▸ Hospital · MN · CCN 240214
Maple Grove Hospital
9875 HOSPITAL DRIVE, MAPLE GROVE, MN, 55369-
148 bedsAcute Care Hospitals2
Compliance grade
A
100/100
Procedures tracked
119
of 209 target codes
Payers
13
with negotiated rates
Rates published
20,092
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 12 | $242 | $127.53 | $68.37 | $131 | $393 |
| ED visit level 2 | CPT | 99282 | 12 | $390 | $205.53 | $125.95 | $237 | $670 |
| ED visit level 3 | CPT | 99283 | 12 | $642 | $338.33 | $219.71 | $360 | $874 |
| ED visit level 4 | CPT | 99284 | 12 | $1,059 | $558.09 | $341.07 | $521 | $1,076 |
| ED visit level 5 | CPT | 99285 | 12 | $1,406 | $740.96 | $494.63 | $673.78 | $1,512.65 |
| Critical care, first hour | CPT | 99291 | 12 | $2,719 | $1,432.91 | $683.33 | $926.01 | $2,175.2 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 12 | $1,042 | $549.13 | $73.93 | $194.73 | $1,432 |
| CT head with contrast | CPT | 70460 | 13 | $1,258 | $662.97 | $123.55 | $322.54 | $1,432 |
| CT head with and without contrast | CPT | 70470 | 13 | $1,245 | $656.11 | $123.55 | $322.54 | $1,432 |
| CT neck with contrast | CPT | 70491 | 13 | $1,168 | $615.54 | $123.55 | $322.54 | $1,432 |
| MRI brain without contrast | CPT | 70551 | 13 | $1,380 | $727.26 | $164.77 | $430.15 | $2,340 |
| MRI brain with contrast | CPT | 70552 | 13 | $1,826 | $962.3 | $258.61 | $664.88 | $2,340 |
| MRI brain with and without contrast | CPT | 70553 | 13 | $1,975 | $1,040.82 | $258.61 | $664.88 | $2,340 |
| Chest X-ray single view | CPT | 71045 | 13 | $282 | $148.61 | $61.1 | $160.94 | $892 |
| Chest X-ray 2 views | CPT | 71046 | 13 | $271 | $142.82 | $61.1 | $160.94 | $892 |
| Chest X-ray 3 views | CPT | 71047 | 12 | $270 | $142.29 | $69.98 | $158.09 | $892 |
| CT chest without contrast | CPT | 71250 | 12 | $927 | $488.53 | $73.93 | $194.73 | $1,432 |
| CT chest with contrast | CPT | 71260 | 13 | $1,135 | $598.14 | $123.55 | $322.54 | $1,432 |
| CT chest with and without contrast | CPT | 71270 | 13 | $1,380 | $727.26 | $123.55 | $322.54 | $1,432 |
| MRI chest without contrast | CPT | 71550 | 13 | $1,366 | $719.88 | $164.77 | $430.15 | $2,340 |
| MRI chest with and without contrast | CPT | 71552 | 13 | $1,955 | $1,030.28 | $258.61 | $664.88 | $2,340 |
| Lumbosacral spine X-ray | CPT | 72100 | 13 | $362 | $190.77 | $73.93 | $194.73 | $892 |
| CT cervical spine without contrast | CPT | 72125 | 12 | $1,055 | $555.98 | $73.93 | $194.73 | $1,432 |
| CT thoracic spine without contrast | CPT | 72128 | 12 | $1,055 | $555.98 | $73.93 | $194.73 | $1,432 |
| CT lumbar spine without contrast | CPT | 72131 | 12 | $945 | $498.01 | $73.93 | $194.73 | $1,432 |
| MRI cervical spine without contrast | CPT | 72141 | 13 | $1,571 | $827.92 | $164.77 | $430.15 | $2,340 |
| MRI thoracic spine without contrast | CPT | 72146 | 13 | $1,407 | $741.49 | $164.77 | $430.15 | $2,340 |
| MRI lumbar spine without contrast | CPT | 72148 | 13 | $1,407 | $741.49 | $164.77 | $430.15 | $2,340 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 12 | $1,772 | $933.84 | $296.15 | $526.58 | $2,340 |
| MRI cervical spine with and without contrast | CPT | 72156 | 13 | $1,955 | $1,030.28 | $258.61 | $664.88 | $2,340 |
