Appleton Area Health
30 S Behl St, Appleton, MN 56208 · 91 Priced Procedures
Typical commercial prices here are +137% above the fair benchmark (2.37×) even after accounting for local nurse/doctor wages and patient complexity.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
Aligned Regional Benchmark Peer
Appleton Area Health prices shoppable and inpatient services (3.7× to 2.8× Medicare, divergence 0.76×) in alignment with regional hospital peers (2.37× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 1.43× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 7% of shoppable procedures (95/100 Cash Honesty)
- CMS clinical safety score (69/100 safety score) with 72% patient recommendation
- Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (2.37× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Commercial insurance median sits at 2.50× Fair BaseRate (3.7× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Even at low-cost facilities (2.37× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Unnegotiated chargemaster list prices average 11.7× Medicare (22¢ true HCRIS cost per $1 gross)
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Appleton Area Health
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 91 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Breast lump removal CPT Code: 19120 | $4,644 | 1.2× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $3,828 | 3.7× |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $1,579 | unverified |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $1,376 | 3.1× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $1,376 | 2.7× |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $1,138 | 4.2× |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $911 | 6.8× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $877 | 2.9× |
| MRI, lower back (no contrast) CPT Code: 72148 | $877 | 2.6× |
| MRI, brain (no contrast) CPT Code: 70551 | $877 | 2.6× |
| MRI, knee or other leg joint CPT Code: 73721 | $877 | 2.4× |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $799 | 6.3× |
| Speech therapy (language evaluation) CPT Code: 92507 | $728 | unverified |
| Ultrasound, thyroid and neck CPT Code: 76536 | $695 | 5.3× |
| Ultrasound, pelvis CPT Code: 76856 | $676 | 5.2× |
| Blood transfusion CPT Code: 36430 | $695 | 1.4× |
| CT scan, head (with contrast) CPT Code: 70460 | $657 | 2.7× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $657 | 2.5× |
| X-ray, lower back CPT Code: 72110 | $513 | 4.6× |
| X-ray, neck (cervical spine) CPT Code: 72040 | $396 | 4.3× |
| X-ray, hip CPT Code: 73502 | $371 | 4.0× |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $380 | 2.6× |
| CT scan, head (no contrast) CPT Code: 70450 | $393 | 2.5× |
| CT scan, pelvis CPT Code: 72192 | $393 | 2.4× |
| CT scan, sinuses CPT Code: 70486 | $393 | 2.4× |
Audit a Bill or Quote at Appleton Area Health (Zero PHI Required)
Above Standard 400% FPL Financial-Assistance Ceiling
At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.
Self-Pay Cash Rate ($4,644) Beats Your Bill
Appleton Area Health's published 45 CFR § 180 self-pay cash rate is $4,644 (vs. $4,644 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $3,875 Fair BaseRate ($4,000 Medicare)
Your bill ($5,464) is $1,589 above the denoised Fair BaseRate ($3,875) and 1.4× the $4,000 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Public IRS & CMS ownership records classify Appleton Area Health as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.
Clinical Quality, Patient Experience & Infection Benchmarks
CMS Price Transparency Administrative Enforcement Log
Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Appleton Area Health. Prior administrative notices do not necessarily reflect current compliance status.
- 2025-03-11·administrative_or_closure
Closure Notice
Recorded - 2024-12-03·warning_notice
Warning Notice
Recorded
Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Appleton Area Health.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.