Diagnostic Services

When you select a link from the following service classifications, a pricing table will display immediately below the link you selected. By reselecting the same link, the pricing table will close, and you then can select another service classification to view more price and payment information.

CT Scans

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CT Scans		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Abdominal CT scan	74160	$1,525	$145	$1,670	$911	$132	$1,043	$525	$65	$590
Chest CT scan	71250	$0	$651	$651	$0	$589	$589	$0	$290	$290
Head CT scan	70450	$469	$98	$567	$318	$89	$407	$199	$44	$243
Pelvis CT scan	Multiple	$1,768	$299	$2,067	$1,039	$270	$1,309	$623	$134	$757

Updated: February 2007

Lab tests

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Lab tests		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Complete blood count (CBC)	85025	$0	$21	$21	$0	$19	$19	$0	$11	$11
Glucose test	82947	$0	$11	$11	$0	$9	$9	$0	$5	$5
Lipid profile	80061	$0	$56	$56	$0	$34	$34	$0	$19	$19
Pap test (with liquid base preparation)	88142	$0	$55	$55	$0	$47	$47	$0	$15	$15
Prostate specific antigen (PSA)	84153	$0	$50	$50	$0	$41	$41	$0	$26	$26
Urinalysis (urine analysis)	81001	$0	$8	$8	$0	$7	$7	$0	$4	$4

Updated: February 2007

Mammograms

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Mammograms		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Bilateral screening (both breasts)	Multiple	$0	$224	$224	$0	$173	$173	$0	$84	$84
Bilateral diagnostic (both breasts)	Multiple	$0	$259	$259	$0	$197	$197	$0	$95	$95
Diagnostic digitization, screening bilateral (both breasts)	Multiple	$0	$336	$336	$0	$248	$248	$0	$134	$134

Updated: February 2007

MRIs

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MRIs		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Brain MRI	70553	$1,401	$269	$1,670	$1,139	$245	$1,384	$582	$121	$703
Knee MRI	73721	$0	$1,121	$1,121	$0	$1,020	$1,020	$0	$503	$503
Pelvis MRI	72197	$1,401	$258	$1,659	$918	$237	$1,155	$582	$115	$697
Spine MRI	72148	$0	$1,261	$1,261	$0	$1,150	$1,150	$0	$561	$561

Updated: February 2007

Pregnancy and prenatal tests

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Pregnancy and prenatal tests		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
ABO type (blood typing)	86900	$0	$9	$9	$0	$7	$7	$0	$4	$4
Amniocentesis	59000	$0	$307	$307	$0	$278	$278	$0	$133	$133
Antibody detection	86850	$0	$32	$32	$0	$22	$22	$0	$14	$14
Chlamydia test	87491	$0	$101	$101	$0	$77	$77	$0	$49	$49
Fetal non-stress test	59025	$0	$93	$93	$0	$83	$83	$0	$39	$39
Obstetric ultrasound	76805	$0	$300	$300	$0	$267	$267	$0	$133	$133
Pregnancy test	81025	$0	$17	$17	$0	$14	$14	$0	$9	$9
Rh type	86901	$0	$18	$18	$0	$14	$14	$0	$8	$8
Urine culture	87086	$0	$22	$22	$0	$18	$18	$0	$11	$11

Updated: February 2007

Stress tests

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Stress tests		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Bicycle stress test - echocardiogram	Multiple	$1,614	$268	$1,882	$661	$241	$902	$576	$120	$696
Radiologic stress test	Multiple	$2,625	$313	$2,938	$1,449	$285	$1,734	$1,308	$141	$1,449

Updated: February 2007

Ultrasounds

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Ultrasounds		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Ultrasound, pelvis, complete	76856	$0	$214	$214	$0	$191	$191	$0	$95	$95

Updated: February 2007

X-rays

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X-rays		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of test	CPT Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Bone density scan (dexa scan)	77080	$0	$247	$247	$0	$280	$280	$0	$136	$136
Chest X-ray (single view)	71010	$0	$62	$62	$0	$56	$56	$0	$27	$27
Chest X-ray (two views)	71020	$0	$80	$80	$0	$72	$72	$0	$35	$35
Chest X-ray (multiple views)	71030	$0	$104	$104	$0	$96	$96	$0	$46	$46
Foot X-ray	73630	$0	$66	$66	$0	$60	$60	$0	$29	$29
Spine X-ray	72020	$0	$54	$54	$0	$50	$50	$0	$24	$24

Updated: February 2007

Pricing and payment considerations

In viewing our pricing tables, note the following.

• For individuals with health insurance, the average insurance payment shown on our pricing tables includes all patient expense responsibilities (co-pays, deductibles and co-insurance). The actual portion of cost for which an insured patient is responsible will depend upon each individual's insurance benefits and whether deductible or out-of-pocket maximums have been met. Your insurance company can best explain your individual health plan coverage and how much out-of-pocket expenses you may incur.
• The total charge listed is intended to be comprehensive of all charges normally associated with the specified service or condition. If the service is done at the hospital, a facility (hospital) and a professional (clinic) charge will be shown. If the service is done at the clinic, only a professional (clinic) charge will be shown.
• While the date when prices were last updated is indicated on each price table above, prices are subject to change without notice. If you have questions about service prices, please refer to frequently asked questions, or call 952-993-5586.

Read more about Park Nicollet billing and insurance information. Refer to our overview of service options to better understand how Park Nicollet serves patients in Minneapolis and surrounding suburbs and greater Minnesota communities.