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 service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Abdominal CT scan*	74160	$1,405	$137	$1,542	$441	$128	$569	$325	$63	$388
Chest CT Scan**	71250	—	$609	$609	—	$565	$565	—	$271	$271
Head CT Scan*	70450	$380	$91	$471	$306	$86	$392	$206	$42	$248
Pelvis CT Scan*	Multiple	$1,771	$280	$2,051	$825	$264	$1,089	$721	$123	$844

Updated February 2009

Lab tests

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Lab tests		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Complete blood count (CBC)**	85025	—	$22	$22	—	$19	$19	—	$11	$11
Glucose Test**	82947	—	$11	$11	—	$9	$9	—	$6	$6
Lipid profile**	80061	—	$57	$57	—	$36	$36	—	$20	$20
Pap test (with liquid base preparation)**	88142	—	$56	$56	—	$48	$48	—	$15	$15
Prostate specific antigen (PSA)**	84153	—	$51	$51	—	$44	$44	—	$27	$27
Urinalysis (urine analysis)**	81001	—	$8	$8	—	$7	$7	—	$5	$5

Updated February 2009

Mammograms

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Mammograms		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Bilateral screening, analog (only at Bloomington, Carlson, Maple Grove, Minneapolis & Shakopee)**	77057, 77052	—	$205	$205	—	$201	$201	—	$89	$89
Bilateral screening diagnostic (only at JBBC-St Louis Park, JBBC-Wayzata, Burnsville & Chanhassen)**	G0204, 77051	—	$380	$380	—	$332	$332	—	$159	$159
Bilateral screening digital**	G0202, 77052	—	$339	$339	—	$309	$309	—	$137	$137

Updated February 2009

MRIs

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MRIs		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Brain MRI*	70553	$1,869	$252	$2,121	$1,347	$231	$1,578	$570	$117	$686
Knee MRI**	73721	—	$1,124	$1,124	—	$1,057	$1,057	—	$521	$521
Pelvis MRI*	72197	$1,874	$241	$2,115	$1,351	$192	$1,543	$570	$112	$682
Spine MRI**	72148	—	$1,148	$1,148	—	$1,085	$1,085	—	$502	$502

Updated February 2009

Pregnancy and prenatal tests

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Pregnancy and prenatal tests		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
ABO type (blood typing)**	86900	—	$9	$9	—	$7	$7	—	$4	$4
Amniocentesis**	59000	—	$722	$722	—	$635	$635	—	$295	$295
Antibody detection**	86850	—	$33	$33	—	$23	$23	—	$15	$15
Chlamydia Test**	87491	—	$103	$103	—	$80	$80	—	$51	$51
Fetal non-stress test**	59025	—	$105	$105	—	$94	$94	—	$41	$41
Obstetric ultrasound**	76805	—	$300	$300	—	$277	$277	—	$139	$139
Pregnancy test**	81025	—	$17	$17	—	$15	$15	—	$9	$9
Rh type**	86901	—	$25	$25	—	$10	$10	—	$4	$4
Urine culture**	87086	—	$23	$23	—	$19	$19	—	$12	$12

Updated February 2009

Stress tests

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Stress tests		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Bicycle stress test - echocardiogram*	Multiple	$1,276	$337	$1,613	$826	$227	$1,053	$484	$114	$598
Radiologic stress test*	Multiple	$2,150	$450	$2,600	$1,705	$426	$2,131	$1,275	$200	$1,475

Updated February 2009

Ultrasounds

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Ultrasounds		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Ultrasound, pelvis, complete**	76856, 76830	—	$477	$477	—	$410	$410	—	$229	$229

Updated February 2009

X-Rays

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X-Rays		Park Nicollet Charges			Average Insurance Payment			Average Medicare Payment
Type of service	CPT/DRG Code	MH	PNC	Total	MH	PNC	Total	MH	PNC	Total
Bone density scan (dexa scan)**	77080	—	$195	$195	—	$189	$189	—	$72	$72
Chest X-ray (single view)**	71010	—	$53	$53	—	$50	$50	—	$25	$25
Chest X-ray (two views)**	71020	—	$69	$69	—	$63	$63	—	$30	$30
Chest X-ray (multiple views)**	71030	—	$98	$98	—	$89	$89	—	$44	$44
Foot X-ray**	73630	—	$64	$64	—	$59	$59	—	$22	$22
Spine X-ray**	72020	—	$50	$50	—	$48	$48	—	$29	$29

Updated February 2009

Pricing and payment considerations

In viewing our pricing tables, note the following.

• Services and charges may vary, depending on where the service is offered-at Methodist Hospital or a Park Nicollet Clinic location. Information provided in the table reflects pricing for the location where the service occurs most often. A single asterisk (*) notes the pricing if the service is provided at Methodist Hospital. Two asterisks (**) means that the service is provided at a clinic location.
• 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 Methodist Hospital as noted by the single asterisk (*), a facility charge for the hospital and a professional charge for the clinic will be billed to you separately. If the service is done at a clinic location (**) you will receive one bill that will include all charges.
• Some prices are classified by 'levels' of service. Levels of service are defined by the complexity of a visit, the nature of a patient's individual condition, paperwork requirements, and examination and counseling time.
• 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.
• 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.