▸ Hospital · WI · CCN 520059
Aurora Medical Center Burlington
252 MCHENRY ST, BURLINGTON, WI, 53105-
43 bedsAcute Care Hospitals2
Compliance grade
A
100/100
Procedures tracked
182
of 209 target codes
Payers
18
with negotiated rates
Rates published
42,030
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 16 | — | — | $1,337 | $26,546 | $31,923 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 18 | $470 | $235 | $75 | $338.4 | $2,200 |
| ED visit level 2 | CPT | 99282 | 18 | $940 | $470 | $324 | $454.68 | $2,200 |
| ED visit level 3 | CPT | 99283 | 18 | $1,880 | $940 | $483 | $1,128 | $2,200 |
| ED visit level 4 | CPT | 99284 | 18 | $1,190 | $595 | $714 | $2,180 | $3,627 |
| ED visit level 5 | CPT | 99285 | 18 | $1,840 | $920 | $1,104 | $2,180 | $3,627 |
| Critical care, first hour | CPT | 99291 | 7 | $2,830 | $1,415 | $1,698 | $2,264 | $3,899 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| CT head with contrast | CPT | 70460 | 18 | $3,140 | $1,570 | $475 | $1,014 | $2,669 |
| CT head with and without contrast | CPT | 70470 | 18 | $4,610 | $2,305 | $475 | $1,014 | $3,918.5 |
| CT neck with contrast | CPT | 70491 | 18 | $3,140 | $1,570 | $475 | $1,014 | $2,669 |
| MRI brain without contrast | CPT | 70551 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI brain with contrast | CPT | 70552 | 18 | $4,420 | $2,210 | $650 | $1,352 | $3,757 |
| MRI brain with and without contrast | CPT | 70553 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| Chest X-ray single view | CPT | 71045 | 18 | $330 | $165 | $198 | $279.18 | $460 |
| Chest X-ray 2 views | CPT | 71046 | 18 | $385 | $192.5 | $200 | $315 | $460 |
| Chest X-ray 3 views | CPT | 71047 | 18 | $485 | $242.5 | $200 | $336 | $460 |
| CT chest without contrast | CPT | 71250 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| CT chest with contrast | CPT | 71260 | 18 | $3,140 | $1,570 | $475 | $1,014 | $2,669 |
| CT chest with and without contrast | CPT | 71270 | 18 | $4,610 | $2,305 | $475 | $1,014 | $3,918.5 |
| MRI chest without contrast | CPT | 71550 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI chest with and without contrast | CPT | 71552 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| Lumbosacral spine X-ray | CPT | 72100 | 18 | $590 | $295 | $200 | $339 | $501.5 |
| CT cervical spine without contrast | CPT | 72125 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| CT thoracic spine without contrast | CPT | 72128 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| CT lumbar spine without contrast | CPT | 72131 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| MRI cervical spine without contrast | CPT | 72141 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI thoracic spine without contrast | CPT | 72146 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI lumbar spine without contrast | CPT | 72148 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 18 | $4,420 | $2,210 | $650 | $1,352 | $3,757 |
| MRI cervical spine with and without contrast | CPT | 72156 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| MRI lumbar spine with contrast | CPT | 72158 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| CT pelvis without contrast | CPT | 72192 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| CT pelvis with contrast | CPT | 72193 | 18 | $3,140 | $1,570 | $475 | $1,014 | $2,669 |
| Shoulder X-ray | CPT | 73030 | 18 | $970 | $485 | $200 | $388 | $824.5 |
| Humerus X-ray | CPT | 73060 | 18 | $1,180 | $590 | $200 | $442.5 | $1,003 |
| Hand X-ray 3 views | CPT | 73130 | 18 | $820 | $410 | $200 | $339 | $697 |
| MRI upper extremity joint without contrast | CPT | 73221 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| Knee X-ray 1-2 views | CPT | 73560 | 18 | $780 | $390 | $200 | $329.94 | $663 |
| Ankle X-ray 3 views | CPT | 73610 | 18 | $1,260 | $630 | $200 | $460 | $1,071 |
| MRI lower extremity joint without contrast | CPT | 73721 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| CT abdomen without contrast | CPT | 74150 | 18 | $2,940 | $1,470 | $475 | $1,014 | $2,499 |
| CT abdomen with contrast | CPT | 74160 | 18 | $3,140 | $1,570 | $475 | $1,014 | $2,669 |
