Aurora Medical Center Grafton
Aurora Medical Center Grafton in Grafton, WI publishes cash prices for 344 common procedures listed here, from its own machine-readable price file updated Nov 4, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 159 of 338 procedures and below it for 88. By typical cash price it ranks #57 of 103 Wisconsin hospitals and #11 of 16 hospitals in the Milwaukee, WI area, cheapest first. Select a procedure to compare it with other hospitals nearby.
975 Port Washington Rd, Grafton, WI 53024 Collected Nov 5, 2026 Source price file Check a bill from this hospital (262) 329-1000
Acute care hospital Nonprofit hospital Emergency department CMS star rating 5 of 5 CCN 520207 · CMS hospital register NPI 1265740195
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Aurora Medical Center Grafton 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/WO DYE | $2,410.00 | $4,820.00 | $174.71–$4,097.00 | 1% above | 50% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/WO DYE | $2,410.00 | $4,820.00 | $2,892.00–$4,097.00 | — | 50% |
| Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN 2 VIEWS | $337.50 | $675.00 | $104.13–$573.75 | 41% above | 50% |
| Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN 2 VIEWS | $337.50 | $675.00 | $405.00–$573.75 | — | 50% |
| Ankle X-ray, complete, 3 or more views CPT 73610 XR ANKLE COMPLETE | $330.00 | $660.00 | $86.68–$561.00 | 40% above | 50% |
| Ankle X-ray, complete, 3 or more views CPT 73610 XR ANKLE BIL COMPLETE | $660.00 | $1,320.00 | $86.68–$1,122.00 | 180% above | 50% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XR ANKLE COMPLETE | $330.00 | $660.00 | $396.00–$561.00 | — | 50% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XR ANKLE BIL COMPLETE | $660.00 | $1,320.00 | $792.00–$1,122.00 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NONINV VASC ASSESS-SINGLE SITE | $385.00 | $770.00 | $132.52–$1,046.00 | at median | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON-INVAS PHYS UNI 1-2 LVL LTD | $385.00 | $770.00 | $132.52–$1,046.00 | at median | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NONINV VASC ASSESS-SINGLE SITE | $385.00 | $770.00 | $462.00–$654.50 | — | 50% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NON-INVAS PHYS UNI 1-2 LVL LTD | $385.00 | $770.00 | $462.00–$654.50 | — | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 7% above | 50% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGRAM | $530.00 | $1,060.00 | $174.71–$901.00 | at median | 50% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPHAGRAM | $530.00 | $1,060.00 | $636.00–$901.00 | — | 50% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE IMAGING/WHOLE BODY | $1,490.00 | $2,980.00 | $398.19–$2,533.00 | at median | 50% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE IMAGING/WHOLE BODY | $1,490.00 | $2,980.00 | $1,788.00–$2,533.00 | — | 50% |
| Breast ultrasound, complete, one breast CPT 76641 US BREAST W/AXILLA COMPLETE | $595.00 | $1,190.00 | $104.13–$1,011.50 | 12% above | 50% |
| Breast ultrasound, complete, one breast CPT 76641 US BREAST BIL W/AXILLA COMPLETE | $1,190.00 | $2,380.00 | $104.13–$2,023.00 | 124% above | 50% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST W/AXILLA COMPLETE | $595.00 | $1,190.00 | $714.00–$1,011.50 | — | 50% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST BIL W/AXILLA COMPLETE | $1,190.00 | $2,380.00 | $1,428.00–$2,023.00 | — | 50% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST W/AXILLA LIMITED | $445.00 | $890.00 | $86.68–$756.50 | 13% above | 50% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST BIL W/AXILLA LIMITED | $890.00 | $1,780.00 | $86.68–$1,513.00 | 127% above | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST W/AXILLA LIMITED | $445.00 | $890.00 | $534.00–$756.50 | — | 50% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST BIL W/AXILLA LIMITED | $890.00 | $1,780.00 | $1,068.00–$1,513.00 | — | 50% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PELVIS W/DYE & POSTPROCESSING | $3,045.00 | $6,090.00 | $347.49–$5,176.50 | at median | 50% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PELVIS W/DYE & POSTPROCESSING | $3,045.00 | $6,090.00 | $3,654.00–$5,176.50 | — | 50% |
| CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD | $2,030.00 | $4,060.00 | $174.71–$3,451.00 | 2% below | 50% |
| CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD | $2,030.00 | $4,060.00 | $2,436.00–$3,451.00 | — | 50% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK | $2,030.00 | $4,060.00 | $174.71–$3,451.00 | at median | 50% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK | $2,030.00 | $4,060.00 | $2,436.00–$3,451.00 | — | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST | $2,030.00 | $4,060.00 | $174.71–$3,451.00 | at median | 50% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST | $2,030.00 | $4,060.00 | $2,436.00–$3,451.00 | — | 50% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT HEART VESSEL W/CONTRAST | $1,750.00 | $3,500.00 | $347.49–$3,033.00 | at median | 50% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT HEART VESSEL W/CONTRAST | $1,750.00 | $3,500.00 | $2,100.00–$2,975.00 | — | 50% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS W/O DYE | $3,080.00 | $6,160.00 | $237.66–$5,236.00 | 23% above | 50% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN & PELVIS W/O DYE | $3,080.00 | $6,160.00 | $3,696.00–$5,236.00 | — | 50% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/DYE | $3,280.00 | $6,560.00 | $347.49–$5,576.00 | 2% above | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/DYE | $3,280.00 | $6,560.00 | $3,936.00–$5,576.00 | — | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN & PELVIS W/WO DYE | $4,820.00 | $9,640.00 | $347.49–$8,194.00 | 31% above | 50% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN & PELVIS W/WO DYE | $4,820.00 | $9,640.00 | $5,784.00–$8,194.00 | — | 50% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/DYE | $1,640.00 | $3,280.00 | $174.71–$2,788.00 | at median | 50% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/DYE | $1,640.00 | $3,280.00 | $1,968.00–$2,788.00 | — | 50% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 22% above | 50% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLIOFACIAL W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 11% above | 50% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLIOFACIAL W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 20% above | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| CT scan of the head with contrast CPT 70460 CT HEAD W/DYE | $1,640.00 | $3,280.00 | $174.71–$2,788.00 | 6% above | 50% |
| CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/DYE | $1,640.00 | $3,280.00 | $1,968.00–$2,788.00 | — | 50% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO DYE | $2,410.00 | $4,820.00 | $174.71–$4,097.00 | 31% above | 50% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO DYE | $2,410.00 | $4,820.00 | $2,892.00–$4,097.00 | — | 50% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L SPINE W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | at median | 50% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L SPINE W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C SPINE W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | at median | 50% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C SPINE W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,640.00 | $3,280.00 | $174.71–$2,788.00 | at median | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $1,640.00 | $3,280.00 | $1,968.00–$2,788.00 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX EXTRACRANIAL BILATERAL | $1,090.00 | $2,180.00 | $237.66–$1,853.00 | — | 50% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX EXTRACRANIAL BILATERAL | $1,090.00 | $2,180.00 | $1,308.00–$1,853.00 | — | 50% |
| Chest CT scan without and with contrast CPT 71270 CT CHEST DX W/WO DYE | $2,410.00 | $4,820.00 | $174.71–$4,097.00 | 5% above | 50% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST DX W/WO DYE | $2,410.00 | $4,820.00 | $2,892.00–$4,097.00 | — | 50% |
| Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS | $292.50 | $585.00 | $86.68–$497.25 | 36% above | 50% |
| Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS | $292.50 | $585.00 | $351.00–$497.25 | — | 50% |
| Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW | $242.50 | $485.00 | $86.68–$476.00 | 50% above | 50% |
| Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW | $242.50 | $485.00 | $291.00–$412.25 | — | 50% |
| Collarbone (clavicle) X-ray, complete CPT 73000 XR CLAVICLE COMPLETE | $300.00 | $600.00 | $86.68–$510.00 | 45% above | 50% |
| Collarbone (clavicle) X-ray, complete CPT 73000 XR CLAVICLE BIL COMPLETE | $600.00 | $1,200.00 | $86.68–$1,020.00 | 190% above | 50% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 XR CLAVICLE COMPLETE | $300.00 | $600.00 | $360.00–$510.00 | — | 50% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 XR CLAVICLE BIL COMPLETE | $600.00 | $1,200.00 | $720.00–$1,020.00 | — | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM COMPLETE | $815.00 | $1,630.00 | $104.13–$1,385.50 | 48% above | 50% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM COMPLETE | $815.00 | $1,630.00 | $978.00–$1,385.50 | — | 50% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA AXIAL SKELETON | $467.50 | $935.00 | $104.13–$794.75 | 17% above | 50% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA AXIAL SKELETON | $467.50 | $935.00 | $561.00–$794.75 | — | 50% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA APPENDICULAR SKELETON | $282.50 | $565.00 | $86.68–$480.25 | at median | 50% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA APPENDICULAR SKELETON | $282.50 | $565.00 | $339.00–$480.25 | — | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB DETAILED SINGLE FETUS | $560.00 | $1,120.00 | $237.66–$952.00 | 18% below | 50% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB DETAILED SINGLE FETUS | $560.00 | $1,120.00 | $672.00–$952.00 | — | 50% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST DX W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 7% above | 50% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST DX W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST DX W/DYE | $1,640.00 | $3,280.00 | $174.71–$2,788.00 | at median | 50% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST DX W/DYE | $1,640.00 | $3,280.00 | $1,968.00–$2,788.00 | — | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAM DX BILATERAL | $295.00 | $590.00 | $150.03–$501.50 | — | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAM SCREEN & DX BILATERAL | $475.00 | $950.00 | $150.03–$807.50 | — | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM DX BILATERAL | $295.00 | $590.00 | $354.00–$501.50 | — | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM SCREEN & DX BILATERAL | $475.00 | $950.00 | $570.00–$807.50 | — | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM DX UNILATERAL | $230.00 | $460.00 | $118.52–$391.00 | 25% below | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM SCREEN & DX UNILATERAL | $412.50 | $825.00 | $118.52–$701.25 | 34% above | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM DX UNILATERAL | $230.00 | $460.00 | $276.00–$391.00 | — | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM SCREEN & DX UNILATERAL | $412.50 | $825.00 | $495.00–$701.25 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 VA LOWER EXT DUPLEX BILATERAL | $1,025.00 | $2,050.00 | $237.66–$1,742.50 | — | 50% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 VA LOWER EXT DUPLEX BILATERAL | $1,025.00 | $2,050.00 | $1,230.00–$1,742.50 | — | 50% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX SCAN EXT VEIN BILATERAL | $1,075.00 | $2,150.00 | $237.66–$1,827.50 | — | 50% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX SCAN EXT VEIN BILATERAL | $1,075.00 | $2,150.00 | $1,290.00–$1,827.50 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO/DOPPLER/COLOR W/O CONTRAST | $2,275.00 | $4,550.00 | $544.25–$3,867.50 | 30% above | 50% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO/DOPPLER/COLOR W/CONTRAST | $2,375.00 | $4,750.00 | $544.25–$4,037.50 | 35% above | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO/DOPPLER/COLOR W/O CONTRAST | $2,275.00 | $4,550.00 | $2,730.00–$3,867.50 | — | 50% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO/DOPPLER/COLOR W/CONTRAST | $2,375.00 | $4,750.00 | $2,850.00–$4,037.50 | — | 50% |
| Elbow X-ray, 2 views CPT 73070 XR ELBOW 2 VIEW | $247.50 | $495.00 | $86.68–$476.00 | 29% above | 50% |
| Elbow X-ray, 2 views CPT 73070 XR ELBOW 1 VIEW | $247.50 | $495.00 | $86.68–$476.00 | 29% above | 50% |
| Elbow X-ray, 2 views CPT 73070 XR ELBOW BIL 2V | $495.00 | $990.00 | $86.68–$841.50 | 159% above | 50% |
| Elbow X-ray, 2 views inpatient CPT 73070 XR ELBOW 1 VIEW | $247.50 | $495.00 | $297.00–$420.75 | — | 50% |
| Elbow X-ray, 2 views inpatient CPT 73070 XR ELBOW 2 VIEW | $247.50 | $495.00 | $297.00–$420.75 | — | 50% |
| Elbow X-ray, 2 views inpatient CPT 73070 XR ELBOW BIL 2V | $495.00 | $990.00 | $594.00–$841.50 | — | 50% |
| Elbow X-ray, complete, 3 or more views CPT 73080 XR ELBOW 3 VIEW | $310.00 | $620.00 | $86.68–$527.00 | 32% above | 50% |
