Hospital Appleton, WI

Ascension NE Wisconsin - St Elizabeth Campus

Listed in its price file as “Ascension NE Wisconsin, Inc.”.

Ascension NE Wisconsin - St Elizabeth Campus in Appleton, WI publishes cash prices for 380 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Wisconsin median for 296 of 374 procedures and above it for 76. By typical cash price it ranks #2 of 103 Wisconsin hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1506 S. Oneida St Appleton WI 54915 Collected Sep 23, 2026 Source price file Check a bill from this hospital (920) 738-2000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 520009 · CMS hospital register NPI 1407803638

Financial assistance

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

Ascension NE Wisconsin - St Elizabeth Campus 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 HC CT ABDOMEN W/WO CONTRAST	$522.69	$917.00	$70.54–$667.54	78% below	43%
Abdominal X-ray, 2 views CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS	$199.50	$350.00	$11.55–$85.71	17% below	43%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-RAY EXAM OF ANKLE 3/> VIEWS	$103.74	$182.00	$8.96–$82.88	56% below	43%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC UPR/L XTR NON-INVAS ART STUDY 2 LEVELS LIMITED	$369.36	$648.00	$12.19–$596.16	4% below	43%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREMITY WO CONTRAST	$269.61	$473.00	$50.39–$428.44	81% below	43%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC X-RAY EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$118.56	$208.00	$30.23–$166.33	78% below	43%
Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE IMAGING WHOLE BODY	$3,127.02	$5,486.00	$42.55–$730.48	110% above	43%
Breast ultrasound, complete, one breast CPT 76641 HC PRO ULTRASOUND BREAST COMPLETE	$254.79	$447.00	$36.99–$257.60	52% below	43%
Breast ultrasound, complete, one breast CPT 76641 HC ULTRASOUND BREAST COMPLETE	$493.05	$865.00	$36.99–$257.60	7% below	43%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC PRO ULTRASOUND BREAST LIMITED	$233.70	$410.00	$34.41–$210.65	40% below	43%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC ULTRASOUND BREAST LIMITED	$410.97	$721.00	$34.41–$210.65	5% above	43%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CTA ABDOMEN PELVIS W/WO CONTRAST	$1,023.15	$1,795.00	$110.26–$970.47	66% below	43%
CT angiography (CTA) of the head CPT 70496 HC STROKE CT ANGIOGRAPHY HEAD AI	$714.78	$1,254.00	$88.12–$988.60	66% below	43%
CT angiography (CTA) of the head CPT 70496 HC CTA HEAD W/WO CONTRAST	$714.78	$1,254.00	$88.12–$988.60	66% below	43%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK W/WO CONTRAST	$714.78	$1,254.00	$88.12–$1,029.08	65% below	43%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CTA CHEST W/WO CONTRAST	$713.07	$1,251.00	$91.56–$739.38	65% below	43%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CTA HEART COR ARTERIES GRAFTS	$509.01	$893.00	$120.45–$864.63	71% below	43%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART CALCIUM SCORE PREPAID	$27.93	$49.00	$29.13–$38.57	57% below	43%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN PELVIS WO CONTRAST	$713.07	$1,251.00	$87.75–$480.52	72% below	43%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST	$808.26	$1,418.00	$91.80–$784.40	75% below	43%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN PELVIS CONTRAST 1/> REGIONS	$855.57	$1,501.00	$101.15–$882.11	77% below	43%
CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST	$439.47	$771.00	$64.27–$593.04	73% below	43%
CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST	$309.51	$543.00	$60.09–$358.24	75% below	43%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST	$285.57	$501.00	$43.24–$410.79	79% below	43%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD WO CONTRAST	$698.25	$1,225.00	$42.89–$294.90	46% below	43%
CT scan of the head with contrast CPT 70460 HC CT HEAD W CONTRAST	$768.36	$1,348.00	$57.14–$391.67	50% below	43%
CT scan of the head without and with contrast CPT 70470 HC CT HEAD W/WO CONTRAST	$837.90	$1,470.00	$64.27–$458.82	54% below	43%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST	$369.36	$648.00	$50.39–$383.79	76% below	43%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE WO CONTRAST	$380.76	$668.00	$50.39–$387.78	75% below	43%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST	$428.64	$752.00	$58.62–$580.34	74% below	43%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC CAROTID DUPLEX BILATERAL STUDY	$836.19	$1,467.00	$39.61–$1,349.64	—	43%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W/WO CONTRAST	$570.57	$1,001.00	$63.04–$598.10	75% below	43%
Chest X-ray, 2 views CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS	$183.54	$322.00	$11.18–$78.02	14% below	43%
Chest X-ray, single view CPT 71045 HC X-RAY EXAM CHEST 1 VIEW	$56.43	$99.00	$8.97–$60.86	65% below	43%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-RAY EXAM OF CLAVICLE COMPLETE	$50.73	$89.00	$8.59–$74.35	75% below	43%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE	$410.97	$721.00	$37.36–$272.08	25% below	43%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL	$117.99	$207.00	$10.35–$94.11	70% below	43%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY/PERIPHERAL	$58.71	$103.00	$10.35–$77.08	79% below	43%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST	$375.63	$659.00	$54.56–$382.21	74% below	43%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST	$475.38	$834.00	$58.97–$480.63	71% below	43%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BI	$711.93	$1,249.00	$50.39–$405.50	—	43%
Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNI	$570.00	$1,000.00	$41.04–$321.38	85% above	43%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLX ART LOWER EXTREM BILAT	$1,072.17	$1,881.00	$39.25–$1,730.52	—	43%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC VEN DUPL SCAN BILAT UP/LW	$1,094.40	$1,920.00	$34.33–$1,766.40	—	43%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/DOPPLER COMPLETE W/O CONTRAST	$1,600.56	$2,808.00	$73.25–$682.35	9% below	43%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/DOPPLER COMPLETE W CONTRAST	$1,723.68	$3,024.00	$73.25–$682.35	2% below	43%
Elbow X-ray, 2 views CPT 73070 HC X-RAY EXAM OF ELBOW 2 VIEWS	$50.73	$89.00	$8.59–$67.56	73% below	43%
Elbow X-ray, complete, 3 or more views CPT 73080 HC X-RAY EXAM OF ELBOW 3/> VIEWS	$82.08	$144.00	$8.96–$73.56	65% below	43%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT SELLA WO CONTRAST	$348.27	$611.00	$65.00–$511.59	76% below	43%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC X-RAY EXAM OF FACIAL BONES 3/>VIEWS	$60.99	$107.00	$13.38–$76.73	80% below	43%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC X-RAY EXAM OF FOREARM	$71.25	$125.00	$8.23–$68.40	64% below	43%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY IMAGING W OR WO GB	$867.54	$1,522.00	$37.00–$822.02	41% below	43%
Hand X-ray, 2 views CPT 73120 HC X-RAY EXAM OF HAND 2 VIEWS	$60.99	$107.00	$8.59–$71.80	68% below	43%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-RAY EXAM OF HEEL 2 VIEWS	$50.73	$89.00	$8.23–$66.71	74% below	43%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC HOME SLEEP TEST TYPE III	$1,810.32	$3,176.00	$46.82–$2,887.00	195% above	43%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMNOGRAPHY WITH CPAP	$3,853.77	$6,761.00	$130.63–$3,687.00	5% above	43%
