▸ Hospital · MN · CCN 241306
Olivia Hospital & Clinic
100 HEALTH WAY, OLIVIA, MN, 56277-1397
16 bedsCritical Access Hospitals9
Compliance grade
A
97/100
Procedures tracked
133
of 209 target codes
Payers
8
with negotiated rates
Rates published
11,446
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychiatric diagnostic evaluation | CPT | 90791 | 7 | $784 | $478.24 | $152.23 | $257.69 | $776.63 |
| Psychiatric eval with medical services | CPT | 90792 | 7 | $875 | $533.75 | $170.03 | $295.5 | $866.78 |
| Psychotherapy 30 minutes | CPT | 90832 | 7 | $337 | $205.57 | $68.85 | $90.73 | $333.83 |
| Psychotherapy 45 minutes | CPT | 90834 | 7 | $447 | $272.67 | $91.1 | $119.86 | $442.8 |
| Psychotherapy 60 minutes | CPT | 90837 | 7 | $662 | $403.82 | $134.42 | $167.56 | $655.78 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 7 | $255 | $155.55 | $7.89 | $89.2 | $252.6 |
| ED visit level 2 | CPT | 99282 | 7 | $429 | $261.69 | $32.05 | $150.06 | $424.97 |
| ED visit level 3 | CPT | 99283 | 7 | $648 | $395.28 | $49.09 | $226.67 | $641.91 |
| ED visit level 4 | CPT | 99284 | 7 | $897 | $547.17 | $72.82 | $313.77 | $888.57 |
| ED visit level 5 | CPT | 99285 | 7 | $2,943 | $1,795.23 | $95.81 | $526.35 | $2,915.34 |
| Critical care, first hour | CPT | 99291 | 7 | $2,064 | $1,259.04 | $127.17 | $698.61 | $2,044.6 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 7 | $2,134 | $1,301.74 | $470.25 | $864.27 | $2,113.94 |
| CT head with contrast | CPT | 70460 | 7 | $2,134 | $1,301.74 | $446.6 | $864.27 | $2,113.94 |
| CT head with and without contrast | CPT | 70470 | 7 | $2,856 | $1,742.16 | $446.6 | $1,156.68 | $2,829.15 |
| CT neck with contrast | CPT | 70491 | 7 | $2,073 | $1,264.53 | $446.6 | $839.57 | $2,053.51 |
| MRI brain without contrast | CPT | 70551 | 7 | $2,984 | $1,820.24 | $578.05 | $1,208.52 | $2,955.95 |
| MRI brain with contrast | CPT | 70552 | 7 | $3,478 | $2,121.58 | $607.75 | $1,408.59 | $3,445.31 |
| MRI brain with and without contrast | CPT | 70553 | 7 | $3,986 | $2,431.46 | $607.75 | $1,614.33 | $3,948.53 |
| Chest X-ray single view | CPT | 71045 | 7 | $362 | $220.82 | $63.06 | $146.61 | $358.6 |
| Chest X-ray 2 views | CPT | 71046 | 7 | $413 | $251.93 | $118.25 | $167.27 | $409.12 |
| Chest X-ray 3 views | CPT | 71047 | 7 | $362 | $220.82 | $83.49 | $127.97 | $358.6 |
| CT chest without contrast | CPT | 71250 | 7 | $2,283 | $1,392.63 | $352.55 | $924.62 | $2,261.54 |
| CT chest with contrast | CPT | 71260 | 7 | $2,283 | $1,392.63 | $446.6 | $924.62 | $2,261.54 |
| CT chest with and without contrast | CPT | 71270 | 7 | $3,123 | $1,905.03 | $446.6 | $1,264.82 | $3,093.64 |
| MRI chest without contrast | CPT | 71550 | 7 | $3,573 | $2,179.53 | $578.05 | $1,447.07 | $3,539.41 |
| MRI chest with and without contrast | CPT | 71552 | 7 | $3,847 | $2,346.67 | $607.75 | $1,558.04 | $3,810.84 |
| Lumbosacral spine X-ray | CPT | 72100 | 7 | $505 | $308.05 | $87.97 | $204.53 | $500.25 |
| CT cervical spine without contrast | CPT | 72125 | 7 | $2,365 | $1,442.65 | $352.55 | $957.83 | $2,342.77 |
| CT thoracic spine without contrast | CPT | 72128 | 7 | $2,510 | $1,531.1 | $352.55 | $1,016.55 | $2,486.41 |
| CT lumbar spine without contrast | CPT | 72131 | 7 | $2,692 | $1,642.12 | $352.55 | $1,057.65 | $2,666.7 |
| MRI cervical spine without contrast | CPT | 72141 | 7 | $3,573 | $2,179.53 | $578.05 | $1,447.07 | $3,539.41 |
| MRI thoracic spine without contrast | CPT | 72146 | 7 | $3,573 | $2,179.53 | $578.05 | $1,447.07 | $3,539.41 |
| MRI lumbar spine without contrast | CPT | 72148 | 7 | $3,573 | $2,179.53 | $578.05 | $1,447.07 | $3,539.41 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 7 | $3,641 | $2,221.01 | $607.75 | $1,474.61 | $3,606.77 |
| MRI cervical spine with and without contrast | CPT | 72156 | 7 | $3,978 | $2,426.58 | $607.75 | $1,611.09 | $3,940.61 |
| MRI lumbar spine with contrast | CPT | 72158 | 7 | $4,179 | $2,549.19 | $607.75 | $1,692.5 | $4,139.72 |
| CT pelvis without contrast | CPT | 72192 | 7 | $2,190 | $1,335.9 | $352.55 | $886.95 | $2,169.41 |
| CT pelvis with contrast | CPT | 72193 | 7 | $2,140 | $1,305.4 | $446.6 | $866.7 | $2,119.88 |
| Shoulder X-ray | CPT | 73030 | 7 | $373 | $227.53 | $16.9 | $94.16 | $369.49 |
| Humerus X-ray | CPT | 73060 | 7 | $363 | $221.43 | $63.23 | $147.02 | $359.59 |
| Hand X-ray 3 views | CPT | 73130 | 7 | $399 | $243.39 | $69.51 | $161.6 | $395.25 |
| MRI upper extremity joint without contrast | CPT | 73221 | 7 | $3,478 | $2,121.58 | $578.05 | $1,408.59 | $3,445.31 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 7 | $3,953 | $2,411.33 | $785.59 | $1,397.39 | $3,915.84 |
| Knee X-ray 1-2 views | CPT | 73560 | 7 | $342 | $208.62 | $59.58 | $138.51 | $338.79 |
| Ankle X-ray 3 views | CPT | 73610 | 7 | $411 | $250.71 | $32.56 | $159.57 | $407.14 |
| MRI lower extremity joint without contrast | CPT | 73721 | 7 | $3,478 | $2,121.58 | $578.05 | $1,408.59 | $3,445.31 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 7 | $3,953 | $2,411.33 | $607.75 | $1,600.97 | $3,915.84 |
| CT abdomen without contrast | CPT | 74150 | 7 | $2,396 | $1,461.56 | $352.55 | $970.38 | $2,373.48 |
| CT abdomen with contrast | CPT | 74160 | 7 | $2,396 | $1,461.56 | $446.6 | $970.38 | $2,373.48 |
| CT abdomen with and without contrast | CPT | 74170 | 7 | $2,745 | $1,674.45 | $446.6 | $1,111.73 | $2,719.2 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 7 | $3,243 | $1,978.23 | $578.05 | $1,313.42 | $3,212.52 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 7 | $3,542 | $2,160.62 | $607.75 | $1,434.51 | $3,508.71 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 7 | $3,897 | $2,377.17 | $607.75 | $1,578.29 | $3,860.37 |
| MRI abdomen without contrast | CPT | 74181 | 7 | $3,573 | $2,179.53 | $578.05 | $1,447.07 | $3,539.41 |
| MRI abdomen with and without contrast | CPT | 74183 | 7 | $3,953 | $2,411.33 | $607.75 | $1,600.97 | $3,915.84 |
| Abdominal ultrasound complete | CPT | 76700 | 7 | $1,132 | $690.52 | $197.19 | $458.46 | $1,121.36 |
| Abdominal ultrasound limited | CPT | 76705 | 7 | $884 | $539.24 | $39.54 | $208.95 | $875.69 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 7 | $1,142 | $696.62 | $198.94 | $462.51 | $1,131.27 |
| Obstetric ultrasound first trimester | CPT | 76801 | 7 | $1,290 | $786.9 | $224.72 | $522.45 | $1,277.87 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 7 | $1,290 | $786.9 | $224.72 | $522.45 | $1,277.87 |
| Transvaginal ultrasound | CPT | 76830 | 7 | $1,027 | $626.47 | $178.9 | $415.94 | $1,017.35 |
| Pelvic ultrasound complete | CPT | 76856 | 7 | $984 | $600.24 | $171.41 | $398.52 | $974.75 |
| Scrotal ultrasound | CPT | 76870 | 7 | $982 | $599.02 | $171.06 | $397.71 | $972.77 |
| Diagnostic mammography unilateral | CPT | 77065 | 7 | $389 | $237.29 | $67.76 | $157.55 | $385.34 |
| Diagnostic mammography bilateral | CPT | 77066 | 7 | $470 | $286.7 | $81.87 | $190.35 | $465.58 |
| Screening mammography bilateral | CPT | 77067 | 8 | $478 | $291.58 | $90.6 | $168.97 | $495 |
| EKG tracing only | CPT | 93005 | 7 | $261 | $159.21 | $4.81 | $92.26 | $258.55 |
| EKG interpretation only | CPT | 93010 | 7 | $42 | $25.62 | $7.32 | $13.18 | $40.77 |
| Transthoracic echocardiogram complete | CPT | 93306 | 7 | $2,140 | $1,305.4 | $704.57 | $858.23 | $2,549.25 |
| Stress echocardiogram | CPT | 93350 | 7 | $1,114 | $679.54 | $194.06 | $451.17 | $1,103.53 |
| inpatient | ||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 5 | $17,100 | $10,893 | $2,838.68 | $3,897.27 | $40,513 |
| COPD w MCC | MS-DRG | 190 | 5 | $12,869 | $8,197.65 | $2,838.68 | $3,897.27 | $28,152 |
| COPD w CC | MS-DRG | 191 | 5 | $8,780.3 | $5,593.05 | $2,838.68 | $3,897.27 | $21,531 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 5 | $13,425 | $8,551.41 | $2,838.68 | $3,897.27 | $20,551 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 5 | $10,440 | $6,650.44 | $2,838.68 | $3,897.27 | $15,609 |
| Heart failure & shock w MCC | MS-DRG | 291 | 5 | $14,204 | $9,047.63 | $2,838.68 | $3,897.27 | $32,704 |
| Heart failure & shock w CC | MS-DRG | 292 | 5 | $18,994 | $12,099 | $2,838.68 | $3,897.27 | $21,586 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 5 | $8,661.3 | $5,517.25 | $2,838.68 | $3,897.27 | $18,528 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 5 | $12,704 | $8,092.23 | $2,838.68 | $3,897.27 | $19,556 |
| Kidney/UTI w MCC | MS-DRG | 689 | 5 | $30,707 | $19,560 | $2,838.68 | $3,897.27 | $29,333 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 5 | $13,899 | $8,853.66 | $2,838.68 | $3,897.27 | $20,115 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 5 | $19,281 | $12,282 | $2,838.68 | $3,897.27 | $49,179 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 5 | $14,160 | $9,019.6 | $2,838.68 | $3,897.27 | $25,839 |
| Initial hospital care, low complexity | CPT | 99221 | 7 | $269 | $164.09 | $46.86 | $101.45 | $261.12 |
| Initial hospital care, moderate complexity | CPT | 99222 | 7 | $364 | $222.04 | $63.41 | $149.45 | $353.33 |
| Initial hospital care, high complexity | CPT | 99223 | 7 | $443 | $270.23 | $77.17 | $199.48 | $430.02 |
| Hospital discharge, <30 min | CPT | 99238 | 7 | $165 | $100.65 | $28.74 | $93.34 | $160.17 |
| Hospital discharge, >30 min | CPT | 99239 | 7 | $299 | $182.39 | $52.09 | $132.85 | $290.24 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 8 | $210 | $128.1 | $7.89 | $74.24 | $208.03 |
| Electrolyte panel | CPT | 80051 | 8 | $210 | $128.1 | $6.54 | $74.24 | $208.03 |
| Comprehensive metabolic panel | CPT | 80053 | 8 | $293 | $178.73 | $9.85 | $103.58 | $290.25 |
| Lipid panel | CPT | 80061 | 8 | $188 | $114.68 | $12.49 | $66.46 | $186.23 |
| Renal function panel | CPT | 80069 | 8 | $411 | $250.71 | $8.09 | $145.29 | $407.14 |
| Hepatic function panel | CPT | 80076 | 8 | $318 | $193.98 | $7.62 | $112.41 | $315.01 |
| Urinalysis non-automated | CPT | 81002 | 7 | $19 | $11.59 | $3.31 | $7.7 | $18.82 |
| Urinalysis automated | CPT | 81003 | 8 | $58 | $58 | $2.1 | $20.5 | $57.45 |
| Glucose quantitative | CPT | 82947 | 8 | $125 | $76.25 | $3.67 | $44.19 | $123.83 |
| Hemoglobin A1c | CPT | 83036 | 8 | $140 | $85.4 | $9.06 | $49.49 | $138.68 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 8 | $185 | $112.85 | $15.67 | $61.25 | $183.26 |
| Complete blood count with automated differential | CPT | 85025 | 8 | $198 | $120.78 | $7.25 | $69.99 | $196.14 |
| Complete blood count without differential | CPT | 85027 | 8 | $175 | $106.75 | $6.03 | $47.55 | $173.36 |
| Urine culture bacterial | CPT | 87086 | 8 | $171 | $104.31 | $7.53 | $60.45 | $169.39 |
| Urine culture identification | CPT | 87088 | 8 | $6 | $3.66 | $1.05 | $2.72 | $7.54 |
