Hospital Milwaukee-Waukesha, WI

Aurora St Lukes Medical Center of Aurora Health Care Metro

Aurora St Lukes Medical Center of Aurora Health Care Metro in Milwaukee, WI publishes cash prices for 358 common procedures listed here, from its own machine-readable price file updated Nov 5, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 171 of 352 procedures and below it for 88. By typical cash price it ranks #54 of 103 Wisconsin hospitals and #9 of 16 hospitals in the Milwaukee, WI area, cheapest first. Select a procedure to compare it with other hospitals nearby.

2900 W Oklahoma Ave, Milwaukee, WI 53215 Collected Nov 7, 2026 Source price file Check a bill from this hospital (414) 649-6000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 520138 · CMS hospital register NPI 1861447179

Financial assistance

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

Aurora St Lukes Medical Center of Aurora Health Care Metro 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	$415.00	$830.00	$104.13–$705.50	73% above	50%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN 2 VIEWS	$415.00	$830.00	$498.00–$705.50	—	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 NON-INVAS PHYS UNI 1-2 LVL LTD	$385.00	$770.00	$132.52–$796.00	at median	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NONINV VASC ASSESS-SINGLE SITE	$385.00	$770.00	$132.52–$796.00	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	$685.00	$1,370.00	$104.13–$1,164.50	29% above	50%
Breast ultrasound, complete, one breast CPT 76641 US BREAST BIL W/AXILLA COMPLETE	$1,370.00	$2,740.00	$104.13–$2,329.00	158% above	50%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST W/AXILLA COMPLETE	$685.00	$1,370.00	$822.00–$1,164.50	—	50%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST BIL W/AXILLA COMPLETE	$1,370.00	$2,740.00	$1,644.00–$2,329.00	—	50%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST W/AXILLA LIMITED	$510.00	$1,020.00	$86.68–$867.00	30% above	50%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST BIL W/AXILLA LIMITED	$1,020.00	$2,040.00	$86.68–$1,734.00	160% above	50%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST W/AXILLA LIMITED	$510.00	$1,020.00	$612.00–$867.00	—	50%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST BIL W/AXILLA LIMITED	$1,020.00	$2,040.00	$1,224.00–$1,734.00	—	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–$2,975.00	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	$200.00	$400.00	$86.68–$476.00	7% below	50%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$200.00	$400.00	$240.00–$340.00	—	50%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$172.50	$345.00	$86.68–$476.00	7% above	50%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$172.50	$345.00	$207.00–$293.25	—	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	$560.00	$1,120.00	$104.13–$952.00	2% above	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM COMPLETE	$560.00	$1,120.00	$672.00–$952.00	—	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	$2,990.00	$5,980.00	$544.25–$5,083.00	70% above	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO/DOPPLER/COLOR W/CONTRAST	$3,090.00	$6,180.00	$544.25–$5,253.00	76% above	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO/DOPPLER/COLOR W/O CONTRAST	$2,990.00	$5,980.00	$3,588.00–$5,083.00	—	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO/DOPPLER/COLOR W/CONTRAST	$3,090.00	$6,180.00	$3,708.00–$5,253.00	—	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 1 VIEW	$372.50	$745.00	$104.13–$633.25	98% above	50%
Hand X-ray, 2 views CPT 73120 XR HAND 2 VIEW	$372.50	$745.00	$104.13–$633.25	98% above	50%
Hand X-ray, 2 views CPT 73120 XR HAND BIL 1 VIEW	$745.00	$1,490.00	$104.13–$1,266.50	295% above	50%
Hand X-ray, 2 views CPT 73120 XR HAND BIL 2 VIEW	$745.00	$1,490.00	$104.13–$1,266.50	295% above	50%
Hand X-ray, 2 views inpatient CPT 73120 XR HAND 1 VIEW	$372.50	$745.00	$447.00–$633.25	—	50%
Hand X-ray, 2 views inpatient CPT 73120 XR HAND 2 VIEW	$372.50	$745.00	$447.00–$633.25	—	50%
Hand X-ray, 2 views inpatient CPT 73120 XR HAND BIL 1 VIEW	$745.00	$1,490.00	$894.00–$1,266.50	—	50%
Hand X-ray, 2 views inpatient CPT 73120 XR HAND BIL 2 VIEW	$745.00	$1,490.00	$894.00–$1,266.50	—	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 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 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 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–$730.00	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	$405.00	$810.00	$86.68–$688.50	59% above	50%
