: $887.71
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	$887.71 – $4,761
Ultrasound of the lower bowel by endoscope: 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $1,183.61 BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 DOC — Government: $2,284.37 MOLINA — Medicare Managed Care Plan: $887.71 Network Health Plan — HMO/POS: $4,761
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	$689.87 – $3,335
Screening colonoscopy (not high risk): 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $919.83 BCBS — Blue Access PPO: $1,322.11 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $1,276.45 BCBS — Blue Traditional Traditional: $1,322.11 Centivo — Broad(WI1) Other Commercial Plan: $2,959 Centivo — Median(WI2) Other Commercial Plan: $2,959 Centivo — Value(WI3) Other Commercial Plan: $2,959 DOC — Government: $1,775.27 MOLINA — Medicare Managed Care Plan: $689.87 Network Health Plan — HMO/POS: $3,030
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	$4,484.77 – $18,364
Gallbladder removal by laparoscope: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $5,979.69 BCBS — Blue Access PPO: $6,462 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $5,257 BCBS — Blue Traditional Traditional: $6,462 Centivo — Broad(WI1) Other Commercial Plan: $18,364 Centivo — Median(WI2) Other Commercial Plan: $18,364 Centivo — Value(WI3) Other Commercial Plan: $18,364 DOC — Government: $11,540.80 FABOH — All Commercial Plans: $7,926 MOLINA — Medicare Managed Care Plan: $4,484.77
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$2,656.06 – $8,770
Groin (inguinal) hernia repair, age 5 or older: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $3,541.41 BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589 Centivo — Broad(WI1) Other Commercial Plan: $8,770 Centivo — Median(WI2) Other Commercial Plan: $8,770 Centivo — Value(WI3) Other Commercial Plan: $8,770 DOC — Government: $6,834.92 FABOH — All Commercial Plans: $5,415 MOLINA — Medicare Managed Care Plan: $2,656.06
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Biopsy of prostate	Not listed in the file	Not listed in the file	$3,388 – $4,761
Prostate biopsy: rates for 7 insurance plans BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $3,579 Centivo — Median(WI2) Other Commercial Plan: $3,579 Centivo — Value(WI3) Other Commercial Plan: $3,579 Network Health Plan — HMO/POS: $4,761
Prostate biopsy CPT 55700 · Inpatient or outpatient · Hospital (facility) fee In the file: Noncdm Charge Record	$667.86	$367.32	Not listed in the file
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparo radical prostatectomy	Not listed in the file	Not listed in the file	$7,609 – $27,583
Prostate removal by laparoscope (radical prostatectomy): 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $10,514.07 BCBS — Blue Access PPO: $9,356 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $7,609 BCBS — Blue Traditional Traditional: $9,356 Centivo — Broad(WI1) Other Commercial Plan: $26,827 Centivo — Median(WI2) Other Commercial Plan: $26,827 Centivo — Value(WI3) Other Commercial Plan: $26,827 DOC — Government: $20,292.15 MOLINA — Medicare Managed Care Plan: $7,885.55 Network Health Plan — HMO/POS: $27,583
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$2,401.40 – $7,791
Hysteroscopy with biopsy of the uterus lining: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $3,201.87 BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $7,529 Centivo — Median(WI2) Other Commercial Plan: $7,529 Centivo — Value(WI3) Other Commercial Plan: $7,529 DOC — Government: $6,179.61 FABOH — All Commercial Plans: $3,824 MOLINA — Medicare Managed Care Plan: $2,401.40
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	$523.65 – $3,335
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $698.19 BCBS — Blue Access PPO: $3,335 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $2,654 BCBS — Blue Traditional Traditional: $3,335 Centivo — Broad(WI1) Other Commercial Plan: $2,959 Centivo — Median(WI2) Other Commercial Plan: $2,959 Centivo — Value(WI3) Other Commercial Plan: $2,959 DOC — Government: $1,347.51 MOLINA — Medicare Managed Care Plan: $523.65 Network Health Plan — HMO/POS: $3,030
