Does Holy Family Memorial publish its standard charges and chargemaster?

Yes. Holy Family Memorial publishes a machine-readable file with 81,072 standard-charge rows — gross charges, cash prices, and payer-negotiated rates, earning a CMS price transparency compliance grade of A. Browse the negotiated rates by procedure and payer on this page.

How much does Holy Family Memorial charge for procedures?

Holy Family Memorial (Manitowoc, WI) publishes a separately negotiated rate for each insurance payer, plus a discounted cash price and a gross (list) charge, for every procedure in its price transparency file. This page compares each procedure's negotiated median against the national median so you can see whether a price is above or below market.

▸ Hospital · WI · CCN 520107

Holy Family Memorial

Manitowoc, WI, 54221

45 bedsAcute Care Hospitals2

Compliance grade

100/100

Rates published

81,072

last crawl 2026-05-24

Procedures tracked

197

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All WI hospitalsJSON

The report bundles all published codes × every payer rate + compliance grade as a downloadable PDF + CSV with a data-version manifest.

Source MRF: https://sthpiprd.blob.core.windows.net/machine-readable-files/10297/390806395_holy-family-memorial-inc_standardcharges.csv · CSV

Procedures & rates

vs nat'l shows this hospital's negotiated median against the national median for that code (green = at/below market, amber = 1–1.5×, red = >1.5× the national median).

