ThedaCare · Appleton, WI
41
In-network payers
292
Disclosed rate categories
160
Beds
4
Care quality
Thedacare Regional Medical Center Appleton is a 160-bed voluntary non-profit - private hospital in Appleton, WI, affiliated with ThedaCare. Below you'll find publicly disclosed negotiated rates and facility details, including 41 in-network payers and 292 disclosed rate categories.
CCN (Medicare provider number)
520160
NPI
1902832306
Type
Short Term Acute Care Hospital
Ownership
Voluntary Non-Profit - Private
Beds
160
Care Quality
4
Insurance acceptance may vary by specific plan, network status, and services required. Contact your insurance provider or the hospital's billing department to confirm coverage details.
The 24 services Thedacare Regional Medical Center Appleton most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
Book a demo to see hidden insurer names, more payer rates, and hospital data.
Childbirth · Inpatient
MS-DRG 807
$6,219 - $8,487
from 4 insurers · median $7,314
CMS lists this service as CPT 59400, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Childbirth · Inpatient
MS-DRG 788
$11,391 - $17,971
from 4 insurers · median $13,954
CMS lists this service as CPT 59510, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 788, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Medicine & Surgery · Inpatient
MS-DRG 470
$29,335 - $34,832
from 4 insurers · median $30,124
37 Medicare discharges for this DRG in CMS hospital data
CT imaging
CPT 74177
$844 - $3,491
from 4 insurers · median $1,069
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$1,680 - $13,550
from 4 insurers · median $10,100
83 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Gynecology
CPT 58558
$3,046 - $6,659
from 4 insurers · median $4,338
14 Medicare claims in Level 4 Gynecologic Procedures (CMS 2024)
Medicine & Surgery · Inpatient
MS-DRG 216
$148,777 - $152,064
from 3 insurers · median $149,277
Hospital reports cardiac thoracic surgery services to CMS
Gynecology
CPT 58571
$9,015 - $15,798
from 3 insurers · median $13,787
34 Medicare claims in Level 2 Laparoscopy and Related Services (CMS 2024)
Digestive procedures
CPT 49650
$9,015 - $15,678
from 3 insurers · median $11,303
83 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Mammography
CPT 77067
$100 - $553
from 4 insurers · median $433
Common here, based on CMS Medicare volume
Cardiology and vascular testing
CPT 93306
$584 - $1,525
from 4 insurers · median $1,433
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45385
$1,257 - $3,173
from 4 insurers · median $3,056
Common here, based on CMS Medicare volume
Digestive procedures
CPT 47563
$1,827 - $12,109
from 4 insurers · median $10,042
83 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Nuclear imaging
CPT 78815
$3,804 - $6,396
from 4 insurers · median $4,556
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45380
$1,217 - $3,233
from 4 insurers · median $3,087
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 49505
$1,337 - $7,614
from 4 insurers · median $5,771
37 Medicare claims in Level 1 Abdominal/Peritoneal/Biliary and Related Procedures (CMS 2024)
Medicine & Surgery · Inpatient
MS-DRG 460
$49,137 - $69,924
from 4 insurers · median $56,025
Hospital reports orthopedic surgery services to CMS
CT imaging
CPT 71275
$467 - $2,553
from 4 insurers · median $992
Common here, based on CMS Medicare volume
Nuclear imaging
CPT 78452
$1,179 - $3,444
from 4 insurers · median $2,342
Common here, based on CMS Medicare volume
Childbirth · Inpatient
MS-DRG 807
$6,219 - $8,487
from 4 insurers · median $7,314
CMS lists this service as CPT 59610, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
CT imaging
CPT 70450
$278 - $1,546
from 4 insurers · median $339
Common here, based on CMS Medicare volume
MRI imaging
CPT 70553
$926 - $2,630
from 4 insurers · median $1,187
Common here, based on CMS Medicare volume
X-ray and bone density
CPT 71046
$92 - $240
from 4 insurers · median $169
Common here, based on CMS Medicare volume
CT imaging
CPT 71260
$467 - $2,097
from 4 insurers · median $660
Common here, based on CMS Medicare volume
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
| Insurer | Services | Median % of Medicare | Above nearby | Below nearby |
|---|---|---|---|---|
| Insurer A* | 24 | 260% | 0 | 20 |
| Insurer B* | 24 | 257% | 7 | 12 |
| Insurer C* | 23 | 253% | 8 | 7 |
| Insurer D* | 22 | 111% | 1 | 18 |
How we chose these services: 7 appear in this hospital's own Medicare claims, 12 are common here based on CMS Medicare volume, and 5 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for Thedacare Regional Medical Center Appleton.
