Essentia Health St Marys Hospital-Superior
Essentia Health St Marys Hospital-Superior in Superior, WI publishes cash prices for 367 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 203 of 360 procedures and below it for 156. By typical cash price it ranks #73 of 103 Wisconsin hospitals and #8 of 12 hospitals in the Duluth, MN area, cheapest first. Select a procedure to compare it with other hospitals nearby.
Essentia Health St. Mary's Hospital -Superior, 3500 Tower Ave Superior, WI 54880 Collected Sep 23, 2026 Source price file Check a bill from this hospital (715) 817-7000
Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 521329 · CMS hospital register NPI 1083657886
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Essentia Health St Marys Hospital-Superior 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 ABDOMEN W/O & W/DYE | $1,742.56 | $2,358.00 | $754.56–$2,133.99 | 27% below | 26% |
| Abdominal X-ray, 2 views CPT 74019 X-RAY EXAM ABDOMEN 2 VIEWS | $285.99 | $387.00 | $123.84–$350.24 | 19% above | 26% |
| Abdominal X-ray, 2 views inpatient CPT 74019 X-RAY EXAM ABDOMEN 2 VIEWS | $285.99 | $387.00 | $155.57–$350.24 | — | 26% |
| Ankle X-ray, complete, 3 or more views CPT 73610 XRAY ANKLE MINIMUM 3 VWS | $235.00 | $318.00 | $101.76–$287.79 | at median | 26% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XRAY ANKLE MINIMUM 3 VWS | $235.00 | $318.00 | $127.84–$287.79 | — | 26% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 EXTREMITY STUDY | $451.53 | $611.00 | $195.52–$552.96 | 17% above | 26% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O DYE | $1,264.43 | $1,711.00 | $547.52–$1,548.46 | 12% below | 26% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O DYE | $1,264.43 | $1,711.00 | $687.82–$1,548.46 | — | 26% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN, WHOLE BODY | $1,224.52 | $1,657.00 | $530.24–$1,499.58 | 18% below | 26% |
| Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE | $447.83 | $606.00 | $193.92–$548.43 | 16% below | 26% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED | $351.02 | $475.00 | $152.00–$429.88 | 11% below | 26% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PELV W/O&W/DYE | $2,844.41 | $3,849.00 | $1,231.68–$3,483.34 | 7% below | 26% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY, HEAD | $1,916.97 | $2,594.00 | $830.08–$2,347.57 | 8% below | 26% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY, HEAD | $1,916.97 | $2,594.00 | $1,042.79–$2,347.57 | — | 26% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY, NECK | $1,894.80 | $2,564.00 | $820.48–$2,320.42 | 7% below | 26% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY, NECK | $1,894.80 | $2,564.00 | $1,030.73–$2,320.42 | — | 26% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY, CHEST | $1,933.22 | $2,616.00 | $837.12–$2,367.48 | 5% below | 26% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY, CHEST | $1,933.22 | $2,616.00 | $1,051.63–$2,367.48 | — | 26% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST | $2,197.05 | $2,973.00 | $951.36–$2,690.56 | 13% below | 26% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST | $2,197.05 | $2,973.00 | $1,195.15–$2,690.56 | — | 26% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN&PELVIS W/CONTRAST | $2,528.12 | $3,421.00 | $1,094.72–$3,096.00 | 21% below | 26% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN&PELVIS W/CONTRAST | $2,528.12 | $3,421.00 | $1,375.24–$3,096.00 | — | 26% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELV 1+ SECTION/REGNS | $2,955.26 | $3,999.00 | $1,279.68–$3,619.10 | 20% below | 26% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELV 1+ SECTION/REGNS | $2,955.26 | $3,999.00 | $1,607.60–$3,619.10 | — | 26% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/DYE | $1,511.99 | $2,046.00 | $654.72–$1,851.63 | 8% below | 26% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/DYE | $1,511.99 | $2,046.00 | $822.49–$1,851.63 | — | 26% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O DYE | $1,178.70 | $1,595.00 | $510.40–$1,443.48 | 7% below | 26% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O DYE | $1,178.70 | $1,595.00 | $641.19–$1,443.48 | — | 26% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIALW/O DYE | $1,391.54 | $1,883.00 | $602.56–$1,704.12 | at median | 26% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIALW/O DYE | $1,391.54 | $1,883.00 | $756.97–$1,704.12 | — | 26% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,258.52 | $1,703.00 | $544.96–$1,541.22 | 2% below | 26% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE | $1,258.52 | $1,703.00 | $684.61–$1,541.22 | — | 26% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE | $1,297.68 | $1,756.00 | $561.92–$1,589.18 | 16% below | 26% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $1,589.59 | $2,151.00 | $688.32–$1,946.66 | 14% below | 26% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE | $1,457.31 | $1,972.00 | $631.04–$1,784.66 | 5% below | 26% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O DYE | $1,457.31 | $1,972.00 | $792.74–$1,784.66 | — | 26% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE | $1,435.14 | $1,942.00 | $621.44–$1,757.51 | 7% below | 26% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE | $1,435.14 | $1,942.00 | $780.68–$1,757.51 | — | 26% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,469.87 | $1,989.00 | $636.48–$1,800.04 | 10% below | 26% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $1,469.87 | $1,989.00 | $799.58–$1,800.04 | — | 26% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CV CAROTID IMAGING-BILAT | $861.67 | $1,166.00 | $373.12–$1,055.23 | — | 26% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CV CAROTID IMAGING-BILAT | $861.67 | $1,166.00 | $468.73–$1,055.23 | — | 26% |
| Chest CT scan without and with contrast CPT 71270 DIAGNOSTIC CT THORAX W&WO CONTRAST (TC) | $1,590.33 | $2,152.00 | $688.64–$1,947.56 | 31% below | 26% |
| Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $231.31 | $313.00 | $100.16–$283.26 | 8% above | 26% |
| Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $231.31 | $313.00 | $125.83–$283.26 | — | 26% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $226.13 | $306.00 | $97.92–$276.93 | 40% above | 26% |
| Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW | $226.13 | $306.00 | $123.01–$276.93 | — | 26% |
| Collarbone (clavicle) X-ray, complete CPT 73000 XRAY CLAVICLE COMPLETE | $204.70 | $277.00 | $88.64–$250.68 | 1% below | 26% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL TC | $526.17 | $712.00 | $227.84–$644.36 | 4% below | 26% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL TC | $526.17 | $712.00 | $286.22–$644.36 | — | 26% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA, BONE DENSITY STUDY, HIPS/PELV/SPINE | $398.32 | $539.00 | $172.48–$487.80 | at median | 26% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA, BONE DENSITY STUDY, HIPS/PELV/SPINE | $398.32 | $539.00 | $216.68–$487.80 | — | 26% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA, BONE DENSITY STUDY, RADIUS/WRIST/HEEL | $192.88 | $261.00 | $83.52–$236.20 | 32% below | 26% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 DIAGNOSTIC CT THORAX W/O CONTRAST (TC) | $1,339.07 | $1,812.00 | $579.84–$1,639.86 | 7% below | 26% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 DIAGNOSTIC CT THORAX W/O CONTRAST (TC) | $1,339.07 | $1,812.00 | $728.42–$1,639.86 | — | 26% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 DIAGNOSTIC CT THORAX W/ CONTRAST (TC) | $1,559.29 | $2,110.00 | $675.20–$1,909.55 | 5% below | 26% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 DIAGNOSTIC CT THORAX W/ CONTRAST (TC) | $1,559.29 | $2,110.00 | $848.22–$1,909.55 | — | 26% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF | $399.80 | $541.00 | $173.12–$489.60 | — | 26% |
| Diagnostic mammogram, one breast one side CPT 77065 DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF | $327.38 | $443.00 | $141.76–$400.92 | 6% above | 26% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ART LOWER EXTREMITY-BILAT | $946.66 | $1,281.00 | $409.92–$1,159.30 | — | 26% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 ART LOWER EXTREMITY-BILAT | $946.66 | $1,281.00 | $514.96–$1,159.30 | — | 26% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEN DUPLEX BILATERAL | $966.61 | $1,308.00 | $418.56–$1,183.74 | — | 26% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VEN DUPLEX BILATERAL | $966.61 | $1,308.00 | $525.82–$1,183.74 | — | 26% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER, COMPLETE | $1,622.10 | $2,195.00 | $702.40–$1,986.48 | 8% below | 26% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER, COMPLETE | $1,622.10 | $2,195.00 | $882.39–$1,986.48 | — | 26% |
| Elbow X-ray, 2 views CPT 73070 XRAY ELBOW 2 VWS | $203.96 | $276.00 | $88.32–$249.78 | 7% above | 26% |
| Elbow X-ray, 2 views inpatient CPT 73070 XRAY ELBOW 2 VWS | $203.96 | $276.00 | $110.95–$249.78 | — | 26% |
| Elbow X-ray, complete, 3 or more views CPT 73080 XRAY ELBOW 3+VWS TC | $238.70 | $323.00 | $103.36–$292.32 | 1% above | 26% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/EAR/FOSA W/O DYE | $1,196.44 | $1,619.00 | $518.08–$1,465.20 | 17% below | 26% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 XRAY FACIAL BONES MINIMUM 3 VWS | $254.96 | $345.00 | $110.40–$312.23 | 15% below | 26% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 XRAY FOREARM 2 VWS | $206.92 | $280.00 | $89.60–$253.40 | 5% above | 26% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XRAY FOREARM 2 VWS | $206.92 | $280.00 | $112.56–$253.40 | — | 26% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGING | $1,370.11 | $1,854.00 | $593.28–$1,677.87 | 7% below | 26% |
| Hand X-ray, 2 views CPT 73120 XRAY HAND 2VWS TC | $219.48 | $297.00 | $95.04–$268.79 | 16% above | 26% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 XRAY CALCANEUS MINIMUM 2 VWS | $192.14 | $260.00 | $83.20–$235.30 | 3% below | 26% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY, UNATTENDED | $540.21 | $731.00 | $233.92–$661.56 | 12% below | 26% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY, UNATTENDED | $540.21 | $731.00 | $293.86–$661.56 | — | 26% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY W/CPAP | $3,887.14 | $5,260.00 | $1,683.20–$4,760.30 | 6% above | 26% |
| Knee X-ray, 3 views CPT 73562 XRAY KNEE 3 VWS | $247.56 | $335.00 | $107.20–$303.18 | 3% below | 26% |
| Knee X-ray, 3 views inpatient CPT 73562 XRAY KNEE 3 VWS | $247.56 | $335.00 | $134.67–$303.18 | — | 26% |
| Knee X-ray, complete, 4 or more views CPT 73564 XRAY KNEE 4 OR MORE VWS | $281.56 | $381.00 | $121.92–$344.80 | 2% above | 26% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 XRAY KNEE 4 OR MORE VWS | $281.56 | $381.00 | $153.16–$344.80 | — | 26% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O DYE | $1,314.68 | $1,779.00 | $569.28–$1,610.00 | 10% below | 26% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O DYE | $1,314.68 | $1,779.00 | $715.16–$1,610.00 | — | 26% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED TC | $467.79 | $633.00 | $202.56–$572.86 | 5% above | 26% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED TC | $467.79 | $633.00 | $254.47–$572.86 | — | 26% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXT NON-VASC LIMITED, REALTIME W/ IMG TC | $374.67 | $507.00 | $162.24–$458.84 | 31% above | 26% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT LUNG CA SCREEN WO CONTRAST | $850.59 | $1,151.00 | $368.32–$1,041.66 | 91% above | 26% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XRAY TIBIA & FIBULA 2 VWS | $227.61 | $308.00 | $98.56–$278.74 | 7% above | 26% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XRAY TIBIA & FIBULA 2 VWS | $227.61 | $308.00 | $123.82–$278.74 | — | 26% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA, HEAD W/OUT CONTRAST | $2,189.66 | $2,963.00 | $948.16–$2,681.52 | 1% below | 26% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JNT WO/CONT TC | $2,103.93 | $2,847.00 | $911.04–$2,576.54 | 5% below | 26% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI,LWREXT,JNT W/O+W/CONT | $2,568.76 | $3,476.00 | $1,112.32–$3,145.78 | 25% below | 26% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI,LWREXT,JNT W/O+W/CONT | $2,568.76 | $3,476.00 | $1,397.35–$3,145.78 | — | 26% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O TC | $2,179.31 | $2,949.00 | $943.68–$2,668.84 | 1% below | 26% |
| MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O TC | $2,179.31 | $2,949.00 | $1,185.50–$2,668.84 | — | 26% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI, ABDOMEN W/O+ W/CONTR | $2,948.61 | $3,990.00 | $1,276.80–$3,610.95 | 14% below | 26% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI, ABDOMEN W/O+ W/CONTR | $2,948.61 | $3,990.00 | $1,603.98–$3,610.95 | — | 26% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST TC | $2,169.70 | $2,936.00 | $939.52–$2,657.08 | 2% below | 26% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST TC | $2,169.70 | $2,936.00 | $1,180.27–$2,657.08 | — | 26% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W & WO CONTRAST | $2,901.31 | $3,926.00 | $1,256.32–$3,553.03 | 15% below | 26% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W & WO CONTRAST | $2,901.31 | $3,926.00 | $1,578.25–$3,553.03 | — | 26% |
| MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST | $2,092.85 | $2,832.00 | $906.24–$2,562.96 | 5% below | 26% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST | $2,092.85 | $2,832.00 | $1,138.46–$2,562.96 | — | 26% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W&WO CONTRAST | $2,917.57 | $3,948.00 | $1,263.36–$3,572.94 | 15% below | 26% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST | $2,126.84 | $2,878.00 | $920.96–$2,604.59 | 4% below | 26% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W&WO CONTRAST | $2,785.29 | $3,769.00 | $1,206.08–$3,410.94 | 18% below | 26% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W&WO CONTRAST | $2,785.29 | $3,769.00 | $1,515.14–$3,410.94 | — | 26% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE WO CONTRAST | $2,116.50 | $2,864.00 | $916.48–$2,591.92 | 4% below | 26% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE WO CONTRAST | $2,116.50 | $2,864.00 | $1,151.33–$2,591.92 | — | 26% |
| MRI of the pelvis without and with contrast CPT 72197 MRI, PELVIS, W/O THEN W/ | $2,827.41 | $3,826.00 | $1,224.32–$3,462.53 | 17% below | 26% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI,PELVIS W/OUT CONTRAST | $2,115.76 | $2,863.00 | $916.16–$2,591.02 | 4% below | 26% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXTREMITY JOINT W/O TC | $2,143.84 | $2,901.00 | $928.32–$2,625.40 | 3% below | 26% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XRAY CERVICAL SPINE 4 OR 5 VWS | $321.46 | $435.00 | $139.20–$393.68 | at median | 26% |
| Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/DYE | $1,415.18 | $1,915.00 | $612.80–$1,733.08 | 14% below | 26% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/DYE | $1,415.18 | $1,915.00 | $769.83–$1,733.08 | — | 26% |
| Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O DYE | $1,141.02 | $1,544.00 | $494.08–$1,397.32 | 20% below | 26% |
| Neck soft tissue X-ray CPT 70360 XRAY NECK, SOFT TISSUE | $206.92 | $280.00 | $89.60–$253.40 | 1% below | 26% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT, MULT | $2,837.02 | $3,839.00 | $1,228.48–$3,474.30 | 8% below | 26% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O DYE | $1,334.63 | $1,806.00 | $577.92–$1,634.43 | 4% above | 26% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O DYE | $1,334.63 | $1,806.00 | $726.01–$1,634.43 | — | 26% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US FOLLICLES-LIMITED TC | $339.20 | $459.00 | $146.88–$415.40 | 15% below | 26% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US FOLLICLES-LIMITED TC | $339.20 | $459.00 | $184.52–$415.40 | — | 26% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC TC COMPLETE | $489.22 | $662.00 | $211.84–$599.11 | 7% below | 26% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US,PREG. UTERUS,FETAL/MAT.EVAL.,>1ST TRIM.(>/= 14 WKS 0 DYS),TRANSABD;SINGLE/FIRST GEST., TECH | $502.52 | $680.00 | $217.60–$615.40 | 12% below | 26% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS, SINGLE FETUS - RADIOLOGY, TECH | $453.01 | $613.00 | $196.16–$554.76 | 12% below | 26% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY TC LIMITED | $401.28 | $543.00 | $173.76–$491.42 | 9% above | 26% |
| Rib X-ray, one side, 2 views one side CPT 71100 XRAY RIBS UNILAT 2 VWS | $214.31 | $290.00 | $92.80–$262.45 | 4% below | 26% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 XRAY RIBS UNILAT 2 VWS | $214.31 | $290.00 | $116.58–$262.45 | — | 26% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XRAY RIBS UNILAT 2 VWS WITH PA CHEST | $298.56 | $404.00 | $129.28–$365.62 | 8% above | 26% |
| Screening mammogram, both breasts CPT 77067 DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF | $337.72 | $457.00 | $146.24–$413.58 | 25% above | 26% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 XRAY SHOULDER MINIMUM 2 VWS | $239.44 | $324.00 | $103.68–$293.22 | 2% above | 26% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XRAY SHOULDER MINIMUM 2 VWS | $239.44 | $324.00 | $130.25–$293.22 | — | 26% |
| Sinus X-ray, complete, 3 or more views CPT 70220 XRAY SINUSES MINIMUM 3 VWS | $232.78 | $315.00 | $100.80–$285.08 | 12% below | 26% |
| Skull X-ray, fewer than 4 views CPT 70250 XRAY SKULL LESS THAN 4 VWS | $235.00 | $318.00 | $101.76–$287.79 | 4% below | 26% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY, 4 OR MORE | $3,557.55 | $4,814.00 | $1,540.48–$4,356.67 | 4% above | 26% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-RAY EXAM FEMUR MIN 2 VWS | $245.35 | $332.00 | $106.24–$300.46 | at median | 26% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-RAY EXAM FEMUR MIN 2 VWS | $245.35 | $332.00 | $133.46–$300.46 | — | 26% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT CHEST SPINE W/O DYE | $1,423.31 | $1,926.00 | $616.32–$1,743.03 | 8% below | 26% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT CHEST SPINE W/O DYE | $1,423.31 | $1,926.00 | $774.25–$1,743.03 | — | 26% |
| Toe X-ray, 2 or more views CPT 73660 XRAY TOE(S) TC | $185.49 | $251.00 | $80.32–$227.16 | 8% below | 26% |
| Toe X-ray, 2 or more views inpatient CPT 73660 XRAY TOE(S) TC | $185.49 | $251.00 | $100.90–$227.16 | — | 26% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL TC | $417.54 | $565.00 | $180.80–$511.32 | 11% below | 26% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US, OBSTETRIC | $408.67 | $553.00 | $176.96–$500.46 | 4% above | 26% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN TC | $611.15 | $827.00 | $264.64–$748.44 | 10% below | 26% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN TC | $611.15 | $827.00 | $332.45–$748.44 | — | 26% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENTS TC | $481.09 | $651.00 | $208.32–$589.16 | 3% below | 26% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENTS TC | $481.09 | $651.00 | $261.70–$589.16 | — | 26% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD/NECK TC | $474.44 | $642.00 | $205.44–$581.01 | 7% below | 26% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD/NECK TC | $474.44 | $642.00 | $258.08–$581.01 | — | 26% |
| Upper arm X-ray (humerus), 2 views CPT 73060 XRAY HUMERUS MINIMUM 2 VWS | $227.61 | $308.00 | $98.56–$278.74 | 8% above | 26% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 XRAY HUMERUS MINIMUM 2 VWS | $227.61 | $308.00 | $123.82–$278.74 | — | 26% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VEN DUPLEX LIMITED | $604.50 | $818.00 | $261.76–$740.29 | 15% below | 26% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DUPLEX SCAN UNI | $619.28 | $838.00 | $268.16–$758.39 | 13% below | 26% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 VEN DUPLEX LIMITED | $604.50 | $818.00 | $328.84–$740.29 | — | 26% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 VENOUS DUPLEX SCAN UNI | $619.28 | $838.00 | $336.88–$758.39 | — | 26% |
| Wrist X-ray, 2 views CPT 73100 XRAY WRIST 2 VWS | $213.57 | $289.00 | $92.48–$261.54 | 1% below | 26% |