| Elbow X-ray, complete, 3 or more views CPT 73080 XR ELBOW BIL MIN 3V | $620.00 | $1,240.00 | $86.68–$1,054.00 | 163% above | 50% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 XR ELBOW 3 VIEW | $310.00 | $620.00 | $372.00–$527.00 | — | 50% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 XR ELBOW BIL MIN 3V | $620.00 | $1,240.00 | $744.00–$1,054.00 | — | 50% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/SELLA/FOSSA/MASTOID/EAR W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 7% above | 50% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT/SELLA/FOSSA/MASTOID/EAR W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL BONES COMPLETE | $420.00 | $840.00 | $104.13–$714.00 | 40% above | 50% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR FACIAL BONES COMPLETE | $420.00 | $840.00 | $504.00–$714.00 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 XR FOREARM 1 VIEW | $292.50 | $585.00 | $86.68–$497.25 | 48% above | 50% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 XR FOREARM 2 VIEW | $292.50 | $585.00 | $86.68–$497.25 | 48% above | 50% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 XR FOREARM BIL 2V | $585.00 | $1,170.00 | $86.68–$994.50 | 197% above | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XR FOREARM 2 VIEW | $292.50 | $585.00 | $351.00–$497.25 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XR FOREARM 1 VIEW | $292.50 | $585.00 | $351.00–$497.25 | — | 50% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XR FOREARM BIL 2V | $585.00 | $1,170.00 | $702.00–$994.50 | — | 50% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY IMAGING W/WO GB | $1,465.00 | $2,930.00 | $398.19–$2,490.50 | 1% below | 50% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY IMAGING W/WO GB | $1,465.00 | $2,930.00 | $1,758.00–$2,490.50 | — | 50% |
| Hand X-ray, 2 views CPT 73120 XR HAND 2 VIEW | $257.50 | $515.00 | $104.13–$476.00 | 37% above | 50% |
| Hand X-ray, 2 views CPT 73120 XR HAND 1 VIEW | $257.50 | $515.00 | $104.13–$476.00 | 37% above | 50% |
| Hand X-ray, 2 views CPT 73120 XR HAND BIL 1 VIEW | $515.00 | $1,030.00 | $104.13–$875.50 | 173% above | 50% |
| Hand X-ray, 2 views CPT 73120 XR HAND BIL 2 VIEW | $515.00 | $1,030.00 | $104.13–$875.50 | 173% above | 50% |
| Hand X-ray, 2 views inpatient CPT 73120 XR HAND 2 VIEW | $257.50 | $515.00 | $309.00–$437.75 | — | 50% |
| Hand X-ray, 2 views inpatient CPT 73120 XR HAND 1 VIEW | $257.50 | $515.00 | $309.00–$437.75 | — | 50% |
| Hand X-ray, 2 views inpatient CPT 73120 XR HAND BIL 2 VIEW | $515.00 | $1,030.00 | $618.00–$875.50 | — | 50% |
| Hand X-ray, 2 views inpatient CPT 73120 XR HAND BIL 1 VIEW | $515.00 | $1,030.00 | $618.00–$875.50 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 XR HEEL 1 VIEW MIN | $267.50 | $535.00 | $86.68–$476.00 | 35% above | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 XR HEEL 2 VIEW MIN | $267.50 | $535.00 | $86.68–$476.00 | 35% above | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 XR HEEL BIL 2 VIEW MIN | $535.00 | $1,070.00 | $86.68–$909.50 | 169% above | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 XR HEEL 1 VIEW MIN | $267.50 | $535.00 | $321.00–$454.75 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 XR HEEL 2 VIEW MIN | $267.50 | $535.00 | $321.00–$454.75 | — | 50% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 XR HEEL BIL 2 VIEW MIN | $535.00 | $1,070.00 | $642.00–$909.50 | — | 50% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATTENDED | $340.00 | $680.00 | $215.07–$784.00 | 45% below | 50% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATTENDED | $340.00 | $680.00 | $408.00–$578.00 | — | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY W CPAP/BIPAP | $3,300.00 | $6,600.00 | $525.00–$5,610.00 | 10% below | 50% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY W CPAP/BIPAP | $3,300.00 | $6,600.00 | $3,960.00–$5,610.00 | — | 50% |
| Knee X-ray, 3 views CPT 73562 XR KNEE 3 VIEW | $282.50 | $565.00 | $86.68–$480.25 | 11% above | 50% |
| Knee X-ray, 3 views CPT 73562 XR KNEE BIL 3 VIEW | $565.00 | $1,130.00 | $86.68–$960.50 | 122% above | 50% |
| Knee X-ray, 3 views inpatient CPT 73562 XR KNEE 3 VIEW | $282.50 | $565.00 | $339.00–$480.25 | — | 50% |
| Knee X-ray, 3 views inpatient CPT 73562 XR KNEE BIL 3 VIEW | $565.00 | $1,130.00 | $678.00–$960.50 | — | 50% |
| Knee X-ray, complete, 4 or more views CPT 73564 XR KNEE COMPLETE 4 VIEW MINIMUM | $350.00 | $700.00 | $104.13–$595.00 | 26% above | 50% |
| Knee X-ray, complete, 4 or more views CPT 73564 XR KNEE COMPLETE BIL 4 VIEW MIN | $700.00 | $1,400.00 | $104.13–$1,190.00 | 153% above | 50% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 XR KNEE COMPLETE 4 VIEW MINIMUM | $350.00 | $700.00 | $420.00–$595.00 | — | 50% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 XR KNEE COMPLETE BIL 4 VIEW MIN | $700.00 | $1,400.00 | $840.00–$1,190.00 | — | 50% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 6% above | 50% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LTD | $705.00 | $1,410.00 | $104.13–$1,198.50 | 58% above | 50% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LTD | $705.00 | $1,410.00 | $846.00–$1,198.50 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LTD JOINT/NONVASCULAR BIL EXTREMITY | $295.00 | $590.00 | $104.13–$725.00 | 3% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US JOINT LTD NONVASCULAR EXTREMITY | $295.00 | $590.00 | $104.13–$725.00 | 3% above | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US JOINT LTD NONVASCULAR EXTREMITY | $295.00 | $590.00 | $354.00–$501.50 | — | 50% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LTD JOINT/NONVASCULAR BIL EXTREMITY | $295.00 | $590.00 | $354.00–$501.50 | — | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCRN W/O DYE | $445.00 | $890.00 | $104.13–$1,760.00 | at median | 50% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCRN W/O DYE | $445.00 | $890.00 | $534.00–$756.50 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XR TIBIA AND FIBULA 2 VIEW | $307.50 | $615.00 | $86.68–$522.75 | 45% above | 50% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XR TIBIA AND FIBULA 1 VIEW | $307.50 | $615.00 | $86.68–$522.75 | 45% above | 50% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XR TIBIA/FIBULA BIL 1 VIEW | $615.00 | $1,230.00 | $86.68–$1,045.50 | 189% above | 50% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XR TIBIA AND FIBULA BIL 2 VIEW | $615.00 | $1,230.00 | $86.68–$1,045.50 | 189% above | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XR TIBIA AND FIBULA 1 VIEW | $307.50 | $615.00 | $369.00–$522.75 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XR TIBIA AND FIBULA 2 VIEW | $307.50 | $615.00 | $369.00–$522.75 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XR TIBIA AND FIBULA BIL 2 VIEW | $615.00 | $1,230.00 | $738.00–$1,045.50 | — | 50% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XR TIBIA/FIBULA BIL 1 VIEW | $615.00 | $1,230.00 | $738.00–$1,045.50 | — | 50% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 MR BREAST W/WO W/CAD CONTRAST BILAT | $3,375.00 | $6,750.00 | $325.09–$5,737.50 | — | 50% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MR BREAST W/WO W/CAD CONTRAST BILAT | $3,375.00 | $6,750.00 | $4,050.00–$5,737.50 | — | 50% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR LOWER EXTREM JOINT W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR LOWER EXTREM JOINT W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR LOWER EXTREM JOINT W/WO DYE | $3,415.00 | $6,830.00 | $347.49–$5,805.50 | at median | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR LOWER EXTREM JOINT W/WO DYE | $3,415.00 | $6,830.00 | $4,098.00–$5,805.50 | — | 50% |
| MRI of the abdomen without contrast CPT 74181 MR ABDOMEN W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the abdomen without contrast inpatient CPT 74181 MR ABDOMEN W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MR ABDOMEN W/WO DYE | $3,415.00 | $6,830.00 | $347.49–$5,805.50 | at median | 50% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR ABDOMEN W/WO DYE | $3,415.00 | $6,830.00 | $4,098.00–$5,805.50 | — | 50% |
| MRI of the brain, no contrast dye CPT 70551 MR BRAIN W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN W/WO DYE | $3,415.00 | $6,830.00 | $347.49–$5,805.50 | at median | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN W/WO DYE | $3,415.00 | $6,830.00 | $4,098.00–$5,805.50 | — | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MR L SPINE WO DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR L SPINE WO DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MR L SPINE W/WO DYE | $3,415.00 | $6,830.00 | $347.49–$5,805.50 | at median | 50% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR L SPINE W/WO DYE | $3,415.00 | $6,830.00 | $4,098.00–$5,805.50 | — | 50% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR T SPINE WO DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR T SPINE WO DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MR C SPINE W/WO DYE | $3,415.00 | $6,830.00 | $347.49–$5,805.50 | at median | 50% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR C SPINE W/WO DYE | $3,415.00 | $6,830.00 | $4,098.00–$5,805.50 | — | 50% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MR CERVICAL SPINE LTD WITHOUT DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MR C SPINE W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR C SPINE W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR CERVICAL SPINE LTD WITHOUT DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the pelvis without and with contrast CPT 72197 MR PELVIS W/WO DYE | $3,415.00 | $6,830.00 | $347.49–$5,805.50 | at median | 50% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS W/WO DYE | $3,415.00 | $6,830.00 | $4,098.00–$5,805.50 | — | 50% |
| MRI of the pelvis, no contrast dye CPT 72195 MR PELVIS W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MR PELVIS W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MR UPPER EXTREM JOINT W/O DYE | $2,210.00 | $4,420.00 | $237.66–$3,757.00 | at median | 50% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MR UPPER EXTREM JOINT W/O DYE | $2,210.00 | $4,420.00 | $2,652.00–$3,757.00 | — | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR CERVICAL SPINE 4-5 VIEWS | $525.00 | $1,050.00 | $104.13–$892.50 | 64% above | 50% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR CERVICAL SPINE 4-5 VIEWS | $525.00 | $1,050.00 | $630.00–$892.50 | — | 50% |
| Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/DYE | $1,640.00 | $3,280.00 | $174.71–$2,788.00 | at median | 50% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W/DYE | $1,640.00 | $3,280.00 | $1,968.00–$2,788.00 | — | 50% |
| Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 8% above | 50% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUES | $292.50 | $585.00 | $86.68–$497.25 | 39% above | 50% |
| Neck soft tissue X-ray inpatient CPT 70360 XR NECK SOFT TISSUES | $292.50 | $585.00 | $351.00–$497.25 | — | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYO PERF SPECT MULTIPLE | $4,010.00 | $8,020.00 | $1,289.52–$6,817.00 | 30% above | 50% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYO PERF SPECT MULTIPLE | $4,010.00 | $8,020.00 | $4,812.00–$6,817.00 | — | 50% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET CT SKULL/THIGH | $4,245.00 | $8,490.00 | $1,424.28–$7,216.50 | at median | 50% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET CT SKULL/THIGH | $4,245.00 | $8,490.00 | $5,094.00–$7,216.50 | — | 50% |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | 21% above | 50% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED | $530.00 | $1,060.00 | $104.13–$901.00 | 32% above | 50% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED | $530.00 | $1,060.00 | $636.00–$901.00 | — | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS COMPLETE | $815.00 | $1,630.00 | $104.13–$1,385.50 | 55% above | 50% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS COMPLETE | $815.00 | $1,630.00 | $978.00–$1,385.50 | — | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >/=14 WK SINGLE FETUS | $690.00 | $1,380.00 | $104.13–$1,173.00 | 20% above | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >/=14 WK SINGLE FETUS | $690.00 | $1,380.00 | $828.00–$1,173.00 | — | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 WK SINGLE FETUS | $560.00 | $1,120.00 | $104.13–$952.00 | 9% above | 50% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 WK SINGLE FETUS | $560.00 | $1,120.00 | $672.00–$952.00 | — | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED | $405.00 | $810.00 | $104.13–$725.00 | 10% above | 50% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED | $405.00 | $810.00 | $486.00–$688.50 | — | 50% |
| Rib X-ray, one side, 2 views CPT 71100 XR RIBS 2 VIEW | $387.50 | $775.00 | $86.68–$658.75 | 73% above | 50% |
| Rib X-ray, one side, 2 views inpatient CPT 71100 XR RIBS 2 VIEW | $387.50 | $775.00 | $465.00–$658.75 | — | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 XR RIBS W/CHEST 3 VIEW | $580.00 | $1,160.00 | $104.13–$986.00 | 109% above | 50% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 XR RIBS W/CHEST 3 VIEW | $580.00 | $1,160.00 | $696.00–$986.00 | — | 50% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMOGRAM SCREENING BILATERAL | $230.00 | $460.00 | $120.91–$391.00 | — | 50% |
