Does Thedacare Medical Center - Wild Rose have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Thedacare Medical Center - Wild Rose. In a medical emergency, call 911.

Where is Thedacare Medical Center - Wild Rose?

601 Grove Ave, Wild Rose, WI 54984, in Waushara County, Wisconsin.

What is the phone number of Thedacare Medical Center - Wild Rose?

(920) 622-3257, as listed by Medicare (CMS).

What is the Medicare star rating of Thedacare Medical Center - Wild Rose?

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

Thedacare Medical Center - Wild Rose

Quick answers

Does Thedacare Medical Center - Wild Rose have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Thedacare Medical Center - Wild Rose. In a medical emergency, call 911.
Where is Thedacare Medical Center - Wild Rose?: 601 Grove Ave, Wild Rose, WI 54984, in Waushara County, Wisconsin.
What is the phone number of Thedacare Medical Center - Wild Rose?: (920) 622-3257, as listed by Medicare (CMS).
What is the Medicare star rating of Thedacare Medical Center - Wild Rose?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[4][5][6][8]

Emergency Medicine
Anesthesiology
Physical Therapy
Speech-Language Pathology
Rehabilitation
Diagnostic Services

Treatments^{[4][5][6][8][9]}

Emergency care
Physical therapy

Procedures^[8]

Outpatient surgery

Programs and centers^[5][6]

Emergency department
Therapy services

Emergency care (hospital website)^[4][5][7]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level IV

Visiting and practical information

Interpreters and languages	ThedaCare offers video, audio and in-person medical interpreters, including Chinese, French, Hmong and Spanish (system-wide page)^[10]
Patient portal	MyThedaCare

Doctors and clinicians (36)

36 doctors and other clinicians list Thedacare Medical Center - Wild Rose 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 12 more: the button below opens the full list.

Other emergency rooms nearby

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

Thedacare Medical Center-Waupaca14 mi · Waupaca, WI · Critical Access Hospital
Thedacare Medical Center - Berlin Inc21 mi · Berlin, WI · Critical Access Hospital
Aspirus Stevens Point Hospital & Clinics, Inc.29 mi · Stevens Point, WI · Acute Care Hospital
Thedacare Medical Center - New London29 mi · New London, WI · Critical Access Hospital
Aspirus Riverview Hospital & Clinics Inc32 mi · Wisconsin Rapids, WI · Acute Care Hospital

Other hospitals nearby

Gundersen Moundview Hospital and Clinics32 mi · Friendship, WI · Critical Access Hospital

Nursing homes, hospice, home health and dialysis nearby

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

Nursing homes

WI Veterans Hm Ainsworth Hall14 mi · King, WI · 4 of 5 stars
WI Veterans Home Moses Hall14 mi · King, WI · 5 of 5 stars
Bethany Home14 mi · Waupaca, WI · 4 of 5 stars

All nursing homes in the state →

Hospice providers

Compassus Wausau22 mi · Plover, WI · 3 of 5 stars

All hospice providers in the state →

Home health agencies

Aveanna Home Health11 mi · Waupaca, WI · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC Dialysis - Waupaca11 mi · Waupaca, WI · 4 of 5 stars
DaVita Green Lake County Dialysis19 mi · Berlin, WI · 3 of 5 stars
DaVita Stevens Point Dialysis22 mi · Plover, WI · 2 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.

Bjosc, LLC22 mi · Plover, 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

Noble @ Wild Rose Middle/High0.5 mi · Wild Rose, WI · Community health center
Noble @ Wild Rose Elementary0.7 mi · Wild Rose, WI · Community health center
Noble Community Clinics - Mobile Health Services8.2 mi · Wautoma, WI · Community health center

Clinics and urgent care

Aspirus Amherst Clinic16 mi · Amherst, WI · Rural health clinic
Aspirus Plover Clinic - Plover Road22 mi · Plover, WI · Rural health clinic
Moundview Memorial Hospital & Clinics, Inc.23 mi · Westfield, WI · Rural health clinic

Pharmacies

Aurora Pharmacy Inc8.2 mi · Wautoma, WI · Pharmacy
La Clinica de los Campesinos, Inc8.2 mi · Wautoma, WI · Pharmacy
Wautoma Hometown Pharmacy LLC8.2 mi · Wautoma, WI · Community/retail pharmacy

Assisted living nearby

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

Rosemore Village1.2 mi · Wild Rose, WI
Arbor Pines Inc8.2 mi · Wautoma, WI
Heartland House CBRF8.2 mi · Wautoma, WI
Horizon House8.2 mi · Wautoma, 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 Thedacare Medical Center - Wild Rose 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)	Not reported to Medicare
Overall rating of the hospital	Not reported to Medicare
Would recommend the hospital	Not reported to Medicare
Nurses communicated well	Not reported to Medicare
Doctors communicated well	Not reported to Medicare
Staff explained medicines	Not reported to Medicare
Information about recovery at home	Not reported to Medicare
Room and bathroom kept clean	Not reported to Medicare
Quiet at night	Not reported to Medicare
Rated the hospital 9 or 10 out of 10	86%National average: 72%
Would definitely recommend the hospital	86%National average: 71%
Nurses “always” communicated well	91%National average: 80%
Doctors “always” communicated well	86%National average: 80%
Staff “always” explained medicines before giving them	85%National average: 62%
Were given information about recovery at home	96%National average: 86%
Room and bathroom “always” clean	88%National average: 74%
Area around the room “always” quiet at night	74%National average: 60%
Completed surveys	39Response rate: 39%

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

Infections caught in the hospital

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

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

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

Complications and deaths

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

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

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

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Too few cases to report
Readmitted within 30 days: heart failure	Too few cases to report
Readmitted within 30 days: pneumonia	17.7%
Readmitted within 30 days: COPD	Too few cases to report
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; 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)	121 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)	Not reported to Medicare

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 80 common services exactly as Thedacare Medical Center - Wild Rose lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$408	$228.48	$80.78 – $387.60
New patient office visit (about 30–44 minutes): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $236.64 Anthem Blue Access/Traditional (PPO) 1/1/25: $212.16 Anthem Blue Preferred/Preferred Plus: $216.24 Anthem Blue Preferred/Preferred Plus — HMO/POS: $195.84 Anthem Blue Priority: $337.01 Cigna 1/1/23: $224.40 HB Common Ground -1/1/25: $252.96 HB Network Health Plan ACA-1/1/25: $285.60 HB Network Health Plan-1/1/25: $285.60 HB Network-HMO/POS: $257.04
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC New Pt Level 3	$301.10	$168.62	$81.30 – $248.71
New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $248.71 Arise AboutHealth: $201.74 Cigna 1/1/23: $165.61 HB Common Ground -1/1/25: $186.68 HB Network PPO: $240.88 HB Network-HMO/POS: $174.64 HB Trilogy: $159.58 HEALTHPARTNERS BROAD: $147.54 Humana HMO/POS/NPOS: $81.30 Humana PPO: $81.30
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$408	$228.48	$80.78 – $387.60
New patient office visit (about 30–44 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $337.01 Arise AboutHealth: $273.36 Cigna 1/1/23: $224.40 HB Common Ground -1/1/25: $252.96 HB Network PPO: $326.40 HB Network-HMO/POS: $236.64 HB Trilogy: $216.24 HEALTHPARTNERS BROAD: $199.92 Humana HMO/POS/NPOS: $110.16 Humana PPO: $110.16
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$608.60	$340.82	$130.95 – $578.17
New patient office visit (about 45–59 minutes): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $352.99 Anthem Blue Access/Traditional (PPO) 1/1/25: $316.47 Anthem Blue Preferred/Preferred Plus: $322.56 Anthem Blue Preferred/Preferred Plus — HMO/POS: $292.13 Anthem Blue Priority: $502.70 Cigna 1/1/23: $334.73 HB Common Ground -1/1/25: $377.33 HB Network Health Plan ACA-1/1/25: $426.02 HB Network Health Plan-1/1/25: $426.02 HB Network-HMO/POS: $383.42
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC New Pt Level 4	$313.50	$175.56	$84.65 – $258.95
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $258.95 Arise AboutHealth: $210.05 Cigna 1/1/23: $172.43 HB Common Ground -1/1/25: $194.37 HB Network PPO: $250.80 HB Network-HMO/POS: $181.83 HB Trilogy: $166.16 HEALTHPARTNERS BROAD: $153.62 Humana HMO/POS/NPOS: $84.65 Humana PPO: $84.65
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$608.60	$340.82	$130.95 – $578.17
New patient office visit (about 45–59 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $502.70 Arise AboutHealth: $407.76 Cigna 1/1/23: $334.73 HB Common Ground -1/1/25: $377.33 HB Network PPO: $486.88 HB Network-HMO/POS: $352.99 HB Trilogy: $322.56 HEALTHPARTNERS BROAD: $298.21 Humana HMO/POS/NPOS: $164.32 Humana PPO: $164.32
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$803.10	$449.74	$177.80 – $762.95
New patient office visit (about 60–74 minutes): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $465.80 Anthem Blue Access/Traditional (PPO) 1/1/25: $417.61 Anthem Blue Preferred/Preferred Plus: $425.64 Anthem Blue Preferred/Preferred Plus — HMO/POS: $385.49 Anthem Blue Priority: $663.36 Cigna 1/1/23: $441.71 HB Common Ground -1/1/25: $497.92 HB Network Health Plan ACA-1/1/25: $562.17 HB Network Health Plan-1/1/25: $562.17 HB Network-HMO/POS: $505.95
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC New Pt Level 5	$543.80	$304.53	$146.83 – $449.18
New patient office visit (about 60–74 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $449.18 Arise AboutHealth: $364.35 Cigna 1/1/23: $299.09 HB Common Ground -1/1/25: $337.16 HB Network PPO: $435.04 HB Network-HMO/POS: $315.40 HB Trilogy: $288.21 HEALTHPARTNERS BROAD: $266.46 Humana HMO/POS/NPOS: $146.83 Humana PPO: $146.83
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$803.10	$449.74	$177.80 – $762.95
New patient office visit (about 60–74 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $663.36 Arise AboutHealth: $538.08 Cigna 1/1/23: $441.71 HB Common Ground -1/1/25: $497.92 HB Network PPO: $642.48 HB Network-HMO/POS: $465.80 HB Trilogy: $425.64 HEALTHPARTNERS BROAD: $393.52 Humana HMO/POS/NPOS: $216.84 Humana PPO: $216.84
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$293.50	$164.36	$57.67 – $278.83
Established patient office visit (about 20–29 minutes): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $170.23 Anthem Blue Access/Traditional (PPO) 1/1/25: $152.62 Anthem Blue Preferred/Preferred Plus: $155.56 Anthem Blue Preferred/Preferred Plus — HMO/POS: $140.88 Anthem Blue Priority: $242.43 Cigna 1/1/23: $161.43 HB Common Ground -1/1/25: $181.97 HB Network Health Plan ACA-1/1/25: $205.45 HB Network Health Plan-1/1/25: $205.45 HB Network-HMO/POS: $184.91
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Est Pt Level 3	$313.50	$175.56	$84.65 – $258.95
Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $258.95 Arise AboutHealth: $210.05 Cigna 1/1/23: $172.43 HB Common Ground -1/1/25: $194.37 HB Network PPO: $250.80 HB Network-HMO/POS: $181.83 HB Trilogy: $166.16 HEALTHPARTNERS BROAD: $153.62 Humana HMO/POS/NPOS: $84.65 Humana PPO: $84.65
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$293.50	$164.36	$57.67 – $278.83
Established patient office visit (about 20–29 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $242.43 Arise AboutHealth: $196.65 Cigna 1/1/23: $161.43 HB Common Ground -1/1/25: $181.97 HB Network PPO: $234.80 HB Network-HMO/POS: $170.23 HB Trilogy: $155.56 HEALTHPARTNERS BROAD: $143.82 Humana HMO/POS/NPOS: $79.25 Humana PPO: $79.25
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$415.60	$232.74	$85.32 – $394.82
Established patient office visit (about 30–39 minutes): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $241.05 Anthem Blue Access/Traditional (PPO) 1/1/25: $216.11 Anthem Blue Preferred/Preferred Plus: $220.27 Anthem Blue Preferred/Preferred Plus — HMO/POS: $199.49 Anthem Blue Priority: $343.29 Cigna 1/1/23: $228.58 HB Common Ground -1/1/25: $257.67 HB Network Health Plan ACA-1/1/25: $290.92 HB Network Health Plan-1/1/25: $290.92 HB Network-HMO/POS: $261.83
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Est Pt Level 4	$325.80	$182.45	$87.97 – $269.11
Established patient office visit (about 30–39 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $269.11 Arise AboutHealth: $218.29 Cigna 1/1/23: $179.19 HB Common Ground -1/1/25: $202 HB Network PPO: $260.64 HB Network-HMO/POS: $188.96 HB Trilogy: $172.67 HEALTHPARTNERS BROAD: $159.64 Humana HMO/POS/NPOS: $87.97 Humana PPO: $87.97
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$415.60	$232.74	$85.32 – $394.82
Established patient office visit (about 30–39 minutes): 10 of 15 insurance plan rates Anthem Blue Priority: $343.29 Arise AboutHealth: $278.45 Cigna 1/1/23: $228.58 HB Common Ground -1/1/25: $257.67 HB Network PPO: $332.48 HB Network-HMO/POS: $241.05 HB Trilogy: $220.27 HEALTHPARTNERS BROAD: $203.64 Humana HMO/POS/NPOS: $112.21 Humana PPO: $112.21
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE CONSULTATION,LEVEL III	$447.20	$250.43	$94.04 – $369.39
Office consultation with a specialist (moderate): 10 of 15 insurance plan rates Anthem Blue Priority: $369.39 Arise AboutHealth: $299.62 Cigna 1/1/23: $245.96 HB Common Ground -1/1/25: $277.26 HB Network PPO: $357.76 HB Network-HMO/POS: $259.38 HB Trilogy: $237.02 HEALTHPARTNERS BROAD: $219.13 Humana HMO/POS/NPOS: $120.74 Humana PPO: $120.74
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OFFICE CONSULTATION,LEVEL IV	$626	$350.56	$142.61 – $517.08
Office consultation with a specialist (moderate to high): 10 of 15 insurance plan rates Anthem Blue Priority: $517.08 Arise AboutHealth: $419.42 Cigna 1/1/23: $344.30 HB Common Ground -1/1/25: $388.12 HB Network PPO: $500.80 HB Network-HMO/POS: $363.08 HB Trilogy: $331.78 HEALTHPARTNERS BROAD: $306.74 Humana HMO/POS/NPOS: $169.02 Humana PPO: $169.02
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREVENTIVE VISIT,NEW,18-39	$449	$251.44	$90.96 – $370.87
Preventive checkup, new patient, age 18–39: 10 of 15 insurance plan rates Anthem Blue Priority: $370.87 Arise AboutHealth: $300.83 Cigna 1/1/23: $246.95 HB Common Ground -1/1/25: $278.38 HB Network PPO: $359.20 HB Network-HMO/POS: $260.42 HB Trilogy: $237.97 HEALTHPARTNERS BROAD: $220.01 Humana HMO/POS/NPOS: $121.23 Humana PPO: $121.23
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PREVENTIVE VISIT,NEW,40-64	$519.60	$290.98	$110.32 – $429.19
Preventive checkup, new patient, age 40–64: 10 of 15 insurance plan rates Anthem Blue Priority: $429.19 Arise AboutHealth: $348.13 Cigna 1/1/23: $285.78 HB Common Ground -1/1/25: $322.15 HB Network PPO: $415.68 HB Network-HMO/POS: $301.37 HB Trilogy: $275.39 HEALTHPARTNERS BROAD: $254.60 Humana HMO/POS/NPOS: $140.29 Humana PPO: $140.29
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof ER-Moderate Severity Level III	$404.40	$226.46	$157.72 – $393.40
Emergency room visit (moderate): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $234.55 Anthem Blue Access/Traditional (PPO) 1/1/25: $210.29 Anthem Blue Preferred/Preferred Plus: $214.33 Anthem Blue Preferred/Preferred Plus — HMO/POS: $194.11 Anthem Blue Priority: $334.03 Cigna 1/1/23: $222.42 HB Common Ground -1/1/25: $250.73 HB Network Health Plan ACA-1/1/25: $283.08 HB Network Health Plan-1/1/25: $283.08 HB Network-HMO/POS: $254.77
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF ER-MODERATE SEVERITY LEVEL III	$414.10	$231.90	$157.72 – $393.40
Emergency room visit (moderate): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $240.18 Anthem Blue Access/Traditional (PPO) 1/1/25: $215.33 Anthem Blue Preferred/Preferred Plus: $219.47 Anthem Blue Preferred/Preferred Plus — HMO/POS: $198.77 Anthem Blue Priority: $342.05 Cigna 1/1/23: $227.76 HB Common Ground -1/1/25: $256.74 HB Network Health Plan ACA-1/1/25: $289.87 HB Network Health Plan-1/1/25: $289.87 HB Network-HMO/POS: $260.88
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Emergency Dept Visit,Level III	$1,087	$608.72	$1,465 – $2,005
Emergency room visit (moderate): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $1,984 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,628 Anthem Blue Preferred/Preferred Plus: $1,613 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,465 Payer Name — Plan Name: $2,005
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof ER-Moderate Complex Level IV	$684.40	$383.26	$266.92 – $665.76
Emergency room visit (moderately high): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $396.95 Anthem Blue Access/Traditional (PPO) 1/1/25: $355.89 Anthem Blue Preferred/Preferred Plus: $362.73 Anthem Blue Preferred/Preferred Plus — HMO/POS: $328.51 Anthem Blue Priority: $565.31 Cigna 1/1/23: $376.42 HB Common Ground -1/1/25: $424.33 HB Network Health Plan ACA-1/1/25: $479.08 HB Network Health Plan-1/1/25: $479.08 HB Network-HMO/POS: $431.17
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF ER-MODERATE COMPLEX LEVEL IV	$700.80	$392.45	$266.92 – $665.76
Emergency room visit (moderately high): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $406.46 Anthem Blue Access/Traditional (PPO) 1/1/25: $364.42 Anthem Blue Preferred/Preferred Plus: $371.42 Anthem Blue Preferred/Preferred Plus — HMO/POS: $336.38 Anthem Blue Priority: $578.86 Cigna 1/1/23: $385.44 HB Common Ground -1/1/25: $434.50 HB Network Health Plan ACA-1/1/25: $490.56 HB Network Health Plan-1/1/25: $490.56 HB Network-HMO/POS: $441.50
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Emergency Dept Visit,Level IV	$1,638	$917.28	$2,596 – $3,259
Emergency room visit (moderately high): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $3,227 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,882 Anthem Blue Preferred/Preferred Plus: $2,853 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,596 Payer Name — Plan Name: $3,259
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof ER-High Complex Level V	$992.70	$555.91	$387.15 – $965.68
Emergency room visit (high): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $575.77 Anthem Blue Access/Traditional (PPO) 1/1/25: $516.20 Anthem Blue Preferred/Preferred Plus: $526.13 Anthem Blue Preferred/Preferred Plus — HMO/POS: $476.50 Anthem Blue Priority: $819.97 Cigna 1/1/23: $545.99 HB Common Ground -1/1/25: $615.47 HB Network Health Plan ACA-1/1/25: $694.89 HB Network Health Plan-1/1/25: $694.89 HB Network-HMO/POS: $625.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF ER-HIGH COMPLEX LEVEL V	$1,016.50	$569.24	$387.15 – $965.68
Emergency room visit (high): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $589.57 Anthem Blue Access/Traditional (PPO) 1/1/25: $528.58 Anthem Blue Preferred/Preferred Plus: $538.75 Anthem Blue Preferred/Preferred Plus — HMO/POS: $487.92 Anthem Blue Priority: $839.63 Cigna 1/1/23: $559.08 HB Common Ground -1/1/25: $630.23 HB Network Health Plan ACA-1/1/25: $711.55 HB Network Health Plan-1/1/25: $711.55 HB Network-HMO/POS: $640.40
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Emergency Dept Visit,Level V	$2,583	$1,446.48	$2,853
Emergency room visit (high): rates for 1 insurance plan Anthem Blue Preferred/Preferred Plus: $2,853