Knee X-ray, 3 views CPT 73562 HC X-RAY EXAM OF KNEE 3 VIEWS	$142.50	$250.00	$9.69–$93.12	44% below	43%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-RAY EXAM KNEE 4 OR MORE VIEWS	$183.54	$322.00	$11.89–$104.36	34% below	43%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREMITY WO CONTRAST	$270.18	$474.00	$50.39–$382.21	81% below	43%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMINAL LTD	$410.97	$721.00	$29.50–$218.74	8% below	43%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$83.22	$146.00	$26.63–$137.29	71% below	43%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LOW DOSE CT THORAX LUNG SCREENING	$700.53	$1,229.00	$54.56–$373.59	57% above	43%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-RAY EXAM TIBIA/FIBULA 2 VIEWS	$78.09	$137.00	$8.23–$72.66	63% below	43%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST	$852.72	$1,496.00	$60.46–$952.88	61% below	43%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W OR/& WO CONT PREPAY BILAT	$285.00	$500.00	$116.13–$372.11	—	43%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W/CONT, BILAT	$1,399.92	$2,456.00	$116.13–$953.66	—	43%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI W/O FOL W/CONT, BREAST BILAT	$1,521.90	$2,670.00	$116.13–$953.66	—	43%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI JOINT LOWER EXTREMITY WO CONTRAST	$926.82	$1,626.00	$68.68–$548.68	58% below	43%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI JOINT LOWER EXTREMITY W/WO CONTRAST	$1,047.66	$1,838.00	$108.63–$1,082.35	69% below	43%
MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST	$772.92	$1,356.00	$73.62–$728.27	65% below	43%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO CONTRAST	$1,451.79	$2,547.00	$110.85–$1,117.97	57% below	43%
MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CONTRAST	$873.24	$1,532.00	$74.72–$852.88	60% below	43%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/WO CONTRAST	$1,171.92	$2,056.00	$115.40–$1,067.96	66% below	43%
MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE WO CONTRAST	$1,451.79	$2,547.00	$75.07–$722.71	34% below	43%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST	$1,100.67	$1,931.00	$115.76–$1,037.80	68% below	43%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE WO CONTRAST	$808.26	$1,418.00	$74.72–$723.51	63% below	43%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST	$1,070.46	$1,878.00	$115.76–$1,044.15	69% below	43%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE WO CONTRAST	$866.97	$1,521.00	$74.72–$721.90	61% below	43%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/WO CONTRAST	$905.16	$1,588.00	$110.85–$1,113.21	73% below	43%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST	$633.84	$1,112.00	$73.97–$841.75	71% below	43%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI JOINT UPPER EXTREMITY WO CONTRAST	$1,055.64	$1,852.00	$68.68–$550.09	52% below	43%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC X-RAY EXAM NECK SPINE 4/5VWS	$94.62	$166.00	$13.76–$120.73	71% below	43%
Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST	$380.76	$668.00	$69.80–$486.53	77% below	43%
Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST	$268.47	$471.00	$64.64–$395.16	81% below	43%
Neck soft tissue X-ray CPT 70360 HC X-RAY EXAM OF NECK	$50.73	$89.00	$9.33–$72.74	76% below	43%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC MYOCARDIAL SPECT MULTIPLE STUDIES	$2,461.26	$4,318.00	$80.76–$1,140.25	20% below	43%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET/CT IMAGE SKULL BASE-THIGH	$1,898.67	$3,331.00	$120.16–$3,330.77	55% below	43%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST	$333.45	$585.00	$54.94–$349.01	74% below	43%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US NON-OB PELVIC LTD /FOLLOW UP	$197.22	$346.00	$24.95–$183.00	51% below	43%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US NON-OB PELVIC COMPLETE	$253.08	$444.00	$34.66–$263.35	52% below	43%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB 14 WKS / > SINGLE FETUS	$180.69	$317.00	$50.60–$245.18	68% below	43%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB < 14WKS SINGLE FETUS	$147.06	$258.00	$50.25–$245.18	71% below	43%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LTD 1 / > FETUS	$144.21	$253.00	$32.81–$202.02	61% below	43%
Rib X-ray, one side, 2 views CPT 71100 HC X-RAY EXAM RIBS UNI 2 VIEWS	$98.04	$172.00	$11.18–$84.82	56% below	43%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC X-RAY EXAM UNILAT RIBS/CHEST	$98.04	$172.00	$13.76–$97.79	65% below	43%
Screening mammogram, both breasts both sides CPT 77067 HC SCREEN MAMMO BI INCL CAD	$314.07	$551.00	$38.46–$327.96	—	43%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC X-RAY EXAM OF SHOULDER 2/> VIEWS	$103.74	$182.00	$9.69–$78.69	56% below	43%
Sinus X-ray, complete, 3 or more views CPT 70220 HC X-RAY EXAM OF SINUSES 3/> VIEWS	$57.00	$100.00	$11.18–$87.37	78% below	43%
Skull X-ray, fewer than 4 views CPT 70250 HC X-RAY EXAM OF SKULL < 4 VIEWS	$60.99	$107.00	$9.33–$84.64	75% below	43%
Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMNOGRAM STUDY	$3,550.53	$6,229.00	$125.71–$3,687.00	4% above	43%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC STRESS TTE CONT ECG W/ CONTRAST	$940.50	$1,650.00	$87.75–$771.52	54% below	43%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC STRESS TTE CONT ECG W/O CONTRAST	$940.50	$1,650.00	$87.75–$771.52	54% below	43%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOWING FUNCTION CINE/VIDEO CONTRAST STUDY	$201.21	$353.00	$26.91–$309.90	56% below	43%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM OF FEMUR 2/> VIEWS	$104.31	$183.00	$9.33–$82.09	58% below	43%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE WO CONTRAST	$286.14	$502.00	$50.39–$385.40	81% below	43%
Toe X-ray, 2 or more views CPT 73660 HC X-RAY EXAM OF TOE(S) 2 VIEWS	$50.73	$89.00	$6.75–$66.56	75% below	43%
Transvaginal pelvic ultrasound CPT 76830 HC US NON-OB TRANSVAGINAL	$164.73	$289.00	$35.01–$245.18	65% below	43%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL EXAM	$120.27	$211.00	$38.32–$156.81	69% below	43%
Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMINAL COMPLETE	$428.64	$752.00	$40.68–$295.07	37% below	43%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM & TESTICLES	$232.56	$408.00	$32.08–$252.09	53% below	43%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF SOFT TISSUES HEAD AND NECK	$410.97	$721.00	$28.38–$278.06	19% below	43%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XRAY EXAM UPPER GI TRC SINGLE CONTRAST STUDY	$191.52	$336.00	$40.67–$288.23	72% below	43%
Upper arm X-ray (humerus), 2 views CPT 73060 HC X-RAY EXAM OF HUMERUS	$70.68	$124.00	$8.23–$74.35	66% below	43%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUP VENOUS EXTREMITY UNILATERAL/LIMITED	$729.60	$1,280.00	$22.14–$1,177.60	2% above	43%
Wrist X-ray, 2 views CPT 73100 HC X-RAY EXAM OF WRIST 2 VIEWS	$54.72	$96.00	$8.59–$77.75	75% below	43%
Wrist X-ray, complete, 3 or more views CPT 73110 HC X-RAY EXAM OF WRIST 3/> VIEWS	$103.74	$182.00	$8.96–$92.23	59% below	43%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY HIP WITH PELVIS 2/3 VIEW	$183.54	$322.00	$11.54–$107.76	37% below	43%
X-ray of the abdomen, 1 view CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW	$183.54	$322.00	$9.33–$69.34	13% below	43%
X-ray of the ankle, 2 views CPT 73600 HC X-RAY EXAM OF ANKLE 2 VIEWS	$50.73	$89.00	$8.23–$75.19	74% below	43%
X-ray of the finger(s), 2 or more views CPT 73140 HC X-RAY EXAM OF FINGER(S)	$50.73	$89.00	$7.11–$84.42	79% below	43%
X-ray of the foot, 2 views CPT 73620 HC X-RAY EXAM OF FOOT 2 VIEWS	$63.27	$111.00	$7.87–$65.87	67% below	43%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-RAY EXAM OF FOOT 3/> VIEWS	$103.74	$182.00	$8.60–$77.80	57% below	43%
X-ray of the hand, 3 or more views CPT 73130 HC X-RAY EXAM OF HAND 3/> VIEWS	$103.74	$182.00	$8.96–$82.88	56% below	43%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-RAY EXAM OF KNEE 1 OR 2 VIEWS	$71.25	$125.00	$8.59–$79.46	66% below	43%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC X-RAY EXAM L-S SPINE 2/3 VWS	$99.18	$174.00	$11.54–$90.77	66% below	43%
X-ray of the lower back, 4 or more views CPT 72110 HC X-RAY EXAM L-2 SPINE 4/>VWS	$156.18	$274.00	$13.38–$115.57	58% below	43%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC X-RAY EXAM THORAC SPINE 2VWS	$94.62	$166.00	$10.43–$75.39	60% below	43%
X-ray of the nasal bones, 3 or more views CPT 70160 HC X-RAY EXAM OF NASAL BONES	$50.73	$89.00	$8.60–$86.28	79% below	43%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC X-RAY EXAM NECK SPINE 2-3 VW	$91.20	$160.00	$11.54–$90.77	62% below	43%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC X-RAY EXAM OF PELVIS 1 OR 2 VIEWS	$62.70	$110.00	$8.96–$67.60	72% below	43%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC X-RAY EXAM SACRUM & COCCYX 2/>	$76.95	$135.00	$8.96–$74.40	64% below	43%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
ACTH blood test CPT 82024 HC ASSAY OF ACTH	$91.77	$161.00	$40.55–$86.81	58% below	43%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC ALANINE AMINO (ALT) (SGPT)	$13.68	$24.00	$5.57–$17.67	61% below	43%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC TRANSFERASE (AST) (SGOT)	$13.68	$24.00	$5.44–$17.28	71% below	43%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC ACUTE HEPATITIS PANEL	$130.53	$229.00	$50.01–$107.07	57% below	43%
Albumin blood test CPT 82040 HC ASSAY OF SERUM ALBUMIN	$13.11	$23.00	$5.20–$16.52	65% below	43%
Aldosterone blood test CPT 82088 HC ASSAY OF ALDOSTERONE	$96.90	$170.00	$42.79–$91.59	50% below	43%
Alkaline phosphatase (ALP) blood test CPT 84075 HC ASSAY ALKALINE PHOSPHATASE	$13.68	$24.00	$5.44–$17.28	72% below	43%
Allergy blood test, specific IgE, per allergen CPT 86003 HC ALLERGEN SPECIFIC IGE	$12.54	$22.00	$4.64–$10.02	50% below	43%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC ALPHA-FETOPROTEIN SERUM	$39.90	$70.00	$17.61–$37.70	52% below	43%
Ammonia blood test CPT 82140 HC ASSAY OF AMMONIA	$38.76	$68.00	$15.30–$32.75	57% below	43%
Amylase blood test CPT 82150 HC ASSAY OF AMYLASE	$33.06	$58.00	$6.80–$45.94	46% below	43%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC CCP ANTIBODY	$32.49	$57.00	$13.60–$29.09	61% below	43%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC ANTINUCLEAR ANTIBODIES	$45.03	$79.00	$12.69–$23.41	34% below	43%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC ASSAY OF NATRIURETIC PEPTIDE	$80.37	$141.00	$41.22–$113.38	44% below	43%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC ASSAY OF NATRIURETIC PEPTIDE - POC	$80.37	$141.00	$41.22–$113.38	44% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULT BACT EX URINE, BLOOD, STOOL	$10.26	$18.00	$9.05–$16.53	80% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, WOUND