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Inj Epidural Lumbar Sacral W Img	$3,107	$1,708.85	Not listed in the file
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj foramen epidural l/s	Not listed in the file	Not listed in the file	$656.13 – $3,335
Nerve root injection, lower back, with imaging guidance: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $874.84 BCBS — Blue Access PPO: $3,335 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $2,654 BCBS — Blue Traditional Traditional: $3,335 Centivo — Broad(WI1) Other Commercial Plan: $2,959 Centivo — Median(WI2) Other Commercial Plan: $2,959 Centivo — Value(WI3) Other Commercial Plan: $2,959 DOC — Government: $1,688.44 FABOH — All Commercial Plans: $1,221 MOLINA — Medicare Managed Care Plan: $656.13
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Inj Transforam Nerve L/S Sngl	$4,049	$2,226.95	Not listed in the file
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Inj Trans Nerve L/S Sngl Bilat	$8,100	$4,455	Not listed in the file
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	$1,448.59 – $7,791
Carpal tunnel release: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $1,931.46 BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $7,529 Centivo — Median(WI2) Other Commercial Plan: $7,529 Centivo — Value(WI3) Other Commercial Plan: $7,529 DOC — Government: $3,727.72 FABOH — All Commercial Plans: $3,170 MOLINA — Medicare Managed Care Plan: $1,448.59
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Ed Carpal Tunnel Release Unilat	$8,305	$4,567.75	Not listed in the file
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Hospital (facility) fee In the file: Hc Carpal Tunnel Release Bilat	$12,517	$6,884.35	Not listed in the file
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	$408.01 – $3,335
Laser treatment of clouding after cataract surgery: 10 of 11 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $544.01 BCBS — Blue Access PPO: $3,335 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $2,654 BCBS — Blue Traditional Traditional: $3,335 Centivo — Broad(WI1) Other Commercial Plan: $2,959 Centivo — Median(WI2) Other Commercial Plan: $2,959 Centivo — Value(WI3) Other Commercial Plan: $2,959 DOC — Government: $1,049.93 MOLINA — Medicare Managed Care Plan: $408.01 Network Health Plan — HMO/POS: $3,030
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cataract surg w/iol 1 stage	Not listed in the file	Not listed in the file	$1,712.02 – $7,791
Cataract removal with lens implant: 10 of 12 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $2,282.69 BCBS — Blue Access PPO: $4,106 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,388 BCBS — Blue Traditional Traditional: $4,106 Centivo — Broad(WI1) Other Commercial Plan: $7,529 Centivo — Median(WI2) Other Commercial Plan: $7,529 Centivo — Value(WI3) Other Commercial Plan: $7,529 DOC — Government: $4,405.59 FABOH — All Commercial Plans: $4,112 MOLINA — Medicare Managed Care Plan: $1,712.02

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$3,735 – $4,589
Vaginal delivery, with care before and after: rates for 3 insurance plans BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589
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	$3,735 – $4,589
Cesarean delivery (C-section), with care before and after: rates for 3 insurance plans BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589
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	$3,735 – $4,589
Vaginal delivery after a previous C-section, with care before and after: rates for 3 insurance plans BCBS — Blue Access PPO: $4,589 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $3,735 BCBS — Blue Traditional Traditional: $4,589

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc	Not listed in the file	Not listed in the file	$53,723.83 – $201,250.39
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 26 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $71,631.77 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $152,582.33 Centivo — Broad(WI1) Other Commercial Plan: $176,491.49 Centivo — Median(WI2) Other Commercial Plan: $168,948.96 Centivo — Value(WI3) Other Commercial Plan: $159,459.64 Dean Health Plan — Medicare Managed Care Plan: $71,631.77 FABOH — All Commercial Plans: $106,798.83 Health Payment System — All Commercial Plans: $128,027.50 Humana — Medicare Managed Care Plan: $71,631.77 ICARE — Medicare Managed Care Plan: $71,631.77