| Screening mammogram, both breasts one side CPT 77067 MAMMOGRAM SCREENING UNILATERAL | $190.00 | $380.00 | $120.91–$371.00 | 29% below | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMOGRAM SCREENING BILATERAL | $230.00 | $460.00 | $276.00–$391.00 | — | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MAMMOGRAM SCREENING UNILATERAL | $190.00 | $380.00 | $228.00–$323.00 | — | 50% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 XR SHOULDER COMPLETE | $302.50 | $605.00 | $86.68–$514.25 | 29% above | 50% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 XR SHOULDER BIL MIN 2 VIEWS | $605.00 | $1,210.00 | $86.68–$1,028.50 | 158% above | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR SHOULDER COMPLETE | $302.50 | $605.00 | $363.00–$514.25 | — | 50% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR SHOULDER BIL MIN 2 VIEWS | $605.00 | $1,210.00 | $726.00–$1,028.50 | — | 50% |
| Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUSES COMPLETE | $445.00 | $890.00 | $86.68–$756.50 | 68% above | 50% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR SINUSES COMPLETE | $445.00 | $890.00 | $534.00–$756.50 | — | 50% |
| Skull X-ray, fewer than 4 views CPT 70250 XR SKULL < 4 VIEW | $292.50 | $585.00 | $104.13–$497.25 | 20% above | 50% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 XR SKULL < 4 VIEW | $292.50 | $585.00 | $351.00–$497.25 | — | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY 4/> PAREMETERS | $3,300.00 | $6,600.00 | $525.00–$5,610.00 | 3% below | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY 4/> PAREMETERS | $3,300.00 | $6,600.00 | $3,960.00–$5,610.00 | — | 50% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO-STRESS W/EKG W/O CONTRAST | $2,820.00 | $5,640.00 | $544.25–$4,794.00 | 38% above | 50% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO-STRESS W/EKG W/CONTRAST | $2,920.00 | $5,840.00 | $544.25–$4,964.00 | 42% above | 50% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO-STRESS W/EKG W/O CONTRAST | $2,820.00 | $5,640.00 | $3,384.00–$4,794.00 | — | 50% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO-STRESS W/EKG W/CONTRAST | $2,920.00 | $5,840.00 | $3,504.00–$4,964.00 | — | 50% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 XR SWALLOWING FUNCTION W/VIDEO | $457.50 | $915.00 | $174.71–$777.75 | at median | 50% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR SWALLOWING FUNCTION W/VIDEO | $457.50 | $915.00 | $549.00–$777.75 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 XR FEMUR 2 VIEW MINIMUM | $362.50 | $725.00 | $86.68–$616.25 | 47% above | 50% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 XR FEMUR BIL 2 VIEW MINIMUM | $725.00 | $1,450.00 | $86.68–$1,232.50 | 195% above | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 XR FEMUR 2 VIEW MINIMUM | $362.50 | $725.00 | $435.00–$616.25 | — | 50% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 XR FEMUR BIL 2 VIEW MINIMUM | $725.00 | $1,450.00 | $870.00–$1,232.50 | — | 50% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT T SPINE W/O DYE | $1,540.00 | $3,080.00 | $104.13–$2,618.00 | at median | 50% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT T SPINE W/O DYE | $1,540.00 | $3,080.00 | $1,848.00–$2,618.00 | — | 50% |
| Toe X-ray, 2 or more views CPT 73660 XR TOE(S) 2 VIEW MIN | $277.50 | $555.00 | $86.68–$476.00 | 38% above | 50% |
| Toe X-ray, 2 or more views inpatient CPT 73660 XR TOE(S) 2 VIEW MIN | $277.50 | $555.00 | $333.00–$471.75 | — | 50% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $510.00 | $1,020.00 | $104.13–$867.00 | 9% above | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $510.00 | $1,020.00 | $612.00–$867.00 | — | 50% |
| Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL | $472.50 | $945.00 | $104.13–$803.25 | 21% above | 50% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL | $472.50 | $945.00 | $567.00–$803.25 | — | 50% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $935.00 | $1,870.00 | $104.13–$1,589.50 | 38% above | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $935.00 | $1,870.00 | $1,122.00–$1,589.50 | — | 50% |
| Ultrasound of the scrotum and testicles CPT 76870 US TESTICLES | $620.00 | $1,240.00 | $104.13–$1,054.00 | 26% above | 50% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICLES | $620.00 | $1,240.00 | $744.00–$1,054.00 | — | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US, SOFT TISSUE HEAD/NECK | $685.00 | $1,370.00 | $104.13–$1,164.50 | 34% above | 50% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US, SOFT TISSUE HEAD/NECK | $685.00 | $1,370.00 | $822.00–$1,164.50 | — | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI W/O KUB | $685.00 | $1,370.00 | $174.71–$1,164.50 | at median | 50% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UPPER GI W/O KUB | $685.00 | $1,370.00 | $822.00–$1,164.50 | — | 50% |
| Upper arm X-ray (humerus), 2 views CPT 73060 XR HUMERUS | $307.50 | $615.00 | $86.68–$522.75 | 46% above | 50% |
| Upper arm X-ray (humerus), 2 views CPT 73060 XR HUMERUS BIL 2V | $615.00 | $1,230.00 | $86.68–$1,045.50 | 193% above | 50% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 XR HUMERUS | $307.50 | $615.00 | $369.00–$522.75 | — | 50% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 XR HUMERUS BIL 2V | $615.00 | $1,230.00 | $738.00–$1,045.50 | — | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US EXTRMITY VEINS LTD | $715.00 | $1,430.00 | $104.13–$1,215.50 | at median | 50% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US EXTRMITY VEINS LTD | $715.00 | $1,430.00 | $858.00–$1,215.50 | — | 50% |
| Wrist X-ray, 2 views CPT 73100 XR WRIST 1 VIEW | $257.50 | $515.00 | $86.68–$476.00 | 19% above | 50% |
| Wrist X-ray, 2 views CPT 73100 XR WRIST 2 VIEW | $257.50 | $515.00 | $86.68–$476.00 | 19% above | 50% |
| Wrist X-ray, 2 views CPT 73100 XR WRIST BIL 2 VIEW | $515.00 | $1,030.00 | $86.68–$875.50 | 139% above | 50% |
| Wrist X-ray, 2 views inpatient CPT 73100 XR WRIST 1 VIEW | $257.50 | $515.00 | $309.00–$437.75 | — | 50% |
| Wrist X-ray, 2 views inpatient CPT 73100 XR WRIST 2 VIEW | $257.50 | $515.00 | $309.00–$437.75 | — | 50% |
| Wrist X-ray, 2 views inpatient CPT 73100 XR WRIST BIL 2 VIEW | $515.00 | $1,030.00 | $618.00–$875.50 | — | 50% |
| Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR WRIST BILAT MIN 3 VIEWS | $595.00 | $1,190.00 | $86.68–$1,011.50 | — | 50% |
| Wrist X-ray, complete, 3 or more views CPT 73110 XR WRIST COMPLETE | $297.50 | $595.00 | $86.68–$505.75 | 17% above | 50% |
| Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR WRIST BILAT MIN 3 VIEWS | $595.00 | $1,190.00 | $714.00–$1,011.50 | — | 50% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XR WRIST COMPLETE | $297.50 | $595.00 | $357.00–$505.75 | — | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP & PELVIS UNILAT 2-3 VIEWS | $360.00 | $720.00 | $86.68–$612.00 | 24% above | 50% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP & PELVIS UNILAT 2-3 VIEWS | $360.00 | $720.00 | $432.00–$612.00 | — | 50% |
| X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW | $267.50 | $535.00 | $86.68–$476.00 | 27% above | 50% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW | $267.50 | $535.00 | $321.00–$454.75 | — | 50% |
| X-ray of the ankle, 2 views CPT 73600 XR ANKLE 1 VIEW | $277.50 | $555.00 | $86.68–$476.00 | 40% above | 50% |
| X-ray of the ankle, 2 views CPT 73600 XR ANKLE 2 VIEW | $277.50 | $555.00 | $86.68–$476.00 | 40% above | 50% |
| X-ray of the ankle, 2 views CPT 73600 XR ANKLE BIL 2 VIEW | $555.00 | $1,110.00 | $86.68–$943.50 | 179% above | 50% |
| X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE 1 VIEW | $277.50 | $555.00 | $333.00–$471.75 | — | 50% |
| X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE 2 VIEW | $277.50 | $555.00 | $333.00–$471.75 | — | 50% |
| X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE BIL 2 VIEW | $555.00 | $1,110.00 | $666.00–$943.50 | — | 50% |
| X-ray of the finger(s), 2 or more views CPT 73140 XR FINGER(S) 2 VIEW MINIMUM | $285.00 | $570.00 | $86.68–$484.50 | 17% above | 50% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 XR FINGER(S) 2 VIEW MINIMUM | $285.00 | $570.00 | $342.00–$484.50 | — | 50% |
| X-ray of the foot, 2 views CPT 73620 XR FOOT 1 VIEW LIMITED | $282.50 | $565.00 | $86.68–$480.25 | 49% above | 50% |
| X-ray of the foot, 2 views CPT 73620 XR FOOT 2 VIEW | $282.50 | $565.00 | $86.68–$480.25 | 49% above | 50% |
| X-ray of the foot, 2 views CPT 73620 XR FOOT BIL 2 VIEW | $565.00 | $1,130.00 | $86.68–$960.50 | 197% above | 50% |
| X-ray of the foot, 2 views CPT 73620 XR FOOT 1 VIEW BIL LIMITED | $565.00 | $1,130.00 | $86.68–$960.50 | 197% above | 50% |
| X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 1 VIEW LIMITED | $282.50 | $565.00 | $339.00–$480.25 | — | 50% |
| X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 2 VIEW | $282.50 | $565.00 | $339.00–$480.25 | — | 50% |
| X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 1 VIEW BIL LIMITED | $565.00 | $1,130.00 | $678.00–$960.50 | — | 50% |
| X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT BIL 2 VIEW | $565.00 | $1,130.00 | $678.00–$960.50 | — | 50% |
| X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT COMPLETE 3 VIEW MINIMUM | $340.00 | $680.00 | $86.68–$578.00 | 41% above | 50% |
| X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT COMPLETE BIL 3 VIEW MINIMUM | $680.00 | $1,360.00 | $86.68–$1,156.00 | 182% above | 50% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT COMPLETE 3 VIEW MINIMUM | $340.00 | $680.00 | $408.00–$578.00 | — | 50% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT COMPLETE BIL 3 VIEW MINIMUM | $680.00 | $1,360.00 | $816.00–$1,156.00 | — | 50% |
| X-ray of the hand, 3 or more views CPT 73130 XR HAND 3 VIEW MINIMUM | $297.50 | $595.00 | $86.68–$505.75 | 27% above | 50% |
| X-ray of the hand, 3 or more views CPT 73130 XR HAND BIL 3 VIEW MINIMUM | $595.00 | $1,190.00 | $86.68–$1,011.50 | 154% above | 50% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 XR HAND 3 VIEW MINIMUM | $297.50 | $595.00 | $357.00–$505.75 | — | 50% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 XR HAND BIL 3 VIEW MINIMUM | $595.00 | $1,190.00 | $714.00–$1,011.50 | — | 50% |
| X-ray of the knee, 1 or 2 views CPT 73560 XR KNEE 1 OR 2 VIEW | $235.00 | $470.00 | $86.68–$476.00 | 11% above | 50% |
| X-ray of the knee, 1 or 2 views CPT 73560 XR KNEE BIL 1 OR 2 VIEW | $470.00 | $940.00 | $86.68–$799.00 | 122% above | 50% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE 1 OR 2 VIEW | $235.00 | $470.00 | $282.00–$399.50 | — | 50% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE BIL 1 OR 2 VIEW | $470.00 | $940.00 | $564.00–$799.00 | — | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEW | $385.00 | $770.00 | $104.13–$654.50 | 32% above | 50% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEW | $385.00 | $770.00 | $462.00–$654.50 | — | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4 VIEW MIN | $540.00 | $1,080.00 | $104.13–$918.00 | 45% above | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4 VIEW MIN | $540.00 | $1,080.00 | $648.00–$918.00 | — | 50% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE 2 VIEW | $355.00 | $710.00 | $104.13–$603.50 | 49% above | 50% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE 2 VIEW | $355.00 | $710.00 | $426.00–$603.50 | — | 50% |
| X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES | $347.50 | $695.00 | $86.68–$590.75 | 43% above | 50% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES | $347.50 | $695.00 | $417.00–$590.75 | — | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR CERVICAL SPINE 2-3 VIEWS | $355.00 | $710.00 | $86.68–$603.50 | 48% above | 50% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL SPINE 2-3 VIEWS | $355.00 | $710.00 | $426.00–$603.50 | — | 50% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEW | $282.50 | $565.00 | $104.13–$480.25 | 27% above | 50% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1 OR 2 VIEW | $282.50 | $565.00 | $339.00–$480.25 | — | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM & COCCYX 2 VIEW MIN | $347.50 | $695.00 | $86.68–$590.75 | 61% above | 50% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM & COCCYX 2 VIEW MIN | $347.50 | $695.00 | $417.00–$590.75 | — | 50% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH | $220.00 | $440.00 | $34.33–$374.00 | at median | 50% |
| ACTH blood test inpatient CPT 82024 ACTH | $220.00 | $440.00 | $264.00–$374.00 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 POC SGPT | $35.00 | $70.00 | $4.71–$59.50 | at median | 50% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT | $65.00 | $130.00 | $4.71–$110.50 | 86% above | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 POC SGPT | $35.00 | $70.00 | $42.00–$59.50 | — | 50% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT | $60.00 | $120.00 | $4.60–$102.00 | 26% above | 50% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $332.50 | $665.00 | $42.34–$565.25 | 9% above | 50% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL | $332.50 | $665.00 | $399.00–$565.25 | — | 50% |
| Albumin blood test CPT 82040 ALBUMIN, SERUM | $37.50 | $75.00 | $4.40–$63.75 | at median | 50% |
| Albumin blood test inpatient CPT 82040 ALBUMIN, SERUM | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $147.50 | $295.00 | $36.22–$250.75 | 24% below | 50% |
| Aldosterone blood test CPT 82088 ALDOSTERONE URINE | $147.50 | $295.00 | $36.22–$250.75 | 24% below | 50% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE URINE | $147.50 | $295.00 | $177.00–$250.75 | — | 50% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $147.50 | $295.00 | $177.00–$250.75 | — | 50% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE | $55.00 | $110.00 | $4.60–$93.50 | 13% above | 50% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE | $55.00 | $110.00 | $66.00–$93.50 | — | 50% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE QUANT EA | $25.00 | $50.00 | $4.64–$42.50 | at median | 50% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE QUANT EA | $25.00 | $50.00 | $30.00–$42.50 | — | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, MATERNAL SCREEN | $55.00 | $110.00 | $14.91–$93.50 | 34% below | 50% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, TUMOR MARKER | $112.50 | $225.00 | $14.91–$191.25 | 35% above | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, MATERNAL SCREEN | $55.00 | $110.00 | $66.00–$93.50 | — | 50% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, TUMOR MARKER | $112.50 | $225.00 | $135.00–$191.25 | — | 50% |
| Ammonia blood test CPT 82140 SRDP AMMONIA URINE | $75.00 | $150.00 | $12.95–$127.50 | 16% below | 50% |
| Ammonia blood test CPT 82140 AMMONIA | $87.50 | $175.00 | $12.95–$148.75 | 3% below | 50% |
| Ammonia blood test inpatient CPT 82140 SRDP AMMONIA URINE | $75.00 | $150.00 | $90.00–$127.50 | — | 50% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Amylase blood test CPT 82150 AMYLASE | $70.00 | $140.00 | $5.76–$119.00 | 13% above | 50% |
| Amylase blood test CPT 82150 AMYLASE, URINE | $72.50 | $145.00 | $5.76–$123.25 | 17% above | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE | $70.00 | $140.00 | $84.00–$119.00 | — | 50% |
| Amylase blood test inpatient CPT 82150 AMYLASE, URINE | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINTED PEPTIDE AB | $82.50 | $165.00 | $11.51–$140.25 | at median | 50% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINTED PEPTIDE AB | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES (ANA) | $97.50 | $195.00 | $10.74–$165.75 | 42% above | 50% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES (ANA) | $97.50 | $195.00 | $117.00–$165.75 | — | 50% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE | $102.50 | $205.00 | $31.41–$174.25 | 28% below | 50% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE | $102.50 | $205.00 | $123.00–$174.25 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 H PYLORI CULTURE | $52.50 | $105.00 | $7.66–$89.25 | at median | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, AEROBIC | $82.50 | $165.00 | $7.66–$140.25 | 57% above | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 H PYLORI CULTURE | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, AEROBIC | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Basic metabolic panel (blood test) CPT 80048 POC BASIC METABOLIC PANEL | $12.50 | $25.00 | $7.52–$30.89 | 86% below | 50% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $120.00 | $240.00 | $7.52–$204.00 | 36% above | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 POC BASIC METABOLIC PANEL | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $120.00 | $240.00 | $144.00–$204.00 | — | 50% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $60.00 | $120.00 | $4.46–$102.00 | 28% above | 50% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATHOLOGY, LEVEL IV | $317.50 | $635.00 | $40.78–$539.75 | 47% above | 50% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATHOLOGY, LEVEL IV | $317.50 | $635.00 | $381.00–$539.75 | — | 50% |
| Blood culture for bacteria CPT 87040 CULTURE, BLOOD | $82.50 | $165.00 | $9.18–$140.25 | 4% below | 50% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE, BLOOD | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $12.50 | $25.00 | $2.40–$30.68 | 15% below | 50% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Blood glucose (sugar) test CPT 82947 POC GLUCOSE SERUM | $17.50 | $35.00 | $3.50–$29.75 | 28% below | 50% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE, BLOOD | $30.00 | $60.00 | $3.50–$51.00 | 23% above | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 POC GLUCOSE SERUM | $17.50 | $35.00 | $21.00–$29.75 | — | 50% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, BLOOD | $30.00 | $60.00 | $36.00–$51.00 | — | 50% |
| Blood lead test CPT 83655 POC BLOOD LEAD | $32.50 | $65.00 | $10.76–$55.25 | 41% below | 50% |
| Blood lead test CPT 83655 LEAD, URINE | $60.00 | $120.00 | $10.76–$102.00 | 9% above | 50% |
| Blood lead test CPT 83655 LEAD | $60.00 | $120.00 | $10.76–$102.00 | 9% above | 50% |
| Blood lead test inpatient CPT 83655 POC BLOOD LEAD | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Blood lead test inpatient CPT 83655 LEAD | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Blood lead test inpatient CPT 83655 LEAD, URINE | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 POC PREG TEST CLINITEK | $17.50 | $35.00 | $6.69–$29.75 | 72% below | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUALITATIVE | $107.50 | $215.00 | $6.69–$182.75 | 73% above | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 POC PREG TEST CLINITEK | $17.50 | $35.00 | $21.00–$29.75 | — | 50% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUALITATIVE | $107.50 | $215.00 | $129.00–$182.75 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPING | $42.50 | $85.00 | $2.66–$72.25 | at median | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPING, BC | $42.50 | $85.00 | $2.66–$72.25 | at median | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPING, BC | $42.50 | $85.00 | $51.00–$72.25 | — | 50% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO TYPING | $42.50 | $85.00 | $51.00–$72.25 | — | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 POC NITROGEN SERUM | $17.50 | $35.00 | $3.51–$29.75 | 32% below | 50% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN | $27.50 | $55.00 | $3.51–$46.75 | 7% above | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 POC NITROGEN SERUM | $17.50 | $35.00 | $21.00–$29.75 | — | 50% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN | $27.50 | $55.00 | $33.00–$46.75 | — | 50% |
| C-peptide blood test CPT 84681 C-PEPTIDE | $90.00 | $180.00 | $16.03–$153.00 | 4% above | 50% |
| C-peptide blood test inpatient CPT 84681 C-PEPTIDE | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $62.50 | $125.00 | $4.60–$106.25 | 14% above | 50% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN | $62.50 | $125.00 | $75.00–$106.25 | — | 50% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE TOXIN BY PCR | $117.50 | $235.00 | $31.19–$199.75 | 22% below | 50% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE TOXIN BY PCR | $117.50 | $235.00 | $141.00–$199.75 | — | 50% |
| CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN 19-9 | $112.50 | $225.00 | $18.50–$191.25 | at median | 50% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN 19-9 | $112.50 | $225.00 | $135.00–$191.25 | — | 50% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125 | $120.00 | $240.00 | $18.50–$204.00 | at median | 50% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125 | $120.00 | $240.00 | $144.00–$204.00 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 CDC | $10.00 | $20.00 | $10.00–$183.72 | 93% below | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 POC COVID-19 PCR | $50.00 | $100.00 | $41.05–$183.72 | 63% below | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 PCR | $90.00 | $180.00 | $41.05–$183.72 | 33% below | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 CDC | $10.00 | $20.00 | $12.00–$17.00 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 POC COVID-19 PCR | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 PCR | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Calcium blood test, total CPT 82310 CALCIUM SERUM | $52.50 | $105.00 | $4.58–$89.25 | at median | 50% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $147.50 | $295.00 | $16.86–$250.75 | 9% above | 50% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA | $147.50 | $295.00 | $177.00–$250.75 | — | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 AB, VARICELLA ZOSTER IGG | $87.50 | $175.00 | $11.45–$148.75 | 20% above | 50% |
| Chickenpox (varicella) immunity blood test CPT 86787 AB, VARICELLA ZOSTER IGM | $87.50 | $175.00 | $11.45–$148.75 | 20% above | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 AB, VARICELLA ZOSTER IGG | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 AB, VARICELLA ZOSTER IGM | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 MISC LAB | $115.00 | $230.00 | $31.19–$195.50 | 20% below | 50% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 MISC LAB | $115.00 | $230.00 | $138.00–$195.50 | — | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 POC LIPID PROFILE | $70.00 | $140.00 | $11.90–$119.00 | 21% below | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $130.00 | $260.00 | $11.90–$221.00 | 46% above | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 POC LIPID PROFILE | $70.00 | $140.00 | $84.00–$119.00 | — | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $130.00 | $260.00 | $156.00–$221.00 | — | 50% |
| Complete blood count (CBC) with differential CPT 85025 CBC W/AUTO DIFF | $72.50 | $145.00 | $6.90–$123.25 | at median | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTO DIFF | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Complete blood count (CBC), no differential CPT 85027 CBC WO DIFF | $52.50 | $105.00 | $5.74–$89.25 | at median | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WO DIFF | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $162.50 | $325.00 | $9.39–$276.25 | 43% above | 50% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $162.50 | $325.00 | $195.00–$276.25 | — | 50% |
| Cortisol blood test, total CPT 82533 CORTISOL, SALIVARY | $120.00 | $240.00 | $14.49–$204.00 | at median | 50% |
| Cortisol blood test, total CPT 82533 CORTISOL, TOTAL | $120.00 | $240.00 | $14.49–$204.00 | at median | 50% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL, TOTAL | $120.00 | $240.00 | $144.00–$204.00 | — | 50% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL, SALIVARY | $120.00 | $240.00 | $144.00–$204.00 | — | 50% |
| Creatine kinase (CK) blood test, total CPT 82550 CK TOTAL | $65.00 | $130.00 | $5.78–$110.50 | 2% above | 50% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK TOTAL | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| Creatinine blood test CPT 82565 POC CREATININE | $22.50 | $45.00 | $4.55–$38.25 | 29% below | 50% |
| Creatinine blood test CPT 82565 CREATININE BLOOD | $37.50 | $75.00 | $4.55–$63.75 | 18% above | 50% |
| Creatinine blood test inpatient CPT 82565 POC CREATININE | $22.50 | $45.00 | $27.00–$38.25 | — | 50% |
| Creatinine blood test inpatient CPT 82565 CREATININE BLOOD | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Cytomegalovirus (CMV) antibody test CPT 86644 AB, CMV NEGATIVE BLOOD PRODUCT | $57.50 | $115.00 | $12.79–$97.75 | 19% below | 50% |
| Cytomegalovirus (CMV) antibody test CPT 86644 AB, CYTOMEGALOVIRUS | $97.50 | $195.00 | $12.79–$165.75 | 38% above | 50% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 AB, CMV NEGATIVE BLOOD PRODUCT | $57.50 | $115.00 | $69.00–$97.75 | — | 50% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 AB, CYTOMEGALOVIRUS | $97.50 | $195.00 | $117.00–$165.75 | — | 50% |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANTITATIVE | $62.50 | $125.00 | $9.05–$106.25 | 21% below | 50% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANTITATIVE | $62.50 | $125.00 | $75.00–$106.25 | — | 50% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE | $142.50 | $285.00 | $19.77–$242.25 | at median | 50% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE | $142.50 | $285.00 | $171.00–$242.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHANOL SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 METHAQUALONE SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 PROPOXYPHENE SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 OXYCODONE SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 HEROIN METABOLITE SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 MARIJUANA METAB SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ECSTASY SCREEN | $37.50 | $75.00 | $45.00–$226.82 | 68% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN CLASS A SINGLE | $52.50 | $105.00 | $51.72–$226.82 | 55% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 LSD SCREEN | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 NICOTINE SCREEN UR | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 TRICYCLICS SCREEN | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 SYNTHETIC CANNABINOID SCR | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 TOXICOLOGY SCREEN URINE | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN MEDICAL PNL | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 COCAINE & CANNAB SCREEN | $72.50 | $145.00 | $51.72–$226.82 | 37% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PANEL MECON | $100.00 | $200.00 | $51.72–$226.82 | 14% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 PAIN MANAMENT DRUG SCREEN | $100.00 | $200.00 | $51.72–$226.82 | 14% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PANEL URINE | $100.00 | $200.00 | $51.72–$226.82 | 14% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PANEL BLOOD | $100.00 | $200.00 | $51.72–$226.82 | 14% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PAIN MGMT PANEL | $110.00 | $220.00 | $51.72–$226.82 | 5% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 GHB SCREEN | $112.50 | $225.00 | $51.72–$226.82 | 3% below | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN UMBILICAL CORD TISSUE | $145.00 | $290.00 | $51.72–$246.50 | 25% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL GLUCURONIDE | $155.00 | $310.00 | $51.72–$263.50 | 34% above | 50% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 SEDATIVE HYPNOTIC PANEL | $362.50 | $725.00 | $51.72–$616.25 | 213% above | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 METHAQUALONE SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 MARIJUANA METAB SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 OXYCODONE SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HEROIN METABOLITE SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ECSTASY SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHANOL SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PROPOXYPHENE SCREEN | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN CLASS A SINGLE | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 TRICYCLICS SCREEN | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN MEDICAL PNL | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COCAINE & CANNAB SCREEN | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 LSD SCREEN | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 TOXICOLOGY SCREEN URINE | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 SYNTHETIC CANNABINOID SCR | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 NICOTINE SCREEN UR | $72.50 | $145.00 | $87.00–$123.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PAIN MANAMENT DRUG SCREEN | $100.00 | $200.00 | $120.00–$170.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PANEL URINE | $100.00 | $200.00 | $120.00–$170.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PANEL MECON | $100.00 | $200.00 | $120.00–$170.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PANEL BLOOD | $100.00 | $200.00 | $120.00–$170.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PAIN MGMT PANEL | $110.00 | $220.00 | $132.00–$187.00 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 GHB SCREEN | $112.50 | $225.00 | $135.00–$191.25 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN UMBILICAL CORD TISSUE | $145.00 | $290.00 | $174.00–$246.50 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL GLUCURONIDE | $155.00 | $310.00 | $186.00–$263.50 | — | 50% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 SEDATIVE HYPNOTIC PANEL | $362.50 | $725.00 | $435.00–$616.25 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 POC ELECTROLYTE PANEL | $32.50 | $65.00 | $6.23–$55.25 | 33% below | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $60.00 | $120.00 | $6.23–$102.00 | 23% above | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 POC ELECTROLYTE PANEL | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 AB, EBV VIRAL CAPSID IGG | $82.50 | $165.00 | $16.13–$140.25 | at median | 50% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 AB, EBV VIRAL CAPSID IGM | $82.50 | $165.00 | $16.13–$140.25 | at median | 50% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 AB, EBV VIRAL CAPSID IGG | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 AB, EBV VIRAL CAPSID IGM | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Estradiol blood test CPT 82670 POC ESTRADIOL LEVEL | $67.50 | $135.00 | $24.83–$114.75 | 47% below | 50% |
| Estradiol blood test CPT 82670 ESTRADIOL | $125.00 | $250.00 | $24.83–$212.50 | 3% below | 50% |
| Estradiol blood test inpatient CPT 82670 POC ESTRADIOL LEVEL | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Estradiol blood test inpatient CPT 82670 ESTRADIOL | $125.00 | $250.00 | $150.00–$212.50 | — | 50% |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $142.50 | $285.00 | $16.52–$242.25 | 23% above | 50% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH | $142.50 | $285.00 | $171.00–$242.25 | — | 50% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL | $217.50 | $435.00 | $17.45–$369.75 | 16% above | 50% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL | $217.50 | $435.00 | $261.00–$369.75 | — | 50% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $92.50 | $185.00 | $12.12–$157.25 | 2% above | 50% |
| Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN | $92.50 | $185.00 | $111.00–$157.25 | — | 50% |
| Fibrinogen blood test CPT 85384 FIBRINOGEN | $67.50 | $135.00 | $7.78–$114.75 | at median | 50% |
| Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID, SERUM | $142.50 | $285.00 | $13.07–$242.25 | 44% above | 50% |
| Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID, SERUM | $142.50 | $285.00 | $171.00–$242.25 | — | 50% |
| Free T3 thyroid hormone test CPT 84481 T3, FREE | $97.50 | $195.00 | $15.06–$165.75 | at median | 50% |
| Free T3 thyroid hormone test inpatient CPT 84481 T3, FREE | $97.50 | $195.00 | $117.00–$165.75 | — | 50% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4, FREE | $92.50 | $185.00 | $8.02–$157.25 | 15% above | 50% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4, FREE | $92.50 | $185.00 | $111.00–$157.25 | — | 50% |
| Free testosterone test CPT 84402 TESTOSTERONE, FREE | $117.50 | $235.00 | $22.64–$199.75 | at median | 50% |
| Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE | $117.50 | $235.00 | $141.00–$199.75 | — | 50% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT | $77.50 | $155.00 | $6.40–$131.75 | 45% above | 50% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT | $77.50 | $155.00 | $93.00–$131.75 | — | 50% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $287.50 | $575.00 | $37.77–$488.75 | 4% above | 50% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL | $287.50 | $575.00 | $345.00–$488.75 | — | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE, POST GLUCOSE DOSE | $57.50 | $115.00 | $4.22–$97.75 | 16% above | 50% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE, POST GLUCOSE DOSE | $57.50 | $115.00 | $69.00–$97.75 | — | 50% |
| Glucose tolerance test, 3 samples CPT 82951 GTT, 3 SPECIMENS | $110.00 | $220.00 | $11.44–$187.00 | 23% above | 50% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 GTT, 3 SPECIMENS | $110.00 | $220.00 | $132.00–$187.00 | — | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 MISC LAB | $107.50 | $215.00 | $31.19–$182.75 | 25% below | 50% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 MISC LAB | $107.50 | $215.00 | $129.00–$182.75 | — | 50% |
| H. pylori antibody blood test CPT 86677 AB, HELICOBACTER PYLORI IGG | $112.50 | $225.00 | $13.48–$191.25 | 21% above | 50% |
| H. pylori antibody blood test CPT 86677 AB, HELICOBACTER PYLORI IGM | $112.50 | $225.00 | $13.48–$191.25 | 21% above | 50% |
| H. pylori antibody blood test inpatient CPT 86677 AB, HELICOBACTER PYLORI IGM | $112.50 | $225.00 | $135.00–$191.25 | — | 50% |
| H. pylori antibody blood test inpatient CPT 86677 AB, HELICOBACTER PYLORI IGG | $112.50 | $225.00 | $135.00–$191.25 | — | 50% |
| H. pylori stool antigen test CPT 87338 H PYLORI STOOL | $130.00 | $260.00 | $12.78–$221.00 | 1% above | 50% |
| H. pylori stool antigen test inpatient CPT 87338 H PYLORI STOOL | $130.00 | $260.00 | $156.00–$221.00 | — | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANTITATIVE | $387.50 | $775.00 | $75.64–$658.75 | at median | 50% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANTITATIVE | $387.50 | $775.00 | $465.00–$658.75 | — | 50% |
| HIV-1 and HIV-2 antibody test CPT 86703 AB, HIV-1/HIV-2 | $77.50 | $155.00 | $12.18–$131.75 | at median | 50% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 AB, HIV-1/HIV-2 | $77.50 | $155.00 | $93.00–$131.75 | — | 50% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 MISC LAB | $102.50 | $205.00 | $21.40–$174.25 | at median | 50% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 MISC LAB | $102.50 | $205.00 | $123.00–$174.25 | — | 50% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK W/O PAP | $142.50 | $285.00 | $31.19–$242.25 | at median | 50% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK W/O PAP | $142.50 | $285.00 | $171.00–$242.25 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 POC HEMOGLOBIN A1C | $20.00 | $40.00 | $8.63–$35.44 | 71% below | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C | $85.00 | $170.00 | $8.63–$144.50 | 23% above | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 POC HEMOGLOBIN A1C | $20.00 | $40.00 | $24.00–$34.00 | — | 50% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C | $85.00 | $170.00 | $102.00–$144.50 | — | 50% |
| Hemoglobin blood test CPT 85018 POC HEMOGLOBIN | $12.50 | $25.00 | $2.10–$21.25 | 29% below | 50% |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $17.50 | $35.00 | $2.10–$29.75 | at median | 50% |
| Hemoglobin blood test inpatient CPT 85018 POC HEMOGLOBIN | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN | $17.50 | $35.00 | $21.00–$29.75 | — | 50% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE AB TOTAL | $80.00 | $160.00 | $10.71–$136.00 | at median | 50% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE AB TOTAL | $80.00 | $160.00 | $96.00–$136.00 | — | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB | $80.00 | $160.00 | $9.54–$136.00 | 8% above | 50% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB | $80.00 | $160.00 | $96.00–$136.00 | — | 50% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG | $87.50 | $175.00 | $9.18–$148.75 | 35% above | 50% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Hepatitis C antibody blood test (screening) CPT 86803 POC HEPATITIS C ANTIBODY SCREENING | $62.50 | $125.00 | $12.68–$106.25 | 22% below | 50% |
| Hepatitis C antibody blood test (screening) CPT 86803 MISC LAB | $115.00 | $230.00 | $12.68–$195.50 | 43% above | 50% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 POC HEPATITIS C ANTIBODY SCREENING | $62.50 | $125.00 | $75.00–$106.25 | — | 50% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 MISC LAB | $115.00 | $230.00 | $138.00–$195.50 | — | 50% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C VIRUS QUANT | $200.00 | $400.00 | $38.08–$340.00 | 16% below | 50% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRUS QUANT | $200.00 | $400.00 | $240.00–$340.00 | — | 50% |
| Herpes blood test, HSV-1 antibody CPT 86695 AB, HERPES SIMPLEX TYPE 1 IGG | $67.50 | $135.00 | $11.72–$114.75 | 1% below | 50% |
| Herpes blood test, HSV-1 antibody CPT 86695 AB, HERPES SIMPLEX TYPE 1 | $67.50 | $135.00 | $11.72–$114.75 | 1% below | 50% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 AB, HERPES SIMPLEX TYPE 1 IGG | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 AB, HERPES SIMPLEX TYPE 1 | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 AB, HERPES SIMPLEX TYPE 2 IGG | $67.50 | $135.00 | $17.21–$114.75 | 17% below | 50% |
| Herpes blood test, HSV-2 antibody CPT 86696 AB, HERPES SIMPLEX TYPE 2 | $67.50 | $135.00 | $17.21–$114.75 | 17% below | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 AB, HERPES SIMPLEX TYPE 2 IGG | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 AB, HERPES SIMPLEX TYPE 2 | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CRP, HIGH SENSITIVITY | $80.00 | $160.00 | $11.51–$136.00 | at median | 50% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP, HIGH SENSITIVITY | $80.00 | $160.00 | $96.00–$136.00 | — | 50% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE | $165.00 | $330.00 | $14.99–$280.50 | 39% above | 50% |
| Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE | $165.00 | $330.00 | $198.00–$280.50 | — | 50% |
| Insulin blood test CPT 83525 INSULIN, TOTAL | $67.50 | $135.00 | $10.16–$114.75 | at median | 50% |
| Insulin blood test inpatient CPT 83525 INSULIN, TOTAL | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Iron blood test (serum iron) CPT 83540 IRON | $70.00 | $140.00 | $5.75–$119.00 | 31% above | 50% |
| Iron blood test (serum iron) CPT 83540 IRON QUANTITATIVE TISSUE | $85.00 | $170.00 | $5.75–$144.50 | 59% above | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON | $70.00 | $140.00 | $84.00–$119.00 | — | 50% |
| Iron blood test (serum iron) inpatient CPT 83540 IRON QUANTITATIVE TISSUE | $85.00 | $170.00 | $102.00–$144.50 | — | 50% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $75.00 | $150.00 | $7.77–$127.50 | 21% above | 50% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $75.00 | $150.00 | $90.00–$127.50 | — | 50% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $147.50 | $295.00 | $7.72–$250.75 | 44% above | 50% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $147.50 | $295.00 | $177.00–$250.75 | — | 50% |
| LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE | $97.50 | $195.00 | $16.46–$165.75 | at median | 50% |
| LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE | $97.50 | $195.00 | $117.00–$165.75 | — | 50% |
| Lactate (lactic acid) blood test CPT 83605 POC LACTIC ACID | $35.00 | $70.00 | $9.50–$59.50 | 50% below | 50% |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $67.50 | $135.00 | $9.50–$114.75 | 3% below | 50% |
| Lactate (lactic acid) blood test inpatient CPT 83605 POC LACTIC ACID | $35.00 | $70.00 | $42.00–$59.50 | — | 50% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH | $50.00 | $100.00 | $5.37–$85.00 | at median | 50% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $107.50 | $215.00 | $6.12–$182.75 | 59% above | 50% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE | $107.50 | $215.00 | $129.00–$182.75 | — | 50% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $145.00 | $290.00 | $7.26–$246.50 | 42% above | 50% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $145.00 | $290.00 | $174.00–$246.50 | — | 50% |
| Lyme disease antibody test CPT 86618 AB, LYME DISEASE CSF | $60.00 | $120.00 | $15.14–$102.00 | 28% below | 50% |
| Lyme disease antibody test CPT 86618 AB, LYME DISEASE | $92.50 | $185.00 | $15.14–$157.25 | 11% above | 50% |
| Lyme disease antibody test inpatient CPT 86618 AB, LYME DISEASE CSF | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Lyme disease antibody test inpatient CPT 86618 AB, LYME DISEASE | $92.50 | $185.00 | $111.00–$157.25 | — | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM SRDP | $52.50 | $105.00 | $5.95–$89.25 | at median | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM URINE | $52.50 | $105.00 | $5.95–$89.25 | at median | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM SERUM | $67.50 | $135.00 | $5.95–$114.75 | 29% above | 50% |
| Magnesium blood test CPT 83735 MAGNESIUM, RBC'S | $77.50 | $155.00 | $5.95–$131.75 | 48% above | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM SRDP | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM SERUM | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Magnesium blood test inpatient CPT 83735 MAGNESIUM, RBC'S | $77.50 | $155.00 | $93.00–$131.75 | — | 50% |
| Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA IGG | $82.50 | $165.00 | $11.45–$140.25 | at median | 50% |
| Measles (rubeola) antibody test CPT 86765 AB, RUBEOLA IGM | $82.50 | $165.00 | $11.45–$140.25 | at median | 50% |
| Measles (rubeola) antibody test inpatient CPT 86765 AB, RUBEOLA IGM | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Measles (rubeola) antibody test inpatient CPT 86765 AB, RUBEOLA IGG | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Mono test (heterophile antibody, Monospot) CPT 86308 POC MONOTEST | $40.00 | $80.00 | $4.60–$68.00 | 28% below | 50% |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST | $65.00 | $130.00 | $4.60–$110.50 | 18% above | 50% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 POC MONOTEST | $40.00 | $80.00 | $48.00–$68.00 | — | 50% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| Mumps immunity blood test CPT 86735 AB, MUMPS IGM | $87.50 | $175.00 | $11.60–$148.75 | 2% above | 50% |
| Mumps immunity blood test CPT 86735 AB, MUMPS IGG | $87.50 | $175.00 | $11.60–$148.75 | 2% above | 50% |
| Mumps immunity blood test inpatient CPT 86735 AB, MUMPS IGG | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Mumps immunity blood test inpatient CPT 86735 AB, MUMPS IGM | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $135.00 | $270.00 | $42.50–$229.50 | 44% below | 50% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $135.00 | $270.00 | $162.00–$229.50 | — | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE | $92.50 | $185.00 | $16.35–$157.25 | at median | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE | $92.50 | $185.00 | $111.00–$157.25 | — | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL | $92.50 | $185.00 | $16.35–$157.25 | 3% below | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL | $92.50 | $185.00 | $111.00–$157.25 | — | 50% |
| Pap test (liquid-based, automated screening with review) CPT 88175 PAP THIN PREP AUTO SCREEN | $97.50 | $195.00 | $23.55–$165.75 | 7% below | 50% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 PAP THIN PREP AUTO SCREEN | $97.50 | $195.00 | $117.00–$165.75 | — | 50% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP, THIN PREP | $90.00 | $180.00 | $18.01–$153.00 | at median | 50% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP, THIN PREP | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE | $122.50 | $245.00 | $36.69–$208.25 | 42% below | 50% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE | $122.50 | $245.00 | $147.00–$208.25 | — | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME | $52.50 | $105.00 | $5.34–$89.25 | at median | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME | $52.50 | $105.00 | $63.00–$89.25 | — | 50% |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS | $50.00 | $100.00 | $4.22–$85.00 | 20% above | 50% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| Potassium blood test CPT 84132 POC POTASSIUM SERUM | $20.00 | $40.00 | $4.09–$34.00 | 27% below | 50% |
| Potassium blood test CPT 84132 POTASSIUM SERUM | $37.50 | $75.00 | $4.09–$63.75 | 37% above | 50% |
| Potassium blood test inpatient CPT 84132 POC POTASSIUM SERUM | $20.00 | $40.00 | $24.00–$34.00 | — | 50% |
| Potassium blood test inpatient CPT 84132 POTASSIUM SERUM | $37.50 | $75.00 | $45.00–$63.75 | — | 50% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ | $477.50 | $955.00 | $573.00–$2,770.51 | 60% below | 50% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ | $477.50 | $955.00 | $573.00–$811.75 | — | 50% |
| Progesterone blood test CPT 84144 PROGESTERONE | $122.50 | $245.00 | $18.54–$208.25 | 1% above | 50% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $122.50 | $245.00 | $147.00–$208.25 | — | 50% |
| Prolactin blood test CPT 84146 PROLACTIN | $155.00 | $310.00 | $17.22–$263.50 | 28% above | 50% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $155.00 | $310.00 | $186.00–$263.50 | — | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 POC PROTHROMBIN TIME | $20.00 | $40.00 | $3.50–$34.00 | 41% below | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $35.00 | $70.00 | $3.50–$59.50 | 4% above | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 POC PROTHROMBIN TIME | $20.00 | $40.00 | $24.00–$34.00 | — | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $35.00 | $70.00 | $42.00–$59.50 | — | 50% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 POC DRUG SCREEN-URINE | $20.00 | $40.00 | $10.08–$45.99 | 65% below | 50% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 POC DRUG SCREEN-URINE | $20.00 | $40.00 | $24.00–$34.00 | — | 50% |
| Rapid flu test (influenza antigen) CPT 87804 POC INFLUENZA ANTIGEN RAPID | $35.00 | $70.00 | $13.24–$60.41 | 34% below | 50% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A ANTIGEN, RAPID | $87.50 | $175.00 | $13.24–$148.75 | 66% above | 50% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B ANTIGEN, RAPID | $87.50 | $175.00 | $13.24–$148.75 | 66% above | 50% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 POC INFLUENZA ANTIGEN RAPID | $35.00 | $70.00 | $42.00–$59.50 | — | 50% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA B ANTIGEN, RAPID | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A ANTIGEN, RAPID | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 POC STREP SCREEN | $32.50 | $65.00 | $13.22–$60.33 | 29% below | 50% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 POC STREP SCREEN | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Renin blood test CPT 84244 RENIN | $147.50 | $295.00 | $19.55–$250.75 | at median | 50% |
| Renin blood test inpatient CPT 84244 RENIN | $147.50 | $295.00 | $177.00–$250.75 | — | 50% |
| Rh blood typing CPT 86901 RH TYPING, BC | $42.50 | $85.00 | $2.66–$72.25 | 7% above | 50% |
| Rh blood typing CPT 86901 RH TYPING | $42.50 | $85.00 | $2.66–$72.25 | 7% above | 50% |
| Rh blood typing inpatient CPT 86901 RH TYPING, BC | $42.50 | $85.00 | $51.00–$72.25 | — | 50% |
| Rh blood typing inpatient CPT 86901 RH TYPING | $42.50 | $85.00 | $51.00–$72.25 | — | 50% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $60.00 | $120.00 | $5.04–$102.00 | 3% above | 50% |
| Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Rubella antibody test (immunity check) CPT 86762 AB, RUBELLA IGM | $82.50 | $165.00 | $12.79–$140.25 | at median | 50% |
| Rubella antibody test (immunity check) CPT 86762 AB, RUBELLA IGG | $82.50 | $165.00 | $12.79–$140.25 | at median | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 AB, RUBELLA IGG | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Rubella antibody test (immunity check) inpatient CPT 86762 AB, RUBELLA IGM | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE AUTOMATED | $50.00 | $100.00 | $2.40–$85.00 | 20% above | 50% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE AUTOMATED | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 POC SEMEN ANLYS VOL/COUNT/MOT MORPHOLOGY | $57.50 | $115.00 | $10.71–$97.75 | 57% below | 50% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS | $107.50 | $215.00 | $10.71–$182.75 | 21% below | 50% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 POC SEMEN ANLYS VOL/COUNT/MOT MORPHOLOGY | $57.50 | $115.00 | $69.00–$97.75 | — | 50% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS | $107.50 | $215.00 | $129.00–$182.75 | — | 50% |
| Sodium blood test CPT 84295 POC SODIUM SERUM | $12.50 | $25.00 | $4.28–$21.25 | 50% below | 50% |
| Sodium blood test CPT 84295 SODIUM SERUM | $22.50 | $45.00 | $4.28–$38.25 | 9% below | 50% |
| Sodium blood test inpatient CPT 84295 POC SODIUM SERUM | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Sodium blood test inpatient CPT 84295 SODIUM SERUM | $22.50 | $45.00 | $27.00–$38.25 | — | 50% |
| Stool ova and parasites exam CPT 87177 OVA & PARASITES | $65.00 | $130.00 | $7.91–$110.50 | at median | 50% |
| Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 POC OCCULT BLOOD FECAL SCREENING | $10.00 | $20.00 | $3.50–$17.00 | 53% below | 50% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECAL SCREENING | $20.00 | $40.00 | $3.50–$34.00 | 5% below | 50% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 POC OCCULT BLOOD FECAL SCREENING | $10.00 | $20.00 | $12.00–$17.00 | — | 50% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD FECAL SCREENING | $20.00 | $40.00 | $24.00–$34.00 | — | 50% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD FECAL IMMUNOASSAY | $50.00 | $100.00 | $14.14–$85.00 | 17% below | 50% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD FECAL IMMUNOASSAY | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 AB, TREPONEMA PALLIDUM | $55.00 | $110.00 | $11.77–$93.50 | at median | 50% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 AB, TREPONEMA PALLIDUM | $55.00 | $110.00 | $66.00–$93.50 | — | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 MISC LAB | $40.00 | $80.00 | $3.80–$68.00 | 1% above | 50% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 MISC LAB | $40.00 | $80.00 | $48.00–$68.00 | — | 50% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB, INTERFERON AG RESPONSE | $180.00 | $360.00 | $55.10–$306.00 | 29% below | 50% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB, INTERFERON AG RESPONSE | $180.00 | $360.00 | $216.00–$306.00 | — | 50% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL | $115.00 | $230.00 | $22.94–$195.50 | at median | 50% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL | $115.00 | $230.00 | $138.00–$195.50 | — | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB | $70.00 | $140.00 | $12.94–$119.00 | at median | 50% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER-KIDNEY MICROSOME AB | $85.00 | $170.00 | $12.94–$144.50 | 21% above | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB | $70.00 | $140.00 | $84.00–$119.00 | — | 50% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER-KIDNEY MICROSOME AB | $85.00 | $170.00 | $102.00–$144.50 | — | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 NEWBORN TSH | $12.50 | $25.00 | $14.94–$61.33 | 86% below | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $107.50 | $215.00 | $14.94–$182.75 | 20% above | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 NEWBORN TSH | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $107.50 | $215.00 | $129.00–$182.75 | — | 50% |
| Total IgE blood test CPT 82785 IMMUNOGLOBULIN IGE | $110.00 | $220.00 | $14.63–$187.00 | 8% above | 50% |
| Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN IGE | $110.00 | $220.00 | $132.00–$187.00 | — | 50% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL | $55.00 | $110.00 | $3.87–$93.50 | 19% above | 50% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL | $55.00 | $110.00 | $66.00–$93.50 | — | 50% |
| Total thyroxine (T4) blood test CPT 84436 T4, TOTAL | $75.00 | $150.00 | $6.10–$127.50 | 44% above | 50% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4, TOTAL | $75.00 | $150.00 | $90.00–$127.50 | — | 50% |
| Total triiodothyronine (T3) blood test CPT 84480 T3, TOTAL | $107.50 | $215.00 | $12.60–$182.75 | at median | 50% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3, TOTAL | $107.50 | $215.00 | $129.00–$182.75 | — | 50% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $95.00 | $190.00 | $11.34–$161.50 | at median | 50% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $95.00 | $190.00 | $114.00–$161.50 | — | 50% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS, RNA | $120.00 | $240.00 | $31.19–$204.00 | 12% below | 50% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS, RNA | $120.00 | $240.00 | $144.00–$204.00 | — | 50% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $67.50 | $135.00 | $5.10–$114.75 | 25% above | 50% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES | $67.50 | $135.00 | $81.00–$114.75 | — | 50% |
| Troponin test, quantitative CPT 84484 POC TROPONIN | $50.00 | $100.00 | $9.98–$85.00 | 41% below | 50% |
| Troponin test, quantitative CPT 84484 TROPONIN, QUANTITATIVE | $90.00 | $180.00 | $9.98–$153.00 | 7% above | 50% |
| Troponin test, quantitative inpatient CPT 84484 POC TROPONIN | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| Troponin test, quantitative inpatient CPT 84484 TROPONIN, QUANTITATIVE | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Uric acid blood test CPT 84550 URIC ACID SERUM | $60.00 | $120.00 | $4.02–$102.00 | 19% above | 50% |
| Uric acid blood test inpatient CPT 84550 URIC ACID SERUM | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Urinalysis with microscope exam, automated CPT 81001 POC URINE DIP W/ MICRO | $32.50 | $65.00 | $2.82–$55.25 | 10% below | 50% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO WITH MICRO | $60.00 | $120.00 | $2.82–$102.00 | 66% above | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 POC URINE DIP W/ MICRO | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO WITH MICRO | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Urinalysis with microscope exam, manual CPT 81000 POC URINALYSIS SCREEN | $12.50 | $25.00 | $3.22–$21.25 | at median | 50% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 POC URINALYSIS SCREEN | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Urinalysis without microscope exam, automated CPT 81003 POC URINALYSIS AUTO W/O MICRO | $15.00 | $30.00 | $1.99–$25.50 | 40% below | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O MICRO | $27.50 | $55.00 | $1.99–$46.75 | 10% above | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC URINALYSIS AUTO W/O MICRO | $15.00 | $30.00 | $18.00–$25.50 | — | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICRO | $27.50 | $55.00 | $33.00–$46.75 | — | 50% |
| Urinalysis without microscope exam, manual CPT 81002 POC URINE DIPSTICK W/O MICRO | $12.50 | $25.00 | $2.78–$21.25 | 9% below | 50% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS SCREEN MANUAL | $15.00 | $30.00 | $2.78–$25.50 | 9% above | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC URINE DIPSTICK W/O MICRO | $12.50 | $25.00 | $15.00–$21.25 | — | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS SCREEN MANUAL | $15.00 | $30.00 | $18.00–$25.50 | — | 50% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE, URINE QUANTITATIVE | $82.50 | $165.00 | $7.18–$140.25 | 9% above | 50% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, URINE QUANTITATIVE | $82.50 | $165.00 | $99.00–$140.25 | — | 50% |
| Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE TIMED | $65.00 | $130.00 | $5.14–$110.50 | at median | 50% |
| Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE | $65.00 | $130.00 | $5.14–$110.50 | at median | 50% |
| Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE 24 HR | $65.00 | $130.00 | $5.14–$110.50 | at median | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE TIMED | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE 24 HR | $65.00 | $130.00 | $78.00–$110.50 | — | 50% |
| Urine pregnancy test, read by color change CPT 81025 MISC LAB | $45.00 | $90.00 | $6.89–$76.50 | 9% below | 50% |
| Urine pregnancy test, read by color change inpatient CPT 81025 MISC LAB | $45.00 | $90.00 | $54.00–$76.50 | — | 50% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $102.50 | $205.00 | $13.40–$174.25 | at median | 50% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 | $102.50 | $205.00 | $123.00–$174.25 | — | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-OH | $155.00 | $310.00 | $26.31–$263.50 | at median | 50% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-OH | $155.00 | $310.00 | $186.00–$263.50 | — | 50% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D, 1, 25-DIHYDROXY | $160.00 | $320.00 | $34.22–$272.00 | at median | 50% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D, 1, 25-DIHYDROXY | $160.00 | $320.00 | $192.00–$272.00 | — | 50% |
| Zinc blood test CPT 84630 ZINC | $80.00 | $160.00 | $10.12–$136.00 | at median | 50% |
| Zinc blood test inpatient CPT 84630 ZINC | $80.00 | $160.00 | $96.00–$136.00 | — | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 MISC LAB | $165.00 | $330.00 | $13.38–$280.50 | 40% above | 50% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 MISC LAB | $165.00 | $330.00 | $198.00–$280.50 | — | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine both sides CPT 64615 DENERVATION MUSCLES BILAT MIGRAINE | $535.00 | $1,070.00 | $305.73–$19,665.00 | — | 50% |
| Botox injections for chronic migraine inpatient both sides CPT 64615 DENERVATION MUSCLES BILAT MIGRAINE | $535.00 | $1,070.00 | $642.00–$909.50 | — | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BREAST BX STEREO GUIDANCE 1ST | $3,730.00 | $7,460.00 | $1,645.05–$9,936.00 | 47% above | 50% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BREAST BX STEREO GUIDANCE 1ST | $3,730.00 | $7,460.00 | $4,476.00–$6,341.00 | — | 50% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $1,095.00 | $2,190.00 | $658.32–$3,033.00 | 11% above | 50% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION | $1,095.00 | $2,190.00 | $1,314.00–$1,861.50 | — | 50% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION | $125.00 | $250.00 | $99.50–$9,124.00 | 39% below | 50% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION | $125.00 | $250.00 | $150.00–$212.50 | — | 50% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 TYMPANOSTOMY & TUBE INSERT | $950.00 | $1,900.00 | $537.19–$6,461.00 | 82% above | 50% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 TYMPANOSTOMY & TUBE INSERT | $950.00 | $1,900.00 | $1,140.00–$1,615.00 | — | 50% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVE EAR WAX W/IRRIGATION UNILAT | $30.00 | $60.00 | $24.00–$1,680.00 | 68% below | 50% |
| Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVE EAR WAX W/IRRIGATION UNILAT | $30.00 | $60.00 | $36.00–$51.00 | — | 50% |
| Earwax removal with instruments, one ear one side CPT 69210 REMOVE EAR WAX W/INSTRUMENT UNILAT | $50.00 | $100.00 | $40.00–$1,680.00 | 40% below | 50% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 REMOVE EAR WAX W/INSTRUMENT UNILAT | $50.00 | $100.00 | $60.00–$85.00 | — | 50% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY, ENDOMETRIAL | $270.00 | $540.00 | $201.37–$19,665.00 | 1% below | 50% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY, ENDOMETRIAL | $270.00 | $540.00 | $324.00–$459.00 | — | 50% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HYSTEROSALPINGOGRAM INJECT | $695.00 | $1,390.00 | $225.03–$19,665.00 | 107% above | 50% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HYSTEROSALPINGOGRAM INJECT | $695.00 | $1,390.00 | $834.00–$1,181.50 | — | 50% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF INTRAUTERINE DEVICE | $595.00 | $1,190.00 | $100.10–$19,665.00 | 96% above | 50% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION OF INTRAUTERINE DEVICE | $595.00 | $1,190.00 | $714.00–$1,011.50 | — | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION(S) TENDON SHEATH | $605.00 | $1,210.00 | $305.73–$3,623.00 | 77% above | 50% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION(S) TENDON SHEATH | $605.00 | $1,210.00 | $726.00–$1,028.50 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJECT/ASPIRATE MAJOR JOINT* | $267.50 | $535.00 | $122.00–$454.75 | 38% below | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ/ASPIRATE MAJOR JOINT W/O US | $705.00 | $1,410.00 | $305.73–$3,623.00 | 63% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ/ASPIRATE MAJOR JOINT W/O US BIL | $1,410.00 | $2,820.00 | $305.73–$3,623.00 | 225% above | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJECT/ASPIRATE MAJOR JOINT* | $267.50 | $535.00 | $321.00–$454.75 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ/ASPIRATE MAJOR JOINT W/O US | $705.00 | $1,410.00 | $846.00–$1,198.50 | — | 50% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ/ASPIRATE MAJOR JOINT W/O US BIL | $1,410.00 | $2,820.00 | $1,692.00–$2,397.00 | — | 50% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 DRUG IMPLANT INSERT | $317.50 | $635.00 | $132.52–$19,665.00 | 20% above | 50% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 DRUG IMPLANT INSERT | $317.50 | $635.00 | $381.00–$539.75 | — | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 INJ/ASPIRATE INTERM JOINT W/O US | $650.00 | $1,300.00 | $305.73–$3,623.00 | 103% above | 50% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 INJ/ASPIRATE INTERM JOINT W/O US | $650.00 | $1,300.00 | $780.00–$1,105.00 | — | 50% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJ/ASPIRATE SMALL JOINT W/O US | $565.00 | $1,130.00 | $305.73–$3,623.00 | 52% above | 50% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 INJ/ASPIRATE SMALL JOINT W/O US | $565.00 | $1,130.00 | $678.00–$960.50 | — | 50% |
| Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION 1ST/SINGLE | $235.00 | $470.00 | $187.06–$19,665.00 | at median | 50% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION 1ST/SINGLE | $235.00 | $470.00 | $282.00–$399.50 | — | 50% |
| Occipital nerve block (injection for headaches) CPT 64405 INJECT NERVE OCCIPITAL | $540.00 | $1,080.00 | $305.73–$3,623.00 | 17% above | 50% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECT NERVE OCCIPITAL | $540.00 | $1,080.00 | $648.00–$918.00 | — | 50% |
| Paracentesis with imaging guidance CPT 49083 PARACENTESIS W/IMAGING | $840.00 | $1,680.00 | $668.64–$3,623.00 | 35% below | 50% |
| Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W/IMAGING | $840.00 | $1,680.00 | $1,008.00–$1,428.00 | — | 50% |
| Removal of a foreign object under the skin, simple CPT 10120 INCISE & REMOVE FB SQ, SIMPLE | $220.00 | $440.00 | $122.00–$374.00 | 35% below | 50% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISE & REMOVE FB SQ, SIMPLE | $220.00 | $440.00 | $264.00–$374.00 | — | 50% |
| Short arm splint (forearm and hand) CPT 29125 SPLINT SHORT ARM STATIC | $210.00 | $420.00 | $132.52–$1,680.00 | 19% above | 50% |
| Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT SHORT ARM STATIC | $210.00 | $420.00 | $252.00–$357.00 | — | 50% |
| Short leg cast (below the knee) CPT 29405 CAST SHORT LEG | $235.00 | $470.00 | $235.00–$1,680.00 | at median | 50% |
| Short leg cast (below the knee) inpatient CPT 29405 CAST SHORT LEG | $235.00 | $470.00 | $282.00–$399.50 | — | 50% |
| Short leg splint (calf to foot) CPT 29515 SPLINT SHORT LEG | $235.00 | $470.00 | $161.86–$1,680.00 | 13% above | 50% |
| Short leg splint (calf to foot) inpatient CPT 29515 SPLINT SHORT LEG | $235.00 | $470.00 | $282.00–$399.50 | — | 50% |
| Skin biopsy, punch, one lesion CPT 11104 BX SKIN PUNCH SINGLE LESION | $240.00 | $480.00 | $191.04–$19,665.00 | at median | 50% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 BX SKIN PUNCH SINGLE LESION | $240.00 | $480.00 | $288.00–$408.00 | — | 50% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC | $605.00 | $1,210.00 | $481.58–$3,623.00 | at median | 50% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC | $605.00 | $1,210.00 | $726.00–$1,028.50 | — | 50% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX SKIN TAGENTIAL SINGLE LESION | $240.00 | $480.00 | $191.04–$19,665.00 | at median | 50% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BX SKIN TAGENTIAL SINGLE LESION | $240.00 | $480.00 | $288.00–$408.00 | — | 50% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/IMAGING | $1,200.00 | $2,400.00 | $624.82–$3,623.00 | at median | 50% |
| Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/IMAGING | $1,200.00 | $2,400.00 | $1,440.00–$2,040.00 | — | 50% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TRIGGER POINTS 1-2 MUSCLES | $935.00 | $1,870.00 | $305.73–$3,623.00 | 163% above | 50% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECT TRIGGER POINTS 1-2 MUSCLES | $935.00 | $1,870.00 | $1,122.00–$1,589.50 | — | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BREAST BX US GUIDANCE 1ST | $2,980.00 | $5,960.00 | $1,645.05–$9,936.00 | 48% above | 50% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BREAST BX US GUIDANCE 1ST | $2,980.00 | $5,960.00 | $3,576.00–$5,066.00 | — | 50% |
| Vein ablation, radiofrequency, first vein CPT 36475 VARICOSE VEIN RFA 1ST | $5,380.00 | $10,760.00 | $3,144.97–$19,665.00 | 38% above | 50% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 VARICOSE VEIN RFA 1ST | $5,380.00 | $10,760.00 | $6,456.00–$9,146.00 | — | 50% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLOOD COMPONENT(S) | $760.00 | $1,520.00 | $439.43–$1,680.00 | 30% above | 50% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLOOD COMPONENT(S) | $760.00 | $1,520.00 | $912.00–$1,292.00 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM SPEC AEROSOL INDUCED | $87.50 | $175.00 | $87.50–$218.11 | 1% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RESP TX INITIAL OR SUBSEQUENT | $90.00 | $180.00 | $90.00–$289.00 | 4% above | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM SPEC AEROSOL INDUCED | $87.50 | $175.00 | $105.00–$148.75 | — | 50% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RESP TX INITIAL OR SUBSEQUENT | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR | $500.00 | $1,000.00 | $329.00–$1,847.00 | 11% below | 50% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR | $500.00 | $1,000.00 | $600.00–$850.00 | — | 50% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE AUDIOLOGY | $155.00 | $310.00 | $128.16–$450.00 | at median | 50% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPREHENSIVE AUDIOLOGY | $155.00 | $310.00 | $186.00–$263.50 | — | 50% |