| MRI lumbar spine with contrast | CPT | 72158 | 13 | $1,975 | $1,040.82 | $258.61 | $664.88 | $2,340 |
| CT pelvis without contrast | CPT | 72192 | 12 | $945 | $498.01 | $73.93 | $194.73 | $1,432 |
| CT pelvis with contrast | CPT | 72193 | 13 | $1,292 | $680.88 | $123.55 | $322.54 | $1,432 |
| Shoulder X-ray | CPT | 73030 | 13 | $668 | $352.04 | $61.1 | $167.62 | $892 |
| Humerus X-ray | CPT | 73060 | 12 | $618 | $325.69 | $69.98 | $209.13 | $892 |
| Hand X-ray 3 views | CPT | 73130 | 13 | $578 | $304.61 | $61.1 | $167.62 | $892 |
| MRI upper extremity joint without contrast | CPT | 73221 | 13 | $2,814 | $1,482.98 | $164.77 | $452.02 | $2,340 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 13 | $1,955 | $1,030.28 | $258.61 | $664.88 | $2,340 |
| Knee X-ray 1-2 views | CPT | 73560 | 13 | $714 | $376.28 | $61.1 | $167.62 | $892 |
| Ankle X-ray 3 views | CPT | 73610 | 13 | $588 | $309.88 | $61.1 | $167.62 | $892 |
| MRI lower extremity joint without contrast | CPT | 73721 | 13 | $3,060 | $1,612.62 | $164.77 | $452.02 | $2,448 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 13 | $2,128 | $1,121.46 | $258.61 | $664.88 | $2,340 |
| CT abdomen without contrast | CPT | 74150 | 12 | $917 | $483.26 | $73.93 | $194.73 | $1,432 |
| CT abdomen with contrast | CPT | 74160 | 12 | $1,292 | $680.88 | $141.48 | $257.65 | $1,432 |
| CT abdomen with and without contrast | CPT | 74170 | 13 | $1,232 | $649.26 | $123.55 | $322.54 | $1,432 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 13 | $927 | $488.53 | $164.77 | $430.15 | $1,432 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 13 | $1,341 | $706.71 | $258.61 | $639.34 | $1,432 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 13 | $1,232 | $649.26 | $258.61 | $639.34 | $1,432 |
| MRI abdomen without contrast | CPT | 74181 | 13 | $1,407 | $741.49 | $164.77 | $430.15 | $2,340 |
| MRI abdomen with and without contrast | CPT | 74183 | 13 | $1,975 | $1,040.82 | $258.61 | $664.88 | $2,340 |
| Abdominal ultrasound complete | CPT | 76700 | 13 | $623 | $328.32 | $73.93 | $193.01 | $498.4 |
| Abdominal ultrasound limited | CPT | 76705 | 12 | $427 | $225.03 | $73.93 | $153.98 | $341.6 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 12 | $430 | $226.61 | $73.93 | $155.06 | $344 |
| Obstetric ultrasound first trimester | CPT | 76801 | 13 | $546 | $287.74 | $73.93 | $191.29 | $436.8 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 13 | $608 | $320.42 | $73.93 | $194.73 | $486.4 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 13 | $682 | $359.41 | $164.77 | $265.65 | $596.38 |
| Transvaginal ultrasound | CPT | 76830 | 13 | $370 | $194.99 | $73.93 | $133.42 | $296 |
| Pelvic ultrasound complete | CPT | 76856 | 12 | $446 | $235.04 | $73.93 | $160.83 | $356.8 |
| Scrotal ultrasound | CPT | 76870 | 13 | $482 | $254.01 | $73.93 | $166.2 | $385.6 |
| Screening mammography bilateral | CPT | 77067 | 12 | $462 | $243.47 | $38.02 | $123.08 | $468.77 |
| EKG tracing only | CPT | 93005 | 13 | $186 | $98.02 | $41.13 | $67.07 | $148.8 |
