Hospital Green Bay, WI

St Clare Memorial Hospital

St Clare Memorial Hospital in Oconto Falls, WI publishes cash prices for 347 common procedures listed here, from its own machine-readable price file updated Mar 24, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 197 of 343 procedures and below it for 129. By typical cash price it ranks #75 of 103 Wisconsin hospitals and #4 of 6 hospitals in the Green Bay, WI area, cheapest first. Select a procedure to compare it with other hospitals nearby.

855 S MAIN STREET, OCONTO FALLS, WI 54154 Collected Sep 23, 2026 Source price file Check a bill from this hospital (920) 846-3444

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 521310 · CMS hospital register NPI 1851477913

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

St Clare Memorial Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABD WO CNTRST FLWD CNTRST	$2,091.54	$3,169.00	$179.20–$3,169.00	12% below	34%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD WO CNTRST FLWD CNTRST	$2,091.54	$3,169.00	$179.20–$3,169.00	—	34%
Abdominal X-ray, 2 views CPT 74019 RADEX ABDOMEN 2 VIEWS	$332.64	$504.00	$91.15–$504.00	39% above	34%
Abdominal X-ray, 2 views CPT 74019 HC XRAY ABDOMEN AP & LAT (2 V BABY PORT)	$332.64	$504.00	$91.15–$504.00	39% above	34%
Abdominal X-ray, 2 views inpatient CPT 74019 RADEX ABDOMEN 2 VIEWS	$332.64	$504.00	$91.15–$504.00	—	34%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XRAY ABDOMEN AP & LAT (2 V BABY PORT)	$332.64	$504.00	$91.15–$504.00	—	34%
Ankle X-ray, complete, 3 or more views CPT 73610 HC XRAY ANKLE (MIN 3 V)	$315.48	$478.00	$88.91–$478.00	34% above	34%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XRAY ANKLE (MIN 3 V)	$315.48	$478.00	$88.91–$478.00	—	34%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$410.52	$622.00	$135.93–$622.00	7% above	34%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC ABI/PPG SINGLE LEVEL	$1,116.72	$1,692.00	$135.93–$1,692.00	190% above	34%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$410.52	$622.00	$135.93–$622.00	—	34%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC ABI/PPG SINGLE LEVEL	$1,116.72	$1,692.00	$135.93–$1,692.00	—	34%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTRM WO CONT	$1,335.18	$2,023.00	$106.81–$2,023.00	7% below	34%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTRM WO CONT	$1,335.18	$2,023.00	$106.81–$2,023.00	—	34%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XRAY ESOPHAGUS	$516.12	$782.00	$91.15–$782.00	3% below	34%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XRAY ESOPHAGUS	$516.12	$782.00	$91.15–$782.00	—	34%
Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE SCAN WHOLE BODY	$1,389.96	$2,106.00	$408.43–$2,106.00	7% below	34%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC BONE SCAN WHOLE BODY	$1,389.96	$2,106.00	$408.43–$2,106.00	—	34%
Breast ultrasound, complete, one breast CPT 76641 HC US BREAST COMPLETE	$546.48	$828.00	$106.81–$828.00	3% above	34%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST COMPLETE	$546.48	$828.00	$106.81–$828.00	—	34%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST LIMITED	$392.70	$595.00	$88.91–$595.00	at median	34%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST LIMITED	$392.70	$595.00	$88.91–$595.00	—	34%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABD/PELV W & WO CONTRAST	$3,358.08	$5,088.00	$356.43–$5,088.00	10% above	34%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABD/PELV W & WO CONTRAST	$3,358.08	$5,088.00	$356.43–$5,088.00	—	34%
CT angiography (CTA) of the head CPT 70496 HC CT ANGIO HEAD W/WO	$2,091.54	$3,169.00	$179.20–$3,169.00	1% above	34%
CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIO HEAD W/WO	$2,091.54	$3,169.00	$179.20–$3,169.00	—	34%
CT angiography (CTA) of the neck CPT 70498 HC CT ANGIO NECK W/WO CONTRAST	$1,818.96	$2,756.00	$179.20–$2,756.00	10% below	34%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIO NECK W/WO CONTRAST	$1,818.96	$2,756.00	$179.20–$2,756.00	—	34%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST W&W/O CONTRAST	$1,859.88	$2,818.00	$179.20–$2,818.00	8% below	34%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CTA CHEST W&W/O CONTRAST	$1,859.88	$2,818.00	$179.20–$2,818.00	—	34%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN/PELVIS W/O CONTRAST	$2,544.96	$3,856.00	$243.77–$3,856.00	1% above	34%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN/PELVIS W/O CONTRAST	$2,544.96	$3,856.00	$243.77–$3,856.00	—	34%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN/PELVIS W/CONTRAST	$3,016.86	$4,571.00	$356.43–$4,571.00	6% below	34%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN/PELVIS W/CONTRAST	$3,016.86	$4,571.00	$356.43–$4,571.00	—	34%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN/PELVIS W&W/O CONTR	$3,550.14	$5,379.00	$356.43–$5,379.00	4% below	34%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN/PELVIS W&W/O CONTR	$3,550.14	$5,379.00	$356.43–$5,379.00	—	34%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,750.32	$2,652.00	$179.20–$2,652.00	7% above	34%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/CONTRAST	$1,750.32	$2,652.00	$179.20–$2,652.00	—	34%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,259.28	$1,908.00	$106.81–$1,908.00	at median	34%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,259.28	$1,908.00	$106.81–$1,908.00	—	34%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE	$1,271.16	$1,926.00	$106.81–$1,926.00	9% below	34%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O DYE	$1,271.16	$1,926.00	$106.81–$1,926.00	—	34%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST	$1,259.28	$1,908.00	$106.81–$1,908.00	2% below	34%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD/BRAIN W/O CONTRAST	$1,259.28	$1,908.00	$106.81–$1,908.00	—	34%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE	$1,770.12	$2,682.00	$179.20–$2,682.00	15% above	34%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/DYE	$1,770.12	$2,682.00	$179.20–$2,682.00	—	34%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE	$1,818.96	$2,756.00	$179.20–$2,756.00	1% below	34%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/DYE	$1,818.96	$2,756.00	$179.20–$2,756.00	—	34%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L-SPINE W/O CONTRAST	$1,359.60	$2,060.00	$106.81–$2,060.00	12% below	34%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L-SPINE W/O CONTRAST	$1,359.60	$2,060.00	$106.81–$2,060.00	—	34%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C-SPINE W/O CONTRAST	$1,357.62	$2,057.00	$106.81–$2,057.00	12% below	34%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C-SPINE W/O CONTRAST	$1,357.62	$2,057.00	$106.81–$2,057.00	—	34%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/CONTRAST	$1,539.12	$2,332.00	$179.20–$2,332.00	6% below	34%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/CONTRAST	$1,539.12	$2,332.00	$179.20–$2,332.00	—	34%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX CAROTID BILAT	$1,877.04	$2,844.00	$243.77–$2,844.00	—	34%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX CAROTID BILAT	$1,877.04	$2,844.00	$243.77–$2,844.00	—	34%
Chest CT scan without and with contrast CPT 71270 HC CT CHEST W&W/O CONTRAST	$1,818.96	$2,756.00	$179.20–$2,756.00	21% below	34%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST W&W/O CONTRAST	$1,818.96	$2,756.00	$179.20–$2,756.00	—	34%
Chest X-ray, 2 views CPT 71046 HC XR CHEST 2V PORTABLE	$275.88	$418.00	$88.91–$418.00	29% above	34%
Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$275.88	$418.00	$88.91–$418.00	29% above	34%
Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$275.88	$418.00	$88.91–$418.00	—	34%
Chest X-ray, 2 views inpatient CPT 71046 HC XR CHEST 2V PORTABLE	$275.88	$418.00	$88.91–$418.00	—	34%
Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW	$259.38	$393.00	$69.71–$393.00	60% above	34%
Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW	$259.38	$393.00	$69.71–$393.00	—	34%
Collarbone (clavicle) X-ray, complete CPT 73000 X-RAY EXAM OF COLLAR BONE	$333.96	$506.00	$88.91–$506.00	61% above	34%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 X-RAY EXAM OF COLLAR BONE	$333.96	$506.00	$88.91–$506.00	—	34%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITIONEAL	$566.28	$858.00	$106.81–$858.00	3% above	34%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITIONEAL	$566.28	$858.00	$106.81–$858.00	—	34%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC BONE DENSITY DXA	$592.02	$897.00	$106.81–$897.00	49% above	34%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC BONE DENSITY DXA	$592.02	$897.00	$106.81–$897.00	—	34%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC BONE DENSITY PERIPHERAL	$544.50	$825.00	$86.33–$825.00	93% above	34%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC BONE DENSITY PERIPHERAL	$544.50	$825.00	$86.33–$825.00	—	34%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US PREGNANCY DETAILED SGL	$650.10	$985.00	$163.49–$985.00	5% below	34%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US PREGNANCY DETAILED SGL	$650.10	$985.00	$163.49–$985.00	—	34%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST W/O CONTRAST	$1,264.56	$1,916.00	$106.81–$1,916.00	12% below	34%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST W/O CONTRAST	$1,264.56	$1,916.00	$106.81–$1,916.00	—	34%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W/CONTRAST	$1,539.12	$2,332.00	$179.20–$2,332.00	6% below	34%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W/CONTRAST	$1,539.12	$2,332.00	$179.20–$2,332.00	—	34%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$369.60	$560.00	$77.45–$560.00	—	34%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$369.60	$560.00	$77.45–$560.00	—	34%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$310.20	$470.00	$77.45–$470.00	1% above	34%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$310.20	$470.00	$77.45–$470.00	—	34%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX ARTERIAL LWR EXT BI	$1,951.62	$2,957.00	$243.77–$2,957.00	—	34%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX ARTERIAL LWR EXT BI	$1,951.62	$2,957.00	$243.77–$2,957.00	—	34%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$1,283.70	$1,945.00	$243.77–$1,945.00	8% above	34%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$1,283.70	$1,945.00	$243.77–$1,945.00	—	34%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC ECHO/CARDIAC DOP/COLOR FLOW	$1,709.40	$2,590.00	$523.69–$2,590.00	3% below	34%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC ECHO/CARDIAC DOP/COLOR FLOW	$1,709.40	$2,590.00	$523.69–$2,590.00	—	34%
Elbow X-ray, 2 views CPT 73070 HC XRAY ELBOW (2 V)	$315.48	$478.00	$86.33–$478.00	65% above	34%
Elbow X-ray, 2 views inpatient CPT 73070 HC XRAY ELBOW (2 V)	$315.48	$478.00	$86.33–$478.00	—	34%
Elbow X-ray, complete, 3 or more views CPT 73080 HC XRAY ELBOW (MIN 3 V)	$337.92	$512.00	$88.91–$512.00	44% above	34%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC XRAY ELBOW (MIN 3 V)	$337.92	$512.00	$88.91–$512.00	—	34%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT/IAC/EAR W/O CONTRAST	$1,351.02	$2,047.00	$106.81–$2,047.00	6% below	34%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT/IAC/EAR W/O CONTRAST	$1,351.02	$2,047.00	$106.81–$2,047.00	—	34%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$391.38	$593.00	$91.15–$593.00	30% above	34%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC XR FACIAL BONES MIN 3 VIEWS	$391.38	$593.00	$91.15–$593.00	—	34%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC XRAY FOREARM (2 V)	$315.48	$478.00	$87.72–$478.00	60% above	34%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC XRAY FOREARM (2 V)	$315.48	$478.00	$87.72–$478.00	—	34%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SCAN	$1,663.20	$2,520.00	$408.43–$2,520.00	12% above	34%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SCAN	$1,663.20	$2,520.00	$408.43–$2,520.00	—	34%
Hand X-ray, 2 views CPT 73120 HC XRAY HAND 2 VIEW	$310.20	$470.00	$91.15–$470.00	65% above	34%
Hand X-ray, 2 views inpatient CPT 73120 HC XRAY HAND 2 VIEW	$310.20	$470.00	$91.15–$470.00	—	34%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC XRAY OS CALCIS HEEL	$316.80	$480.00	$86.33–$480.00	60% above	34%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC XRAY OS CALCIS HEEL	$316.80	$480.00	$86.33–$480.00	—	34%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC SLEEP STUDY W/CPAP	$4,039.86	$6,121.00	$455.52–$6,121.00	10% above	34%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC SLEEP STUDY W/CPAP ONE ON ONE	$4,287.36	$6,496.00	$455.52–$6,496.00	17% above	34%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC SLEEP STUDY W/CPAP	$4,039.86	$6,121.00	$455.52–$6,121.00	—	34%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC SLEEP STUDY W/CPAP ONE ON ONE	$4,287.36	$6,496.00	$455.52–$6,496.00	—	34%
Knee X-ray, 3 views CPT 73562 HC XRAY KNEE (3 V)	$327.36	$496.00	$88.91–$496.00	29% above	34%
Knee X-ray, 3 views inpatient CPT 73562 HC XRAY KNEE (3 V)	$327.36	$496.00	$88.91–$496.00	—	34%
Knee X-ray, complete, 4 or more views CPT 73564 HC XRAY KNEE (MIN 4 V)	$363.00	$550.00	$91.15–$550.00	31% above	34%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC XRAY KNEE (MIN 4 V)	$363.00	$550.00	$91.15–$550.00	—	34%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTRM WO CONT	$1,430.88	$2,168.00	$106.81–$2,168.00	2% below	34%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTRM WO CONT	$1,430.88	$2,168.00	$106.81–$2,168.00	—	34%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LTD	$578.16	$876.00	$106.81–$876.00	30% above	34%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LTD	$578.16	$876.00	$106.81–$876.00	—	34%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US EXTREMITY NON VASCULAR LMTD	$384.78	$583.00	$106.81–$583.00	34% above	34%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US EXTREMITY NON VASCULAR LMTD	$384.78	$583.00	$106.81–$583.00	—	34%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST	$769.56	$1,166.00	$106.81–$1,166.00	73% above	34%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LOW DOSE LUNG SCN W/O CONTAST	$769.56	$1,166.00	$106.81–$1,166.00	—	34%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC XRAY TIBIA/FIBULA 2 VIEW	$330.00	$500.00	$88.91–$500.00	55% above	34%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC XRAY TIBIA/FIBULA 2 VIEW	$330.00	$500.00	$88.91–$500.00	—	34%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD W/O CONTRAST	$2,310.00	$3,500.00	$243.77–$3,500.00	5% above	34%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD W/O CONTRAST	$2,310.00	$3,500.00	$243.77–$3,500.00	—	34%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LWR EXT JOINT W/O CONTRAST	$2,420.88	$3,668.00	$243.77–$3,668.00	10% above	34%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LWR EXT JOINT W/O CONTRAST	$2,420.88	$3,668.00	$243.77–$3,668.00	—	34%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LWR EXT JOINT W&W/O CONTRAST	$2,669.70	$4,045.00	$356.43–$4,045.00	22% below	34%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LWR EXT JOINT W&W/O CONTRAST	$2,669.70	$4,045.00	$356.43–$4,045.00	—	34%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CON	$2,656.50	$4,025.00	$243.77–$4,025.00	20% above	34%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CON	$2,656.50	$4,025.00	$243.77–$4,025.00	—	34%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W&W/O CON	$3,375.24	$5,114.00	$356.43–$5,114.00	1% below	34%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W&W/O CON	$3,375.24	$5,114.00	$356.43–$5,114.00	—	34%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O CONTRAST	$2,360.16	$3,576.00	$243.77–$3,576.00	7% above	34%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O CONTRAST	$2,360.16	$3,576.00	$243.77–$3,576.00	—	34%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE	$2,721.18	$4,123.00	$356.43–$4,123.00	20% below	34%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE	$2,721.18	$4,123.00	$356.43–$4,123.00	—	34%
MRI of the lower back, no contrast dye CPT 72148 HC MRI L-SPINE W/O CONTRAST	$2,337.72	$3,542.00	$243.77–$3,542.00	6% above	34%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI L-SPINE W/O CONTRAST	$2,337.72	$3,542.00	$243.77–$3,542.00	—	34%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI L-SPINE W&W/O CON	$2,700.06	$4,091.00	$356.43–$4,091.00	21% below	34%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI L-SPINE W&W/O CON	$2,700.06	$4,091.00	$356.43–$4,091.00	—	34%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI T-SPINE W/O CONTRAST	$2,295.48	$3,478.00	$243.77–$3,478.00	4% above	34%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI T-SPINE W/O CONTRAST	$2,295.48	$3,478.00	$243.77–$3,478.00	—	34%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI C-SPINE W&W/O CON	$2,001.12	$3,032.00	$356.43–$3,032.00	41% below	34%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI C-SPINE W&W/O CON	$2,001.12	$3,032.00	$356.43–$3,032.00	—	34%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI C-SPINE W/O CONTRAST	$1,815.00	$2,750.00	$243.77–$2,750.00	18% below	34%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI C-SPINE W/O CONTRAST	$1,815.00	$2,750.00	$243.77–$2,750.00	—	34%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W&W/O CON	$2,893.44	$4,384.00	$356.43–$4,384.00	15% below	34%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W&W/O CON	$2,893.44	$4,384.00	$356.43–$4,384.00	—	34%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CON	$2,277.00	$3,450.00	$243.77–$3,450.00	3% above	34%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CON	$2,277.00	$3,450.00	$243.77–$3,450.00	—	34%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPR EXT JOINT W/O CONTRAST	$2,420.88	$3,668.00	$243.77–$3,668.00	10% above	34%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPR EXT JOINT W/O CONTRAST	$2,420.88	$3,668.00	$243.77–$3,668.00	—	34%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC XR C-SPINE 4-5 VIEW	$467.28	$708.00	$91.15–$708.00	46% above	34%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC XR C-SPINE 4-5 VIEW	$467.28	$708.00	$91.15–$708.00	—	34%
Neck soft tissue CT scan with contrast CPT 70491 HC CT NECK SFT TISS W/CONTRAST	$1,595.22	$2,417.00	$179.20–$2,417.00	3% below	34%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT NECK SFT TISS W/CONTRAST	$1,595.22	$2,417.00	$179.20–$2,417.00	—	34%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O DYE	$1,259.28	$1,908.00	$106.81–$1,908.00	11% below	34%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O DYE	$1,259.28	$1,908.00	$106.81–$1,908.00	—	34%
Neck soft tissue X-ray CPT 70360 HC XRAY NECK SOFT TISSUE	$316.80	$480.00	$88.91–$480.00	51% above	34%
Neck soft tissue X-ray inpatient CPT 70360 HC XRAY NECK SOFT TISSUE	$316.80	$480.00	$88.91–$480.00	—	34%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT MULT	$3,365.34	$5,099.00	$1,223.76–$5,099.00	9% above	34%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HT MUSCLE IMAGE SPECT MULT	$3,365.34	$5,099.00	$1,223.76–$5,099.00	—	34%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O CONTRAST	$1,259.28	$1,908.00	$106.81–$1,908.00	1% below	34%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O CONTRAST	$1,259.28	$1,908.00	$106.81–$1,908.00	—	34%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS NON-OB LTD	$482.46	$731.00	$106.81–$731.00	20% above	34%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS NON-OB LTD	$482.46	$731.00	$106.81–$731.00	—	34%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS NON OB	$615.12	$932.00	$106.81–$932.00	17% above	34%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS NON OB	$615.12	$932.00	$106.81–$932.00	—	34%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY >14 WEEKS SGL	$573.54	$869.00	$106.81–$869.00	at median	34%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANCY >14 WEEKS SGL	$573.54	$869.00	$106.81–$869.00	—	34%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US PREGNANCY <14 WEEKS SGL	$454.74	$689.00	$106.81–$689.00	11% below	34%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US PREGNANCY <14 WEEKS SGL	$454.74	$689.00	$106.81–$689.00	—	34%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US FETAL HEART BEAT	$335.28	$508.00	$106.81–$508.00	9% below	34%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US FETAL HEART BEAT	$335.28	$508.00	$106.81–$508.00	—	34%
Rib X-ray, one side, 2 views CPT 71100 HC XR RIBS 2V UNI	$322.74	$489.00	$88.91–$489.00	44% above	34%
Rib X-ray, one side, 2 views inpatient CPT 71100 HC XR RIBS 2V UNI	$322.74	$489.00	$88.91–$489.00	—	34%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS W/CXR 3+V UNI	$477.18	$723.00	$91.15–$723.00	72% above	34%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC XR RIBS CHEST MIN 3 VIEW-PRV 72 HR	$477.18	$723.00	$91.15–$723.00	72% above	34%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS W/CXR 3+V UNI	$477.18	$723.00	$91.15–$723.00	—	34%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC XR RIBS CHEST MIN 3 VIEW-PRV 72 HR	$477.18	$723.00	$91.15–$723.00	—	34%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$310.20	$470.00	$77.45–$470.00	—	34%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$310.20	$470.00	$77.45–$470.00	—	34%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XRAY SHOULDER TRAUMA (MIN 2V)	$315.48	$478.00	$88.91–$478.00	34% above	34%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC XRAY SHOULDER (MIN 2 V)	$315.48	$478.00	$88.91–$478.00	34% above	34%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XRAY SHOULDER (MIN 2 V)	$315.48	$478.00	$88.91–$478.00	—	34%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XRAY SHOULDER TRAUMA (MIN 2V)	$315.48	$478.00	$88.91–$478.00	—	34%
Sinus X-ray, complete, 3 or more views CPT 70220 HC XR SINUSES MIN 3 VIEWS	$391.38	$593.00	$88.91–$593.00	48% above	34%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC XR SINUSES MIN 3 VIEWS	$391.38	$593.00	$88.91–$593.00	—	34%
Skull X-ray, fewer than 4 views CPT 70250 HC XR SKULL LESS THAN 4 VIEWS	$326.70	$495.00	$91.15–$495.00	34% above	34%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC XR SKULL LESS THAN 4 VIEWS	$326.70	$495.00	$91.15–$495.00	—	34%
Sleep study in a lab (polysomnography) CPT 95810 HC SLEEP STUDY	$3,812.16	$5,776.00	$455.52–$5,776.00	12% above	34%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC SLEEP STUDY	$3,812.16	$5,776.00	$455.52–$5,776.00	—	34%
Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY XM SWLNG FUNCJ C+	$523.38	$793.00	$179.20–$793.00	14% above	34%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-RAY XM SWLNG FUNCJ C+	$523.38	$793.00	$179.20–$793.00	—	34%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC XR FEMUR 2+VIEWS	$322.74	$489.00	$88.91–$489.00	31% above	34%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC XR FEMUR 2+VIEWS	$322.74	$489.00	$88.91–$489.00	—	34%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T-SPINE W/O CONTRAST	$1,448.04	$2,194.00	$106.81–$2,194.00	6% below	34%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T-SPINE W/O CONTRAST	$1,448.04	$2,194.00	$106.81–$2,194.00	—	34%
Toe X-ray, 2 or more views CPT 73660 HC XRAY TOE MIN 2 VIEW	$315.48	$478.00	$88.91–$478.00	57% above	34%
Toe X-ray, 2 or more views inpatient CPT 73660 HC XRAY TOE MIN 2 VIEW	$315.48	$478.00	$88.91–$478.00	—	34%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL	$531.30	$805.00	$106.81–$805.00	13% above	34%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL	$531.30	$805.00	$106.81–$805.00	—	34%
Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANCY TRANSVAGINAL	$440.22	$667.00	$106.81–$667.00	12% above	34%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANCY TRANSVAGINAL	$440.22	$667.00	$106.81–$667.00	—	34%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN CMPL	$769.56	$1,166.00	$106.81–$1,166.00	13% above	34%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN CMPL	$769.56	$1,166.00	$106.81–$1,166.00	—	34%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM	$578.16	$876.00	$106.81–$876.00	17% above	34%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM	$578.16	$876.00	$106.81–$876.00	—	34%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US SOFT TISSUE HEAD/NECK	$552.42	$837.00	$106.81–$837.00	8% above	34%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US SOFT TISSUE HEAD/NECK	$552.42	$837.00	$106.81–$837.00	—	34%
Upper arm X-ray (humerus), 2 views CPT 73060 HC XRAY HUMERUS (2 V)	$315.48	$478.00	$88.91–$478.00	50% above	34%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC XRAY HUMERUS (2 V)	$315.48	$478.00	$88.91–$478.00	—	34%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX VENOUS EXT UNI/LMTD UPPER	$628.32	$952.00	$106.81–$952.00	12% below	34%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX VENOUS EXT UNI/LMTD	$881.10	$1,335.00	$106.81–$1,335.00	23% above	34%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX VENOUS EXT UNI/LMTD UPPER	$628.32	$952.00	$106.81–$952.00	—	34%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX VENOUS EXT UNI/LMTD	$881.10	$1,335.00	$106.81–$1,335.00	—	34%
Wrist X-ray, 2 views CPT 73100 HC XRAY WRIST 2 VIEWS	$315.48	$478.00	$88.91–$478.00	46% above	34%
Wrist X-ray, 2 views inpatient CPT 73100 HC XRAY WRIST 2 VIEWS	$315.48	$478.00	$88.91–$478.00	—	34%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST	$318.78	$483.00	$88.91–$483.00	25% above	34%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY EXAM OF WRIST	$318.78	$483.00	$88.91–$483.00	—	34%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC XR HIP W/PELVIS UNI 2-3VWS	$363.66	$551.00	$88.91–$551.00	25% above	34%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC XR HIP W/PELVIS UNI 2-3VWS	$363.66	$551.00	$88.91–$551.00	—	34%
X-ray of the abdomen, 1 view CPT 74018 HC XRAY ABDOMEN 1V	$310.86	$471.00	$87.72–$471.00	48% above	34%
X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW	$310.86	$471.00	$87.72–$471.00	48% above	34%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XRAY ABDOMEN 1V	$310.86	$471.00	$87.72–$471.00	—	34%
X-ray of the abdomen, 1 view inpatient CPT 74018 RADEX ABDOMEN 1 VIEW	$310.86	$471.00	$87.72–$471.00	—	34%
X-ray of the ankle, 2 views CPT 73600 HC XRAY ANKLE (2 V)	$315.48	$478.00	$88.91–$478.00	59% above	34%
X-ray of the ankle, 2 views inpatient CPT 73600 HC XRAY ANKLE (2 V)	$315.48	$478.00	$88.91–$478.00	—	34%
X-ray of the finger(s), 2 or more views CPT 73140 HC XRAY FINGER MIN 2 VIEWS	$315.48	$478.00	$88.91–$478.00	29% above	34%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XRAY FINGER MIN 2 VIEWS	$315.48	$478.00	$88.91–$478.00	—	34%
X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT	$319.44	$484.00	$84.95–$484.00	68% above	34%
X-ray of the foot, 2 views inpatient CPT 73620 X-RAY EXAM OF FOOT	$319.44	$484.00	$84.95–$484.00	—	34%
X-ray of the foot, complete, 3 or more views CPT 73630 HC XRAY FOOT (MIN 3 V)	$335.94	$509.00	$88.91–$509.00	39% above	34%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XRAY FOOT (MIN 3 V)	$335.94	$509.00	$88.91–$509.00	—	34%
X-ray of the hand, 3 or more views CPT 73130 HC HAND 3 VIEW-PRV 72 HR	$295.68	$448.00	$88.91–$448.00	26% above	34%
X-ray of the hand, 3 or more views CPT 73130 HC XRAY HAND MIN 3 VIEW	$388.74	$589.00	$88.91–$589.00	66% above	34%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND 3 VIEW-PRV 72 HR	$295.68	$448.00	$88.91–$448.00	—	34%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC XRAY HAND MIN 3 VIEW	$388.74	$589.00	$88.91–$589.00	—	34%
X-ray of the knee, 1 or 2 views CPT 73560 HC XRAY KNEE (1 OR 2 V)	$315.48	$478.00	$88.91–$478.00	49% above	34%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XRAY KNEE (1 OR 2 V)	$315.48	$478.00	$88.91–$478.00	—	34%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR L-SPINE 2V OR	$363.66	$551.00	$91.15–$551.00	25% above	34%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR L-SPINE 2-3V	$363.66	$551.00	$91.15–$551.00	25% above	34%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR L-SPINE 2V OR	$363.66	$551.00	$91.15–$551.00	—	34%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR L-SPINE 2-3V	$363.66	$551.00	$91.15–$551.00	—	34%
X-ray of the lower back, 4 or more views CPT 72110 HC XR L-SPINE 4+V	$582.78	$883.00	$91.15–$883.00	56% above	34%
X-ray of the lower back, 4 or more views CPT 72110 HC XR L-SPINE 5V OBLIQUES	$582.78	$883.00	$91.15–$883.00	56% above	34%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XR L-SPINE 4+V	$582.78	$883.00	$91.15–$883.00	—	34%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XR L-SPINE 5V OBLIQUES	$582.78	$883.00	$91.15–$883.00	—	34%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR T-SPINE 2V	$329.34	$499.00	$91.15–$499.00	39% above	34%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR T-SPINE 2V	$329.34	$499.00	$91.15–$499.00	—	34%
X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$315.48	$478.00	$88.91–$478.00	30% above	34%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES MIN 3 VIEWS	$315.48	$478.00	$88.91–$478.00	—	34%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$420.42	$637.00	$88.91–$637.00	75% above	34%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR C-SPINE 2-3V	$420.42	$637.00	$88.91–$637.00	75% above	34%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR C-SPINE 2-3V	$420.42	$637.00	$88.91–$637.00	—	34%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$420.42	$637.00	$88.91–$637.00	—	34%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2V FROG	$326.04	$494.00	$79.41–$494.00	47% above	34%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1-2V	$326.04	$494.00	$79.41–$494.00	47% above	34%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2V FROG	$326.04	$494.00	$79.41–$494.00	—	34%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1-2V	$326.04	$494.00	$79.41–$494.00	—	34%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR SACRUM 2+V	$330.00	$500.00	$88.91–$500.00	53% above	34%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR SACRUM/COCCYX 2+V	$330.00	$500.00	$88.91–$500.00	53% above	34%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR SACRUM/COCCYX 2+V	$330.00	$500.00	$88.91–$500.00	—	34%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR SACRUM 2+V	$330.00	$500.00	$88.91–$500.00	—	34%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
ACTH blood test CPT 82024 HC ACTH	$233.64	$354.00	$38.62–$354.00	6% above	34%
ACTH blood test inpatient CPT 82024 HC ACTH	$233.64	$354.00	$38.62–$354.00	—	34%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT	$32.34	$49.00	$5.30–$49.00	8% below	34%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALT/SGPT-PRV 72 HR	$60.06	$91.00	$5.30–$91.00	72% above	34%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT	$32.34	$49.00	$5.30–$49.00	—	34%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC ALT/SGPT-PRV 72 HR	$60.06	$91.00	$5.30–$91.00	—	34%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST	$32.34	$49.00	$5.18–$49.00	32% below	34%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC AST/SGOT-PRV 72 HR	$60.06	$91.00	$5.18–$91.00	27% above	34%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC AST	$32.34	$49.00	$5.18–$49.00	—	34%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC AST/SGOT-PRV 72 HR	$60.06	$91.00	$5.18–$91.00	—	34%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC HEPATITIS PANEL ACUTE	$316.80	$480.00	$47.63–$480.00	4% above	34%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC HEPATITIS PANEL ACUTE	$316.80	$480.00	$47.63–$480.00	—	34%
Albumin blood test CPT 82040 ASSAY OF SERUM ALBUMIN	$31.02	$47.00	$4.95–$47.00	17% below	34%
Albumin blood test inpatient CPT 82040 ASSAY OF SERUM ALBUMIN	$31.02	$47.00	$4.95–$47.00	—	34%
Aldosterone blood test CPT 82088 HC ALDOSTERONE	$252.12	$382.00	$40.75–$382.00	29% above	34%
Aldosterone blood test inpatient CPT 82088 HC ALDOSTERONE	$252.12	$382.00	$40.75–$382.00	—	34%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ALKALINE PHOSPHATASE	$25.74	$39.00	$5.18–$39.00	47% below	34%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC ALKALINE PHOSPHATASE	$25.74	$39.00	$5.18–$39.00	—	34%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN IGE QN EA-REF	$9.24	$14.00	$3.36–$14.00	63% below	34%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC ALLERGEN IGE QN EA-REF	$9.24	$14.00	$3.36–$14.00	—	34%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM	$99.00	$150.00	$16.77–$150.00	19% above	34%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM	$99.00	$150.00	$16.77–$150.00	—	34%
Ammonia blood test CPT 82140 HC AMMONIA	$89.76	$136.00	$14.57–$136.00	at median	34%
Ammonia blood test inpatient CPT 82140 HC AMMONIA	$89.76	$136.00	$14.57–$136.00	—	34%
Amylase blood test CPT 82150 HC AMYLASE	$54.12	$82.00	$6.48–$82.00	12% below	34%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE-PRV 72HR	$70.62	$107.00	$6.48–$107.00	14% above	34%
Amylase blood test inpatient CPT 82150 HC AMYLASE	$54.12	$82.00	$6.48–$82.00	—	34%
Amylase blood test inpatient CPT 82150 HC ASSAY OF AMYLASE-PRV 72HR	$70.62	$107.00	$6.48–$107.00	—	34%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP AB	$89.10	$135.00	$12.95–$135.00	8% above	34%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC CCP AB	$89.10	$135.00	$12.95–$135.00	—	34%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$68.64	$104.00	$12.09–$104.00	at median	34%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANA SCREEN-PRV 72 HR	$116.82	$177.00	$12.09–$177.00	70% above	34%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$68.64	$104.00	$12.09–$104.00	—	34%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC ANA SCREEN-PRV 72 HR	$116.82	$177.00	$12.09–$177.00	—	34%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC BNP NATRIURETIC PEPTIDE-PRV 72 HR	$174.24	$264.00	$39.26–$264.00	22% above	34%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$207.24	$314.00	$39.26–$314.00	45% above	34%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC BNP NATRIURETIC PEPTIDE-PRV 72 HR	$174.24	$264.00	$39.26–$264.00	—	34%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$207.24	$314.00	$39.26–$314.00	—	34%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC BODY FLUID CULTURE	$91.74	$139.00	$8.62–$139.00	75% above	34%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTHR SPECIMN AEROBIC	$237.60	$360.00	$8.62–$360.00	353% above	34%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC BODY FLUID CULTURE	$91.74	$139.00	$8.62–$139.00	—	34%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE OTHR SPECIMN AEROBIC	$237.60	$360.00	$8.62–$360.00	—	34%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL	$85.80	$130.00	$8.46–$130.00	3% below	34%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL-PRV 72 HR	$125.40	$190.00	$8.46–$190.00	42% above	34%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL	$85.80	$130.00	$8.46–$130.00	—	34%
Basic metabolic panel (blood test) inpatient CPT 80048 HC BASIC METABOLIC PANEL-PRV 72 HR	$125.40	$190.00	$8.46–$190.00	—	34%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$35.64	$54.00	$4.24–$54.00	24% below	34%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$35.64	$54.00	$4.24–$54.00	—	34%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$297.66	$451.00	$52.32–$451.00	38% above	34%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST	$297.66	$451.00	$52.32–$451.00	—	34%
Blood culture for bacteria CPT 87040 HC BACTERIA BLOOD CULTURE T1	$99.00	$150.00	$10.32–$150.00	15% above	34%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE	$99.00	$150.00	$10.32–$150.00	15% above	34%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE-72HR PRV	$124.74	$189.00	$10.32–$189.00	45% above	34%
Blood culture for bacteria inpatient CPT 87040 HC BACTERIA BLOOD CULTURE T1	$99.00	$150.00	$10.32–$150.00	—	34%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE	$99.00	$150.00	$10.32–$150.00	—	34%
Blood culture for bacteria inpatient CPT 87040 HC BLOOD CULTURE-72HR PRV	$124.74	$189.00	$10.32–$189.00	—	34%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$16.50	$25.00	$4.36–$25.00	12% above	34%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE-PRV 72 HR	$27.06	$41.00	$4.36–$41.00	84% above	34%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLL VENOUS BLD VENIPUNCTURE	$16.50	$25.00	$4.36–$25.00	—	34%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE-PRV 72 HR	$27.06	$41.00	$4.36–$41.00	—	34%
Blood glucose (sugar) test CPT 82947 HC GLUCOSE	$24.42	$37.00	$3.93–$37.00	at median	34%
Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE	$24.42	$37.00	$3.93–$37.00	—	34%
Blood lead test CPT 83655 ASSAY OF LEAD	$72.60	$110.00	$12.11–$110.00	32% above	34%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$72.60	$110.00	$12.11–$110.00	—	34%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC HCG QL	$62.04	$94.00	$7.52–$94.00	at median	34%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC HCG QL	$62.04	$94.00	$7.52–$94.00	—	34%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC BLOOD TYPING ABO	$129.36	$196.00	$3.09–$196.00	204% above	34%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC BLOOD TYPING ABO	$129.36	$196.00	$3.09–$196.00	—	34%
Blood urea nitrogen (BUN) test CPT 84520 ASSAY OF UREA NITROGEN	$25.74	$39.00	$3.95–$39.00	at median	34%
Blood urea nitrogen (BUN) test inpatient CPT 84520 ASSAY OF UREA NITROGEN	$25.74	$39.00	$3.95–$39.00	—	34%
C-peptide blood test CPT 84681 HC C PEPTIDE	$81.18	$123.00	$7.34–$123.00	7% below	34%
C-peptide blood test inpatient CPT 84681 HC C PEPTIDE	$81.18	$123.00	$7.34–$123.00	—	34%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$39.60	$60.00	$5.18–$60.00	27% below	34%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN-PRV 72 HR	$125.40	$190.00	$5.18–$190.00	130% above	34%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN	$39.60	$60.00	$5.18–$60.00	—	34%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-REACTIVE PROTEIN-PRV 72 HR	$125.40	$190.00	$5.18–$190.00	—	34%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDUM DIFFICILE	$237.60	$360.00	$37.27–$360.00	58% above	34%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC CLOSTRIDUM DIFFICILE	$237.60	$360.00	$37.27–$360.00	—	34%
CA 19-9 blood test (tumor marker) CPT 86301 HC TUMOR AG CA 19-9	$139.92	$212.00	$20.81–$212.00	24% above	34%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC TUMOR AG CA 19-9	$139.92	$212.00	$20.81–$212.00	—	34%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC TUMOR AG CA 125	$138.60	$210.00	$20.81–$210.00	16% above	34%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC TUMOR AG CA 125-PRV 72 HR	$151.80	$230.00	$20.81–$230.00	26% above	34%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC TUMOR AG CA 125	$138.60	$210.00	$20.81–$210.00	—	34%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC TUMOR AG CA 125-PRV 72 HR	$151.80	$230.00	$20.81–$230.00	—	34%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$119.46	$181.00	$43.44–$181.00	12% below	34%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC SARS-COV-2 COVID-19 AMP PRB	$126.06	$191.00	$45.84–$191.00	7% below	34%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$119.46	$181.00	$43.44–$181.00	—	34%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC SARS-COV-2 COVID-19 AMP PRB	$126.06	$191.00	$45.84–$191.00	—	34%
Calcium blood test, total CPT 82310 HC CALCIUM	$31.02	$47.00	$5.16–$47.00	41% below	34%
Calcium blood test, total inpatient CPT 82310 HC CALCIUM	$31.02	$47.00	$5.16–$47.00	—	34%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN	$135.30	$205.00	$18.96–$205.00	at median	34%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN	$135.30	$205.00	$18.96–$205.00	—	34%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER QN	$49.50	$75.00	$8.17–$75.00	32% below	34%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA ZOSTER ATB	$68.64	$104.00	$8.17–$104.00	6% below	34%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER QN	$49.50	$75.00	$8.17–$75.00	—	34%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC VARICELLA ZOSTER ATB	$68.64	$104.00	$8.17–$104.00	—	34%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE	$217.14	$329.00	$35.09–$329.00	52% above	34%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLMYD TRACH DNA AMP PROBE	$217.14	$329.00	$35.09–$329.00	—	34%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$89.10	$135.00	$13.39–$135.00	at median	34%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL-PRV 72 HR	$149.82	$227.00	$13.39–$227.00	68% above	34%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL	$89.10	$135.00	$13.39–$135.00	—	34%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC LIPID PANEL-PRV 72 HR	$149.82	$227.00	$13.39–$227.00	—	34%
Complete blood count (CBC) with differential CPT 85025 HC CBC AUTO W/AUTO DIFF	$59.40	$90.00	$7.77–$90.00	18% below	34%
Complete blood count (CBC) with differential CPT 85025 HC CBC AUTO W/AUTO DIFF-PRV 72 HR	$64.02	$97.00	$7.77–$97.00	12% below	34%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC AUTO W/AUTO DIFF	$59.40	$90.00	$7.77–$90.00	—	34%
Complete blood count (CBC) with differential inpatient CPT 85025 HC CBC AUTO W/AUTO DIFF-PRV 72 HR	$64.02	$97.00	$7.77–$97.00	—	34%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED	$43.56	$66.00	$6.47–$66.00	17% below	34%
Complete blood count (CBC), no differential CPT 85027 HC CBC W/O DIFF-PRV 72 HR	$108.24	$164.00	$6.47–$164.00	106% above	34%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED	$43.56	$66.00	$6.47–$66.00	—	34%
Complete blood count (CBC), no differential inpatient CPT 85027 HC CBC W/O DIFF-PRV 72 HR	$108.24	$164.00	$6.47–$164.00	—	34%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$118.80	$180.00	$10.56–$180.00	4% above	34%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$118.80	$180.00	$10.56–$180.00	—	34%
Cortisol blood test, total CPT 82533 HC CORTISOL TOTAL	$99.00	$150.00	$16.30–$150.00	18% below	34%
Cortisol blood test, total CPT 82533 HC ACTH STIM 3 SPECIMENS	$99.00	$150.00	$16.30–$150.00	18% below	34%
Cortisol blood test, total inpatient CPT 82533 HC ACTH STIM 3 SPECIMENS	$99.00	$150.00	$16.30–$150.00	—	34%
Cortisol blood test, total inpatient CPT 82533 HC CORTISOL TOTAL	$99.00	$150.00	$16.30–$150.00	—	34%
Creatine kinase (CK) blood test, total CPT 82550 HC CREATINE KINASE (CPK) TOTAL	$42.24	$64.00	$6.51–$64.00	34% below	34%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC CREATINE KINASE (CPK) TOTAL	$42.24	$64.00	$6.51–$64.00	—	34%
Creatinine blood test CPT 82565 HC CREATININE	$31.68	$48.00	$5.12–$48.00	at median	34%
Creatinine blood test CPT 82565 HC CREATININE-PRV 72HR	$62.04	$94.00	$5.12–$94.00	96% above	34%
Creatinine blood test inpatient CPT 82565 HC CREATININE	$31.68	$48.00	$5.12–$48.00	—	34%
Creatinine blood test inpatient CPT 82565 HC CREATININE-PRV 72HR	$62.04	$94.00	$5.12–$94.00	—	34%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY	$99.00	$150.00	$14.39–$150.00	40% above	34%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY	$99.00	$150.00	$14.39–$150.00	—	34%
D-dimer blood test (blood clot marker) CPT 85379 HC D DIMER QN	$68.64	$104.00	$10.18–$104.00	14% below	34%
D-dimer blood test (blood clot marker) CPT 85379 HC D-DIMMER QUAN-PRV 72 HR	$130.68	$198.00	$10.18–$198.00	64% above	34%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D DIMER QN	$68.64	$104.00	$10.18–$104.00	—	34%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC D-DIMMER QUAN-PRV 72 HR	$130.68	$198.00	$10.18–$198.00	—	34%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DHEA SULFATE	$134.64	$204.00	$22.23–$204.00	6% below	34%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC DHEA SULFATE	$134.64	$204.00	$22.23–$204.00	—	34%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$258.72	$392.00	$62.14–$392.00	123% above	34%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$258.72	$392.00	$62.14–$392.00	—	34%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$48.84	$74.00	$7.01–$74.00	at median	34%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC ELECTROLYTE PANEL	$48.84	$74.00	$7.01–$74.00	—	34%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EBV VIRAL CAP	$118.14	$179.00	$18.14–$179.00	43% above	34%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC EBV VIRAL CAP	$118.14	$179.00	$18.14–$179.00	—	34%
Estradiol blood test CPT 82670 HC ESTRADIOL	$170.94	$259.00	$27.94–$259.00	33% above	34%
Estradiol blood test inpatient CPT 82670 HC ESTRADIOL	$170.94	$259.00	$27.94–$259.00	—	34%
FSH (follicle-stimulating hormone) test CPT 83001 HC FSH	$117.48	$178.00	$18.58–$178.00	2% above	34%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC FSH	$117.48	$178.00	$18.58–$178.00	—	34%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$126.06	$191.00	$19.63–$191.00	33% below	34%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$126.06	$191.00	$19.63–$191.00	—	34%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN	$81.18	$123.00	$13.63–$123.00	10% below	34%
Ferritin blood test (iron stores) CPT 82728 HC FERRITIN-PRV 72 HR	$114.18	$173.00	$13.63–$173.00	26% above	34%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN	$81.18	$123.00	$13.63–$123.00	—	34%
Ferritin blood test (iron stores) inpatient CPT 82728 HC FERRITIN-PRV 72 HR	$114.18	$173.00	$13.63–$173.00	—	34%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN	$68.64	$104.00	$9.72–$104.00	2% above	34%
Fibrinogen blood test inpatient CPT 85384 HC FIBRINOGEN	$68.64	$104.00	$9.72–$104.00	—	34%
Folate (folic acid) blood test CPT 82746 HC FOLIC ACID SERUM	$89.76	$136.00	$14.70–$136.00	9% below	34%
Folate (folic acid) blood test inpatient CPT 82746 HC FOLIC ACID SERUM	$89.76	$136.00	$14.70–$136.00	—	34%
Free T3 thyroid hormone test CPT 84481 HC T3 FREE	$72.60	$110.00	$16.62–$110.00	26% below	34%
Free T3 thyroid hormone test inpatient CPT 84481 HC T3 FREE	$72.60	$110.00	$16.62–$110.00	—	34%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC T4 FREE DIRECT DIALYSIS	$54.12	$82.00	$9.02–$82.00	33% below	34%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC T4 FREE	$54.12	$82.00	$9.02–$82.00	33% below	34%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC T4 FREE-PRV 72 HR	$130.02	$197.00	$9.02–$197.00	61% above	34%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC T4 FREE	$54.12	$82.00	$9.02–$82.00	—	34%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC T4 FREE DIRECT DIALYSIS	$54.12	$82.00	$9.02–$82.00	—	34%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC T4 FREE-PRV 72 HR	$130.02	$197.00	$9.02–$197.00	—	34%
Free testosterone test CPT 84402 HC TESTOSTERONE FREE	$152.46	$231.00	$25.47–$231.00	30% above	34%
Free testosterone test inpatient CPT 84402 HC TESTOSTERONE FREE	$152.46	$231.00	$25.47–$231.00	—	34%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC GGT/GGTP	$44.22	$67.00	$7.20–$67.00	17% below	34%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC GGT/GGTP	$44.22	$67.00	$7.20–$67.00	—	34%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL-72HR	$295.68	$448.00	$11.92–$448.00	7% above	34%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC GENERAL HEALTH PANEL	$300.30	$455.00	$11.92–$455.00	9% above	34%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL-72HR	$295.68	$448.00	$11.92–$448.00	—	34%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC GENERAL HEALTH PANEL	$300.30	$455.00	$11.92–$455.00	—	34%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE SCREEN	$72.60	$110.00	$4.75–$110.00	47% above	34%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC GLUCOSE SCREEN	$72.60	$110.00	$4.75–$110.00	—	34%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE	$89.76	$136.00	$12.87–$136.00	at median	34%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC GLUCOSE TOLERANCE	$89.76	$136.00	$12.87–$136.00	—	34%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N GONOR RNA TMA	$217.14	$329.00	$35.09–$329.00	52% above	34%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC NEISSERIA AMP	$237.60	$360.00	$35.09–$360.00	66% above	34%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N GONOR RNA TMA	$217.14	$329.00	$35.09–$329.00	—	34%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC NEISSERIA AMP	$237.60	$360.00	$35.09–$360.00	—	34%
H. pylori antibody blood test CPT 86677 HC H PYLORI AB	$79.86	$121.00	$8.17–$121.00	14% below	34%
H. pylori antibody blood test inpatient CPT 86677 HC H PYLORI AB	$79.86	$121.00	$8.17–$121.00	—	34%
H. pylori stool antigen test CPT 87338 HC H PYLORI AG STOOL	$104.28	$158.00	$14.38–$158.00	19% below	34%
H. pylori stool antigen test CPT 87338 HC EIA QL H PYLORI AG STOOL	$118.14	$179.00	$14.38–$179.00	9% below	34%
H. pylori stool antigen test inpatient CPT 87338 HC H PYLORI AG STOOL	$104.28	$158.00	$14.38–$158.00	—	34%
H. pylori stool antigen test inpatient CPT 87338 HC EIA QL H PYLORI AG STOOL	$118.14	$179.00	$14.38–$179.00	—	34%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$287.76	$436.00	$85.10–$436.00	26% below	34%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$287.76	$436.00	$85.10–$436.00	—	34%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV 1 HIV 2 AB SGL ASSAY	$89.10	$135.00	$13.71–$135.00	15% above	34%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC HIV 1 HIV 2 AB SGL ASSAY	$89.10	$135.00	$13.71–$135.00	—	34%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$99.00	$150.00	$24.08–$150.00	3% below	34%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$99.00	$150.00	$24.08–$150.00	—	34%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HI-RISK TYP POOLED RSLT	$138.60	$210.00	$35.09–$210.00	3% below	34%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HI-RISK TYP POOLED RSLT	$138.60	$210.00	$35.09–$210.00	—	34%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HGB-PRV 72 HR	$103.62	$157.00	$9.71–$157.00	50% above	34%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC GLYCOSYLATED HGB-PRV 72 HR	$103.62	$157.00	$9.71–$157.00	—	34%
Hemoglobin blood test CPT 85018 HC HGB	$17.16	$26.00	$2.37–$26.00	2% below	34%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN-PRV 72 HR	$55.44	$84.00	$2.37–$84.00	217% above	34%
Hemoglobin blood test inpatient CPT 85018 HC HGB	$17.16	$26.00	$2.37–$26.00	—	34%
Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN-PRV 72 HR	$55.44	$84.00	$2.37–$84.00	—	34%
Hepatitis B core antibody test (total) CPT 86704 HC HEP CORE AB	$79.86	$121.00	$12.05–$121.00	at median	34%
Hepatitis B core antibody test (total) CPT 86704 HC HEP CORE AB (ATB)	$87.12	$132.00	$12.05–$132.00	9% above	34%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEP CORE AB	$79.86	$121.00	$12.05–$121.00	—	34%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC HEP CORE AB (ATB)	$87.12	$132.00	$12.05–$132.00	—	34%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY	$68.64	$104.00	$10.74–$104.00	7% below	34%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY	$68.64	$104.00	$10.74–$104.00	—	34%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$68.64	$104.00	$10.33–$104.00	6% above	34%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA	$68.64	$104.00	$10.33–$104.00	—	34%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEP C AB	$99.00	$150.00	$14.27–$150.00	23% above	34%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC HEP C AB	$99.00	$150.00	$14.27–$150.00	—	34%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C QN	$287.76	$436.00	$42.84–$436.00	22% above	34%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC HEPATITIS C QN	$287.76	$436.00	$42.84–$436.00	—	34%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$85.80	$130.00	$13.19–$130.00	26% above	34%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX AB-PRV 72 HR	$122.76	$186.00	$13.19–$186.00	81% above	34%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$85.80	$130.00	$13.19–$130.00	—	34%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC HERPES SIMPLEX AB-PRV 72 HR	$122.76	$186.00	$13.19–$186.00	—	34%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX AB II-PRV 72 HR	$122.76	$186.00	$19.35–$186.00	51% above	34%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$129.36	$196.00	$19.35–$196.00	59% above	34%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC HERPES SIMPLEX AB II-PRV 72 HR	$122.76	$186.00	$19.35–$186.00	—	34%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$129.36	$196.00	$19.35–$196.00	—	34%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN (HS)	$147.84	$224.00	$12.95–$224.00	85% above	34%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN (HS)	$147.84	$224.00	$12.95–$224.00	—	34%
Homocysteine blood test CPT 83090 HC HOMOCYSTEINE	$107.58	$163.00	$17.92–$163.00	9% below	34%
Homocysteine blood test CPT 83090 HC HOMOCYSTINE-PREVEA 72HR	$118.14	$179.00	$17.92–$179.00	at median	34%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTEINE	$107.58	$163.00	$17.92–$163.00	—	34%
Homocysteine blood test inpatient CPT 83090 HC HOMOCYSTINE-PREVEA 72HR	$118.14	$179.00	$17.92–$179.00	—	34%
Insulin blood test CPT 83525 HC INSULIN TOTAL	$62.70	$95.00	$11.43–$95.00	7% below	34%
Insulin blood test inpatient CPT 83525 HC INSULIN TOTAL	$62.70	$95.00	$11.43–$95.00	—	34%
Iron blood test (serum iron) CPT 83540 HC IRON LIVER TISSUE	$39.60	$60.00	$6.47–$60.00	26% below	34%
Iron blood test (serum iron) CPT 83540 HC IRON TOTAL	$39.60	$60.00	$6.47–$60.00	26% below	34%
Iron blood test (serum iron) CPT 83540 HC IRON TOTAL-PRV 72 HR	$67.32	$102.00	$6.47–$102.00	26% above	34%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON TOTAL	$39.60	$60.00	$6.47–$60.00	—	34%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON LIVER TISSUE	$39.60	$60.00	$6.47–$60.00	—	34%
Iron blood test (serum iron) inpatient CPT 83540 HC IRON TOTAL-PRV 72 HR	$67.32	$102.00	$6.47–$102.00	—	34%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY	$62.04	$94.00	$8.74–$94.00	at median	34%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING CAPACITY-PRV 72 HR	$89.10	$135.00	$8.74–$135.00	44% above	34%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY	$62.04	$94.00	$8.74–$94.00	—	34%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC IRON BINDING CAPACITY-PRV 72 HR	$89.10	$135.00	$8.74–$135.00	—	34%
Kidney function blood test panel CPT 80069 HC RENAL PANEL	$113.52	$172.00	$8.68–$172.00	11% above	34%
Kidney function blood test panel inpatient CPT 80069 HC RENAL PANEL	$113.52	$172.00	$8.68–$172.00	—	34%
LH (luteinizing hormone) test CPT 83002 HC LUTEINIZING HORMONE (LH)	$117.48	$178.00	$18.52–$178.00	20% above	34%
LH (luteinizing hormone) test inpatient CPT 83002 HC LUTEINIZING HORMONE (LH)	$117.48	$178.00	$18.52–$178.00	—	34%
Lactate (lactic acid) blood test CPT 83605 HC LACTATE/LACTIC ACID	$72.60	$110.00	$11.57–$110.00	4% above	34%
Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID	$72.60	$110.00	$11.57–$110.00	4% above	34%
Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTIC ACID	$72.60	$110.00	$11.57–$110.00	—	34%
Lactate (lactic acid) blood test inpatient CPT 83605 HC LACTATE/LACTIC ACID	$72.60	$110.00	$11.57–$110.00	—	34%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDRO (LDH)	$43.56	$66.00	$6.04–$66.00	13% below	34%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE DEHYDRO (LDH)-PRV 72 HR	$59.40	$90.00	$6.04–$90.00	19% above	34%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDRO (LDH)	$43.56	$66.00	$6.04–$66.00	—	34%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC LACTATE DEHYDRO (LDH)-PRV 72 HR	$59.40	$90.00	$6.04–$90.00	—	34%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE-PRV 72 HR	$102.30	$155.00	$6.89–$155.00	51% above	34%
Lipase blood test (pancreas enzyme) CPT 83690 HC LIPASE	$120.12	$182.00	$6.89–$182.00	77% above	34%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE-PRV 72 HR	$102.30	$155.00	$6.89–$155.00	—	34%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC LIPASE	$120.12	$182.00	$6.89–$182.00	—	34%
Liver function blood test panel CPT 80076 HC LIVER (HEPATIC) PANEL	$68.64	$104.00	$8.17–$104.00	33% below	34%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL-PRV 72 HR	$131.34	$199.00	$8.17–$199.00	29% above	34%
Liver function blood test panel inpatient CPT 80076 HC LIVER (HEPATIC) PANEL	$68.64	$104.00	$8.17–$104.00	—	34%
Liver function blood test panel inpatient CPT 80076 HC HEPATIC FUNCTION PANEL-PRV 72 HR	$131.34	$199.00	$8.17–$199.00	—	34%
Lyme disease antibody test CPT 86618 HC LYME AB	$118.14	$179.00	$17.03–$179.00	42% above	34%
Lyme disease antibody test CPT 86618 HC LYMES DISEASE-PRV 72 HR	$138.60	$210.00	$17.03–$210.00	66% above	34%
Lyme disease antibody test inpatient CPT 86618 HC LYME AB	$118.14	$179.00	$17.03–$179.00	—	34%
Lyme disease antibody test inpatient CPT 86618 HC LYMES DISEASE-PRV 72 HR	$138.60	$210.00	$17.03–$210.00	—	34%
Magnesium blood test CPT 83735 HC MAGNESIUM	$48.84	$74.00	$6.70–$74.00	7% below	34%
Magnesium blood test CPT 83735 HC MAGNESIUM-PRV 72 HR	$62.04	$94.00	$6.70–$94.00	18% above	34%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM	$48.84	$74.00	$6.70–$74.00	—	34%
Magnesium blood test inpatient CPT 83735 HC MAGNESIUM-PRV 72 HR	$62.04	$94.00	$6.70–$94.00	—	34%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$89.10	$135.00	$12.88–$135.00	8% above	34%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY	$89.10	$135.00	$12.88–$135.00	—	34%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE SCR MONO	$68.64	$104.00	$5.18–$104.00	24% above	34%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE SCRN-PRV 72 HR	$80.52	$122.00	$5.18–$122.00	46% above	34%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE SCR MONO	$68.64	$104.00	$5.18–$104.00	—	34%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC HETEROPHILE SCRN-PRV 72 HR	$80.52	$122.00	$5.18–$122.00	—	34%
Mumps immunity blood test CPT 86735 MUMPS ANTIBODY	$108.90	$165.00	$13.05–$165.00	27% above	34%
Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY	$108.90	$165.00	$13.05–$165.00	—	34%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$256.74	$389.00	$18.84–$389.00	6% above	34%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$256.74	$389.00	$18.84–$389.00	—	34%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC PSA FREE	$117.48	$178.00	$18.39–$178.00	27% above	34%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC PSA FREE	$117.48	$178.00	$18.39–$178.00	—	34%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA TOTAL	$117.48	$178.00	$18.39–$178.00	24% above	34%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC PSA TOTAL	$117.48	$178.00	$18.39–$178.00	—	34%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTOPATH CERVICAL	$127.38	$193.00	$20.26–$193.00	42% above	34%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER	$139.26	$211.00	$20.26–$211.00	55% above	34%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC CYTOPATH CERVICAL	$127.38	$193.00	$20.26–$193.00	—	34%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH C/V THIN LAYER	$139.26	$211.00	$20.26–$211.00	—	34%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHORMONE PTH-PREV 72HR	$248.16	$376.00	$41.28–$376.00	16% above	34%
Parathyroid hormone (PTH) blood test CPT 83970 HC PARATHYROID HORMONE (PTH)	$252.12	$382.00	$41.28–$382.00	18% above	34%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHORMONE PTH-PREV 72HR	$248.16	$376.00	$41.28–$376.00	—	34%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC PARATHYROID HORMONE (PTH)	$252.12	$382.00	$41.28–$382.00	—	34%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT (LUPUS)	$46.86	$71.00	$6.01–$71.00	11% below	34%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT	$49.50	$75.00	$6.01–$75.00	6% below	34%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC PTT-PRV 72 HR	$56.10	$85.00	$6.01–$85.00	7% above	34%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC APTT	$91.08	$138.00	$6.01–$138.00	73% above	34%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT (LUPUS)	$46.86	$71.00	$6.01–$71.00	—	34%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT	$49.50	$75.00	$6.01–$75.00	—	34%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC PTT-PRV 72 HR	$56.10	$85.00	$6.01–$85.00	—	34%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC APTT	$91.08	$138.00	$6.01–$138.00	—	34%
Phosphorus (phosphate) blood test CPT 84100 HC PHOSPHORUS	$29.04	$44.00	$4.74–$44.00	30% below	34%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC PHOSPHORUS	$29.04	$44.00	$4.74–$44.00	—	34%
Potassium blood test CPT 84132 HC POTASSIUM	$29.04	$44.00	$4.76–$44.00	6% above	34%
Potassium blood test CPT 84132 HC POTASSIUM SERUM-PRV 72 HR	$59.40	$90.00	$4.76–$90.00	117% above	34%
Potassium blood test inpatient CPT 84132 HC POTASSIUM	$29.04	$44.00	$4.76–$44.00	—	34%
Potassium blood test inpatient CPT 84132 HC POTASSIUM SERUM-PRV 72 HR	$59.40	$90.00	$4.76–$90.00	—	34%
Progesterone blood test CPT 84144 HC PROGESTERONE	$117.48	$178.00	$20.86–$178.00	3% below	34%
Progesterone blood test inpatient CPT 84144 HC PROGESTERONE	$117.48	$178.00	$20.86–$178.00	—	34%
Prolactin blood test CPT 84146 HC PROLACTIN	$117.48	$178.00	$19.38–$178.00	3% below	34%
Prolactin blood test inpatient CPT 84146 HC PROLACTIN	$117.48	$178.00	$19.38–$178.00	—	34%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME (PT)	$31.68	$48.00	$4.29–$48.00	6% below	34%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME (PT)-PRV 72 HR	$65.34	$99.00	$4.29–$99.00	94% above	34%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME (PT)	$31.68	$48.00	$4.29–$48.00	—	34%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME (PT)-PRV 72 HR	$65.34	$99.00	$4.29–$99.00	—	34%
Rapid flu test (influenza antigen) CPT 87804 HC FLU PRV 72HR	$85.14	$129.00	$16.55–$129.00	61% above	34%
Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA ASSAY W/OPTIC	$85.14	$129.00	$16.55–$129.00	61% above	34%
Rapid flu test (influenza antigen) CPT 87804 HC FLU-PRV 72 HR	$88.44	$134.00	$16.55–$134.00	67% above	34%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC FLU PRV 72HR	$85.14	$129.00	$16.55–$129.00	—	34%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA ASSAY W/OPTIC	$85.14	$129.00	$16.55–$129.00	—	34%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC FLU-PRV 72 HR	$88.44	$134.00	$16.55–$134.00	—	34%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC OPTICAL STREP	$79.86	$121.00	$16.53–$121.00	75% above	34%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP-PRV 72 HR	$80.52	$122.00	$16.53–$122.00	77% above	34%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC OPTICAL STREP	$79.86	$121.00	$16.53–$121.00	—	34%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP-PRV 72 HR	$80.52	$122.00	$16.53–$122.00	—	34%
Renin blood test CPT 84244 HC RENIN	$134.64	$204.00	$21.99–$204.00	9% below	34%
Renin blood test inpatient CPT 84244 HC RENIN	$134.64	$204.00	$21.99–$204.00	—	34%
Rh blood typing CPT 86901 HC BLOOD TYPING RH	$39.60	$60.00	$3.09–$60.00	at median	34%
Rh blood typing inpatient CPT 86901 HC BLOOD TYPING RH	$39.60	$60.00	$3.09–$60.00	—	34%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QN	$38.94	$59.00	$5.67–$59.00	33% below	34%
Rheumatoid factor (RF) test inpatient CPT 86431 HC RHEUMATOID FACTOR QN	$38.94	$59.00	$5.67–$59.00	—	34%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$99.00	$150.00	$14.39–$150.00	20% above	34%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY	$99.00	$150.00	$14.39–$150.00	—	34%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC SED RATE AUTO	$36.96	$56.00	$2.70–$56.00	11% below	34%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC ESR AUTO- PRV 72 HR	$59.40	$90.00	$2.70–$90.00	43% above	34%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC SED RATE AUTO	$36.96	$56.00	$2.70–$56.00	—	34%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC ESR AUTO- PRV 72 HR	$59.40	$90.00	$2.70–$90.00	—	34%
Sodium blood test CPT 84295 HC SODIUM	$20.46	$31.00	$4.81–$31.00	18% below	34%
Sodium blood test inpatient CPT 84295 HC SODIUM	$20.46	$31.00	$4.81–$31.00	—	34%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$59.40	$90.00	$8.90–$90.00	9% below	34%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS	$59.40	$90.00	$8.90–$90.00	—	34%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECAL SCRN	$21.12	$32.00	$3.66–$32.00	at median	34%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC BLOOD OCCULT-PRV 72 HR	$52.14	$79.00	$3.66–$79.00	147% above	34%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECAL SCRN	$21.12	$32.00	$3.66–$32.00	—	34%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC BLOOD OCCULT-PRV 72 HR	$52.14	$79.00	$3.66–$79.00	—	34%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLOOD FECAL HGB	$99.00	$150.00	$15.92–$150.00	64% above	34%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLOOD FECAL HGB	$99.00	$150.00	$15.92–$150.00	—	34%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM	$38.28	$58.00	$11.13–$58.00	30% below	34%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM	$38.28	$58.00	$11.13–$58.00	—	34%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS VDRL RPR QL CSF	$7.11	$10.78	$2.59–$10.78	82% below	34%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS VDRL RPR QL	$32.34	$49.00	$4.27–$49.00	18% below	34%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS VDRL RPR QL CSF	$7.11	$10.78	$2.59–$10.78	—	34%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC SYPHILIS VDRL RPR QL	$32.34	$49.00	$4.27–$49.00	—	34%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB QUANTIFERON GOLD	$415.14	$629.00	$61.98–$629.00	64% above	34%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB QUANTIFERON GOLD	$415.14	$629.00	$61.98–$629.00	—	34%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTOSTERONE TOTAL	$152.46	$231.00	$25.81–$231.00	33% above	34%
Testosterone blood test, total (not free testosterone) CPT 84403 HC TESTERONE TOTAL-PRV 72HR	$170.94	$259.00	$25.81–$259.00	49% above	34%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTOSTERONE TOTAL	$152.46	$231.00	$25.81–$231.00	—	34%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC TESTERONE TOTAL-PRV 72HR	$170.94	$259.00	$25.81–$259.00	—	34%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL AB	$99.00	$150.00	$14.55–$150.00	41% above	34%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC MICROSOMAL AB	$99.00	$150.00	$14.55–$150.00	—	34%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORM	$99.00	$150.00	$16.80–$150.00	10% above	34%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC TSH WITH HAMA TREATMENT	$99.00	$150.00	$16.80–$150.00	10% above	34%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC THYROID STIMULATING HORM-PRV 72 HR	$114.84	$174.00	$16.80–$174.00	28% above	34%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORM	$99.00	$150.00	$16.80–$150.00	—	34%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC TSH WITH HAMA TREATMENT	$99.00	$150.00	$16.80–$150.00	—	34%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC THYROID STIMULATING HORM-PRV 72 HR	$114.84	$174.00	$16.80–$174.00	—	34%
Total IgE blood test CPT 82785 HC GAMMAGLOBULIN IGE	$99.00	$150.00	$16.46–$150.00	3% below	34%
Total IgE blood test inpatient CPT 82785 HC GAMMAGLOBULIN IGE	$99.00	$150.00	$16.46–$150.00	—	34%
Total cholesterol blood test CPT 82465 ASSAY BLD/SERUM CHOLESTEROL	$51.48	$78.00	$4.35–$78.00	11% above	34%
Total cholesterol blood test inpatient CPT 82465 ASSAY BLD/SERUM CHOLESTEROL	$51.48	$78.00	$4.35–$78.00	—	34%
Total thyroxine (T4) blood test CPT 84436 HC THYROXINE (T-4) TOTAL	$31.68	$48.00	$6.87–$48.00	39% below	34%
Total thyroxine (T4) blood test inpatient CPT 84436 HC THYROXINE (T-4) TOTAL	$31.68	$48.00	$6.87–$48.00	—	34%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 TOTAL	$89.76	$136.00	$14.18–$136.00	16% below	34%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC T3 TOTAL	$89.76	$136.00	$14.18–$136.00	—	34%
Transferrin blood test CPT 84466 HC TRANSFERRIN	$43.56	$66.00	$12.76–$66.00	54% below	34%
Transferrin blood test inpatient CPT 84466 HC TRANSFERRIN	$43.56	$66.00	$12.76–$66.00	—	34%
Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES	$35.64	$54.00	$5.74–$54.00	34% below	34%
Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES	$35.64	$54.00	$5.74–$54.00	—	34%
Troponin test, quantitative CPT 84484 HC TROPONIN QN	$84.48	$128.00	$12.47–$128.00	at median	34%
Troponin test, quantitative inpatient CPT 84484 HC TROPONIN QN	$84.48	$128.00	$12.47–$128.00	—	34%
Uric acid blood test CPT 84550 HC URIC ACID	$31.02	$47.00	$4.52–$47.00	39% below	34%
Uric acid blood test CPT 84550 HC URIC ACID-PRV 72 HR	$67.32	$102.00	$4.52–$102.00	33% above	34%
Uric acid blood test inpatient CPT 84550 HC URIC ACID	$31.02	$47.00	$4.52–$47.00	—	34%
Uric acid blood test inpatient CPT 84550 HC URIC ACID-PRV 72 HR	$67.32	$102.00	$4.52–$102.00	—	34%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W/MICRO	$38.28	$58.00	$3.17–$58.00	6% above	34%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTO W/MICRO-PRV 72 HR	$84.48	$128.00	$3.17–$128.00	134% above	34%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTO W/MICRO	$38.28	$58.00	$3.17–$58.00	—	34%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC URINALYSIS AUTO W/MICRO-PRV 72 HR	$84.48	$128.00	$3.17–$128.00	—	34%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS SPECIFIC GRAVITY-PRV 72 HR	$33.00	$50.00	$2.25–$50.00	32% above	34%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC URINALYSIS SPECIFIC GRAVITY-PRV 72 HR	$33.00	$50.00	$2.25–$50.00	—	34%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE W/COLONY CT	$59.40	$90.00	$8.07–$90.00	21% below	34%
Urine culture for bacteria, with colony count CPT 87086 HC CULTURE URINE W/COLONY CT-PRV 72 HR	$91.08	$138.00	$8.07–$138.00	21% above	34%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE URINE W/COLONY CT	$59.40	$90.00	$8.07–$90.00	—	34%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC CULTURE URINE W/COLONY CT-PRV 72 HR	$91.08	$138.00	$8.07–$138.00	—	34%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN URINE QN	$43.56	$66.00	$5.78–$66.00	33% below	34%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN URINE	$144.54	$219.00	$5.78–$219.00	122% above	34%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN URINE QN	$43.56	$66.00	$5.78–$66.00	—	34%
Urine microalbumin (albumin) test inpatient CPT 82043 HC MICROALBUMIN URINE	$144.54	$219.00	$5.78–$219.00	—	34%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$59.40	$90.00	$8.61–$90.00	20% above	34%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST-PRV 72 HR	$73.26	$111.00	$8.61–$111.00	48% above	34%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST	$59.40	$90.00	$8.61–$90.00	—	34%
Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST-PRV 72 HR	$73.26	$111.00	$8.61–$111.00	—	34%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B12	$89.76	$136.00	$15.08–$136.00	12% below	34%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B12-PRV 72 HR	$188.10	$285.00	$15.08–$285.00	84% above	34%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B12	$89.76	$136.00	$15.08–$136.00	—	34%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC VITAMIN B12-PRV 72 HR	$188.10	$285.00	$15.08–$285.00	—	34%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 HYDROX-PRV 72 HR	$180.18	$273.00	$29.60–$273.00	16% above	34%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 OH	$180.18	$273.00	$29.60–$273.00	16% above	34%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25 HYDROX-PRV 72 HR	$180.18	$273.00	$29.60–$273.00	—	34%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D 25 OH	$180.18	$273.00	$29.60–$273.00	—	34%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VITAMIN D (1 25 DIHYDROXY)	$233.64	$354.00	$38.50–$354.00	46% above	34%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC VITAMIN D (1 25 DIHYDROXY)	$233.64	$354.00	$38.50–$354.00	—	34%
Zinc blood test CPT 84630 ASSAY OF ZINC	$62.70	$95.00	$11.39–$95.00	22% below	34%
Zinc blood test inpatient CPT 84630 ASSAY OF ZINC	$62.70	$95.00	$11.39–$95.00	—	34%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC HCG QN	$91.08	$138.00	$15.05–$138.00	23% below	34%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC HCG QN	$91.08	$138.00	$15.05–$138.00	—	34%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC DIST FIB FX W/O MANIP	$487.74	$739.00	$177.36–$783.34	11% below	34%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC DIST FIB FX W/O MANIP	$487.74	$739.00	$177.36–$783.34	—	34%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION EXTERNAL	$1,704.78	$2,583.00	$619.92–$2,583.00	73% above	34%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION EXTERNAL	$1,704.78	$2,583.00	$619.92–$2,583.00	—	34%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC CLSD DIS.RADIUS W/O MANIP	$551.10	$835.00	$200.40–$835.00	10% below	34%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC CLSD DIS.RADIUS W/O MANIP	$551.10	$835.00	$200.40–$835.00	—	34%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$1,171.50	$1,775.00	$95.40–$1,881.50	18% above	34%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$1,171.50	$1,775.00	$95.40–$1,881.50	—	34%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$122.10	$185.00	$44.40–$185.00	32% above	34%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$122.10	$185.00	$44.40–$185.00	—	34%
Earwax removal with instruments, one ear CPT 69210 HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION	$99.66	$151.00	$36.24–$151.00	19% above	34%
Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION	$99.66	$151.00	$36.24–$151.00	—	34%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC	$1,878.36	$2,846.00	$683.04–$2,846.00	42% above	34%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CRV/THRC	$1,878.36	$2,846.00	$683.04–$2,846.00	—	34%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT FACET LUMBAR/SACRA;SINGLE	$2,281.62	$3,457.00	$829.68–$3,457.00	41% above	34%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT FACET LUMBAR/SACRA;SINGLE	$2,281.62	$3,457.00	$829.68–$3,457.00	—	34%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATH/INTRO SALINE/CONTRAST SIS	$528.00	$800.00	$192.00–$800.00	57% above	34%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC CATH/INTRO SALINE/CONTRAST SIS	$528.00	$800.00	$192.00–$800.00	—	34%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D SKIN ABSCESS	$306.90	$465.00	$95.40–$465.00	5% above	34%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSC SMP FAC	$306.90	$465.00	$111.60–$465.00	5% above	34%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSC SMP	$306.90	$465.00	$111.60–$465.00	5% above	34%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D SKIN ABSCESS	$306.90	$465.00	$95.40–$465.00	—	34%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSC SMP FAC	$306.90	$465.00	$111.60–$465.00	—	34%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSC SMP	$306.90	$465.00	$111.60–$465.00	—	34%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT	$341.22	$517.00	$124.08–$517.00	at median	34%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 NJX 1 TENDON SHEATH/LIGAMENT	$341.22	$517.00	$124.08–$517.00	—	34%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ASPIR/INJECT MAJOR JOINT OR BURSA	$708.18	$1,073.00	$257.52–$1,073.00	63% above	34%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT	$708.18	$1,073.00	$257.52–$1,073.00	63% above	34%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT	$708.18	$1,073.00	$257.52–$1,073.00	63% above	34%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ASPIR/INJECT MAJOR JOINT OR BURSA	$708.18	$1,073.00	$257.52–$1,073.00	—	34%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT	$708.18	$1,073.00	$257.52–$1,073.00	—	34%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT	$708.18	$1,073.00	$257.52–$1,073.00	—	34%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$697.62	$1,057.00	$253.68–$1,057.00	118% above	34%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$697.62	$1,057.00	$253.68–$1,057.00	—	34%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$499.62	$757.00	$181.68–$757.00	35% above	34%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$499.62	$757.00	$181.68–$757.00	—	34%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC INTRM S/A/T/EXT 2.5CM OR <	$642.18	$973.00	$233.52–$973.00	22% above	34%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC WOUND REPAIR INTERMEDIATE FACIL	$642.18	$973.00	$233.52–$973.00	22% above	34%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC INTRM S/A/T/EXT 2.5CM OR <	$642.18	$973.00	$233.52–$973.00	—	34%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC WOUND REPAIR INTERMEDIATE FACIL	$642.18	$973.00	$233.52–$973.00	—	34%
Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTRLAMNR LUM/SAC W/GUIDE	$1,704.78	$2,583.00	$619.92–$2,583.00	49% above	34%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTRLAMNR LUM/SAC W/GUIDE	$1,704.78	$2,583.00	$619.92–$2,583.00	—	34%
Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ INTRLAMNR LUM/SAC W/O GUIDE	$1,186.68	$1,798.00	$431.52–$1,798.00	44% above	34%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ INTRLAMNR LUM/SAC W/O GUIDE	$1,186.68	$1,798.00	$431.52–$1,798.00	—	34%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ TRANSF LUMBAR SACRAL SINGLE	$1,779.36	$2,696.00	$647.04–$2,696.00	66% above	34%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ TRANSF LUMBAR SACRAL SINGLE	$1,779.36	$2,696.00	$647.04–$2,696.00	—	34%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC LESION 0.5<	$1,475.76	$2,236.00	$536.64–$2,236.00	324% above	34%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC LESION 0.5<	$1,475.76	$2,236.00	$536.64–$2,236.00	—	34%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SIMPLE 1	$266.64	$404.00	$96.96–$404.00	13% above	34%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SIMPLE 1	$266.64	$404.00	$96.96–$404.00	—	34%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$919.38	$1,393.00	$313.60–$1,393.00	99% above	34%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA&/STRD GR OCPL NRV	$919.38	$1,393.00	$313.60–$1,393.00	—	34%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$1,721.94	$2,609.00	$626.16–$2,609.00	34% above	34%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$1,721.94	$2,609.00	$626.16–$2,609.00	—	34%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL NAIL BED PRV 72 HR	$280.50	$425.00	$95.40–$450.50	14% below	34%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL&NAIL MATRIX	$1,176.12	$1,782.00	$95.40–$1,782.00	260% above	34%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVAL NAIL BED PRV 72 HR	$280.50	$425.00	$95.40–$450.50	—	34%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL&NAIL MATRIX	$1,176.12	$1,782.00	$95.40–$1,782.00	—	34%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$2,366.10	$3,585.00	$860.40–$3,585.00	55% above	34%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$2,366.10	$3,585.00	$860.40–$3,585.00	—	34%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC RADIOFREQ;LUMBO/SACRAL;SINGLE	$3,202.98	$4,853.00	$1,164.72–$4,853.00	29% above	34%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC RADIOFREQ;LUMBO/SACRAL;SINGLE	$3,202.98	$4,853.00	$1,164.72–$4,853.00	—	34%
Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$461.34	$699.00	$167.76–$699.00	37% above	34%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$461.34	$699.00	$167.76–$699.00	—	34%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC COLON SCREENING HIGH RISK- G0105	$2,880.90	$4,365.00	$950.10–$4,365.00	53% above	34%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC COLON SCREENING HIGH RISK- G0105	$2,880.90	$4,365.00	$950.10–$4,365.00	—	34%
Short arm cast (elbow to hand) CPT 29075 HC CAST APPL; ELBOW TO FINGERS	$277.20	$420.00	$100.80–$420.00	10% above	34%
Short arm cast (elbow to hand) inpatient CPT 29075 HC CAST APPL; ELBOW TO FINGERS	$277.20	$420.00	$100.80–$420.00	—	34%
Short arm splint (forearm and hand) CPT 29125 HC APPL SPLINT ARM SHORT STATIC	$308.88	$468.00	$112.32–$468.00	76% above	34%
Short arm splint (forearm and hand) inpatient CPT 29125 HC APPL SPLINT ARM SHORT STATIC	$308.88	$468.00	$112.32–$468.00	—	34%
Short leg cast (below the knee) CPT 29405 HC APPL CAST SHORT LEG	$384.78	$583.00	$139.92–$583.00	64% above	34%
Short leg cast (below the knee) inpatient CPT 29405 HC APPL CAST SHORT LEG	$384.78	$583.00	$139.92–$583.00	—	34%
Short leg splint (calf to foot) CPT 29515 HC APPL SHRT LEG SPLNT FAC	$384.78	$583.00	$122.92–$583.00	85% above	34%
Short leg splint (calf to foot) inpatient CPT 29515 HC APPL SHRT LEG SPLNT FAC	$384.78	$583.00	$122.92–$583.00	—	34%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <	$503.58	$763.00	$183.12–$763.00	55% above	34%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <	$503.58	$763.00	$183.12–$763.00	—	34%
Skin biopsy, punch, one lesion CPT 11104 HC BIOPSY SKIN PUNCH INIT LESN	$401.28	$608.00	$145.92–$644.48	67% above	34%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC BIOPSY SKIN PUNCH INIT LESN	$401.28	$608.00	$145.92–$644.48	—	34%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL SKIN TAG LESIONS <=15 FAC	$246.18	$373.00	$89.52–$373.00	74% above	34%
Skin tag removal, up to 15 tags inpatient CPT 11200 HC REMOVAL SKIN TAG LESIONS <=15 FAC	$246.18	$373.00	$89.52–$373.00	—	34%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR	$1,019.04	$1,544.00	$370.56–$1,544.00	68% above	34%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LMBR SPI PNXR	$1,019.04	$1,544.00	$370.56–$1,544.00	—	34%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5	$553.08	$838.00	$201.12–$838.00	174% above	34%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5	$553.08	$838.00	$201.12–$838.00	—	34%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SIMP F/E/E/N/L/MM 2.5CM OR <	$622.38	$943.00	$204.98–$943.00	101% above	34%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SIMP F/E/E/N/L/MM 2.5CM OR <	$622.38	$943.00	$204.98–$943.00	—	34%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC BIOPSY SKIN TANGENTIAL INIT LESN	$306.24	$464.00	$111.36–$491.84	28% above	34%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC BIOPSY SKIN TANGENTIAL INIT LESN	$306.24	$464.00	$111.36–$491.84	—	34%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$1,364.88	$2,068.00	$456.60–$2,068.00	14% above	34%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$1,364.88	$2,068.00	$456.60–$2,068.00	—	34%
Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$355.08	$538.00	$129.12–$538.00	at median	34%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$355.08	$538.00	$129.12–$538.00	—	34%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC US GUIDED NEEDLE BX BREAST	$3,779.16	$5,726.00	$500.00–$5,726.00	87% above	34%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$3,779.16	$5,726.00	$1,374.24–$5,726.00	87% above	34%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG	$3,779.16	$5,726.00	$1,374.24–$5,726.00	—	34%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC US GUIDED NEEDLE BX BREAST	$3,779.16	$5,726.00	$500.00–$5,726.00	—	34%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION B9 LES UP TO 14	$229.68	$348.00	$83.52–$348.00	17% above	34%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION B9 LES UP TO 14	$229.68	$348.00	$83.52–$348.00	—	34%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$533.28	$808.00	$95.40–$808.00	at median	34%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBR SKIN/SUBQ TISS INIT W/PROC 20CM	$533.28	$808.00	$95.40–$808.00	at median	34%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$533.28	$808.00	$95.40–$808.00	—	34%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBR SKIN/SUBQ TISS INIT W/PROC 20CM	$533.28	$808.00	$95.40–$808.00	—	34%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD PROD ADMIN	$883.74	$1,339.00	$321.36–$1,339.00	51% above	34%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD PROD ADMIN	$883.74	$1,339.00	$321.36–$1,339.00	—	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI/DPI INHAL TX SUBSQ	$79.20	$120.00	$28.80–$223.72	8% below	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI/DPI TX INITIAL	$79.20	$120.00	$28.80–$223.72	8% below	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC HIGH EFF NEB AERO EACH	$204.60	$310.00	$74.40–$310.00	137% above	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$204.60	$310.00	$74.40–$310.00	137% above	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT-PRV 72 HR	$244.20	$370.00	$88.80–$370.00	182% above	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI/DPI INHAL TX SUBSQ	$79.20	$120.00	$28.80–$223.72	—	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI/DPI TX INITIAL	$79.20	$120.00	$28.80–$223.72	—	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$204.60	$310.00	$74.40–$310.00	—	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC HIGH EFF NEB AERO EACH	$204.60	$310.00	$74.40–$310.00	—	34%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT-PRV 72 HR	$244.20	$370.00	$88.80–$370.00	—	34%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION SGL/INIT<1H	$772.20	$1,170.00	$280.80–$1,170.00	38% above	34%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION SGL/INIT<1H	$772.20	$1,170.00	$280.80–$1,170.00	—	34%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$1,448.04	$2,194.00	$526.56–$2,194.00	19% below	34%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR	$1,448.04	$2,194.00	$526.56–$2,194.00	—	34%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE/DROWSY	$787.38	$1,193.00	$220.60–$1,193.00	18% above	34%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE/DROWSY	$787.38	$1,193.00	$220.60–$1,193.00	—	34%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC EKG COMPLETE-PRV 72 HR	$193.38	$293.00	$41.73–$293.00	187% above	34%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC EKG COMPLETE-PRV 72 HR	$193.38	$293.00	$41.73–$293.00	—	34%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG-PRV 72 HR	$155.10	$235.00	$41.73–$235.00	5% above	34%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG	$186.78	$283.00	$41.73–$283.00	27% above	34%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG-PRV 72 HR	$155.10	$235.00	$41.73–$235.00	—	34%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG	$186.78	$283.00	$41.73–$283.00	—	34%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ER LEVEL 1	$140.58	$213.00	$51.12–$213.00	25% below	34%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ER LEVEL 1	$140.58	$213.00	$51.12–$213.00	—	34%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ER LEVEL 2	$208.56	$316.00	$75.84–$316.00	35% below	34%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ER LEVEL 2	$208.56	$316.00	$75.84–$316.00	—	34%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ER LEVEL 3	$329.34	$499.00	$119.76–$499.00	44% below	34%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ER LEVEL 3	$329.34	$499.00	$119.76–$499.00	—	34%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER LEVEL 4	$538.56	$816.00	$195.84–$816.00	41% below	34%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ER LEVEL 4	$538.56	$816.00	$195.84–$816.00	—	34%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER LEVEL 5	$788.04	$1,194.00	$286.56–$1,194.00	46% below	34%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER LEVEL 5 SANE	$1,723.92	$2,612.00	$608.43–$2,612.00	18% above	34%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ER LEVEL 5	$788.04	$1,194.00	$286.56–$1,194.00	—	34%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ER LEVEL 5 SANE	$1,723.92	$2,612.00	$608.43–$2,612.00	—	34%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST TRACING ONLY	$990.66	$1,501.00	$220.60–$1,501.00	25% above	34%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST TRACING ONLY	$990.66	$1,501.00	$220.60–$1,501.00	—	34%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$375.54	$569.00	$136.56–$569.00	32% above	34%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR	$375.54	$569.00	$136.56–$569.00	—	34%
IV infusion of a medicine, first hour CPT 96365 HC INFUSION THERAPY 1ST HOUR	$439.56	$666.00	$159.84–$666.00	38% above	34%
IV infusion of a medicine, first hour inpatient CPT 96365 HC INFUSION THERAPY 1ST HOUR	$439.56	$666.00	$159.84–$666.00	—	34%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$205.92	$312.00	$74.88–$312.00	25% above	34%
IV push of a medicine, first drug inpatient CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$205.92	$312.00	$74.88–$312.00	—	34%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$105.60	$160.00	$38.40–$160.00	31% above	34%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$105.60	$160.00	$38.40–$160.00	—	34%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION	$93.72	$142.00	$30.86–$142.00	2% below	34%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REEDUCATION	$93.72	$142.00	$30.86–$142.00	—	34%
New patient office visit, about 30 minutes CPT 99203 HC CLINIC VISIT INTERM NEW-PRV 72 HR	$94.38	$143.00	$34.32–$143.00	52% below	34%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN	$252.12	$382.00	$91.68–$382.00	28% above	34%
New patient office visit, about 45 minutes CPT 99204 HC CLINIC VISIT COMPLEX NEW-PRV 72 HR	$141.24	$214.00	$51.36–$214.00	37% below	34%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN	$287.10	$435.00	$95.40–$435.00	28% above	34%
New patient office visit, about 60 minutes CPT 99205 HC CLINIC VISIT COMPREH NEW-PRV 72 HR	$192.06	$291.00	$69.84–$291.00	37% below	34%
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN	$347.82	$527.00	$95.40–$527.00	14% above	34%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC CLINIC VISIT LIMITED NEW-PRV 72 HR	$58.74	$89.00	$21.36–$89.00	55% below	34%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN	$208.56	$316.00	$75.84–$316.00	60% above	34%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY 15MIN	$98.34	$149.00	$35.76–$149.00	47% below	34%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY	$99.00	$150.00	$36.00–$150.00	46% below	34%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY 30MIN	$112.86	$171.00	$41.04–$171.00	39% below	34%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY 45MIN	$124.74	$189.00	$45.36–$189.00	33% below	34%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY 60MIN	$155.76	$236.00	$56.64–$236.00	16% below	34%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY 15MIN	$98.34	$149.00	$35.76–$149.00	—	34%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY	$99.00	$150.00	$36.00–$150.00	—	34%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY 30MIN	$112.86	$171.00	$41.04–$171.00	—	34%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY 45MIN	$124.74	$189.00	$45.36–$189.00	—	34%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY 60MIN	$155.76	$236.00	$56.64–$236.00	—	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY 15MIN	$95.70	$145.00	$34.80–$145.00	70% below	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY	$99.00	$150.00	$36.00–$150.00	69% below	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY 30MIN	$113.52	$172.00	$41.28–$172.00	64% below	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY 45MIN	$124.08	$188.00	$45.12–$188.00	61% below	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY 60MIN	$155.10	$235.00	$56.40–$235.00	51% below	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY 15MIN	$95.70	$145.00	$34.80–$145.00	—	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY	$99.00	$150.00	$36.00–$150.00	—	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY 30MIN	$113.52	$172.00	$41.28–$172.00	—	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY 45MIN	$124.08	$188.00	$45.12–$188.00	—	34%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY 60MIN	$155.10	$235.00	$56.40–$235.00	—	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY 15MIN	$95.70	$145.00	$34.80–$145.00	48% below	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY	$99.00	$150.00	$36.00–$150.00	46% below	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY 30MIN	$113.52	$172.00	$41.28–$172.00	39% below	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY 45MIN	$124.08	$188.00	$45.12–$188.00	33% below	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY 60MIN	$155.10	$235.00	$56.40–$235.00	16% below	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY 15MIN	$95.70	$145.00	$34.80–$145.00	—	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY	$99.00	$150.00	$36.00–$150.00	—	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY 30MIN	$113.52	$172.00	$41.28–$172.00	—	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY 45MIN	$124.08	$188.00	$45.12–$188.00	—	34%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY 60MIN	$155.10	$235.00	$56.40–$235.00	—	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY 15MIN	$95.70	$145.00	$34.80–$145.00	62% below	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY	$99.00	$150.00	$36.00–$150.00	60% below	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY 30MIN	$113.52	$172.00	$41.28–$172.00	55% below	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY 45MIN	$124.08	$188.00	$45.12–$188.00	50% below	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY 60MIN	$155.10	$235.00	$56.40–$235.00	38% below	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY 15MIN	$95.70	$145.00	$34.80–$145.00	—	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY	$99.00	$150.00	$36.00–$150.00	—	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY 30MIN	$113.52	$172.00	$41.28–$172.00	—	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY 45MIN	$124.08	$188.00	$45.12–$188.00	—	34%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY 60MIN	$155.10	$235.00	$56.40–$235.00	—	34%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY EA 15 MIN	$80.52	$122.00	$25.53–$122.00	17% below	34%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY EA 15 MIN	$80.52	$122.00	$25.53–$122.00	—	34%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERA EXER; EA 15 MIN	$80.52	$122.00	$28.25–$122.00	17% below	34%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERA EXER; EA 15 MIN	$80.52	$122.00	$28.25–$122.00	—	34%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$36.96	$56.00	$13.44–$56.00	28% above	34%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$36.96	$56.00	$13.44–$56.00	—	34%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC CLINIC VISIT COMPRH EST-PRV 72 HR	$153.12	$232.00	$55.68–$232.00	48% below	34%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC CLINIC VISIT COMPRH EST	$339.24	$514.00	$95.40–$514.00	15% above	34%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC CLINIC VISIT INTERM EST-PRV 72 HR	$69.96	$106.00	$25.44–$106.00	57% below	34%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC CLINIC VISIT INTERM EST	$243.54	$369.00	$88.56–$369.00	48% above	34%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC CLINIC VISIT COMPLX EST-PRV 72 HR	$102.96	$156.00	$37.44–$156.00	45% below	34%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC CLINIC VISIT COMPLX EST	$268.62	$407.00	$95.40–$407.00	44% above	34%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC CLINIC VISIT LIMIT EST	$199.32	$302.00	$72.48–$302.00	106% above	34%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC CLINIC VISIT LIMIT EST-PRV 72 HR	$268.62	$407.00	$95.40–$407.00	178% above	34%
Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN	$345.18	$523.00	$125.52–$523.00	3% below	34%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEN	$345.18	$523.00	$125.52–$523.00	—	34%
Speech therapy session, individual CPT 92507 HC SPEECH THERAPY TREATMENT	$195.36	$296.00	$59.16–$296.00	23% below	34%
Speech therapy session, individual CPT 92507 TX SP LANG VOICE COMM INDIV	$224.40	$340.00	$59.16–$340.00	11% below	34%
Speech therapy session, individual inpatient CPT 92507 HC SPEECH THERAPY TREATMENT	$195.36	$296.00	$59.16–$296.00	—	34%
Speech therapy session, individual inpatient CPT 92507 TX SP LANG VOICE COMM INDIV	$224.40	$340.00	$59.16–$340.00	—	34%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY/PFT PKG	$363.00	$550.00	$93.60–$550.00	30% above	34%
Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY/PFT PKG	$363.00	$550.00	$93.60–$550.00	—	34%
Spirometry before and after a bronchodilator CPT 94060 HC EVAL OF BRONCHOSPASM-PRV 72 HR	$359.70	$545.00	$90.89–$545.00	26% below	34%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING	$654.72	$992.00	$167.54–$992.00	35% above	34%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC EVAL OF BRONCHOSPASM-PRV 72 HR	$359.70	$545.00	$90.89–$545.00	—	34%
Spirometry before and after a bronchodilator inpatient CPT 94060 EVALUATION OF WHEEZING	$654.72	$992.00	$167.54–$992.00	—	34%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACTIVITIES EA 15 MIN	$95.70	$145.00	$32.94–$145.00	6% above	34%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACTIVITIES EA 15 MIN	$95.70	$145.00	$32.94–$145.00	—	34%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$227.70	$345.00	$82.80–$345.00	14% above	34%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$227.70	$345.00	$82.80–$345.00	—	34%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE 0.5 ML SUSY per 0.5 mL	$101.11	$153.20	$34.57–$153.20	217% above	34%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VACCINE 0.5 ML SUSY per 0.5 mL	$101.11	$153.20	$34.57–$153.20	—	34%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 0.5 ML SUSY per 0.5 mL	$706.27	$1,070.10	$256.82–$1,070.10	141% above	34%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 0.5 ML SUSY per 0.5 mL	$706.27	$1,070.10	$256.82–$1,070.10	—	34%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PNEUMOVAX POLY 24 VALENT	$59.40	$90.00	$21.60–$90.00	58% below	34%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PNEUMOVAX POLY 24 VALENT	$59.40	$90.00	$21.60–$90.00	—	34%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE SUSR per 1 mL	$1,084.28	$1,642.85	$182.75–$1,642.85	87% above	34%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE SUSR per 1 mL	$1,084.28	$1,642.85	$182.75–$1,642.85	—	34%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS & DIPHTHERIA TOXOIDS (ADULT) 5-2 LFU INJ per 0.5 mL	$138.04	$209.15	$34.57–$209.15	233% above	34%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS & DIPHTHERIA TOXOIDS (ADULT) 5-2 LFU INJ per 0.5 mL	$138.04	$209.15	$34.57–$209.15	—	34%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC DTAP VACCINE >7 YEARS	$41.58	$63.00	$15.12–$63.00	49% below	34%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 5-2.5-18.5 LF-MCG/0.5 SUSY per 0.5 mL	$158.99	$240.90	$34.57–$240.90	95% above	34%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC DTAP VACCINE >7 YEARS	$41.58	$63.00	$15.12–$63.00	—	34%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 5-2.5-18.5 LF-MCG/0.5 SUSY per 0.5 mL	$158.99	$240.90	$34.57–$240.90	—	34%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUN ADMIN ONE VACC	$73.26	$111.00	$26.64–$111.00	89% above	34%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUN ADMIN ONE VACCINE-PRV 72 HR	$82.50	$125.00	$30.00–$125.00	113% above	34%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC RABIES VACC ADMIN IM	$120.12	$182.00	$43.68–$182.00	210% above	34%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUN ADMIN ONE VACC	$73.26	$111.00	$26.64–$111.00	—	34%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUN ADMIN ONE VACCINE-PRV 72 HR	$82.50	$125.00	$30.00–$125.00	—	34%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC RABIES VACC ADMIN IM	$120.12	$182.00	$43.68–$182.00	—	34%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$42.90	$65.00	$15.60–$66.86	32% above	34%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD	$42.90	$65.00	$15.60–$66.86	—	34%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.hshs.org/getmedia/aa25aee9-926d-4a3b-9697-b98148e40f18/390848401_st-clare-memorial-hospital-inc_standardcharges.zip