1818 North Meade Street, Appleton, WI 54911
(920) 731-4101
The nearest hospitals of similar type and size. Their rates are compared with Thedacare Regional Medical Center Appleton for the same insurers and services above.
Aurora Medical Center Oshkosh
▲ Rates typically 34% higher than Thedacare Regional Medical Center Appleton (20 services)
Ascension Ne Wisconsin - Mercy Campus
▼ Rates typically 26% lower than Thedacare Regional Medical Center Appleton (21 services)
St. Marys Hospital Medical Center
▲ Rates typically 22% higher than Thedacare Regional Medical Center Appleton (21 services)
Bellin Hospital
▲ Rates typically 7% higher than Thedacare Regional Medical Center Appleton (21 services)
Aurora Baycare Medical Center
▲ Rates typically 60% higher than Thedacare Regional Medical Center Appleton (21 services)
St. Agnes Hospital
▲ Rates typically 40% higher than Thedacare Regional Medical Center Appleton (21 services)
Ne Wisconsin - St. Elizabeth Campus
Thedacare Regional Medical Center - Neenah
All Saints Hospital Spring Street
About Thedacare Regional Medical Center Appleton's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Thedacare Regional Medical Center Appleton range from $926 to $2,630 across 4 insurers. Aetna's rate is $2,630. The median at nearby comparable hospitals is $2,567. What a patient pays depends on their plan's deductible, coinsurance and network status.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Thedacare Regional Medical Center Appleton range from $844 to $3,491 across 4 insurers. Aetna's rate is $3,491. The median at nearby comparable hospitals is $2,468. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with polyp removal (CPT 45385), published negotiated rates at Thedacare Regional Medical Center Appleton range from $1,257 to $3,173 across 4 insurers. UnitedHealthcare's rate is $3,173. The median at nearby comparable hospitals is $3,841. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Vaginal delivery, hospital stay (MS-DRG 807), published negotiated rates at Thedacare Regional Medical Center Appleton range from $6,219 to $8,487 across 4 insurers. Blue Cross Blue Shield's rate is $6,219. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Thedacare Regional Medical Center Appleton range from $100 to $553 across 4 insurers. Cigna's rate is $364. The median at nearby comparable hospitals is $325. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Major lower-extremity joint replacement without MCC (MS-DRG 470), published negotiated rates at Thedacare Regional Medical Center Appleton range from $29,335 to $34,832 across 4 insurers. Blue Cross Blue Shield's rate is $29,983. The median at nearby comparable hospitals is $32,173. What a patient pays depends on their plan's deductible, coinsurance and network status.
Thedacare Regional Medical Center Appleton has 160 beds. Facility type: Short Term Acute Care Hospital.
Thedacare Regional Medical Center Appleton is located at 1818 North Meade Street, Appleton, WI 54911. Its main phone number is (920) 731-4101.
Thedacare Regional Medical Center Appleton's CMS Certification Number (CCN), also called its Medicare provider number, is 520160.
The National Provider Identifier (NPI) on file for Thedacare Regional Medical Center Appleton is 1902832306.
Thedacare Regional Medical Center Appleton is affiliated with ThedaCare.
Thedacare Regional Medical Center Appleton lists 41 in-network payers, including Aetna, Aspirus Health Plan, Avera Health Plans, BCBS, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
292 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
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{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers