Does UnityPoint Health - Meriter have an emergency room?

Yes. Medicare (CMS) data lists emergency services at UnityPoint Health - Meriter. In a medical emergency, call 911.

Where is UnityPoint Health - Meriter?

202 S Park St, Madison, WI 53715, in Dane County, Wisconsin.

What is the phone number of UnityPoint Health - Meriter?

(608) 417-6210, as listed by Medicare (CMS).

What is the Medicare star rating of UnityPoint Health - Meriter?

5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to UnityPoint Health - Meriter for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for UnityPoint Health - Meriter under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.1930; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

UnityPoint Health - Meriter — Phone, Address & ER

Quick answers

Does UnityPoint Health - Meriter have an emergency room?: Yes. Medicare (CMS) data lists emergency services at UnityPoint Health - Meriter. In a medical emergency, call 911.
Where is UnityPoint Health - Meriter?: 202 S Park St, Madison, WI 53715, in Dane County, Wisconsin.
What is the phone number of UnityPoint Health - Meriter?: (608) 417-6210, as listed by Medicare (CMS).
What is the Medicare star rating of UnityPoint Health - Meriter?: 5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to UnityPoint Health - Meriter for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for UnityPoint Health - Meriter under the Hospital-Acquired Condition Reduction Program (Total HAC Score: 0.1930; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^{[4][5][8][10][13]}

Maternity and newborn care
Behavioral and mental health
Pediatrics
Therapy and rehabilitation
Surgery
Intensive care (ICU)
Neonatal intensive care (NICU)

Treatments^[12]

Infusion therapy
IV hydration
IV antibiotics
Blood products
Therapeutic phlebotomy
PICC line placement

Procedures^[7]

Cesarean birth

Programs and centers^{[4][8][9][11][12]}

Birthing Center
Level III NICU
Fetal Diagnosis and Treatment Center
Digestive Health Center
Center for Perinatal Care (joint with UW Health)
Community Paramedic Program
Health Outreach Program
Child and adolescent psychiatry

Emergency care (hospital website)^[4][5][6][9]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Visitors welcome daily 6:00 a.m. to 9:00 p.m.; up to two visitors at a time, with limits by clinical need^[9]
Parking	Patient and visitor ramp entrance on South Brooks Street; patients and immediate family park free with a validated ticket^[4]

Doctors and clinicians (1,271)

1,271 doctors and other clinicians list UnityPoint Health - Meriter as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 1,247 more: the button below opens the full list.

Other emergency rooms nearby

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

SSM Health St Mary's Hospital - Madison0.4 mi · Madison, WI · Acute Care Hospital
Madison VA Medical Center1.5 mi · Madison, WI · Federal/VA Acute Care Hospital
University of WI Hospitals & Clinics Authority1.7 mi · Madison, WI · Acute Care Hospital
Stoughton Hospital14 mi · Stoughton, WI · Critical Access Hospital
Edgerton Hospital and Health Services24 mi · Edgerton, WI · Critical Access Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Madison

Select Specialty Hospital Madison0.1 mi · Madison, WI · Long-Term Acute Care Hospital
Mendota Mental Health Institute4.7 mi · Madison, WI · Psychiatric Hospital
Encompass Health Rehabilitation Hospital of Fitchburg5.0 mi · Fitchburg, WI · Inpatient Rehabilitation Hospital

All hospitals in Madison · Hospitals in Dane County · Hospitals near me

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

Capitol Lakes Health Center0.8 mi · Madison, WI · 4 of 5 stars
Oak Park Place of Nakoma3.0 mi · Madison, WI · 3 of 5 stars
Middleton Village Nursing and Rehab4.9 mi · Middleton, WI · 1 of 5 stars

All nursing homes in the state →

Hospice providers

Bristol Hospice Madison2.0 mi · Madison, WI · 1 of 5 stars
Interim Healthcare of WI Madison2.0 mi · Madison, WI
Agrace Hospicecare3.8 mi · Madison, WI · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Aveanna Home Health1.5 mi · Madison, WI · 4 of 5 stars
Interim Healthcare of Wisconsin2.0 mi · Madison, WI · 3.5 of 5 stars
Awooncare Home Health, LLC3.8 mi · Fitchburg, WI

All home health agencies in the state →

Dialysis facilities

Fresenius Kidney Care Fitchburg2.0 mi · Madison, WI · 2 of 5 stars
Fresenius Medical Care - Madison Capitol2.0 mi · Fitchburg, WI · 3 of 5 stars
Fresenius Kidney Care Middleton6.1 mi · Madison, WI

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

SSM Health Surgery Center0.9 mi · Madison, WI
Madison SurgiCenter, LLC3.8 mi · Madison, WI
Novamed Surgery Center of Madison6.1 mi · Madison, 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

Wingra Family Medical Center0.7 mi · Madison, WI · Community health center
Joyce & Marshall Erdman Clinic1.6 mi · Madison, WI · Community health center
Madison Pediatric Dental & Orthodontics3.9 mi · Monona, WI · Community health center

Clinics and urgent care

Group Health Cooperative of South Central Wisconsin1.5 mi · Madison, WI · Urgent care center
American Current Care P.A.5.6 mi · Madison, WI · Urgent care center
American Current Care P.A.5.6 mi · Madison, WI · Urgent care center

Pharmacies

University of Wisconsin System Non Payroll0.8 mi · Madison, WI · Clinic pharmacy
Dean Retail Services Inc0.9 mi · Madison, WI · Community/retail pharmacy
Dean Retail Services Inc0.9 mi · Madison, WI · Community/retail pharmacy

Assisted living nearby

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

Arc House1.5 mi · Madison, WI
Capitol Lakes1.5 mi · Madison, WI
Arc Maternal & Infant Program2.0 mi · Madison, WI
The Ridge at Madison2.0 mi · Fitchburg, 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 UnityPoint Health - Meriter reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

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

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Patients got help quickly from staff	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Restfulness of Environment	3 of 5 stars
Care Coordination	3 of 5 stars
Symptoms After Stay	4 of 5 stars
Rated the hospital 9 or 10 out of 10	75%National average: 72%
Would definitely recommend the hospital	76%National average: 71%
Nurses “always” communicated well	81%National average: 80%
Doctors “always” communicated well	79%National average: 80%
“Always” got help as soon as they wanted	58%National average: 64%
Staff “always” explained medicines before giving them	65%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	72%National average: 73%
Completed surveys	497Response rate: 21%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.

Infections caught in the hospital

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

Central line bloodstream infections (CLABSI)	0.721No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.457No different from the national benchmark
Surgical site infections after colon surgery	1.759No different from the national benchmark
Surgical site infections after abdominal hysterectomy	2.116No different from the national benchmark
MRSA bloodstream infections	0Better than the national benchmark
Clostridioides difficile (C. diff) intestinal infections	1.261No different from the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Complications and deaths

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

Deaths within 30 days: heart attack patients	11%
Deaths within 30 days: heart failure patients	10.4%
Deaths within 30 days: pneumonia patients	12.9%
Deaths within 30 days: COPD patients	7.7%
Deaths within 30 days: stroke patients	8.6%
Serious complications (patient safety indicator PSI-90)	0.83No different from the national rate
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

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

Returned to any hospital within 30 days (all patients)	16.6%
Readmitted within 30 days: heart attack	12.8%
Readmitted within 30 days: heart failure	22.6%
Readmitted within 30 days: pneumonia	17.3%
Readmitted within 30 days: COPD	19.5%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: hip or knee replacement

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 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)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	142 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	66%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for UnityPoint Health - Meriter, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	0.1930Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart attack	0.9610Fewer readmissions than expected
Heart failure	1.0138More readmissions than expected
Pneumonia	1.0463More readmissions than expected
COPD (chronic lung disease)	0.9439Fewer readmissions than expected
No result published	Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score	46.17 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	60.00 out of 100
Person and community engagement (patient survey)	48.00 out of 100
Safety (infections and sepsis care)	26.67 out of 100
Efficiency and cost reduction (Medicare spending)	50.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio	0.93Below the national median hospital (1.00): Medicare spent less

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

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 Madison Best hospitals in Madison

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as UnityPoint Health - Meriter 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 →

$ 2 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Show the prices of 86 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES	$321	$256.80	$73.83 – $304.95
New patient office visit (about 30–44 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $139.18 Anthem Blue Cross and Blue Shield — HMO/POS: $173.61 Anthem Blue Cross and Blue Shield — Medicare Advantage: $74.83 Anthem Blue Cross and Blue Shield — PPO: $196.05 Anthem Blue Cross and Blue Shield — Traditional: $304.95 Aspirus — HMO/POS: $112.35 Aspirus — Medicare Advantage: $74.83 Aspirus — PPO: $73.83 Cigna — Commercial: $89.88 Health Partners Open Network — Commercial: $127.02
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES (26)	$128	$102.40	$29.44 – $196.05
New patient office visit (about 30–44 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $139.18 Anthem Blue Cross and Blue Shield — HMO/POS: $173.61 Anthem Blue Cross and Blue Shield — Medicare Advantage: $74.83 Anthem Blue Cross and Blue Shield — PPO: $196.05 Anthem Blue Cross and Blue Shield — Traditional: $121.60 Aspirus — HMO/POS: $44.80 Aspirus — Medicare Advantage: $74.83 Aspirus — PPO: $29.44 Cigna — Commercial: $35.84 Health Partners Open Network — Commercial: $127.02
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES (TC)	$193	$154.40	$44.39 – $196.05
New patient office visit (about 30–44 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $139.18 Anthem Blue Cross and Blue Shield — HMO/POS: $173.61 Anthem Blue Cross and Blue Shield — Medicare Advantage: $74.83 Anthem Blue Cross and Blue Shield — PPO: $196.05 Anthem Blue Cross and Blue Shield — Traditional: $183.35 Aspirus — HMO/POS: $67.55 Aspirus — Medicare Advantage: $74.83 Aspirus — PPO: $44.39 Cigna — Commercial: $54.04 Health Partners Open Network — Commercial: $127.02
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES	$477	$381.60	$109.71 – $453.15
New patient office visit (about 45–59 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $227.42 Anthem Blue Cross and Blue Shield — HMO/POS: $283.67 Anthem Blue Cross and Blue Shield — Medicare Advantage: $122.27 Anthem Blue Cross and Blue Shield — PPO: $320.35 Anthem Blue Cross and Blue Shield — Traditional: $453.15 Aspirus — HMO/POS: $166.95 Aspirus — Medicare Advantage: $122.27 Aspirus — PPO: $109.71 Cigna — Commercial: $133.56 Health Partners Open Network — Commercial: $214.84
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES (TC)	$285	$228	$65.55 – $320.35
New patient office visit (about 45–59 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $227.42 Anthem Blue Cross and Blue Shield — HMO/POS: $283.67 Anthem Blue Cross and Blue Shield — Medicare Advantage: $122.27 Anthem Blue Cross and Blue Shield — PPO: $320.35 Anthem Blue Cross and Blue Shield — Traditional: $270.75 Aspirus — HMO/POS: $99.75 Aspirus — Medicare Advantage: $122.27 Aspirus — PPO: $65.55 Cigna — Commercial: $79.80 Health Partners Open Network — Commercial: $214.84
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES (26)	$192	$153.60	$44.16 – $320.35
New patient office visit (about 45–59 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $227.42 Anthem Blue Cross and Blue Shield — HMO/POS: $283.67 Anthem Blue Cross and Blue Shield — Medicare Advantage: $122.27 Anthem Blue Cross and Blue Shield — PPO: $320.35 Anthem Blue Cross and Blue Shield — Traditional: $182.40 Aspirus — HMO/POS: $67.20 Aspirus — Medicare Advantage: $122.27 Aspirus — PPO: $44.16 Cigna — Commercial: $53.76 Health Partners Open Network — Commercial: $214.84
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$622	$497.60	$143.06 – $590.90
New patient office visit (about 60–74 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $308.89 Anthem Blue Cross and Blue Shield — HMO/POS: $385.28 Anthem Blue Cross and Blue Shield — Medicare Advantage: $166.07 Anthem Blue Cross and Blue Shield — PPO: $435.10 Anthem Blue Cross and Blue Shield — Traditional: $590.90 Aspirus — HMO/POS: $217.70 Aspirus — Medicare Advantage: $166.07 Aspirus — PPO: $143.06 Cigna — Commercial: $174.16 Health Partners Open Network — Commercial: $279.38
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES (26)	$250	$200	$57.50 – $435.10
New patient office visit (about 60–74 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $308.89 Anthem Blue Cross and Blue Shield — HMO/POS: $385.28 Anthem Blue Cross and Blue Shield — Medicare Advantage: $166.07 Anthem Blue Cross and Blue Shield — PPO: $435.10 Anthem Blue Cross and Blue Shield — Traditional: $237.50 Aspirus — HMO/POS: $87.50 Aspirus — Medicare Advantage: $166.07 Aspirus — PPO: $57.50 Cigna — Commercial: $70 Health Partners Open Network — Commercial: $279.38
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES (TC)	$372	$297.60	$85.56 – $435.10
New patient office visit (about 60–74 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $308.89 Anthem Blue Cross and Blue Shield — HMO/POS: $385.28 Anthem Blue Cross and Blue Shield — Medicare Advantage: $166.07 Anthem Blue Cross and Blue Shield — PPO: $435.10 Anthem Blue Cross and Blue Shield — Traditional: $353.40 Aspirus — HMO/POS: $130.20 Aspirus — Medicare Advantage: $166.07 Aspirus — PPO: $85.56 Cigna — Commercial: $104.16 Health Partners Open Network — Commercial: $279.38
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN	$239	$191.20	$54.97 – $227.05
Established patient office visit (about 20–29 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $113.03 Anthem Blue Cross and Blue Shield — HMO/POS: $140.99 Anthem Blue Cross and Blue Shield — Medicare Advantage: $60.77 Anthem Blue Cross and Blue Shield — PPO: $159.22 Anthem Blue Cross and Blue Shield — Traditional: $227.05 Aspirus — HMO/POS: $83.65 Aspirus — Medicare Advantage: $60.77 Aspirus — PPO: $54.97 Cigna — Commercial: $66.92 Health Partners Open Network — Commercial: $83.62
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE CONSULT LVL 3	$641.46	$513.17	$60.77 – $609.39
Established patient office visit (about 20–29 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $113.03 Anthem Blue Cross and Blue Shield — HMO/POS: $140.99 Anthem Blue Cross and Blue Shield — Medicare Advantage: $60.77 Anthem Blue Cross and Blue Shield — PPO: $159.22 Anthem Blue Cross and Blue Shield — Traditional: $609.39 Aspirus — HMO/POS: $224.51 Aspirus — Medicare Advantage: $60.77 Aspirus — PPO: $147.54 Cigna — Commercial: $179.61 Health Partners Open Network — Commercial: $83.62
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OP VISIT EST PT LEVEL 3	$343.01	$274.41	$60.77 – $325.86
Established patient office visit (about 20–29 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $113.03 Anthem Blue Cross and Blue Shield — HMO/POS: $140.99 Anthem Blue Cross and Blue Shield — Medicare Advantage: $60.77 Anthem Blue Cross and Blue Shield — PPO: $159.22 Anthem Blue Cross and Blue Shield — Traditional: $325.86 Aspirus — HMO/POS: $120.05 Aspirus — Medicare Advantage: $60.77 Aspirus — PPO: $78.89 Cigna — Commercial: $96.04 Health Partners Open Network — Commercial: $83.62
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN	$331	$264.80	$76.13 – $314.45
Established patient office visit (about 30–39 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $166.28 Anthem Blue Cross and Blue Shield — HMO/POS: $207.41 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.40 Anthem Blue Cross and Blue Shield — PPO: $234.23 Anthem Blue Cross and Blue Shield — Traditional: $314.45 Aspirus — HMO/POS: $115.85 Aspirus — Medicare Advantage: $89.40 Aspirus — PPO: $76.13 Cigna — Commercial: $92.68 Health Partners Open Network — Commercial: $129.20
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE CONSULT LVL 4	$867.17	$693.74	$89.40 – $823.81
Established patient office visit (about 30–39 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $166.28 Anthem Blue Cross and Blue Shield — HMO/POS: $207.41 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.40 Anthem Blue Cross and Blue Shield — PPO: $234.23 Anthem Blue Cross and Blue Shield — Traditional: $823.81 Aspirus — HMO/POS: $303.51 Aspirus — Medicare Advantage: $89.40 Aspirus — PPO: $199.45 Cigna — Commercial: $242.81 Health Partners Open Network — Commercial: $129.20
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OP VISIT EST PT LEVEL 4	$411.31	$329.05	$89.40 – $390.74
Established patient office visit (about 30–39 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $166.28 Anthem Blue Cross and Blue Shield — HMO/POS: $207.41 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.40 Anthem Blue Cross and Blue Shield — PPO: $234.23 Anthem Blue Cross and Blue Shield — Traditional: $390.74 Aspirus — HMO/POS: $143.96 Aspirus — Medicare Advantage: $89.40 Aspirus — PPO: $94.60 Cigna — Commercial: $115.17 Health Partners Open Network — Commercial: $129.20
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES	$506	$404.80	$116.38 – $480.70
Office consultation with a specialist (moderate): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $126.50 Anthem Blue Cross and Blue Shield — HMO/POS: $126.50 Anthem Blue Cross and Blue Shield — PPO: $126.50 Anthem Blue Cross and Blue Shield — Traditional: $480.70 Aspirus — HMO/POS: $177.10 Aspirus — Medicare Advantage: $253 Aspirus — PPO: $116.38 Cigna — Commercial: $141.68 Health Partners Open Network — Commercial: $166.22 Medical Associates Health Plan — HMO/POS/PPO: $187.22
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES (26)	$205	$164	$47.15 – $216.56
Office consultation with a specialist (moderate): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $51.25 Anthem Blue Cross and Blue Shield — HMO/POS: $51.25 Anthem Blue Cross and Blue Shield — PPO: $51.25 Anthem Blue Cross and Blue Shield — Traditional: $194.75 Aspirus — HMO/POS: $71.75 Aspirus — Medicare Advantage: $102.50 Aspirus — PPO: $47.15 Cigna — Commercial: $57.40 Health Partners Open Network — Commercial: $166.22 Medical Associates Health Plan — HMO/POS/PPO: $75.85
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES (TC)	$301	$240.80	$69.23 – $285.95
Office consultation with a specialist (moderate): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $75.25 Anthem Blue Cross and Blue Shield — HMO/POS: $75.25 Anthem Blue Cross and Blue Shield — PPO: $75.25 Anthem Blue Cross and Blue Shield — Traditional: $285.95 Aspirus — HMO/POS: $105.35 Aspirus — Medicare Advantage: $150.50 Aspirus — PPO: $69.23 Cigna — Commercial: $84.28 Health Partners Open Network — Commercial: $166.22 Medical Associates Health Plan — HMO/POS/PPO: $111.37
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee In the file: PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES	$680	$544	$156.40 – $646
Office consultation with a specialist (moderate to high): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $170 Anthem Blue Cross and Blue Shield — HMO/POS: $170 Anthem Blue Cross and Blue Shield — PPO: $170 Anthem Blue Cross and Blue Shield — Traditional: $646 Aspirus — HMO/POS: $238 Aspirus — Medicare Advantage: $340 Aspirus — PPO: $156.40 Cigna — Commercial: $190.40 Health Partners Open Network — Commercial: $262.53 Medical Associates Health Plan — HMO/POS/PPO: $251.60
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES (26)	$272	$217.60	$62.56 – $348.07
Office consultation with a specialist (moderate to high): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $68 Anthem Blue Cross and Blue Shield — HMO/POS: $68 Anthem Blue Cross and Blue Shield — PPO: $68 Anthem Blue Cross and Blue Shield — Traditional: $258.40 Aspirus — HMO/POS: $95.20 Aspirus — Medicare Advantage: $136 Aspirus — PPO: $62.56 Cigna — Commercial: $76.16 Health Partners Open Network — Commercial: $262.53 Medical Associates Health Plan — HMO/POS/PPO: $100.64
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES (TC)	$408	$326.40	$93.84 – $387.60
Office consultation with a specialist (moderate to high): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $102 Anthem Blue Cross and Blue Shield — HMO/POS: $102 Anthem Blue Cross and Blue Shield — PPO: $102 Anthem Blue Cross and Blue Shield — Traditional: $387.60 Aspirus — HMO/POS: $142.80 Aspirus — Medicare Advantage: $204 Aspirus — PPO: $93.84 Cigna — Commercial: $114.24 Health Partners Open Network — Commercial: $262.53 Medical Associates Health Plan — HMO/POS/PPO: $150.96
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PREVENTIVE VISIT,NEW,18-39	$445	$356	$102.35 – $422.75
Preventive checkup, new patient, age 18–39: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $111.25 Anthem Blue Cross and Blue Shield — HMO/POS: $111.25 Anthem Blue Cross and Blue Shield — PPO: $111.25 Anthem Blue Cross and Blue Shield — Traditional: $422.75 Aspirus — HMO/POS: $155.75 Aspirus — Medicare Advantage: $222.50 Aspirus — PPO: $102.35 Cigna — Commercial: $124.60 Health Partners Open Network — Commercial: $136.77 Medical Associates Health Plan — HMO/POS/PPO: $164.65
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR PREVENTIVE VISIT,NEW,18-39 (TC)	$268	$214.40	$61.64 – $254.60
Preventive checkup, new patient, age 18–39: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $67 Anthem Blue Cross and Blue Shield — HMO/POS: $67 Anthem Blue Cross and Blue Shield — PPO: $67 Anthem Blue Cross and Blue Shield — Traditional: $254.60 Aspirus — HMO/POS: $93.80 Aspirus — Medicare Advantage: $134 Aspirus — PPO: $61.64 Cigna — Commercial: $75.04 Health Partners Open Network — Commercial: $136.77 Medical Associates Health Plan — HMO/POS/PPO: $99.16
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR PREVENTIVE VISIT,NEW,18-39 (26)	$177	$141.60	$40.71 – $222.25
Preventive checkup, new patient, age 18–39: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $44.25 Anthem Blue Cross and Blue Shield — HMO/POS: $44.25 Anthem Blue Cross and Blue Shield — PPO: $44.25 Anthem Blue Cross and Blue Shield — Traditional: $168.15 Aspirus — HMO/POS: $61.95 Aspirus — Medicare Advantage: $88.50 Aspirus — PPO: $40.71 Cigna — Commercial: $49.56 Health Partners Open Network — Commercial: $136.77 Medical Associates Health Plan — HMO/POS/PPO: $65.49
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PREVENTIVE VISIT,NEW,40-64	$463	$370.40	$106.49 – $439.85
Preventive checkup, new patient, age 40–64: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $115.75 Anthem Blue Cross and Blue Shield — HMO/POS: $115.75 Anthem Blue Cross and Blue Shield — PPO: $115.75 Anthem Blue Cross and Blue Shield — Traditional: $439.85 Aspirus — HMO/POS: $162.05 Aspirus — Medicare Advantage: $231.50 Aspirus — PPO: $106.49 Cigna — Commercial: $129.64 Health Partners Open Network — Commercial: $166.18 Medical Associates Health Plan — HMO/POS/PPO: $171.31
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR PREVENTIVE VISIT,NEW,40-64 (TC)	$278	$222.40	$63.94 – $269.80
Preventive checkup, new patient, age 40–64: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $69.50 Anthem Blue Cross and Blue Shield — HMO/POS: $69.50 Anthem Blue Cross and Blue Shield — PPO: $69.50 Anthem Blue Cross and Blue Shield — Traditional: $264.10 Aspirus — HMO/POS: $97.30 Aspirus — Medicare Advantage: $139 Aspirus — PPO: $63.94 Cigna — Commercial: $77.84 Health Partners Open Network — Commercial: $166.18 Medical Associates Health Plan — HMO/POS/PPO: $102.86
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR PREVENTIVE VISIT,NEW,40-64 (26)	$185	$148	$42.55 – $269.80
Preventive checkup, new patient, age 40–64: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $46.25 Anthem Blue Cross and Blue Shield — HMO/POS: $46.25 Anthem Blue Cross and Blue Shield — PPO: $46.25 Anthem Blue Cross and Blue Shield — Traditional: $175.75 Aspirus — HMO/POS: $64.75 Aspirus — Medicare Advantage: $92.50 Aspirus — PPO: $42.55 Cigna — Commercial: $51.80 Health Partners Open Network — Commercial: $166.18 Medical Associates Health Plan — HMO/POS/PPO: $68.45
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED LEVEL 3 VISIT	$1,630.18	$1,304.15	$267.45 – $2,158
Emergency room visit (moderate): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,298 Anthem Blue Cross and Blue Shield — HMO/POS: $1,443 Anthem Blue Cross and Blue Shield — Medicare Advantage: $267.45 Anthem Blue Cross and Blue Shield — PPO: $2,158 Anthem Blue Cross and Blue Shield — Traditional: $1,548.67 Aspirus — HMO/POS: $586.86 Aspirus — Medicare Advantage: $267.45 Aspirus — PPO: $374.94 Cigna — Commercial: $489.05 Health Partners Open Network — Commercial: $595.02
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED LEVEL 3 INIT ASSESS	$55	$44	$12.65 – $2,158
Emergency room visit (moderate): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,298 Anthem Blue Cross and Blue Shield — HMO/POS: $1,443 Anthem Blue Cross and Blue Shield — Medicare Advantage: $267.45 Anthem Blue Cross and Blue Shield — PPO: $2,158 Anthem Blue Cross and Blue Shield — Traditional: $52.25 Aspirus — HMO/POS: $19.80 Aspirus — Medicare Advantage: $267.45 Aspirus — PPO: $12.65 Cigna — Commercial: $16.50 Health Partners Open Network — Commercial: $20.08
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · Doctor (professional) fee In the file: PR EMERGENCY DEPARTMENT VISIT LOW MDM	$409	$327.20	$64.30 – $388.55
Emergency room visit (moderate): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $119.60 Anthem Blue Cross and Blue Shield — HMO/POS: $149.18 Anthem Blue Cross and Blue Shield — Medicare Advantage: $64.30 Anthem Blue Cross and Blue Shield — PPO: $168.47 Anthem Blue Cross and Blue Shield — Traditional: $388.55 Aspirus — HMO/POS: $143.15 Aspirus — Medicare Advantage: $64.30 Aspirus — PPO: $94.07 Cigna — Commercial: $114.52 Health Partners Open Network — Commercial: $105.08
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED LEVEL 4 INIT ASSESS	$55	$44	$12.65 – $3,880
Emergency room visit (moderately high): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,335 Anthem Blue Cross and Blue Shield — HMO/POS: $2,597 Anthem Blue Cross and Blue Shield — Medicare Advantage: $411.31 Anthem Blue Cross and Blue Shield — PPO: $3,880 Anthem Blue Cross and Blue Shield — Traditional: $52.25 Aspirus — HMO/POS: $19.80 Aspirus — Medicare Advantage: $411.31 Aspirus — PPO: $12.65 Cigna — Commercial: $16.50 Health Partners Open Network — Commercial: $20.08
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED LEVEL 4 VISIT	$2,594.98	$2,075.99	$411.31 – $3,880
Emergency room visit (moderately high): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,335 Anthem Blue Cross and Blue Shield — HMO/POS: $2,597 Anthem Blue Cross and Blue Shield — Medicare Advantage: $411.31 Anthem Blue Cross and Blue Shield — PPO: $3,880 Anthem Blue Cross and Blue Shield — Traditional: $2,465.23 Aspirus — HMO/POS: $934.19 Aspirus — Medicare Advantage: $411.31 Aspirus — PPO: $596.85 Cigna — Commercial: $778.49 Health Partners Open Network — Commercial: $947.17
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · Doctor (professional) fee In the file: PR EMERGENCY DEPARTMENT VISIT MODERATE MDM	$554	$443.20	$109.38 – $526.30
Emergency room visit (moderately high): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $203.45 Anthem Blue Cross and Blue Shield — HMO/POS: $253.76 Anthem Blue Cross and Blue Shield — Medicare Advantage: $109.38 Anthem Blue Cross and Blue Shield — PPO: $286.58 Anthem Blue Cross and Blue Shield — Traditional: $526.30 Aspirus — HMO/POS: $193.90 Aspirus — Medicare Advantage: $109.38 Aspirus — PPO: $127.42 Cigna — Commercial: $155.12 Health Partners Open Network — Commercial: $199.47
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED LEVEL 5 VISIT	$3,751.36	$3,001.09	$592.21 – $3,880
Emergency room visit (high): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,335 Anthem Blue Cross and Blue Shield — HMO/POS: $2,597 Anthem Blue Cross and Blue Shield — Medicare Advantage: $592.21 Anthem Blue Cross and Blue Shield — PPO: $3,880 Anthem Blue Cross and Blue Shield — Traditional: $3,563.79 Aspirus — HMO/POS: $1,350.49 Aspirus — Medicare Advantage: $592.21 Aspirus — PPO: $862.81 Cigna — Commercial: $1,125.41 Health Partners Open Network — Commercial: $1,369.25
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ED LEVEL 5 INIT ASSESS	$55	$44	$12.65 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $3,880
Emergency room visit (high): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,335 Anthem Blue Cross and Blue Shield — HMO/POS: $2,597 Anthem Blue Cross and Blue Shield — Medicare Advantage: $592.21 Anthem Blue Cross and Blue Shield — PPO: $3,880 Anthem Blue Cross and Blue Shield — Traditional: $52.25 Aspirus — HMO/POS: $19.80 Aspirus — Medicare Advantage: $592.21 Aspirus — PPO: $12.65 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Cigna — Commercial: $16.50 Health Partners Open Network — Commercial: $20.08
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · Doctor (professional) fee In the file: PR EMERGENCY DEPARTMENT VISIT HIGH MDM	$907	$725.60	$158.44 – $861.65
Emergency room visit (high): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $294.70 Anthem Blue Cross and Blue Shield — HMO/POS: $367.58 Anthem Blue Cross and Blue Shield — Medicare Advantage: $158.44 Anthem Blue Cross and Blue Shield — PPO: $415.11 Anthem Blue Cross and Blue Shield — Traditional: $861.65 Aspirus — HMO/POS: $317.45 Aspirus — Medicare Advantage: $158.44 Aspirus — PPO: $208.61 Cigna — Commercial: $253.96 Health Partners Open Network — Commercial: $296.09

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: HC METABOLIC PANEL TOTAL CA	$183.52	$146.82	$8.46 – $174.34
Basic metabolic panel (blood test): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $8.46 Anthem Blue Cross and Blue Shield — HMO/POS: $8.46 Anthem Blue Cross and Blue Shield — Medicare Advantage: $8.46 Anthem Blue Cross and Blue Shield — PPO: $8.46 Anthem Blue Cross and Blue Shield — Traditional: $174.34 Aspirus — HMO/POS: $66.07 Aspirus — Medicare Advantage: $8.46 Aspirus — PPO: $42.21 Cigna — Commercial: $55.06 Health Partners Open Network — Commercial: $66.98
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG BASIC METABOLIC PANEL CALCIUM TOTAL	$158	$126.40	$5.08 – $150.10
Basic metabolic panel (blood test): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $39.50 Anthem Blue Cross and Blue Shield — HMO/POS: $39.50 Anthem Blue Cross and Blue Shield — PPO: $39.50 Anthem Blue Cross and Blue Shield — Traditional: $150.10 Aspirus — HMO/POS: $55.30 Aspirus — Medicare Advantage: $79 Aspirus — PPO: $36.34 Cigna — Commercial: $44.24 Health Partners Open Network — Commercial: $13.16 Medical Associates Health Plan — HMO/POS/PPO: $58.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC METABOLIC PANEL TOTAL CA	$183.52	$146.82	$42.21 – $174.34
Basic metabolic panel (blood test): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $77.70 Anthem Blue Cross and Blue Shield — HMO/POS: $95.36 Anthem Blue Cross and Blue Shield — PPO: $105.95 Anthem Blue Cross and Blue Shield — Traditional: $174.34 Aspirus — HMO/POS: $66.07 Aspirus — Medicare Advantage: $110.11 Aspirus — PPO: $42.21 Mercy Care — HMO/POS: $60.93 Prevea 360 — Commercial: $155.99 Security Health Plan — HMO/POS/SAS: $56.89
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHEN METABOLIC PANEL	$228.28	$182.63	$10.56 – $216.87
Comprehensive metabolic panel (blood test): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $10.56 Anthem Blue Cross and Blue Shield — HMO/POS: $10.56 Anthem Blue Cross and Blue Shield — Medicare Advantage: $10.56 Anthem Blue Cross and Blue Shield — PPO: $10.56 Anthem Blue Cross and Blue Shield — Traditional: $216.87 Aspirus — HMO/POS: $82.18 Aspirus — Medicare Advantage: $10.56 Aspirus — PPO: $52.50 Cigna — Commercial: $68.48 Health Partners Open Network — Commercial: $83.32
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG METABOLIC PANEL,COMPREHENSIVE	$168	$134.40	$6.34 – $159.60
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $42 Anthem Blue Cross and Blue Shield — HMO/POS: $42 Anthem Blue Cross and Blue Shield — PPO: $42 Anthem Blue Cross and Blue Shield — Traditional: $159.60 Aspirus — HMO/POS: $58.80 Aspirus — Medicare Advantage: $84 Aspirus — PPO: $38.64 Cigna — Commercial: $47.04 Health Partners Open Network — Commercial: $16.43 Medical Associates Health Plan — HMO/POS/PPO: $62.16
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHEN METABOLIC PANEL	$228.28	$182.63	$52.50 – $216.87
Comprehensive metabolic panel (blood test): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $96.65 Anthem Blue Cross and Blue Shield — HMO/POS: $118.61 Anthem Blue Cross and Blue Shield — PPO: $131.79 Anthem Blue Cross and Blue Shield — Traditional: $216.87 Aspirus — HMO/POS: $82.18 Aspirus — Medicare Advantage: $136.97 Aspirus — PPO: $52.50 Mercy Care — HMO/POS: $75.79 Prevea 360 — Commercial: $194.04 Security Health Plan — HMO/POS/SAS: $70.77
Obstetric blood test panel CPT 80055 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG OBSTETRIC PANEL	$367	$293.60	$28.69 – $348.65
Obstetric blood test panel: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $91.75 Anthem Blue Cross and Blue Shield — HMO/POS: $91.75 Anthem Blue Cross and Blue Shield — PPO: $91.75 Anthem Blue Cross and Blue Shield — Traditional: $348.65 Aspirus — HMO/POS: $128.45 Aspirus — Medicare Advantage: $183.50 Aspirus — PPO: $84.41 Cigna — Commercial: $102.76 Health Partners Open Network — Commercial: $74.37 Medical Associates Health Plan — HMO/POS/PPO: $135.79
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$47.81
Obstetric blood test panel: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $47.81 Anthem Blue Cross and Blue Shield — HMO/POS: $47.81 Anthem Blue Cross and Blue Shield — Medicare Advantage: $47.81 Anthem Blue Cross and Blue Shield — PPO: $47.81 Aspirus — Medicare Advantage: $47.81 Humana — Medicare Advantage: $47.81 IlliniCare — Medicare Advantage: $47.81 MeridianCare — Medicare Advantage: $47.81 Prevea 360 — Medicare Advantage: $47.81 United Healthcare — Medicare Advantage: $47.81
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$289.43	$231.55	$13.39 – $274.96
Cholesterol panel (lipid panel): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $13.39 Anthem Blue Cross and Blue Shield — HMO/POS: $13.39 Anthem Blue Cross and Blue Shield — Medicare Advantage: $13.39 Anthem Blue Cross and Blue Shield — PPO: $13.39 Anthem Blue Cross and Blue Shield — Traditional: $274.96 Aspirus — HMO/POS: $104.19 Aspirus — Medicare Advantage: $13.39 Aspirus — PPO: $66.57 Cigna — Commercial: $86.83 Health Partners Open Network — Commercial: $105.64
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG LIPID PANEL	$219	$175.20	$8.03 – $208.05
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $54.75 Anthem Blue Cross and Blue Shield — HMO/POS: $54.75 Anthem Blue Cross and Blue Shield — PPO: $54.75 Anthem Blue Cross and Blue Shield — Traditional: $208.05 Aspirus — HMO/POS: $76.65 Aspirus — Medicare Advantage: $109.50 Aspirus — PPO: $50.37 Cigna — Commercial: $61.32 Health Partners Open Network — Commercial: $20.82 Medical Associates Health Plan — HMO/POS/PPO: $81.03
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$289.43	$231.55	$66.57 – $274.96
Cholesterol panel (lipid panel): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $122.54 Anthem Blue Cross and Blue Shield — HMO/POS: $150.39 Anthem Blue Cross and Blue Shield — PPO: $167.09 Anthem Blue Cross and Blue Shield — Traditional: $274.96 Aspirus — HMO/POS: $104.19 Aspirus — Medicare Advantage: $173.66 Aspirus — PPO: $66.57 Mercy Care — HMO/POS: $96.09 Prevea 360 — Commercial: $246.02 Security Health Plan — HMO/POS/SAS: $89.72
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$187.97	$150.38	$8.68 – $178.57
Kidney function panel: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $8.68 Anthem Blue Cross and Blue Shield — HMO/POS: $8.68 Anthem Blue Cross and Blue Shield — Medicare Advantage: $8.68 Anthem Blue Cross and Blue Shield — PPO: $8.68 Anthem Blue Cross and Blue Shield — Traditional: $178.57 Aspirus — HMO/POS: $67.67 Aspirus — Medicare Advantage: $8.68 Aspirus — PPO: $43.23 Cigna — Commercial: $56.39 Health Partners Open Network — Commercial: $68.61
Kidney function panel CPT 80069 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG RENAL FUNCTION PANEL	$140	$112	$5.21 – $133
Kidney function panel: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $35 Anthem Blue Cross and Blue Shield — HMO/POS: $35 Anthem Blue Cross and Blue Shield — PPO: $35 Anthem Blue Cross and Blue Shield — Traditional: $133 Aspirus — HMO/POS: $49 Aspirus — Medicare Advantage: $70 Aspirus — PPO: $32.20 Cigna — Commercial: $39.20 Health Partners Open Network — Commercial: $13.51 Medical Associates Health Plan — HMO/POS/PPO: $51.80
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$187.97	$150.38	$43.23 – $178.57
Kidney function panel: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $79.59 Anthem Blue Cross and Blue Shield — HMO/POS: $97.67 Anthem Blue Cross and Blue Shield — PPO: $108.52 Anthem Blue Cross and Blue Shield — Traditional: $178.57 Aspirus — HMO/POS: $67.67 Aspirus — Medicare Advantage: $112.78 Aspirus — PPO: $43.23 Mercy Care — HMO/POS: $62.41 Prevea 360 — Commercial: $159.77 Security Health Plan — HMO/POS/SAS: $58.27
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$177.55	$142.04	$8.17 – $168.67
Liver function panel: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $8.17 Anthem Blue Cross and Blue Shield — HMO/POS: $8.17 Anthem Blue Cross and Blue Shield — Medicare Advantage: $8.17 Anthem Blue Cross and Blue Shield — PPO: $8.17 Anthem Blue Cross and Blue Shield — Traditional: $168.67 Aspirus — HMO/POS: $63.92 Aspirus — Medicare Advantage: $8.17 Aspirus — PPO: $40.84 Cigna — Commercial: $53.27 Health Partners Open Network — Commercial: $64.81
Liver function panel CPT 80076 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG HEPATIC FUNCTION PANEL	$116	$92.80	$4.90 – $110.20
Liver function panel: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $29 Anthem Blue Cross and Blue Shield — HMO/POS: $29 Anthem Blue Cross and Blue Shield — PPO: $29 Anthem Blue Cross and Blue Shield — Traditional: $110.20 Aspirus — HMO/POS: $40.60 Aspirus — Medicare Advantage: $58 Aspirus — PPO: $26.68 Cigna — Commercial: $32.48 Health Partners Open Network — Commercial: $12.71 Medical Associates Health Plan — HMO/POS/PPO: $42.92
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$177.55	$142.04	$40.84 – $168.67
Liver function panel: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $75.17 Anthem Blue Cross and Blue Shield — HMO/POS: $92.25 Anthem Blue Cross and Blue Shield — PPO: $102.50 Anthem Blue Cross and Blue Shield — Traditional: $168.67 Aspirus — HMO/POS: $63.92 Aspirus — Medicare Advantage: $106.53 Aspirus — PPO: $40.84 Mercy Care — HMO/POS: $58.95 Prevea 360 — Commercial: $150.92 Security Health Plan — HMO/POS/SAS: $55.04
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AUTOM URINE DIP W MICRO	$56.62	$45.30	$3.17 – $53.79
Urine test (automated, with microscope): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3.17 Anthem Blue Cross and Blue Shield — HMO/POS: $3.17 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3.17 Anthem Blue Cross and Blue Shield — PPO: $3.17 Anthem Blue Cross and Blue Shield — Traditional: $53.79 Aspirus — HMO/POS: $20.38 Aspirus — Medicare Advantage: $3.17 Aspirus — PPO: $13.02 Cigna — Commercial: $16.99 Health Partners Open Network — Commercial: $20.67
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG URINALYSIS, AUTO, W/SCOPE	$79	$63.20	$3.17 – $75.05
Urine test (automated, with microscope): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $19.75 Anthem Blue Cross and Blue Shield — HMO/POS: $19.75 Anthem Blue Cross and Blue Shield — PPO: $19.75 Anthem Blue Cross and Blue Shield — Traditional: $75.05 Aspirus — HMO/POS: $27.65 Aspirus — Medicare Advantage: $39.50 Aspirus — PPO: $18.17 Cigna — Commercial: $22.12 Health Partners Open Network — Commercial: $4.93 Medical Associates Health Plan — HMO/POS/PPO: $29.23
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AUTOM URINE DIP W MICRO	$56.62	$45.30	$13.02 – $53.79
Urine test (automated, with microscope): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $23.97 Anthem Blue Cross and Blue Shield — HMO/POS: $29.42 Anthem Blue Cross and Blue Shield — PPO: $32.69 Anthem Blue Cross and Blue Shield — Traditional: $53.79 Aspirus — HMO/POS: $20.38 Aspirus — Medicare Advantage: $33.97 Aspirus — PPO: $13.02 Mercy Care — HMO/POS: $18.80 Prevea 360 — Commercial: $48.13 Security Health Plan — HMO/POS/SAS: $17.55
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$45.80	$36.64	$3.48 – $43.51
Urine test (manual, without microscope): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3.48 Anthem Blue Cross and Blue Shield — HMO/POS: $3.48 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3.48 Anthem Blue Cross and Blue Shield — PPO: $3.48 Anthem Blue Cross and Blue Shield — Traditional: $43.51 Aspirus — HMO/POS: $16.49 Aspirus — Medicare Advantage: $3.48 Aspirus — PPO: $10.53 Cigna — Commercial: $13.74 Health Partners Open Network — Commercial: $16.72
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG URINALYSIS NONAUTO W/O SCOPE	$95	$76	$3.48 – $90.25
Urine test (manual, without microscope): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $23.75 Anthem Blue Cross and Blue Shield — HMO/POS: $23.75 Anthem Blue Cross and Blue Shield — PPO: $23.75 Anthem Blue Cross and Blue Shield — Traditional: $90.25 Aspirus — HMO/POS: $33.25 Aspirus — Medicare Advantage: $47.50 Aspirus — PPO: $21.85 Cigna — Commercial: $26.60 Health Partners Open Network — Commercial: $4.88 Medical Associates Health Plan — HMO/POS/PPO: $35.15
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$45.80	$36.64	$10.53 – $43.51
Urine test (manual, without microscope): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $19.39 Anthem Blue Cross and Blue Shield — HMO/POS: $23.80 Anthem Blue Cross and Blue Shield — PPO: $26.44 Anthem Blue Cross and Blue Shield — Traditional: $43.51 Aspirus — HMO/POS: $16.49 Aspirus — Medicare Advantage: $27.48 Aspirus — PPO: $10.53 Mercy Care — HMO/POS: $15.21 Prevea 360 — Commercial: $38.93 Security Health Plan — HMO/POS/SAS: $14.20
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AUTOM URINALYSIS WO MICRO	$39.80	$31.84	$2.25 – $37.81
Urine test (automated, without microscope): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2.25 Anthem Blue Cross and Blue Shield — HMO/POS: $2.25 Anthem Blue Cross and Blue Shield — Medicare Advantage: $2.25 Anthem Blue Cross and Blue Shield — PPO: $2.25 Anthem Blue Cross and Blue Shield — Traditional: $37.81 Aspirus — HMO/POS: $14.33 Aspirus — Medicare Advantage: $2.25 Aspirus — PPO: $9.15 Cigna — Commercial: $11.94 Health Partners Open Network — Commercial: $14.53
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG URINALYSIS, AUTO, W/O SCOPE	$48	$38.40	$2.25 – $45.60
Urine test (automated, without microscope): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $12 Anthem Blue Cross and Blue Shield — HMO/POS: $12 Anthem Blue Cross and Blue Shield — PPO: $12 Anthem Blue Cross and Blue Shield — Traditional: $45.60 Aspirus — HMO/POS: $16.80 Aspirus — Medicare Advantage: $24 Aspirus — PPO: $11.04 Cigna — Commercial: $13.44 Health Partners Open Network — Commercial: $3.49 Medical Associates Health Plan — HMO/POS/PPO: $17.76
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AUTOM URINALYSIS WO MICRO	$39.80	$31.84	$9.15 – $37.81
Urine test (automated, without microscope): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $16.85 Anthem Blue Cross and Blue Shield — HMO/POS: $20.68 Anthem Blue Cross and Blue Shield — PPO: $22.98 Anthem Blue Cross and Blue Shield — Traditional: $37.81 Aspirus — HMO/POS: $14.33 Aspirus — Medicare Advantage: $23.88 Aspirus — PPO: $9.15 Mercy Care — HMO/POS: $13.21 Prevea 360 — Commercial: $33.83 Security Health Plan — HMO/POS/SAS: $12.34
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSA; TOTAL	$257.58	$206.07	$18.39 – $244.70
PSA (prostate specific antigen) blood test: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $18.39 Anthem Blue Cross and Blue Shield — HMO/POS: $18.39 Anthem Blue Cross and Blue Shield — Medicare Advantage: $18.39 Anthem Blue Cross and Blue Shield — PPO: $18.39 Anthem Blue Cross and Blue Shield — Traditional: $244.70 Aspirus — HMO/POS: $92.73 Aspirus — Medicare Advantage: $18.39 Aspirus — PPO: $59.24 Cigna — Commercial: $77.27 Health Partners Open Network — Commercial: $94.02
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG PROSTATE SPECIFIC ANTIGEN,TOTAL	$170	$136	$11.03 – $161.50
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $42.50 Anthem Blue Cross and Blue Shield — HMO/POS: $42.50 Anthem Blue Cross and Blue Shield — PPO: $42.50 Anthem Blue Cross and Blue Shield — Traditional: $161.50 Aspirus — HMO/POS: $59.50 Aspirus — Medicare Advantage: $85 Aspirus — PPO: $39.10 Cigna — Commercial: $47.60 Health Partners Open Network — Commercial: $28.62 Medical Associates Health Plan — HMO/POS/PPO: $62.90
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSA; TOTAL	$257.58	$206.07	$59.24 – $244.70
PSA (prostate specific antigen) blood test: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $109.06 Anthem Blue Cross and Blue Shield — HMO/POS: $133.84 Anthem Blue Cross and Blue Shield — PPO: $148.70 Anthem Blue Cross and Blue Shield — Traditional: $244.70 Aspirus — HMO/POS: $92.73 Aspirus — Medicare Advantage: $154.55 Aspirus — PPO: $59.24 Mercy Care — HMO/POS: $85.52 Prevea 360 — Commercial: $218.94 Security Health Plan — HMO/POS/SAS: $79.85
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$227.05	$181.64	$16.80 – $215.70
Thyroid stimulating hormone (TSH) test: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $16.80 Anthem Blue Cross and Blue Shield — HMO/POS: $16.80 Anthem Blue Cross and Blue Shield — Medicare Advantage: $16.80 Anthem Blue Cross and Blue Shield — PPO: $16.80 Anthem Blue Cross and Blue Shield — Traditional: $215.70 Aspirus — HMO/POS: $81.74 Aspirus — Medicare Advantage: $16.80 Aspirus — PPO: $52.22 Cigna — Commercial: $68.12 Health Partners Open Network — Commercial: $82.87
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG ASSAY THYROID STIM HORMONE	$173	$138.40	$10.08 – $164.35
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $43.25 Anthem Blue Cross and Blue Shield — HMO/POS: $43.25 Anthem Blue Cross and Blue Shield — PPO: $43.25 Anthem Blue Cross and Blue Shield — Traditional: $164.35 Aspirus — HMO/POS: $60.55 Aspirus — Medicare Advantage: $86.50 Aspirus — PPO: $39.79 Cigna — Commercial: $48.44 Health Partners Open Network — Commercial: $26.14 Medical Associates Health Plan — HMO/POS/PPO: $64.01
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$227.05	$181.64	$52.22 – $215.70
Thyroid stimulating hormone (TSH) test: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $96.13 Anthem Blue Cross and Blue Shield — HMO/POS: $117.98 Anthem Blue Cross and Blue Shield — PPO: $131.08 Anthem Blue Cross and Blue Shield — Traditional: $215.70 Aspirus — HMO/POS: $81.74 Aspirus — Medicare Advantage: $136.23 Aspirus — PPO: $52.22 Mercy Care — HMO/POS: $75.38 Prevea 360 — Commercial: $192.99 Security Health Plan — HMO/POS/SAS: $70.39
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPL CBC W PLT W AUTOM DIFF	$149.13	$119.31	$7.77 – $141.67
Complete blood count (CBC) with differential: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $7.77 Anthem Blue Cross and Blue Shield — HMO/POS: $7.77 Anthem Blue Cross and Blue Shield — Medicare Advantage: $7.77 Anthem Blue Cross and Blue Shield — PPO: $7.77 Anthem Blue Cross and Blue Shield — Traditional: $141.67 Aspirus — HMO/POS: $53.69 Aspirus — Medicare Advantage: $7.77 Aspirus — PPO: $34.30 Cigna — Commercial: $44.74 Health Partners Open Network — Commercial: $54.43
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG COMPLETE CBC & AUTO DIFF WBC	$117	$93.60	$4.66 – $111.15
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $29.25 Anthem Blue Cross and Blue Shield — HMO/POS: $29.25 Anthem Blue Cross and Blue Shield — PPO: $29.25 Anthem Blue Cross and Blue Shield — Traditional: $111.15 Aspirus — HMO/POS: $40.95 Aspirus — Medicare Advantage: $58.50 Aspirus — PPO: $26.91 Cigna — Commercial: $32.76 Health Partners Open Network — Commercial: $12.08 Medical Associates Health Plan — HMO/POS/PPO: $43.29
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPL CBC W PLT W AUTOM DIFF	$149.13	$119.31	$34.30 – $141.67
Complete blood count (CBC) with differential: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $63.14 Anthem Blue Cross and Blue Shield — HMO/POS: $77.49 Anthem Blue Cross and Blue Shield — PPO: $86.09 Anthem Blue Cross and Blue Shield — Traditional: $141.67 Aspirus — HMO/POS: $53.69 Aspirus — Medicare Advantage: $89.48 Aspirus — PPO: $34.30 Mercy Care — HMO/POS: $49.51 Prevea 360 — Commercial: $126.76 Security Health Plan — HMO/POS/SAS: $46.23
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPL AUTOM CBC W PLT	$124.07	$99.26	$6.47 – $117.87
Complete blood count (CBC), automated: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6.47 Anthem Blue Cross and Blue Shield — HMO/POS: $6.47 Anthem Blue Cross and Blue Shield — Medicare Advantage: $6.47 Anthem Blue Cross and Blue Shield — PPO: $6.47 Anthem Blue Cross and Blue Shield — Traditional: $117.87 Aspirus — HMO/POS: $44.67 Aspirus — Medicare Advantage: $6.47 Aspirus — PPO: $28.54 Cigna — Commercial: $37.22 Health Partners Open Network — Commercial: $45.29
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG COMPLETE CBC	$107	$85.60	$3.88 – $101.65
Complete blood count (CBC), automated: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $26.75 Anthem Blue Cross and Blue Shield — HMO/POS: $26.75 Anthem Blue Cross and Blue Shield — PPO: $26.75 Anthem Blue Cross and Blue Shield — Traditional: $101.65 Aspirus — HMO/POS: $37.45 Aspirus — Medicare Advantage: $53.50 Aspirus — PPO: $24.61 Cigna — Commercial: $29.96 Health Partners Open Network — Commercial: $10.06 Medical Associates Health Plan — HMO/POS/PPO: $39.59
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPL AUTOM CBC W PLT	$124.07	$99.26	$28.54 – $117.87
Complete blood count (CBC), automated: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $52.53 Anthem Blue Cross and Blue Shield — HMO/POS: $64.47 Anthem Blue Cross and Blue Shield — PPO: $71.63 Anthem Blue Cross and Blue Shield — Traditional: $117.87 Aspirus — HMO/POS: $44.67 Aspirus — Medicare Advantage: $74.44 Aspirus — PPO: $28.54 Mercy Care — HMO/POS: $41.19 Prevea 360 — Commercial: $105.46 Security Health Plan — HMO/POS/SAS: $38.46
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$76.54	$61.24	$4.29 – $72.71
Blood clotting time test (prothrombin time, PT): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $4.29 Anthem Blue Cross and Blue Shield — HMO/POS: $4.29 Anthem Blue Cross and Blue Shield — Medicare Advantage: $4.29 Anthem Blue Cross and Blue Shield — PPO: $4.29 Anthem Blue Cross and Blue Shield — Traditional: $72.71 Aspirus — HMO/POS: $27.55 Aspirus — Medicare Advantage: $4.29 Aspirus — PPO: $17.60 Cigna — Commercial: $22.96 Health Partners Open Network — Commercial: $27.94
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG PROTHROMBIN TIME	$57	$45.60	$4.29 – $54.15
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $14.25 Anthem Blue Cross and Blue Shield — HMO/POS: $14.25 Anthem Blue Cross and Blue Shield — PPO: $14.25 Anthem Blue Cross and Blue Shield — Traditional: $54.15 Aspirus — HMO/POS: $19.95 Aspirus — Medicare Advantage: $28.50 Aspirus — PPO: $13.11 Cigna — Commercial: $15.96 Health Partners Open Network — Commercial: $6.13 Medical Associates Health Plan — HMO/POS/PPO: $21.09
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$76.54	$61.24	$17.60 – $72.71
Blood clotting time test (prothrombin time, PT): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $32.41 Anthem Blue Cross and Blue Shield — HMO/POS: $39.77 Anthem Blue Cross and Blue Shield — PPO: $44.19 Anthem Blue Cross and Blue Shield — Traditional: $72.71 Aspirus — HMO/POS: $27.55 Aspirus — Medicare Advantage: $45.92 Aspirus — PPO: $17.60 Mercy Care — HMO/POS: $25.41 Prevea 360 — Commercial: $65.06 Security Health Plan — HMO/POS/SAS: $23.73
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PTT; PLASMA OR WHOLE BLOOD	$116.11	$92.89	$6.01 – $110.30
Blood clotting test (partial thromboplastin time, PTT): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6.01 Anthem Blue Cross and Blue Shield — HMO/POS: $6.01 Anthem Blue Cross and Blue Shield — Medicare Advantage: $6.01 Anthem Blue Cross and Blue Shield — PPO: $6.01 Anthem Blue Cross and Blue Shield — Traditional: $110.30 Aspirus — HMO/POS: $41.80 Aspirus — Medicare Advantage: $6.01 Aspirus — PPO: $26.71 Cigna — Commercial: $34.83 Health Partners Open Network — Commercial: $42.38
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG THROMBOPLAS TIME PARTIAL	$73	$58.40	$3.61 – $69.35
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $18.25 Anthem Blue Cross and Blue Shield — HMO/POS: $18.25 Anthem Blue Cross and Blue Shield — PPO: $18.25 Anthem Blue Cross and Blue Shield — Traditional: $69.35 Aspirus — HMO/POS: $25.55 Aspirus — Medicare Advantage: $36.50 Aspirus — PPO: $16.79 Cigna — Commercial: $20.44 Health Partners Open Network — Commercial: $9.35 Medical Associates Health Plan — HMO/POS/PPO: $27.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PTT; PLASMA OR WHOLE BLOOD	$116.11	$92.89	$26.71 – $110.30
Blood clotting test (partial thromboplastin time, PTT): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $49.16 Anthem Blue Cross and Blue Shield — HMO/POS: $60.33 Anthem Blue Cross and Blue Shield — PPO: $67.03 Anthem Blue Cross and Blue Shield — Traditional: $110.30 Aspirus — HMO/POS: $41.80 Aspirus — Medicare Advantage: $69.67 Aspirus — PPO: $26.71 Mercy Care — HMO/POS: $38.55 Prevea 360 — Commercial: $98.69 Security Health Plan — HMO/POS/SAS: $35.99