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: BASIC METABOLIC PANEL	$61.60	$34.50	Not listed in the file
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PANEL, COMPREHENSIVE METABOLIC	$76.90	$43.06	Not listed in the file
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIPID PANEL	$97.50	$54.60	Not listed in the file
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RENAL FUNCTION PANEL	$79.30	$44.41	Not listed in the file
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LIVER PANEL	$60	$33.60	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/MICRO	$18.20	$10.19	Not listed in the file
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, DIP ONLY, NONAUTO	$14.30	$8.01	Not listed in the file
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: URINALYSIS, DIP ONLY, AUTO	$12.50	$7	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE SPECIFIC ANTIGEN	$133.90	$74.98	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATE SPECIFIC ANTIGEN, TOTAL	$133.90	$74.98	Not listed in the file
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PROSTATIC SPC AG, SYMPTOMATIC	$133.90	$74.98	Not listed in the file
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: THYROID STIMULATING HORMONE (TSH)	$122.30	$68.49	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	$122.30	$68.49	Not listed in the file
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CT W/DIFF	$56.80	$31.81	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CT W/MANUAL DIFF	$47.10	$26.38	Not listed in the file
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COMPLETE BLOOD CT NO DIFF	$47.10	$26.38	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	$21.90	$12.26	Not listed in the file
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PARTIAL THROMBOPLASTIN TIME	$43.70	$24.47	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: HC CT Head W/O Contrast (70450)	$1,672.80	$936.77	$230.85 – $2,447.49
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $230.85 HB Common Ground -1/1/25: $259.28 HB Network Health Plan ACA-1/1/25: $292.74 HB Network Health Plan-1/1/25: $259.28 Health EOS: $769.49 Health EOS-1/1/24: $1,421.88 HEALTHPARTNERS NARROW/FOCUSED: $267.65 HEALTHPARTNERS SELECT: $267.65 HPS: $685.85 HPS-1/1/25: $802.94
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT HEAD W/O CONTRAST (70450)	$1,706.30	$955.53	$230.85 – $2,447.49
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $235.47 HB Common Ground -1/1/25: $264.48 HB Network Health Plan ACA-1/1/25: $298.60 HB Network Health Plan-1/1/25: $264.48 Health EOS: $784.90 Health EOS-1/1/24: $1,450.36 HEALTHPARTNERS NARROW/FOCUSED: $273.01 HEALTHPARTNERS SELECT: $273.01 HPS: $699.58 HPS-1/1/25: $819.02
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT HEAD W/O CONTRAST	$597.50	$334.60	$82.46 – $567.63
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $82.46 HB Common Ground -1/1/25: $92.61 HB Network Health Plan ACA-1/1/25: $104.56 HB Network Health Plan-1/1/25: $92.61 Health EOS: $274.85 Health EOS-1/1/24: $507.88 HEALTHPARTNERS NARROW/FOCUSED: $95.60 HEALTHPARTNERS SELECT: $95.60 HPS: $244.98 HPS-1/1/25: $286.80
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI Brain WO and W Contrast	$3,246.70	$1,818.15	$448.04 – $5,183.77
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $448.04 HB Common Ground -1/1/25: $503.24 HB Network Health Plan ACA-1/1/25: $568.17 HB Network Health Plan-1/1/25: $503.24 Health EOS: $1,493.48 Health EOS-1/1/24: $2,759.70 HEALTHPARTNERS NARROW/FOCUSED: $519.47 HEALTHPARTNERS SELECT: $519.47 HPS: $1,331.15 HPS-1/1/25: $1,558.42
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI BRAIN WO AND W CONTRAST	$4,220.70	$2,363.59	$448.04 – $5,183.77
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $582.46 HB Common Ground -1/1/25: $654.21 HB Network Health Plan ACA-1/1/25: $738.62 HB Network Health Plan-1/1/25: $654.21 Health EOS: $1,941.52 Health EOS-1/1/24: $3,587.60 HEALTHPARTNERS NARROW/FOCUSED: $675.31 HEALTHPARTNERS SELECT: $675.31 HPS: $1,730.49 HPS-1/1/25: $2,025.94
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI BRAIN WO AND W CONTRAST	$1,919.60	$1,074.98	$264.90 – $1,823.62
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $264.90 HB Common Ground -1/1/25: $297.54 HB Network Health Plan ACA-1/1/25: $335.93 HB Network Health Plan-1/1/25: $297.54 Health EOS: $883.02 Health EOS-1/1/24: $1,631.66 HEALTHPARTNERS NARROW/FOCUSED: $307.14 HEALTHPARTNERS SELECT: $307.14 HPS: $787.04 HPS-1/1/25: $921.41
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Radiologic Exam Chest 2 Views	$269.90	$151.14	$37.25 – $399
Chest X-ray, 2 views: 10 of 11 insurance plan rates Cigna 1/1/23: $37.25 HB Common Ground -1/1/25: $41.83 HB Network Health Plan ACA-1/1/25: $47.23 HB Network Health Plan-1/1/25: $41.83 Health EOS: $124.15 Health EOS-1/1/24: $229.42 HEALTHPARTNERS NARROW/FOCUSED: $43.18 HEALTHPARTNERS SELECT: $43.18 HPS: $110.66 HPS-1/1/25: $129.55
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: RADIOLOGIC EXAM CHEST 2 VIEWS	$265.90	$148.90	$11.45 – $252.61
Chest X-ray, 2 views: 10 of 11 insurance plan rates Cigna 1/1/23: $36.69 HB Common Ground -1/1/25: $41.21 HB Network Health Plan ACA-1/1/25: $46.53 HB Network Health Plan-1/1/25: $41.21 Health EOS: $122.31 Health EOS-1/1/24: $226.02 HEALTHPARTNERS NARROW/FOCUSED: $42.54 HEALTHPARTNERS SELECT: $42.54 HPS: $109.02 HPS-1/1/25: $127.63
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RADIOLOGIC EXAM CHEST 2 VIEWS	$420	$235.20	$37.25 – $399
Chest X-ray, 2 views: 10 of 11 insurance plan rates Cigna 1/1/23: $57.96 HB Common Ground -1/1/25: $65.10 HB Network Health Plan ACA-1/1/25: $73.50 HB Network Health Plan-1/1/25: $65.10 Health EOS: $193.20 Health EOS-1/1/24: $357 HEALTHPARTNERS NARROW/FOCUSED: $67.20 HEALTHPARTNERS SELECT: $67.20 HPS: $172.20 HPS-1/1/25: $201.60
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 Lumbar Spine 4 Vw	$422.30	$236.49	$58.28 – $588.43
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates Cigna 1/1/23: $58.28 HB Common Ground -1/1/25: $65.46 HB Network Health Plan ACA-1/1/25: $73.90 HB Network Health Plan-1/1/25: $65.46 Health EOS: $194.26 Health EOS-1/1/24: $358.96 HEALTHPARTNERS NARROW/FOCUSED: $67.57 HEALTHPARTNERS SELECT: $67.57 HPS: $173.14 HPS-1/1/25: $202.70
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-RAY LUMBAR SPINE 4 VW	$406.20	$227.47	$14.20 – $385.89
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates Cigna 1/1/23: $56.06 HB Common Ground -1/1/25: $62.96 HB Network Health Plan ACA-1/1/25: $71.09 HB Network Health Plan-1/1/25: $62.96 Health EOS: $186.85 Health EOS-1/1/24: $345.27 HEALTHPARTNERS NARROW/FOCUSED: $64.99 HEALTHPARTNERS SELECT: $64.99 HPS: $166.54 HPS-1/1/25: $194.98
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 LUMBAR SPINE 4 VW	$549	$307.44	$58.28 – $588.43
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates Cigna 1/1/23: $75.76 HB Common Ground -1/1/25: $85.10 HB Network Health Plan ACA-1/1/25: $96.08 HB Network Health Plan-1/1/25: $85.10 Health EOS: $252.54 Health EOS-1/1/24: $466.65 HEALTHPARTNERS NARROW/FOCUSED: $87.84 HEALTHPARTNERS SELECT: $87.84 HPS: $225.09 HPS-1/1/25: $263.52
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI Lumbar Spine WO Contrast	$2,629.10	$1,472.30	$362.82 – $4,189.60
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $362.82 HB Common Ground -1/1/25: $407.51 HB Network Health Plan ACA-1/1/25: $460.09 HB Network Health Plan-1/1/25: $407.51 Health EOS: $1,209.39 Health EOS-1/1/24: $2,234.74 HEALTHPARTNERS NARROW/FOCUSED: $420.66 HEALTHPARTNERS SELECT: $420.66 HPS: $1,077.93 HPS-1/1/25: $1,261.97
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LUMBAR SPINE WO CONTRAST	$3,417.80	$1,913.97	$362.82 – $4,189.60
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $471.66 HB Common Ground -1/1/25: $529.76 HB Network Health Plan ACA-1/1/25: $598.12 HB Network Health Plan-1/1/25: $529.76 Health EOS: $1,572.19 Health EOS-1/1/24: $2,905.13 HEALTHPARTNERS NARROW/FOCUSED: $546.85 HEALTHPARTNERS SELECT: $546.85 HPS: $1,401.30 HPS-1/1/25: $1,640.54
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: MRI LUMBAR SPINE WO CONTRAST	$1,103.20	$617.79	$152.24 – $1,048.04
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $152.24 HB Common Ground -1/1/25: $171 HB Network Health Plan ACA-1/1/25: $193.06 HB Network Health Plan-1/1/25: $171 Health EOS: $507.47 Health EOS-1/1/24: $937.72 HEALTHPARTNERS NARROW/FOCUSED: $176.51 HEALTHPARTNERS SELECT: $176.51 HPS: $452.31 HPS-1/1/25: $529.54
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT Scan of Pelvis Contrast	$1,789.60	$1,002.18	$246.96 – $2,928.95
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $246.96 HB Common Ground -1/1/25: $277.39 HB Network Health Plan ACA-1/1/25: $313.18 HB Network Health Plan-1/1/25: $277.39 Health EOS: $823.22 Health EOS-1/1/24: $1,521.16 HEALTHPARTNERS NARROW/FOCUSED: $286.34 HEALTHPARTNERS SELECT: $286.34 HPS: $733.74 HPS-1/1/25: $859.01
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT SCAN OF PELVIS CONTRAST	$1,825.40	$1,022.22	$246.96 – $2,928.95
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $251.91 HB Common Ground -1/1/25: $282.94 HB Network Health Plan ACA-1/1/25: $319.45 HB Network Health Plan-1/1/25: $282.94 Health EOS: $839.68 Health EOS-1/1/24: $1,551.59 HEALTHPARTNERS NARROW/FOCUSED: $292.06 HEALTHPARTNERS SELECT: $292.06 HPS: $748.41 HPS-1/1/25: $876.19
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: CT SCAN OF PELVIS CONTRAST	$1,521.90	$852.26	$210.02 – $1,445.81
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $210.02 HB Common Ground -1/1/25: $235.89 HB Network Health Plan ACA-1/1/25: $266.33 HB Network Health Plan-1/1/25: $235.89 Health EOS: $700.07 Health EOS-1/1/24: $1,293.62 HEALTHPARTNERS NARROW/FOCUSED: $243.50 HEALTHPARTNERS SELECT: $243.50 HPS: $623.98 HPS-1/1/25: $730.51
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, Joint of Leg	$3,374.10	$1,889.50	$465.63 – $3,818.72
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $465.63 HB Common Ground -1/1/25: $522.99 HB Network Health Plan ACA-1/1/25: $590.47 HB Network Health Plan-1/1/25: $522.99 Health EOS: $1,552.09 Health EOS-1/1/24: $2,867.99 HEALTHPARTNERS NARROW/FOCUSED: $539.86 HEALTHPARTNERS SELECT: $539.86 HPS: $1,383.38 HPS-1/1/25: $1,619.57
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI, JOINT OF LEG	$1,812.80	$1,015.17	$173.22 – $1,722.16
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $250.17 HB Common Ground -1/1/25: $280.98 HB Network Health Plan ACA-1/1/25: $317.24 HB Network Health Plan-1/1/25: $280.98 Health EOS: $833.89 Health EOS-1/1/24: $1,540.88 HEALTHPARTNERS NARROW/FOCUSED: $290.05 HEALTHPARTNERS SELECT: $290.05 HPS: $743.25 HPS-1/1/25: $870.14
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, JOINT OF LEG	$4,019.70	$2,251.03	$465.63 – $3,818.72
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $554.72 HB Common Ground -1/1/25: $623.05 HB Network Health Plan ACA-1/1/25: $703.45 HB Network Health Plan-1/1/25: $623.05 Health EOS: $1,849.06 Health EOS-1/1/24: $3,416.75 HEALTHPARTNERS NARROW/FOCUSED: $643.15 HEALTHPARTNERS SELECT: $643.15 HPS: $1,648.08 HPS-1/1/25: $1,929.46
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT Abdomen&Pelvis W/Contrast	$4,107.50	$2,300.20	$510.60 – $4,607.12
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $566.84 HB Common Ground -1/1/25: $636.66 HB Network Health Plan ACA-1/1/25: $718.81 HB Network Health Plan-1/1/25: $636.66 Health EOS: $1,889.45 Health EOS-1/1/24: $3,491.38 HEALTHPARTNERS NARROW/FOCUSED: $657.20 HEALTHPARTNERS SELECT: $657.20 HPS: $1,684.08 HPS-1/1/25: $1,971.60
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT ABDOMEN&PELVIS W/CONTRAST	$2,734.70	$1,531.43	$103.25 – $2,597.97
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $377.39 HB Common Ground -1/1/25: $423.88 HB Network Health Plan ACA-1/1/25: $478.57 HB Network Health Plan-1/1/25: $423.88 Health EOS: $1,257.96 Health EOS-1/1/24: $2,324.50 HEALTHPARTNERS NARROW/FOCUSED: $437.55 HEALTHPARTNERS SELECT: $437.55 HPS: $1,121.23 HPS-1/1/25: $1,312.66
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABDOMEN&PELVIS W/CONTRAST	$3,700	$2,072	$510.60 – $4,607.12
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates Cigna 1/1/23: $510.60 HB Common Ground -1/1/25: $573.50 HB Network Health Plan ACA-1/1/25: $647.50 HB Network Health Plan-1/1/25: $573.50 Health EOS: $1,702 Health EOS-1/1/24: $3,145 HEALTHPARTNERS NARROW/FOCUSED: $592 HEALTHPARTNERS SELECT: $592 HPS: $1,517 HPS-1/1/25: $1,776
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US Abdomen Complete	$986.10	$552.22	$136.08 – $1,074.45
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates Cigna 1/1/23: $136.08 HB Common Ground -1/1/25: $152.85 HB Network Health Plan ACA-1/1/25: $172.57 HB Network Health Plan-1/1/25: $152.85 Health EOS: $453.61 Health EOS-1/1/24: $838.19 HEALTHPARTNERS NARROW/FOCUSED: $157.78 HEALTHPARTNERS SELECT: $157.78 HPS: $404.30 HPS-1/1/25: $473.33
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US ABDOMEN COMPLETE	$1,015.70	$568.79	$136.08 – $1,074.45
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates Cigna 1/1/23: $140.17 HB Common Ground -1/1/25: $157.43 HB Network Health Plan ACA-1/1/25: $177.75 HB Network Health Plan-1/1/25: $157.43 Health EOS: $467.22 Health EOS-1/1/24: $863.35 HEALTHPARTNERS NARROW/FOCUSED: $162.51 HEALTHPARTNERS SELECT: $162.51 HPS: $416.44 HPS-1/1/25: $487.54
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US ABDOMEN COMPLETE	$677.80	$379.57	$93.54 – $643.91
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates Cigna 1/1/23: $93.54 HB Common Ground -1/1/25: $105.06 HB Network Health Plan ACA-1/1/25: $118.62 HB Network Health Plan-1/1/25: $105.06 Health EOS: $311.79 Health EOS-1/1/24: $576.13 HEALTHPARTNERS NARROW/FOCUSED: $108.45 HEALTHPARTNERS SELECT: $108.45 HPS: $277.90 HPS-1/1/25: $325.34
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US OB >14 Weeks, Single Fetus	$871.70	$488.15	$120.29 – $1,200.04
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Cigna 1/1/23: $120.29 HB Common Ground -1/1/25: $135.11 HB Network Health Plan ACA-1/1/25: $152.55 HB Network Health Plan-1/1/25: $135.11 Health EOS: $400.98 Health EOS-1/1/24: $740.95 HEALTHPARTNERS NARROW/FOCUSED: $139.47 HEALTHPARTNERS SELECT: $139.47 HPS: $357.40 HPS-1/1/25: $418.42
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US OB >14 WEEKS, SINGLE FETUS	$897.90	$502.82	$120.29 – $1,200.04
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Cigna 1/1/23: $123.91 HB Common Ground -1/1/25: $139.17 HB Network Health Plan ACA-1/1/25: $157.13 HB Network Health Plan-1/1/25: $139.17 Health EOS: $413.03 Health EOS-1/1/24: $763.22 HEALTHPARTNERS NARROW/FOCUSED: $143.66 HEALTHPARTNERS SELECT: $143.66 HPS: $368.14 HPS-1/1/25: $430.99
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: US OB >14 WEEKS, SINGLE (76805)	$761.90	$426.66	$105.14 – $723.81
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Cigna 1/1/23: $105.14 HB Common Ground -1/1/25: $118.09 HB Network Health Plan ACA-1/1/25: $133.33 HB Network Health Plan-1/1/25: $118.09 Health EOS: $350.47 Health EOS-1/1/24: $647.62 HEALTHPARTNERS NARROW/FOCUSED: $121.90 HEALTHPARTNERS SELECT: $121.90 HPS: $312.38 HPS-1/1/25: $365.71
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US Transvaginal	$610.60	$341.94	$84.26 – $941.07
Transvaginal ultrasound: 10 of 11 insurance plan rates Cigna 1/1/23: $84.26 HB Common Ground -1/1/25: $94.64 HB Network Health Plan ACA-1/1/25: $106.86 HB Network Health Plan-1/1/25: $94.64 Health EOS: $280.88 Health EOS-1/1/24: $519.01 HEALTHPARTNERS NARROW/FOCUSED: $97.70 HEALTHPARTNERS SELECT: $97.70 HPS: $250.35 HPS-1/1/25: $293.09
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US TRANSVAGINAL	$1,036.20	$580.27	$103.43 – $984.39
Transvaginal ultrasound: 10 of 11 insurance plan rates Cigna 1/1/23: $143 HB Common Ground -1/1/25: $160.61 HB Network Health Plan ACA-1/1/25: $181.34 HB Network Health Plan-1/1/25: $160.61 Health EOS: $476.65 Health EOS-1/1/24: $880.77 HEALTHPARTNERS NARROW/FOCUSED: $165.79 HEALTHPARTNERS SELECT: $165.79 HPS: $424.84 HPS-1/1/25: $497.38
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL	$628.90	$352.18	$84.26 – $941.07
Transvaginal ultrasound: 10 of 11 insurance plan rates Cigna 1/1/23: $86.79 HB Common Ground -1/1/25: $97.48 HB Network Health Plan ACA-1/1/25: $110.06 HB Network Health Plan-1/1/25: $97.48 Health EOS: $289.29 Health EOS-1/1/24: $534.57 HEALTHPARTNERS NARROW/FOCUSED: $100.62 HEALTHPARTNERS SELECT: $100.62 HPS: $257.85 HPS-1/1/25: $301.87
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Diagnostic Mammography Computer-Aided Detcj Uni	$550	$308	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$561	$314.16	Not listed in the file
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$749.50	$419.72	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Diagnostic Mammography Computer-Aided Detcj Bi	$550	$308	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$561	$314.16	Not listed in the file
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$956	$535.36	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Screening Mammography Bi 2-View Breast Inc Cad	$548.50	$307.16	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$575	$322	Not listed in the file
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier TC In the file: SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$792.60	$443.86	Not listed in the file

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Ekg-Electrocardiogram, Global	$290.30	$162.57	$78.38 – $254.16
Electrocardiogram (ECG/EKG) with reading: 10 of 15 insurance plan rates Anthem Blue Priority: $239.79 Arise AboutHealth: $194.50 Cigna 1/1/23: $159.67 HB Common Ground -1/1/25: $179.99 HB Network PPO: $232.24 HB Network-HMO/POS: $168.37 HB Trilogy: $153.86 HEALTHPARTNERS BROAD: $142.25 Humana HMO/POS/NPOS: $78.38 Humana PPO: $78.38
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ELECTROCARDIOGRAM, COMPLETE	$94.70	$53.03	$25.57 – $78.22
Electrocardiogram (ECG/EKG) with reading: 10 of 15 insurance plan rates Anthem Blue Priority: $78.22 Arise AboutHealth: $63.45 Cigna 1/1/23: $52.09 HB Common Ground -1/1/25: $58.71 HB Network PPO: $75.76 HB Network-HMO/POS: $54.93 HB Trilogy: $50.19 HEALTHPARTNERS BROAD: $46.40 Humana HMO/POS/NPOS: $25.57 Humana PPO: $25.57
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EKG-ELECTROCARDIOGRAM, GLOBAL	$307.70	$172.31	$78.38 – $254.16
Electrocardiogram (ECG/EKG) with reading: 10 of 15 insurance plan rates Anthem Blue Priority: $254.16 Arise AboutHealth: $206.16 Cigna 1/1/23: $169.24 HB Common Ground -1/1/25: $190.77 HB Network PPO: $246.16 HB Network-HMO/POS: $178.47 HB Trilogy: $163.08 HEALTHPARTNERS BROAD: $150.77 Humana HMO/POS/NPOS: $83.08 Humana PPO: $83.08
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Left Hrt Cath Includes Lvg (93452)	$7,426	$4,158.56	$10,152 – $12,533
Left heart catheterization (diagnostic): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $12,407 Anthem Blue Access/Traditional (PPO) 1/1/25: $11,278 Anthem Blue Preferred/Preferred Plus: $11,166 Anthem Blue Preferred/Preferred Plus — HMO/POS: $10,152 Payer Name — Plan Name: $12,533
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEFT HRT CATH INCLUDES LVG (93452)	$7,426	$4,158.56	$10,152 – $12,533
Left heart catheterization (diagnostic): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $12,407 Anthem Blue Access/Traditional (PPO) 1/1/25: $11,278 Anthem Blue Preferred/Preferred Plus: $11,166 Anthem Blue Preferred/Preferred Plus — HMO/POS: $10,152 Payer Name — Plan Name: $12,533
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Electrophys Eval,Comprehensive (93619)	$22,437.50	$12,565	$24,363 – $30,078
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $29,779 Anthem Blue Access/Traditional (PPO) 1/1/25: $27,069 Anthem Blue Preferred/Preferred Plus: $26,799 Anthem Blue Preferred/Preferred Plus — HMO/POS: $24,363 Payer Name — Plan Name: $30,078
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ELECTROPHYS EVAL,COMPREHENSIVE (93619)	$22,437.50	$12,565	$24,363 – $30,078
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $29,779 Anthem Blue Access/Traditional (PPO) 1/1/25: $27,069 Anthem Blue Preferred/Preferred Plus: $26,799 Anthem Blue Preferred/Preferred Plus — HMO/POS: $24,363 Payer Name — Plan Name: $30,078
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier 26 In the file: ELECTROPHYS EVAL,COMPREHENSIVE	$3,205.60	$1,795.14	$24,363 – $30,078
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $29,779 Anthem Blue Access/Traditional (PPO) 1/1/25: $27,069 Anthem Blue Preferred/Preferred Plus: $26,799 Anthem Blue Preferred/Preferred Plus — HMO/POS: $24,363 Payer Name — Plan Name: $30,078
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Ep/Transseptal/a Fib Abl W Vein Isolation (93656)	$41,618.30	$23,306.25	$24,363 – $30,078
Heart rhythm study with ablation for atrial fibrillation: rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $29,779 Anthem Blue Access/Traditional (PPO) 1/1/25: $27,069 Anthem Blue Preferred/Preferred Plus: $26,799 Anthem Blue Preferred/Preferred Plus — HMO/POS: $24,363 Payer Name — Plan Name: $30,078
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 PULM VEIN ISOLATION	$9,563.90	$5,355.78	$24,363 – $30,078
Heart rhythm study with ablation for atrial fibrillation: rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $29,779 Anthem Blue Access/Traditional (PPO) 1/1/25: $27,069 Anthem Blue Preferred/Preferred Plus: $26,799 Anthem Blue Preferred/Preferred Plus — HMO/POS: $24,363 Payer Name — Plan Name: $30,078
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	$41,618.30	$23,306.25	$24,363 – $30,078
Heart rhythm study with ablation for atrial fibrillation: rates for 5 insurance plans Anthem Blue Access/Traditional (PPO): $29,779 Anthem Blue Access/Traditional (PPO) 1/1/25: $27,069 Anthem Blue Preferred/Preferred Plus: $26,799 Anthem Blue Preferred/Preferred Plus — HMO/POS: $24,363 Payer Name — Plan Name: $30,078
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Sleep Study-Psg	$4,388.70	$2,457.67	$1,847 – $3,133
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans Anthem Blue Access/Traditional (PPO): $3,103 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,818 Anthem Blue Preferred/Preferred Plus: $2,789 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,537 Payer Name — Plan Name: $3,133 UHC Medicare Advantage: $1,847
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: SLEEP STUDY-PSG	$4,032.20	$2,258.03	$1,847 – $3,133
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans Anthem Blue Access/Traditional (PPO): $3,103 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,818 Anthem Blue Preferred/Preferred Plus: $2,789 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,537 Payer Name — Plan Name: $3,133 UHC Medicare Advantage: $1,847
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SLEEP STUDY-PSG	$4,915.30	$2,752.57	$1,847 – $3,133
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans Anthem Blue Access/Traditional (PPO): $3,103 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,818 Anthem Blue Preferred/Preferred Plus: $2,789 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,537 Payer Name — Plan Name: $3,133 UHC Medicare Advantage: $1,847

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: LAT THERAPUTIC EXERCISE	$207.10	$115.98	$70.02 – $80.31
Physical therapy: therapeutic exercise (each 15 minutes): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAT THERAPUTIC EXERCISE W/MOD 15 MIN(747)	$207.10	$115.98	$70.02 – $80.31
Physical therapy: therapeutic exercise (each 15 minutes): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC Pt-Therapeutic Exercise	$108.70	$60.87	$70.02 – $80.31
Physical therapy: therapeutic exercise (each 15 minutes): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC Pt Eval Low Complex 20 Min	$248.50	$139.16	$70.02 – $80.31
Physical therapy evaluation (low complexity): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC PT EVAL LOW COMPLEX 20 MIN	$273	$152.88	$70.02 – $80.31
Physical therapy evaluation (low complexity): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC Pt Eval Mod Complex 30 Min	$335.50	$187.88	$70.02 – $80.31
Physical therapy evaluation (moderate complexity): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC PT EVAL MOD COMPLEX 30 MIN	$352	$197.12	$70.02 – $80.31
Physical therapy evaluation (moderate complexity): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC Pt Eval High Complex 45 Min	$335.50	$187.88	$70.02 – $80.31
Physical therapy evaluation (high complexity): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee · modifier GP In the file: HC PT EVAL HIGH COMPLEX 45 MIN	$393	$220.08	$70.02 – $80.31
Physical therapy evaluation (high complexity): rates for 3 insurance plans HB Network-HMO/POS: $80.31 HB Trilogy: $74.74 HEALTHPARTNERS BROAD: $70.02
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Psych Therapy 30 Min W/Pt &/or Family	$194.80	$109.09	$52.60 – $167.43
Psychotherapy, 30 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $160.90 Arise AboutHealth: $130.52 Cigna 1/1/23: $107.14 HB Common Ground -1/1/25: $120.78 HB Network PPO: $155.84 HB Network-HMO/POS: $112.98 HB Trilogy: $103.24 HEALTHPARTNERS BROAD: $95.45 Humana HMO/POS/NPOS: $52.60 Humana PPO: $52.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Individual Psychotherapy Lvl 1	$194.80	$109.09	$52.60 – $167.43
Psychotherapy, 30 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $160.90 Arise AboutHealth: $130.52 Cigna 1/1/23: $107.14 HB Common Ground -1/1/25: $120.78 HB Network PPO: $155.84 HB Network-HMO/POS: $112.98 HB Trilogy: $103.24 HEALTHPARTNERS BROAD: $95.45 Humana HMO/POS/NPOS: $52.60 Humana PPO: $52.60
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Php Individual Psychotherapy Lvl 1	$194.80	$109.09	$52.60 – $167.43
Psychotherapy, 30 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $160.90 Arise AboutHealth: $130.52 Cigna 1/1/23: $107.14 HB Common Ground -1/1/25: $120.78 HB Network PPO: $155.84 HB Network-HMO/POS: $112.98 HB Trilogy: $103.24 HEALTHPARTNERS BROAD: $95.45 Humana HMO/POS/NPOS: $52.60 Humana PPO: $52.60
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Psych Therapy 45 Min W/Pt &/or Family	$384.30	$215.21	$103.76 – $382.77
Psychotherapy, 45 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $317.43 Arise AboutHealth: $257.48 Cigna 1/1/23: $211.37 HB Common Ground -1/1/25: $238.27 HB Network PPO: $307.44 HB Network-HMO/POS: $222.89 HB Trilogy: $203.68 HEALTHPARTNERS BROAD: $188.31 Humana HMO/POS/NPOS: $103.76 Humana PPO: $103.76
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Individual Psychotherapy Lvl 2	$384.30	$215.21	$103.76 – $382.77
Psychotherapy, 45 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $317.43 Arise AboutHealth: $257.48 Cigna 1/1/23: $211.37 HB Common Ground -1/1/25: $238.27 HB Network PPO: $307.44 HB Network-HMO/POS: $222.89 HB Trilogy: $203.68 HEALTHPARTNERS BROAD: $188.31 Humana HMO/POS/NPOS: $103.76 Humana PPO: $103.76
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Php Individual Psychotherapy Lvl 2	$384.30	$215.21	$103.76 – $382.77
Psychotherapy, 45 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $317.43 Arise AboutHealth: $257.48 Cigna 1/1/23: $211.37 HB Common Ground -1/1/25: $238.27 HB Network PPO: $307.44 HB Network-HMO/POS: $222.89 HB Trilogy: $203.68 HEALTHPARTNERS BROAD: $188.31 Humana HMO/POS/NPOS: $103.76 Humana PPO: $103.76
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Psych Therapy 60 Min W/Pt &/or Family	$383.80	$214.93	$103.63 – $382.77
Psychotherapy, 60 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $317.02 Arise AboutHealth: $257.15 Cigna 1/1/23: $211.09 HB Common Ground -1/1/25: $237.96 HB Network PPO: $307.04 HB Network-HMO/POS: $222.60 HB Trilogy: $203.41 HEALTHPARTNERS BROAD: $188.06 Humana HMO/POS/NPOS: $103.63 Humana PPO: $103.63
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Php Psych Therapy 60 Min W/Pt &/or Family	$383.80	$214.93	$103.63 – $382.77
Psychotherapy, 60 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $317.02 Arise AboutHealth: $257.15 Cigna 1/1/23: $211.09 HB Common Ground -1/1/25: $237.96 HB Network PPO: $307.04 HB Network-HMO/POS: $222.60 HB Trilogy: $203.41 HEALTHPARTNERS BROAD: $188.06 Humana HMO/POS/NPOS: $103.63 Humana PPO: $103.63
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PSYCHOTHERAPY W/PATIENT 60 MINUTES	$551.40	$308.78	$131.52 – $455.46
Psychotherapy, 60 minutes: 10 of 15 insurance plan rates Anthem Blue Priority: $455.46 Arise AboutHealth: $369.44 Cigna 1/1/23: $303.27 HB Common Ground -1/1/25: $341.87 HB Network PPO: $441.12 HB Network-HMO/POS: $319.81 HB Trilogy: $292.24 HEALTHPARTNERS BROAD: $270.19 Humana HMO/POS/NPOS: $148.88 Humana PPO: $148.88
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Family Mtg W/O Pt Present	$301.10	$168.62	$81.30 – $258.54
Family psychotherapy, without the patient: 10 of 15 insurance plan rates Anthem Blue Priority: $248.71 Arise AboutHealth: $201.74 Cigna 1/1/23: $165.61 HB Common Ground -1/1/25: $186.68 HB Network PPO: $240.88 HB Network-HMO/POS: $174.64 HB Trilogy: $159.58 HEALTHPARTNERS BROAD: $147.54 Humana HMO/POS/NPOS: $81.30 Humana PPO: $81.30
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Iop Family Psychotherapy W/O Pat 50 Min	$301.10	$168.62	$81.30 – $258.54
Family psychotherapy, without the patient: 10 of 15 insurance plan rates Anthem Blue Priority: $248.71 Arise AboutHealth: $201.74 Cigna 1/1/23: $165.61 HB Common Ground -1/1/25: $186.68 HB Network PPO: $240.88 HB Network-HMO/POS: $174.64 HB Trilogy: $159.58 HEALTHPARTNERS BROAD: $147.54 Humana HMO/POS/NPOS: $81.30 Humana PPO: $81.30
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$379.60	$212.58	$101.82 – $313.55
Family psychotherapy, without the patient: 10 of 15 insurance plan rates Anthem Blue Priority: $313.55 Arise AboutHealth: $254.33 Cigna 1/1/23: $208.78 HB Common Ground -1/1/25: $235.35 HB Network PPO: $303.68 HB Network-HMO/POS: $220.17 HB Trilogy: $201.19 HEALTHPARTNERS BROAD: $186 Humana HMO/POS/NPOS: $102.49 Humana PPO: $102.49
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Family Mtg W Pt Present	$265.80	$148.85	$71.77 – $285.38
Family psychotherapy, with the patient: 10 of 15 insurance plan rates Anthem Blue Priority: $219.55 Arise AboutHealth: $178.09 Cigna 1/1/23: $146.19 HB Common Ground -1/1/25: $164.80 HB Network PPO: $212.64 HB Network-HMO/POS: $154.16 HB Trilogy: $140.87 HEALTHPARTNERS BROAD: $130.24 Humana HMO/POS/NPOS: $71.77 Humana PPO: $71.77
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Family Visit Lvl 2	$265.80	$148.85	$71.77 – $285.38
Family psychotherapy, with the patient: 10 of 15 insurance plan rates Anthem Blue Priority: $219.55 Arise AboutHealth: $178.09 Cigna 1/1/23: $146.19 HB Common Ground -1/1/25: $164.80 HB Network PPO: $212.64 HB Network-HMO/POS: $154.16 HB Trilogy: $140.87 HEALTHPARTNERS BROAD: $130.24 Humana HMO/POS/NPOS: $71.77 Humana PPO: $71.77
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Iop Family Mtg W Pt Present	$265.80	$148.85	$71.77 – $285.38
Family psychotherapy, with the patient: 10 of 15 insurance plan rates Anthem Blue Priority: $219.55 Arise AboutHealth: $178.09 Cigna 1/1/23: $146.19 HB Common Ground -1/1/25: $164.80 HB Network PPO: $212.64 HB Network-HMO/POS: $154.16 HB Trilogy: $140.87 HEALTHPARTNERS BROAD: $130.24 Humana HMO/POS/NPOS: $71.77 Humana PPO: $71.77
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Group Therapy Level 2 Hr	$243.20	$136.19	$65.66 – $208.98
Group psychotherapy: 10 of 15 insurance plan rates Anthem Blue Priority: $200.88 Arise AboutHealth: $162.94 Cigna 1/1/23: $133.76 HB Common Ground -1/1/25: $150.78 HB Network PPO: $194.56 HB Network-HMO/POS: $141.06 HB Trilogy: $128.90 HEALTHPARTNERS BROAD: $119.17 Humana HMO/POS/NPOS: $65.66 Humana PPO: $65.66
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Group Psychotherapy	$243.20	$136.19	$65.66 – $208.98
Group psychotherapy: 10 of 15 insurance plan rates Anthem Blue Priority: $200.88 Arise AboutHealth: $162.94 Cigna 1/1/23: $133.76 HB Common Ground -1/1/25: $150.78 HB Network PPO: $194.56 HB Network-HMO/POS: $141.06 HB Trilogy: $128.90 HEALTHPARTNERS BROAD: $119.17 Humana HMO/POS/NPOS: $65.66 Humana PPO: $65.66
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GROUP PSYCHOTHERAPY	$252.90	$141.62	$59.83 – $208.90
Group psychotherapy: 10 of 15 insurance plan rates Anthem Blue Priority: $208.90 Arise AboutHealth: $169.44 Cigna 1/1/23: $139.10 HB Common Ground -1/1/25: $156.80 HB Network PPO: $202.32 HB Network-HMO/POS: $146.68 HB Trilogy: $134.04 HEALTHPARTNERS BROAD: $123.92 Humana HMO/POS/NPOS: $68.28 Humana PPO: $68.28

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: HC Excise Breast Lesion	$8,813.90	$4,935.78	$2,379.75 – $7,498.68
Removal of breast growth (open surgery): 10 of 15 insurance plan rates Anthem Blue Priority: $7,280.28 Arise AboutHealth: $5,905.31 Cigna 1/1/23: $4,847.65 HB Common Ground -1/1/25: $5,464.62 HB Network PPO: $7,051.12 HB Network-HMO/POS: $5,112.06 HB Trilogy: $4,671.37 HEALTHPARTNERS BROAD: $4,318.81 Humana HMO/POS/NPOS: $2,379.75 Humana PPO: $2,379.75
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: EXCISE BREAST LESION	$3,205	$1,794.80	$687.74 – $2,647.33
Removal of breast growth (open surgery): 10 of 15 insurance plan rates Anthem Blue Priority: $2,647.33 Arise AboutHealth: $2,147.35 Cigna 1/1/23: $1,762.75 HB Common Ground -1/1/25: $1,987.10 HB Network PPO: $2,564 HB Network-HMO/POS: $1,858.90 HB Trilogy: $1,698.65 HEALTHPARTNERS BROAD: $1,570.45 Humana HMO/POS/NPOS: $865.35 Humana PPO: $865.35
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EXCISE BREAST LESION	$9,078.30	$5,083.85	$2,379.75 – $7,498.68
Removal of breast growth (open surgery): 10 of 15 insurance plan rates Anthem Blue Priority: $7,498.68 Arise AboutHealth: $6,082.46 Cigna 1/1/23: $4,993.07 HB Common Ground -1/1/25: $5,628.55 HB Network PPO: $7,262.64 HB Network-HMO/POS: $5,265.41 HB Trilogy: $4,811.50 HEALTHPARTNERS BROAD: $4,448.37 Humana HMO/POS/NPOS: $2,451.14 Humana PPO: $2,451.14
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Total Hip Replacement	$6,467.10	$3,621.58	$1,746.12 – $6,944.35
Total hip replacement: 10 of 15 insurance plan rates Anthem Blue Priority: $5,341.82 Arise AboutHealth: $4,332.96 Cigna 1/1/23: $3,556.91 HB Common Ground -1/1/25: $4,009.60 HB Network PPO: $5,173.68 HB Network-HMO/POS: $3,750.92 HB Trilogy: $3,427.56 HEALTHPARTNERS BROAD: $3,168.88 Humana HMO/POS/NPOS: $1,746.12 Humana PPO: $1,746.12
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP REPLACEMENT	$11,216.60	$6,281.30	$3,028.48 – $9,264.91
Total hip replacement: 10 of 15 insurance plan rates Anthem Blue Priority: $9,264.91 Arise AboutHealth: $7,515.12 Cigna 1/1/23: $6,169.13 HB Common Ground -1/1/25: $6,954.29 HB Network PPO: $8,973.28 HB Network-HMO/POS: $6,505.63 HB Trilogy: $5,944.80 HEALTHPARTNERS BROAD: $5,496.13 Humana HMO/POS/NPOS: $3,028.48 Humana PPO: $3,028.48
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TOTAL HIP REPLACEMENT	$8,407	$4,707.92	$1,746.12 – $6,944.35
Total hip replacement: 10 of 15 insurance plan rates Anthem Blue Priority: $6,944.18 Arise AboutHealth: $5,632.69 Cigna 1/1/23: $4,623.85 HB Common Ground -1/1/25: $5,212.34 HB Network PPO: $6,725.60 HB Network-HMO/POS: $4,876.06 HB Trilogy: $4,455.71 HEALTHPARTNERS BROAD: $4,119.43 Humana HMO/POS/NPOS: $2,269.89 Humana PPO: $2,269.89
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Total Knee Replacement	$14,973.10	$8,384.94	$4,042.74 – $13,816.42
Total knee replacement: 10 of 15 insurance plan rates Anthem Blue Priority: $12,367.78 Arise AboutHealth: $10,031.98 Cigna 1/1/23: $8,235.21 HB Common Ground -1/1/25: $9,283.32 HB Network PPO: $11,978.48 HB Network-HMO/POS: $8,684.40 HB Trilogy: $7,935.74 HEALTHPARTNERS BROAD: $7,336.82 Humana HMO/POS/NPOS: $4,042.74 Humana PPO: $4,042.74
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE REPLACEMENT	$11,206.30	$6,275.53	$3,025.70 – $9,256.40
Total knee replacement: 10 of 15 insurance plan rates Anthem Blue Priority: $9,256.40 Arise AboutHealth: $7,508.22 Cigna 1/1/23: $6,163.47 HB Common Ground -1/1/25: $6,947.91 HB Network PPO: $8,965.04 HB Network-HMO/POS: $6,499.65 HB Trilogy: $5,939.34 HEALTHPARTNERS BROAD: $5,491.09 Humana HMO/POS/NPOS: $3,025.70 Humana PPO: $3,025.70
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TOTAL KNEE REPLACEMENT	$15,422.30	$8,636.49	$4,042.74 – $13,816.42
Total knee replacement: 10 of 15 insurance plan rates Anthem Blue Priority: $12,738.82 Arise AboutHealth: $10,332.94 Cigna 1/1/23: $8,482.27 HB Common Ground -1/1/25: $9,561.83 HB Network PPO: $12,337.84 HB Network-HMO/POS: $8,944.93 HB Trilogy: $8,173.82 HEALTHPARTNERS BROAD: $7,556.93 Humana HMO/POS/NPOS: $4,164.02 Humana PPO: $4,164.02
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHLDR ARTHROSCOP,PART ACROMIOPLAS	$3,246.40	$1,817.98	$1,266.10 – $3,084.08
Shoulder arthroscopy: shaving of shoulder bone: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,882.91 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,688.13 Anthem Blue Preferred/Preferred Plus: $1,720.59 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,558.27 Anthem Blue Priority: $2,681.53 Cigna 1/1/23: $1,785.52 HB Common Ground -1/1/25: $2,012.77 HB Network Health Plan ACA-1/1/25: $2,272.48 HB Network Health Plan-1/1/25: $2,272.48 HB Network-HMO/POS: $2,045.23
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Shldr Arthroscop,Part Acromioplas	$3,904.20	$2,186.35	$1,054.13 – $3,321.59
Shoulder arthroscopy: shaving of shoulder bone: 10 of 15 insurance plan rates Anthem Blue Priority: $3,224.87 Arise AboutHealth: $2,615.81 Cigna 1/1/23: $2,147.31 HB Common Ground -1/1/25: $2,420.60 HB Network PPO: $3,123.36 HB Network-HMO/POS: $2,264.44 HB Trilogy: $2,069.23 HEALTHPARTNERS BROAD: $1,913.06 Humana HMO/POS/NPOS: $1,054.13 Humana PPO: $1,054.13
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SHLDR ARTHROSCOP,PART ACROMIOPLAS	$4,021.30	$2,251.93	$1,054.13 – $3,321.59
Shoulder arthroscopy: shaving of shoulder bone: 10 of 15 insurance plan rates Anthem Blue Priority: $3,321.59 Arise AboutHealth: $2,694.27 Cigna 1/1/23: $2,211.72 HB Common Ground -1/1/25: $2,493.21 HB Network PPO: $3,217.04 HB Network-HMO/POS: $2,332.35 HB Trilogy: $2,131.29 HEALTHPARTNERS BROAD: $1,970.44 Humana HMO/POS/NPOS: $1,085.75 Humana PPO: $1,085.75
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MENISCECTOMY MEDIAL OR LATERAL	$4,814.70	$2,696.23	$1,877.73 – $4,573.97
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $2,792.53 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,503.64 Anthem Blue Preferred/Preferred Plus: $2,551.79 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,311.06 Anthem Blue Priority: $3,976.94 Cigna 1/1/23: $2,648.09 HB Common Ground -1/1/25: $2,985.11 HB Network Health Plan ACA-1/1/25: $3,370.29 HB Network Health Plan-1/1/25: $3,370.29 HB Network-HMO/POS: $3,033.26
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Meniscectomy Medial or Lateral	$8,868.60	$4,966.42	$2,394.52 – $7,545.26
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates Anthem Blue Priority: $7,325.46 Arise AboutHealth: $5,941.96 Cigna 1/1/23: $4,877.73 HB Common Ground -1/1/25: $5,498.53 HB Network PPO: $7,094.88 HB Network-HMO/POS: $5,143.79 HB Trilogy: $4,700.36 HEALTHPARTNERS BROAD: $4,345.61 Humana HMO/POS/NPOS: $2,394.52 Humana PPO: $2,394.52
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MENISCECTOMY MEDIAL OR LATERAL	$9,134.70	$5,115.43	$2,394.52 – $7,545.26
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates Anthem Blue Priority: $7,545.26 Arise AboutHealth: $6,120.25 Cigna 1/1/23: $5,024.09 HB Common Ground -1/1/25: $5,663.51 HB Network PPO: $7,307.76 HB Network-HMO/POS: $5,298.13 HB Trilogy: $4,841.39 HEALTHPARTNERS BROAD: $4,476 Humana HMO/POS/NPOS: $2,466.37 Humana PPO: $2,466.37
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Remove Tonsils/Adenoids,<12 Y/O	$11,130	$6,232.80	$3,005.10 – $9,469.18
Removal of tonsils and adenoids (under age 12): 10 of 15 insurance plan rates Anthem Blue Priority: $9,193.38 Arise AboutHealth: $7,457.10 Cigna 1/1/23: $6,121.50 HB Common Ground -1/1/25: $6,900.60 HB Network PPO: $8,904 HB Network-HMO/POS: $6,455.40 HB Trilogy: $5,898.90 HEALTHPARTNERS BROAD: $5,453.70 Humana HMO/POS/NPOS: $3,005.10 Humana PPO: $3,005.10
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS/ADENOIDS,<12 Y/O	$3,396.90	$1,902.26	$917.16 – $2,805.84
Removal of tonsils and adenoids (under age 12): 10 of 15 insurance plan rates Anthem Blue Priority: $2,805.84 Arise AboutHealth: $2,275.92 Cigna 1/1/23: $1,868.30 HB Common Ground -1/1/25: $2,106.08 HB Network PPO: $2,717.52 HB Network-HMO/POS: $1,970.20 HB Trilogy: $1,800.36 HEALTHPARTNERS BROAD: $1,664.48 Humana HMO/POS/NPOS: $917.16 Humana PPO: $917.16
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC REMOVE TONSILS/ADENOIDS,<12 Y/O	$11,463.90	$6,419.78	$3,005.10 – $9,469.18
Removal of tonsils and adenoids (under age 12): 10 of 15 insurance plan rates Anthem Blue Priority: $9,469.18 Arise AboutHealth: $7,680.81 Cigna 1/1/23: $6,305.15 HB Common Ground -1/1/25: $7,107.62 HB Network PPO: $9,171.12 HB Network-HMO/POS: $6,649.06 HB Trilogy: $6,075.87 HEALTHPARTNERS BROAD: $5,617.31 Humana HMO/POS/NPOS: $3,095.25 Humana PPO: $3,095.25
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof Upper GI Endoscopy,Diagnosis	$1,366	$764.96	$532.74 – $1,328.86
Upper GI endoscopy (diagnostic): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $792.28 Anthem Blue Access/Traditional (PPO) 1/1/25: $710.32 Anthem Blue Preferred/Preferred Plus: $723.98 Anthem Blue Preferred/Preferred Plus — HMO/POS: $655.68 Anthem Blue Priority: $1,128.32 Cigna 1/1/23: $751.30 HB Common Ground -1/1/25: $846.92 HB Network Health Plan ACA-1/1/25: $956.20 HB Network Health Plan-1/1/25: $956.20 HB Network-HMO/POS: $860.58
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF UPPER GI ENDOSCOPY,DIAGNOSIS	$1,398.80	$783.33	$532.74 – $1,328.86
Upper GI endoscopy (diagnostic): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $811.30 Anthem Blue Access/Traditional (PPO) 1/1/25: $727.38 Anthem Blue Preferred/Preferred Plus: $741.36 Anthem Blue Preferred/Preferred Plus — HMO/POS: $671.42 Anthem Blue Priority: $1,155.41 Cigna 1/1/23: $769.34 HB Common Ground -1/1/25: $867.26 HB Network Health Plan ACA-1/1/25: $979.16 HB Network Health Plan-1/1/25: $979.16 HB Network-HMO/POS: $881.24
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Upper GI Endoscopy,Diagnosis	$2,621.40	$1,467.98	$707.78 – $2,959.89
Upper GI endoscopy (diagnostic): 10 of 15 insurance plan rates Anthem Blue Priority: $2,165.28 Arise AboutHealth: $1,756.34 Cigna 1/1/23: $1,441.77 HB Common Ground -1/1/25: $1,625.27 HB Network PPO: $2,097.12 HB Network-HMO/POS: $1,520.41 HB Trilogy: $1,389.34 HEALTHPARTNERS BROAD: $1,284.49 Humana HMO/POS/NPOS: $707.78 Humana PPO: $707.78
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof Upper GI Endoscopy,Biopsy	$1,542	$863.52	$601.38 – $1,475.07
Upper GI endoscopy with biopsy: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $894.36 Anthem Blue Access/Traditional (PPO) 1/1/25: $801.84 Anthem Blue Preferred/Preferred Plus: $817.26 Anthem Blue Preferred/Preferred Plus — HMO/POS: $740.16 Anthem Blue Priority: $1,273.69 Cigna 1/1/23: $848.10 HB Common Ground -1/1/25: $956.04 HB Network Health Plan ACA-1/1/25: $1,079.40 HB Network Health Plan-1/1/25: $1,079.40 HB Network-HMO/POS: $971.46
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: UPPER GI ENDOSCOPY,BIOPSY	$4,458.90	$2,496.98	$605.55 – $4,235.96
Upper GI endoscopy with biopsy: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $2,586.16 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,318.63 Anthem Blue Preferred/Preferred Plus: $2,363.22 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,140.27 Anthem Blue Priority: $3,683.05 Cigna 1/1/23: $2,452.40 HB Common Ground -1/1/25: $2,764.52 HB Network Health Plan ACA-1/1/25: $3,121.23 HB Network Health Plan-1/1/25: $3,121.23 HB Network-HMO/POS: $2,809.11
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF UPPER GI ENDOSCOPY,BIOPSY	$1,552.70	$869.51	$601.38 – $1,475.07
Upper GI endoscopy with biopsy: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $900.57 Anthem Blue Access/Traditional (PPO) 1/1/25: $807.40 Anthem Blue Preferred/Preferred Plus: $822.93 Anthem Blue Preferred/Preferred Plus — HMO/POS: $745.30 Anthem Blue Priority: $1,282.53 Cigna 1/1/23: $853.99 HB Common Ground -1/1/25: $962.67 HB Network Health Plan ACA-1/1/25: $1,086.89 HB Network Health Plan-1/1/25: $1,086.89 HB Network-HMO/POS: $978.20
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Prof Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$2,051.50	$1,148.84	$800.09 – $1,995.67
Colonoscopy (diagnostic): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,189.87 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,066.78 Anthem Blue Preferred/Preferred Plus: $1,087.30 Anthem Blue Preferred/Preferred Plus — HMO/POS: $984.72 Anthem Blue Priority: $1,694.54 Cigna 1/1/23: $1,128.33 HB Common Ground -1/1/25: $1,271.93 HB Network Health Plan ACA-1/1/25: $1,436.05 HB Network Health Plan-1/1/25: $1,436.05 HB Network-HMO/POS: $1,292.45
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$2,100.70	$1,176.39	$800.09 – $1,995.67
Colonoscopy (diagnostic): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,218.41 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,092.36 Anthem Blue Preferred/Preferred Plus: $1,113.37 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,008.34 Anthem Blue Priority: $1,735.18 Cigna 1/1/23: $1,155.39 HB Common Ground -1/1/25: $1,302.43 HB Network Health Plan ACA-1/1/25: $1,470.49 HB Network Health Plan-1/1/25: $1,470.49 HB Network-HMO/POS: $1,323.44
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$3,109.60	$1,741.38	$839.59 – $2,645.60
Colonoscopy (diagnostic): 10 of 15 insurance plan rates Anthem Blue Priority: $2,568.53 Arise AboutHealth: $2,083.43 Cigna 1/1/23: $1,710.28 HB Common Ground -1/1/25: $1,927.95 HB Network PPO: $2,487.68 HB Network-HMO/POS: $1,803.57 HB Trilogy: $1,648.09 HEALTHPARTNERS BROAD: $1,523.70 Humana HMO/POS/NPOS: $839.59 Humana PPO: $839.59
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof Colonoscopy W/Biopsy Single/Multiple	$2,233.90	$1,250.98	$871.22 – $2,173.13
Colonoscopy with biopsy: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,295.66 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,161.63 Anthem Blue Preferred/Preferred Plus: $1,183.97 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,072.27 Anthem Blue Priority: $1,845.20 Cigna 1/1/23: $1,228.65 HB Common Ground -1/1/25: $1,385.02 HB Network Health Plan ACA-1/1/25: $1,563.73 HB Network Health Plan-1/1/25: $1,563.73 HB Network-HMO/POS: $1,407.36
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$5,116	$2,864.96	$892.13 – $4,860.20
Colonoscopy with biopsy: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $2,967.28 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,660.32 Anthem Blue Preferred/Preferred Plus: $2,711.48 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,455.68 Anthem Blue Priority: $4,225.82 Cigna 1/1/23: $2,813.80 HB Common Ground -1/1/25: $3,171.92 HB Network Health Plan ACA-1/1/25: $3,581.20 HB Network Health Plan-1/1/25: $3,581.20 HB Network-HMO/POS: $3,223.08
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$2,287.50	$1,281	$871.22 – $2,173.13
Colonoscopy with biopsy: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,326.75 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,189.50 Anthem Blue Preferred/Preferred Plus: $1,212.38 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,098 Anthem Blue Priority: $1,889.48 Cigna 1/1/23: $1,258.13 HB Common Ground -1/1/25: $1,418.25 HB Network Health Plan ACA-1/1/25: $1,601.25 HB Network Health Plan-1/1/25: $1,601.25 HB Network-HMO/POS: $1,441.13
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$2,828.80	$1,584.13	$1,103.23 – $2,751.87
Colonoscopy with removal of polyps (snare): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,640.70 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,470.98 Anthem Blue Preferred/Preferred Plus: $1,499.26 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,357.82 Anthem Blue Priority: $2,336.59 Cigna 1/1/23: $1,555.84 HB Common Ground -1/1/25: $1,753.86 HB Network Health Plan ACA-1/1/25: $1,980.16 HB Network Health Plan-1/1/25: $1,980.16 HB Network-HMO/POS: $1,782.14
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$5,333.40	$2,986.70	$1,129.71 – $5,066.73
Colonoscopy with removal of polyps (snare): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $3,093.37 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,773.37 Anthem Blue Preferred/Preferred Plus: $2,826.70 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,560.03 Anthem Blue Priority: $4,405.39 Cigna 1/1/23: $2,933.37 HB Common Ground -1/1/25: $3,306.71 HB Network Health Plan ACA-1/1/25: $3,733.38 HB Network Health Plan-1/1/25: $3,733.38 HB Network-HMO/POS: $3,360.04
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$2,896.70	$1,622.15	$1,103.23 – $2,751.87
Colonoscopy with removal of polyps (snare): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,680.09 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,506.28 Anthem Blue Preferred/Preferred Plus: $1,535.25 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,390.42 Anthem Blue Priority: $2,392.67 Cigna 1/1/23: $1,593.19 HB Common Ground -1/1/25: $1,795.95 HB Network Health Plan ACA-1/1/25: $2,027.69 HB Network Health Plan-1/1/25: $2,027.69 HB Network-HMO/POS: $1,824.92
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Colonoscopy W/Endoscope US	$4,230.40	$2,369.02	$1,142.21 – $4,593.72
Ultrasound of the lower bowel by endoscope: 10 of 15 insurance plan rates Anthem Blue Priority: $3,494.31 Arise AboutHealth: $2,834.37 Cigna 1/1/23: $2,326.72 HB Common Ground -1/1/25: $2,622.85 HB Network PPO: $3,384.32 HB Network-HMO/POS: $2,453.63 HB Trilogy: $2,242.11 HEALTHPARTNERS BROAD: $2,072.90 Humana HMO/POS/NPOS: $1,142.21 Humana PPO: $1,142.21
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COLONOSCOPY W/ENDOSCOPE US	$4,357.30	$2,440.09	$1,142.21 – $4,593.72
Ultrasound of the lower bowel by endoscope: 10 of 15 insurance plan rates Anthem Blue Priority: $3,599.13 Arise AboutHealth: $2,919.39 Cigna 1/1/23: $2,396.52 HB Common Ground -1/1/25: $2,701.53 HB Network PPO: $3,485.84 HB Network-HMO/POS: $2,527.23 HB Trilogy: $2,309.37 HEALTHPARTNERS BROAD: $2,135.08 Humana HMO/POS/NPOS: $1,176.47 Humana PPO: $1,176.47
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC Prof Colorec Canc Scrn,Scopy Not Hi Risk	$2,052.70	$1,149.51	$800.55 – $1,996.90
Screening colonoscopy (not high risk): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,190.57 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,067.40 Anthem Blue Preferred/Preferred Plus: $1,087.93 Anthem Blue Preferred/Preferred Plus — HMO/POS: $985.30 Anthem Blue Priority: $1,695.53 Cigna 1/1/23: $1,128.99 HB Common Ground -1/1/25: $1,272.67 HB Network Health Plan ACA-1/1/25: $1,436.89 HB Network Health Plan-1/1/25: $1,436.89 HB Network-HMO/POS: $1,293.20
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLON CA SCRN NOT HI RSK IND	$3,988.90	$2,233.78	$819.78 – $3,789.46
Screening colonoscopy (not high risk): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $2,313.56 Anthem Blue Access/Traditional (PPO) 1/1/25: $2,074.23 Anthem Blue Preferred/Preferred Plus: $2,114.12 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,914.67 Anthem Blue Priority: $3,294.83 Cigna 1/1/23: $2,193.90 HB Common Ground -1/1/25: $2,473.12 HB Network Health Plan ACA-1/1/25: $2,792.23 HB Network Health Plan-1/1/25: $2,792.23 HB Network-HMO/POS: $2,513.01
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: HC PROF COLOREC CANC SCRN,SCOPY NOT HI RISK	$2,102	$1,177.12	$800.55 – $1,996.90
Screening colonoscopy (not high risk): 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $1,219.16 Anthem Blue Access/Traditional (PPO) 1/1/25: $1,093.04 Anthem Blue Preferred/Preferred Plus: $1,114.06 Anthem Blue Preferred/Preferred Plus — HMO/POS: $1,008.96 Anthem Blue Priority: $1,736.25 Cigna 1/1/23: $1,156.10 HB Common Ground -1/1/25: $1,303.24 HB Network Health Plan ACA-1/1/25: $1,471.40 HB Network Health Plan-1/1/25: $1,471.40 HB Network-HMO/POS: $1,324.26
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CHOLECYSTECTOMY LAPAROSCOPIC	$7,356.80	$4,119.81	$2,869.15 – $6,988.96
Gallbladder removal by laparoscope: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $4,266.94 Anthem Blue Access/Traditional (PPO) 1/1/25: $3,825.54 Anthem Blue Preferred/Preferred Plus: $3,899.10 Anthem Blue Preferred/Preferred Plus — HMO/POS: $3,531.26 Anthem Blue Priority: $6,076.72 Cigna 1/1/23: $4,046.24 HB Common Ground -1/1/25: $4,561.22 HB Network Health Plan ACA-1/1/25: $5,149.76 HB Network Health Plan-1/1/25: $5,149.76 HB Network-HMO/POS: $4,634.78
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Cholecystectomy Laparoscopic	$15,845.70	$8,873.59	$4,278.34 – $22,046.11
Gallbladder removal by laparoscope: 10 of 15 insurance plan rates Anthem Blue Priority: $13,088.55 Arise AboutHealth: $10,616.62 Cigna 1/1/23: $8,715.14 HB Common Ground -1/1/25: $9,824.33 HB Network PPO: $12,676.56 HB Network-HMO/POS: $9,190.51 HB Trilogy: $8,398.22 HEALTHPARTNERS BROAD: $7,764.39 Humana HMO/POS/NPOS: $4,278.34 Humana PPO: $4,278.34
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CHOLECYSTECTOMY LAPAROSCOPIC	$16,321.10	$9,139.82	$4,278.34 – $22,046.11
Gallbladder removal by laparoscope: 10 of 15 insurance plan rates Anthem Blue Priority: $13,481.23 Arise AboutHealth: $10,935.14 Cigna 1/1/23: $8,976.61 HB Common Ground -1/1/25: $10,119.08 HB Network PPO: $13,056.88 HB Network-HMO/POS: $9,466.24 HB Trilogy: $8,650.18 HEALTHPARTNERS BROAD: $7,997.34 Humana HMO/POS/NPOS: $4,406.70 Humana PPO: $4,406.70
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: REPAIR ING HERNIA,5+Y/O,REDUCIBL	$5,858.70	$3,280.87	$2,284.89 – $5,565.77
Groin (inguinal) hernia repair, age 5 or older: 10 of 20 insurance plan rates Anthem Blue Access/Traditional (PPO): $3,398.05 Anthem Blue Access/Traditional (PPO) 1/1/25: $3,046.52 Anthem Blue Preferred/Preferred Plus: $3,105.11 Anthem Blue Preferred/Preferred Plus — HMO/POS: $2,812.18 Anthem Blue Priority: $4,839.29 Cigna 1/1/23: $3,222.29 HB Common Ground -1/1/25: $3,632.39 HB Network Health Plan ACA-1/1/25: $4,101.09 HB Network Health Plan-1/1/25: $4,101.09 HB Network-HMO/POS: $3,690.98
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Repair Ing Hernia,5+Y/O,Reducibl	$9,963.50	$5,579.56	$2,690.15 – $9,712.36
Groin (inguinal) hernia repair, age 5 or older: 10 of 15 insurance plan rates Anthem Blue Priority: $8,229.85 Arise AboutHealth: $6,675.55 Cigna 1/1/23: $5,479.93 HB Common Ground -1/1/25: $6,177.37 HB Network PPO: $7,970.80 HB Network-HMO/POS: $5,778.83 HB Trilogy: $5,280.66 HEALTHPARTNERS BROAD: $4,882.12 Humana HMO/POS/NPOS: $2,690.15 Humana PPO: $2,690.15
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC REPAIR ING HERNIA,5+Y/O,REDUCIBL	$10,262.40	$5,746.94	$2,690.15 – $9,712.36
Groin (inguinal) hernia repair, age 5 or older: 10 of 15 insurance plan rates Anthem Blue Priority: $8,476.74 Arise AboutHealth: $6,875.81 Cigna 1/1/23: $5,644.32 HB Common Ground -1/1/25: $6,362.69 HB Network PPO: $8,209.92 HB Network-HMO/POS: $5,952.19 HB Trilogy: $5,439.07 HEALTHPARTNERS BROAD: $5,028.58 Humana HMO/POS/NPOS: $2,770.85 Humana PPO: $2,770.85
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Biopsy of Prostate,Needle/Punch	$4,825.40	$2,702.22	$1,302.86 – $4,607.02
Prostate biopsy: 10 of 15 insurance plan rates Anthem Blue Priority: $3,985.78 Arise AboutHealth: $3,233.02 Cigna 1/1/23: $2,653.97 HB Common Ground -1/1/25: $2,991.75 HB Network PPO: $3,860.32 HB Network-HMO/POS: $2,798.73 HB Trilogy: $2,557.46 HEALTHPARTNERS BROAD: $2,364.45 Humana HMO/POS/NPOS: $1,302.86 Humana PPO: $1,302.86
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Laparo Radical Prostatectomy	$15,577.60	$8,723.46	$4,205.95 – $13,253.09
Prostate removal by laparoscope (radical prostatectomy): 10 of 15 insurance plan rates Anthem Blue Priority: $12,867.10 Arise AboutHealth: $10,436.99 Cigna 1/1/23: $8,567.68 HB Common Ground -1/1/25: $9,658.11 HB Network PPO: $12,462.08 HB Network-HMO/POS: $9,035.01 HB Trilogy: $8,256.13 HEALTHPARTNERS BROAD: $7,633.02 Humana HMO/POS/NPOS: $4,205.95 Humana PPO: $4,205.95
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD W/NERVE SPARING	$10,825.70	$6,062.39	$2,922.94 – $8,942.03
Prostate removal by laparoscope (radical prostatectomy): 10 of 15 insurance plan rates Anthem Blue Priority: $8,942.03 Arise AboutHealth: $7,253.22 Cigna 1/1/23: $5,954.14 HB Common Ground -1/1/25: $6,711.93 HB Network PPO: $8,660.56 HB Network-HMO/POS: $6,278.91 HB Trilogy: $5,737.62 HEALTHPARTNERS BROAD: $5,304.59 Humana HMO/POS/NPOS: $2,922.94 Humana PPO: $2,922.94
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LAPARO RADICAL PROSTATECTOMY	$16,044.90	$8,985.14	$4,205.95 – $13,253.09
Prostate removal by laparoscope (radical prostatectomy): 10 of 15 insurance plan rates Anthem Blue Priority: $13,253.09 Arise AboutHealth: $10,750.08 Cigna 1/1/23: $8,824.70 HB Common Ground -1/1/25: $9,947.84 HB Network PPO: $12,835.92 HB Network-HMO/POS: $9,306.04 HB Trilogy: $8,503.80 HEALTHPARTNERS BROAD: $7,862 Humana HMO/POS/NPOS: $4,332.12 Humana PPO: $4,332.12
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Hysteroscopy Biopsy	$8,845.10	$4,953.26	$2,268.81 – $7,306.05
Hysteroscopy with biopsy of the uterus lining: 10 of 15 insurance plan rates Anthem Blue Priority: $7,306.05 Arise AboutHealth: $5,926.22 Cigna 1/1/23: $4,864.81 HB Common Ground -1/1/25: $5,483.96 HB Network PPO: $7,076.08 HB Network-HMO/POS: $5,130.16 HB Trilogy: $4,687.90 HEALTHPARTNERS BROAD: $4,334.10 Humana HMO/POS/NPOS: $2,388.18 Humana PPO: $2,388.18
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY	$9,289.70	$5,202.23	$414.18 – $7,673.29
Hysteroscopy with biopsy of the uterus lining: 10 of 15 insurance plan rates Anthem Blue Priority: $7,673.29 Arise AboutHealth: $6,224.10 Cigna 1/1/23: $5,109.34 HB Common Ground -1/1/25: $5,759.61 HB Network PPO: $7,431.76 HB Network-HMO/POS: $5,388.03 HB Trilogy: $4,923.54 HEALTHPARTNERS BROAD: $4,551.95 Humana HMO/POS/NPOS: $2,508.22 Humana PPO: $2,508.22
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HYSTEROSCOPY BIOPSY	$8,403	$4,705.68	$2,268.81 – $7,306.05
Hysteroscopy with biopsy of the uterus lining: 10 of 15 insurance plan rates Anthem Blue Priority: $6,940.88 Arise AboutHealth: $5,630.01 Cigna 1/1/23: $4,621.65 HB Common Ground -1/1/25: $5,209.86 HB Network PPO: $6,722.40 HB Network-HMO/POS: $4,873.74 HB Trilogy: $4,453.59 HEALTHPARTNERS BROAD: $4,117.47 Humana HMO/POS/NPOS: $2,268.81 Humana PPO: $2,268.81
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn (62323)	$2,049	$1,147.44	$553.23 – $1,869.49
Spinal injection, lower back (epidural), with imaging guidance: 10 of 15 insurance plan rates Anthem Blue Priority: $1,692.47 Arise AboutHealth: $1,372.83 Cigna 1/1/23: $1,126.95 HB Common Ground -1/1/25: $1,270.38 HB Network PPO: $1,639.20 HB Network-HMO/POS: $1,188.42 HB Trilogy: $1,085.97 HEALTHPARTNERS BROAD: $1,004.01 Humana HMO/POS/NPOS: $553.23 Humana PPO: $553.23
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN (62323)	$2,352.20	$1,317.23	$238.28 – $1,942.92
Spinal injection, lower back (epidural), with imaging guidance: 10 of 15 insurance plan rates Anthem Blue Priority: $1,942.92 Arise AboutHealth: $1,575.97 Cigna 1/1/23: $1,293.71 HB Common Ground -1/1/25: $1,458.36 HB Network PPO: $1,881.76 HB Network-HMO/POS: $1,364.28 HB Trilogy: $1,246.67 HEALTHPARTNERS BROAD: $1,152.58 Humana HMO/POS/NPOS: $635.09 Humana PPO: $635.09
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN (62323)	$2,110.50	$1,181.88	$553.23 – $1,869.49
Spinal injection, lower back (epidural), with imaging guidance: 10 of 15 insurance plan rates Anthem Blue Priority: $1,743.27 Arise AboutHealth: $1,414.04 Cigna 1/1/23: $1,160.78 HB Common Ground -1/1/25: $1,308.51 HB Network PPO: $1,688.40 HB Network-HMO/POS: $1,224.09 HB Trilogy: $1,118.57 HEALTHPARTNERS BROAD: $1,034.15 Humana HMO/POS/NPOS: $569.84 Humana PPO: $569.84
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Transforaminal Injection Lumbar or Sacral 1 Level (64483)	$2,692.40	$1,507.74	$726.95 – $2,290.66
Nerve root injection, lower back, with imaging guidance: 10 of 15 insurance plan rates Anthem Blue Priority: $2,223.92 Arise AboutHealth: $1,803.91 Cigna 1/1/23: $1,480.82 HB Common Ground -1/1/25: $1,669.29 HB Network PPO: $2,153.92 HB Network-HMO/POS: $1,561.59 HB Trilogy: $1,426.97 HEALTHPARTNERS BROAD: $1,319.28 Humana HMO/POS/NPOS: $726.95 Humana PPO: $726.95
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Lumbar Nerve Block Bilateral (64483.02)	$2,692.40	$1,507.74	$726.95 – $2,290.66
Nerve root injection, lower back, with imaging guidance: 10 of 15 insurance plan rates Anthem Blue Priority: $2,223.92 Arise AboutHealth: $1,803.91 Cigna 1/1/23: $1,480.82 HB Common Ground -1/1/25: $1,669.29 HB Network PPO: $2,153.92 HB Network-HMO/POS: $1,561.59 HB Trilogy: $1,426.97 HEALTHPARTNERS BROAD: $1,319.28 Humana HMO/POS/NPOS: $726.95 Humana PPO: $726.95
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TRANSFORAMINAL INJECTION LUMBAR OR SACRAL 1 LEVEL (64483)	$2,238.10	$1,253.34	$267.52 – $1,848.67
Nerve root injection, lower back, with imaging guidance: 10 of 15 insurance plan rates Anthem Blue Priority: $1,848.67 Arise AboutHealth: $1,499.53 Cigna 1/1/23: $1,230.96 HB Common Ground -1/1/25: $1,387.62 HB Network PPO: $1,790.48 HB Network-HMO/POS: $1,298.10 HB Trilogy: $1,186.19 HEALTHPARTNERS BROAD: $1,096.67 Humana HMO/POS/NPOS: $604.29 Humana PPO: $604.29
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Neuroplasty Median Nerve Carpl	$5,688	$3,185.28	$1,535.76 – $4,839.20
Carpal tunnel release: 10 of 15 insurance plan rates Anthem Blue Priority: $4,698.29 Arise AboutHealth: $3,810.96 Cigna 1/1/23: $3,128.40 HB Common Ground -1/1/25: $3,526.56 HB Network PPO: $4,550.40 HB Network-HMO/POS: $3,299.04 HB Trilogy: $3,014.64 HEALTHPARTNERS BROAD: $2,787.12 Humana HMO/POS/NPOS: $1,535.76 Humana PPO: $1,535.76
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: NEUROPLASTY MEDIAN NERVE CARPL	$3,980.10	$2,228.86	$1,054.86 – $3,287.56
Carpal tunnel release: 10 of 15 insurance plan rates Anthem Blue Priority: $3,287.56 Arise AboutHealth: $2,666.67 Cigna 1/1/23: $2,189.06 HB Common Ground -1/1/25: $2,467.66 HB Network PPO: $3,184.08 HB Network-HMO/POS: $2,308.46 HB Trilogy: $2,109.45 HEALTHPARTNERS BROAD: $1,950.25 Humana HMO/POS/NPOS: $1,074.63 Humana PPO: $1,074.63
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC NEUROPLASTY MEDIAN NERVE CARPL	$5,858.60	$3,280.82	$1,535.76 – $4,839.20
Carpal tunnel release: 10 of 15 insurance plan rates Anthem Blue Priority: $4,839.20 Arise AboutHealth: $3,925.26 Cigna 1/1/23: $3,222.23 HB Common Ground -1/1/25: $3,632.33 HB Network PPO: $4,686.88 HB Network-HMO/POS: $3,397.99 HB Trilogy: $3,105.06 HEALTHPARTNERS BROAD: $2,870.71 Humana HMO/POS/NPOS: $1,581.82 Humana PPO: $1,581.82
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC Remv Cataract Extracap,Insert	$7,228.90	$4,048.18	$1,951.80 – $6,150.23
Cataract removal with lens implant: 10 of 15 insurance plan rates Anthem Blue Priority: $5,971.07 Arise AboutHealth: $4,843.36 Cigna 1/1/23: $3,975.90 HB Common Ground -1/1/25: $4,481.92 HB Network PPO: $5,783.12 HB Network-HMO/POS: $4,192.76 HB Trilogy: $3,831.32 HEALTHPARTNERS BROAD: $3,542.16 Humana HMO/POS/NPOS: $1,951.80 Humana PPO: $1,951.80
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC REMV CATARACT EXTRACAP,INSERT	$7,445.80	$4,169.65	$1,951.80 – $6,150.23
Cataract removal with lens implant: 10 of 15 insurance plan rates Anthem Blue Priority: $6,150.23 Arise AboutHealth: $4,988.69 Cigna 1/1/23: $4,095.19 HB Common Ground -1/1/25: $4,616.40 HB Network PPO: $5,956.64 HB Network-HMO/POS: $4,318.56 HB Trilogy: $3,946.27 HEALTHPARTNERS BROAD: $3,648.44 Humana HMO/POS/NPOS: $2,010.37 Humana PPO: $2,010.37

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) · Doctor (professional) fee In the file: FULL ROUT OBSTE CARE,VAGINAL DELIV	$8,865.20	$4,964.51	$2,393.60 – $7,322.66
Vaginal delivery, with care before and after: 10 of 15 insurance plan rates Anthem Blue Priority: $7,322.66 Arise AboutHealth: $5,939.68 Cigna 1/1/23: $4,875.86 HB Common Ground -1/1/25: $5,496.42 HB Network PPO: $7,092.16 HB Network-HMO/POS: $5,141.82 HB Trilogy: $4,698.56 HEALTHPARTNERS BROAD: $4,343.95 Humana HMO/POS/NPOS: $2,393.60 Humana PPO: $2,393.60
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: FULL ROUT OBSTE CARE,CESAREAN DELIV	$9,710.60	$5,437.94	$2,621.86 – $8,020.96
Cesarean delivery (C-section), with care before and after: 10 of 15 insurance plan rates Anthem Blue Priority: $8,020.96 Arise AboutHealth: $6,506.10 Cigna 1/1/23: $5,340.83 HB Common Ground -1/1/25: $6,020.57 HB Network PPO: $7,768.48 HB Network-HMO/POS: $5,632.15 HB Trilogy: $5,146.62 HEALTHPARTNERS BROAD: $4,758.19 Humana HMO/POS/NPOS: $2,621.86 Humana PPO: $2,621.86
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ROUT OB CARE,VAG DELIV,PREV C-SEC	$9,185.50	$5,143.88	$2,480.09 – $7,587.22
Vaginal delivery after a previous C-section, with care before and after: 10 of 15 insurance plan rates Anthem Blue Priority: $7,587.22 Arise AboutHealth: $6,154.29 Cigna 1/1/23: $5,052.03 HB Common Ground -1/1/25: $5,695.01 HB Network PPO: $7,348.40 HB Network-HMO/POS: $5,327.59 HB Trilogy: $4,868.32 HEALTHPARTNERS BROAD: $4,500.90 Humana HMO/POS/NPOS: $2,480.09 Humana PPO: $2,480.09

Source: Thedacare Medical Center - Wild Rose’s standard charges file (hospitalpricetransparencyfiles.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on August 8, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the price transparency link on the hospital’s website (thedacare.org), because the hospital has no cms-hpt.txt file; both are required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Critical Access Hospital
Address	601 Grove Ave, Wild Rose, WI 54984
County	Waushara County
State	Wisconsin
Phone	(920) 622‑3257
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	Not rated by CMS
CMS Certification Number	521303
Name in Medicare records	THEDACARE MEDICAL CENTER - WILD ROSE
Profile level	Medicare data + hospital website
Official website	directory.thedacare.org
Corrections	Report an error or suggest an update →

Sources

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

From the hospital’s website

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

ThedaCare Medical Center-Wild Rose — directory.thedacare.org
ThedaCare Medical Center-Wild Rose Emergency Department | ThedaCare — directory.thedacare.org
ThedaCare Therapy Services-Wild Rose | ThedaCare — directory.thedacare.org
Trauma Services | ThedaCare — thedacare.org
Wild Rose | ThedaCare — thedacare.org
Emergency Care | ThedaCare — thedacare.org
Interpreter Services | ThedaCare — thedacare.org