▸ Hospital · MN · CCN 241314

Johnson Memorial Hospital

1282 WALNUT STREET, DAWSON, MN, 241314

Compliance grade

100/100

Procedures tracked

119

of 209 target codes

Payers

with negotiated rates

Rates published

2,516

last crawl 2026-05-22

▸ Compare with other hospitals All MN hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://jmhsmn.org/410694689_Johnson-Memorial-Health-Services_standardcharges.json · JSON

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychiatric diagnostic evaluation	CPT	90791	5	$392.06	$333.25	$144.44	$259.84	$405.95
Psychiatric eval with medical services	CPT	90792	4	$528.33	$449.08	$165.78	$251.97	$486.06
Psychotherapy 30 minutes	CPT	90832	5	$190	$161.5	$71.52	$127.02	$417.38
Psychotherapy 45 minutes	CPT	90834	4	$235	$199.75	$94.54	$145.21	$216.2
Psychotherapy 60 minutes	CPT	90837	5	$278.51	$236.73	$139.17	$227.4	$397.5
Crisis psychotherapy 60 minutes	CPT	90839	4	$312.79	$265.87	$133.35	$227.57	$287.77
emergency
ED visit level 1	CPT	99281	7	$394.65	$335.45	$134.29	$264.6	$363.08
ED visit level 2	CPT	99282	8	$498.62	$423.83	$29.65	$114.2	$795.5
ED visit level 3	CPT	99283	11	$703.78	$598.21	$50.9	$255.94	$611.41
ED visit level 4	CPT	99284	8	$1,238.07	$1,052.36	$86.59	$397.54	$1,243.34
ED visit level 5	CPT	99285	8	$1,801.41	$1,531.2	$126.21	$532.78	$1,657.3
Critical care, first hour	CPT	99291	4	$2,476.14	$2,104.72	$237.47	$459.95	$2,278.05
imaging
CT head without contrast	CPT	70450	9	$1,985	$1,687.25	$262	$984.09	$1,826.2
CT head with contrast	CPT	70460	4	$2,406	$2,045.1	$438	$657	$2,213.52
CT head with and without contrast	CPT	70470	4	$2,659	$2,260.15	$438	$657	$2,446.28
CT neck with contrast	CPT	70491	4	$2,653	$2,255.05	$438	$657	$2,440.76
MRI brain without contrast	CPT	70551	5	$3,109.5	$2,643.07	$584.5	$1,463.86	$2,860.74
MRI brain with contrast	CPT	70552	5	$3,277.12	$2,785.55	$917	$1,463.86	$3,014.95
MRI brain with and without contrast	CPT	70553	5	$3,489.3	$2,965.91	$917	$1,705	$3,210.16
Chest X-ray single view	CPT	71045	7	$427.54	$363.41	$94.5	$198.2	$393.34
Chest X-ray 2 views	CPT	71046	10	$427.54	$363.41	$62.97	$263.24	$302.25
CT chest without contrast	CPT	71250	7	$1,857.64	$1,578.99	$262	$911.38	$1,709.03
CT chest with contrast	CPT	71260	5	$2,083.61	$1,771.07	$835.27	$1,054.5	$1,916.92
CT chest with and without contrast	CPT	71270	5	$2,363.69	$2,009.14	$438	$876	$2,174.59
MRI chest without contrast	CPT	71550	4	$2,880.34	$2,448.29	$584.5	$1,169	$2,649.92
MRI chest with contrast	CPT	71551	4	$3,336.53	$2,836.05	$1,909	$2,692.86	$3,818
MRI chest with and without contrast	CPT	71552	4	$3,748.16	$3,185.94	$917	$1,834	$3,448.31
Lumbosacral spine X-ray	CPT	72100	7	$450.88	$383.25	$122.96	$368	$510.93
CT cervical spine without contrast	CPT	72125	6	$2,117.56	$1,799.93	$262	$975.63	$1,948.15
CT thoracic spine without contrast	CPT	72128	5	$1,632.73	$1,387.82	$262	$524	$1,502.11
CT lumbar spine without contrast	CPT	72131	6	$1,738.82	$1,478	$262	$671.43	$1,599.71
MRI cervical spine without contrast	CPT	72141	5	$3,427	$2,912.95	$584.5	$1,456	$3,152.84
MRI thoracic spine without contrast	CPT	72146	5	$2,927.02	$2,487.97	$584.5	$1,169	$2,692.86
MRI lumbar spine without contrast	CPT	72148	9	$3,271	$2,780.35	$572.31	$1,495	$3,009.32
MRI lumbar spine with and without contrast	CPT	72149	4	$3,601.76	$3,061.5	$917	$1,375.5	$3,313.62
MRI cervical spine with and without contrast	CPT	72156	5	$2,952.48	$2,509.61	$917	$1,520.76	$2,716.29
MRI lumbar spine with contrast	CPT	72158	5	$3,601.76	$3,061.5	$917	$1,834	$3,313.62
CT pelvis without contrast	CPT	72192	4	$2,056	$1,747.6	$262	$1,055.7	$1,891.52
CT pelvis with contrast	CPT	72193	7	$2,519	$2,141.15	$438	$1,733.33	$3,049.6
Shoulder X-ray	CPT	73030	6	$302.36	$257.01	$125.09	$150.15	$278.17
Humerus X-ray	CPT	73060	2	$302.36	$257.01	$137.8	$207.99	$278.17
Hand X-ray 3 views	CPT	73130	6	$279.02	$237.17	$127.2	$208.48	$1,276.58
MRI upper extremity joint without contrast	CPT	73221	5	$2,927.02	$2,487.97	$458.1	$916.2	$2,692.86
MRI upper extremity joint with and without contrast	CPT	73223	4	$3,457.47	$2,938.85	$917	$1,375.5	$3,180.88
Knee X-ray 1-2 views	CPT	73560	6	$302.36	$257.01	$100.44	$147.55	$257.34
Ankle X-ray 3 views	CPT	73610	8	$394.65	$335.45	$103.3	$274.21	$659.75
MRI lower extremity joint without contrast	CPT	73721	7	$3,033	$2,578.05	$637.72	$1,423.5	$2,790.36
MRI lower extremity joint with and without contrast	CPT	73723	4	$4,519	$3,841.15	$917	$1,375.5	$4,157.48
CT abdomen without contrast	CPT	74150	4	$1,734.57	$1,474.38	$262	$393	$1,595.81
CT abdomen with contrast	CPT	74160	5	$2,014.65	$1,712.45	$438	$566.09	$1,853.48
CT abdomen with and without contrast	CPT	74170	4	$2,544.04	$2,162.43	$438	$657	$2,340.52
CT abdomen and pelvis without contrast	CPT	74176	7	$3,601.76	$3,061.5	$584.5	$1,733.33	$3,313.62
CT abdomen and pelvis with contrast	CPT	74177	7	$3,714.21	$3,157.08	$811.48	$1,830.5	$3,417.07
CT abdomen and pelvis with and without contrast	CPT	74178	8	$4,839.83	$4,113.86	$509.24	$2,135.34	$4,452.64
MRI abdomen without contrast	CPT	74181	4	$2,927.02	$2,487.97	$584.5	$876.75	$2,692.86
MRI abdomen with and without contrast	CPT	74183	5	$3,601.76	$3,061.5	$917	$1,856	$5,056
Abdominal ultrasound complete	CPT	76700	3	$1,041.8	$885.53	$490.25	$958.46	$1,373.16
Abdominal ultrasound limited	CPT	76705	9	$929.35	$789.95	$51.25	$213.71	$1,003.61
Retroperitoneal ultrasound complete	CPT	76770	3	$1,024.83	$871.11	$96.34	$665.93	$942.84
Obstetric ultrasound first trimester	CPT	76801	4	$822.2	$698.87	$220.5	$436.28	$575
Obstetric ultrasound after first trimester	CPT	76805	4	$890.1	$756.59	$238.14	$629.27	$653.41
Transvaginal ultrasound	CPT	76830	4	$900.7	$765.6	$262.86	$567	$828.65
Pelvic ultrasound complete	CPT	76856	4	$900.7	$765.6	$210.19	$679.95	$945.15
Scrotal ultrasound	CPT	76870	6	$816.89	$694.36	$56.13	$147.54	$1,082.68
Diagnostic mammography unilateral	CPT	77065	4	$478.47	$406.7	$149.59	$427.37	$1,375.66
Diagnostic mammography bilateral	CPT	77066	3	$601.53	$511.3	$188.4	$288.36	$553.41
Screening mammography bilateral	CPT	77067	10	$516.66	$439.16	$82.75	$296.97	$436.47
EKG tracing only	CPT	93005	9	$222.48	$189.11	$24.02	$112	$188.77
EKG interpretation only	CPT	93010	5	$79.31	$67.41	$6.17	$12.03	$72.97
Transthoracic echocardiogram complete	CPT	93306	9	$2,404.02	$2,043.42	$153.35	$999.9	$1,809.69
Transthoracic echocardiogram	CPT	93307	1	$2,132.1	$1,812.28	$1,961.53	$1,961.53	$1,961.53
inpatient
Initial hospital care, low complexity	CPT	99221	4	$293.55	$249.52	$55.1	$175.1	$270.07
Initial hospital care, moderate complexity	CPT	99222	4	$398.61	$338.82	$87.9	$228.7	$366.72
Initial hospital care, high complexity	CPT	99223	5	$587.1	$499.04	$118.08	$339.47	$540.13
Hospital discharge, <30 min	CPT	99238	4	$218.55	$185.77	$56.94	$125.07	$201.06
Hospital discharge, >30 min	CPT	99239	4	$322.51	$274.13	$81.34	$181.64	$296.71
lab
Basic metabolic panel (BMP)	CPT	80048	10	$196	$166.6	$79.99	$157.02	$176.7
Electrolyte panel	CPT	80051	1	$145	$123.25	$133.4	$133.4	$133.4
Comprehensive metabolic panel	CPT	80053	10	$258	$219.3	$78.32	$204.39	$269.5
Lipid panel	CPT	80061	10	$167	$141.95	$38.45	$100.08	$119.82
Renal function panel	CPT	80069	9	$181	$153.85	$83.92	$142.63	$175
Hepatic function panel	CPT	80076	1	$175	$148.75	$161	$161	$161
Urinalysis automated	CPT	81003	10	$57	$48.45	$18.76	$40.1	$60.3
Glucose quantitative	CPT	82947	9	$69	$58.65	$20.22	$36.11	$62.48
Hemoglobin A1c	CPT	83036	10	$109	$92.65	$32.22	$76.07	$95.19
Thyroid stimulating hormone (TSH)	CPT	84443	10	$164	$139.4	$50.57	$112.95	$151.82
Complete blood count with automated differential	CPT	85025	10	$153	$130.05	$50.36	$114.48	$130.84
Complete blood count without differential	CPT	85027	10	$118	$100.3	$42.7	$68.3	$98
Urine culture bacterial	CPT	87086	1	$91	$77.35	$83.72	$83.72	$83.72
Tissue exam by pathologist level IV	CPT	88305	10	$639	$543.15	$103.5	$212.08	$587.88
office
Office visit, new patient, 15-29 min	CPT	99202	5	$231.28	$196.59	$58.51	$128.73	$294.27
Office visit, new patient, 30-44 minutes	CPT	99203	5	$333.12	$283.15	$90.52	$181.49	$343.75
Office visit, new patient, 45-59 min	CPT	99204	5	$499.68	$424.73	$136.71	$275.57	$544.54
Office visit, new patient, 60-74 min	CPT	99205	4	$608.96	$517.62	$156.16	$346.34	$560.24
Office visit, established patient, 5 min	CPT	99211	7	$169.74	$144.28	$15.86	$38.98	$156.16
Office visit, established patient, 10-19 min	CPT	99212	8	$177.17	$150.59	$7.27	$92.48	$379.48
Office visit, established patient, 20-29 minutes	CPT	99213	10	$266.29	$226.35	$43.57	$139.5	$388.55
Office visit, established patient, 30-39 minutes	CPT	99214	6	$355.4	$302.09	$97.7	$182.24	$392.74
Office visit, established patient, 40-54 min	CPT	99215	4	$444.55	$377.87	$149.3	$244.66	$408.98
preventive
Upper GI endoscopy diagnostic	CPT	43235	5	$998.31	$848.56	$135.08	$259.12	$528.11
Upper GI endoscopy with biopsy	CPT	43239	4	$1,183.96	$1,006.37	$248.92	$459.3	$698.39
Sigmoidoscopy diagnostic	CPT	45330	5	$1,124.55	$955.87	$30.73	$167.5	$344.45
Colonoscopy diagnostic	CPT	45378	5	$1,124.55	$955.87	$201.54	$390.47	$645.28
Colonoscopy with biopsy	CPT	45380	4	$1,465.1	$1,245.33	$359.96	$449.56	$825.44
Colonoscopy with polyp removal	CPT	45385	4	$1,465.1	$1,245.33	$383.37	$615.27	$846.88
surgery
Total shoulder arthroplasty	CPT	23472	4	$5,586.1	$4,748.19	$932.19	$2,561.23	$3,013.22
Total hip replacement	CPT	27130	4	$6,305.66	$5,359.81	$830.3	$2,386.13	$2,807.21
Total knee replacement	CPT	27447	4	$3,328.96	$2,829.62	$828.76	$2,384.91	$2,805.78
Knee revision arthroplasty single component	CPT	27486	4	$3,396.79	$2,887.27	$913.15	$2,474.6	$2,911.29
Knee revision arthroplasty all components	CPT	27487	4	$5,544.49	$4,712.82	$1,122.59	$3,095.08	$3,641.27
Shoulder arthroscopy with decompression	CPT	29826	4	$478.95	$407.11	$103.69	$311.16	$366.06
Shoulder arthroscopy with rotator cuff repair	CPT	29827	4	$3,081.76	$2,619.5	$705	$1,852.29	$2,179.16
Knee arthroscopy with meniscectomy	CPT	29881	4	$1,761.11	$1,496.94	$377.2	$949.33	$1,116.86
Laparoscopic appendectomy	CPT	44970	4	$2,404	$2,043.4	$406.53	$1,060.37	$1,247.49
Laparoscopic cholecystectomy	CPT	47562	4	$1,732.45	$1,472.58	$442.81	$1,161.04	$1,365.92
Lap inguinal hernia repair	CPT	49650	4	$1,647.05	$1,399.99	$300.78	$754.7	$887.89
Vaginal hysterectomy	CPT	58260	4	$6,269.92	$5,329.43	$532.35	$1,431.31	$1,683.9
Lap-assisted vaginal hysterectomy	CPT	58550	4	$3,680.26	$3,128.22	$562.97	$1,528.32	$1,798.02
Lap salpingo-oophorectomy	CPT	58661	4	$7,050.74	$5,993.13	$416.05	$1,129.92	$1,329.32

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 11)

Payer	Codes covered	Median rate
UnitedHealthcare	119	$296.71
Blue Cross Blue Shield	113	$583.26
blue plus	113	$262
Medicaid	101	$262
Medicare	63	$230.71
Humana	45	$261.35
medica	34	$255.58
healthpartners	29	$220.27
preferred one	23	$212.08
Aetna	20	$176.7
avera health plans	2	$450