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 OR BRAIN WO CONTRAST	$2,413.04	$1,930.44	$102.72 – $2,292.39
CT scan of the head or brain, without contrast: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $657 Anthem Blue Cross and Blue Shield — HMO/POS: $733 Anthem Blue Cross and Blue Shield — Medicare Advantage: $102.72 Anthem Blue Cross and Blue Shield — PPO: $1,098 Anthem Blue Cross and Blue Shield — Traditional: $2,292.39 Aspirus — HMO/POS: $868.69 Aspirus — Medicare Advantage: $102.72 Aspirus — PPO: $555 Cigna — Commercial: $723.91 Health Partners Open Network — Commercial: $880.76
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT HEAD OR BRAIN WO CONTRAST	$2,413.04	$1,930.44	$555 – $2,292.39
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,021.68 Anthem Blue Cross and Blue Shield — HMO/POS: $1,253.82 Anthem Blue Cross and Blue Shield — PPO: $1,393.05 Anthem Blue Cross and Blue Shield — Traditional: $2,292.39 Aspirus — HMO/POS: $868.69 Aspirus — Medicare Advantage: $1,447.82 Aspirus — PPO: $555 Mercy Care — HMO/POS: $801.13 Prevea 360 — Commercial: $2,051.08 Security Health Plan — HMO/POS/SAS: $748.04
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient · Doctor (professional) fee In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$100.78 – $333.58
CT scan of the head or brain, without contrast: 10 of 14 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $203.58 Anthem Blue Cross and Blue Shield — HMO/POS: $239.86 Anthem Blue Cross and Blue Shield — Medicare Advantage: $100.78 Anthem Blue Cross and Blue Shield — PPO: $239.86 Aspirus — Medicare Advantage: $100.78 Health Partners Open Network — Commercial: $226.12 Humana — Medicare Advantage: $105.82 IlliniCare — Medicare Advantage: $100.78 Medical Associates Health Plan — HMO/POS/PPO: $333.58 MeridianCare — Medicare Advantage: $105.82
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI BRAIN W WO CONTRAST	$3,962.09	$3,169.68	$344.96 – $3,763.99
MRI of the brain, before and after contrast: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,318 Anthem Blue Cross and Blue Shield — HMO/POS: $1,464 Anthem Blue Cross and Blue Shield — Medicare Advantage: $344.96 Anthem Blue Cross and Blue Shield — PPO: $2,191 Anthem Blue Cross and Blue Shield — Traditional: $3,763.99 Aspirus — HMO/POS: $1,426.35 Aspirus — Medicare Advantage: $344.96 Aspirus — PPO: $911.28 Cigna — Commercial: $1,188.63 Health Partners Open Network — Commercial: $1,446.16
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI BRAIN W WO CONTRAST	$3,962.09	$3,169.68	$911.28 – $3,763.99
MRI of the brain, before and after contrast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,677.55 Anthem Blue Cross and Blue Shield — HMO/POS: $2,058.70 Anthem Blue Cross and Blue Shield — PPO: $2,287.31 Anthem Blue Cross and Blue Shield — Traditional: $3,763.99 Aspirus — HMO/POS: $1,426.35 Aspirus — Medicare Advantage: $2,377.25 Aspirus — PPO: $911.28 Mercy Care — HMO/POS: $1,315.41 Prevea 360 — Commercial: $3,367.78 Security Health Plan — HMO/POS/SAS: $1,228.25
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$300.52 – $994.72
MRI of the brain, before and after contrast: rates for 10 insurance plans Anthem Blue Cross and Blue Shield — Medicare Advantage: $300.52 Aspirus — Medicare Advantage: $300.52 Health Partners Open Network — Commercial: $865.17 Humana — Medicare Advantage: $315.55 IlliniCare — Medicare Advantage: $300.52 Medical Associates Health Plan — HMO/POS/PPO: $994.72 MeridianCare — Medicare Advantage: $315.55 Prevea 360 — Medicare Advantage: $300.52 United Healthcare — Commercial: $806.07 United Healthcare — Medicare Advantage: $300.52
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC X-RAY EXAM CHEST 2 VIEWS	$659.90	$527.92	$85.05 – $626.91
Chest X-ray, 2 views: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $85.05 Anthem Blue Cross and Blue Shield — HMO/POS: $85.05 Anthem Blue Cross and Blue Shield — Medicare Advantage: $85.05 Anthem Blue Cross and Blue Shield — PPO: $85.05 Anthem Blue Cross and Blue Shield — Traditional: $626.91 Aspirus — HMO/POS: $237.56 Aspirus — Medicare Advantage: $85.05 Aspirus — PPO: $151.78 Cigna — Commercial: $197.97 Health Partners Open Network — Commercial: $240.86
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG RADIOLOGIC EXAM CHEST 2 VIEWS	$260	$208	$31.17 – $247
Chest X-ray, 2 views: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $65 Anthem Blue Cross and Blue Shield — HMO/POS: $65 Anthem Blue Cross and Blue Shield — Medicare Advantage: $31.17 Anthem Blue Cross and Blue Shield — PPO: $65 Anthem Blue Cross and Blue Shield — Traditional: $247 Aspirus — HMO/POS: $91 Aspirus — Medicare Advantage: $31.17 Aspirus — PPO: $59.80 Cigna — Commercial: $72.80 Health Partners Open Network — Commercial: $61.21
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC X-RAY EXAM CHEST 2 VIEWS	$659.90	$527.92	$151.78 – $626.91
Chest X-ray, 2 views: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $279.40 Anthem Blue Cross and Blue Shield — HMO/POS: $342.88 Anthem Blue Cross and Blue Shield — PPO: $380.96 Anthem Blue Cross and Blue Shield — Traditional: $626.91 Aspirus — HMO/POS: $237.56 Aspirus — Medicare Advantage: $395.94 Aspirus — PPO: $151.78 Mercy Care — HMO/POS: $219.09 Prevea 360 — Commercial: $560.92 Security Health Plan — HMO/POS/SAS: $204.57
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LUMBOSACR SPINE MIN 4 VIEWS	$1,157.32	$925.86	$102.72 – $1,099.45
X-ray of the lower spine, at least 4 views: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $102.72 Anthem Blue Cross and Blue Shield — HMO/POS: $102.72 Anthem Blue Cross and Blue Shield — Medicare Advantage: $102.72 Anthem Blue Cross and Blue Shield — PPO: $102.72 Anthem Blue Cross and Blue Shield — Traditional: $1,099.45 Aspirus — HMO/POS: $416.64 Aspirus — Medicare Advantage: $102.72 Aspirus — PPO: $266.18 Cigna — Commercial: $347.20 Health Partners Open Network — Commercial: $422.42
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG X-RAY LUMBAR SPINE 4 VW	$757	$605.60	$48.25 – $719.15
X-ray of the lower spine, at least 4 views: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $189.25 Anthem Blue Cross and Blue Shield — HMO/POS: $189.25 Anthem Blue Cross and Blue Shield — Medicare Advantage: $48.25 Anthem Blue Cross and Blue Shield — PPO: $189.25 Anthem Blue Cross and Blue Shield — Traditional: $719.15 Aspirus — HMO/POS: $264.95 Aspirus — Medicare Advantage: $48.25 Aspirus — PPO: $174.11 Cigna — Commercial: $211.96 Health Partners Open Network — Commercial: $104.17
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LUMBOSACR SPINE MIN 4 VIEWS	$1,157.32	$925.86	$266.18 – $1,099.45
X-ray of the lower spine, at least 4 views: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $490.01 Anthem Blue Cross and Blue Shield — HMO/POS: $601.34 Anthem Blue Cross and Blue Shield — PPO: $668.12 Anthem Blue Cross and Blue Shield — Traditional: $1,099.45 Aspirus — HMO/POS: $416.64 Aspirus — Medicare Advantage: $694.39 Aspirus — PPO: $266.18 Mercy Care — HMO/POS: $384.23 Prevea 360 — Commercial: $983.72 Security Health Plan — HMO/POS/SAS: $358.77
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI SPINE LUMBAR WO CONTRAST	$2,648.54	$2,118.84	$233.48 – $2,516.11
MRI of the lower back (lumbar spine), without contrast: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,318 Anthem Blue Cross and Blue Shield — HMO/POS: $1,464 Anthem Blue Cross and Blue Shield — Medicare Advantage: $233.48 Anthem Blue Cross and Blue Shield — PPO: $2,191 Anthem Blue Cross and Blue Shield — Traditional: $2,516.11 Aspirus — HMO/POS: $953.47 Aspirus — Medicare Advantage: $233.48 Aspirus — PPO: $609.16 Cigna — Commercial: $794.56 Health Partners Open Network — Commercial: $966.72
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI SPINE LUMBAR WO CONTRAST	$2,648.54	$2,118.84	$609.16 – $2,516.11
MRI of the lower back (lumbar spine), without contrast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,121.39 Anthem Blue Cross and Blue Shield — HMO/POS: $1,376.18 Anthem Blue Cross and Blue Shield — PPO: $1,529 Anthem Blue Cross and Blue Shield — Traditional: $2,516.11 Aspirus — HMO/POS: $953.47 Aspirus — Medicare Advantage: $1,589.12 Aspirus — PPO: $609.16 Mercy Care — HMO/POS: $879.32 Prevea 360 — Commercial: $2,251.26 Security Health Plan — HMO/POS/SAS: $821.05
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$180.40 – $597.12
MRI of the lower back (lumbar spine), without contrast: rates for 10 insurance plans Anthem Blue Cross and Blue Shield — Medicare Advantage: $180.40 Aspirus — Medicare Advantage: $180.40 Health Partners Open Network — Commercial: $506.36 Humana — Medicare Advantage: $189.42 IlliniCare — Medicare Advantage: $180.40 Medical Associates Health Plan — HMO/POS/PPO: $597.12 MeridianCare — Medicare Advantage: $189.42 Prevea 360 — Medicare Advantage: $180.40 United Healthcare — Commercial: $480.18 United Healthcare — Medicare Advantage: $180.40
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT PELVIS W CONTRAST	$6,131.56	$4,905.25	$171.95 – $5,824.98
CT scan of the pelvis, with contrast: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $657 Anthem Blue Cross and Blue Shield — HMO/POS: $733 Anthem Blue Cross and Blue Shield — Medicare Advantage: $171.95 Anthem Blue Cross and Blue Shield — PPO: $1,098 Anthem Blue Cross and Blue Shield — Traditional: $5,824.98 Aspirus — HMO/POS: $2,207.36 Aspirus — Medicare Advantage: $171.95 Aspirus — PPO: $1,410.26 Cigna — Commercial: $1,839.47 Health Partners Open Network — Commercial: $2,238.02
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT PELVIS W CONTRAST	$6,131.56	$4,905.25	$1,410.26 – $5,824.98
CT scan of the pelvis, with contrast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,596.10 Anthem Blue Cross and Blue Shield — HMO/POS: $3,185.96 Anthem Blue Cross and Blue Shield — PPO: $3,539.75 Anthem Blue Cross and Blue Shield — Traditional: $5,824.98 Aspirus — HMO/POS: $2,207.36 Aspirus — Medicare Advantage: $3,678.94 Aspirus — PPO: $1,410.26 Mercy Care — HMO/POS: $2,035.68 Prevea 360 — Commercial: $5,211.83 Security Health Plan — HMO/POS/SAS: $1,900.78
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient · Doctor (professional) fee In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$213.79 – $707.64
CT scan of the pelvis, with contrast: rates for 10 insurance plans Anthem Blue Cross and Blue Shield — Medicare Advantage: $213.79 Aspirus — Medicare Advantage: $213.79 Health Partners Open Network — Commercial: $494.75 Humana — Medicare Advantage: $224.48 IlliniCare — Medicare Advantage: $213.79 Medical Associates Health Plan — HMO/POS/PPO: $707.64 MeridianCare — Medicare Advantage: $224.48 Prevea 360 — Medicare Advantage: $213.79 United Healthcare — Commercial: $534.34 United Healthcare — Medicare Advantage: $213.79
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 LOW EXTR ANY JOINT WO CONTRAST	$2,583.45	$2,066.76	$233.48 – $2,454.28
MRI of a leg joint (such as the knee), without contrast: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,318 Anthem Blue Cross and Blue Shield — HMO/POS: $1,464 Anthem Blue Cross and Blue Shield — Medicare Advantage: $233.48 Anthem Blue Cross and Blue Shield — PPO: $2,191 Anthem Blue Cross and Blue Shield — Traditional: $2,454.28 Aspirus — HMO/POS: $930.04 Aspirus — Medicare Advantage: $233.48 Aspirus — PPO: $594.19 Cigna — Commercial: $775.04 Health Partners Open Network — Commercial: $942.96
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI LOW EXTR ANY JOINT WO CONTRAST	$2,583.45	$2,066.76	$594.19 – $2,454.28
MRI of a leg joint (such as the knee), without contrast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,093.83 Anthem Blue Cross and Blue Shield — HMO/POS: $1,342.36 Anthem Blue Cross and Blue Shield — PPO: $1,491.43 Anthem Blue Cross and Blue Shield — Traditional: $2,454.28 Aspirus — HMO/POS: $930.04 Aspirus — Medicare Advantage: $1,550.07 Aspirus — PPO: $594.19 Mercy Care — HMO/POS: $857.71 Prevea 360 — Commercial: $2,195.93 Security Health Plan — HMO/POS/SAS: $800.87
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient · Doctor (professional) fee In the file: MRI JNT OF LWR EXTRE W/O DYE	Not listed in the file	Not listed in the file	$191.67 – $634.43
MRI of a leg joint (such as the knee), without contrast: rates for 10 insurance plans Anthem Blue Cross and Blue Shield — Medicare Advantage: $191.67 Aspirus — Medicare Advantage: $191.67 Health Partners Open Network — Commercial: $540.86 Humana — Medicare Advantage: $201.25 IlliniCare — Medicare Advantage: $191.67 Medical Associates Health Plan — HMO/POS/PPO: $634.43 MeridianCare — Medicare Advantage: $201.25 Prevea 360 — Medicare Advantage: $191.67 United Healthcare — Commercial: $505.18 United Healthcare — Medicare Advantage: $191.67
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	$6,131.56	$4,905.25	$344.96 – $5,824.98
CT scan of the abdomen and pelvis, with contrast: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $657 Anthem Blue Cross and Blue Shield — HMO/POS: $733 Anthem Blue Cross and Blue Shield — Medicare Advantage: $344.96 Anthem Blue Cross and Blue Shield — PPO: $1,098 Anthem Blue Cross and Blue Shield — Traditional: $5,824.98 Aspirus — HMO/POS: $2,207.36 Aspirus — Medicare Advantage: $344.96 Aspirus — PPO: $1,410.26 Cigna — Commercial: $1,839.47 Health Partners Open Network — Commercial: $2,238.02
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT ABDOMEN & PELVIS W CONTRAST	$6,131.56	$4,905.25	$1,410.26 – $5,824.98
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,596.10 Anthem Blue Cross and Blue Shield — HMO/POS: $3,185.96 Anthem Blue Cross and Blue Shield — PPO: $3,539.75 Anthem Blue Cross and Blue Shield — Traditional: $5,824.98 Aspirus — HMO/POS: $2,207.36 Aspirus — Medicare Advantage: $3,678.94 Aspirus — PPO: $1,410.26 Mercy Care — HMO/POS: $2,035.68 Prevea 360 — Commercial: $5,211.83 Security Health Plan — HMO/POS/SAS: $1,900.78
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient · Doctor (professional) fee In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$284.58 – $941.96
CT scan of the abdomen and pelvis, with contrast: rates for 10 insurance plans Anthem Blue Cross and Blue Shield — Medicare Advantage: $284.58 Aspirus — Medicare Advantage: $284.58 Health Partners Open Network — Commercial: $650.23 Humana — Medicare Advantage: $298.81 IlliniCare — Medicare Advantage: $284.58 Medical Associates Health Plan — HMO/POS/PPO: $941.96 MeridianCare — Medicare Advantage: $298.81 Prevea 360 — Medicare Advantage: $284.58 United Healthcare — Commercial: $722.21 United Healthcare — Medicare Advantage: $284.58
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US EXAM ABDOMEN COMPLETE	$2,076.21	$1,660.97	$102.72 – $1,972.40
Ultrasound of the abdomen, complete: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $526 Anthem Blue Cross and Blue Shield — HMO/POS: $587 Anthem Blue Cross and Blue Shield — Medicare Advantage: $102.72 Anthem Blue Cross and Blue Shield — PPO: $870 Anthem Blue Cross and Blue Shield — Traditional: $1,972.40 Aspirus — HMO/POS: $747.44 Aspirus — Medicare Advantage: $102.72 Aspirus — PPO: $477.53 Cigna — Commercial: $622.86 Health Partners Open Network — Commercial: $757.82
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient · Doctor (professional) fee In the file: US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE	$862	$689.60	$107.02 – $818.90
Ultrasound of the abdomen, complete: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $215.50 Anthem Blue Cross and Blue Shield — HMO/POS: $215.50 Anthem Blue Cross and Blue Shield — Medicare Advantage: $107.02 Anthem Blue Cross and Blue Shield — PPO: $215.50 Anthem Blue Cross and Blue Shield — Traditional: $818.90 Aspirus — HMO/POS: $301.70 Aspirus — Medicare Advantage: $107.02 Aspirus — PPO: $198.26 Cigna — Commercial: $241.36 Health Partners Open Network — Commercial: $236
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US EXAM ABDOMEN COMPLETE	$2,076.21	$1,660.97	$477.53 – $1,972.40
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $879.07 Anthem Blue Cross and Blue Shield — HMO/POS: $1,078.80 Anthem Blue Cross and Blue Shield — PPO: $1,198.60 Anthem Blue Cross and Blue Shield — Traditional: $1,972.40 Aspirus — HMO/POS: $747.44 Aspirus — Medicare Advantage: $1,245.73 Aspirus — PPO: $477.53 Mercy Care — HMO/POS: $689.30 Prevea 360 — Commercial: $1,764.78 Security Health Plan — HMO/POS/SAS: $643.63
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US OB COMPLETE SNGL FETUS	$1,769.83	$1,415.87	$102.72 – $1,681.34
Pregnancy ultrasound (after the first trimester): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $526 Anthem Blue Cross and Blue Shield — HMO/POS: $587 Anthem Blue Cross and Blue Shield — Medicare Advantage: $102.72 Anthem Blue Cross and Blue Shield — PPO: $870 Anthem Blue Cross and Blue Shield — Traditional: $1,681.34 Aspirus — HMO/POS: $637.14 Aspirus — Medicare Advantage: $102.72 Aspirus — PPO: $407.06 Cigna — Commercial: $530.95 Health Partners Open Network — Commercial: $645.99
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient · Doctor (professional) fee In the file: US, OB >/= 14 WKS, SNGL FETUS	$919	$735.20	$124.60 – $873.05
Pregnancy ultrasound (after the first trimester): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $229.75 Anthem Blue Cross and Blue Shield — HMO/POS: $229.75 Anthem Blue Cross and Blue Shield — Medicare Advantage: $124.60 Anthem Blue Cross and Blue Shield — PPO: $229.75 Anthem Blue Cross and Blue Shield — Traditional: $873.05 Aspirus — HMO/POS: $321.65 Aspirus — Medicare Advantage: $124.60 Aspirus — PPO: $211.37 Cigna — Commercial: $257.32 Health Partners Open Network — Commercial: $269.77
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US OB COMPLETE SNGL FETUS	$1,769.83	$1,415.87	$407.06 – $1,681.34
Pregnancy ultrasound (after the first trimester): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $749.35 Anthem Blue Cross and Blue Shield — HMO/POS: $919.60 Anthem Blue Cross and Blue Shield — PPO: $1,021.72 Anthem Blue Cross and Blue Shield — Traditional: $1,681.34 Aspirus — HMO/POS: $637.14 Aspirus — Medicare Advantage: $1,061.90 Aspirus — PPO: $407.06 Mercy Care — HMO/POS: $587.58 Prevea 360 — Commercial: $1,504.36 Security Health Plan — HMO/POS/SAS: $548.65
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US NON OB TRANSVAG	$1,769.83	$1,415.87	$102.72 – $1,681.34
Transvaginal ultrasound: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $526 Anthem Blue Cross and Blue Shield — HMO/POS: $587 Anthem Blue Cross and Blue Shield — Medicare Advantage: $102.72 Anthem Blue Cross and Blue Shield — PPO: $870 Anthem Blue Cross and Blue Shield — Traditional: $1,681.34 Aspirus — HMO/POS: $637.14 Aspirus — Medicare Advantage: $102.72 Aspirus — PPO: $407.06 Cigna — Commercial: $530.95 Health Partners Open Network — Commercial: $645.99
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient · Doctor (professional) fee In the file: PR ECHOGRAPHY,TRANSVAGINAL	$855	$684	$109.22 – $812.25
Transvaginal ultrasound: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $213.75 Anthem Blue Cross and Blue Shield — HMO/POS: $213.75 Anthem Blue Cross and Blue Shield — Medicare Advantage: $109.22 Anthem Blue Cross and Blue Shield — PPO: $213.75 Anthem Blue Cross and Blue Shield — Traditional: $812.25 Aspirus — HMO/POS: $299.25 Aspirus — Medicare Advantage: $109.22 Aspirus — PPO: $196.65 Cigna — Commercial: $239.40 Health Partners Open Network — Commercial: $228.80
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US NON OB TRANSVAG	$1,769.83	$1,415.87	$407.06 – $1,681.34
Transvaginal ultrasound: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $749.35 Anthem Blue Cross and Blue Shield — HMO/POS: $919.60 Anthem Blue Cross and Blue Shield — PPO: $1,021.72 Anthem Blue Cross and Blue Shield — Traditional: $1,681.34 Aspirus — HMO/POS: $637.14 Aspirus — Medicare Advantage: $1,061.90 Aspirus — PPO: $407.06 Mercy Care — HMO/POS: $587.58 Prevea 360 — Commercial: $1,504.36 Security Health Plan — HMO/POS/SAS: $548.65
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$459	$367.20	$105.57 – $436.05
Diagnostic mammogram, one breast: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $114.75 Anthem Blue Cross and Blue Shield — HMO/POS: $114.75 Anthem Blue Cross and Blue Shield — Medicare Advantage: $116.61 Anthem Blue Cross and Blue Shield — PPO: $114.75 Anthem Blue Cross and Blue Shield — Traditional: $436.05 Aspirus — HMO/POS: $160.65 Aspirus — Medicare Advantage: $116.61 Aspirus — PPO: $105.57 Cigna — Commercial: $128.52 Health Partners Open Network — Commercial: $259.38
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$332 – $546
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $332 Anthem Blue Cross and Blue Shield — HMO/POS: $365 Anthem Blue Cross and Blue Shield — Medicare Advantage: $81.01 Anthem Blue Cross and Blue Shield — PPO: $546 Aspirus — Medicare Advantage: $81.01 Humana — Medicare Advantage: $81.01 IlliniCare — Medicare Advantage: $81.01 MeridianCare — Medicare Advantage: $81.01 Prevea 360 — Medicare Advantage: $81.01 United Healthcare — Medicare Advantage: $81.01
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI (26)	$138	$110.40	$31.74 – $131.10
Diagnostic mammogram, one breast: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $34.50 Anthem Blue Cross and Blue Shield — HMO/POS: $34.50 Anthem Blue Cross and Blue Shield — Medicare Advantage: $35.61 Anthem Blue Cross and Blue Shield — PPO: $34.50 Anthem Blue Cross and Blue Shield — Traditional: $131.10 Aspirus — HMO/POS: $48.30 Aspirus — Medicare Advantage: $35.61 Aspirus — PPO: $31.74 Cigna — Commercial: $38.64 Health Partners Open Network — Commercial: $82.57
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$578	$462.40	$132.94 – $549.10
Diagnostic mammogram, both breasts: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $144.50 Anthem Blue Cross and Blue Shield — HMO/POS: $144.50 Anthem Blue Cross and Blue Shield — Medicare Advantage: $147.22 Anthem Blue Cross and Blue Shield — PPO: $144.50 Anthem Blue Cross and Blue Shield — Traditional: $549.10 Aspirus — HMO/POS: $202.30 Aspirus — Medicare Advantage: $147.22 Aspirus — PPO: $132.94 Cigna — Commercial: $161.84 Health Partners Open Network — Commercial: $328.22
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$332 – $546
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $332 Anthem Blue Cross and Blue Shield — HMO/POS: $365 Anthem Blue Cross and Blue Shield — Medicare Advantage: $103.30 Anthem Blue Cross and Blue Shield — PPO: $546 Aspirus — Medicare Advantage: $103.30 Humana — Medicare Advantage: $103.30 IlliniCare — Medicare Advantage: $103.30 MeridianCare — Medicare Advantage: $103.30 Prevea 360 — Medicare Advantage: $103.30 United Healthcare — Medicare Advantage: $103.30
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI (26)	$168	$134.40	$38.64 – $159.60
Diagnostic mammogram, both breasts: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $42 Anthem Blue Cross and Blue Shield — HMO/POS: $42 Anthem Blue Cross and Blue Shield — Medicare Advantage: $43.92 Anthem Blue Cross and Blue Shield — PPO: $42 Anthem Blue Cross and Blue Shield — Traditional: $159.60 Aspirus — HMO/POS: $58.80 Aspirus — Medicare Advantage: $43.92 Aspirus — PPO: $38.64 Cigna — Commercial: $47.04 Health Partners Open Network — Commercial: $101.87
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Doctor (professional) fee In the file: CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$466	$372.80	$107.18 – $442.70
Screening mammogram, both breasts: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $116.50 Anthem Blue Cross and Blue Shield — HMO/POS: $116.50 Anthem Blue Cross and Blue Shield — Medicare Advantage: $119.22 Anthem Blue Cross and Blue Shield — PPO: $116.50 Anthem Blue Cross and Blue Shield — Traditional: $442.70 Aspirus — HMO/POS: $163.10 Aspirus — Medicare Advantage: $119.22 Aspirus — PPO: $107.18 Cigna — Commercial: $130.48 Health Partners Open Network — Commercial: $264.13
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$85.54
Screening mammogram, both breasts: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $332 Anthem Blue Cross and Blue Shield — HMO/POS: $365 Anthem Blue Cross and Blue Shield — Medicare Advantage: $85.54 Anthem Blue Cross and Blue Shield — PPO: $546 Aspirus — Medicare Advantage: $85.54 Humana — Medicare Advantage: $85.54 IlliniCare — Medicare Advantage: $85.54 MeridianCare — Medicare Advantage: $85.54 Prevea 360 — Medicare Advantage: $85.54 United Healthcare — Medicare Advantage: $85.54
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD (TC)	$337	$269.60	$77.51 – $320.15
Screening mammogram, both breasts: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $84.25 Anthem Blue Cross and Blue Shield — HMO/POS: $84.25 Anthem Blue Cross and Blue Shield — Medicare Advantage: $85.54 Anthem Blue Cross and Blue Shield — PPO: $84.25 Anthem Blue Cross and Blue Shield — Traditional: $320.15 Aspirus — HMO/POS: $117.95 Aspirus — Medicare Advantage: $85.54 Aspirus — PPO: $77.51 Cigna — Commercial: $94.36 Health Partners Open Network — Commercial: $186.99

