▸ Hospital · WI · CCN 523302
Childrens Hospital Of Wisconsin Fox Valley
130 SECOND STREET, NEENAH, WI, 54956
42 bedsChildrens2
Compliance grade
A
100/100
Procedures tracked
149
of 209 target codes
Payers
30
with negotiated rates
Rates published
15,843
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 1 | — | — | $42,386 | $42,386 | $42,386 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 32 | $85 | $46.75 | $12.89 | $68 | $107 |
| ED visit level 2 | CPT | 99282 | 30 | $180.5 | $99.28 | $126.35 | $153.43 | $868 |
| ED visit level 3 | CPT | 99283 | 30 | $332.25 | $182.74 | $232.58 | $282.41 | $1,905 |
| ED visit level 4 | CPT | 99284 | 30 | $565.25 | $310.89 | $395.68 | $480.46 | $4,005 |
| ED visit level 5 | CPT | 99285 | 30 | $1,614 | $887.7 | $1,129.8 | $1,371.9 | $4,005 |
| Critical care, first hour | CPT | 99291 | 30 | $1,860.75 | $1,023.41 | $1,302.53 | $1,581.64 | $5,870 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 30 | $1,127 | $619.85 | $788.9 | $955.7 | $1,070.65 |
| CT head with contrast | CPT | 70460 | 30 | $2,157 | $1,186.35 | $1,509.9 | $1,829.14 | $2,049.15 |
| CT neck with contrast | CPT | 70491 | 30 | $1,749.25 | $962.09 | $1,224.48 | $1,483.37 | $1,661.79 |
| MRI brain without contrast | CPT | 70551 | 30 | $4,220.25 | $2,321.14 | $2,954.18 | $3,587.21 | $4,009.24 |
| MRI brain with and without contrast | CPT | 70553 | 30 | $3,544 | $1,949.2 | $2,480.8 | $3,012.4 | $3,366.8 |
| Chest X-ray single view | CPT | 71045 | 30 | $171 | $94.05 | $119.7 | $145.01 | $162.45 |
| Chest X-ray 2 views | CPT | 71046 | 30 | $248.25 | $136.54 | $173.78 | $210.52 | $235.84 |
| CT chest without contrast | CPT | 71250 | 30 | $2,326.5 | $1,279.58 | $1,628.55 | $1,972.88 | $2,210.18 |
| CT chest with contrast | CPT | 71260 | 30 | $2,744.25 | $1,509.34 | $1,920.98 | $2,327.13 | $2,607.04 |
| CT cervical spine without contrast | CPT | 72125 | 30 | $1,394.75 | $767.11 | $976.33 | $1,182.75 | $1,325.01 |
| MRI cervical spine without contrast | CPT | 72141 | 30 | $3,622.5 | $1,992.38 | $2,535.75 | $3,079.13 | $3,441.38 |
| CT pelvis with contrast | CPT | 72193 | 30 | $2,130.75 | $1,171.91 | $1,491.53 | $1,806.88 | $2,024.21 |
| Humerus X-ray | CPT | 73060 | 1 | $243 | $133.65 | $184.92 | $184.92 | $184.92 |
| Hand X-ray 3 views | CPT | 73130 | 30 | $435.5 | $239.53 | $304.85 | $369.31 | $413.73 |
| Knee X-ray 1-2 views | CPT | 73560 | 1 | $320.25 | $176.14 | $243.71 | $243.71 | $243.71 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 30 | $5,212 | $2,866.6 | $3,648.4 | $4,430.2 | $4,951.4 |
| CT abdomen with contrast | CPT | 74160 | 1 | $2,713.75 | $1,492.56 | $2,065.16 | $2,065.16 | $2,065.16 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 30 | $1,432.75 | $788.01 | $1,002.93 | $1,214.98 | $1,361.11 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 30 | $3,648.75 | $2,006.81 | $2,554.13 | $3,094.14 | $3,466.31 |
| Abdominal ultrasound complete | CPT | 76700 | 30 | $722.5 | $397.38 | $505.75 | $614.13 | $686.38 |
| Abdominal ultrasound limited | CPT | 76705 | 30 | $786.75 | $432.71 | $550.73 | $668.74 | $747.41 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 30 | $649.5 | $357.23 | $454.65 | $552.08 | $617.03 |
| Pelvic ultrasound complete | CPT | 76856 | 30 | $666.75 | $366.71 | $466.73 | $566.74 | $633.41 |
| Scrotal ultrasound | CPT | 76870 | 30 | $649.5 | $357.23 | $454.65 | $552.08 | $617.03 |
| EKG tracing only | CPT | 93005 | 30 | $267.75 | $147.26 | $135.8 | $185.87 | $254.36 |
| Transthoracic echocardiogram complete | CPT | 93306 | 30 | $2,110.75 | $1,160.91 | $1,477.53 | $1,794.14 | $2,005.21 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 1 | — | — | $61,024 | $61,024 | $61,024 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 1 | — | — | $30,658 | $30,658 | $30,658 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 1 | — | — | $20,768 | $20,768 | $20,768 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $47,420 | $47,420 | $47,420 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $33,613 | $33,613 | $33,613 |
| COPD w CC | MS-DRG | 191 | 1 | — | — | $25,581 | $25,581 | $25,581 |
| COPD w/o CC/MCC | MS-DRG | 192 | 1 | — | — | $19,481 | $19,481 | $19,481 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $24,455 | $24,455 | $24,455 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 1 | — | — | $19,072 | $19,072 | $19,072 |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $48,676 | $48,676 | $48,676 |
| AMI discharged alive w CC | MS-DRG | 281 | 1 | — | — | $27,890 | $27,890 | $27,890 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $21,942 | $21,942 | $21,942 |
| Heart failure & shock w MCC | MS-DRG | 291 | 1 | — | — | $38,957 | $38,957 | $38,957 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $25,763 | $25,763 | $25,763 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 1 | — | — | $17,175 | $17,175 | $17,175 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $36,535 | $36,535 | $36,535 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $22,325 | $22,325 | $22,325 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 1 | — | — | $17,178 | $17,178 | $17,178 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $29,759 | $29,759 | $29,759 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 1 | — | — | $19,129 | $19,129 | $19,129 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 1 | — | — | $23,657 | $23,657 | $23,657 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 1 | — | — | $47,572 | $47,572 | $47,572 |
| Kidney/UTI w MCC | MS-DRG | 689 | 1 | — | — | $35,209 | $35,209 | $35,209 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $24,564 | $24,564 | $24,564 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 1 | — | — | $58,945 | $58,945 | $58,945 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $31,052 | $31,052 | $31,052 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 35 | $284.5 | $156.48 | $8.46 | $227.6 | $270.28 |
| General health panel | CPT | 80050 | 7 | — | — | $51.44 | $56.07 | $64.3 |
| Electrolyte panel | CPT | 80051 | 35 | $142 | $78.1 | $7.01 | $113.6 | $134.9 |
| Comprehensive metabolic panel | CPT | 80053 | 35 | $95.25 | $52.39 | $10.56 | $76.2 | $90.49 |
| Lipid panel | CPT | 80061 | 35 | $201.75 | $110.96 | $13.39 | $161.4 | $191.66 |
| Renal function panel | CPT | 80069 | 7 | — | — | $8.68 | $9.46 | $10.85 |
| Hepatic function panel | CPT | 80076 | 35 | $212.5 | $116.88 | $8.17 | $170 | $201.88 |
| Urinalysis non-automated | CPT | 81002 | 38 | $42 | $23.1 | $3.48 | $15.51 | $39.9 |
| Urinalysis automated | CPT | 81003 | 35 | $18 | $9.9 | $2.25 | $14.4 | $17.1 |
| Glucose quantitative | CPT | 82947 | 35 | $35.25 | $19.39 | $3.93 | $19.91 | $33.49 |
| Hemoglobin A1c | CPT | 83036 | 35 | $109 | $59.95 | $9.71 | $87.2 | $103.55 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 35 | $190.75 | $104.91 | $16.8 | $152.6 | $181.21 |
| Complete blood count with automated differential | CPT | 85025 | 35 | $103.5 | $56.93 | $7.77 | $82.8 | $98.33 |
| Complete blood count without differential | CPT | 85027 | 35 | $87.25 | $47.99 | $6.47 | $69.8 | $82.89 |
| Urine culture bacterial | CPT | 87086 | 35 | $95 | $52.25 | $8.07 | $76 | $90.25 |
| Urine culture identification | CPT | 87088 | 35 | $45.75 | $25.16 | $8.09 | $36.6 | $43.46 |
| Tissue exam by pathologist level IV | CPT | 88305 | 35 | $229.75 | $126.36 | $65.52 | $183.8 | $218.26 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 1 | — | — | $3,990 | $3,990 | $3,990 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 1 | — | — | $8,006 | $8,450 | $8,894 |
| Vaginal delivery only | CPT | 59409 | 2 | — | — | $6,842 | $7,870 | $10,500 |