| CT abdomen with and without contrast | CPT | 74170 | 18 | $4,610 | $2,305 | $475 | $1,014 | $3,918.5 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 18 | $5,880 | $2,940 | $475 | $1,014 | $4,998 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 18 | $6,280 | $3,140 | $475 | $1,014 | $5,338 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 18 | $9,220 | $4,610 | $475 | $1,014 | $7,837 |
| MRI abdomen without contrast | CPT | 74181 | 18 | $4,220 | $2,110 | $650 | $1,352 | $3,587 |
| MRI abdomen with and without contrast | CPT | 74183 | 18 | $6,530 | $3,265 | $650 | $1,352 | $5,550.5 |
| Abdominal ultrasound complete | CPT | 76700 | 18 | $1,140 | $570 | $300 | $526 | $969 |
| Abdominal ultrasound limited | CPT | 76705 | 18 | $850 | $425 | $300 | $525 | $722.5 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 18 | $1,030 | $515 | $300 | $526 | $875.5 |
| Obstetric ultrasound first trimester | CPT | 76801 | 18 | $1,070 | $535 | $300 | $526 | $909.5 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 18 | $1,320 | $660 | $300 | $526 | $1,122 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 18 | $1,070 | $535 | $300 | $526 | $909.5 |
| Transvaginal ultrasound | CPT | 76830 | 18 | $995 | $497.5 | $300 | $526 | $845.75 |
| Pelvic ultrasound complete | CPT | 76856 | 18 | $1,370 | $685 | $300 | $526 | $1,164.5 |
| Scrotal ultrasound | CPT | 76870 | 18 | $1,190 | $595 | $300 | $526 | $1,011.5 |
| Diagnostic mammography unilateral | CPT | 77065 | 18 | $825 | $412.5 | $200 | $340 | $701.25 |
| Diagnostic mammography bilateral | CPT | 77066 | 18 | $950 | $475 | $200 | $360 | $807.5 |
| Screening mammography bilateral | CPT | 77067 | 18 | $445 | $222.5 | $200 | $305 | $378.25 |
| EKG tracing only | CPT | 93005 | 18 | $315 | $157.5 | $157.5 | $240 | $310 |
| Transthoracic echocardiogram complete | CPT | 93306 | 18 | $5,260 | $2,630 | $2,069 | $3,282.5 | $4,471 |
| Transthoracic echocardiogram | CPT | 93307 | 18 | $3,640 | $1,820 | $1,765 | $2,366 | $3,094 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 16 | — | — | $29,914 | $37,461 | $45,049 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 16 | — | — | $15,292 | $19,150 | $23,030 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 16 | — | — | $10,351 | $12,962 | $15,588 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 16 | — | — | $24,309 | $30,442 | $36,609 |
| COPD w MCC | MS-DRG | 190 | 16 | — | — | $16,888 | $21,148 | $25,433 |
| COPD w CC | MS-DRG | 191 | 16 | — | — | $12,919 | $16,179 | $19,456 |
| COPD w/o CC/MCC | MS-DRG | 192 | 16 | — | — | $9,732.59 | $12,188 | $14,657 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 16 | — | — | $12,331 | $15,442 | $18,571 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 16 | — | — | $9,364.16 | $11,727 | $14,102 |
| AMI discharged alive w MCC | MS-DRG | 280 | 16 | — | — | $24,683 | $30,911 | $37,173 |
| AMI discharged alive w CC | MS-DRG | 281 | 16 | — | — | $13,862 | $17,359 | $20,876 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 16 | — | — | $10,904 | $13,655 | $16,421 |
| Heart failure & shock w MCC | MS-DRG | 291 | 16 | — | — | $19,622 | $24,572 | $29,550 |
| Heart failure & shock w CC | MS-DRG | 292 | 16 | — | — | $12,951 | $16,218 | $19,504 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 16 | — | — | $8,251.35 | $10,333 | $12,426 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 16 | — | — | $18,134 | $22,710 | $27,310 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 16 | — | — | $11,118 | $13,923 | $16,743 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 16 | — | — | $8,413.76 | $10,537 | $12,671 |
| GI hemorrhage w CC | MS-DRG | 378 | 16 | — | — | $14,826 | $18,566 | $22,328 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 16 | — | — | $9,574.69 | $11,990 | $14,419 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 16 | — | — | $11,734 | $14,695 | $17,671 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 16 | — | — | $22,931 | $28,717 | $34,534 |
| Kidney/UTI w MCC | MS-DRG | 689 | 16 | — | — | $17,599 | $22,039 | $26,504 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 16 | — | — | $12,070 | $15,115 | $18,176 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 16 | — | — | $29,506 | $36,950 | $44,436 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 16 | — | — | $15,504 | $19,416 | $23,349 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 18 | $235 | $117.5 | $6.77 | $24.84 | $199.75 |
