Does Ascension SE Wisconsin Hospital - Elmbrook Campus publish its standard charges and chargemaster?

Yes. Ascension SE Wisconsin Hospital - Elmbrook Campus publishes a machine-readable file with 8,282 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 Ascension SE Wisconsin Hospital - Elmbrook Campus charge for procedures?

Ascension SE Wisconsin Hospital - Elmbrook Campus (Brookfield, 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 520170

Ascension SE Wisconsin Hospital - Elmbrook Campus

Brookfield, WI, 53045-

108 beds11

Compliance grade

100/100

Rates published

8,282

last crawl 2026-05-24

Procedures tracked

194

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://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/wi-csv/390816857-1427007384_ascension-se-wisconsin-hospital-inc-elmbroook_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	6	—	—	$1,502	$6,062.23	0.47×	$14,464
Psychiatric diagnostic evaluation	CPT	90791	4	—	—	$156.01	$156.01	0.88×	$440.5
Psychiatric eval with medical services	CPT	90792	4	—	—	$156.01	$156.01	0.90×	$486.98
Psychotherapy 30 minutes	CPT	90832	4	—	—	$156.01	$156.01	1.0×	$218.41
Psychotherapy 45 minutes	CPT	90834	4	—	—	$156.01	$156.01	0.97×	$284.51
Psychotherapy 60 minutes	CPT	90837	4	—	—	$156.01	$156.01	0.82×	$426.53
Crisis psychotherapy 60 minutes	CPT	90839	4	—	—	$156.01	$156.01	0.98×	$445.88
emergency
ED visit level 1	CPT	99281	10	$493	$261.29	$56.72	$321	2.3×	$634
ED visit level 2	CPT	99282	10	$864	$457.92	$110.53	$478.29	2.0×	$899
ED visit level 3	CPT	99283	10	$1,952	$1,034.56	$165.41	$1,075	2.7×	$2,011
ED visit level 4	CPT	99284	10	$3,334	$1,767.02	$313.78	$2,147	3.2×	$4,880
ED visit level 5	CPT	99285	10	$3,434	$1,820.02	$462.81	$2,987	2.9×	$4,880
Critical care, first hour	CPT	99291	9	$2,614	$1,385.42	$730.62	$2,623.5	2.4×	$7,179
imaging
CT head without contrast	CPT	70450	7	$1,588	$841.64	$103.26	$144.85	0.70×	$1,238.64
CT head with contrast	CPT	70460	7	$1,604	$850.12	$172.86	$242	1.0×	$1,251.12
CT head with and without contrast	CPT	70470	7	$1,628	$862.84	$172.86	$242	0.91×	$1,269.84
CT neck with contrast	CPT	70491	7	$1,604	$850.12	$172.86	$242	0.88×	$1,251.12
MRI brain without contrast	CPT	70551	7	$2,523	$1,337.19	$234.71	$328.59	0.81×	$1,967.94
MRI brain with contrast	CPT	70552	7	$2,625	$1,391.25	$304.91	$485.49	1.0×	$2,047.5
MRI brain with and without contrast	CPT	70553	7	$2,692	$1,426.76	$346.78	$485.49	0.82×	$2,099.76
Chest X-ray single view	CPT	71045	7	$218	$115.54	$31.21	$85.5	0.90×	$204
Chest X-ray 2 views	CPT	71046	7	$323	$171.19	$37.34	$93.64	0.95×	$251.94
Chest X-ray 3 views	CPT	71047	7	$353	$187.09	$48.24	$102.6	1.1×	$275.34
CT chest without contrast	CPT	71250	7	$1,588	$841.64	$103.26	$159.84	0.74×	$1,238.64
CT chest with contrast	CPT	71260	7	$1,604	$850.12	$172.86	$242	0.86×	$1,251.12
CT chest with and without contrast	CPT	71270	7	$1,620	$858.6	$172.86	$242	0.83×	$1,263.6
MRI chest without contrast	CPT	71550	7	$2,523	$1,337.19	$234.71	$328.59	0.76×	$1,967.94
MRI chest with contrast	CPT	71551	6	—	—	$295.22	$836	1.0×	$1,609.16
MRI chest with and without contrast	CPT	71552	7	$2,692	$1,426.76	$346.78	$485.49	0.81×	$2,099.76
Lumbosacral spine X-ray	CPT	72100	7	$293	$155.29	$38.5	$109.61	1.1×	$245.18
CT cervical spine without contrast	CPT	72125	7	$1,620	$858.6	$103.26	$164.12	0.81×	$1,263.6
CT thoracic spine without contrast	CPT	72128	7	$1,588	$841.64	$103.26	$158.02	0.79×	$1,238.64
CT lumbar spine without contrast	CPT	72131	7	$1,588	$841.64	$103.26	$158.02	0.78×	$1,238.64
MRI cervical spine without contrast	CPT	72141	7	$2,523	$1,337.19	$234.71	$328.59	0.83×	$1,967.94
MRI thoracic spine without contrast	CPT	72146	7	$2,523	$1,337.19	$234.71	$328.59	0.88×	$1,967.94
MRI lumbar spine without contrast	CPT	72148	7	$2,532	$1,341.96	$234.71	$328.59	0.87×	$1,974.96
MRI lumbar spine with and without contrast	CPT	72149	7	$2,617	$1,387.01	$305.64	$485.49	1.1×	$2,041.26
MRI cervical spine with and without contrast	CPT	72156	7	$2,692	$1,426.76	$346.78	$485.49	0.90×	$2,099.76
MRI lumbar spine with contrast	CPT	72158	7	$2,719	$1,441.07	$346.78	$485.49	0.89×	$2,120.82
CT pelvis without contrast	CPT	72192	7	$1,588	$841.64	$103.26	$165.36	0.83×	$1,238.64
CT pelvis with contrast	CPT	72193	7	$1,637	$867.61	$172.86	$242	0.86×	$1,276.86
Shoulder X-ray	CPT	73030	7	$299	$158.47	$32.4	$90.59	0.98×	$233.22
Humerus X-ray	CPT	73060	7	$279	$147.87	$28.74	$90.52	1.0×	$217.62
Hand X-ray 3 views	CPT	73130	7	$323	$171.19	$29.98	$93.5	1.0×	$251.94
MRI upper extremity joint without contrast	CPT	73221	7	$2,557	$1,355.21	$232.67	$328.59	0.79×	$1,994.46
MRI upper extremity joint with and without contrast	CPT	73223	7	$2,800	$1,484	$346.78	$485.49	0.79×	$2,184
Knee X-ray 1-2 views	CPT	73560	7	$279	$147.87	$28.74	$94.07	1.0×	$217.62
Ankle X-ray 3 views	CPT	73610	7	$299	$158.47	$29.98	$94.69	1.0×	$233.22
MRI lower extremity joint without contrast	CPT	73721	7	$2,557	$1,355.21	$232.67	$328.59	0.70×	$1,994.46
MRI lower extremity joint with and without contrast	CPT	73723	7	$2,692	$1,426.76	$346.78	$485.49	0.77×	$2,099.76
CT abdomen without contrast	CPT	74150	7	$1,588	$841.64	$103.26	$174.25	0.93×	$1,238.64
CT abdomen with contrast	CPT	74160	7	$1,604	$850.12	$172.86	$242	0.84×	$1,251.12
CT abdomen with and without contrast	CPT	74170	7	$1,628	$862.84	$172.86	$242	0.72×	$1,269.84
CT abdomen and pelvis without contrast	CPT	74176	7	$2,287	$1,212.11	$234.71	$328.59	0.90×	$1,783.86
CT abdomen and pelvis with contrast	CPT	74177	7	$2,405	$1,274.65	$312.23	$485.49	0.88×	$1,875.9
CT abdomen and pelvis with and without contrast	CPT	74178	7	$2,405	$1,274.65	$343.48	$485.49	0.84×	$1,875.9
MRI abdomen without contrast	CPT	74181	7	$2,532	$1,341.96	$234.71	$328.59	0.84×	$1,974.96
MRI abdomen with and without contrast	CPT	74183	7	$2,692	$1,426.76	$346.78	$485.49	0.86×	$2,099.76
Abdominal ultrasound complete	CPT	76700	7	$784	$415.52	$103.26	$144.56	0.97×	$611.52
Abdominal ultrasound limited	CPT	76705	7	$707	$374.71	$100.98	$144.56	0.99×	$551.46
Retroperitoneal ultrasound complete	CPT	76770	7	$963	$510.39	$103.26	$144.56	1.0×	$751.14
Obstetric ultrasound first trimester	CPT	76801	7	$693	$367.29	$103.26	$158	1.1×	$540.54
Obstetric ultrasound after first trimester	CPT	76805	7	$693	$367.29	$103.26	$158.34	1.0×	$540.54
Obstetric ultrasound with fetal anatomy	CPT	76811	6	—	—	$234.71	$328.59	1.4×	$613.38
Transvaginal ultrasound	CPT	76830	7	$886	$469.58	$103.26	$144.56	0.98×	$691.08
Pelvic ultrasound complete	CPT	76856	7	$700	$371	$103.26	$144.56	1.0×	$546
Scrotal ultrasound	CPT	76870	7	$728	$385.84	$103.26	$131.07	1.00×	$567.84
Diagnostic mammography unilateral	CPT	77065	9	$513	$271.89	$36.64	$133.14	0.89×	$445.46
Diagnostic mammography bilateral	CPT	77066	9	$720	$381.6	$44.99	$164	0.86×	$565.28
Screening mammography bilateral	CPT	77067	9	$489	$259.17	$34.34	$126.24	0.80×	$456.3
EKG complete	CPT	93000	1	—	—	$55.83	$55.83	2.3×	$55.83
EKG tracing only	CPT	93005	4	$491	$260.23	$27.44	$57.68	0.49×	$80.75
EKG interpretation only	CPT	93010	1	—	—	$28.39	$28.39	1.6×	$28.39
Transthoracic echocardiogram complete	CPT	93306	4	$5,824	$3,086.72	$214.17	$532.41	0.89×	$750.65
Transthoracic echocardiogram	CPT	93307	4	$2,657	$1,408.21	$152.52	$234.71	0.95×	$430.1
Stress echocardiogram	CPT	93350	4	$4,180	$2,215.4	$239.46	$532.41	1.0×	$793.42
inpatient
Respiratory infections & inflammations w MCC	MS-DRG	177	3	—	—	$11,559	$11,559	0.75×	$16,182
COPD w MCC	MS-DRG	190	3	—	—	$8,193.11	$8,193.11	0.73×	$11,470
COPD w CC	MS-DRG	191	3	—	—	$6,235.26	$6,235.26	0.71×	$8,729.36
COPD w/o CC/MCC	MS-DRG	192	3	—	—	$4,748.56	$4,748.56	0.68×	$6,647.98
Simple pneumonia & pleurisy w CC	MS-DRG	194	3	—	—	$5,960.85	$5,960.85	0.70×	$8,345.19
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	3	—	—	$4,648.71	$4,648.71	0.70×	$6,508.19
AMI discharged alive w MCC	MS-DRG	280	3	—	—	$11,865	$11,865	0.76×	$16,611
AMI discharged alive w CC	MS-DRG	281	3	—	—	$6,798.13	$6,798.13	0.70×	$9,517.38
AMI discharged alive w/o CC/MCC	MS-DRG	282	3	—	—	$5,348.42	$5,348.42	0.69×	$7,487.79
Heart failure & shock w MCC	MS-DRG	291	3	—	—	$9,495.64	$9,495.64	0.74×	$13,294
Heart failure & shock w CC	MS-DRG	292	3	—	—	$6,279.64	$6,279.64	0.70×	$8,791.5
Heart failure & shock w/o CC/MCC	MS-DRG	293	3	—	—	$4,186.42	$4,186.42	0.67×	$5,860.99
Cardiac arrhythmia w MCC	MS-DRG	308	3	—	—	$8,905.4	$8,905.4	0.74×	$12,468
Cardiac arrhythmia w CC	MS-DRG	309	3	—	—	$5,441.61	$5,441.61	0.70×	$7,618.25
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	3	—	—	$4,187.16	$4,187.16	0.67×	$5,862.02
GI hemorrhage w CC	MS-DRG	378	3	—	—	$7,253.76	$7,253.76	0.72×	$10,155
GI hemorrhage w/o CC/MCC	MS-DRG	379	3	—	—	$4,662.76	$4,662.76	0.68×	$6,527.86
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	3	—	—	$5,766.32	$5,766.32	0.72×	$8,072.85
Fractures of femur w/o MCC	MS-DRG	533	3	—	—	$11,596	$11,596	0.76×	$16,234
Kidney/UTI w MCC	MS-DRG	689	3	—	—	$8,582.17	$8,582.17	0.74×	$12,015
Kidney/UTI w/o MCC	MS-DRG	690	3	—	—	$5,987.47	$5,987.47	0.72×	$8,382.46
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	3	—	—	$14,368	$14,368	0.77×	$20,115
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	3	—	—	$7,568.85	$7,568.85	0.73×	$10,596
Initial hospital care, low complexity	CPT	99221	1	—	—	$269.34	$269.34	2.9×	$269.34
Initial hospital care, moderate complexity	CPT	99222	1	—	—	$365.38	$365.38	2.2×	$365.38
Initial hospital care, high complexity	CPT	99223	1	—	—	$540.36	$540.36	2.4×	$540.36
Hospital discharge, <30 min	CPT	99238	1	—	—	$193.86	$193.86	2.3×	$193.86
Hospital discharge, >30 min	CPT	99239	1	—	—	$286.93	$286.93	2.4×	$286.93
lab
Basic metabolic panel (BMP)	CPT	80048	13	$96	$50.88	$8.46	$11.84	0.37×	$39.74
General health panel	CPT	80050	4	$344	$182.32	$59.01	$61.78	0.58×	$149.9
Electrolyte panel	CPT	80051	13	$79	$41.87	$7.01	$9.81	0.41×	$32.95
Comprehensive metabolic panel	CPT	80053	13	$124	$65.72	$10.56	$14.78	0.33×	$49.65
Lipid panel	CPT	80061	13	$96	$50.88	$13.39	$18.68	0.49×	$87.35
Renal function panel	CPT	80069	13	$108	$57.24	$8.68	$12.15	0.45×	$40.81
Hepatic function panel	CPT	80076	13	$98	$51.94	$8.17	$11.44	0.43×	$38.4
Urinalysis non-automated	CPT	81002	13	$26	$13.78	$3.48	$4.45	0.64×	$12.01
Urinalysis automated	CPT	81003	13	$17	$9.01	$2.25	$3.15	0.23×	$10.63
Glucose quantitative	CPT	82947	13	$49	$25.97	$3.93	$5.5	0.31×	$18.46
Hemoglobin A1c	CPT	83036	13	$72	$38.16	$9.71	$13.59	0.50×	$45.61
Thyroid stimulating hormone (TSH)	CPT	84443	13	$120	$63.6	$16.8	$23.52	0.50×	$78.97
Complete blood count with automated differential	CPT	85025	13	$60	$31.8	$7.77	$10.88	0.41×	$36.54
Complete blood count without differential	CPT	85027	13	$46	$24.38	$6.47	$9.06	0.42×	$30.39
Urine culture bacterial	CPT	87086	13	$74	$39.22	$8.07	$11.3	0.48×	$37.95
Urine culture identification	CPT	87088	13	$69	$36.57	$8.09	$11.33	0.51×	$38.05
Tissue exam by pathologist level IV	CPT	88305	8	$950	$503.5	$33.88	$53.33	0.52×	$247.09
maternity
Fetal non-stress test	CPT	59025	5	$1,111	$588.83	$65.83	$195.34	1.0×	$866.58
Routine obstetric care including vaginal delivery	CPT	59400	1	—	—	$7,480.78	$7,480.78	3.3×	$7,480.78
Vaginal delivery only	CPT	59409	1	—	—	$2,919.47	$2,919.47	1.3×	$2,919.47
Vaginal delivery with postpartum	CPT	59410	1	—	—	$3,720.3	$3,720.3	3.5×	$3,720.3
Routine obstetric care with C-section	CPT	59510	1	—	—	$8,280.97	$8,280.97	3.3×	$8,280.97
C-section delivery only	CPT	59514	1	—	—	$3,284.04	$3,284.04	3.4×	$3,284.04
C-section with postpartum	CPT	59515	1	—	—	$4,514.49	$4,514.49	3.6×	$4,514.49
office
Office visit, new patient, 15-29 min	CPT	99202	2	—	—	$68.79	$133.83	1.6×	$198.87
Office visit, new patient, 30-44 minutes	CPT	99203	2	—	—	$105.67	$196.08	1.6×	$286.49
Office visit, new patient, 45-59 min	CPT	99204	2	—	—	$158.64	$297.99	1.7×	$437.33
Office visit, new patient, 60-74 min	CPT	99205	2	—	—	$209.02	$378.79	1.7×	$548.55
Office visit, established patient, 5 min	CPT	99211	2	$214	$113.42	$22.35	$37.63	0.58×	$52.91
Office visit, established patient, 10-19 min	CPT	99212	2	$363	$192.39	$53.91	$84.91	1.1×	$115.9
Office visit, established patient, 20-29 minutes	CPT	99213	2	$434	$230.02	$86.74	$140.27	1.2×	$193.8
Office visit, established patient, 30-39 minutes	CPT	99214	2	$582	$308.46	$122.48	$204.22	1.3×	$285.95
Office visit, established patient, 40-54 min	CPT	99215	1	$646	$342.38	$385.16	$385.16	2.0×	$385.16
preventive
Upper GI endoscopy diagnostic	CPT	43235	4	—	—	$910.39	$910.39	0.99×	$1,274.55
Upper GI endoscopy with biopsy	CPT	43239	4	—	—	$910.39	$910.39	0.94×	$1,438.7
Sigmoidoscopy diagnostic	CPT	45330	4	—	—	$603.74	$885.29	1.0×	$1,239.41
Sigmoidoscopy with biopsy	CPT	45331	4	—	—	$885.29	$885.29	0.99×	$1,239.41
Colonoscopy diagnostic	CPT	45378	4	—	—	$885.29	$885.29	1.0×	$1,371.04
Colonoscopy with biopsy	CPT	45380	1	—	—	$1,697.78	$1,697.78	1.4×	$1,697.78
Colonoscopy with polyp removal	CPT	45385	1	—	—	$1,779.51	$1,779.51	1.5×	$1,779.51
surgery
Total shoulder arthroplasty	CPT	23472	2	—	—	$5,281.9	$16,161	3.9×	$27,040
Hip hemiarthroplasty	CPT	27125	4	—	—	$4,113.26	$27,090	21.6×	$40,016
Total hip replacement	CPT	27130	5	—	—	$4,917.26	$27,040	6.2×	$40,016
Total knee replacement	CPT	27447	5	—	—	$4,916.21	$27,040	6.5×	$40,016
Knee revision arthroplasty single component	CPT	27486	5	—	—	$5,098.31	$27,040	16.1×	$40,016
Knee revision arthroplasty all components	CPT	27487	4	—	—	$6,366.44	$27,090	13.5×	$40,016
Shoulder arthroscopy with decompression	CPT	29826	1	—	—	$633.47	$633.47	1.9×	$633.47
Shoulder arthroscopy with rotator cuff repair	CPT	29827	1	—	—	$3,858.5	$3,858.5	1.2×	$3,858.5
Knee arthroscopy with meniscectomy	CPT	29881	1	—	—	$1,968.84	$1,968.84	0.96×	$1,968.84
ACL reconstruction	CPT	29888	1	—	—	$3,575.24	$3,575.24	1.1×	$3,575.24
Major small/large bowel procedures w MCC	MS-DRG	329	3	—	—	$33,998	$33,998	0.79×	$47,597
Major small/large bowel procedures w CC	MS-DRG	330	3	—	—	$17,731	$17,731	0.76×	$24,823
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	3	—	—	$12,448	$12,448	0.76×	$17,427
CABG single arterial graft	CPT	33533	1	—	—	$6,761.15	$6,761.15	3.6×	$6,761.15
CABG 2 arterial grafts	CPT	33534	1	—	—	$7,945.91	$7,945.91	3.7×	$7,945.91
CABG 3 arterial grafts	CPT	33535	1	—	—	$8,852.89	$8,852.89	3.9×	$8,852.89
CABG 4+ arterial grafts	CPT	33536	1	—	—	$9,538.28	$9,538.28	3.9×	$9,538.28
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	3	—	—	$12,512	$12,512	0.76×	$17,517
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	3	—	—	$10,102	$10,102	0.75×	$14,143
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	3	—	—	$25,201	$25,201	0.78×	$35,281
Open appendectomy	CPT	44950	1	—	—	$2,312.94	$2,312.94	2.0×	$2,312.94
Laparoscopic appendectomy	CPT	44970	1	—	—	$2,165.12	$2,165.12	1.4×	$2,165.12
Major joint replacement w MCC	MS-DRG	469	3	—	—	$22,435	$22,435	0.76×	$31,409