| Transthoracic echocardiogram complete | CPT | 93306 | 13 | $1,487 | $783.65 | $370.97 | $925.12 | $1,569 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 9 | $13,052 | $6,878.2 | $3,711 | $16,163 | $39,246 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 9 | $14,758 | $7,777.39 | $8,248.98 | $8,754.02 | $20,063 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 9 | $14,698 | $7,746.03 | $5,778.28 | $6,143.02 | $13,580 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 9 | $12,146 | $6,400.79 | $12,738 | $13,571 | $31,893 |
| COPD w MCC | MS-DRG | 190 | 9 | $8,864.21 | $4,671.44 | $9,043.39 | $9,597.07 | $22,157 |
| COPD w CC | MS-DRG | 191 | 9 | $9,048.13 | $4,768.36 | $7,067.47 | $7,500.17 | $16,950 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 9 | $11,598 | $6,112.35 | $2,459 | $7,051.23 | $16,178 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 9 | $7,085.18 | $3,733.89 | $5,227.57 | $5,621.78 | $12,286 |
| AMI discharged alive w MCC | MS-DRG | 280 | 9 | $11,236 | $5,921.39 | $3,361 | $13,452 | $32,384 |
| AMI discharged alive w CC | MS-DRG | 281 | 9 | $9,909.93 | $5,222.53 | $3,224 | $7,844.54 | $18,187 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 9 | $9,048.51 | $4,768.56 | $3,581 | $6,435.42 | $14,306 |
| Heart failure & shock w MCC | MS-DRG | 291 | 9 | $15,034 | $7,922.68 | $10,405 | $11,042 | $25,743 |
| Heart failure & shock w CC | MS-DRG | 292 | 9 | $20,960 | $11,046 | $7,083.19 | $7,516.85 | $16,991 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 9 | $21,008 | $11,071 | $4,606.34 | $5,033.79 | $10,826 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 9 | $11,891 | $6,266.3 | $9,664.09 | $10,256 | $23,792 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 9 | $13,693 | $7,216.08 | $6,170.46 | $6,548.25 | $14,586 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 9 | $9,045.28 | $4,766.86 | $4,697 | $5,119.61 | $11,039 |
| GI hemorrhage w CC | MS-DRG | 378 | 9 | $15,713 | $8,280.58 | $2,854 | $8,344.08 | $19,452 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 9 | $12,523 | $6,599.68 | $6,477.46 | $6,874.04 | $15,395 |
| Kidney/UTI w MCC | MS-DRG | 689 | 9 | $10,479 | $5,522.39 | $9,397.54 | $9,972.9 | $23,090 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 9 | $11,583 | $6,104.01 | $6,644.43 | $7,051.23 | $15,835 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 9 | $13,898 | $7,324.25 | $3,362 | $15,952 | $38,712 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 9 | $13,721 | $7,231.01 | $8,354.56 | $8,866.06 | $20,341 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 13 | $47 | $24.77 | $6.23 | $9 | $50.13 |
| Electrolyte panel | CPT | 80051 | 13 | $24 | $12.65 | $5.03 | $7.46 | $21.15 |
| Comprehensive metabolic panel | CPT | 80053 | 13 | $59 | $31.09 | $7.66 | $11.23 | $47.81 |
| Lipid panel | CPT | 80061 | 13 | $42 | $22.13 | $8.68 | $17.82 | $40.28 |
| Renal function panel | CPT | 80069 | 13 | $22 | $11.59 | $6.47 | $9.23 | $47.63 |
| Hepatic function panel | CPT | 80076 | 13 | $46 | $24.24 | $5.99 | $8.69 | $74.86 |
| Urinalysis non-automated | CPT | 81002 | 12 | $6 | $3.16 | $2.25 | $3.58 | $6.26 |
| Urinalysis automated | CPT | 81003 | 13 | $14 | $7.38 | $1.68 | $2.33 | $11.2 |