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	vs nat'l	Neg max
behavioral
Psychoses	MS-DRG	885	16	—	—	$2,284	$18,860	1.5×	$41,155
Psychiatric diagnostic evaluation	CPT	90791	10	—	—	$152.81	$152.81	0.86×	$165.04
Psychiatric eval with medical services	CPT	90792	10	—	—	$152.81	$152.81	0.88×	$165.04
Psychotherapy 30 minutes	CPT	90832	10	—	—	$152.81	$152.81	1.0×	$165.04
Psychotherapy 45 minutes	CPT	90834	10	—	—	$152.81	$152.81	0.95×	$165.04
Psychotherapy 60 minutes	CPT	90837	10	—	—	$152.81	$152.81	0.80×	$165.04
Crisis psychotherapy 60 minutes	CPT	90839	10	—	—	$152.81	$152.81	0.96×	$165.04
emergency
ED visit level 1	CPT	99281	25	$375	$206.25	$69.3	$171.15	1.2×	$943
ED visit level 2	CPT	99282	25	$525	$288.75	$150.62	$378	1.6×	$1,854
ED visit level 3	CPT	99283	25	$1,100	$605	$263.35	$792	2.0×	$4,183
ED visit level 4	CPT	99284	25	$1,800	$990	$360.69	$874.4	1.3×	$5,506
ED visit level 5	CPT	99285	25	$2,500	$1,375	$369.6	$929.6	0.89×	$6,052
Critical care, first hour	CPT	99291	25	$3,675	$2,021.25	$801.41	$2,646	2.5×	$6,427
imaging
CT head without contrast	CPT	70450	25	$1,854	$1,019.7	$101.14	$1,192.12	5.8×	$1,631.52
CT head with contrast	CPT	70460	25	$2,060	$1,133	$168.07	$1,306	5.6×	$1,812.8
CT head with and without contrast	CPT	70470	25	$2,266	$1,246.3	$169.31	$1,359.6	5.1×	$1,994.08
CT neck with contrast	CPT	70491	25	$2,060	$1,133	$169.31	$1,306	4.8×	$1,812.8
MRI brain without contrast	CPT	70551	25	$2,500	$1,375	$229.9	$1,671	4.1×	$2,440
MRI brain with contrast	CPT	70552	25	$3,500	$1,925	$339.67	$2,175.25	4.5×	$3,080
MRI brain with and without contrast	CPT	70553	25	$4,500	$2,475	$339.67	$2,570	4.4×	$3,960
Chest X-ray single view	CPT	71045	25	$191	$105.05	$28.92	$137.52	1.5×	$597
Chest X-ray 2 views	CPT	71046	25	$244	$134.2	$39.06	$175.68	1.8×	$597
Chest X-ray 3 views	CPT	71047	25	$425	$233.75	$49.2	$293.25	3.1×	$597
CT chest without contrast	CPT	71250	25	$1,442	$793.1	$101.14	$1,035.62	4.8×	$1,565
CT chest with contrast	CPT	71260	25	$1,648	$906.4	$169.31	$1,087.68	3.9×	$1,565
CT chest with and without contrast	CPT	71270	25	$1,854	$1,019.7	$169.31	$1,198.61	4.1×	$1,631.52
MRI chest without contrast	CPT	71550	25	$2,750	$1,512.5	$229.9	$1,801.25	4.2×	$2,440
MRI chest with contrast	CPT	71551	10	—	—	$751.43	$751.43	0.92×	$811.54
MRI chest with and without contrast	CPT	71552	25	$4,950	$2,722.5	$339.67	$2,722.5	4.5×	$4,356
Lumbosacral spine X-ray	CPT	72100	25	$237	$130.35	$49.2	$170.64	1.6×	$597
CT cervical spine without contrast	CPT	72125	25	$2,060	$1,133	$101.14	$1,315.29	6.5×	$1,812.8
CT thoracic spine without contrast	CPT	72128	25	$2,060	$1,133	$101.14	$1,315.29	6.6×	$1,812.8
CT lumbar spine without contrast	CPT	72131	25	$2,060	$1,133	$101.14	$1,315.29	6.5×	$1,812.8
MRI cervical spine without contrast	CPT	72141	25	$3,000	$1,650	$229.9	$1,939.5	4.9×	$2,640
MRI thoracic spine without contrast	CPT	72146	25	$3,000	$1,650	$229.9	$1,939.5	5.2×	$2,640
MRI lumbar spine without contrast	CPT	72148	25	$3,000	$1,650	$229.9	$1,939.5	5.2×	$2,640
MRI lumbar spine with and without contrast	CPT	72149	25	$3,500	$1,925	$339.67	$2,175.25	4.8×	$3,080
MRI cervical spine with and without contrast	CPT	72156	25	$4,000	$2,200	$339.67	$2,400	4.4×	$3,520
MRI lumbar spine with contrast	CPT	72158	25	$4,000	$2,200	$339.67	$2,400	4.4×	$3,520
CT pelvis without contrast	CPT	72192	25	$2,884	$1,586.2	$101.14	$1,647.7	8.2×	$2,537.92