Knee X-ray, 3 views CPT 73562 XR KNEE BIL 3 VIEW	$810.00	$1,620.00	$86.68–$1,377.00	219% above	50%
Knee X-ray, 3 views inpatient CPT 73562 XR KNEE 3 VIEW	$405.00	$810.00	$486.00–$688.50	—	50%
Knee X-ray, 3 views inpatient CPT 73562 XR KNEE BIL 3 VIEW	$810.00	$1,620.00	$972.00–$1,377.00	—	50%
Knee X-ray, complete, 4 or more views CPT 73564 XR KNEE COMPLETE 4 VIEW MINIMUM	$500.00	$1,000.00	$104.13–$850.00	81% above	50%
Knee X-ray, complete, 4 or more views CPT 73564 XR KNEE COMPLETE BIL 4 VIEW MIN	$1,000.00	$2,000.00	$104.13–$1,700.00	261% above	50%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 XR KNEE COMPLETE 4 VIEW MINIMUM	$500.00	$1,000.00	$600.00–$850.00	—	50%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 XR KNEE COMPLETE BIL 4 VIEW MIN	$1,000.00	$2,000.00	$1,200.00–$1,700.00	—	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	$760.00	$1,520.00	$104.13–$1,292.00	71% above	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LTD	$760.00	$1,520.00	$912.00–$1,292.00	—	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/FIBULA BIL 1 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 AND FIBULA BIL 2 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 CPT 73721 MR LOWER EXT JOINT BIL WO CONTRAST	$4,420.00	$8,840.00	$237.66–$7,514.00	100% above	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, no contrast dye inpatient CPT 73721 MR LOWER EXT JOINT BIL WO CONTRAST	$4,420.00	$8,840.00	$5,304.00–$7,514.00	—	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 SHUNT EVAL LTD WO CON	$2,210.00	$4,420.00	$237.66–$3,757.00	at median	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, no contrast dye inpatient CPT 70551 MR BRAIN SHUNT EVAL LTD WO CON	$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 LUMBAR SPINE LTD WITHOUT DYE	$2,210.00	$4,420.00	$237.66–$3,757.00	at median	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, no contrast dye inpatient CPT 72148 MR LUMBAR SPINE LTD WITHOUT 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 LUMBAR SPINE LTD WITH/WITHOUT 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 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 LUMBAR SPINE LTD WITH/WITHOUT DYE	$3,415.00	$6,830.00	$4,098.00–$5,805.50	—	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 THORACIC SPINE LTD WITHOUT 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 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 mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR THORACIC SPINE LTD WITHOUT 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 CERVICAL SPINE LTD WITH/WITHOUT 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 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 CERVICAL SPINE LTD WITH/WITHOUT DYE	$3,415.00	$6,830.00	$4,098.00–$5,805.50	—	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 CERVICAL SPINE LTD WITHOUT 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 C SPINE W/O 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 CPT 73221 MR UPPER EXTREM JOINT BIL WO CONTRAST	$4,420.00	$8,840.00	$237.66–$7,514.00	100% above	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%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MR UPPER EXTREM JOINT BIL WO CONTRAST	$4,420.00	$8,840.00	$5,304.00–$7,514.00	—	50%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR CERVICAL SPINE 4-5 VIEWS	$685.00	$1,370.00	$104.13–$1,164.50	113% above	50%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR CERVICAL SPINE 4-5 VIEWS	$685.00	$1,370.00	$822.00–$1,164.50	—	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	$4,770.00	$9,540.00	$1,289.52–$8,109.00	54% above	50%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYO PERF SPECT MULTIPLE	$4,770.00	$9,540.00	$5,724.00–$8,109.00	—	50%
OCT scan of the retina (optical coherence tomography) CPT 92134 OPHTH IMAGING RETINA	$102.50	$205.00	$58.76–$577.00	140% above	50%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 OPHTH IMAGING RETINA	$102.50	$205.00	$123.00–$174.25	—	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	$477.50	$955.00	$104.13–$811.75	19% above	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED	$477.50	$955.00	$573.00–$811.75	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS COMPLETE	$730.00	$1,460.00	$104.13–$1,241.00	39% above	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS COMPLETE	$730.00	$1,460.00	$876.00–$1,241.00	—	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	$415.00	$830.00	$86.68–$705.50	85% above	50%
Rib X-ray, one side, 2 views inpatient CPT 71100 XR RIBS 2 VIEW	$415.00	$830.00	$498.00–$705.50	—	50%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 XR RIBS W/CHEST 3 VIEW	$615.00	$1,230.00	$104.13–$1,045.50	121% above	50%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 XR RIBS W/CHEST 3 VIEW	$615.00	$1,230.00	$738.00–$1,045.50	—	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	$405.00	$810.00	$86.68–$688.50	73% above	50%
Shoulder X-ray, complete, 2 or more views CPT 73030 XR SHOULDER BIL MIN 2 VIEWS	$810.00	$1,620.00	$86.68–$1,377.00	245% above	50%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR SHOULDER COMPLETE	$405.00	$810.00	$486.00–$688.50	—	50%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR SHOULDER BIL MIN 2 VIEWS	$810.00	$1,620.00	$972.00–$1,377.00	—	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	$2,935.00	$5,870.00	$544.25–$4,989.50	43% above	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO-STRESS W/EKG W/CONTRAST	$3,035.00	$6,070.00	$544.25–$5,159.50	48% above	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO-STRESS W/EKG W/O CONTRAST	$2,935.00	$5,870.00	$3,522.00–$4,989.50	—	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO-STRESS W/EKG W/CONTRAST	$3,035.00	$6,070.00	$3,642.00–$5,159.50	—	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 CPT 73660 XR TOES BIL MIN 2V	$555.00	$1,110.00	$86.68–$943.50	175% 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%
Toe X-ray, 2 or more views inpatient CPT 73660 XR TOES BIL MIN 2V	$555.00	$1,110.00	$666.00–$943.50	—	50%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$482.50	$965.00	$104.13–$820.25	3% above	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$482.50	$965.00	$579.00–$820.25	—	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	$1,015.00	$2,030.00	$104.13–$1,725.50	49% above	50%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$1,015.00	$2,030.00	$1,218.00–$1,725.50	—	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	$610.00	$1,220.00	$104.13–$1,037.00	20% above	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US, SOFT TISSUE HEAD/NECK	$610.00	$1,220.00	$732.00–$1,037.00	—	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 2 VIEW	$315.00	$630.00	$86.68–$535.50	46% above	50%
Wrist X-ray, 2 views CPT 73100 XR WRIST 1 VIEW	$315.00	$630.00	$86.68–$535.50	46% above	50%
Wrist X-ray, 2 views CPT 73100 XR WRIST BIL 2 VIEW	$630.00	$1,260.00	$86.68–$1,071.00	192% above	50%
Wrist X-ray, 2 views inpatient CPT 73100 XR WRIST 1 VIEW	$315.00	$630.00	$378.00–$535.50	—	50%
Wrist X-ray, 2 views inpatient CPT 73100 XR WRIST 2 VIEW	$315.00	$630.00	$378.00–$535.50	—	50%
Wrist X-ray, 2 views inpatient CPT 73100 XR WRIST BIL 2 VIEW	$630.00	$1,260.00	$756.00–$1,071.00	—	50%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR WRIST BILAT MIN 3 VIEWS	$725.00	$1,450.00	$86.68–$1,232.50	—	50%
Wrist X-ray, complete, 3 or more views CPT 73110 XR WRIST COMPLETE	$362.50	$725.00	$86.68–$616.25	43% above	50%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR WRIST BILAT MIN 3 VIEWS	$725.00	$1,450.00	$870.00–$1,232.50	—	50%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XR WRIST COMPLETE	$362.50	$725.00	$435.00–$616.25	—	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	$332.50	$665.00	$86.68–$565.25	58% above	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$332.50	$665.00	$399.00–$565.25	—	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 2 VIEW	$277.50	$555.00	$333.00–$471.75	—	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 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 CPT 73140 XR FINGER(S) 2 VIEW MINIMUM BIL	$570.00	$1,140.00	$86.68–$969.00	133% 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 finger(s), 2 or more views inpatient CPT 73140 XR FINGER(S) 2 VIEW MINIMUM BIL	$570.00	$1,140.00	$684.00–$969.00	—	50%
X-ray of the foot, 2 views CPT 73620 XR FOOT 1 VIEW LIMITED	$337.50	$675.00	$86.68–$573.75	78% above	50%
X-ray of the foot, 2 views CPT 73620 XR FOOT 2 VIEW	$337.50	$675.00	$86.68–$573.75	78% above	50%
X-ray of the foot, 2 views CPT 73620 XR FOOT 1 VIEW BIL LIMITED	$675.00	$1,350.00	$86.68–$1,147.50	255% above	50%
X-ray of the foot, 2 views CPT 73620 XR FOOT BIL 2 VIEW	$675.00	$1,350.00	$86.68–$1,147.50	255% above	50%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 2 VIEW	$337.50	$675.00	$405.00–$573.75	—	50%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 1 VIEW LIMITED	$337.50	$675.00	$405.00–$573.75	—	50%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 1 VIEW BIL LIMITED	$675.00	$1,350.00	$810.00–$1,147.50	—	50%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT BIL 2 VIEW	$675.00	$1,350.00	$810.00–$1,147.50	—	50%
X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT COMPLETE 3 VIEW MINIMUM	$402.50	$805.00	$86.68–$684.25	67% above	50%
X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT COMPLETE BIL 3 VIEW MINIMUM	$805.00	$1,610.00	$86.68–$1,368.50	234% above	50%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT COMPLETE 3 VIEW MINIMUM	$402.50	$805.00	$483.00–$684.25	—	50%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT COMPLETE BIL 3 VIEW MINIMUM	$805.00	$1,610.00	$966.00–$1,368.50	—	50%
X-ray of the hand, 3 or more views CPT 73130 XR HAND 3 VIEW MINIMUM	$430.00	$860.00	$86.68–$731.00	83% above	50%
X-ray of the hand, 3 or more views CPT 73130 XR HAND BIL 3 VIEW MINIMUM	$860.00	$1,720.00	$86.68–$1,462.00	267% above	50%
X-ray of the hand, 3 or more views inpatient CPT 73130 XR HAND 3 VIEW MINIMUM	$430.00	$860.00	$516.00–$731.00	—	50%
X-ray of the hand, 3 or more views inpatient CPT 73130 XR HAND BIL 3 VIEW MINIMUM	$860.00	$1,720.00	$1,032.00–$1,462.00	—	50%
X-ray of the knee, 1 or 2 views CPT 73560 XR KNEE 1 OR 2 VIEW	$337.50	$675.00	$86.68–$573.75	59% above	50%
X-ray of the knee, 1 or 2 views CPT 73560 XR KNEE BIL 1 OR 2 VIEW	$675.00	$1,350.00	$86.68–$1,147.50	219% above	50%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE 1 OR 2 VIEW	$337.50	$675.00	$405.00–$573.75	—	50%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE BIL 1 OR 2 VIEW	$675.00	$1,350.00	$810.00–$1,147.50	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEW	$505.00	$1,010.00	$104.13–$858.50	73% above	50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEW	$505.00	$1,010.00	$606.00–$858.50	—	50%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4 VIEW MIN	$710.00	$1,420.00	$104.13–$1,207.00	90% above	50%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4 VIEW MIN	$710.00	$1,420.00	$852.00–$1,207.00	—	50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE 2 VIEW	$467.50	$935.00	$104.13–$794.75	97% above	50%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE 2 VIEW	$467.50	$935.00	$561.00–$794.75	—	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	$467.50	$935.00	$86.68–$794.75	95% above	50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL SPINE 2-3 VIEWS	$467.50	$935.00	$561.00–$794.75	—	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 POC BNP (NATRIURETIC PEPTIDE)	$57.50	$115.00	$31.41–$143.30	60% below	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 POC BNP (NATRIURETIC PEPTIDE)	$57.50	$115.00	$69.00–$97.75	—	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 KIDNEY BIOPSY, LEVEL IV	$317.50	$635.00	$40.78–$539.75	47% above	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 KIDNEY BIOPSY, LEVEL IV	$317.50	$635.00	$381.00–$539.75	—	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	$60.00	$120.00	$10.76–$102.00	9% above	50%
Blood lead test CPT 83655 LEAD, URINE	$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, BC	$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	$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, TOTAL	$120.00	$240.00	$14.49–$204.00	at median	50%
Cortisol blood test, total CPT 82533 CORTISOL, SALIVARY	$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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 METHAQUALONE 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 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 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 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 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 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 PANEL BLOOD	$100.00	$200.00	$120.00–$170.00	—	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 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 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 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 POC FIBRINOGEN ACT	$37.50	$75.00	$7.78–$63.75	44% below	50%
Fibrinogen blood test CPT 85384 FIBRINOGEN	$67.50	$135.00	$7.78–$114.75	at median	50%
Fibrinogen blood test inpatient CPT 85384 POC FIBRINOGEN ACT	$37.50	$75.00	$45.00–$63.75	—	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 IGM	$112.50	$225.00	$13.48–$191.25	21% above	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 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	$67.50	$135.00	$11.72–$114.75	1% below	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 inpatient CPT 86695 AB, HERPES SIMPLEX TYPE 1	$67.50	$135.00	$81.00–$114.75	—	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-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 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 inpatient CPT 86696 AB, HERPES SIMPLEX TYPE 2	$67.50	$135.00	$81.00–$114.75	—	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%
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 URINE	$52.50	$105.00	$5.95–$89.25	at median	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 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 IGM	$82.50	$165.00	$11.45–$140.25	at median	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 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 IGG	$87.50	$175.00	$11.60–$148.75	2% above	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 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 B ANTIGEN, RAPID	$87.50	$175.00	$13.24–$148.75	66% above	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) 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 IGG	$82.50	$165.00	$12.79–$140.25	at median	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) inpatient CPT 86762 AB, RUBELLA IGM	$82.50	$165.00	$99.00–$140.25	—	50%
Rubella antibody test (immunity check) inpatient CPT 86762 AB, RUBELLA IGG	$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 HEMOGLOBIN, URINE	$25.00	$50.00	$1.99–$42.50	at median	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 HEMOGLOBIN, URINE	$25.00	$50.00	$30.00–$42.50	—	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	$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 CPT 82043 ALBUMIN URINE TIMED	$65.00	$130.00	$5.14–$110.50	at median	50%
Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE 24 HR	$65.00	$130.00	$78.00–$110.50	—	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 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–$24,323.00	—	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	$3,250.00	$6,500.00	$1,645.05–$9,936.00	28% above	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BREAST BX STEREO GUIDANCE 1ST	$3,250.00	$6,500.00	$3,900.00–$5,525.00	—	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$2,425.00	$4,850.00	$658.32–$4,122.50	146% above	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$2,425.00	$4,850.00	$2,910.00–$4,122.50	—	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 CPT 69210 CERUMEN IMPACTION REMOVAL*	$50.00	$100.00	$60.00–$261.00	40% below	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 CPT 69210 CERUMEN IMPACTION REMOVAL*	$50.00	$100.00	$60.00–$85.00	—	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	$187.38–$24,323.00	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–$24,323.00	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–$24,323.00	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–$24,323.00	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%
Miscarriage treatment with D&C, first trimester CPT 59820 SURG RX MISSED ABORTN,1ST TRI	$775.00	$1,550.00	$537.85–$17,957.00	33% below	50%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 SURG RX MISSED ABORTN,1ST TRI	$775.00	$1,550.00	$930.00–$1,317.50	—	50%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION 1ST/SINGLE	$235.00	$470.00	$163.09–$24,323.00	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) both sides CPT 64405 INJ NERVE OCCIPITAL BILATERAL	$1,080.00	$2,160.00	$305.73–$3,623.00	—	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 both sides CPT 64405 INJ NERVE OCCIPITAL BILATERAL	$1,080.00	$2,160.00	$1,296.00–$1,836.00	—	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	$1,790.00	$3,580.00	$903.39–$3,623.00	39% above	50%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W/IMAGING	$1,790.00	$3,580.00	$2,148.00–$3,043.00	—	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 cast (elbow to hand) CPT 29075 APPLY CAST SHORT ARM	$225.00	$450.00	$225.00–$1,680.00	11% below	50%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLY CAST SHORT ARM	$225.00	$450.00	$270.00–$382.50	—	50%