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · Doctor (professional) fee In the file: PR ELECTROCARDIOGRAM, COMPLETE	$340	$272	$13.14 – $323
Electrocardiogram (ECG/EKG) with reading: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $35.22 Anthem Blue Cross and Blue Shield — HMO/POS: $40.73 Anthem Blue Cross and Blue Shield — Medicare Advantage: $13.14 Anthem Blue Cross and Blue Shield — PPO: $40.73 Anthem Blue Cross and Blue Shield — Traditional: $323 Aspirus — HMO/POS: $119 Aspirus — Medicare Advantage: $13.14 Aspirus — PPO: $78.20 Cigna — Commercial: $95.20 Health Partners Open Network — Commercial: $33.44
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LEFT HRT CATH W/VENTRCLGRPHY	$18,197.19	$14,557.76	$3,106.79 – $21,851
Left heart catheterization (diagnostic): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $13,171 Anthem Blue Cross and Blue Shield — HMO/POS: $14,635 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3,106.79 Anthem Blue Cross and Blue Shield — PPO: $21,851 Anthem Blue Cross and Blue Shield — Traditional: $17,287.33 Aspirus — HMO/POS: $6,550.99 Aspirus — Medicare Advantage: $3,106.79 Aspirus — PPO: $4,185.35 Cigna — Commercial: $5,459.16 Health Partners Open Network — Commercial: $6,641.97
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient · Doctor (professional) fee In the file: PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I	$5,086	$4,068.80	$782.96 – $4,831.70
Left heart catheterization (diagnostic): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,098.33 Anthem Blue Cross and Blue Shield — HMO/POS: $2,427.18 Anthem Blue Cross and Blue Shield — Medicare Advantage: $782.96 Anthem Blue Cross and Blue Shield — PPO: $2,427.18 Anthem Blue Cross and Blue Shield — Traditional: $4,831.70 Aspirus — HMO/POS: $1,780.10 Aspirus — Medicare Advantage: $782.96 Aspirus — PPO: $1,169.78 Cigna — Commercial: $1,424.08 Health Partners Open Network — Commercial: $1,717.50
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LEFT HRT CATH W/VENTRCLGRPHY	$18,197.19	$14,557.76	$4,185.35 – $17,287.33
Left heart catheterization (diagnostic): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $7,704.69 Anthem Blue Cross and Blue Shield — HMO/POS: $9,455.26 Anthem Blue Cross and Blue Shield — PPO: $10,505.24 Anthem Blue Cross and Blue Shield — Traditional: $17,287.33 Aspirus — HMO/POS: $6,550.99 Aspirus — Medicare Advantage: $10,918.31 Aspirus — PPO: $4,185.35 Mercy Care — HMO/POS: $6,041.47 Prevea 360 — Commercial: $15,467.61 Security Health Plan — HMO/POS/SAS: $5,641.13
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMP EP EVAL WO A INDUCTION	$26,223.90	$20,979.12	$6,031.50 – $39,335
Heart rhythm study (electrophysiology evaluation): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $24,566 Anthem Blue Cross and Blue Shield — HMO/POS: $26,344 Anthem Blue Cross and Blue Shield — Medicare Advantage: $7,329.50 Anthem Blue Cross and Blue Shield — PPO: $39,335 Anthem Blue Cross and Blue Shield — Traditional: $24,912.71 Aspirus — HMO/POS: $9,440.60 Aspirus — Medicare Advantage: $7,329.50 Aspirus — PPO: $6,031.50 Cigna — Commercial: $7,867.17 Health Partners Open Network — Commercial: $9,571.72
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient · Doctor (professional) fee In the file: PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION	$7,653	$6,122.40	$642.44 – $7,270.35
Heart rhythm study (electrophysiology evaluation): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,651.07 Anthem Blue Cross and Blue Shield — HMO/POS: $1,914.47 Anthem Blue Cross and Blue Shield — Medicare Advantage: $642.44 Anthem Blue Cross and Blue Shield — PPO: $1,914.47 Anthem Blue Cross and Blue Shield — Traditional: $7,270.35 Aspirus — HMO/POS: $2,678.55 Aspirus — Medicare Advantage: $642.44 Aspirus — PPO: $1,760.19 Cigna — Commercial: $2,142.84 Health Partners Open Network — Commercial: $1,360.27
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMP EP EVAL WO A INDUCTION	$26,223.90	$20,979.12	$6,031.50 – $24,912.71
Heart rhythm study (electrophysiology evaluation): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $11,103.20 Anthem Blue Cross and Blue Shield — HMO/POS: $13,625.94 Anthem Blue Cross and Blue Shield — PPO: $15,139.06 Anthem Blue Cross and Blue Shield — Traditional: $24,912.71 Aspirus — HMO/POS: $9,440.60 Aspirus — Medicare Advantage: $15,734.34 Aspirus — PPO: $6,031.50 Mercy Care — HMO/POS: $8,706.33 Prevea 360 — Commercial: $22,290.32 Security Health Plan — HMO/POS/SAS: $8,129.41
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB PULM VEIN ISOL	$55,962.71	$44,770.17	$12,871.42 – $53,164.57
Heart rhythm study with ablation for atrial fibrillation: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $24,566 Anthem Blue Cross and Blue Shield — HMO/POS: $26,344 Anthem Blue Cross and Blue Shield — Medicare Advantage: $23,696.24 Anthem Blue Cross and Blue Shield — PPO: $39,335 Anthem Blue Cross and Blue Shield — Traditional: $53,164.57 Aspirus — HMO/POS: $20,146.58 Aspirus — Medicare Advantage: $23,696.24 Aspirus — PPO: $12,871.42 Cigna — Commercial: $16,788.81 Health Partners Open Network — Commercial: $20,426.39
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient · Doctor (professional) fee In the file: PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION	$9,422	$7,537.60	$804.59 – $8,950.90
Heart rhythm study with ablation for atrial fibrillation: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,067.80 Anthem Blue Cross and Blue Shield — HMO/POS: $2,397.68 Anthem Blue Cross and Blue Shield — Medicare Advantage: $804.59 Anthem Blue Cross and Blue Shield — PPO: $2,397.68 Anthem Blue Cross and Blue Shield — Traditional: $8,950.90 Aspirus — HMO/POS: $3,297.70 Aspirus — Medicare Advantage: $804.59 Aspirus — PPO: $2,167.06 Cigna — Commercial: $2,638.16 Health Partners Open Network — Commercial: $2,233.18
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB PULM VEIN ISOL	$55,962.71	$44,770.17	$12,871.42 – $53,164.57
Heart rhythm study with ablation for atrial fibrillation: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $23,694.61 Anthem Blue Cross and Blue Shield — HMO/POS: $29,078.22 Anthem Blue Cross and Blue Shield — PPO: $32,307.27 Anthem Blue Cross and Blue Shield — Traditional: $53,164.57 Aspirus — HMO/POS: $20,146.58 Aspirus — Medicare Advantage: $33,577.63 Aspirus — PPO: $12,871.42 Mercy Care — HMO/POS: $18,579.62 Prevea 360 — Commercial: $47,568.30 Security Health Plan — HMO/POS/SAS: $17,348.44
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee In the file: PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$2,502	$2,001.60	$575.46 – $2,492.02
Sleep study (overnight, in a sleep lab): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,492.89 Anthem Blue Cross and Blue Shield — HMO/POS: $1,731.05 Anthem Blue Cross and Blue Shield — Medicare Advantage: $580.89 Anthem Blue Cross and Blue Shield — PPO: $1,731.05 Anthem Blue Cross and Blue Shield — Traditional: $2,376.90 Aspirus — HMO/POS: $875.70 Aspirus — Medicare Advantage: $580.89 Aspirus — PPO: $575.46 Cigna — Commercial: $700.56 Health Partners Open Network — Commercial: $1,214.60
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$3,082 – $5,111
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,082 Anthem Blue Cross and Blue Shield — HMO/POS: $3,424 Anthem Blue Cross and Blue Shield — Medicare Advantage: $982.72 Anthem Blue Cross and Blue Shield — PPO: $5,111 Aspirus — Medicare Advantage: $982.72 Humana — Medicare Advantage: $982.72 IlliniCare — Medicare Advantage: $982.72 MeridianCare — Medicare Advantage: $982.72 Prevea 360 — Medicare Advantage: $982.72 United Healthcare — Medicare Advantage: $982.72
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND (26)	$1,000	$800	$109.27 – $950
Sleep study (overnight, in a sleep lab): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $280.82 Anthem Blue Cross and Blue Shield — HMO/POS: $325.62 Anthem Blue Cross and Blue Shield — Medicare Advantage: $109.27 Anthem Blue Cross and Blue Shield — PPO: $325.62 Anthem Blue Cross and Blue Shield — Traditional: $950 Aspirus — HMO/POS: $350 Aspirus — Medicare Advantage: $109.27 Aspirus — PPO: $230 Cigna — Commercial: $280 Health Partners Open Network — Commercial: $246.25

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: HC THERAP EXERCISE ROM EA 15M	$214.81	$171.85	$27.97 – $381
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $231 Anthem Blue Cross and Blue Shield — HMO/POS: $255 Anthem Blue Cross and Blue Shield — Medicare Advantage: $27.97 Anthem Blue Cross and Blue Shield — PPO: $381 Anthem Blue Cross and Blue Shield — Traditional: $204.07 Aspirus — HMO/POS: $77.33 Aspirus — Medicare Advantage: $27.97 Aspirus — PPO: $49.41 Cigna — Commercial: $64.44 Health Partners Open Network — Commercial: $78.41
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient · Doctor (professional) fee In the file: PR THERAPEUTIC EXERCISES	$116	$92.80	$26.68 – $119.99
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $71.88 Anthem Blue Cross and Blue Shield — HMO/POS: $83.35 Anthem Blue Cross and Blue Shield — Medicare Advantage: $27.97 Anthem Blue Cross and Blue Shield — PPO: $83.35 Anthem Blue Cross and Blue Shield — Traditional: $110.20 Aspirus — HMO/POS: $40.60 Aspirus — Medicare Advantage: $27.97 Aspirus — PPO: $26.68 Cigna — Commercial: $32.48 Health Partners Open Network — Commercial: $40.67
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THERAP EXERCISE ROM EA 15M	$214.81	$171.85	$49.41 – $204.07
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $90.95 Anthem Blue Cross and Blue Shield — HMO/POS: $111.62 Anthem Blue Cross and Blue Shield — PPO: $124.01 Anthem Blue Cross and Blue Shield — Traditional: $204.07 Aspirus — HMO/POS: $77.33 Aspirus — Medicare Advantage: $128.89 Aspirus — PPO: $49.41 Mercy Care — HMO/POS: $71.32 Prevea 360 — Commercial: $182.59 Security Health Plan — HMO/POS/SAS: $66.59
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEX	$570.06	$456.05	$95.13 – $541.56
Physical therapy evaluation (low complexity): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $231 Anthem Blue Cross and Blue Shield — HMO/POS: $255 Anthem Blue Cross and Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross and Blue Shield — PPO: $381 Anthem Blue Cross and Blue Shield — Traditional: $541.56 Aspirus — HMO/POS: $205.22 Aspirus — Medicare Advantage: $95.13 Aspirus — PPO: $131.11 Cigna — Commercial: $171.02 Health Partners Open Network — Commercial: $208.07
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEX	$570.06	$456.05	$131.11 – $541.56
Physical therapy evaluation (low complexity): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $241.36 Anthem Blue Cross and Blue Shield — HMO/POS: $296.20 Anthem Blue Cross and Blue Shield — PPO: $329.10 Anthem Blue Cross and Blue Shield — Traditional: $541.56 Aspirus — HMO/POS: $205.22 Aspirus — Medicare Advantage: $342.04 Aspirus — PPO: $131.11 Mercy Care — HMO/POS: $189.26 Prevea 360 — Commercial: $484.55 Security Health Plan — HMO/POS/SAS: $176.72
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$84.30 – $408.11
Physical therapy evaluation (low complexity): 10 of 14 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $244.48 Anthem Blue Cross and Blue Shield — HMO/POS: $283.49 Anthem Blue Cross and Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross and Blue Shield — PPO: $283.49 Aspirus — Medicare Advantage: $95.13 Health Partners Open Network — Commercial: $136.91 Humana — Medicare Advantage: $99.89 IlliniCare — Medicare Advantage: $95.13 Medical Associates Health Plan — HMO/POS/PPO: $408.11 MeridianCare — Medicare Advantage: $99.89
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL MOD COMPLEX	$615.66	$492.53	$95.13 – $584.88
Physical therapy evaluation (moderate complexity): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $231 Anthem Blue Cross and Blue Shield — HMO/POS: $255 Anthem Blue Cross and Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross and Blue Shield — PPO: $381 Anthem Blue Cross and Blue Shield — Traditional: $584.88 Aspirus — HMO/POS: $221.64 Aspirus — Medicare Advantage: $95.13 Aspirus — PPO: $141.60 Cigna — Commercial: $184.70 Health Partners Open Network — Commercial: $224.72
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL MOD COMPLEX	$615.66	$492.53	$141.60 – $584.88
Physical therapy evaluation (moderate complexity): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $260.67 Anthem Blue Cross and Blue Shield — HMO/POS: $319.90 Anthem Blue Cross and Blue Shield — PPO: $355.42 Anthem Blue Cross and Blue Shield — Traditional: $584.88 Aspirus — HMO/POS: $221.64 Aspirus — Medicare Advantage: $369.40 Aspirus — PPO: $141.60 Mercy Care — HMO/POS: $204.40 Prevea 360 — Commercial: $523.31 Security Health Plan — HMO/POS/SAS: $190.85
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$84.30 – $408.11
Physical therapy evaluation (moderate complexity): 10 of 14 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $244.48 Anthem Blue Cross and Blue Shield — HMO/POS: $283.49 Anthem Blue Cross and Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross and Blue Shield — PPO: $283.49 Aspirus — Medicare Advantage: $95.13 Health Partners Open Network — Commercial: $136.91 Humana — Medicare Advantage: $99.89 IlliniCare — Medicare Advantage: $95.13 Medical Associates Health Plan — HMO/POS/PPO: $408.11 MeridianCare — Medicare Advantage: $99.89
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEX	$664.92	$531.94	$95.13 – $631.67
Physical therapy evaluation (high complexity): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $231 Anthem Blue Cross and Blue Shield — HMO/POS: $255 Anthem Blue Cross and Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross and Blue Shield — PPO: $381 Anthem Blue Cross and Blue Shield — Traditional: $631.67 Aspirus — HMO/POS: $239.37 Aspirus — Medicare Advantage: $95.13 Aspirus — PPO: $152.93 Cigna — Commercial: $199.48 Health Partners Open Network — Commercial: $242.70
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEX	$664.92	$531.94	$152.93 – $631.67
Physical therapy evaluation (high complexity): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $281.53 Anthem Blue Cross and Blue Shield — HMO/POS: $345.49 Anthem Blue Cross and Blue Shield — PPO: $383.86 Anthem Blue Cross and Blue Shield — Traditional: $631.67 Aspirus — HMO/POS: $239.37 Aspirus — Medicare Advantage: $398.95 Aspirus — PPO: $152.93 Mercy Care — HMO/POS: $220.75 Prevea 360 — Commercial: $565.18 Security Health Plan — HMO/POS/SAS: $206.13
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient · Doctor (professional) fee In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$84.30 – $408.11
Physical therapy evaluation (high complexity): 10 of 14 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $244.48 Anthem Blue Cross and Blue Shield — HMO/POS: $283.49 Anthem Blue Cross and Blue Shield — Medicare Advantage: $95.13 Anthem Blue Cross and Blue Shield — PPO: $283.49 Aspirus — Medicare Advantage: $95.13 Health Partners Open Network — Commercial: $136.91 Humana — Medicare Advantage: $99.89 IlliniCare — Medicare Advantage: $95.13 Medical Associates Health Plan — HMO/POS/PPO: $408.11 MeridianCare — Medicare Advantage: $99.89
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX W PT 30 MIN (16-37 MIN)	$280.56	$224.45	$64.53 – $266.53
Psychotherapy, 30 minutes: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $118.79 Anthem Blue Cross and Blue Shield — HMO/POS: $145.78 Anthem Blue Cross and Blue Shield — Medicare Advantage: $155.19 Anthem Blue Cross and Blue Shield — PPO: $161.97 Anthem Blue Cross and Blue Shield — Traditional: $266.53 Aspirus — HMO/POS: $101 Aspirus — Medicare Advantage: $155.19 Aspirus — PPO: $64.53 Cigna — Commercial: $84.17 Health Partners Open Network — Commercial: $102.40
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PSYTX W PT 30 MINUTES	$231.36	$185.09	$53.21 – $290.48
Psychotherapy, 30 minutes: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $174.01 Anthem Blue Cross and Blue Shield — HMO/POS: $201.78 Anthem Blue Cross and Blue Shield — Medicare Advantage: $67.71 Anthem Blue Cross and Blue Shield — PPO: $201.78 Anthem Blue Cross and Blue Shield — Traditional: $219.79 Aspirus — HMO/POS: $80.98 Aspirus — Medicare Advantage: $67.71 Aspirus — PPO: $53.21 Cigna — Commercial: $64.78 Health Partners Open Network — Commercial: $93.19
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$307	$245.60	$67.71 – $291.65
Psychotherapy, 30 minutes: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $174.01 Anthem Blue Cross and Blue Shield — HMO/POS: $201.78 Anthem Blue Cross and Blue Shield — Medicare Advantage: $67.71 Anthem Blue Cross and Blue Shield — PPO: $201.78 Anthem Blue Cross and Blue Shield — Traditional: $291.65 Aspirus — HMO/POS: $107.45 Aspirus — Medicare Advantage: $67.71 Aspirus — PPO: $70.61 Cigna — Commercial: $85.96 Health Partners Open Network — Commercial: $93.19
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX W PT 45 MIN (38-52 MIN)	$371.27	$297.02	$85.39 – $352.71
Psychotherapy, 45 minutes: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $157.20 Anthem Blue Cross and Blue Shield — HMO/POS: $192.91 Anthem Blue Cross and Blue Shield — Medicare Advantage: $155.19 Anthem Blue Cross and Blue Shield — PPO: $214.33 Anthem Blue Cross and Blue Shield — Traditional: $352.71 Aspirus — HMO/POS: $133.66 Aspirus — Medicare Advantage: $155.19 Aspirus — PPO: $85.39 Cigna — Commercial: $111.38 Health Partners Open Network — Commercial: $135.51
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PSYTX W PT 45 MINUTES	$308.49	$246.80	$70.95 – $383.44
Psychotherapy, 45 minutes: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $229.71 Anthem Blue Cross and Blue Shield — HMO/POS: $266.35 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.38 Anthem Blue Cross and Blue Shield — PPO: $266.35 Anthem Blue Cross and Blue Shield — Traditional: $293.07 Aspirus — HMO/POS: $107.97 Aspirus — Medicare Advantage: $89.38 Aspirus — PPO: $70.95 Cigna — Commercial: $86.38 Health Partners Open Network — Commercial: $128.07
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$425	$340	$89.38 – $403.75
Psychotherapy, 45 minutes: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $229.71 Anthem Blue Cross and Blue Shield — HMO/POS: $266.35 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.38 Anthem Blue Cross and Blue Shield — PPO: $266.35 Anthem Blue Cross and Blue Shield — Traditional: $403.75 Aspirus — HMO/POS: $148.75 Aspirus — Medicare Advantage: $89.38 Aspirus — PPO: $97.75 Cigna — Commercial: $119 Health Partners Open Network — Commercial: $128.07
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX W PT 60 MIN (>53 MIN)	$549.86	$439.89	$126.47 – $522.37
Psychotherapy, 60 minutes: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $232.81 Anthem Blue Cross and Blue Shield — HMO/POS: $285.71 Anthem Blue Cross and Blue Shield — Medicare Advantage: $155.19 Anthem Blue Cross and Blue Shield — PPO: $317.43 Anthem Blue Cross and Blue Shield — Traditional: $522.37 Aspirus — HMO/POS: $197.95 Aspirus — Medicare Advantage: $155.19 Aspirus — PPO: $126.47 Cigna — Commercial: $164.96 Health Partners Open Network — Commercial: $200.70
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PSYTX W PT 60 MINUTES	$492.82	$394.26	$113.35 – $567.14
Psychotherapy, 60 minutes: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $339.75 Anthem Blue Cross and Blue Shield — HMO/POS: $393.96 Anthem Blue Cross and Blue Shield — Medicare Advantage: $132.20 Anthem Blue Cross and Blue Shield — PPO: $393.96 Anthem Blue Cross and Blue Shield — Traditional: $468.18 Aspirus — HMO/POS: $172.49 Aspirus — Medicare Advantage: $132.20 Aspirus — PPO: $113.35 Cigna — Commercial: $137.99 Health Partners Open Network — Commercial: $193.26
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient · Doctor (professional) fee In the file: PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$617	$493.60	$132.20 – $586.15
Psychotherapy, 60 minutes: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $339.75 Anthem Blue Cross and Blue Shield — HMO/POS: $393.96 Anthem Blue Cross and Blue Shield — Medicare Advantage: $132.20 Anthem Blue Cross and Blue Shield — PPO: $393.96 Anthem Blue Cross and Blue Shield — Traditional: $586.15 Aspirus — HMO/POS: $215.95 Aspirus — Medicare Advantage: $132.20 Aspirus — PPO: $141.91 Cigna — Commercial: $172.76 Health Partners Open Network — Commercial: $193.26
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY THERAPY WO PT 50 MIN	$402.57	$322.06	$92.59 – $382.44
Family psychotherapy, without the patient: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $170.45 Anthem Blue Cross and Blue Shield — HMO/POS: $209.18 Anthem Blue Cross and Blue Shield — Medicare Advantage: $155.19 Anthem Blue Cross and Blue Shield — PPO: $232.40 Anthem Blue Cross and Blue Shield — Traditional: $382.44 Aspirus — HMO/POS: $144.93 Aspirus — Medicare Advantage: $155.19 Aspirus — PPO: $92.59 Cigna — Commercial: $120.77 Health Partners Open Network — Commercial: $146.94
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient · Doctor (professional) fee In the file: PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$277	$221.60	$63.71 – $414.20
Family psychotherapy, without the patient: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $248.13 Anthem Blue Cross and Blue Shield — HMO/POS: $287.72 Anthem Blue Cross and Blue Shield — Medicare Advantage: $96.55 Anthem Blue Cross and Blue Shield — PPO: $287.72 Anthem Blue Cross and Blue Shield — Traditional: $263.15 Aspirus — HMO/POS: $96.95 Aspirus — Medicare Advantage: $96.55 Aspirus — PPO: $63.71 Cigna — Commercial: $77.56 Health Partners Open Network — Commercial: $147.33
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FAMILY THERAPY WO PT 50 MIN	$402.57	$322.06	$92.59 – $382.44
Family psychotherapy, without the patient: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $170.45 Anthem Blue Cross and Blue Shield — HMO/POS: $209.18 Anthem Blue Cross and Blue Shield — PPO: $232.40 Anthem Blue Cross and Blue Shield — Traditional: $382.44 Aspirus — HMO/POS: $144.93 Aspirus — Medicare Advantage: $241.54 Aspirus — PPO: $92.59 Mercy Care — HMO/POS: $133.65 Prevea 360 — Commercial: $342.18 Security Health Plan — HMO/POS/SAS: $124.80
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY THERAPY W PT 50 MIN	$402.57	$322.06	$92.59 – $382.44
Family psychotherapy, with the patient: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $170.45 Anthem Blue Cross and Blue Shield — HMO/POS: $209.18 Anthem Blue Cross and Blue Shield — Medicare Advantage: $155.19 Anthem Blue Cross and Blue Shield — PPO: $232.40 Anthem Blue Cross and Blue Shield — Traditional: $382.44 Aspirus — HMO/POS: $144.93 Aspirus — Medicare Advantage: $155.19 Aspirus — PPO: $92.59 Cigna — Commercial: $120.77 Health Partners Open Network — Commercial: $146.94
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient · Doctor (professional) fee In the file: PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$293	$234.40	$67.39 – $432.13
Family psychotherapy, with the patient: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $258.88 Anthem Blue Cross and Blue Shield — HMO/POS: $300.18 Anthem Blue Cross and Blue Shield — Medicare Advantage: $100.73 Anthem Blue Cross and Blue Shield — PPO: $300.18 Anthem Blue Cross and Blue Shield — Traditional: $278.35 Aspirus — HMO/POS: $102.55 Aspirus — Medicare Advantage: $100.73 Aspirus — PPO: $67.39 Cigna — Commercial: $82.04 Health Partners Open Network — Commercial: $159.54
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FAMILY THERAPY W PT 50 MIN	$402.57	$322.06	$92.59 – $382.44
Family psychotherapy, with the patient: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $170.45 Anthem Blue Cross and Blue Shield — HMO/POS: $209.18 Anthem Blue Cross and Blue Shield — PPO: $232.40 Anthem Blue Cross and Blue Shield — Traditional: $382.44 Aspirus — HMO/POS: $144.93 Aspirus — Medicare Advantage: $241.54 Aspirus — PPO: $92.59 Mercy Care — HMO/POS: $133.65 Prevea 360 — Commercial: $342.18 Security Health Plan — HMO/POS/SAS: $124.80
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC GROUP THERAPY NOT MULTI-FAMILY	$396.47	$317.18	$89.35 – $376.65
Group psychotherapy: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $167.87 Anthem Blue Cross and Blue Shield — HMO/POS: $206.01 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.35 Anthem Blue Cross and Blue Shield — PPO: $228.88 Anthem Blue Cross and Blue Shield — Traditional: $376.65 Aspirus — HMO/POS: $142.73 Aspirus — Medicare Advantage: $89.35 Aspirus — PPO: $91.19 Cigna — Commercial: $118.94 Health Partners Open Network — Commercial: $144.71
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CHEM DEPENDENCY GROUP IOP	$1,016.54	$813.24	$89.35 – $965.71
Group psychotherapy: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $460 Anthem Blue Cross and Blue Shield — HMO/POS: $512 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.35 Anthem Blue Cross and Blue Shield — PPO: $764 Anthem Blue Cross and Blue Shield — Traditional: $965.71 Aspirus — HMO/POS: $365.95 Aspirus — Medicare Advantage: $89.35 Aspirus — PPO: $233.80 Cigna — Commercial: $304.96 Health Partners Open Network — Commercial: $371.04
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC IOP PSYCH ADOL/YA	$825.21	$660.17	$89.35 – $783.95
Group psychotherapy: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $460 Anthem Blue Cross and Blue Shield — HMO/POS: $512 Anthem Blue Cross and Blue Shield — Medicare Advantage: $89.35 Anthem Blue Cross and Blue Shield — PPO: $764 Anthem Blue Cross and Blue Shield — Traditional: $783.95 Aspirus — HMO/POS: $297.08 Aspirus — Medicare Advantage: $89.35 Aspirus — PPO: $189.80 Cigna — Commercial: $247.56 Health Partners Open Network — Commercial: $301.20

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee In the file: PR REMOVAL OF BREAST LESION	$2,231	$1,784.80	$373.66 – $2,119.45
Removal of breast growth (open surgery): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $557.75 Anthem Blue Cross and Blue Shield — HMO/POS: $1,248.02 Anthem Blue Cross and Blue Shield — Medicare Advantage: $373.66 Anthem Blue Cross and Blue Shield — PPO: $1,248.02 Anthem Blue Cross and Blue Shield — Traditional: $2,119.45 Aspirus — HMO/POS: $780.85 Aspirus — Medicare Advantage: $373.66 Aspirus — PPO: $513.13 Cigna — Commercial: $624.68 Health Partners Open Network — Commercial: $753.98
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$3,698.78
Removal of breast growth (open surgery): 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6,952 Anthem Blue Cross and Blue Shield — HMO/POS: $7,317 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3,698.78 Anthem Blue Cross and Blue Shield — PPO: $10,922 Aspirus — Medicare Advantage: $3,698.78 Humana — Medicare Advantage: $3,698.78 IlliniCare — Medicare Advantage: $3,698.78 MeridianCare — Medicare Advantage: $3,698.78 Prevea 360 — Medicare Advantage: $3,698.78 United Healthcare — Commercial: $6,026
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: PR REMOVAL OF BREAST LESION (BILAT)	$3,346	$2,676.80	$373.66 – $3,178.70
Removal of breast growth (open surgery): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $836.50 Anthem Blue Cross and Blue Shield — HMO/POS: $1,248.02 Anthem Blue Cross and Blue Shield — Medicare Advantage: $373.66 Anthem Blue Cross and Blue Shield — PPO: $1,248.02 Anthem Blue Cross and Blue Shield — Traditional: $3,178.70 Aspirus — HMO/POS: $1,171.10 Aspirus — Medicare Advantage: $373.66 Aspirus — PPO: $769.58 Cigna — Commercial: $936.88 Health Partners Open Network — Commercial: $753.98
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee In the file: PR TOTAL HIP ARTHROPLASTY	$8,011	$6,408.80	$1,151.57 – $7,610.45
Total hip replacement: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,523.80 Anthem Blue Cross and Blue Shield — HMO/POS: $3,846.24 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,151.57 Anthem Blue Cross and Blue Shield — PPO: $3,846.24 Anthem Blue Cross and Blue Shield — Traditional: $7,610.45 Aspirus — HMO/POS: $2,803.85 Aspirus — Medicare Advantage: $1,151.57 Aspirus — PPO: $1,842.53 Cigna — Commercial: $2,243.08 Health Partners Open Network — Commercial: $2,586.94
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$8,650 – $26,222
Total hip replacement: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $15,808 Anthem Blue Cross and Blue Shield — HMO/POS: $17,560 Anthem Blue Cross and Blue Shield — Medicare Advantage: $12,428.32 Anthem Blue Cross and Blue Shield — PPO: $26,222 Aspirus — Medicare Advantage: $12,428.32 Humana — Medicare Advantage: $12,428.32 IlliniCare — Medicare Advantage: $12,428.32 MeridianCare — Medicare Advantage: $12,428.32 Prevea 360 — Medicare Advantage: $12,428.32 United Healthcare — Commercial: $8,650
Total hip replacement CPT 27130 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: PR TOTAL HIP ARTHROPLASTY (BILAT)	$12,017	$9,613.60	$1,151.57 – $11,416.15
Total hip replacement: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,523.80 Anthem Blue Cross and Blue Shield — HMO/POS: $3,846.24 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,151.57 Anthem Blue Cross and Blue Shield — PPO: $3,846.24 Anthem Blue Cross and Blue Shield — Traditional: $11,416.15 Aspirus — HMO/POS: $4,205.95 Aspirus — Medicare Advantage: $1,151.57 Aspirus — PPO: $2,763.91 Cigna — Commercial: $3,364.76 Health Partners Open Network — Commercial: $2,586.94
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee In the file: PR TOTAL KNEE ARTHROPLASTY	$16,928	$13,542.40	$1,150.22 – $16,081.60
Total knee replacement: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,519.67 Anthem Blue Cross and Blue Shield — HMO/POS: $3,841.73 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,150.22 Anthem Blue Cross and Blue Shield — PPO: $3,841.73 Anthem Blue Cross and Blue Shield — Traditional: $16,081.60 Aspirus — HMO/POS: $5,924.80 Aspirus — Medicare Advantage: $1,150.22 Aspirus — PPO: $3,893.44 Cigna — Commercial: $4,739.84 Health Partners Open Network — Commercial: $2,631.60
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$12,428.32
Total knee replacement: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $17,121 Anthem Blue Cross and Blue Shield — HMO/POS: $19,024 Anthem Blue Cross and Blue Shield — Medicare Advantage: $12,428.32 Anthem Blue Cross and Blue Shield — PPO: $28,405 Aspirus — Medicare Advantage: $12,428.32 Humana — Medicare Advantage: $12,428.32 IlliniCare — Medicare Advantage: $12,428.32 MeridianCare — Medicare Advantage: $12,428.32 Prevea 360 — Medicare Advantage: $12,428.32 United Healthcare — Commercial: $8,650
Total knee replacement CPT 27447 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: PR TOTAL KNEE ARTHROPLASTY (BILAT)	$25,392	$20,313.60	$1,150.22 – $24,122.40
Total knee replacement: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,519.67 Anthem Blue Cross and Blue Shield — HMO/POS: $3,841.73 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,150.22 Anthem Blue Cross and Blue Shield — PPO: $3,841.73 Anthem Blue Cross and Blue Shield — Traditional: $24,122.40 Aspirus — HMO/POS: $8,887.20 Aspirus — Medicare Advantage: $1,150.22 Aspirus — PPO: $5,840.16 Cigna — Commercial: $7,109.76 Health Partners Open Network — Commercial: $2,631.60
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee In the file: PR SHOULDER SCOPE BONE SHAVING	$1,097	$877.60	$151.65 – $1,042.15
Shoulder arthroscopy: shaving of shoulder bone: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $464.05 Anthem Blue Cross and Blue Shield — HMO/POS: $506.51 Anthem Blue Cross and Blue Shield — Medicare Advantage: $151.65 Anthem Blue Cross and Blue Shield — PPO: $506.51 Anthem Blue Cross and Blue Shield — Traditional: $1,042.15 Aspirus — HMO/POS: $383.95 Aspirus — Medicare Advantage: $151.65 Aspirus — PPO: $252.31 Cigna — Commercial: $307.16 Health Partners Open Network — Commercial: $329.08
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$1,756
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan United Healthcare — Commercial: $1,756
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: PR SHOULDER SCOPE BONE SHAVING (BILAT)	$1,645	$1,316	$151.65 – $1,562.75
Shoulder arthroscopy: shaving of shoulder bone: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $464.05 Anthem Blue Cross and Blue Shield — HMO/POS: $506.51 Anthem Blue Cross and Blue Shield — Medicare Advantage: $151.65 Anthem Blue Cross and Blue Shield — PPO: $506.51 Anthem Blue Cross and Blue Shield — Traditional: $1,562.75 Aspirus — HMO/POS: $575.75 Aspirus — Medicare Advantage: $151.65 Aspirus — PPO: $378.35 Cigna — Commercial: $460.60 Health Partners Open Network — Commercial: $329.08
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee In the file: PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG	$7,236	$5,788.80	$496.73 – $6,874.20
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,519.99 Anthem Blue Cross and Blue Shield — HMO/POS: $1,659.08 Anthem Blue Cross and Blue Shield — Medicare Advantage: $496.73 Anthem Blue Cross and Blue Shield — PPO: $1,659.08 Anthem Blue Cross and Blue Shield — Traditional: $6,874.20 Aspirus — HMO/POS: $2,532.60 Aspirus — Medicare Advantage: $496.73 Aspirus — PPO: $1,664.28 Cigna — Commercial: $2,026.08 Health Partners Open Network — Commercial: $1,054.76
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ARTHRS KNE SRG MNISECTMY M/L	Not listed in the file	Not listed in the file	$6,952 – $10,922
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6,952 Anthem Blue Cross and Blue Shield — HMO/POS: $7,317 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3,134.03 Anthem Blue Cross and Blue Shield — PPO: $10,922 Aspirus — Medicare Advantage: $3,134.03 Humana — Medicare Advantage: $3,134.03 IlliniCare — Medicare Advantage: $3,134.03 MeridianCare — Medicare Advantage: $3,134.03 Prevea 360 — Medicare Advantage: $3,134.03 United Healthcare — Commercial: $6,976
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG (BILAT)	$10,854	$8,683.20	$496.73 – $10,311.30
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,519.99 Anthem Blue Cross and Blue Shield — HMO/POS: $1,659.08 Anthem Blue Cross and Blue Shield — Medicare Advantage: $496.73 Anthem Blue Cross and Blue Shield — PPO: $1,659.08 Anthem Blue Cross and Blue Shield — Traditional: $10,311.30 Aspirus — HMO/POS: $3,798.90 Aspirus — Medicare Advantage: $496.73 Aspirus — PPO: $2,496.42 Cigna — Commercial: $3,039.12 Health Partners Open Network — Commercial: $1,054.76
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient · Doctor (professional) fee In the file: REMOVE TONSILS/ADENOIDS,<12 Y/O	$1,607	$1,285.60	$268.71 – $1,526.65
Removal of tonsils and adenoids (under age 12): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $822.25 Anthem Blue Cross and Blue Shield — HMO/POS: $897.49 Anthem Blue Cross and Blue Shield — Medicare Advantage: $268.71 Anthem Blue Cross and Blue Shield — PPO: $897.49 Anthem Blue Cross and Blue Shield — Traditional: $1,526.65 Aspirus — HMO/POS: $562.45 Aspirus — Medicare Advantage: $268.71 Aspirus — PPO: $369.61 Cigna — Commercial: $449.96 Health Partners Open Network — Commercial: $547.27
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$5,714.05
Removal of tonsils and adenoids (under age 12): 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $8,564 Anthem Blue Cross and Blue Shield — HMO/POS: $9,516 Anthem Blue Cross and Blue Shield — Medicare Advantage: $5,714.05 Anthem Blue Cross and Blue Shield — PPO: $14,203 Aspirus — Medicare Advantage: $5,714.05 Humana — Medicare Advantage: $5,714.05 IlliniCare — Medicare Advantage: $5,714.05 MeridianCare — Medicare Advantage: $5,714.05 Prevea 360 — Medicare Advantage: $5,714.05 United Healthcare — Commercial: $6,026
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient · Doctor (professional) fee In the file: PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC	$1,523	$1,218.40	$110.43 – $1,446.85
Upper GI endoscopy (diagnostic): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $337.92 Anthem Blue Cross and Blue Shield — HMO/POS: $368.84 Anthem Blue Cross and Blue Shield — Medicare Advantage: $110.43 Anthem Blue Cross and Blue Shield — PPO: $368.84 Anthem Blue Cross and Blue Shield — Traditional: $1,446.85 Aspirus — HMO/POS: $533.05 Aspirus — Medicare Advantage: $110.43 Aspirus — PPO: $350.29 Cigna — Commercial: $426.44 Health Partners Open Network — Commercial: $253.88
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UGI DIAGNOSTIC	$4,426.82	$3,541.46	$905.61 – $4,205.48
Upper GI endoscopy (diagnostic): 10 of 17 insurance plan rates Anthem Blue Cross and Blue Shield — Medicare Advantage: $905.61 Anthem Blue Cross and Blue Shield — Traditional: $4,205.48 Aspirus — HMO/POS: $1,593.66 Aspirus — Medicare Advantage: $905.61 Aspirus — PPO: $1,018.17 Cigna — Commercial: $1,328.05 Health Partners Open Network — Commercial: $1,615.79 Humana — Medicare Advantage: $905.61 IlliniCare — Medicare Advantage: $905.61 Medical Associates Health Plan — HMO/POS/PPO: $1,593.66
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UGI DIAGNOSTIC	$4,426.82	$3,541.46	$1,018.17 – $4,205.48
Upper GI endoscopy (diagnostic): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,874.32 Anthem Blue Cross and Blue Shield — HMO/POS: $2,300.18 Anthem Blue Cross and Blue Shield — PPO: $2,555.60 Anthem Blue Cross and Blue Shield — Traditional: $4,205.48 Aspirus — HMO/POS: $1,593.66 Aspirus — Medicare Advantage: $2,656.09 Aspirus — PPO: $1,018.17 Mercy Care — HMO/POS: $1,469.70 Prevea 360 — Commercial: $3,762.80 Security Health Plan — HMO/POS/SAS: $1,372.31
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient · Doctor (professional) fee In the file: PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE	$1,768	$1,414.40	$124.37 – $1,679.60
Upper GI endoscopy with biopsy: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $380.57 Anthem Blue Cross and Blue Shield — HMO/POS: $415.40 Anthem Blue Cross and Blue Shield — Medicare Advantage: $124.37 Anthem Blue Cross and Blue Shield — PPO: $415.40 Anthem Blue Cross and Blue Shield — Traditional: $1,679.60 Aspirus — HMO/POS: $618.80 Aspirus — Medicare Advantage: $124.37 Aspirus — PPO: $406.64 Cigna — Commercial: $495.04 Health Partners Open Network — Commercial: $289.14
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC UGI W BX SGL/MULTIPLE	$4,426.82	$3,541.46	$905.61 – $4,205.48
Upper GI endoscopy with biopsy: 10 of 17 insurance plan rates Anthem Blue Cross and Blue Shield — Medicare Advantage: $905.61 Anthem Blue Cross and Blue Shield — Traditional: $4,205.48 Aspirus — HMO/POS: $1,593.66 Aspirus — Medicare Advantage: $905.61 Aspirus — PPO: $1,018.17 Cigna — Commercial: $1,328.05 Health Partners Open Network — Commercial: $1,615.79 Humana — Medicare Advantage: $905.61 IlliniCare — Medicare Advantage: $905.61 Medical Associates Health Plan — HMO/POS/PPO: $1,593.66
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC UGI W BX SGL/MULTIPLE	$4,426.82	$3,541.46	$1,018.17 – $4,205.48
Upper GI endoscopy with biopsy: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,874.32 Anthem Blue Cross and Blue Shield — HMO/POS: $2,300.18 Anthem Blue Cross and Blue Shield — PPO: $2,555.60 Anthem Blue Cross and Blue Shield — Traditional: $4,205.48 Aspirus — HMO/POS: $1,593.66 Aspirus — Medicare Advantage: $2,656.09 Aspirus — PPO: $1,018.17 Mercy Care — HMO/POS: $1,469.70 Prevea 360 — Commercial: $3,762.80 Security Health Plan — HMO/POS/SAS: $1,372.31
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee In the file: PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD	$2,019	$1,615.20	$165.46 – $1,918.05
Colonoscopy (diagnostic): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $506.31 Anthem Blue Cross and Blue Shield — HMO/POS: $552.64 Anthem Blue Cross and Blue Shield — Medicare Advantage: $165.46 Anthem Blue Cross and Blue Shield — PPO: $552.64 Anthem Blue Cross and Blue Shield — Traditional: $1,918.05 Aspirus — HMO/POS: $706.65 Aspirus — Medicare Advantage: $165.46 Aspirus — PPO: $464.37 Cigna — Commercial: $565.32 Health Partners Open Network — Commercial: $404.53
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$880.64
Colonoscopy (diagnostic): 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,371 Anthem Blue Cross and Blue Shield — HMO/POS: $2,636 Anthem Blue Cross and Blue Shield — Medicare Advantage: $880.64 Anthem Blue Cross and Blue Shield — PPO: $3,937 Aspirus — Medicare Advantage: $880.64 Humana — Medicare Advantage: $880.64 IlliniCare — Medicare Advantage: $880.64 MeridianCare — Medicare Advantage: $880.64 Prevea 360 — Medicare Advantage: $880.64 United Healthcare — Commercial: $5,169
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD (TC)	$1,212	$969.60	$165.46 – $1,151.40
Colonoscopy (diagnostic): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $506.31 Anthem Blue Cross and Blue Shield — HMO/POS: $552.64 Anthem Blue Cross and Blue Shield — Medicare Advantage: $165.46 Anthem Blue Cross and Blue Shield — PPO: $552.64 Anthem Blue Cross and Blue Shield — Traditional: $1,151.40 Aspirus — HMO/POS: $424.20 Aspirus — Medicare Advantage: $165.46 Aspirus — PPO: $278.76 Cigna — Commercial: $339.36 Health Partners Open Network — Commercial: $404.53
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee In the file: PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE	$2,412	$1,929.60	$179.93 – $2,291.40
Colonoscopy with biopsy: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $550.59 Anthem Blue Cross and Blue Shield — HMO/POS: $600.97 Anthem Blue Cross and Blue Shield — Medicare Advantage: $179.93 Anthem Blue Cross and Blue Shield — PPO: $600.97 Anthem Blue Cross and Blue Shield — Traditional: $2,291.40 Aspirus — HMO/POS: $844.20 Aspirus — Medicare Advantage: $179.93 Aspirus — PPO: $554.76 Cigna — Commercial: $675.36 Health Partners Open Network — Commercial: $484.27
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$3,030 – $5,169
Colonoscopy with biopsy: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,138.90 Anthem Blue Cross and Blue Shield — PPO: $5,028 Aspirus — Medicare Advantage: $1,138.90 Humana — Medicare Advantage: $1,138.90 IlliniCare — Medicare Advantage: $1,138.90 MeridianCare — Medicare Advantage: $1,138.90 Prevea 360 — Medicare Advantage: $1,138.90 United Healthcare — Commercial: $5,169
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE (TC)	$1,448	$1,158.40	$179.93 – $1,375.60
Colonoscopy with biopsy: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $550.59 Anthem Blue Cross and Blue Shield — HMO/POS: $600.97 Anthem Blue Cross and Blue Shield — Medicare Advantage: $179.93 Anthem Blue Cross and Blue Shield — PPO: $600.97 Anthem Blue Cross and Blue Shield — Traditional: $1,375.60 Aspirus — HMO/POS: $506.80 Aspirus — Medicare Advantage: $179.93 Aspirus — PPO: $333.04 Cigna — Commercial: $405.44 Health Partners Open Network — Commercial: $484.27
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COLONOSCOPY W/LESION REMOVAL BY SNARE	$4,346.62	$3,477.30	$999.72 – $5,169
Colonoscopy with removal of polyps (snare): 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,138.90 Anthem Blue Cross and Blue Shield — PPO: $5,028 Anthem Blue Cross and Blue Shield — Traditional: $4,129.29 Aspirus — HMO/POS: $1,564.78 Aspirus — Medicare Advantage: $1,138.90 Aspirus — PPO: $999.72 Cigna — Commercial: $1,303.99 Health Partners Open Network — Commercial: $1,586.52
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient · Doctor (professional) fee In the file: PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ	$2,716	$2,172.80	$227.49 – $2,580.20
Colonoscopy with removal of polyps (snare): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $696.12 Anthem Blue Cross and Blue Shield — HMO/POS: $759.82 Anthem Blue Cross and Blue Shield — Medicare Advantage: $227.49 Anthem Blue Cross and Blue Shield — PPO: $759.82 Anthem Blue Cross and Blue Shield — Traditional: $2,580.20 Aspirus — HMO/POS: $950.60 Aspirus — Medicare Advantage: $227.49 Aspirus — PPO: $624.68 Cigna — Commercial: $760.48 Health Partners Open Network — Commercial: $574.03
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COLONOSCOPY W/LESION REMOVAL BY SNARE	$4,346.62	$3,477.30	$999.72 – $4,129.29
Colonoscopy with removal of polyps (snare): 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,840.36 Anthem Blue Cross and Blue Shield — HMO/POS: $2,258.50 Anthem Blue Cross and Blue Shield — PPO: $2,509.30 Anthem Blue Cross and Blue Shield — Traditional: $4,129.29 Aspirus — HMO/POS: $1,564.78 Aspirus — Medicare Advantage: $2,607.97 Aspirus — PPO: $999.72 Mercy Care — HMO/POS: $1,443.08 Prevea 360 — Commercial: $3,694.63 Security Health Plan — HMO/POS/SAS: $1,347.45
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient · Doctor (professional) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$231.09 – $771.84
Ultrasound of the lower bowel by endoscope: 10 of 14 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $707.14 Anthem Blue Cross and Blue Shield — HMO/POS: $771.84 Anthem Blue Cross and Blue Shield — Medicare Advantage: $231.09 Anthem Blue Cross and Blue Shield — PPO: $771.84 Aspirus — Medicare Advantage: $231.09 Health Partners Open Network — Commercial: $552.59 Humana — Medicare Advantage: $242.64 IlliniCare — Medicare Advantage: $231.09 Medical Associates Health Plan — HMO/POS/PPO: $767.22 MeridianCare — Medicare Advantage: $242.64
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$3,030 – $5,169
Ultrasound of the lower bowel by endoscope: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,138.90 Anthem Blue Cross and Blue Shield — PPO: $5,028 Aspirus — Medicare Advantage: $1,138.90 Humana — Medicare Advantage: $1,138.90 IlliniCare — Medicare Advantage: $1,138.90 MeridianCare — Medicare Advantage: $1,138.90 Prevea 360 — Medicare Advantage: $1,138.90 United Healthcare — Commercial: $5,169
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee In the file: PR COLON CA SCRN NOT HI RSK IND	$2,019	$1,615.20	$165.57 – $1,918.05
Screening colonoscopy (not high risk): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $504.75 Anthem Blue Cross and Blue Shield — HMO/POS: $504.75 Anthem Blue Cross and Blue Shield — Medicare Advantage: $165.57 Anthem Blue Cross and Blue Shield — PPO: $504.75 Anthem Blue Cross and Blue Shield — Traditional: $1,918.05 Aspirus — HMO/POS: $706.65 Aspirus — Medicare Advantage: $165.57 Aspirus — PPO: $464.37 Cigna — Commercial: $565.32 Health Partners Open Network — Commercial: $383.51
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$2,371 – $3,937
Screening colonoscopy (not high risk): 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,371 Anthem Blue Cross and Blue Shield — HMO/POS: $2,636 Anthem Blue Cross and Blue Shield — Medicare Advantage: $880.64 Anthem Blue Cross and Blue Shield — PPO: $3,937 Aspirus — Medicare Advantage: $880.64 Humana — Medicare Advantage: $880.64 IlliniCare — Medicare Advantage: $880.64 MeridianCare — Medicare Advantage: $880.64 Prevea 360 — Medicare Advantage: $880.64 United Healthcare — Commercial: $3,326
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR COLON CA SCRN NOT HI RSK IND (TC)	$1,212	$969.60	$165.57 – $1,151.40
Screening colonoscopy (not high risk): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $303 Anthem Blue Cross and Blue Shield — HMO/POS: $303 Anthem Blue Cross and Blue Shield — Medicare Advantage: $165.57 Anthem Blue Cross and Blue Shield — PPO: $303 Anthem Blue Cross and Blue Shield — Traditional: $1,151.40 Aspirus — HMO/POS: $424.20 Aspirus — Medicare Advantage: $165.57 Aspirus — PPO: $278.76 Cigna — Commercial: $339.36 Health Partners Open Network — Commercial: $383.51
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LAPAROSCOPY CHOLECYSTECOMY	$24,569.70	$19,655.76	$5,635.53 – $23,341.22
Gallbladder removal by laparoscope: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $10,538 Anthem Blue Cross and Blue Shield — HMO/POS: $11,709 Anthem Blue Cross and Blue Shield — Medicare Advantage: $5,635.53 Anthem Blue Cross and Blue Shield — PPO: $17,482 Anthem Blue Cross and Blue Shield — Traditional: $23,341.22 Aspirus — HMO/POS: $8,845.09 Aspirus — Medicare Advantage: $5,635.53 Aspirus — PPO: $5,651.03 Cigna — Commercial: $7,370.91 Health Partners Open Network — Commercial: $8,967.94
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient · Doctor (professional) fee In the file: PR LAP,CHOLECYSTECTOMY	$6,837	$5,469.60	$582.48 – $6,495.15
Gallbladder removal by laparoscope: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,782.39 Anthem Blue Cross and Blue Shield — HMO/POS: $1,945.48 Anthem Blue Cross and Blue Shield — Medicare Advantage: $582.48 Anthem Blue Cross and Blue Shield — PPO: $1,945.48 Anthem Blue Cross and Blue Shield — Traditional: $6,495.15 Aspirus — HMO/POS: $2,392.95 Aspirus — Medicare Advantage: $582.48 Aspirus — PPO: $1,572.51 Cigna — Commercial: $1,914.36 Health Partners Open Network — Commercial: $1,252.26
Gallbladder removal by laparoscope CPT 47562 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LAPAROSCOPY CHOLECYSTECOMY	$24,569.70	$19,655.76	$5,651.03 – $23,341.22
Gallbladder removal by laparoscope: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $10,402.81 Anthem Blue Cross and Blue Shield — HMO/POS: $12,766.42 Anthem Blue Cross and Blue Shield — PPO: $14,184.09 Anthem Blue Cross and Blue Shield — Traditional: $23,341.22 Aspirus — HMO/POS: $8,845.09 Aspirus — Medicare Advantage: $14,741.82 Aspirus — PPO: $5,651.03 Mercy Care — HMO/POS: $8,157.14 Prevea 360 — Commercial: $20,884.25 Security Health Plan — HMO/POS/SAS: $7,616.61
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee In the file: PR REPAIR ING HERNIA,5+Y/O,REDUCIBL	$3,515	$2,812	$464.21 – $3,339.25
Groin (inguinal) hernia repair, age 5 or older: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,420.48 Anthem Blue Cross and Blue Shield — HMO/POS: $1,550.46 Anthem Blue Cross and Blue Shield — Medicare Advantage: $464.21 Anthem Blue Cross and Blue Shield — PPO: $1,550.46 Anthem Blue Cross and Blue Shield — Traditional: $3,339.25 Aspirus — HMO/POS: $1,230.25 Aspirus — Medicare Advantage: $464.21 Aspirus — PPO: $808.45 Cigna — Commercial: $984.20 Health Partners Open Network — Commercial: $962.18
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$6,952 – $10,922
Groin (inguinal) hernia repair, age 5 or older: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6,952 Anthem Blue Cross and Blue Shield — HMO/POS: $7,317 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3,408.79 Anthem Blue Cross and Blue Shield — PPO: $10,922 Aspirus — Medicare Advantage: $3,408.79 Humana — Medicare Advantage: $3,408.79 IlliniCare — Medicare Advantage: $3,408.79 MeridianCare — Medicare Advantage: $3,408.79 Prevea 360 — Medicare Advantage: $3,408.79 United Healthcare — Commercial: $6,976
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient · Doctor (professional) fee · modifier 50 In the file: PR REPAIR ING HERNIA,5+Y/O,REDUCIBL (BILAT)	$5,272	$4,217.60	$464.21 – $5,008.40
Groin (inguinal) hernia repair, age 5 or older: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,420.48 Anthem Blue Cross and Blue Shield — HMO/POS: $1,550.46 Anthem Blue Cross and Blue Shield — Medicare Advantage: $464.21 Anthem Blue Cross and Blue Shield — PPO: $1,550.46 Anthem Blue Cross and Blue Shield — Traditional: $5,008.40 Aspirus — HMO/POS: $1,845.20 Aspirus — Medicare Advantage: $464.21 Aspirus — PPO: $1,212.56 Cigna — Commercial: $1,476.16 Health Partners Open Network — Commercial: $962.18
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BX PROSTATE NDLE PUNCH	$5,904.37	$4,723.50	$1,358.01 – $5,609.15
Prostate biopsy: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,978.70 Anthem Blue Cross and Blue Shield — PPO: $5,028 Anthem Blue Cross and Blue Shield — Traditional: $5,609.15 Aspirus — HMO/POS: $2,125.57 Aspirus — Medicare Advantage: $1,978.70 Aspirus — PPO: $1,358.01 Cigna — Commercial: $1,771.31 Health Partners Open Network — Commercial: $2,155.10
Prostate biopsy CPT 55700 · Inpatient or outpatient · Doctor (professional) fee In the file: PR BIOPSY OF PROSTATE,NEEDLE/PUNCH	$2,194	$1,755.20	$117.09 – $2,084.30
Prostate biopsy: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $304.43 Anthem Blue Cross and Blue Shield — HMO/POS: $391.08 Anthem Blue Cross and Blue Shield — Medicare Advantage: $117.09 Anthem Blue Cross and Blue Shield — PPO: $391.08 Anthem Blue Cross and Blue Shield — Traditional: $2,084.30 Aspirus — HMO/POS: $767.90 Aspirus — Medicare Advantage: $117.09 Aspirus — PPO: $504.62 Cigna — Commercial: $614.32 Health Partners Open Network — Commercial: $261.61
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BX PROSTATE NDLE PUNCH	$5,904.37	$4,723.50	$1,358.01 – $5,609.15
Prostate biopsy: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,499.91 Anthem Blue Cross and Blue Shield — HMO/POS: $3,067.91 Anthem Blue Cross and Blue Shield — PPO: $3,408.59 Anthem Blue Cross and Blue Shield — Traditional: $5,609.15 Aspirus — HMO/POS: $2,125.57 Aspirus — Medicare Advantage: $3,542.62 Aspirus — PPO: $1,358.01 Mercy Care — HMO/POS: $1,960.25 Prevea 360 — Commercial: $5,018.71 Security Health Plan — HMO/POS/SAS: $1,830.35
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient · Doctor (professional) fee In the file: PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE	$10,545	$8,436	$1,082.73 – $10,017.75
Prostate removal by laparoscope (radical prostatectomy): 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,815.10 Anthem Blue Cross and Blue Shield — HMO/POS: $3,616.32 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,082.73 Anthem Blue Cross and Blue Shield — PPO: $3,616.32 Anthem Blue Cross and Blue Shield — Traditional: $10,017.75 Aspirus — HMO/POS: $3,690.75 Aspirus — Medicare Advantage: $1,082.73 Aspirus — PPO: $2,425.35 Cigna — Commercial: $2,952.60 Health Partners Open Network — Commercial: $3,287.65
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$10,056.41
Prostate removal by laparoscope (radical prostatectomy): 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $17,121 Anthem Blue Cross and Blue Shield — HMO/POS: $19,024 Anthem Blue Cross and Blue Shield — Medicare Advantage: $10,056.41 Anthem Blue Cross and Blue Shield — PPO: $28,405 Aspirus — Medicare Advantage: $10,056.41 Humana — Medicare Advantage: $10,056.41 IlliniCare — Medicare Advantage: $10,056.41 MeridianCare — Medicare Advantage: $10,056.41 Prevea 360 — Medicare Advantage: $10,056.41 United Healthcare — Commercial: $8,650
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee In the file: PR HYSTEROSCOPY,W/ENDO BX	$3,191	$2,552.80	$206.26 – $3,031.45
Hysteroscopy with biopsy of the uterus lining: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $797.75 Anthem Blue Cross and Blue Shield — HMO/POS: $688.91 Anthem Blue Cross and Blue Shield — Medicare Advantage: $206.26 Anthem Blue Cross and Blue Shield — PPO: $688.91 Anthem Blue Cross and Blue Shield — Traditional: $3,031.45 Aspirus — HMO/POS: $1,116.85 Aspirus — Medicare Advantage: $206.26 Aspirus — PPO: $733.93 Cigna — Commercial: $893.48 Health Partners Open Network — Commercial: $498.47
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$3,071.17
Hysteroscopy with biopsy of the uterus lining: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $3,071.17 Anthem Blue Cross and Blue Shield — PPO: $5,028 Aspirus — Medicare Advantage: $3,071.17 Humana — Medicare Advantage: $3,071.17 IlliniCare — Medicare Advantage: $3,071.17 MeridianCare — Medicare Advantage: $3,071.17 Prevea 360 — Medicare Advantage: $3,071.17 United Healthcare — Commercial: $6,026
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient · Doctor (professional) fee · modifier 26 In the file: PR HYSTEROSCOPY,W/ENDO BX (26)	$908	$726.40	$206.26 – $862.60
Hysteroscopy with biopsy of the uterus lining: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $227 Anthem Blue Cross and Blue Shield — HMO/POS: $688.91 Anthem Blue Cross and Blue Shield — Medicare Advantage: $206.26 Anthem Blue Cross and Blue Shield — PPO: $688.91 Anthem Blue Cross and Blue Shield — Traditional: $862.60 Aspirus — HMO/POS: $317.80 Aspirus — Medicare Advantage: $206.26 Aspirus — PPO: $208.84 Cigna — Commercial: $254.24 Health Partners Open Network — Commercial: $498.47
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ INTERLAM L/S W IMG	$2,822.58	$2,258.07	$649.19 – $2,681.45
Spinal injection, lower back (epidural), with imaging guidance: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,195.08 Anthem Blue Cross and Blue Shield — HMO/POS: $1,466.61 Anthem Blue Cross and Blue Shield — Medicare Advantage: $668.92 Anthem Blue Cross and Blue Shield — PPO: $1,629.48 Anthem Blue Cross and Blue Shield — Traditional: $2,681.45 Aspirus — HMO/POS: $1,016.13 Aspirus — Medicare Advantage: $668.92 Aspirus — PPO: $649.19 Cigna — Commercial: $846.77 Health Partners Open Network — Commercial: $1,030.24
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient · Doctor (professional) fee In the file: PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN	$1,375	$1,100	$91 – $1,306.25
Spinal injection, lower back (epidural), with imaging guidance: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $278.46 Anthem Blue Cross and Blue Shield — HMO/POS: $303.94 Anthem Blue Cross and Blue Shield — Medicare Advantage: $91 Anthem Blue Cross and Blue Shield — PPO: $303.94 Anthem Blue Cross and Blue Shield — Traditional: $1,306.25 Aspirus — HMO/POS: $481.25 Aspirus — Medicare Advantage: $91 Aspirus — PPO: $316.25 Cigna — Commercial: $385 Health Partners Open Network — Commercial: $179.07
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ INTERLAM L/S W IMG	$2,822.58	$2,258.07	$649.19 – $2,681.45
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,195.08 Anthem Blue Cross and Blue Shield — HMO/POS: $1,466.61 Anthem Blue Cross and Blue Shield — PPO: $1,629.48 Anthem Blue Cross and Blue Shield — Traditional: $2,681.45 Aspirus — HMO/POS: $1,016.13 Aspirus — Medicare Advantage: $1,693.55 Aspirus — PPO: $649.19 Mercy Care — HMO/POS: $937.10 Prevea 360 — Commercial: $2,399.19 Security Health Plan — HMO/POS/SAS: $875
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ(S) FORAMEN EPID L/S SGL LEV BILAT	$5,839.36	$4,671.49	$859.95 – $5,547.39
Nerve root injection, lower back, with imaging guidance: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,472.39 Anthem Blue Cross and Blue Shield — HMO/POS: $3,034.13 Anthem Blue Cross and Blue Shield — Medicare Advantage: $859.95 Anthem Blue Cross and Blue Shield — PPO: $3,371.06 Anthem Blue Cross and Blue Shield — Traditional: $5,547.39 Aspirus — HMO/POS: $2,102.17 Aspirus — Medicare Advantage: $859.95 Aspirus — PPO: $1,343.05 Cigna — Commercial: $1,751.81 Health Partners Open Network — Commercial: $2,131.37
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV	$2,919.68	$2,335.75	$671.53 – $3,937
Nerve root injection, lower back, with imaging guidance: 10 of 22 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,371 Anthem Blue Cross and Blue Shield — HMO/POS: $2,636 Anthem Blue Cross and Blue Shield — Medicare Advantage: $859.95 Anthem Blue Cross and Blue Shield — PPO: $3,937 Anthem Blue Cross and Blue Shield — Traditional: $2,773.70 Aspirus — HMO/POS: $1,051.08 Aspirus — Medicare Advantage: $859.95 Aspirus — PPO: $671.53 Cigna — Commercial: $875.90 Health Partners Open Network — Commercial: $1,065.68
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · Doctor (professional) fee In the file: PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL	$2,152	$1,721.60	$102.49 – $2,044.40
Nerve root injection, lower back, with imaging guidance: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $313.62 Anthem Blue Cross and Blue Shield — HMO/POS: $342.32 Anthem Blue Cross and Blue Shield — Medicare Advantage: $102.49 Anthem Blue Cross and Blue Shield — PPO: $342.32 Anthem Blue Cross and Blue Shield — Traditional: $2,044.40 Aspirus — HMO/POS: $753.20 Aspirus — Medicare Advantage: $102.49 Aspirus — PPO: $494.96 Cigna — Commercial: $602.56 Health Partners Open Network — Commercial: $210.64
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee In the file: PR REVISE MEDIAN N/CARPAL TUNNEL SURG	$4,503	$3,602.40	$404.46 – $4,277.85
Carpal tunnel release: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,237.65 Anthem Blue Cross and Blue Shield — HMO/POS: $1,350.90 Anthem Blue Cross and Blue Shield — Medicare Advantage: $404.46 Anthem Blue Cross and Blue Shield — PPO: $1,350.90 Anthem Blue Cross and Blue Shield — Traditional: $4,277.85 Aspirus — HMO/POS: $1,576.05 Aspirus — Medicare Advantage: $404.46 Aspirus — PPO: $1,035.69 Cigna — Commercial: $1,260.84 Health Partners Open Network — Commercial: $792.94
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$1,886.22
Carpal tunnel release: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $1,886.22 Anthem Blue Cross and Blue Shield — PPO: $5,028 Aspirus — Medicare Advantage: $1,886.22 Humana — Medicare Advantage: $1,886.22 IlliniCare — Medicare Advantage: $1,886.22 MeridianCare — Medicare Advantage: $1,886.22 Prevea 360 — Medicare Advantage: $1,886.22 United Healthcare — Commercial: $6,026
Carpal tunnel release CPT 64721 · Inpatient or outpatient · Doctor (professional) fee · modifier TC In the file: PR REVISE MEDIAN N/CARPAL TUNNEL SURG (TC)	$2,610	$2,088	$404.46 – $2,479.50
Carpal tunnel release: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $1,237.65 Anthem Blue Cross and Blue Shield — HMO/POS: $1,350.90 Anthem Blue Cross and Blue Shield — Medicare Advantage: $404.46 Anthem Blue Cross and Blue Shield — PPO: $1,350.90 Anthem Blue Cross and Blue Shield — Traditional: $2,479.50 Aspirus — HMO/POS: $913.50 Aspirus — Medicare Advantage: $404.46 Aspirus — PPO: $600.30 Cigna — Commercial: $730.80 Health Partners Open Network — Commercial: $792.94
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient · Doctor (professional) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$285.72 – $954.30
Laser treatment of clouding after cataract surgery: 10 of 13 insurance plan rates Anthem Blue Cross and Blue Shield — HMO/POS: $954.30 Anthem Blue Cross and Blue Shield — Medicare Advantage: $285.72 Anthem Blue Cross and Blue Shield — PPO: $954.30 Aspirus — Medicare Advantage: $285.72 Health Partners Open Network — Commercial: $565.32 Humana — Medicare Advantage: $300.01 IlliniCare — Medicare Advantage: $285.72 Medical Associates Health Plan — HMO/POS/PPO: $948.59 MeridianCare — Medicare Advantage: $300.01 Prevea 360 — Medicare Advantage: $285.72
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$529.90
Laser treatment of clouding after cataract surgery: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $2,371 Anthem Blue Cross and Blue Shield — HMO/POS: $2,636 Anthem Blue Cross and Blue Shield — Medicare Advantage: $529.90 Anthem Blue Cross and Blue Shield — PPO: $3,937 Aspirus — Medicare Advantage: $529.90 Humana — Medicare Advantage: $529.90 IlliniCare — Medicare Advantage: $529.90 MeridianCare — Medicare Advantage: $529.90 Prevea 360 — Medicare Advantage: $529.90 United Healthcare — Commercial: $3,326
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient · Doctor (professional) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$498.40 – $1,664.66
Cataract removal with lens implant: 10 of 13 insurance plan rates Anthem Blue Cross and Blue Shield — HMO/POS: $1,664.66 Anthem Blue Cross and Blue Shield — Medicare Advantage: $498.40 Anthem Blue Cross and Blue Shield — PPO: $1,664.66 Aspirus — Medicare Advantage: $498.40 Health Partners Open Network — Commercial: $1,221.90 Humana — Medicare Advantage: $523.32 IlliniCare — Medicare Advantage: $498.40 Medical Associates Health Plan — HMO/POS/PPO: $1,654.69 MeridianCare — Medicare Advantage: $523.32 Prevea 360 — Medicare Advantage: $498.40
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$2,203
Cataract removal with lens implant: 10 of 12 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,030 Anthem Blue Cross and Blue Shield — HMO/POS: $3,315 Anthem Blue Cross and Blue Shield — Medicare Advantage: $2,203 Anthem Blue Cross and Blue Shield — PPO: $5,028 Aspirus — Medicare Advantage: $2,203 Humana — Medicare Advantage: $2,203 IlliniCare — Medicare Advantage: $2,203 MeridianCare — Medicare Advantage: $2,203 Prevea 360 — Medicare Advantage: $2,203 United Healthcare — Commercial: $6,026