| Vaginal delivery with postpartum | CPT | 59410 | 1 | — | — | $8,006 | $8,450 | $8,894 |
| Routine obstetric care with C-section | CPT | 59510 | 1 | — | — | $8,006 | $8,450 | $8,894 |
| C-section delivery only | CPT | 59514 | 2 | — | — | $6,842 | $7,870 | $8,085 |
| C-section with postpartum | CPT | 59515 | 2 | — | — | $8,006 | $8,085 | $8,894 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 32 | $400 | $220 | $48.35 | $320 | $380 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 32 | $490 | $269.5 | $74.38 | $392 | $465.5 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 32 | $734 | $403.7 | $110.94 | $587.2 | $697.3 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 32 | $970 | $533.5 | $146.41 | $776 | $921.5 |
| Office visit, established patient, 5 min | CPT | 99211 | 32 | $216 | $118.8 | $15.61 | $172.8 | $205.2 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 32 | $307 | $168.85 | $37.79 | $245.6 | $291.65 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 32 | $387 | $212.85 | $60.42 | $309.6 | $367.65 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 32 | $520 | $286 | $85.58 | $416 | $494 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 32 | $751 | $413.05 | $119.97 | $600.8 | $713.45 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 2 | — | — | $5,749 | $6,159 | $8,190 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 2 | — | — | $5,749 | $6,159 | $8,190 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 2 | — | — | $5,749 | $6,159 | $7,350 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 2 | — | — | $5,749 | $6,159 | $7,350 |
| Colonoscopy diagnostic | CPT | 45378 | 2 | — | — | $5,749 | $6,159 | $8,190 |
| Colonoscopy with biopsy | CPT | 45380 | 2 | — | — | $6,842 | $7,870 | $8,190 |
| Colonoscopy with polyp removal | CPT | 45385 | 2 | — | — | $6,842 | $7,870 | $8,190 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 2 | — | — | $13,774 | $13,958 | $25,306 |
| Hip hemiarthroplasty | CPT | 27125 | 2 | — | — | $8,006 | $8,894 | $18,060 |
| Total hip replacement | CPT | 27130 | 2 | — | — | $13,774 | $13,958 | $25,306 |
| Total knee replacement | CPT | 27447 | 2 | — | — | $14,056 | $15,055 | $25,306 |
| Knee revision arthroplasty single component | CPT | 27486 | 2 | — | — | $13,774 | $13,958 | $25,306 |
| Knee revision arthroplasty all components | CPT | 27487 | 2 | — | — | $13,774 | $13,958 | $25,306 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 2 | — | — | $3,990 | $5,749 | $6,159 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 2 | — | — | $13,774 | $13,958 | $18,060 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 2 | — | — | $8,006 | $8,894 | $11,655 |
| ACL reconstruction | CPT | 29888 | 2 | — | — | $13,774 | $13,958 | $18,060 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 1 | — | — | $139,481 | $139,481 | $139,481 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 1 | — | — | $72,743 | $72,743 | $72,743 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 1 | — | — | $51,068 | $51,068 | $51,068 |
| CABG single arterial graft | CPT | 33533 | 2 | — | — | $8,085 | $14,056 | $15,055 |
| CABG 2 arterial grafts | CPT | 33534 | 2 | — | — | $8,085 | $14,056 | $15,055 |
| CABG 3 arterial grafts | CPT | 33535 | 2 | — | — | $8,085 | $14,056 | $15,055 |
| CABG 4+ arterial grafts | CPT | 33536 | 2 | — | — | $8,085 | $14,056 | $15,055 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 1 | — | — | $51,332 | $51,332 | $51,332 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 1 | — | — | $41,445 | $41,445 | $41,445 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | — | — | $103,388 | $103,388 | $103,388 |
| Open appendectomy | CPT | 44950 | 2 | — | — | $8,006 | $8,894 | $11,655 |
| Laparoscopic appendectomy | CPT | 44970 | 2 | $8,211.5 | $4,516.33 | $6,248.95 | $11,564 | $18,060 |