Short arm splint (forearm and hand) CPT 29125 APPLY SPLINT SHORT ARM*	$142.50	$285.00	$122.00–$261.00	19% below	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 APPLY SPLINT SHORT ARM*	$142.50	$285.00	$171.00–$242.25	—	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	$122.00–$399.50	13% above	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%
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	$166.56–$24,323.00	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	$419.87–$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	$166.56–$24,323.00	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	$2,595.00	$5,190.00	$1,645.05–$9,936.00	28% above	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BREAST BX US GUIDANCE 1ST	$2,595.00	$5,190.00	$3,114.00–$4,411.50	—	50%
Vein ablation, radiofrequency, first vein CPT 36475 VARICOSE VEIN RFA 1ST	$5,380.00	$10,760.00	$3,144.97–$24,323.00	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 RESP TX INITIAL OR SUBSEQUENT	$50.00	$100.00	$50.00–$289.00	42% below	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 inpatient CPT 94640 RESP TX INITIAL OR SUBSEQUENT	$50.00	$100.00	$60.00–$85.00	—	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%
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 eye exam by an eye doctor, new patient CPT 92004 EYE EXAM NEW PT COMPREHENSIVE	$165.00	$330.00	$66.00–$280.50	26% above	50%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 EYE EXAM NEW PT COMPREHENSIVE	$165.00	$330.00	$198.00–$280.50	—	50%
Comprehensive eye exam, returning patient CPT 92014 EYE EXAM EST PT COMPREHENSIVE	$137.50	$275.00	$66.00–$233.75	35% above	50%
Comprehensive eye exam, returning patient inpatient CPT 92014 EYE EXAM EST PT COMPREHENSIVE	$137.50	$275.00	$165.00–$233.75	—	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	$2,195.00	$4,390.00	$2,520.00–$4,678.00	23% above	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED CRITICAL CARE 30-74 MIN	$2,195.00	$4,390.00	$2,634.00–$3,731.50	—	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	$297.50	$595.00	$58.76–$505.75	102% above	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING ONLY	$297.50	$595.00	$357.00–$505.75	—	50%
Electroconvulsive therapy (ECT), one session CPT 90870 ELECTROCONVULSIVE THERAPY	$955.00	$1,910.00	$855.34–$1,623.50	31% above	50%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ELECTROCONVULSIVE THERAPY	$955.00	$1,910.00	$1,146.00–$1,623.50	—	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–$2,795.00	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–$2,795.00	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–$2,795.00	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–$2,795.00	31% 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 2 of 5, straightforward problem CPT 99282 ED LEVEL 2	$427.50	$855.00	$320.00–$2,795.00	32% above	50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 FORENSIC NURSE EXAM 2	$490.00	$980.00	$320.00–$2,795.00	52% above	50%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED LEVEL 2	$427.50	$855.00	$513.00–$726.75	—	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	$630.00	$1,260.00	$756.00–$2,795.00	6% above	50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 FORENSIC NURSE EXAM 3	$980.00	$1,960.00	$932.00–$2,795.00	65% above	50%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED LEVEL 3	$630.00	$1,260.00	$756.00–$1,071.00	—	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 ED LEVEL 4	$1,190.00	$2,380.00	$1,428.00–$4,259.00	29% above	50%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED LEVEL 4	$1,190.00	$2,380.00	$1,428.00–$2,023.00	—	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED LEVEL 5	$1,830.00	$3,660.00	$2,196.00–$4,259.00	25% above	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED LEVEL 5	$1,830.00	$3,660.00	$2,196.00–$3,111.00	—	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%
Eye exam, returning patient, intermediate CPT 92012 EYE EXAM EST PT INTERMEDIATE	$112.50	$225.00	$66.00–$191.25	18% above	50%
Eye exam, returning patient, intermediate inpatient CPT 92012 EYE EXAM EST PT INTERMEDIATE	$112.50	$225.00	$135.00–$191.25	—	50%
Family therapy with the patient, 50 minutes CPT 90847 PSYCHOTHERAPY FAMILY W/PT 50 MIN	$235.00	$470.00	$176.79–$399.50	24% above	50%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCHOTHERAPY FAMILY W/PT 50 MIN	$235.00	$470.00	$282.00–$399.50	—	50%
Family therapy without the patient, 50 minutes CPT 90846 PSYCHOTHERAPY FAMILY W/O PT 50 MIN	$185.00	$370.00	$176.79–$314.50	1% above	50%
Family therapy without the patient, 50 minutes inpatient CPT 90846 PSYCHOTHERAPY FAMILY W/O PT 50 MIN	$185.00	$370.00	$222.00–$314.50	—	50%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$127.50	$255.00	$101.19–$216.75	69% above	50%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$127.50	$255.00	$153.00–$216.75	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL 31-60 MIN	$265.00	$530.00	$211.86–$450.50	7% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL 31-60 MIN	$265.00	$530.00	$318.00–$450.50	—	50%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX/DX 1ST HR	$317.50	$635.00	$211.86–$539.75	at median	50%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX/DX 1ST HR	$317.50	$635.00	$381.00–$539.75	—	50%
IV push of a medicine, first drug CPT 96374 RHO(D) IMMUNE GLOBULIN ADMIN IV	$90.00	$180.00	$66.00–$211.86	45% below	50%
IV push of a medicine, first drug CPT 96374 IV PUSH 1ST OR SINGLE DRUG	$90.00	$180.00	$90.00–$347.00	45% below	50%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH 1ST OR SINGLE DRUG	$90.00	$180.00	$108.00–$153.00	—	50%
IV push of a medicine, first drug inpatient CPT 96374 RHO(D) IMMUNE GLOBULIN ADMIN IV	$90.00	$180.00	$108.00–$153.00	—	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 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 inpatient CPT 96372 RHO(D) IMMUNE GLOBULIN ADMIN 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 INJECT SQ OR IM	$57.50	$115.00	$69.00–$97.75	—	50%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVAL	$265.00	$530.00	$176.79–$519.00	21% above	50%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVAL	$265.00	$530.00	$318.00–$450.50	—	50%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NERVE CONDUCTION STUDIES 7-8	$1,410.00	$2,820.00	$371.68–$2,397.00	43% above	50%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NERVE CONDUCTION STUDIES 7-8	$1,410.00	$2,820.00	$1,692.00–$2,397.00	—	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	$197.50	$395.00	$66.00–$335.75	at median	50%
New patient office visit, about 30 minutes CPT 99203 OP SERVICE MOD ACUITY NEW PT*	$350.00	$700.00	$66.00–$595.00	77% above	50%
New patient office visit, about 30 minutes inpatient CPT 99203 OP SERV MOD ACUITY-NEW PT	$197.50	$395.00	$237.00–$335.75	—	50%
New patient office visit, about 30 minutes inpatient CPT 99203 OP SERVICE MOD ACUITY NEW PT*	$350.00	$700.00	$420.00–$595.00	—	50%
New patient office visit, about 45 minutes CPT 99204 OP SERV HIGH ACUITY-NEW PT	$210.00	$420.00	$66.00–$357.00	6% below	50%
New patient office visit, about 45 minutes CPT 99204 OP SERVICE HIGH ACUITY NEW PT*	$600.00	$1,200.00	$66.00–$1,020.00	167% above	50%
New patient office visit, about 45 minutes inpatient CPT 99204 OP SERV HIGH ACUITY-NEW PT	$210.00	$420.00	$252.00–$357.00	—	50%
New patient office visit, about 45 minutes inpatient CPT 99204 OP SERVICE HIGH ACUITY NEW PT*	$600.00	$1,200.00	$720.00–$1,020.00	—	50%
New patient office visit, about 60 minutes CPT 99205 OP SERV COMP ACUITY-NEW PT	$222.50	$445.00	$66.00–$378.25	27% below	50%
New patient office visit, about 60 minutes CPT 99205 OP SERV COMPR-NEW PT*	$480.00	$960.00	$66.00–$816.00	58% above	50%
New patient office visit, about 60 minutes inpatient CPT 99205 OP SERV COMP ACUITY-NEW PT	$222.50	$445.00	$267.00–$378.25	—	50%
New patient office visit, about 60 minutes inpatient CPT 99205 OP SERV COMPR-NEW PT*	$480.00	$960.00	$576.00–$816.00	—	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP SERV LOW ACUITY-NEW PT	$187.50	$375.00	$66.00–$318.75	44% above	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP SERVICE LOW ACUITY NEW PT*	$257.50	$515.00	$66.00–$437.75	97% above	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP SERV LOW ACUITY-NEW PT	$187.50	$375.00	$225.00–$318.75	—	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP SERVICE LOW ACUITY NEW PT*	$257.50	$515.00	$309.00–$437.75	—	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%
Preventive checkup, new patient aged 18–39 CPT 99385 NEW PT; PREV MED 18-39 YR	$80.00	$160.00	$64.00–$136.00	43% below	50%
Preventive checkup, new patient aged 18–39 CPT 99385 NEW PT;PREV MED 18-39 YR*	$362.50	$725.00	$66.00–$616.25	160% above	50%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 NEW PT; PREV MED 18-39 YR	$80.00	$160.00	$96.00–$136.00	—	50%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 NEW PT;PREV MED 18-39 YR*	$362.50	$725.00	$435.00–$616.25	—	50%
Preventive checkup, returning patient aged 18–39 CPT 99395 EST PT;PREV MED, 18-39 YR	$72.50	$145.00	$58.00–$123.25	53% below	50%
Preventive checkup, returning patient aged 18–39 CPT 99395 EST PT; PREV MED, 18-39 YR*	$322.50	$645.00	$66.00–$548.25	108% above	50%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 EST PT;PREV MED, 18-39 YR	$72.50	$145.00	$87.00–$123.25	—	50%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 EST PT; PREV MED, 18-39 YR*	$322.50	$645.00	$387.00–$548.25	—	50%
Psychotherapy for crisis, first 60 minutes CPT 90839 THERAPY CRISIS 1ST 60 MIN	$317.50	$635.00	$176.79–$539.75	8% above	50%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 THERAPY CRISIS 1ST 60 MIN	$317.50	$635.00	$381.00–$539.75	—	50%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY 30 MIN W/PT	$122.50	$245.00	$122.50–$208.25	15% above	50%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY 30 MIN W/PT	$122.50	$245.00	$147.00–$208.25	—	50%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY 45 MIN W/T	$175.00	$350.00	$175.00–$297.50	24% above	50%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY 45 MIN W/T	$175.00	$350.00	$210.00–$297.50	—	50%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY 60 MIN W/PT	$237.50	$475.00	$176.79–$403.75	12% above	50%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY 60 MIN W/PT	$237.50	$475.00	$285.00–$403.75	—	50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP SERV COMP ACUITY-EST PT	$295.00	$590.00	$66.00–$501.50	at median	50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP SERV COMPR-EST PT*	$387.50	$775.00	$66.00–$658.75	31% above	50%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP SERV COMP ACUITY-EST PT	$295.00	$590.00	$354.00–$501.50	—	50%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP SERV COMPR-EST PT*	$387.50	$775.00	$465.00–$658.75	—	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP SERV MOD ACUITY-EST PT	$190.00	$380.00	$66.00–$323.00	16% above	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP SERV MOD ACUITY-EST PT*	$275.00	$550.00	$66.00–$467.50	67% above	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP SERV MOD ACUITY-EST PT	$190.00	$380.00	$228.00–$323.00	—	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP SERV MOD ACUITY-EST PT*	$275.00	$550.00	$330.00–$467.50	—	50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP SERV HIGH ACUITY-EST PT	$222.50	$445.00	$66.00–$378.25	19% above	50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP SERV HIGH ACUITY-EST PT*	$360.00	$720.00	$66.00–$612.00	93% above	50%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP SERV HIGH ACUITY-EST PT	$222.50	$445.00	$267.00–$378.25	—	50%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP SERV HIGH ACUITY-EST PT*	$360.00	$720.00	$432.00–$612.00	—	50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP SERV LOW ACUITY-EST PT	$157.50	$315.00	$56.64–$267.75	63% above	50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP SERV LOW ACUITY-EST PT*	$200.00	$400.00	$56.64–$340.00	107% above	50%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP SERV LOW ACUITY-EST PT	$157.50	$315.00	$189.00–$267.75	—	50%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP SERV LOW ACUITY-EST PT*	$200.00	$400.00	$240.00–$340.00	—	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–$796.00	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–$841.50	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%
Visual field test, extended CPT 92083 VISUAL FIELD EXAM EXTENDED	$165.00	$330.00	$132.52–$577.00	62% above	50%
Visual field test, extended inpatient CPT 92083 VISUAL FIELD EXAM EXTENDED	$165.00	$330.00	$198.00–$280.50	—	50%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
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, 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, 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, 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 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, PNEUMONIA	$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, HEPATITIS B	$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.

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/11257/390806181_aurora-st-lukes-medical-center-of-aurora-health-care-metro-inc_standardcharges.csv