| Tissue exam by pathologist level IV | CPT | 88305 | 8 | $173 | $105.53 | $58.52 | $70.07 | $239.25 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 7 | $821 | $500.81 | $21.95 | $122.31 | $813.28 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 7 | $5,091 | $3,105.51 | $886.85 | $2,631.4 | $4,941.83 |
| Vaginal delivery with postpartum | CPT | 59410 | 7 | $2,608 | $1,590.88 | $454.31 | $1,159.75 | $2,531.59 |
| Routine obstetric care with C-section | CPT | 59510 | 7 | $5,971 | $3,642.31 | $1,040.15 | $2,890.75 | $5,796.05 |
| C-section delivery only | CPT | 59514 | 7 | $2,466 | $1,504.26 | $429.58 | $978.4 | $2,393.75 |
| C-section with postpartum | CPT | 59515 | 7 | $3,488 | $2,127.68 | $607.61 | $1,424.89 | $3,385.8 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 7 | $195 | $118.95 | $33.97 | $66.61 | $189.29 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 7 | $234 | $142.74 | $40.76 | $94.31 | $227.14 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 7 | $563 | $343.43 | $98.07 | $190.74 | $546.5 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 7 | $825 | $503.25 | $143.72 | $271.3 | $800.83 |
| Office visit, established patient, 5 min | CPT | 99211 | 7 | $91 | $55.51 | $9.71 | $36.45 | $90.14 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 7 | $137 | $83.57 | $23.87 | $48.12 | $132.99 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 7 | $167 | $101.87 | $29.09 | $75.92 | $162.11 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 7 | $232 | $141.52 | $40.41 | $111.55 | $225.2 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 7 | $295 | $179.95 | $51.39 | $165.41 | $286.36 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 7 | $1,906 | $1,162.66 | $133.19 | $673.77 | $3,405.6 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 7 | $2,513 | $1,532.93 | $149.94 | $887.34 | $3,405.6 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 7 | $1,451 | $885.11 | $62.44 | $370.54 | $1,437.36 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 7 | $1,940 | $1,183.4 | $79.29 | $603.34 | $1,921.76 |
| Colonoscopy diagnostic | CPT | 45378 | 7 | $2,379 | $1,451.19 | $199.17 | $840.02 | $4,113.45 |
| Colonoscopy with biopsy | CPT | 45380 | 7 | $2,844 | $1,734.84 | $216.54 | $1,004.22 | $3,573.9 |
| Colonoscopy with polyp removal | CPT | 45385 | 7 | $2,949 | $1,798.89 | $273.67 | $1,041.29 | $3,573.9 |
| surgery | ||||||||
| Total hip replacement | CPT | 27130 | 7 | $6,068 | $3,701.48 | $1,057.05 | $1,956.4 | $5,890.21 |
| Total knee replacement | CPT | 27447 | 7 | $6,148 | $3,750.28 | $1,070.98 | $1,971.73 | $5,967.86 |
| Laparoscopic appendectomy | CPT | 44970 | 7 | $8,658 | $5,281.38 | $371.57 | $2,070.5 | $8,576.61 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 5 | $50,016 | $31,860 | $2,838.68 | $3,897.27 | $47,255 |
| Laparoscopic cholecystectomy | CPT | 47562 | 7 | $8,658 | $5,281.38 | $510.06 | $2,842.21 | $8,576.61 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 7 | $3,207 | $1,956.27 | $558.66 | $1,047.36 | $3,113.03 |
| Lap inguinal hernia repair | CPT | 49650 | 7 | $8,658 | $5,281.38 | $466.64 | $1,474.4 | $8,576.61 |
Payer mix (top 8)
| Payer | Codes covered | Median rate |
|---|---|---|
| Blue Cross Blue Shield | 133 | $369.28 |
| Medicaid | 133 | $415.94 |
| Medicare | 133 | $363.3 |
| UnitedHealthcare | 133 | $473.51 |
| healthpartners [900713] | 133 | $1,043.86 |
| First Health | 119 | $953.51 |
| medica [900156] | 119 | $940.73 |
| ma wisconsin replacement [950271] | 16 | $7.76 |