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient · Doctor (professional) fee In the file: PR FULL ROUT OBSTE CARE,VAGINAL DELIV	$6,952	$5,561.60	$1,598.96 – $6,978.47
Vaginal delivery, with care before and after: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $3,909.63 Anthem Blue Cross and Blue Shield — HMO/POS: $4,624.29 Anthem Blue Cross and Blue Shield — Medicare Advantage: $2,101.95 Anthem Blue Cross and Blue Shield — PPO: $4,624.29 Anthem Blue Cross and Blue Shield — Traditional: $6,604.40 Aspirus — HMO/POS: $2,433.20 Aspirus — Medicare Advantage: $2,101.95 Aspirus — PPO: $1,598.96 Cigna — Commercial: $1,946.56 Health Partners Open Network — Commercial: $3,299.55
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$6,952 – $10,922
Vaginal delivery, with care before and after: rates for 4 insurance plans Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6,952 Anthem Blue Cross and Blue Shield — HMO/POS: $7,317 Anthem Blue Cross and Blue Shield — PPO: $10,922 Wellmark UPH Self-Funded — Commercial: $10,922
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient · Doctor (professional) fee In the file: PR FULL ROUT OBSTE CARE,CESAREAN DELIV	$9,569	$7,655.20	$2,200.87 – $9,090.55
Cesarean delivery (C-section), with care before and after: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $4,300.38 Anthem Blue Cross and Blue Shield — HMO/POS: $5,086.47 Anthem Blue Cross and Blue Shield — Medicare Advantage: $2,312.03 Anthem Blue Cross and Blue Shield — PPO: $5,086.47 Anthem Blue Cross and Blue Shield — Traditional: $9,090.55 Aspirus — HMO/POS: $3,349.15 Aspirus — Medicare Advantage: $2,312.03 Aspirus — PPO: $2,200.87 Cigna — Commercial: $2,679.32 Health Partners Open Network — Commercial: $3,666.23
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$6,952 – $10,922
Cesarean delivery (C-section), with care before and after: rates for 4 insurance plans Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6,952 Anthem Blue Cross and Blue Shield — HMO/POS: $7,317 Anthem Blue Cross and Blue Shield — PPO: $10,922 Wellmark UPH Self-Funded — Commercial: $10,922
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient · Doctor (professional) fee In the file: PR ROUT OB CARE,VAG DELIV,PREV C-SEC	$7,307	$5,845.60	$1,680.61 – $7,229
Vaginal delivery after a previous C-section, with care before and after: 10 of 21 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $4,049.98 Anthem Blue Cross and Blue Shield — HMO/POS: $4,790.30 Anthem Blue Cross and Blue Shield — Medicare Advantage: $2,177.41 Anthem Blue Cross and Blue Shield — PPO: $4,790.30 Anthem Blue Cross and Blue Shield — Traditional: $6,941.65 Aspirus — HMO/POS: $2,557.45 Aspirus — Medicare Advantage: $2,177.41 Aspirus — PPO: $1,680.61 Cigna — Commercial: $2,045.96 Health Partners Open Network — Commercial: $3,460.25
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$6,952 – $10,922
Vaginal delivery after a previous C-section, with care before and after: rates for 4 insurance plans Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $6,952 Anthem Blue Cross and Blue Shield — HMO/POS: $7,317 Anthem Blue Cross and Blue Shield — PPO: $10,922 Wellmark UPH Self-Funded — Commercial: $10,922

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$73,669.34 – $239,723.67
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $145,789.52 Anthem Blue Cross and Blue Shield — HMO/POS: $160,990 Anthem Blue Cross and Blue Shield — Medicare Advantage: $73,669.34 Anthem Blue Cross and Blue Shield — PPO: $239,723.67 Aspirus — Medicare Advantage: $73,669.34 Cigna — Commercial: $193,987.11 Health Partners Open Network — Commercial: $215,779.29 Humana — Medicare Advantage: $73,669.34 IlliniCare — Medicare Advantage: $73,669.34 Medical Associates Health Plan — HMO/POS/PPO: $98,923.78
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) · Hospital (facility) fee In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$14,825.13 – $46,833.93
Hip or knee replacement (major joint of the leg), without major complications: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $28,482.36 Anthem Blue Cross and Blue Shield — HMO/POS: $31,452.03 Anthem Blue Cross and Blue Shield — Medicare Advantage: $14,825.13 Anthem Blue Cross and Blue Shield — PPO: $46,833.93 Aspirus — Medicare Advantage: $14,825.13 Cigna — Commercial: $37,898.55 Health Partners Open Network — Commercial: $42,156.01 Humana — Medicare Advantage: $14,825.13 IlliniCare — Medicare Advantage: $14,825.13 Medical Associates Health Plan — HMO/POS/PPO: $19,326.38
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) · Hospital (facility) fee In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$18,476.75 – $58,803.85
Neck (cervical) spinal fusion, without complications: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $35,761.94 Anthem Blue Cross and Blue Shield — HMO/POS: $39,490.60 Anthem Blue Cross and Blue Shield — Medicare Advantage: $18,476.75 Anthem Blue Cross and Blue Shield — PPO: $58,803.85 Aspirus — Medicare Advantage: $18,476.75 Cigna — Commercial: $47,584.74 Health Partners Open Network — Commercial: $52,930.33 Humana — Medicare Advantage: $18,476.75 IlliniCare — Medicare Advantage: $18,476.75 Medical Associates Health Plan — HMO/POS/PPO: $24,265.85
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) · Hospital (facility) fee In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$9,620.89 – $29,774.51
Uterus and ovary surgery (not for cancer), without complications: 10 of 16 insurance plan rates Anthem Blue Cross and Blue Shield — Blue Priority/Pathway: $18,107.56 Anthem Blue Cross and Blue Shield — HMO/POS: $19,995.51 Anthem Blue Cross and Blue Shield — Medicare Advantage: $9,620.89 Anthem Blue Cross and Blue Shield — PPO: $29,774.51 Aspirus — Medicare Advantage: $9,620.89 Cigna — Commercial: $24,093.87 Health Partners Open Network — Commercial: $26,800.53 Humana — Medicare Advantage: $9,620.89 IlliniCare — Medicare Advantage: $9,620.89 Medical Associates Health Plan — HMO/POS/PPO: $12,286.68

Source: UnityPoint Health - Meriter’s standard charges file (sthpiprd.blob.core.windows.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 28, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	202 S Park St, Madison, WI 53715
County	Dane County
State	Wisconsin
Phone	(608) 417‑6210
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	5 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	520089
Name in Medicare records	UNITYPOINT HEALTH - MERITER
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(608) 417‑6000^[4][5]
Official website	unitypoint.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
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.

UnityPoint Health - Meriter — uwhealth.org
UnityPoint Health - Meriter — unitypoint.org
Directions, Parking and Maps - UnityPoint Health - Meriter Hospital — unitypoint.org
UnityPoint Health - Meriter - Birth and Newborn Services — unitypoint.org
UnityPoint Health - Meriter - NICU — unitypoint.org
UnityPoint Health - Meriter Patients & Visitors — unitypoint.org
Surgery - UnityPoint Health - Meriter — unitypoint.org
UnityPoint Health - Meriter - Community Relations — unitypoint.org
UnityPoint Health - Meriter - Infusion Center — unitypoint.org
UnityPoint Health - Meriter - ICU — unitypoint.org

UnityPoint Health - Meriter

Summary

Profile from official sources

At a glance