Spinal fusion (not neck), without major complications MS-DRG 460 · Inpatient (hospital stay) · Hospital (facility) fee In the file: Spinal Fusion Except Cervical Without Mcc	Not listed in the file	Not listed in the file	Not listed in the file
Spinal fusion (not neck), without major complications: rates for 6 insurance plans Cigna — All Commercial Plans: 85% (a percentage in the contract, not a dollar amount) First Health/Coventry — All Commercial Plans: 85% (a percentage in the contract, not a dollar amount) Multiplan — Complementary Network All Commercial Plans: 87% (a percentage in the contract, not a dollar amount) Multiplan — HealthEOS Primary Network All Commercial Plans: 87% (a percentage in the contract, not a dollar amount) Multiplan — PHCS Primary Network All Commercial Plans: 85% (a percentage in the contract, not a dollar amount) Sheboygan Employer Health Network — All Commercial Plans: 75% (a percentage in the contract, not a dollar amount)
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	$10,592.86 – $39,681.06
Hip or knee replacement (major joint of the leg), without major complications: 10 of 26 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $14,123.82 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $30,085.05 Centivo — Broad(WI1) Other Commercial Plan: $34,799.28 Centivo — Median(WI2) Other Commercial Plan: $33,312.10 Centivo — Value(WI3) Other Commercial Plan: $31,441.07 Dean Health Plan — Medicare Managed Care Plan: $14,123.82 FABOH — All Commercial Plans: $21,057.80 Health Payment System — All Commercial Plans: $25,243.51 Humana — Medicare Managed Care Plan: $14,123.82 ICARE — Medicare Managed Care Plan: $14,123.82
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	$13,406.80 – $50,222.08
Neck (cervical) spinal fusion, without complications: 10 of 26 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $17,875.73 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $38,076.96 Centivo — Broad(WI1) Other Commercial Plan: $44,043.49 Centivo — Median(WI2) Other Commercial Plan: $42,161.25 Centivo — Value(WI3) Other Commercial Plan: $39,793.19 Dean Health Plan — Medicare Managed Care Plan: $17,875.73 FABOH — All Commercial Plans: $26,651.67 Health Payment System — All Commercial Plans: $31,949.29 Humana — Medicare Managed Care Plan: $17,875.73 ICARE — Medicare Managed Care Plan: $17,875.73
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	$6,813.50 – $25,523.51
Uterus and ovary surgery (not for cancer), without complications: 10 of 26 insurance plan rates BCBS — Anthem Medicare Managed Care Plan: $9,084.67 BCBS — Blue Preferred / Blue Preferred Plus HMO/POS: $19,351.20 Centivo — Broad(WI1) Other Commercial Plan: $22,383.47 Centivo — Median(WI2) Other Commercial Plan: $21,426.89 Centivo — Value(WI3) Other Commercial Plan: $20,223.41 Dean Health Plan — Medicare Managed Care Plan: $9,084.67 FABOH — All Commercial Plans: $13,544.72 Health Payment System — All Commercial Plans: $16,237.04 Humana — Medicare Managed Care Plan: $9,084.67 ICARE — Medicare Managed Care Plan: $9,084.67

Source: SSM Health St Agnes Hospital-Fond Du Lac’s standard charges file (hospitalpricedisclosure.com, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on April 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	430 E Division St, Fond Du Lac, WI 54935
County	Fond Du Lac County
State	Wisconsin
Phone	(920) 929‑2300
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	520088
Name in Medicare records	SSM HEALTH ST AGNES HOSPITAL-FOND DU LAC
Profile level	Medicare data + hospital website
Official website	ssmhealth.com
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

Emergency Care — ssmhealth.com
Behavioral Health — ssmhealth.com
Imaging — ssmhealth.com
Laboratory Services — ssmhealth.com
Sports and Spine Center - St. Agnes Hospital — ssmhealth.com
Infectious Disease & Treatment — ssmhealth.com
Pharmacy — ssmhealth.com
Samaritan Clinic — ssmhealth.com
SSM Health St. Agnes Hospital - Fond du Lac — ssmhealth.com