| Critical care, first 30 to 74 minutes CPT 99291 ED CRITICAL CARE 30-74 MIN | $2,080.00 | $4,160.00 | $2,046.00–$3,899.00 | 16% above | 50% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 ED CRITICAL CARE 30-74 MIN | $2,080.00 | $4,160.00 | $2,496.00–$3,536.00 | — | 50% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG W/AWAKE & DROWSY | $710.00 | $1,420.00 | $215.07–$1,207.00 | 6% above | 50% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG W/AWAKE & DROWSY | $710.00 | $1,420.00 | $852.00–$1,207.00 | — | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING ONLY | $350.00 | $700.00 | $58.76–$595.00 | 137% above | 50% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING ONLY | $350.00 | $700.00 | $420.00–$595.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED LEVEL 1 TYPE B VISIT | $160.00 | $320.00 | $192.00–$2,277.00 | 15% below | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED LEVEL 1 | $187.50 | $375.00 | $225.00–$2,277.00 | at median | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED DOA | $200.00 | $400.00 | $240.00–$2,277.00 | 7% above | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 FORENSIC NURSE EXAM 1 | $245.00 | $490.00 | $294.00–$2,277.00 | 31% above | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 MEDICAL SCREENING UP TO 1 HR | $342.50 | $685.00 | $320.00–$2,277.00 | 83% above | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED LEVEL 1 TYPE B VISIT | $160.00 | $320.00 | $192.00–$272.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED LEVEL 1 | $187.50 | $375.00 | $225.00–$318.75 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED DOA | $200.00 | $400.00 | $240.00–$340.00 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 FORENSIC NURSE EXAM 1 | $245.00 | $490.00 | $294.00–$416.50 | — | 50% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 MEDICAL SCREENING UP TO 1 HR | $342.50 | $685.00 | $411.00–$582.25 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED LEVEL 2 | $292.50 | $585.00 | $320.00–$2,277.00 | 9% below | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 MEDICAL SCREENING UP TO 2 HR | $402.50 | $805.00 | $320.00–$2,277.00 | 25% above | 50% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 FORENSIC NURSE EXAM 2 | $490.00 | $980.00 | $320.00–$2,277.00 | 52% above | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED LEVEL 2 | $292.50 | $585.00 | $351.00–$497.25 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 MEDICAL SCREENING UP TO 2 HR | $402.50 | $805.00 | $483.00–$684.25 | — | 50% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 FORENSIC NURSE EXAM 2 | $490.00 | $980.00 | $588.00–$833.00 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED LEVEL 3 | $457.50 | $915.00 | $549.00–$2,277.00 | 23% below | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 MEDICAL SCREENING UP TO 3 HR | $470.00 | $940.00 | $564.00–$2,277.00 | 21% below | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 FORENSIC NURSE EXAM 3 | $980.00 | $1,960.00 | $836.00–$2,277.00 | 65% above | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED LEVEL 3 | $457.50 | $915.00 | $549.00–$777.75 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 MEDICAL SCREENING UP TO 3 HR | $470.00 | $940.00 | $564.00–$799.00 | — | 50% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 FORENSIC NURSE EXAM 3 | $980.00 | $1,960.00 | $1,176.00–$1,666.00 | — | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 MEDICAL SCREENING UP TO 4 HR | $530.00 | $1,060.00 | $636.00–$3,772.00 | 42% below | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED LEVEL 4 | $885.00 | $1,770.00 | $1,062.00–$3,772.00 | 4% below | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 MEDICAL SCREENING UP TO 4 HR | $530.00 | $1,060.00 | $636.00–$901.00 | — | 50% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED LEVEL 4 | $885.00 | $1,770.00 | $1,062.00–$1,504.50 | — | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 MEDICAL SCREENING 5 HR OR > | $590.00 | $1,180.00 | $708.00–$3,772.00 | 60% below | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED LEVEL 5 | $1,295.00 | $2,590.00 | $1,554.00–$3,772.00 | 12% below | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 MEDICAL SCREENING 5 HR OR > | $590.00 | $1,180.00 | $708.00–$1,003.00 | — | 50% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED LEVEL 5 | $1,295.00 | $2,590.00 | $1,554.00–$2,201.50 | — | 50% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST | $1,050.00 | $2,100.00 | $215.07–$1,785.00 | 33% above | 50% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST | $1,050.00 | $2,100.00 | $1,260.00–$1,785.00 | — | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL 31-60 MIN | $295.00 | $590.00 | $211.86–$501.50 | 3% above | 50% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL 31-60 MIN | $295.00 | $590.00 | $354.00–$501.50 | — | 50% |
| IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX/DX 1ST HR | $350.00 | $700.00 | $211.86–$595.00 | 10% above | 50% |
| IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX/DX 1ST HR | $350.00 | $700.00 | $420.00–$595.00 | — | 50% |
| IV push of a medicine, first drug CPT 96374 RHO(D) IMMUNE GLOBULIN ADMIN IV | $75.00 | $150.00 | $60.00–$211.86 | 55% below | 50% |
| IV push of a medicine, first drug CPT 96374 IV PUSH 1ST OR SINGLE DRUG | $75.00 | $150.00 | $75.00–$347.00 | 55% below | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 RHO(D) IMMUNE GLOBULIN ADMIN IV | $75.00 | $150.00 | $90.00–$127.50 | — | 50% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH 1ST OR SINGLE DRUG | $75.00 | $150.00 | $90.00–$127.50 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECT SQ OR IM | $57.50 | $115.00 | $57.50–$347.00 | 29% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 RHO(D) IMMUNE GLOBULIN ADMIN IM | $57.50 | $115.00 | $46.00–$121.00 | 29% below | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECT SQ OR IM | $57.50 | $115.00 | $69.00–$97.75 | — | 50% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 RHO(D) IMMUNE GLOBULIN ADMIN IM | $57.50 | $115.00 | $69.00–$97.75 | — | 50% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDIES 7-8 | $242.50 | $485.00 | $242.50–$577.00 | 75% below | 50% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION STUDIES 7-8 | $242.50 | $485.00 | $291.00–$412.25 | — | 50% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE-ED PER UNIT | $90.00 | $180.00 | $31.84–$397.00 | 6% below | 50% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE-ED PER UNIT | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| New patient office visit, about 30 minutes CPT 99203 OP SERV MOD ACUITY-NEW PT | $180.00 | $360.00 | $66.00–$306.00 | 9% below | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OP SERV MOD ACUITY-NEW PT | $180.00 | $360.00 | $216.00–$306.00 | — | 50% |
| New patient office visit, about 45 minutes CPT 99204 OP SERV HIGH ACUITY-NEW PT | $250.00 | $500.00 | $66.00–$425.00 | 11% above | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OP SERV HIGH ACUITY-NEW PT | $250.00 | $500.00 | $300.00–$425.00 | — | 50% |
| New patient office visit, about 60 minutes CPT 99205 OP SERV COMP ACUITY-NEW PT | $295.00 | $590.00 | $66.00–$501.50 | 3% below | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OP SERV COMP ACUITY-NEW PT | $295.00 | $590.00 | $354.00–$501.50 | — | 50% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP SERV LOW ACUITY-NEW PT | $137.50 | $275.00 | $66.00–$233.75 | 5% above | 50% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP SERV LOW ACUITY-NEW PT | $137.50 | $275.00 | $165.00–$233.75 | — | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL VISIT EA 15 MIN | $60.00 | $120.00 | $35.72–$196.00 | at median | 50% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL VISIT EA 15 MIN | $60.00 | $120.00 | $72.00–$102.00 | — | 50% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY | $185.00 | $370.00 | $98.26–$397.00 | at median | 50% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY | $185.00 | $370.00 | $222.00–$314.50 | — | 50% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY | $325.00 | $650.00 | $95.70–$552.50 | 3% above | 50% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY | $325.00 | $650.00 | $390.00–$552.50 | — | 50% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY | $185.00 | $370.00 | $95.70–$397.00 | at median | 50% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY | $185.00 | $370.00 | $222.00–$314.50 | — | 50% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEXITY | $250.00 | $500.00 | $95.70–$425.00 | at median | 50% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEXITY | $250.00 | $500.00 | $300.00–$425.00 | — | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY PER UNIT | $90.00 | $180.00 | $26.94–$397.00 | 7% below | 50% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY PER UNIT | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXER PER UNIT | $90.00 | $180.00 | $28.25–$397.00 | 7% below | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXER PER UNIT | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP SERV COMP ACUITY-EST PT | $245.00 | $490.00 | $66.00–$416.50 | 17% below | 50% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP SERV COMP ACUITY-EST PT | $245.00 | $490.00 | $294.00–$416.50 | — | 50% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP SERV MOD ACUITY-EST PT | $162.50 | $325.00 | $66.00–$276.25 | 1% below | 50% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP SERV MOD ACUITY-EST PT | $162.50 | $325.00 | $195.00–$276.25 | — | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP SERV HIGH ACUITY-EST PT | $190.00 | $380.00 | $66.00–$323.00 | 2% above | 50% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP SERV HIGH ACUITY-EST PT | $190.00 | $380.00 | $228.00–$323.00 | — | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP SERV LOW ACUITY-EST PT | $127.50 | $255.00 | $56.64–$216.75 | 32% above | 50% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP SERV LOW ACUITY-EST PT | $127.50 | $255.00 | $153.00–$216.75 | — | 50% |
| Speech and language evaluation CPT 92523 SPEECH EVAL& LANG COMPREHENSION | $355.00 | $710.00 | $222.00–$603.50 | at median | 50% |
| Speech and language evaluation inpatient CPT 92523 SPEECH EVAL& LANG COMPREHENSION | $355.00 | $710.00 | $426.00–$603.50 | — | 50% |
| Speech therapy session, individual CPT 92507 TREATMENT OF SPEECH, LANG | $267.50 | $535.00 | $74.56–$454.75 | 6% above | 50% |
| Speech therapy session, individual inpatient CPT 92507 TREATMENT OF SPEECH, LANG | $267.50 | $535.00 | $321.00–$454.75 | — | 50% |
| Spirometry (breathing test) CPT 94010 SPIROMETRY, BASIC | $280.00 | $560.00 | $215.07–$1,673.00 | at median | 50% |
| Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY, BASIC | $280.00 | $560.00 | $336.00–$476.00 | — | 50% |
| Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY W/BRONCHODILATOR | $495.00 | $990.00 | $371.68–$1,673.00 | 2% above | 50% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY W/BRONCHODILATOR | $495.00 | $990.00 | $594.00–$841.50 | — | 50% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAP ACTIVITIES PER UNIT | $90.00 | $180.00 | $34.00–$397.00 | at median | 50% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAP ACTIVITIES PER UNIT | $90.00 | $180.00 | $108.00–$153.00 | — | 50% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEUTIC | $130.00 | $260.00 | $130.00–$289.00 | 35% below | 50% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPEUTIC | $130.00 | $260.00 | $156.00–$221.00 | — | 50% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 RECOMBIVAX HB 5 MCG-0.5ML IJ SUSY | $96.51 | $193.01 | $31.67–$164.06 | 72% above | 50% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 RECOMBIVAX HB 5 MCG-0.5ML IJ SUSY | $96.51 | $193.01 | $115.81–$164.06 | — | 50% |
| Rabies vaccine, one dose CPT 90675 RABAVERT IM SUSR | $1,314.60 | $2,629.19 | $313.68–$2,234.81 | 126% above | 50% |
| Rabies vaccine, one dose inpatient CPT 90675 RABAVERT IM SUSR | $1,314.60 | $2,629.19 | $1,577.51–$2,234.81 | — | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX 5-2.5-18.5 LF-MCG-0.5 IM SUSY | $145.53 | $291.05 | $39.48–$247.39 | 78% above | 50% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX 5-2.5-18.5 LF-MCG-0.5 IM SUSY | $145.53 | $291.05 | $174.63–$247.39 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN FEE VACCINE, PNEUMONIA | $32.50 | $65.00 | $32.50–$71.72 | 16% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN FEE VACCINE, INFLUENZA | $32.50 | $65.00 | $32.50–$71.72 | 16% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN FEE VACCINE 1ST | $32.50 | $65.00 | $26.00–$121.00 | 16% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN FEE VACCINE, HEPATITIS B | $32.50 | $65.00 | $32.50–$71.72 | 16% below | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN FEE VACCINE, HEPATITIS B | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN FEE VACCINE 1ST | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN FEE VACCINE, INFLUENZA | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN FEE VACCINE, PNEUMONIA | $32.50 | $65.00 | $39.00–$55.25 | — | 50% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN FEE VACCINE EA ADD'L | $15.00 | $30.00 | $12.00–$121.00 | 54% below | 50% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN FEE VACCINE EA ADD'L | $15.00 | $30.00 | $18.00–$25.50 | — | 50% |
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.