CT pelvis with contrast	CPT	72193	25	$3,090	$1,699.5	$169.31	$1,709.5	6.1×	$2,719.2
Shoulder X-ray	CPT	73030	25	$222	$122.1	$43	$159.84	1.7×	$597
Humerus X-ray	CPT	73060	25	$265	$145.75	$40.75	$190.8	2.1×	$597
Hand X-ray 3 views	CPT	73130	25	$383	$210.65	$48.07	$264.27	2.8×	$597
MRI upper extremity joint without contrast	CPT	73221	25	$4,400	$2,420	$229.9	$2,540	6.1×	$3,872
MRI upper extremity joint with and without contrast	CPT	73223	25	$6,600	$3,630	$339.67	$3,630	5.9×	$5,808
Knee X-ray 1-2 views	CPT	73560	25	$272	$149.6	$44.13	$195.84	2.1×	$597
Ankle X-ray 3 views	CPT	73610	25	$363	$199.65	$48.07	$252.88	2.7×	$597
MRI lower extremity joint without contrast	CPT	73721	25	$4,400	$2,420	$229.9	$2,540	5.4×	$3,872
MRI lower extremity joint with and without contrast	CPT	73723	25	$6,600	$3,630	$339.67	$3,630	5.7×	$5,808
CT abdomen without contrast	CPT	74150	25	$1,854	$1,019.7	$101.14	$1,198.61	6.4×	$1,631.52
CT abdomen with contrast	CPT	74160	25	$2,060	$1,133	$169.31	$1,315.29	4.6×	$1,812.8
CT abdomen with and without contrast	CPT	74170	25	$2,266	$1,246.3	$169.31	$1,408.32	4.2×	$1,994.08
CT abdomen and pelvis without contrast	CPT	74176	25	$3,296	$1,812.8	$229.9	$1,812.8	5.0×	$2,900.48
CT abdomen and pelvis with contrast	CPT	74177	25	$3,502	$1,926.1	$339.67	$1,926.1	3.5×	$3,081.76
CT abdomen and pelvis with and without contrast	CPT	74178	25	$5,150	$2,832.5	$339.67	$2,832.5	4.9×	$4,532
MRI abdomen without contrast	CPT	74181	25	$2,750	$1,512.5	$229.9	$1,801.25	4.6×	$2,440
MRI abdomen with and without contrast	CPT	74183	25	$4,950	$2,722.5	$339.67	$2,722.5	4.8×	$4,356
Abdominal ultrasound complete	CPT	76700	25	$887	$487.85	$101.14	$555.17	3.7×	$780.56
Abdominal ultrasound limited	CPT	76705	25	$639	$351.45	$101.14	$426.87	2.9×	$647
Retroperitoneal ultrasound complete	CPT	76770	25	$859	$472.45	$101.14	$546.17	3.8×	$755.92
Obstetric ultrasound first trimester	CPT	76801	25	$969	$532.95	$101.14	$581.4	4.1×	$852.72
Obstetric ultrasound after first trimester	CPT	76805	25	$1,211	$666.05	$101.14	$704.8	4.6×	$1,065.68
Obstetric ultrasound with fetal anatomy	CPT	76811	10	—	—	$229.9	$229.9	0.98×	$248.29
Transvaginal ultrasound	CPT	76830	25	$990	$544.5	$101.14	$594	4.0×	$871.2
Pelvic ultrasound complete	CPT	76856	25	$816	$448.8	$101.14	$527.55	3.7×	$718.08
Scrotal ultrasound	CPT	76870	25	$716	$393.8	$101.14	$462.9	3.5×	$647
Diagnostic mammography unilateral	CPT	77065	25	$335	$184.25	$110.55	$201	1.3×	$294.8
Diagnostic mammography bilateral	CPT	77066	25	$583	$320.65	$126	$339.31	1.8×	$513.04
Screening mammography bilateral	CPT	77067	25	$480	$264	$119.22	$279.36	1.8×	$422.4
EKG complete	CPT	93000	10	—	—	$13.14	$13.14	0.54×	$14.19
EKG tracing only	CPT	93005	25	$200	$110	$56.5	$144	1.2×	$251
EKG interpretation only	CPT	93010	10	—	—	$7.46	$7.46	0.41×	$8.06
Transthoracic echocardiogram complete	CPT	93306	25	$2,706	$1,488.3	$515	$1,610.07	2.7×	$2,381.28
Transthoracic echocardiogram	CPT	93307	25	$2,200	$1,210	$229.9	$1,309	5.3×	$1,936
Stress echocardiogram	CPT	93350	25	$1,885	$1,036.75	$515	$1,121.58	2.2×	$1,658.8
inpatient
Intracranial hemorrhage/CVA w MCC	MS-DRG	064	16	—	—	$14,076	$27,998	1.4×	$59,252
Intracranial hemorrhage/CVA w CC	MS-DRG	065	16	—	—	$7,071.51	$14,066	1.3×	$29,767
Intracranial hemorrhage/CVA w/o CC/MCC	MS-DRG	066	16	—	—	$4,790.41	$9,528.41	1.2×	$20,165
Respiratory infections & inflammations w MCC	MS-DRG	177	16	—	—	$10,938	$21,756	1.4×	$46,043
COPD w MCC	MS-DRG	190	16	—	—	$7,753.26	$15,422	1.4×	$32,637
