▸ Hospital · WI · CCN 520107
Holy Family Memorial
2300 WESTERN AVENUE, MANITOWOC, WI, 54221
45 bedsAcute Care Hospitals2
Compliance grade
A
100/100
Procedures tracked
197
of 209 target codes
Payers
25
with negotiated rates
Rates published
81,072
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 | — | — | $2,284 | $18,860 | $41,155 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 10 | — | — | $152.81 | $152.81 | $165.04 |
| Psychiatric eval with medical services | CPT | 90792 | 10 | — | — | $152.81 | $152.81 | $165.04 |
| Psychotherapy 30 minutes | CPT | 90832 | 10 | — | — | $152.81 | $152.81 | $165.04 |
| Psychotherapy 45 minutes | CPT | 90834 | 10 | — | — | $152.81 | $152.81 | $165.04 |
| Psychotherapy 60 minutes | CPT | 90837 | 10 | — | — | $152.81 | $152.81 | $165.04 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 10 | — | — | $152.81 | $152.81 | $165.04 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 25 | $375 | $206.25 | $69.3 | $171.15 | $943 |
| ED visit level 2 | CPT | 99282 | 25 | $525 | $288.75 | $150.62 | $378 | $1,854 |
| ED visit level 3 | CPT | 99283 | 25 | $1,100 | $605 | $263.35 | $792 | $4,183 |
| ED visit level 4 | CPT | 99284 | 25 | $1,800 | $990 | $360.69 | $874.4 | $5,506 |
| ED visit level 5 | CPT | 99285 | 25 | $2,500 | $1,375 | $369.6 | $929.6 | $6,052 |
| Critical care, first hour | CPT | 99291 | 25 | $3,675 | $2,021.25 | $801.41 | $2,646 | $6,427 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 25 | $1,854 | $1,019.7 | $101.14 | $1,192.12 | $1,631.52 |
| CT head with contrast | CPT | 70460 | 25 | $2,060 | $1,133 | $168.07 | $1,306 | $1,812.8 |
| CT head with and without contrast | CPT | 70470 | 25 | $2,266 | $1,246.3 | $169.31 | $1,359.6 | $1,994.08 |
| CT neck with contrast | CPT | 70491 | 25 | $2,060 | $1,133 | $169.31 | $1,306 | $1,812.8 |
| MRI brain without contrast | CPT | 70551 | 25 | $2,500 | $1,375 | $229.9 | $1,671 | $2,440 |
| MRI brain with contrast | CPT | 70552 | 25 | $3,500 | $1,925 | $339.67 | $2,175.25 | $3,080 |
| MRI brain with and without contrast | CPT | 70553 | 25 | $4,500 | $2,475 | $339.67 | $2,570 | $3,960 |
| Chest X-ray single view | CPT | 71045 | 25 | $191 | $105.05 | $28.92 | $137.52 | $597 |
| Chest X-ray 2 views | CPT | 71046 | 25 | $244 | $134.2 | $39.06 | $175.68 | $597 |
| Chest X-ray 3 views | CPT | 71047 | 25 | $425 | $233.75 | $49.2 | $293.25 | $597 |
| CT chest without contrast | CPT | 71250 | 25 | $1,442 | $793.1 | $101.14 | $1,035.62 | $1,565 |
| CT chest with contrast | CPT | 71260 | 25 | $1,648 | $906.4 | $169.31 | $1,087.68 | $1,565 |
| CT chest with and without contrast | CPT | 71270 | 25 | $1,854 | $1,019.7 | $169.31 | $1,198.61 | $1,631.52 |
| MRI chest without contrast | CPT | 71550 | 25 | $2,750 | $1,512.5 | $229.9 | $1,801.25 | $2,440 |
| MRI chest with contrast | CPT | 71551 | 10 | — | — | $751.43 | $751.43 | $811.54 |
| MRI chest with and without contrast | CPT | 71552 | 25 | $4,950 | $2,722.5 | $339.67 | $2,722.5 | $4,356 |
| Lumbosacral spine X-ray | CPT | 72100 | 25 | $237 | $130.35 | $49.2 | $170.64 | $597 |
| CT cervical spine without contrast | CPT | 72125 | 25 | $2,060 | $1,133 | $101.14 | $1,315.29 | $1,812.8 |
| CT thoracic spine without contrast | CPT | 72128 | 25 | $2,060 | $1,133 | $101.14 | $1,315.29 | $1,812.8 |
| CT lumbar spine without contrast | CPT | 72131 | 25 | $2,060 | $1,133 | $101.14 | $1,315.29 | $1,812.8 |
| MRI cervical spine without contrast | CPT | 72141 | 25 | $3,000 | $1,650 | $229.9 | $1,939.5 | $2,640 |
| MRI thoracic spine without contrast | CPT | 72146 | 25 | $3,000 | $1,650 | $229.9 | $1,939.5 | $2,640 |
| MRI lumbar spine without contrast | CPT | 72148 | 25 | $3,000 | $1,650 | $229.9 | $1,939.5 | $2,640 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 25 | $3,500 | $1,925 | $339.67 | $2,175.25 | $3,080 |
| MRI cervical spine with and without contrast | CPT | 72156 | 25 | $4,000 | $2,200 | $339.67 | $2,400 | $3,520 |
| MRI lumbar spine with contrast | CPT | 72158 | 25 | $4,000 | $2,200 | $339.67 | $2,400 | $3,520 |
| CT pelvis without contrast | CPT | 72192 | 25 | $2,884 | $1,586.2 | $101.14 | $1,647.7 | $2,537.92 |
| CT pelvis with contrast | CPT | 72193 | 25 | $3,090 | $1,699.5 | $169.31 | $1,709.5 | $2,719.2 |
| Shoulder X-ray | CPT | 73030 | 25 | $222 | $122.1 | $43 | $159.84 | $597 |
| Humerus X-ray | CPT | 73060 | 25 | $265 | $145.75 | $40.75 | $190.8 | $597 |
| Hand X-ray 3 views | CPT | 73130 | 25 | $383 | $210.65 | $48.07 | $264.27 | $597 |
| MRI upper extremity joint without contrast | CPT | 73221 | 25 | $4,400 | $2,420 | $229.9 | $2,540 | $3,872 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 25 | $6,600 | $3,630 | $339.67 | $3,630 | $5,808 |
| Knee X-ray 1-2 views | CPT | 73560 | 25 | $272 | $149.6 | $44.13 | $195.84 | $597 |
| Ankle X-ray 3 views | CPT | 73610 | 25 | $363 | $199.65 | $48.07 | $252.88 | $597 |
| MRI lower extremity joint without contrast | CPT | 73721 | 25 | $4,400 | $2,420 | $229.9 | $2,540 | $3,872 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 25 | $6,600 | $3,630 | $339.67 | $3,630 | $5,808 |
| CT abdomen without contrast | CPT | 74150 | 25 | $1,854 | $1,019.7 | $101.14 | $1,198.61 | $1,631.52 |
| CT abdomen with contrast | CPT | 74160 | 25 | $2,060 | $1,133 | $169.31 | $1,315.29 | $1,812.8 |
| CT abdomen with and without contrast | CPT | 74170 | 25 | $2,266 | $1,246.3 | $169.31 | $1,408.32 | $1,994.08 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 25 | $3,296 | $1,812.8 | $229.9 | $1,812.8 | $2,900.48 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 25 | $3,502 | $1,926.1 | $339.67 | $1,926.1 | $3,081.76 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 25 | $5,150 | $2,832.5 | $339.67 | $2,832.5 | $4,532 |
| MRI abdomen without contrast | CPT | 74181 | 25 | $2,750 | $1,512.5 | $229.9 | $1,801.25 | $2,440 |
| MRI abdomen with and without contrast | CPT | 74183 | 25 | $4,950 | $2,722.5 | $339.67 | $2,722.5 | $4,356 |
| Abdominal ultrasound complete | CPT | 76700 | 25 | $887 | $487.85 | $101.14 | $555.17 | $780.56 |
| Abdominal ultrasound limited | CPT | 76705 | 25 | $639 | $351.45 | $101.14 | $426.87 | $647 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 25 | $859 | $472.45 | $101.14 | $546.17 | $755.92 |
| Obstetric ultrasound first trimester | CPT | 76801 | 25 | $969 | $532.95 | $101.14 | $581.4 | $852.72 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 25 | $1,211 | $666.05 | $101.14 | $704.8 | $1,065.68 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 10 | — | — | $229.9 | $229.9 | $248.29 |
| Transvaginal ultrasound | CPT | 76830 | 25 | $990 | $544.5 | $101.14 | $594 | $871.2 |
| Pelvic ultrasound complete | CPT | 76856 | 25 | $816 | $448.8 | $101.14 | $527.55 | $718.08 |
| Scrotal ultrasound | CPT | 76870 | 25 | $716 | $393.8 | $101.14 | $462.9 | $647 |
| Diagnostic mammography unilateral | CPT | 77065 | 25 | $335 | $184.25 | $110.55 | $201 | $294.8 |
| Diagnostic mammography bilateral | CPT | 77066 | 25 | $583 | $320.65 | $126 | $339.31 | $513.04 |
| Screening mammography bilateral | CPT | 77067 | 25 | $480 | $264 | $119.22 | $279.36 | $422.4 |
| EKG complete | CPT | 93000 | 10 | — | — | $13.14 | $13.14 | $14.19 |
| EKG tracing only | CPT | 93005 | 25 | $200 | $110 | $56.5 | $144 | $251 |
| EKG interpretation only | CPT | 93010 | 10 | — | — | $7.46 | $7.46 | $8.06 |
| Transthoracic echocardiogram complete | CPT | 93306 | 25 | $2,706 | $1,488.3 | $515 | $1,610.07 | $2,381.28 |
| Transthoracic echocardiogram | CPT | 93307 | 25 | $2,200 | $1,210 | $229.9 | $1,309 | $1,936 |
| Stress echocardiogram | CPT | 93350 | 25 | $1,885 | $1,036.75 | $515 | $1,121.58 | $1,658.8 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 16 | — | — | $14,076 | $27,998 | $59,252 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 16 | — | — | $7,071.51 | $14,066 | $29,767 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 16 | — | — | $4,790.41 | $9,528.41 | $20,165 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 16 | — | — | $10,938 | $21,756 | $46,043 |
| COPD w MCC | MS-DRG | 190 | 16 | — | — | $7,753.26 | $15,422 | $32,637 |
| COPD w CC | MS-DRG | 191 | 16 | — | — | $5,900.51 | $11,736 | $24,838 |
| COPD w/o CC/MCC | MS-DRG | 192 | 16 | — | — | $4,493.63 | $8,938.11 | $18,916 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 16 | — | — | $5,640.83 | $11,220 | $23,745 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 16 | — | — | $4,399.13 | $8,750.15 | $18,518 |
| AMI discharged alive w MCC | MS-DRG | 280 | 16 | — | — | $11,228 | $22,333 | $47,263 |
| AMI discharged alive w CC | MS-DRG | 281 | 16 | — | — | $6,433.17 | $12,796 | $27,080 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 16 | — | — | $5,061.29 | $10,067 | $21,305 |
| Heart failure & shock w MCC | MS-DRG | 291 | 16 | — | — | $8,985.86 | $17,873 | $37,826 |
| Heart failure & shock w CC | MS-DRG | 292 | 16 | — | — | $5,942.52 | $11,820 | $25,015 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 16 | — | — | $3,961.68 | $7,880.01 | $16,677 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 16 | — | — | $8,427.3 | $16,762 | $35,475 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 16 | — | — | $5,149.47 | $10,243 | $21,677 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 16 | — | — | $3,962.38 | $7,881.4 | $16,680 |
| GI hemorrhage w CC | MS-DRG | 378 | 16 | — | — | $6,864.33 | $13,654 | $28,895 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 16 | — | — | $4,412.44 | $8,776.6 | $18,574 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 16 | — | — | $5,456.75 | $10,854 | $22,970 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 16 | — | — | $10,973 | $21,826 | $46,191 |
| Kidney/UTI w MCC | MS-DRG | 689 | 16 | — | — | $8,121.43 | $16,154 | $34,187 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 16 | — | — | $5,666.03 | $11,270 | $23,851 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 16 | — | — | $13,596 | $27,044 | $57,234 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 16 | — | — | $7,162.51 | $14,247 | $30,151 |
| Initial hospital care, low complexity | CPT | 99221 | 10 | — | — | $74.98 | $74.98 | $80.97 |
| Initial hospital care, moderate complexity | CPT | 99222 | 10 | — | — | $119.27 | $119.27 | $128.81 |
| Initial hospital care, high complexity | CPT | 99223 | 10 | — | — | $159.24 | $159.24 | $171.98 |
| Hospital discharge, <30 min | CPT | 99238 | 10 | — | — | $74.57 | $74.57 | $80.53 |
| Hospital discharge, >30 min | CPT | 99239 | 10 | — | — | $105.62 | $105.62 | $114.07 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 25 | $75 | $41.25 | $8.46 | $39.38 | $66 |
| General health panel | CPT | 80050 | 3 | — | — | $48.79 | $48.79 | $50.22 |
| Electrolyte panel | CPT | 80051 | 25 | $45 | $24.75 | $7.01 | $23.63 | $39.6 |
| Comprehensive metabolic panel | CPT | 80053 | 25 | $100 | $55 | $10.56 | $52.5 | $88 |
| Lipid panel | CPT | 80061 | 25 | $135 | $74.25 | $13.39 | $74.25 | $118.8 |
| Renal function panel | CPT | 80069 | 25 | $83 | $45.65 | $8.68 | $43.58 | $73.04 |
| Hepatic function panel | CPT | 80076 | 25 | $72 | $39.6 | $8.17 | $37.8 | $63.36 |
| Urinalysis non-automated | CPT | 81002 | 12 | — | — | $3.48 | $3.55 | $8.98 |
| Urinalysis automated | CPT | 81003 | 25 | $55 | $30.25 | $2.25 | $20 | $48.4 |
| Glucose quantitative | CPT | 82947 | 25 | $26 | $14.3 | $3.93 | $13.65 | $22.88 |
| Hemoglobin A1c | CPT | 83036 | 25 | $74 | $40.7 | $5.94 | $14.4 | $65.12 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 25 | $134 | $73.7 | $16.8 | $55.78 | $117.92 |
| Complete blood count with automated differential | CPT | 85025 | 25 | $57 | $31.35 | $7.77 | $29.93 | $50.16 |
| Complete blood count without differential | CPT | 85027 | 25 | $37 | $20.35 | $6.47 | $19.44 | $32.56 |
| Urine culture bacterial | CPT | 87086 | 25 | $52 | $28.6 | $5.12 | $12.4 | $45.76 |
| Urine culture identification | CPT | 87088 | 25 | $54 | $29.7 | $8.09 | $28.35 | $47.52 |
| Tissue exam by pathologist level IV | CPT | 88305 | 25 | $600 | $330 | $43.24 | $302.4 | $528 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 10 | — | — | $191.33 | $191.33 | $1,449 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 10 | — | — | $2,101.95 | $2,101.95 | $7,271 |
| Vaginal delivery only | CPT | 59409 | 10 | — | — | $3,024.05 | $3,054.29 | $8,783 |
| Vaginal delivery with postpartum | CPT | 59410 | 10 | — | — | $928.17 | $928.17 | $7,271 |
| Routine obstetric care with C-section | CPT | 59510 | 10 | — | — | $2,312.03 | $2,312.03 | $7,271 |
| C-section delivery only | CPT | 59514 | 10 | — | — | $768.55 | $768.55 | $3,370 |
| C-section with postpartum | CPT | 59515 | 10 | — | — | $1,140.71 | $1,140.71 | $7,271 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 10 | — | — | $66.74 | $66.74 | $72.08 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 10 | — | — | $103.31 | $103.31 | $111.57 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 10 | — | — | $155.08 | $155.08 | $167.49 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 23 | $567 | $311.85 | $204.46 | $374.22 | $498.96 |
| Office visit, established patient, 5 min | CPT | 99211 | 23 | $141 | $77.55 | $21.72 | $93.06 | $124.08 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 23 | $152 | $83.6 | $52.59 | $100.32 | $133.76 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 23 | $180 | $99 | $84.91 | $118.8 | $158.4 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 23 | $234 | $128.7 | $117 | $154.44 | $205.92 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 23 | $324 | $178.2 | $162 | $213.84 | $285.12 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 10 | — | — | $891.71 | $900.63 | $6,312 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 10 | — | — | $891.71 | $900.63 | $6,312 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 10 | — | — | $867.13 | $875.8 | $4,793 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 10 | — | — | $867.13 | $875.8 | $4,793 |
| Colonoscopy diagnostic | CPT | 45378 | 10 | — | — | $867.13 | $875.8 | $6,312 |
| Colonoscopy with biopsy | CPT | 45380 | 10 | — | — | $1,121.42 | $1,132.64 | $6,312 |
| Colonoscopy with polyp removal | CPT | 45385 | 10 | — | — | $1,121.42 | $1,132.64 | $6,312 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 10 | — | — | $11,646 | $17,491 | $19,754 |
| Hip hemiarthroplasty | CPT | 27125 | 10 | — | — | $1,019.89 | $1,030.09 | $16,779 |
| Total hip replacement | CPT | 27130 | 10 | — | — | $11,646 | $12,238 | $19,754 |
| Total knee replacement | CPT | 27447 | 10 | — | — | $11,646 | $12,238 | $19,754 |
| Knee revision arthroplasty single component | CPT | 27486 | 10 | — | — | $1,261.01 | $1,273.62 | $19,754 |
| Knee revision arthroplasty all components | CPT | 27487 | 10 | — | — | $1,566.58 | $1,582.25 | $19,754 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 10 | — | — | $151.65 | $151.65 | $1,449 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 10 | — | — | $6,794.4 | $6,862.35 | $16,779 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 10 | — | — | $3,085.95 | $3,116.81 | $13,918 |
| ACL reconstruction | CPT | 29888 | 10 | — | — | $6,794.4 | $6,862.35 | $16,779 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 16 | — | — | $32,173 | $63,994 | $135,431 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 16 | — | — | $16,779 | $33,374 | $70,631 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 16 | — | — | $11,779 | $23,430 | $49,585 |
| CABG single arterial graft | CPT | 33533 | 10 | — | — | $1,596.7 | $1,597.03 | $13,007 |
| CABG 2 arterial grafts | CPT | 33534 | 10 | — | — | $1,597.36 | $1,874.9 | $13,007 |
| CABG 3 arterial grafts | CPT | 33535 | 10 | — | — | $1,597.36 | $2,083.29 | $13,007 |
| CABG 4+ arterial grafts | CPT | 33536 | 10 | — | — | $1,597.36 | $2,242.81 | $13,007 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 16 | — | — | $11,840 | $23,551 | $49,841 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 16 | — | — | $9,559.81 | $19,015 | $40,242 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 16 | — | — | $23,848 | $47,435 | $100,387 |
| Open appendectomy | CPT | 44950 | 10 | — | — | $5,934.63 | $5,993.98 | $13,918 |
| Laparoscopic appendectomy | CPT | 44970 | 10 | — | — | $5,549.06 | $5,549.06 | $16,779 |
| Major joint replacement w MCC | MS-DRG | 469 | 16 | — | — | $21,231 | $42,229 | $89,370 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 16 | — | — | $13,501 | $26,855 | $56,833 |
| Laparoscopic cholecystectomy | CPT | 47562 | 10 | — | — | $5,549.06 | $5,549.06 | $16,779 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 10 | — | — | $5,549.06 | $5,549.06 | $16,779 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 16 | — | — | $20,384 | $40,546 | $85,808 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 16 | — | — | $14,660 | $29,160 | $61,712 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 16 | — | — | $11,416 | $22,707 | $48,056 |
| Lap inguinal hernia repair | CPT | 49650 | 10 | — | — | $5,549.06 | $5,549.06 | $16,779 |
| Total abdominal hysterectomy | CPT | 58150 | 10 | — | — | $915.69 | $915.69 | $13,918 |
| Vaginal hysterectomy | CPT | 58260 | 10 | — | — | $4,695.06 | $4,742.01 | $13,918 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 10 | — | — | $5,549.06 | $5,549.06 | $16,779 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 10 | — | — | $9,706.25 | $9,902.11 | $16,779 |
| Lap salpingo-oophorectomy | CPT | 58661 | 10 | — | — | $5,549.06 | $5,549.06 | $16,779 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 16 | — | — | $20,210 | $40,199 | $85,074 |
| OR procedure for obesity w CC | MS-DRG | 620 | 16 | — | — | $11,201 | $22,280 | $47,151 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 16 | — | — | $10,558 | $21,000 | $44,444 |
| Complex cataract surgery | CPT | 66982 | 10 | — | — | $2,169.2 | $2,190.9 | $8,783 |
| Cataract surgery with lens implant | CPT | 66984 | 10 | — | — | $2,169.2 | $2,190.9 | $8,783 |
| Intravitreal injection | CPT | 67028 | 10 | — | — | $315.47 | $318.63 | $1,449 |
| Vitrectomy mechanical | CPT | 67042 | 10 | — | — | $3,826.14 | $3,864.4 | $15,743 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 16 | — | — | $8,684.19 | $17,273 | $36,556 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 16 | — | — | $14,343 | $28,528 | $60,375 |
| PCI single major coronary artery | CPT | 92920 | 25 | $11,176 | $6,146.8 | $3,688.08 | $8,046.72 | $16,779 |
| PCI with drug-eluting stent | CPT | 92928 | 25 | $11,741 | $6,457.55 | $3,874.53 | $9,392.8 | $16,779 |
| PCI bypass graft | CPT | 92937 | 25 | $11,741 | $6,457.55 | $3,874.53 | $9,392.8 | $16,779 |
| Left heart catheterization | CPT | 93452 | 10 | — | — | $3,059.13 | $3,089.72 | $15,743 |
| Coronary angiography with cath | CPT | 93455 | 25 | $11,355 | $6,245.25 | $3,059.13 | $7,834.95 | $15,743 |
| Coronary angiography with bypass cath | CPT | 93458 | 25 | $16,000 | $8,800 | $3,059.13 | $10,448 | $15,743 |
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 |