| Wrist X-ray, complete, 3 or more views CPT 73110 XRAY WRIST MINIMUM 3 VWS | $233.52 | $316.00 | $101.12–$285.98 | 8% below | 26% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XRAY WRIST MINIMUM 3 VWS | $233.52 | $316.00 | $127.03–$285.98 | — | 26% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-RAY EXAM HIP,UNILAT W/PELVIS 2-3 VWS | $276.39 | $374.00 | $119.68–$338.47 | 5% below | 26% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-RAY EXAM HIP,UNILAT W/PELVIS 2-3 VWS | $276.39 | $374.00 | $150.35–$338.47 | — | 26% |
| X-ray of the abdomen, 1 view CPT 74018 X-RAY EXAM ABDOMEN 1 VIEW | $210.62 | $285.00 | $91.20–$257.92 | at median | 26% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 X-RAY EXAM ABDOMEN 1 VIEW | $210.62 | $285.00 | $114.57–$257.92 | — | 26% |
| X-ray of the ankle, 2 views CPT 73600 XRAY ANKLE 2 VWS | $222.44 | $301.00 | $96.32–$272.41 | 12% above | 26% |
| X-ray of the ankle, 2 views inpatient CPT 73600 XRAY ANKLE 2 VWS | $222.44 | $301.00 | $121.00–$272.41 | — | 26% |
| X-ray of the finger(s), 2 or more views CPT 73140 XRAY FINGER(S) TC | $194.36 | $263.00 | $84.16–$238.02 | 20% below | 26% |
| X-ray of the foot, 2 views CPT 73620 XRAY FOOT 2 VWS | $202.49 | $274.00 | $87.68–$247.97 | 7% above | 26% |
| X-ray of the foot, 2 views inpatient CPT 73620 XRAY FOOT 2 VWS | $202.49 | $274.00 | $110.15–$247.97 | — | 26% |
| X-ray of the foot, complete, 3 or more views CPT 73630 XRAY FOOT MINIMUM 3 VWS | $221.70 | $300.00 | $96.00–$271.50 | 8% below | 26% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XRAY FOOT MINIMUM 3 VWS | $221.70 | $300.00 | $120.60–$271.50 | — | 26% |
| X-ray of the hand, 3 or more views CPT 73130 XRAY HAND 3VWS TC | $220.22 | $298.00 | $95.36–$269.69 | 6% below | 26% |
| X-ray of the knee, 1 or 2 views CPT 73560 XRAY KNEE 1 OR 2 VWS | $230.57 | $312.00 | $99.84–$282.36 | 9% above | 26% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 XRAY KNEE 1 OR 2 VWS | $230.57 | $312.00 | $125.42–$282.36 | — | 26% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XRAY LUMBOSACRAL 2 OR 3 VWS | $266.04 | $360.00 | $115.20–$325.80 | 9% below | 26% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XRAY LUMBOSACRAL 2 OR 3 VWS | $266.04 | $360.00 | $144.72–$325.80 | — | 26% |
| X-ray of the lower back, 4 or more views CPT 72110 XRAY LUMBOSACRAL MINIMUM 4 VWS | $343.64 | $465.00 | $148.80–$420.82 | 8% below | 26% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XRAY THORACIC SPINE 2 VWS | $260.87 | $353.00 | $112.96–$319.47 | 10% above | 26% |
| X-ray of the nasal bones, 3 or more views CPT 70160 XRAY NASAL BONES MINIMUM 3 VWS | $218.74 | $296.00 | $94.72–$267.88 | 10% below | 26% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XRAY CERVICAL SPINE 2 OR 3 VWS | $248.30 | $336.00 | $107.52–$304.08 | 3% above | 26% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XRAY CERVICAL SPINE 2 OR 3 VWS | $248.30 | $336.00 | $135.07–$304.08 | — | 26% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XRAY PELVIS 1 OR 2 VWS | $227.61 | $308.00 | $98.56–$278.74 | 3% above | 26% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XRAY PELVIS 1 OR 2 VWS | $227.61 | $308.00 | $123.82–$278.74 | — | 26% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XRAY SACRUM/ COCCYX MINIMUM 2 VWS | $226.87 | $307.00 | $98.24–$277.84 | 5% above | 26% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XRAY SACRUM/ COCCYX MINIMUM 2 VWS | $226.87 | $307.00 | $123.41–$277.84 | — | 26% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT) | $57.64 | $78.00 | $24.96–$70.59 | 65% above | 26% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT) | $57.64 | $78.00 | $31.36–$70.59 | — | 26% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT) | $58.38 | $79.00 | $25.28–$71.50 | 23% above | 26% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT) | $58.38 | $79.00 | $31.76–$71.50 | — | 26% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $283.04 | $383.00 | $122.56–$346.62 | 7% below | 26% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $283.04 | $383.00 | $153.97–$346.62 | — | 26% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ASSAY ALKALINE PHOSPHATASE | $67.25 | $91.00 | $29.12–$82.36 | 38% above | 26% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM | $22.17 | $30.00 | $9.60–$27.15 | 73% below | 26% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM | $22.17 | $30.00 | $12.06–$27.15 | — | 26% |
| Ammonia blood test CPT 82140 AMMONIA | $124.15 | $168.00 | $53.76–$152.04 | 38% above | 26% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $124.15 | $168.00 | $67.54–$152.04 | — | 26% |
| Amylase blood test CPT 82150 ASSAY OF AMYLASE | $71.68 | $97.00 | $31.04–$87.78 | 16% above | 26% |
| Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE | $71.68 | $97.00 | $38.99–$87.78 | — | 26% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $204.70 | $277.00 | $88.64–$250.68 | 44% above | 26% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $204.70 | $277.00 | $111.35–$250.68 | — | 26% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LAB CULTURE BACTERIA | $99.03 | $134.00 | $42.88–$121.27 | 89% above | 26% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LAB CULTURE BACTERIA | $99.03 | $134.00 | $53.87–$121.27 | — | 26% |
| Basic metabolic panel (blood test) CPT 80048 LAB BASIC METABOLIC PANEL | $173.66 | $235.00 | $75.20–$212.68 | 97% above | 26% |
| Basic metabolic panel (blood test) inpatient CPT 80048 LAB BASIC METABOLIC PANEL | $173.66 | $235.00 | $94.47–$212.68 | — | 26% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $55.42 | $75.00 | $24.00–$67.88 | 18% above | 26% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $55.42 | $75.00 | $30.15–$67.88 | — | 26% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION , TECH | $207.66 | $281.00 | $89.92–$254.30 | 4% below | 26% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION , TECH | $207.66 | $281.00 | $112.96–$254.30 | — | 26% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $151.50 | $205.00 | $65.60–$185.52 | 77% above | 26% |
| Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA | $151.50 | $205.00 | $82.41–$185.52 | — | 26% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COMMUNITY PARAMEDIC VENIPUNCTURE | $23.65 | $32.00 | $10.24–$28.96 | 61% above | 26% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE, LAB | $23.65 | $32.00 | $10.24–$28.96 | 61% above | 26% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $23.65 | $32.00 | $10.24–$28.96 | 61% above | 26% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 LEGAL BLOOD ALCHOL DRAW | $31.04 | $42.00 | $13.44–$38.01 | 111% above | 26% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COMMUNITY PARAMEDIC VENIPUNCTURE | $23.65 | $32.00 | $12.86–$28.96 | — | 26% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE | $23.65 | $32.00 | $12.86–$28.96 | — | 26% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE, LAB | $23.65 | $32.00 | $12.86–$28.96 | — | 26% |
| Blood glucose (sugar) test CPT 82947 ASSAY, GLUCOSE, BLOOD QUANT | $54.69 | $74.00 | $23.68–$66.97 | 124% above | 26% |
| Blood glucose (sugar) test inpatient CPT 82947 ASSAY, GLUCOSE, BLOOD QUANT | $54.69 | $74.00 | $29.75–$66.97 | — | 26% |
| Blood lead test CPT 83655 LEAD | $122.67 | $166.00 | $53.12–$150.23 | 123% above | 26% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN, CHORIONIC (HCG), QUALITATIVE | $75.38 | $102.00 | $32.64–$92.31 | 22% above | 26% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN, CHORIONIC (HCG), QUALITATIVE QW | $75.38 | $102.00 | $32.64–$92.31 | 22% above | 26% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN, CHORIONIC (HCG), QUALITATIVE QW | $75.38 | $102.00 | $41.00–$92.31 | — | 26% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN, CHORIONIC (HCG), QUALITATIVE | $75.38 | $102.00 | $41.00–$92.31 | — | 26% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO | $89.42 | $121.00 | $38.72–$109.51 | 110% above | 26% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO | $89.42 | $121.00 | $48.64–$109.51 | — | 26% |
| Blood urea nitrogen (BUN) test CPT 84520 ASSAY OF UREA NITROGEN | $56.90 | $77.00 | $24.64–$69.68 | 121% above | 26% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 ASSAY OF UREA NITROGEN | $56.90 | $77.00 | $30.95–$69.68 | — | 26% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $82.03 | $111.00 | $35.52–$100.46 | 50% above | 26% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $82.03 | $111.00 | $44.62–$100.46 | — | 26% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $164.06 | $222.00 | $71.04–$200.91 | 9% above | 26% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLIFIED PROBE | $164.06 | $222.00 | $89.24–$200.91 | — | 26% |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 | $133.76 | $181.00 | $57.92–$163.80 | 19% above | 26% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 | $133.76 | $181.00 | $72.76–$163.80 | — | 26% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 TUMOR ANTIGEN, CA-125 | $141.15 | $191.00 | $61.12–$172.86 | 18% above | 26% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ QW | $133.76 | $181.00 | $57.92–$163.80 | 1% below | 26% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $133.76 | $181.00 | $57.92–$163.80 | 1% below | 26% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ QW | $133.76 | $181.00 | $72.76–$163.80 | — | 26% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $133.76 | $181.00 | $72.76–$163.80 | — | 26% |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL | $66.51 | $90.00 | $28.80–$81.45 | 27% above | 26% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL | $66.51 | $90.00 | $36.18–$81.45 | — | 26% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN | $129.32 | $175.00 | $56.00–$158.38 | 5% below | 26% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN | $129.32 | $175.00 | $70.35–$158.38 | — | 26% |
| Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY | $80.55 | $109.00 | $34.88–$98.64 | 10% above | 26% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS DNA, AMP PROBE | $128.59 | $174.00 | $55.68–$157.47 | 10% below | 26% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS DNA, AMP PROBE | $128.59 | $174.00 | $69.95–$157.47 | — | 26% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $108.63 | $147.00 | $47.04–$133.04 | 22% above | 26% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $108.63 | $147.00 | $59.09–$133.04 | — | 26% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $121.94 | $165.00 | $52.80–$149.33 | 68% above | 26% |
| Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $121.94 | $165.00 | $66.33–$149.33 | — | 26% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $116.02 | $157.00 | $50.24–$142.08 | 121% above | 26% |
| Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED | $116.02 | $157.00 | $63.11–$142.08 | — | 26% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $218.00 | $295.00 | $94.40–$266.98 | 92% above | 26% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $218.00 | $295.00 | $118.59–$266.98 | — | 26% |
| Cortisol blood test, total CPT 82533 TOTAL CORTISOL | $114.54 | $155.00 | $49.60–$140.28 | 5% below | 26% |
| Cortisol blood test, total inpatient CPT 82533 TOTAL CORTISOL | $114.54 | $155.00 | $62.31–$140.28 | — | 26% |
| Creatine kinase (CK) blood test, total CPT 82550 ASSAY OF CK (CPK) | $65.03 | $88.00 | $28.16–$79.64 | 2% above | 26% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 ASSAY OF CK (CPK) | $65.03 | $88.00 | $35.38–$79.64 | — | 26% |
| Creatinine blood test CPT 82565 CREATININE; BLOOD | $69.47 | $94.00 | $30.08–$85.07 | 119% above | 26% |
| Creatinine blood test inpatient CPT 82565 CREATININE; BLOOD | $69.47 | $94.00 | $37.79–$85.07 | — | 26% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT | $123.41 | $167.00 | $53.44–$151.14 | 55% above | 26% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT | $123.41 | $167.00 | $67.13–$151.14 | — | 26% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 SALICYLATE | $146.32 | $198.00 | $63.36–$179.19 | 26% above | 26% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ACETAMINOPHEN | $146.32 | $198.00 | $63.36–$179.19 | 26% above | 26% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL | $183.27 | $248.00 | $79.36–$224.44 | 58% above | 26% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 OB URINE DRUG SCREEN | $277.12 | $375.00 | $120.00–$339.38 | 139% above | 26% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG SCREEN | $301.51 | $408.00 | $130.56–$369.24 | 160% above | 26% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ACETAMINOPHEN | $146.32 | $198.00 | $79.60–$179.19 | — | 26% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 SALICYLATE | $146.32 | $198.00 | $79.60–$179.19 | — | 26% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE DRUG SCREEN | $301.51 | $408.00 | $164.02–$369.24 | — | 26% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $92.38 | $125.00 | $40.00–$113.12 | 89% above | 26% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL | $92.38 | $125.00 | $50.25–$113.12 | — | 26% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEEN-BARR ANTIBODY VIRAL CAPSID(VAC) | $87.94 | $119.00 | $38.08–$107.70 | 7% above | 26% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEEN-BARR ANTIBODY VIRAL CAPSID(VAC) | $87.94 | $119.00 | $47.84–$107.70 | — | 26% |
| FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING HORMONE | $104.94 | $142.00 | $45.44–$128.51 | 9% below | 26% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $17.74 | $24.00 | $7.68–$21.72 | 91% below | 26% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $161.84 | $219.00 | $70.08–$198.20 | 79% above | 26% |
| Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN | $161.84 | $219.00 | $88.04–$198.20 | — | 26% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN | $8.87 | $12.00 | $3.84–$10.86 | 87% below | 26% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN | $91.64 | $124.00 | $49.85–$112.22 | — | 26% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID (FOLATE), SERUM | $143.37 | $194.00 | $62.08–$175.57 | 45% above | 26% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID (FOLATE), SERUM | $143.37 | $194.00 | $77.99–$175.57 | — | 26% |
| Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE T3, FREE (FREE T3) | $156.67 | $212.00 | $67.84–$191.86 | 61% above | 26% |
| Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3, FREE (FREE T3) | $156.67 | $212.00 | $85.22–$191.86 | — | 26% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXIN, FREE (FREE T4) | $80.55 | $109.00 | $34.88–$98.64 | at median | 26% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXIN, FREE (FREE T4) | $80.55 | $109.00 | $43.82–$98.64 | — | 26% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GGT | $62.82 | $85.00 | $27.20–$76.92 | 18% above | 26% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GGT | $62.82 | $85.00 | $34.17–$76.92 | — | 26% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $271.95 | $368.00 | $117.76–$333.04 | 1% below | 26% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $271.95 | $368.00 | $147.94–$333.04 | — | 26% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $55.42 | $75.00 | $24.00–$67.88 | 12% above | 26% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $117.50 | $159.00 | $50.88–$143.90 | 31% above | 26% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE DNA, AMP PROBE | $125.63 | $170.00 | $54.40–$153.85 | 12% below | 26% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE DNA, AMP PROBE | $125.63 | $170.00 | $68.34–$153.85 | — | 26% |
| H. pylori stool antigen test CPT 87338 LAB H PYLORI STOOL AG | $131.54 | $178.00 | $56.96–$161.09 | 2% above | 26% |
| H. pylori stool antigen test inpatient CPT 87338 LAB H PYLORI STOOL AG | $131.54 | $178.00 | $71.56–$161.09 | — | 26% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 DNA QUANT | $75.38 | $102.00 | $32.64–$92.31 | 81% below | 26% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 ANTIGENS W/HIV 1/2 ANTIB | $89.42 | $121.00 | $38.72–$109.51 | 13% below | 26% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 ANTIGENS W/HIV 1/2 ANTIB | $89.42 | $121.00 | $48.64–$109.51 | — | 26% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH-RISK TYPES | $144.84 | $196.00 | $62.72–$177.38 | 1% above | 26% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH-RISK TYPES | $144.84 | $196.00 | $78.79–$177.38 | — | 26% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST | $73.90 | $100.00 | $32.00–$90.50 | 7% above | 26% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST | $73.90 | $100.00 | $40.20–$90.50 | — | 26% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $46.56 | $63.00 | $20.16–$57.02 | 166% above | 26% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $46.56 | $63.00 | $25.33–$57.02 | — | 26% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY, TOTAL | $137.45 | $186.00 | $59.52–$168.33 | 72% above | 26% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY | $123.41 | $167.00 | $53.44–$151.14 | 67% above | 26% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN | $113.07 | $153.00 | $48.96–$138.46 | 74% above | 26% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN | $113.07 | $153.00 | $61.51–$138.46 | — | 26% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $113.07 | $153.00 | $48.96–$138.46 | 41% above | 26% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $113.07 | $153.00 | $61.51–$138.46 | — | 26% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA QUANT | $39.91 | $54.00 | $17.28–$48.87 | 83% below | 26% |
| Herpes blood test, HSV-1 antibody CPT 86695 LAB HSV IGM TITER PT 1 | $69.47 | $94.00 | $30.08–$85.07 | 2% above | 26% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 | $81.29 | $110.00 | $35.20–$99.55 | at median | 26% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 HIGH SENS CRP | $78.33 | $106.00 | $33.92–$95.93 | 2% below | 26% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HIGH SENS CRP | $78.33 | $106.00 | $42.61–$95.93 | — | 26% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $130.80 | $177.00 | $56.64–$160.18 | 11% above | 26% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN TOTAL | $72.42 | $98.00 | $31.36–$88.69 | 7% above | 26% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $80.55 | $109.00 | $34.88–$98.64 | 51% above | 26% |
| Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON | $80.55 | $109.00 | $43.82–$98.64 | — | 26% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $220.22 | $298.00 | $95.36–$269.69 | 114% above | 26% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $220.22 | $298.00 | $119.80–$269.69 | — | 26% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN (LH) | $104.94 | $142.00 | $45.44–$128.51 | 8% above | 26% |
| Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID | $99.76 | $135.00 | $43.20–$122.18 | 43% above | 26% |
| Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTIC ACID | $99.76 | $135.00 | $54.27–$122.18 | — | 26% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE (LD) (LDH) ENZYME | $65.77 | $89.00 | $28.48–$80.54 | 32% above | 26% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE (LD) (LDH) ENZYME | $65.77 | $89.00 | $35.78–$80.54 | — | 26% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $78.33 | $106.00 | $33.92–$95.93 | 16% above | 26% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE | $78.33 | $106.00 | $42.61–$95.93 | — | 26% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $128.59 | $174.00 | $55.68–$157.47 | 26% above | 26% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $128.59 | $174.00 | $69.95–$157.47 | — | 26% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $99.76 | $135.00 | $43.20–$122.18 | 20% above | 26% |
| Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY | $99.76 | $135.00 | $54.27–$122.18 | — | 26% |
| Magnesium blood test CPT 83735 MAGNESIUM | $88.68 | $120.00 | $38.40–$108.60 | 69% above | 26% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM | $88.68 | $120.00 | $48.24–$108.60 | — | 26% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $80.55 | $109.00 | $34.88–$98.64 | 2% below | 26% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES | $63.55 | $86.00 | $27.52–$77.83 | 15% above | 26% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES | $63.55 | $86.00 | $34.57–$77.83 | — | 26% |
| Mumps immunity blood test CPT 86735 MUMPS | $77.60 | $105.00 | $33.60–$95.02 | 10% below | 26% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LAB PSA SCREENING | $112.33 | $152.00 | $48.64–$137.56 | 18% above | 26% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $119.72 | $162.00 | $51.84–$146.61 | 26% above | 26% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LAB PSA SCREENING | $112.33 | $152.00 | $61.10–$137.56 | — | 26% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL | $119.72 | $162.00 | $65.12–$146.61 | — | 26% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP DIAGNOSTIC THIN LAYER PREP | $91.64 | $124.00 | $39.68–$112.22 | 2% above | 26% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP SCREEN THIN LAYER PREP | $92.38 | $125.00 | $40.00–$113.12 | 3% above | 26% |
| Parathyroid hormone (PTH) blood test CPT 83970 LAB PTH IMMUNOCH PART 1 | $411.62 | $557.00 | $178.24–$504.08 | 93% above | 26% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 LAB PTH IMMUNOCH PART 1 | $411.62 | $557.00 | $223.91–$504.08 | — | 26% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $76.12 | $103.00 | $32.96–$93.22 | 45% above | 26% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $76.12 | $103.00 | $41.41–$93.22 | — | 26% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS | $53.95 | $73.00 | $23.36–$66.06 | 30% above | 26% |
| Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS | $64.29 | $87.00 | $27.84–$78.74 | 55% above | 26% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS | $53.95 | $73.00 | $29.35–$66.06 | — | 26% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS | $64.29 | $87.00 | $34.97–$78.74 | — | 26% |
| Potassium blood test CPT 84132 POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD | $61.34 | $83.00 | $26.56–$75.12 | 124% above | 26% |
| Potassium blood test inpatient CPT 84132 POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD | $61.34 | $83.00 | $33.37–$75.12 | — | 26% |
| Progesterone blood test CPT 84144 PROGESTERONE | $136.72 | $185.00 | $59.20–$167.42 | 13% above | 26% |
| Prolactin blood test CPT 84146 PROLACTIN | $113.07 | $153.00 | $48.96–$138.46 | 6% below | 26% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $113.07 | $153.00 | $61.51–$138.46 | — | 26% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT/INR) QW | $48.04 | $65.00 | $20.80–$58.82 | 43% above | 26% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT/INR) | $48.04 | $65.00 | $20.80–$58.82 | 43% above | 26% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT/INR) | $48.04 | $65.00 | $26.13–$58.82 | — | 26% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT/INR) QW | $48.04 | $65.00 | $26.13–$58.82 | — | 26% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC | $62.08 | $84.00 | $26.88–$76.02 | 18% above | 26% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC | $62.08 | $84.00 | $33.77–$76.02 | — | 26% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC | $69.47 | $94.00 | $30.08–$85.07 | 52% above | 26% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC | $69.47 | $94.00 | $37.79–$85.07 | — | 26% |
| Rh blood typing CPT 86901 BLOOD TYPING RH (D) | $53.95 | $73.00 | $23.36–$66.06 | 36% above | 26% |
| Rh blood typing inpatient CPT 86901 BLOOD TYPING RH (D) | $53.95 | $73.00 | $29.35–$66.06 | — | 26% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $59.86 | $81.00 | $25.92–$73.31 | 2% above | 26% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $95.33 | $129.00 | $41.28–$116.74 | 16% above | 26% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY | $95.33 | $129.00 | $51.86–$116.74 | — | 26% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE, AUTO | $43.60 | $59.00 | $18.88–$53.40 | 5% above | 26% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE, AUTO | $43.60 | $59.00 | $23.72–$53.40 | — | 26% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT | $92.38 | $125.00 | $40.00–$113.12 | 32% below | 26% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN COMPLETE | $92.38 | $125.00 | $40.00–$113.12 | 32% below | 26% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN COMPLETE | $92.38 | $125.00 | $50.25–$113.12 | — | 26% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT | $92.38 | $125.00 | $50.25–$113.12 | — | 26% |
| Sodium blood test CPT 84295 SODIUM; SERUM, PLASMA OR WHOLE BLOOD | $56.90 | $77.00 | $24.64–$69.68 | 129% above | 26% |
| Sodium blood test inpatient CPT 84295 SODIUM; SERUM, PLASMA OR WHOLE BLOOD | $56.90 | $77.00 | $30.95–$69.68 | — | 26% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $33.99 | $46.00 | $14.72–$41.63 | 61% above | 26% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD FECES | $33.99 | $46.00 | $18.49–$41.63 | — | 26% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 DX OCCULT BLOOD IMMUNOASSAY | $83.51 | $113.00 | $36.16–$102.26 | 38% above | 26% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 SCREEN FECALOCCULT IMMUNOASSAY | $83.51 | $113.00 | $36.16–$102.26 | 38% above | 26% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 SCREEN FECALOCCULT IMMUNOASSAY | $83.51 | $113.00 | $45.43–$102.26 | — | 26% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 DX OCCULT BLOOD IMMUNOASSAY | $83.51 | $113.00 | $45.43–$102.26 | — | 26% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM | $71.68 | $97.00 | $31.04–$87.78 | 30% above | 26% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM | $71.68 | $97.00 | $38.99–$87.78 | — | 26% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL | $45.08 | $61.00 | $19.52–$55.20 | 14% above | 26% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST, CELL IMMUNITY MEASURE | $162.58 | $220.00 | $70.40–$199.10 | 36% below | 26% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TUBERCULOSIS TEST, CELL IMMUNITY MEASURE | $162.58 | $220.00 | $88.44–$199.10 | — | 26% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $110.85 | $150.00 | $48.00–$135.75 | 4% below | 26% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $110.85 | $150.00 | $60.30–$135.75 | — | 26% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY | $90.16 | $122.00 | $39.04–$110.41 | 29% above | 26% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY | $87.20 | $118.00 | $47.44–$106.79 | — | 26% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $107.16 | $145.00 | $46.40–$131.22 | 19% above | 26% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE | $107.16 | $145.00 | $58.29–$131.22 | — | 26% |
| Total cholesterol blood test CPT 82465 ASSAY BLD/SERUM CHOLESTEROL | $45.82 | $62.00 | $19.84–$56.11 | 1% below | 26% |
| Transferrin blood test CPT 84466 ASSAY OF TRANSFERRIN | $128.59 | $174.00 | $55.68–$157.47 | 35% above | 26% |
| Transferrin blood test inpatient CPT 84466 ASSAY OF TRANSFERRIN | $128.59 | $174.00 | $69.95–$157.47 | — | 26% |
| Trichomonas test (NAAT) CPT 87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $40.64 | $55.00 | $17.60–$49.78 | 70% below | 26% |
| Trichomonas test (NAAT) inpatient CPT 87661 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $40.64 | $55.00 | $22.11–$49.78 | — | 26% |
| Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES | $59.86 | $81.00 | $25.92–$73.31 | 11% above | 26% |
| Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES | $59.86 | $81.00 | $32.56–$73.31 | — | 26% |
| Troponin test, quantitative CPT 84484 TROPONIN, QUANTITATIVE | $142.63 | $193.00 | $61.76–$174.66 | 69% above | 26% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN, QUANTITATIVE | $142.63 | $193.00 | $77.59–$174.66 | — | 26% |
| Uric acid blood test CPT 84550 URIC ACID; BLOOD | $49.51 | $67.00 | $21.44–$60.64 | 2% below | 26% |
| Uric acid blood test inpatient CPT 84550 URIC ACID; BLOOD | $49.51 | $67.00 | $26.93–$60.64 | — | 26% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, AUTO, W/SCOPE | $56.90 | $77.00 | $24.64–$69.68 | 58% above | 26% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, AUTO, W/SCOPE | $56.90 | $77.00 | $30.95–$69.68 | — | 26% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO W/O SCOPE QW | $36.21 | $49.00 | $15.68–$44.34 | 45% above | 26% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO W/O SCOPE | $36.95 | $50.00 | $16.00–$45.25 | 48% above | 26% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, AUTO W/O SCOPE | $36.95 | $50.00 | $20.10–$45.25 | — | 26% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $22.17 | $30.00 | $9.60–$27.15 | 61% above | 26% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $22.17 | $30.00 | $12.06–$27.15 | — | 26% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT | $82.77 | $112.00 | $35.84–$101.36 | 10% above | 26% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT | $82.77 | $112.00 | $45.02–$101.36 | — | 26% |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN QUANTITATIVE | $78.33 | $106.00 | $33.92–$95.93 | 21% above | 26% |
| Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN QUANTITATIVE | $78.33 | $106.00 | $42.61–$95.93 | — | 26% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $155.19 | $210.00 | $67.20–$190.05 | 51% above | 26% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 | $155.19 | $210.00 | $84.42–$190.05 | — | 26% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25 HYDROXY | $192.14 | $260.00 | $83.20–$235.30 | 24% above | 26% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25 HYDROXY | $192.14 | $260.00 | $104.52–$235.30 | — | 26% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIHYDROXY | $277.12 | $375.00 | $120.00–$339.38 | 73% above | 26% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPINC, CHORIONIC (HCG), QUANT | $100.50 | $136.00 | $43.52–$123.08 | 15% below | 26% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE | $662.88 | $897.00 | $287.04–$811.78 | 10% below | 26% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC | $1,639.10 | $2,218.00 | $709.76–$2,007.29 | 35% below | 26% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST 1ST LESION STRTCTC | $1,639.10 | $2,218.00 | $891.64–$2,007.29 | — | 26% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION, ELECTIVE;EXTERN | $1,342.76 | $1,817.00 | $581.44–$1,644.38 | 36% above | 26% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION, ELECTIVE;EXTERN | $1,342.76 | $1,817.00 | $730.43–$1,644.38 | — | 26% |
| Catheter ablation for atrial fibrillation CPT 93656 TX ATRIAL FIB PULM VEIN ISOL | $13,404.72 | $18,139.00 | $5,804.48–$16,415.80 | 24% below | 26% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 TX ATRIAL FIB PULM VEIN ISOL | $13,404.72 | $18,139.00 | $7,291.88–$16,415.80 | — | 26% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION,CLAMP,NEWBORN | $243.87 | $330.00 | $105.60–$298.65 | 20% above | 26% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION,CLAMP,NEWBORN | $243.87 | $330.00 | $132.66–$298.65 | — | 26% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED RX DIST RAD/ULNA FX | $593.42 | $803.00 | $256.96–$726.72 | 4% below | 26% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY,REMV LESN,SNARE | $2,469.00 | $3,341.00 | $1,069.12–$3,023.60 | 1% above | 26% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY,BIOPSY | $2,264.30 | $3,064.00 | $980.48–$2,772.92 | 11% above | 26% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY,FLEX,DIAGNOSTIC | $2,089.15 | $2,827.00 | $904.64–$2,558.44 | 20% above | 26% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY,FLEX,DIAGNOSTIC | $2,089.15 | $2,827.00 | $1,136.45–$2,558.44 | — | 26% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY,BX CERVIX/ENDOCERV CURR | $773.73 | $1,047.00 | $335.04–$947.54 | 71% above | 26% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY,INSERT URETERAL STENT | $3,666.18 | $4,961.00 | $1,587.52–$4,489.70 | 16% below | 26% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY,INSERT URETERAL STENT | $3,666.18 | $4,961.00 | $1,994.32–$4,489.70 | — | 26% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $1,451.40 | $1,964.00 | $628.48–$1,777.42 | 46% above | 26% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUC BENIGN/PREMAL,1ST LESION | $202.49 | $274.00 | $87.68–$247.97 | 12% above | 26% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT | $80.55 | $109.00 | $34.88–$98.64 | 13% below | 26% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX | $182.53 | $247.00 | $79.04–$223.54 | 118% above | 26% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING | $554.99 | $751.00 | $240.32–$679.66 | 104% above | 26% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ CERV/THORAC WITH IMAGE GUIDANCE | $1,520.86 | $2,058.00 | $658.56–$1,862.49 | 15% above | 26% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S1 LEV(T) | $1,631.71 | $2,208.00 | $706.56–$1,998.24 | 1% above | 26% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY,SCREEN PREV | $1,267.38 | $1,715.00 | $548.80–$1,552.08 | 48% above | 26% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY,DIAGNOSTIC | $1,720.39 | $2,328.00 | $744.96–$2,106.84 | 101% above | 26% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY,SCREEN PREV | $1,267.38 | $1,715.00 | $689.43–$1,552.08 | — | 26% |
| Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE,ONE | $2,346.32 | $3,175.00 | $1,016.00–$2,873.38 | 14% below | 26% |
| Hammertoe correction surgery inpatient CPT 28285 REPAIR OF HAMMERTOE,ONE | $2,346.32 | $3,175.00 | $1,276.35–$2,873.38 | — | 26% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $1,310.25 | $1,773.00 | $567.36–$1,604.56 | 2% above | 26% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY,INT/EXT,SIMPLE | $3,203.56 | $4,335.00 | $1,387.20–$3,923.18 | 6% below | 26% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY,INT/EXT,SIMPLE | $3,203.56 | $4,335.00 | $1,742.67–$3,923.18 | — | 26% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE | $962.92 | $1,303.00 | $416.96–$1,179.22 | 217% above | 26% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE | $962.92 | $1,303.00 | $523.81–$1,179.22 | — | 26% |
| Incision and drainage of a simple or single skin abscess CPT 10060 DRAIN SKIN ABSCESS SIMPLE(T) | $288.21 | $390.00 | $124.80–$352.95 | 1% below | 26% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON/LIGAMENT/CYST | $397.58 | $538.00 | $172.16–$486.89 | 17% above | 26% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ LARGE JOINT/BURSA(T) | $363.59 | $492.00 | $157.44–$445.26 | 16% below | 26% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ LARGE JOINT/BURSA(T) | $363.59 | $492.00 | $197.78–$445.26 | — | 26% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/IN MEDIUM JOINT/BURSA(T) | $305.21 | $413.00 | $132.16–$373.76 | 5% below | 26% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/IN MEDIUM JOINT/BURSA(T) | $305.21 | $413.00 | $166.03–$373.76 | — | 26% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ SMALL JOINT/BURSA(T) | $345.85 | $468.00 | $149.76–$423.54 | 7% below | 26% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYR CLOS WND TRUNK,ARM,LEG <2.5CM | $661.40 | $895.00 | $286.40–$809.98 | 25% above | 26% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ LUMBAR/SACRAL WITH IMAGE GUIDANCE | $1,396.71 | $1,890.00 | $604.80–$1,710.45 | 22% above | 26% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ LUMBAR/SACRAL W/O IMAGE GUIDANCE | $1,734.43 | $2,347.00 | $751.04–$2,124.04 | 110% above | 26% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ LUMBAR/SACRAL W/O IMAGE GUIDANCE | $1,734.43 | $2,347.00 | $943.49–$2,124.04 | — | 26% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ,FORAMEN,L/S,1 LEVEL(T) | $1,701.92 | $2,303.00 | $736.96–$2,084.22 | 59% above | 26% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS SURGERY STATE 1 HEAD NECK HAND FOOT | $1,274.04 | $1,724.00 | $551.68–$1,560.22 | 5% below | 26% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 MOHS SURGERY STATE 1 HEAD NECK HAND FOOT | $1,274.04 | $1,724.00 | $693.05–$1,560.22 | — | 26% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIG .1-.5CM TRUNK,ARM,LE | $733.83 | $993.00 | $317.76–$898.67 | 111% above | 26% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENIG .1-.5CM TRUNK,ARM,LE | $733.83 | $993.00 | $399.19–$898.67 | — | 26% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC SKIN BENIG <5MM FACE,FACIAL | $594.90 | $805.00 | $257.60–$728.52 | 16% above | 26% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC SKIN BENIG <5MM FACE,FACIAL | $594.90 | $805.00 | $323.61–$728.52 | — | 26% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $365.80 | $495.00 | $158.40–$447.98 | 56% above | 26% |
| Occipital nerve block (injection for headaches) CPT 64405 INJ NERV BLCK,GREAT OCCIPTL(T) | $654.75 | $886.00 | $283.52–$801.83 | 42% above | 26% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING(T) | $1,172.79 | $1,587.00 | $507.84–$1,436.24 | 9% below | 26% |
| Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING(T) | $1,172.79 | $1,587.00 | $637.97–$1,436.24 | — | 26% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED | $693.92 | $939.00 | $300.48–$849.80 | 113% above | 26% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT | $2,893.18 | $3,915.00 | $1,252.80–$3,543.08 | 17% above | 26% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY SIMPLE | $612.63 | $829.00 | $265.28–$750.24 | 82% above | 26% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY,SCREEN PREV | $2,098.02 | $2,839.00 | $908.48–$2,569.30 | 9% above | 26% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY,FLEX,SCREEN | $2,119.45 | $2,868.00 | $917.76–$2,595.54 | 12% above | 26% |
| Short arm cast (elbow to hand) CPT 29075 APPLY FOREARM CAST | $263.08 | $356.00 | $113.92–$322.18 | 4% above | 26% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT,STATIC | $226.13 | $306.00 | $97.92–$276.93 | 29% above | 26% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST | $336.98 | $456.00 | $145.92–$412.68 | 43% above | 26% |
| Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST | $336.98 | $456.00 | $183.31–$412.68 | — | 26% |
| Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLINT | $243.87 | $330.00 | $105.60–$298.65 | 18% above | 26% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND CLOSURE 2.5/LESS-DERMABO | $302.25 | $409.00 | $130.88–$370.15 | 7% below | 26% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPR SUPERF WND BODY <2.5CM | $311.12 | $421.00 | $134.72–$381.00 | 4% below | 26% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 WOUND CLOSURE 2.5/LESS-DERMABO | $302.25 | $409.00 | $164.42–$370.15 | — | 26% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION | $342.90 | $464.00 | $148.48–$419.92 | 43% above | 26% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC SKIN MALIG <5MM TRUNK,ARM,LEG | $779.64 | $1,055.00 | $337.60–$954.78 | 112% above | 26% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC SKIN MALIG <5MM TRUNK,ARM,LEG | $779.64 | $1,055.00 | $424.11–$954.78 | — | 26% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS | $396.84 | $537.00 | $171.84–$485.98 | 180% above | 26% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE,LUMBAR,DX(T) | $930.40 | $1,259.00 | $402.88–$1,139.40 | 54% above | 26% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE,LUMBAR,DX(T) | $930.40 | $1,259.00 | $506.12–$1,139.40 | — | 26% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPR SUP NPTERF WND BODY 2.6-7.5 | $439.70 | $595.00 | $190.40–$538.48 | 118% above | 26% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPR SUPERF WND FACE <2.5CM | $329.59 | $446.00 | $142.72–$403.63 | 7% above | 26% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION | $263.08 | $356.00 | $113.92–$322.18 | 10% above | 26% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $1,292.51 | $1,749.00 | $559.68–$1,582.84 | 8% above | 26% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT, 1 OR 2(T) | $356.94 | $483.00 | $154.56–$437.12 | 1% above | 26% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG | $954.05 | $1,291.00 | $413.12–$1,168.36 | 53% below | 26% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG | $954.05 | $1,291.00 | $518.98–$1,168.36 | — | 26% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 UP GI ENDOSCOPY,BALL DIL,30MM | $2,738.00 | $3,705.00 | $1,185.60–$3,353.02 | 3% above | 26% |
| Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY,BIOPSY | $2,287.20 | $3,095.00 | $990.40–$2,800.98 | 45% above | 26% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY,BIOPSY | $2,287.20 | $3,095.00 | $1,244.19–$2,800.98 | — | 26% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $1,736.65 | $2,350.00 | $752.00–$2,126.75 | 14% above | 26% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 UP GI ENDOSCOPY,REMV TUMOR,SNARE | $2,613.84 | $3,537.00 | $1,131.84–$3,200.98 | 18% above | 26% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 UP GI ENDOSCOPY,DILATN W GUIDE | $2,157.14 | $2,919.00 | $934.08–$2,641.70 | 16% above | 26% |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY,DIAGNOSIS | $2,192.61 | $2,967.00 | $949.44–$2,685.14 | 49% above | 26% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S) | $1,722.61 | $2,331.00 | $745.92–$2,109.55 | 10% above | 26% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REMOVAL OF SPERM DUCT(S) | $1,722.61 | $2,331.00 | $937.06–$2,109.55 | — | 26% |
| Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS ABLATION INCOMPETENT VEIN, RADIOFREQ. EXTREMITY,1ST VEIN TREATED | $3,801.42 | $5,144.00 | $1,646.08–$4,655.32 | 3% below | 26% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS ABLATION INCOMPETENT VEIN, RADIOFREQ. EXTREMITY,1ST VEIN TREATED | $3,801.42 | $5,144.00 | $2,067.89–$4,655.32 | — | 26% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESION, 1-14 | $274.17 | $371.00 | $118.72–$335.76 | 39% above | 26% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/TISSUE | $1,126.97 | $1,525.00 | $488.00–$1,380.12 | 111% above | 26% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/TISSUE | $1,126.97 | $1,525.00 | $613.05–$1,380.12 | — | 26% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE | $839.50 | $1,136.00 | $363.52–$1,028.08 | 44% above | 26% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION SERVICE | $839.50 | $1,136.00 | $456.67–$1,028.08 | — | 26% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER TX | $49.51 | $67.00 | $21.44–$60.64 | 43% below | 26% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT | $150.02 | $203.00 | $64.96–$183.72 | 74% above | 26% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER TX | $49.51 | $67.00 | $26.93–$60.64 | — | 26% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $150.02 | $203.00 | $81.61–$183.72 | — | 26% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMOTHERAPY, IV INFUSION, 1 HOUR | $573.46 | $776.00 | $248.32–$702.28 | 2% above | 26% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMOTHERAPY, IV INFUSION, 1 HOUR | $573.46 | $776.00 | $311.95–$702.28 | — | 26% |
| Critical care, first 30 to 74 minutes CPT 99291 FACILITY CRITICAL CARE, E/M 30-74 MINUTES | $1,847.50 | $2,500.00 | $800.00–$2,262.50 | 3% above | 26% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD, TRACING | $195.84 | $265.00 | $84.80–$239.82 | 33% above | 26% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD, TRACING ONLY | $195.84 | $265.00 | $84.80–$239.82 | 33% above | 26% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD, TRACING | $195.84 | $265.00 | $106.53–$239.82 | — | 26% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD, TRACING ONLY | $195.84 | $265.00 | $106.53–$239.82 | — | 26% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 FACILITY EMERGENCY LEVEL 1 VISIT | $208.40 | $282.00 | $90.24–$255.21 | 11% above | 26% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 FACILITY EMERGENCY LEVEL II VISIT | $335.51 | $454.00 | $145.28–$410.87 | 4% above | 26% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 FACILITY EMERGENCY LEVEL III VISIT | $548.34 | $742.00 | $237.44–$671.51 | 8% below | 26% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 FACILITY EMERGENCY LEVEL III VISIT | $548.34 | $742.00 | $298.28–$671.51 | — | 26% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 FACILITY EMERGENCY LEVEL IV VISIT | $897.15 | $1,214.00 | $388.48–$1,098.67 | 2% below | 26% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 FACILITY EMERGENCY LEVEL IV VISIT | $897.15 | $1,214.00 | $488.03–$1,098.67 | — | 26% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 FACILITY EMERGENCY LEVEL V VISIT | $1,364.93 | $1,847.00 | $591.04–$1,671.54 | 7% below | 26% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 FACILITY EMERGENCY LEVEL V VISIT | $1,364.93 | $1,847.00 | $742.49–$1,671.54 | — | 26% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TST,TRACING ONLY | $786.30 | $1,064.00 | $340.48–$962.92 | 1% below | 26% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 FIRST HOUR IV HYDRATION <1 HOUR | $322.20 | $436.00 | $139.52–$394.58 | 13% above | 26% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 FIRST HOUR IV HYDRATION <1 HOUR | $322.20 | $436.00 | $175.27–$394.58 | — | 26% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY, 1 HOUR | $370.24 | $501.00 | $160.32–$453.40 | 17% above | 26% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY, 1 HOUR | $370.24 | $501.00 | $201.40–$453.40 | — | 26% |
| IV push of a medicine, first drug CPT 96374 IV PUSH, SINGLE/1ST DRUG | $205.44 | $278.00 | $88.96–$251.59 | 24% above | 26% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH, SINGLE/1ST DRUG | $205.44 | $278.00 | $111.76–$251.59 | — | 26% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION, SUBQ/IM | $87.94 | $119.00 | $38.08–$107.70 | 9% above | 26% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION, SUBQ/IM | $87.94 | $119.00 | $47.84–$107.70 | — | 26% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION | $256.43 | $347.00 | $111.04–$314.04 | 17% above | 26% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUCATION | $72.42 | $98.00 | $31.36–$88.69 | 24% below | 26% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUCATION | $72.42 | $98.00 | $39.40–$88.69 | — | 26% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPT VISIT,NEW,LEVL III | $116.76 | $158.00 | $50.56–$142.99 | 41% below | 26% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPT VISIT,NEW,LEVL IV | $183.27 | $248.00 | $79.36–$224.44 | 18% below | 26% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPT VISIT,NEW,LEVL IV | $183.27 | $248.00 | $99.70–$224.44 | — | 26% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPT VISIT,NEW,LEVL V | $242.39 | $328.00 | $104.96–$296.84 | 20% below | 26% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPT VISIT,NEW,LEVL II | $76.12 | $103.00 | $32.96–$93.22 | 42% below | 26% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRITION THRPY, 15 MIN | $65.03 | $88.00 | $28.16–$79.64 | 8% above | 26% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT ASSESS & INTERV EA 15 MIN | $65.77 | $89.00 | $28.48–$80.54 | 10% above | 26% |
| Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX | $169.23 | $229.00 | $73.28–$207.24 | 9% below | 26% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX | $169.23 | $229.00 | $92.06–$207.24 | — | 26% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX | $200.27 | $271.00 | $86.72–$245.26 | 37% below | 26% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX | $200.27 | $271.00 | $108.94–$245.26 | — | 26% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX | $168.49 | $228.00 | $72.96–$206.34 | 9% below | 26% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX | $168.49 | $228.00 | $91.66–$206.34 | — | 26% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX | $184.01 | $249.00 | $79.68–$225.34 | 26% below | 26% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX | $184.01 | $249.00 | $100.10–$225.34 | — | 26% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THER TECH,1+REGIONS,EA 15 MIN | $92.38 | $125.00 | $40.00–$113.12 | 5% below | 26% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THER TECH,1+REGIONS,EA 15 MIN | $92.38 | $125.00 | $50.25–$113.12 | — | 26% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES | $101.24 | $137.00 | $43.84–$123.98 | 5% above | 26% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES | $101.24 | $137.00 | $55.07–$123.98 | — | 26% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMKING CESS 4-10 MIN | $31.04 | $42.00 | $13.44–$38.01 | 7% above | 26% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OUTPT VISIT,EST,LEVL V | $156.67 | $212.00 | $67.84–$191.86 | 47% below | 26% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OUTPT VISIT,EST,LEVL V | $156.67 | $212.00 | $85.22–$191.86 | — | 26% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPT VISIT,EST,LEVL III | $79.07 | $107.00 | $34.24–$96.84 | 52% below | 26% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ET THERAPY, 31-45 MINUTES | $118.24 | $160.00 | $51.20–$144.80 | 28% below | 26% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE CONSULTATION,LEVEL III | $132.28 | $179.00 | $57.28–$162.00 | 20% below | 26% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 PULMONARY REHAB EVAL | $144.84 | $196.00 | $62.72–$177.38 | 12% below | 26% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPT VISIT,EST,LEVL III | $79.07 | $107.00 | $43.01–$96.84 | — | 26% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ET THERAPY, 31-45 MINUTES | $118.24 | $160.00 | $64.32–$144.80 | — | 26% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPT VISIT,EST,LEVL IV | $111.59 | $151.00 | $48.32–$136.66 | 40% below | 26% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ET THERAPY, 46-90 MINUTES | $150.76 | $204.00 | $65.28–$184.62 | 19% below | 26% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPT VISIT,EST,LEVL IV | $111.59 | $151.00 | $60.70–$136.66 | — | 26% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ET THERAPY, 46-90 MINUTES | $150.76 | $204.00 | $82.01–$184.62 | — | 26% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPT VISIT,EST,LEVL II | $49.51 | $67.00 | $21.44–$60.64 | 49% below | 26% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ET THERAPY, 16-30 MINUTES | $98.29 | $133.00 | $42.56–$120.36 | 2% above | 26% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE CONSULTATION,LEVEL II | $99.76 | $135.00 | $43.20–$122.18 | 3% above | 26% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPT VISIT,EST,LEVL II | $49.51 | $67.00 | $26.93–$60.64 | — | 26% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ET THERAPY, 16-30 MINUTES | $98.29 | $133.00 | $53.47–$120.36 | — | 26% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE CONSULTATION,LEVEL II | $99.76 | $135.00 | $54.27–$122.18 | — | 26% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE/OUTP CONSULT,LEVEL IV, MODERATE MDM >= 40 MINUTES | $189.18 | $256.00 | $81.92–$231.68 | 41% below | 26% |
| Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN | $300.77 | $407.00 | $130.24–$368.34 | 15% below | 26% |
| Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEN | $300.77 | $407.00 | $163.61–$368.34 | — | 26% |
| Speech therapy session, individual CPT 92507 SPEECH/HEARING THERAPY | $209.88 | $284.00 | $90.88–$257.02 | 17% below | 26% |
| Speech therapy session, individual inpatient CPT 92507 SPEECH/HEARING THERAPY | $209.88 | $284.00 | $114.17–$257.02 | — | 26% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $171.45 | $232.00 | $74.24–$209.96 | 39% below | 26% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY INCL GRAPH REC TC | $186.23 | $252.00 | $80.64–$228.06 | 33% below | 26% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY | $171.45 | $232.00 | $93.26–$209.96 | — | 26% |
| Spirometry before and after a bronchodilator CPT 94060 BRONCH EVAL B/A BRONCH | $328.86 | $445.00 | $142.40–$402.72 | 32% below | 26% |
| Spirometry before and after a bronchodilator CPT 94060 BRONCHO RESPONSE PRE & POST TC | $345.11 | $467.00 | $149.44–$422.64 | 29% below | 26% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCH EVAL B/A BRONCH | $328.86 | $445.00 | $178.89–$402.72 | — | 26% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHO RESPONSE PRE & POST TC | $345.11 | $467.00 | $187.73–$422.64 | — | 26% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES | $73.90 | $100.00 | $32.00–$90.50 | 18% below | 26% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES | $73.90 | $100.00 | $40.20–$90.50 | — | 26% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $215.05 | $291.00 | $93.12–$263.36 | 8% above | 26% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE | $151.18 | $204.58 | $65.47–$185.14 | 124% above | 26% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VACCINE ADJ (65+ YRS) 0.5 ML SUSPENSION PREFILLED SYRINGE | $152.97 | $207.00 | $66.24–$187.34 | 126% above | 26% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE | $151.18 | $204.58 | $82.24–$185.14 | — | 26% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VACCINE ADJ (65+ YRS) 0.5 ML SUSPENSION PREFILLED SYRINGE | $152.97 | $207.00 | $83.21–$187.34 | — | 26% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID-19 VACCINE (PFIZER 12YR+) 30 MCG/0.3ML SUSPENSION PREFILLED SYRINGE | $193.91 | $262.40 | $83.97–$237.47 | 19% above | 26% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE | $193.91 | $262.40 | $83.97–$237.47 | 19% above | 26% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE | $193.91 | $262.40 | $105.48–$237.47 | — | 26% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID-19 VACCINE (PFIZER 12YR+) 30 MCG/0.3ML SUSPENSION PREFILLED SYRINGE | $193.91 | $262.40 | $105.48–$237.47 | — | 26% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTHERIA-ACELLULAR PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 SUSPENSION | $52.84 | $71.50 | $22.88–$64.71 | 28% above | 26% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP/HEPB/IPV VACCINE,IM | $45.82 | $62.00 | $19.84–$56.11 | 67% below | 26% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP/HEPB/IPV VACCINE,IM | $45.82 | $62.00 | $24.92–$56.11 | — | 26% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEPATITIS B RECOMB-IPV SUSPENSION PREFILLED SYRINGE | $172.56 | $233.50 | $93.87–$211.32 | — | 26% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE, NO PRESERV, IM .5ML | $22.17 | $30.00 | $9.60–$27.15 | 31% below | 26% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE, NO PRESERV, IM .5ML | $22.17 | $30.00 | $12.06–$27.15 | — | 26% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV 9-VALENT RECOMB VACCINE SUSPENSION PREFILLED SYRINGE | $545.75 | $738.50 | $236.32–$668.34 | 71% above | 26% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPA/HEPB VACCINE ADULT IM | $145.58 | $197.00 | $63.04–$178.28 | 24% below | 26% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE,ADULT,IM | $125.59 | $169.94 | $54.38–$153.80 | 9% above | 26% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B RECOMB VACCINE 10 MCG/0.5ML SUSPENSION PREFILLED SYRINGE | $52.10 | $70.50 | $22.56–$63.80 | 7% below | 26% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B RECOMB VACCINE 10 MCG/0.5ML SUSPENSION PREFILLED SYRINGE | $52.10 | $70.50 | $28.34–$63.80 | — | 26% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB VACCINE, PRP-T, IM | $40.64 | $55.00 | $17.60–$49.78 | 3% below | 26% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HIB VACCINE, PRP-T, IM | $40.64 | $55.00 | $22.11–$49.78 | — | 26% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML SUSPENSION | $55.40 | $74.96 | $30.13–$67.84 | — | 26% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE HIGH DOSE 65+ | $121.94 | $165.00 | $52.80–$149.33 | 54% above | 26% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE HIGH DOSE 65+ | $121.94 | $165.00 | $66.33–$149.33 | — | 26% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VACCINE RECON SOLN | $170.68 | $230.96 | $92.85–$209.02 | — | 26% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VACCINE, TETRAVALENT | $195.10 | $264.00 | $84.48–$238.92 | 15% below | 26% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG (POWDER) RECON SOLN | $223.92 | $303.00 | $96.96–$274.22 | 2% below | 26% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VACCINE, TETRAVALENT | $195.10 | $264.00 | $106.13–$238.92 | — | 26% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG (POWDER) RECON SOLN | $223.92 | $303.00 | $121.81–$274.22 | — | 26% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL RECOM, VACCINE, SEROGROUP B, 2 DOSE, VFC | $357.39 | $483.61 | $154.76–$437.67 | 54% above | 26% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL RECOM, VACCINE, SEROGROUP B, 2 DOSE | $357.39 | $483.61 | $154.76–$437.67 | 54% above | 26% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL RECOM, VACCINE, SEROGROUP B, 2 DOSE | $357.39 | $483.61 | $194.41–$437.67 | — | 26% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL RECOM, VACCINE, SEROGROUP B, 2 DOSE, VFC | $357.39 | $483.61 | $194.41–$437.67 | — | 26% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOCOCCAL, CONG (PCV13) INJ, PREVNAR 13 | $389.45 | $527.00 | $168.64–$476.94 | 33% above | 26% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL, CONG (PCV13) INJ, PREVNAR 13 | $389.45 | $527.00 | $211.85–$476.94 | — | 26% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL CONJUGATE VACCINE, 20 VALENT (PCV20), FOR INTRAMUSCULAR USE | $450.42 | $609.50 | $195.04–$551.60 | 54% above | 26% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML SUSPENSION PREFILLED SYRINGE | $450.42 | $609.50 | $195.04–$551.60 | 54% above | 26% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL CONJUGATE VACCINE, 20 VALENT (PCV20), FOR INTRAMUSCULAR USE | $450.42 | $609.50 | $245.02–$551.60 | — | 26% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML SUSPENSION PREFILLED SYRINGE | $450.42 | $609.50 | $245.02–$551.60 | — | 26% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE,ADULT,SQ OR IM | $176.62 | $239.00 | $76.48–$216.30 | 25% above | 26% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE,ADULT,SQ OR IM | $176.62 | $239.00 | $96.08–$216.30 | — | 26% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5ML SOLUTION PREFILLED SYRINGE | $986.56 | $1,335.00 | $536.67–$1,208.18 | — | 26% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML RECON SOLN | $510.28 | $690.50 | $277.58–$624.90 | — | 26% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, RABAVERT, IM | $739.56 | $1,000.76 | $320.24–$905.69 | 27% above | 26% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC RECON SUSP | $741.59 | $1,003.50 | $321.12–$908.17 | 28% above | 26% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC RECON SUSP | $739.56 | $1,000.76 | $402.31–$905.69 | — | 26% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, RABAVERT, IM | $739.56 | $1,000.76 | $402.31–$905.69 | — | 26% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS 5-2 LFU INJECTABLE | $72.24 | $97.75 | $31.28–$88.46 | 74% above | 26% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS 5-2 LFU INJECTABLE | $71.68 | $97.00 | $38.99–$87.78 | — | 26% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 SUSPENSION | $81.29 | $110.00 | $35.20–$99.55 | at median | 26% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP, TETANUS, DIPHTHERIA, PERTUSSIS 7+ YRS, BOOSTRIX | $83.51 | $113.00 | $36.16–$102.26 | 2% above | 26% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 SUSPENSION PREFILLED SYRINGE | $86.46 | $116.99 | $37.44–$105.88 | 6% above | 26% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP, TETANUS, DIPHTHERIA, PERTUSSIS 7+ YRS, BOOSTRIX | $83.51 | $113.00 | $45.43–$102.26 | — | 26% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 SUSPENSION PREFILLED SYRINGE | $86.46 | $116.99 | $47.03–$105.88 | — | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TO* | $44.34 | $60.00 | $19.20–$54.30 | 15% above | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN - INFLUENZA | $51.73 | $70.00 | $22.40–$63.35 | 34% above | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) | $57.64 | $78.00 | $24.96–$70.59 | 49% above | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEP B,ADULT 19+ | $57.64 | $78.00 | $24.96–$70.59 | 49% above | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TO* | $51.73 | $70.00 | $28.14–$63.35 | — | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN - INFLUENZA | $51.73 | $70.00 | $28.14–$63.35 | — | 26% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEP B,ADULT 19+ | $57.64 | $78.00 | $31.36–$70.59 | — | 26% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION; EACH ADD'L VACCINE (SINGLE OR COMBO VACCINE/T* | $35.47 | $48.00 | $15.36–$43.44 | 9% above | 26% |
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.essentiahealth.org/standard-charges/2026/411811073_Essentia-St-Marys-Superior_standardcharges.csv