COPD w CC	MS-DRG	191	16	—	—	$5,900.51	$11,736	1.3×	$24,838
COPD w/o CC/MCC	MS-DRG	192	16	—	—	$4,493.63	$8,938.11	1.3×	$18,916
Simple pneumonia & pleurisy w CC	MS-DRG	194	16	—	—	$5,640.83	$11,220	1.3×	$23,745
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	16	—	—	$4,399.13	$8,750.15	1.3×	$18,518
AMI discharged alive w MCC	MS-DRG	280	16	—	—	$11,228	$22,333	1.4×	$47,263
AMI discharged alive w CC	MS-DRG	281	16	—	—	$6,433.17	$12,796	1.3×	$27,080
AMI discharged alive w/o CC/MCC	MS-DRG	282	16	—	—	$5,061.29	$10,067	1.3×	$21,305
Heart failure & shock w MCC	MS-DRG	291	16	—	—	$8,985.86	$17,873	1.4×	$37,826
Heart failure & shock w CC	MS-DRG	292	16	—	—	$5,942.52	$11,820	1.3×	$25,015
Heart failure & shock w/o CC/MCC	MS-DRG	293	16	—	—	$3,961.68	$7,880.01	1.3×	$16,677
Cardiac arrhythmia w MCC	MS-DRG	308	16	—	—	$8,427.3	$16,762	1.4×	$35,475
Cardiac arrhythmia w CC	MS-DRG	309	16	—	—	$5,149.47	$10,243	1.3×	$21,677
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	16	—	—	$3,962.38	$7,881.4	1.3×	$16,680
GI hemorrhage w CC	MS-DRG	378	16	—	—	$6,864.33	$13,654	1.4×	$28,895
GI hemorrhage w/o CC/MCC	MS-DRG	379	16	—	—	$4,412.44	$8,776.6	1.3×	$18,574
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	16	—	—	$5,456.75	$10,854	1.3×	$22,970
Fractures of femur w/o MCC	MS-DRG	533	16	—	—	$10,973	$21,826	1.4×	$46,191
Kidney/UTI w MCC	MS-DRG	689	16	—	—	$8,121.43	$16,154	1.4×	$34,187
Kidney/UTI w/o MCC	MS-DRG	690	16	—	—	$5,666.03	$11,270	1.4×	$23,851
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	16	—	—	$13,596	$27,044	1.4×	$57,234
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	16	—	—	$7,162.51	$14,247	1.4×	$30,151
Initial hospital care, low complexity	CPT	99221	10	—	—	$74.98	$74.98	0.81×	$80.97
Initial hospital care, moderate complexity	CPT	99222	10	—	—	$119.27	$119.27	0.71×	$128.81
Initial hospital care, high complexity	CPT	99223	10	—	—	$159.24	$159.24	0.71×	$171.98
Hospital discharge, <30 min	CPT	99238	10	—	—	$74.57	$74.57	0.87×	$80.53
Hospital discharge, >30 min	CPT	99239	10	—	—	$105.62	$105.62	0.87×	$114.07
lab
Basic metabolic panel (BMP)	CPT	80048	25	$75	$41.25	$8.46	$39.38	1.2×	$66
General health panel	CPT	80050	3	—	—	$48.79	$48.79	0.45×	$50.22
Electrolyte panel	CPT	80051	25	$45	$24.75	$7.01	$23.63	0.99×	$39.6
Comprehensive metabolic panel	CPT	80053	25	$100	$55	$10.56	$52.5	1.2×	$88
Lipid panel	CPT	80061	25	$135	$74.25	$13.39	$74.25	1.9×	$118.8
Renal function panel	CPT	80069	25	$83	$45.65	$8.68	$43.58	1.6×	$73.04
Hepatic function panel	CPT	80076	25	$72	$39.6	$8.17	$37.8	1.4×	$63.36
Urinalysis non-automated	CPT	81002	12	—	—	$3.48	$3.55	0.51×	$8.98
Urinalysis automated	CPT	81003	25	$55	$30.25	$2.25	$20	1.4×	$48.4
Glucose quantitative	CPT	82947	25	$26	$14.3	$3.93	$13.65	0.78×	$22.88
Hemoglobin A1c	CPT	83036	25	$74	$40.7	$5.94	$14.4	0.53×	$65.12
Thyroid stimulating hormone (TSH)	CPT	84443	25	$134	$73.7	$16.8	$55.78	1.2×	$117.92
Complete blood count with automated differential	CPT	85025	25	$57	$31.35	$7.77	$29.93	1.1×	$50.16
Complete blood count without differential	CPT	85027	25	$37	$20.35	$6.47	$19.44	0.90×	$32.56
Urine culture bacterial	CPT	87086	25	$52	$28.6	$5.12	$12.4	0.53×	$45.76
Urine culture identification	CPT	87088	25	$54	$29.7	$8.09	$28.35	1.3×	$47.52
Tissue exam by pathologist level IV	CPT	88305	25	$600	$330	$43.24	$302.4	3.0×	$528
maternity
Fetal non-stress test	CPT	59025	10	—	—	$191.33	$191.33	1.0×	$1,449