Major joint replacement w/o MCC	MS-DRG	470	4	—	—	$14,267	$17,121	0.91×	$21,712
Laparoscopic cholecystectomy	CPT	47562	1	—	—	$2,366.57	$2,366.57	1.3×	$2,366.57
Lap cholecystectomy with cholangiography	CPT	47563	1	—	—	$2,569.41	$2,569.41	1.4×	$2,569.41
Hip & femur procedures except major joint w MCC	MS-DRG	480	3	—	—	$21,541	$21,541	0.77×	$30,157
Hip & femur procedures except major joint w CC	MS-DRG	481	3	—	—	$15,492	$15,492	0.76×	$21,689
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	3	—	—	$12,064	$12,064	0.76×	$16,889
Lap inguinal hernia repair	CPT	49650	1	—	—	$1,540.27	$1,540.27	1.4×	$1,540.27
Total abdominal hysterectomy	CPT	58150	1	—	—	$3,654.69	$3,654.69	3.7×	$3,654.69
Vaginal hysterectomy	CPT	58260	1	—	—	$2,985.9	$2,985.9	1.6×	$2,985.9
Lap-assisted vaginal hysterectomy	CPT	58550	1	—	—	$3,186.5	$3,186.5	2.2×	$3,186.5
Lap-assisted vaginal hysterectomy >250g	CPT	58552	1	—	—	$3,565.25	$3,565.25	1.6×	$3,565.25
Lap salpingo-oophorectomy	CPT	58661	1	—	—	$2,344.04	$2,344.04	1.2×	$2,344.04
OR procedure for obesity w MCC	MS-DRG	619	3	—	—	$21,357	$21,357	0.79×	$29,899
OR procedure for obesity w CC	MS-DRG	620	3	—	—	$11,837	$11,837	0.73×	$16,571
OR procedure for obesity w/o CC/MCC	MS-DRG	621	3	—	—	$11,157	$11,157	0.74×	$15,620
Complex cataract surgery	CPT	66982	1	—	—	$2,894.03	$2,894.03	1.3×	$2,894.03
Cataract surgery with lens implant	CPT	66984	1	—	—	$2,306.33	$2,306.33	1.1×	$2,306.33
Intravitreal injection	CPT	67028	4	—	—	$322.08	$322.08	0.94×	$450.91
Vitrectomy mechanical	CPT	67042	1	—	—	$4,216.28	$4,216.28	1.7×	$4,216.28
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	3	—	—	$9,176.85	$9,176.85	0.75×	$12,848
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	4	—	—	$7,637	$15,156	0.79×	$21,219
PCI single major coronary artery	CPT	92920	3	$16,837	$8,923.61	$1,790.2	$26,696	4.7×	$57,395
PCI with drug-eluting stent	CPT	92928	3	$17,147	$9,087.91	$1,987.1	$26,737	2.7×	$57,395
PCI bypass graft	CPT	92937	3	$17,147	$9,087.91	$1,984.72	$26,737	2.5×	$57,395
Left heart catheterization	CPT	93452	2	$15,799	$8,373.47	$832.15	$7,668	2.5×	$23,664
Coronary angiography with cath	CPT	93455	2	$11,358	$6,019.74	$971.48	$7,668	2.4×	$23,664
Coronary angiography with bypass cath	CPT	93458	2	$20,891	$11,072	$1,026.87	$7,668	2.5×	$23,664

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 20)

Payer	Codes covered	Median rate
wps	155	$379.47
Medicare	136	$172.86
smart health	136	$242
VA Health	136	$172.86
UnitedHealthcare	87	$245.18
trilogy	62	$724
Cigna	61	$1,251.12
Anthem BCBS	32	$87.41
network health	27	$22.16
cchp	23	$19.97
sehn	20	$9
centivo nw3	15	$9.38
alliance	15	$18.75
centivo nw1	15	$10.36
centivo nw2	15	$9.87
wisconsin well woman	12	$85
health payment systems	6	$2,894.5
wisconsin physician services 20190701 tlk baseline	1	$1,502
smarthealth employees 20191001 tlk adj - model	1	$21,712
arise	1	$1,522

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