| General health panel | CPT | 80050 | 18 | $560 | $280 | $37.82 | $336 | $476 |
| Electrolyte panel | CPT | 80051 | 18 | $115 | $57.5 | $5.61 | $51 | $97.75 |
| Comprehensive metabolic panel | CPT | 80053 | 18 | $315 | $157.5 | $8.45 | $31.17 | $267.75 |
| Lipid panel | CPT | 80061 | 18 | $250 | $125 | $10.71 | $111 | $212.5 |
| Renal function panel | CPT | 80069 | 18 | $285 | $142.5 | $6.94 | $25.8 | $242.25 |
| Hepatic function panel | CPT | 80076 | 18 | $280 | $140 | $6.54 | $24.12 | $238 |
| Urinalysis non-automated | CPT | 81002 | 18 | $30 | $15 | $2.78 | $10.5 | $25.5 |
| Urinalysis automated | CPT | 81003 | 18 | $50 | $25 | $1.8 | $24 | $42.5 |
| Glucose quantitative | CPT | 82947 | 18 | $55 | $27.5 | $3.14 | $27 | $46.75 |
| Hemoglobin A1c | CPT | 83036 | 18 | $165 | $82.5 | $7.77 | $34.08 | $140.25 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 18 | $210 | $105 | $13.44 | $42 | $178.5 |
| Complete blood count with automated differential | CPT | 85025 | 18 | $140 | $70 | $6.22 | $22.95 | $119 |
| Complete blood count without differential | CPT | 85027 | 18 | $100 | $50 | $5.18 | $19.11 | $85 |
| Urine culture bacterial | CPT | 87086 | 18 | $160 | $80 | $6.46 | $23.88 | $136 |
| Urine culture identification | CPT | 87088 | 18 | $160 | $80 | $6.47 | $93 | $136 |
| Tissue exam by pathologist level IV | CPT | 88305 | 18 | $615 | $307.5 | $57.17 | $369 | $522.75 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 18 | $550 | $275 | $132.5 | $330 | $14,482 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 13 | — | — | $5,692 | $10,544 | $14,482 |
| Vaginal delivery only | CPT | 59409 | 18 | $4,690 | $2,345 | $1,894 | $5,889 | $8,773 |
| Vaginal delivery with postpartum | CPT | 59410 | 13 | — | — | $1,894 | $9,888.5 | $14,038 |
| Routine obstetric care with C-section | CPT | 59510 | 13 | — | — | $5,692 | $16,632 | $19,887 |
| C-section delivery only | CPT | 59514 | 13 | — | — | $5,692 | $18,765 | $25,737 |
| C-section with postpartum | CPT | 59515 | 13 | — | — | $5,692 | $16,632 | $19,887 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 18 | $300 | $150 | $65 | $93 | $255 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 18 | $360 | $180 | $65 | $93 | $306 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 18 | $540 | $270 | $65 | $93 | $459 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 18 | $620 | $310 | $65 | $93 | $527 |
| Office visit, established patient, 5 min | CPT | 99211 | 18 | $180 | $90 | $60 | $84.6 | $153 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 18 | $240 | $120 | $65 | $93 | $204 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 18 | $280 | $140 | $65 | $93 | $238 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 18 | $340 | $170 | $65 | $93 | $289 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 18 | $390 | $195 | $65 | $93 | $331.5 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 15 | — | — | $1,894 | $2,955 | $4,387 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 15 | — | — | $1,979 | $2,976 | $6,800 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 15 | — | — | $1,183 | $2,115 | $3,500 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 15 | — | — | $1,183 | $2,115 | $3,500 |
| Colonoscopy diagnostic | CPT | 45378 | 15 | — | — | $1,979 | $2,976 | $6,800 |
| Colonoscopy with biopsy | CPT | 45380 | 15 | — | — | $1,979 | $2,976 | $6,800 |
| Colonoscopy with polyp removal | CPT | 45385 | 15 | — | — | $1,979 | $2,976 | $6,800 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 14 | — | — | $8,466 | $18,759 | $25,737 |
| Hip hemiarthroplasty | CPT | 27125 | 13 | — | — | $9,580 | $17,588 | $25,737 |
| Total hip replacement | CPT | 27130 | 14 | — | — | $9,580 | $18,759 | $25,737 |
| Total knee replacement | CPT | 27447 | 14 | — | — | $9,580 | $18,875 | $25,737 |
| Knee revision arthroplasty single component | CPT | 27486 | 13 | — | — | $9,580 | $18,759 | $25,737 |
| Knee revision arthroplasty all components | CPT | 27487 | 13 | — | — | $9,580 | $18,759 | $25,737 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 15 | — | — | $1,291 | $1,950 | $14,586 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 15 | — | — | $8,466 | $13,752 | $16,378 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 15 | — | — | $7,978 | $9,953 | $13,500 |
| ACL reconstruction | CPT | 29888 | 15 | — | — | $6,461 | $13,050 | $16,378 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 16 | — | — | $69,053 | $86,475 | $103,993 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 16 | — | — | $35,545 | $44,513 | $53,531 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 16 | — | — | $24,828 | $31,092 | $37,390 |
| CABG single arterial graft | CPT | 33533 | 14 | — | — | $14,482 | $18,595 | $25,737 |
| CABG 2 arterial grafts | CPT | 33534 | 14 | — | — | $14,482 | $18,595 | $25,737 |
| CABG 3 arterial grafts | CPT | 33535 | 14 | — | — | $14,482 | $18,595 | $25,737 |
| CABG 4+ arterial grafts | CPT | 33536 | 14 | — | — | $14,482 | $18,595 | $25,737 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 16 | — | — | $24,939 | $31,231 | $37,558 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 16 | — | — | $19,814 | $24,813 | $29,840 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 16 | — | — | $53,077 | $66,468 | $79,933 |
| Open appendectomy | CPT | 44950 | 14 | — | — | $7,978 | $9,917.5 | $12,444 |
| Laparoscopic appendectomy | CPT | 44970 | 15 | — | — | $6,461 | $13,500 | $16,378 |
| Major joint replacement w MCC | MS-DRG | 469 | 16 | — | — | $44,951 | $54,587 | $71,911 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 16 | — | — | $25,929 | $31,488 | $41,481 |
| Laparoscopic cholecystectomy | CPT | 47562 | 15 | — | — | $8,466 | $13,752 | $19,000 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 15 | — | — | $8,466 | $13,752 | $19,000 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 16 | — | — | $44,227 | $55,385 | $66,605 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 16 | — | — | $31,202 | $39,075 | $46,990 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 16 | — | — | $23,856 | $29,875 | $35,927 |
| Lap inguinal hernia repair | CPT | 49650 | 15 | — | — | $8,243 | $13,500 | $16,378 |
| Total abdominal hysterectomy | CPT | 58150 | 14 | — | — | $9,882 | $17,346 | $25,737 |
| Vaginal hysterectomy | CPT | 58260 | 15 | — | — | $8,456 | $11,150 | $19,000 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 15 | — | — | $9,580 | $13,752 | $19,000 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 15 | — | — | $11,037 | $13,752 | $16,378 |
| Lap salpingo-oophorectomy | CPT | 58661 | 15 | — | — | $8,466 | $13,752 | $16,378 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 16 | — | — | $41,001 | $50,157 | $61,074 |
| OR procedure for obesity w CC | MS-DRG | 620 | 16 | — | — | $24,016 | $29,378 | $35,773 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 16 | — | — | $21,983 | $26,891 | $32,744 |
| Complex cataract surgery | CPT | 66982 | 15 | — | — | $2,789 | $3,350 | $17,500 |
| Cataract surgery with lens implant | CPT | 66984 | 15 | — | — | $2,789 | $3,350 | $17,500 |
| Intravitreal injection | CPT | 67028 | 15 | — | — | $1,183 | $1,789 | $3,500 |
| Vitrectomy mechanical | CPT | 67042 | 15 | — | — | $8,466 | $11,210 | $19,000 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 16 | — | — | $18,026 | $22,574 | $27,147 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 16 | — | — | $29,384 | $36,798 | $44,252 |
| PCI single major coronary artery | CPT | 92920 | 14 | — | — | $11,037 | $13,401 | $16,378 |
| PCI with drug-eluting stent | CPT | 92928 | 14 | — | — | $11,302 | $15,345 | $19,887 |
| PCI bypass graft | CPT | 92937 | 14 | — | — | $11,302 | $15,345 | $19,887 |
| Left heart catheterization | CPT | 93452 | 14 | — | — | $7,978 | $10,357 | $12,855 |
| Coronary angiography with cath | CPT | 93455 | 14 | — | — | $7,978 | $10,357 | $12,855 |
| Coronary angiography with bypass cath | CPT | 93458 | 14 | — | — | $7,978 | $10,357 | $12,855 |
Payer mix (top 18)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 182 | $978.81 |
| aurora caregiver | 181 | $2,184 |
| centivo | 181 | $1,967 |
| wisconsin physician service | 181 | $2,226 |
| health payment systems | 181 | $2,300 |
| hs technology | 181 | $2,138 |
| Molina | 181 | $1,825 |
| quartz group | 181 | $1,950 |
| quartz one | 181 | $1,670 |
| trilogy | 181 | $2,340 |
| common ground | 181 | $1,492 |
| everpointe elite | 181 | $1,352 |
| Anthem BCBS | 179 | $969 |
| UnitedHealthcare | 177 | $1,001.98 |
| Cigna | 159 | $1,159.02 |
| healthpartners | 136 | $802.5 |
| health eos | 93 | $658 |
| health eos plus | 93 | $493.5 |