Routine obstetric care including vaginal delivery	CPT	59400	10	—	—	$2,101.95	$2,101.95	0.92×	$7,271
Vaginal delivery only	CPT	59409	10	—	—	$3,024.05	$3,054.29	1.4×	$8,783
Vaginal delivery with postpartum	CPT	59410	10	—	—	$928.17	$928.17	0.87×	$7,271
Routine obstetric care with C-section	CPT	59510	10	—	—	$2,312.03	$2,312.03	0.92×	$7,271
C-section delivery only	CPT	59514	10	—	—	$768.55	$768.55	0.80×	$3,370
C-section with postpartum	CPT	59515	10	—	—	$1,140.71	$1,140.71	0.90×	$7,271
office
Office visit, new patient, 15-29 min	CPT	99202	10	—	—	$66.74	$66.74	0.77×	$72.08
Office visit, new patient, 30-44 minutes	CPT	99203	10	—	—	$103.31	$103.31	0.84×	$111.57
Office visit, new patient, 45-59 min	CPT	99204	10	—	—	$155.08	$155.08	0.89×	$167.49
Office visit, new patient, 60-74 min	CPT	99205	23	$567	$311.85	$204.46	$374.22	1.7×	$498.96
Office visit, established patient, 5 min	CPT	99211	23	$141	$77.55	$21.72	$93.06	1.4×	$124.08
Office visit, established patient, 10-19 min	CPT	99212	23	$152	$83.6	$52.59	$100.32	1.3×	$133.76
Office visit, established patient, 20-29 minutes	CPT	99213	23	$180	$99	$84.91	$118.8	1.0×	$158.4
Office visit, established patient, 30-39 minutes	CPT	99214	23	$234	$128.7	$117	$154.44	1.0×	$205.92
Office visit, established patient, 40-54 min	CPT	99215	23	$324	$178.2	$162	$213.84	1.1×	$285.12
preventive
Upper GI endoscopy diagnostic	CPT	43235	10	—	—	$891.71	$900.63	0.98×	$6,312
Upper GI endoscopy with biopsy	CPT	43239	10	—	—	$891.71	$900.63	0.93×	$6,312
Sigmoidoscopy diagnostic	CPT	45330	10	—	—	$867.13	$875.8	1.0×	$4,793
Sigmoidoscopy with biopsy	CPT	45331	10	—	—	$867.13	$875.8	0.98×	$4,793
Colonoscopy diagnostic	CPT	45378	10	—	—	$867.13	$875.8	1.00×	$6,312
Colonoscopy with biopsy	CPT	45380	10	—	—	$1,121.42	$1,132.64	0.93×	$6,312
Colonoscopy with polyp removal	CPT	45385	10	—	—	$1,121.42	$1,132.64	0.94×	$6,312
surgery
Total shoulder arthroplasty	CPT	23472	10	—	—	$11,646	$17,491	4.2×	$19,754
Hip hemiarthroplasty	CPT	27125	10	—	—	$1,019.89	$1,030.09	0.82×	$16,779
Total hip replacement	CPT	27130	10	—	—	$11,646	$12,238	2.8×	$19,754
Total knee replacement	CPT	27447	10	—	—	$11,646	$12,238	2.9×	$19,754
Knee revision arthroplasty single component	CPT	27486	10	—	—	$1,261.01	$1,273.62	0.76×	$19,754
Knee revision arthroplasty all components	CPT	27487	10	—	—	$1,566.58	$1,582.25	0.79×	$19,754
Shoulder arthroscopy with decompression	CPT	29826	10	—	—	$151.65	$151.65	0.46×	$1,449
Shoulder arthroscopy with rotator cuff repair	CPT	29827	10	—	—	$6,794.4	$6,862.35	2.1×	$16,779
Knee arthroscopy with meniscectomy	CPT	29881	10	—	—	$3,085.95	$3,116.81	1.5×	$13,918
ACL reconstruction	CPT	29888	10	—	—	$6,794.4	$6,862.35	2.1×	$16,779
Major small/large bowel procedures w MCC	MS-DRG	329	16	—	—	$32,173	$63,994	1.5×	$135,431
Major small/large bowel procedures w CC	MS-DRG	330	16	—	—	$16,779	$33,374	1.4×	$70,631
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	16	—	—	$11,779	$23,430	1.4×	$49,585
CABG single arterial graft	CPT	33533	10	—	—	$1,596.7	$1,597.03	0.85×	$13,007
CABG 2 arterial grafts	CPT	33534	10	—	—	$1,597.36	$1,874.9	0.87×	$13,007
CABG 3 arterial grafts	CPT	33535	10	—	—	$1,597.36	$2,083.29	0.92×	$13,007
CABG 4+ arterial grafts	CPT	33536	10	—	—	$1,597.36	$2,242.81	0.92×	$13,007
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	16	—	—	$11,840	$23,551	1.4×	$49,841
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	16	—	—	$9,559.81	$19,015	1.4×	$40,242