| Major joint replacement w MCC | MS-DRG | 469 | 1 | — | — | $92,042 | $92,042 | $92,042 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 1 | — | — | $58,532 | $58,532 | $58,532 |
| Laparoscopic cholecystectomy | CPT | 47562 | 2 | — | — | $11,290 | $11,838 | $18,060 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 2 | — | — | $11,290 | $11,838 | $18,060 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 1 | — | — | $88,374 | $88,374 | $88,374 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 1 | — | — | $63,558 | $63,558 | $63,558 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 1 | — | — | $49,493 | $49,493 | $49,493 |
| Lap inguinal hernia repair | CPT | 49650 | 2 | — | — | $11,290 | $11,838 | $18,060 |
| Total abdominal hysterectomy | CPT | 58150 | 2 | — | — | $11,290 | $11,655 | $11,838 |
| Vaginal hysterectomy | CPT | 58260 | 2 | — | — | $10,196 | $10,948 | $11,655 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 2 | — | — | $11,290 | $11,838 | $18,060 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 2 | — | — | $14,056 | $15,055 | $18,060 |
| Lap salpingo-oophorectomy | CPT | 58661 | 2 | — | — | $11,290 | $11,838 | $18,060 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 1 | — | — | $87,618 | $87,618 | $87,618 |
| OR procedure for obesity w CC | MS-DRG | 620 | 1 | — | — | $48,561 | $48,561 | $48,561 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 1 | — | — | $45,772 | $45,772 | $45,772 |
| Complex cataract surgery | CPT | 66982 | 2 | — | — | $6,842 | $7,870 | $10,500 |
| Cataract surgery with lens implant | CPT | 66984 | 2 | — | — | $6,842 | $7,870 | $10,500 |
| Intravitreal injection | CPT | 67028 | 2 | — | — | $3,990 | $5,749 | $6,159 |
| Vitrectomy mechanical | CPT | 67042 | 2 | — | — | $10,196 | $10,948 | $13,913 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 1 | — | — | $37,649 | $37,649 | $37,649 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 1 | — | — | $62,180 | $62,180 | $62,180 |
| PCI single major coronary artery | CPT | 92920 | 1 | — | — | $18,060 | $18,060 | $18,060 |
| PCI with drug-eluting stent | CPT | 92928 | 1 | — | — | $18,060 | $18,060 | $18,060 |
| PCI bypass graft | CPT | 92937 | 1 | — | — | $18,060 | $18,060 | $18,060 |
| Left heart catheterization | CPT | 93452 | 1 | — | — | $13,913 | $13,913 | $13,913 |
| Coronary angiography with cath | CPT | 93455 | 1 | — | — | $13,913 | $13,913 | $13,913 |
| Coronary angiography with bypass cath | CPT | 93458 | 1 | — | — | $13,913 | $13,913 | $13,913 |
Payer mix (top 30)
| Payer | Codes covered | Median rate |
|---|---|---|
| UnitedHealthcare | 146 | $1,675.73 |
| Anthem BCBS | 96 | $613.67 |
| america's ppo | 53 | $363.45 |
| aspirus health plan | 53 | $307.32 |
| centivo | 53 | $315.85 |
| advocate aurora healthcare | 53 | $317.67 |
| Aetna | 53 | $292.38 |
| employer health care alliance cooperative | 53 | $241.59 |
| First Health | 53 | $396.87 |
| froedtert health | 53 | $348.35 |
| group health cooperative of south central wisconsin | 53 | $375.98 |
| health partners | 53 | $346.28 |
| health payment systems | 53 | $353.42 |
| medical college of wisconsin | 53 | $292.43 |
| Multiplan | 53 | $274.83 |
| network health plan | 53 | $292.64 |
| oan llc | 53 | $334.2 |
| security health plan | 53 | $346.74 |
| sheboygan employer's health network | 53 | $355.09 |
| trilogy health solutions | 53 | $326.63 |
| wps health plan | 53 | $336.99 |
| Cigna | 53 | $375.98 |
| common ground healthcare cooperative | 53 | $326.63 |
| dean health plan | 53 | $334.2 |
| prevea health network | 43 | $391.95 |
| group health cooperative of eau claire | 43 | $348.4 |
| healthsmart | 43 | $391.95 |
| bellin thedacare | 43 | $391.95 |
| praire states | 43 | $370.18 |
| quartz health insurance | 43 | $370.18 |