| Glucose quantitative | CPT | 82947 | 13 | $23 | $12.12 | $2.87 | $5.55 | $18.4 |
| Hemoglobin A1c | CPT | 83036 | 13 | $34 | $17.92 | $7.18 | $10.05 | $29.2 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 13 | $73 | $38.47 | $12.21 | $23.44 | $58.4 |
| Complete blood count with automated differential | CPT | 85025 | 13 | $43 | $22.66 | $5.75 | $12.11 | $34.4 |
| Complete blood count without differential | CPT | 85027 | 13 | $37 | $19.5 | $4.31 | $6.7 | $29.6 |
| Urine culture bacterial | CPT | 87086 | 13 | $55 | $28.98 | $5.99 | $8.35 | $44 |
| Tissue exam by pathologist level IV | CPT | 88305 | 13 | $579 | $305.13 | $36.44 | $99.95 | $463.2 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 13 | $627 | $330.43 | $134 | $226.1 | $501.6 |
| Vaginal delivery only | CPT | 59409 | 6 | $5,226 | $2,754.1 | $1,719.35 | $3,574.58 | $4,180.8 |
| surgery | ||||||||
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 9 | $43,162 | $22,746 | $4,016 | $36,446 | $90,597 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 9 | $41,761 | $22,008 | $4,050 | $19,081 | $46,635 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 9 | $31,185 | $16,434 | $12,997 | $13,860 | $32,574 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 9 | $25,749 | $13,570 | $13,052 | $13,922 | $32,720 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 9 | $24,026 | $12,661 | $10,500 | $11,143 | $25,996 |
| Major joint replacement w MCC | MS-DRG | 469 | 9 | $37,994 | $20,023 | $7,840 | $26,134 | $64,491 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 9 | $35,681 | $18,804 | $9,311 | $15,656 | $37,201 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 9 | $54,589 | $28,768 | $3,919 | $23,580 | $58,025 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 9 | $41,634 | $21,941 | $3,958.81 | $16,831 | $40,937 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 9 | $29,459 | $15,525 | $12,513 | $13,318 | $31,299 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 9 | $25,469 | $13,422 | $9,610.18 | $10,199 | $23,650 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 9 | $60,531 | $31,900 | $8,226 | $16,200 | $38,552 |
| PCI single major coronary artery | CPT | 92920 | 12 | $14,311 | $7,541.9 | $3,614 | $5,998.24 | $14,067 |
| PCI with drug-eluting stent | CPT | 92928 | 12 | $20,165 | $10,627 | $3,614 | $11,816 | $27,980 |
| PCI bypass graft | CPT | 92937 | 12 | $20,165 | $10,627 | $3,614 | $11,816 | $27,980 |
| Coronary angiography with cath | CPT | 93455 | 12 | $7,007 | $3,692.69 | $2,509.29 | $3,534.77 | $7,935.62 |
| Coronary angiography with bypass cath | CPT | 93458 | 12 | $7,870 | $4,147.49 | $2,509.29 | $3,534.77 | $7,935.62 |
Payer mix (top 13)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 119 | $265.65 |
| Blue Cross Blue Shield | 119 | $194.73 |
| medica [1086] | 119 | $1,299 |
| ucare [1148] | 118 | $251.85 |
| health partners [1061] | 118 | $258.61 |
| Humana | 118 | $244.52 |
| UnitedHealthcare | 118 | $439.21 |
| Medicare | 118 | $244.52 |
| Cigna | 101 | $452.02 |
| Multiplan | 84 | $540 |
| phcs [1172] | 84 | $506.25 |
| america's ppo [1010] | 84 | $471.6 |
| Medicaid | 73 | $168.33 |