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	16	—	—	$23,848	$47,435	1.5×	$100,387
Open appendectomy	CPT	44950	10	—	—	$5,934.63	$5,993.98	5.3×	$13,918
Laparoscopic appendectomy	CPT	44970	10	—	—	$5,549.06	$5,549.06	3.6×	$16,779
Major joint replacement w MCC	MS-DRG	469	16	—	—	$21,231	$42,229	1.4×	$89,370
Major joint replacement w/o MCC	MS-DRG	470	16	—	—	$13,501	$26,855	1.4×	$56,833
Laparoscopic cholecystectomy	CPT	47562	10	—	—	$5,549.06	$5,549.06	3.1×	$16,779
Lap cholecystectomy with cholangiography	CPT	47563	10	—	—	$5,549.06	$5,549.06	3.0×	$16,779
Hip & femur procedures except major joint w MCC	MS-DRG	480	16	—	—	$20,384	$40,546	1.4×	$85,808
Hip & femur procedures except major joint w CC	MS-DRG	481	16	—	—	$14,660	$29,160	1.4×	$61,712
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	16	—	—	$11,416	$22,707	1.4×	$48,056
Lap inguinal hernia repair	CPT	49650	10	—	—	$5,549.06	$5,549.06	4.9×	$16,779
Total abdominal hysterectomy	CPT	58150	10	—	—	$915.69	$915.69	0.94×	$13,918
Vaginal hysterectomy	CPT	58260	10	—	—	$4,695.06	$4,742.01	2.6×	$13,918
Lap-assisted vaginal hysterectomy	CPT	58550	10	—	—	$5,549.06	$5,549.06	3.8×	$16,779
Lap-assisted vaginal hysterectomy >250g	CPT	58552	10	—	—	$9,706.25	$9,902.11	4.4×	$16,779
Lap salpingo-oophorectomy	CPT	58661	10	—	—	$5,549.06	$5,549.06	2.7×	$16,779
OR procedure for obesity w MCC	MS-DRG	619	16	—	—	$20,210	$40,199	1.5×	$85,074
OR procedure for obesity w CC	MS-DRG	620	16	—	—	$11,201	$22,280	1.4×	$47,151
OR procedure for obesity w/o CC/MCC	MS-DRG	621	16	—	—	$10,558	$21,000	1.4×	$44,444
Complex cataract surgery	CPT	66982	10	—	—	$2,169.2	$2,190.9	0.99×	$8,783
Cataract surgery with lens implant	CPT	66984	10	—	—	$2,169.2	$2,190.9	1.0×	$8,783
Intravitreal injection	CPT	67028	10	—	—	$315.47	$318.63	0.93×	$1,449
Vitrectomy mechanical	CPT	67042	10	—	—	$3,826.14	$3,864.4	1.5×	$15,743
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	16	—	—	$8,684.19	$17,273	1.4×	$36,556
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	16	—	—	$14,343	$28,528	1.5×	$60,375
PCI single major coronary artery	CPT	92920	25	$11,176	$6,146.8	$3,688.08	$8,046.72	1.4×	$16,779
PCI with drug-eluting stent	CPT	92928	25	$11,741	$6,457.55	$3,874.53	$9,392.8	0.94×	$16,779
PCI bypass graft	CPT	92937	25	$11,741	$6,457.55	$3,874.53	$9,392.8	0.86×	$16,779
Left heart catheterization	CPT	93452	10	—	—	$3,059.13	$3,089.72	1.00×	$15,743
Coronary angiography with cath	CPT	93455	25	$11,355	$6,245.25	$3,059.13	$7,834.95	2.5×	$15,743
Coronary angiography with bypass cath	CPT	93458	25	$16,000	$8,800	$3,059.13	$10,448	3.4×	$15,743

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 25)

Payer	Codes covered	Median rate
UnitedHealthcare	197	$2,035
network health plan	197	$1,692
Anthem BCBS	197	$1,470
security health plan	196	$617.96
community care incorporated	196	$339.67
Molina	196	$366.84
Humana	196	$339.67
allwell	196	$346.46
health partners	196	$915.69
icare	196	$339.67
chorus community health plan	135	$1,768.25
health payment systems	135	$1,175
wps health plan	134	$1,850
dean health plan	134	$1,250
centivo	128	$1,176.8
medical college of wisconsin	128	$907.5
Multiplan	91	$783.6
First Health	91	$861.96
preferred one	91	$783.6
Cigna	91	$705.24
sheboygan employers health network	91	$587.7
trilogy	91	$646.47
healthsmart	91	$812.99
aspirus	91	$783.6
healtheos	91	$783.6

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