AEROBIC WITH GRAM STAIN	$10.26	$18.00	$9.05–$16.53	80% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, NASAL	$22.23	$39.00	$9.05–$19.37	58% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, EYE	$22.23	$39.00	$9.05–$19.37	58% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, EAR	$22.23	$39.00	$9.05–$19.37	58% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, THROAT	$22.23	$39.00	$9.05–$19.37	58% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE OTHER SPECIMEN AEROBIC RECTAL SCRN	$43.89	$77.00	$9.05–$19.37	16% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE OTHER SPECIMEN AEROBIC	$43.89	$77.00	$9.05–$19.37	16% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, GENITAL	$44.46	$78.00	$9.05–$19.37	15% below	43%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC CULTURE, SPUTUM	$47.88	$84.00	$9.05–$19.37	9% below	43%
Basic metabolic panel (blood test) CPT 80048 HC BASIC METABOLIC PANEL-CALCIUM, TOTAL	$66.69	$117.00	$8.88–$59.96	25% below	43%
Bilirubin blood test, total CPT 82247 HC BILIRUBIN TOTAL	$13.11	$23.00	$5.27–$16.77	72% below	43%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATHOLOGY GROSS EXAM LVL IV	$124.83	$219.00	$39.50–$94.86	42% below	43%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC SURGICAL PATHOLOGY GROSS EXAM LEVEL IV	$385.32	$676.00	$39.50–$94.86	79% above	43%
Blood culture for bacteria CPT 87040 HC BLOOD CULTURE FOR BACTERIA	$75.81	$133.00	$10.84–$23.22	12% below	43%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE	$13.11	$23.00	$3.00–$9.00	11% below	43%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE - LEGAL	$13.11	$23.00	$3.00–$9.00	11% below	43%
Blood glucose (sugar) test CPT 82947 HC ASSAY GLUCOSE BLOOD QUANTITATIVE - POC	$9.69	$17.00	$4.13–$13.10	60% below	43%
Blood glucose (sugar) test CPT 82947 HC ASSAY GLUCOSE BLOOD QUANTITATIVE	$9.69	$17.00	$4.13–$13.10	60% below	43%
Blood lead test CPT 83655 HC ASSAY OF LEAD - POC	$25.08	$44.00	$12.72–$40.44	54% below	43%
Blood lead test CPT 83655 HC ASSAY OF LEAD	$25.08	$44.00	$12.72–$40.44	54% below	43%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC CHORIONIC GONADOTROPIN ASSAY	$38.76	$68.00	$7.90–$53.34	38% below	43%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN	$10.83	$19.00	$4.15–$13.19	58% below	43%
Blood urea nitrogen (BUN) test CPT 84520 HC ASSAY OF UREA NITROGEN - POC	$10.83	$19.00	$4.15–$13.19	58% below	43%
C-peptide blood test CPT 84681 HC ASSAY OF C-PEPTIDE	$18.81	$33.00	$7.47–$28.72	78% below	43%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-REACTIVE PROTEIN	$13.11	$23.00	$5.44–$11.63	76% below	43%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C DIFF, TOX GEN(S), AMPL TECHN	$43.32	$76.00	$39.13–$67.40	71% below	43%
C. difficile toxin gene test (stool PCR) CPT 87493 HC CLOSTRIDIUM DIFFICILE AMPLIFIED PROBE	$80.37	$141.00	$39.13–$78.87	47% below	43%
CA 19-9 blood test (tumor marker) CPT 86301 HC IMMUNOASSAY TUMOR CA 19-9	$49.59	$87.00	$21.85–$46.78	56% below	43%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC IMMUNOASSAY TUMOR CA 125	$49.59	$87.00	$21.85–$46.78	59% below	43%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19 TEST AMPLIFIED PROBE TECHNIQUE	$74.67	$131.00	$51.31–$70.81	45% below	43%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19 TEST AMPLIFIED PROBE TECHNIQUE - POC	$74.67	$131.00	$51.31–$70.81	45% below	43%
Calcium blood test, total CPT 82310 HC ASSAY OF CALCIUM TOTAL	$17.10	$30.00	$5.42–$17.23	67% below	43%
Carcinoembryonic antigen (CEA) test CPT 82378 HC CARCINOEMBRYONIC ANTIGEN	$78.66	$138.00	$19.91–$42.64	42% below	43%
Chickenpox (varicella) immunity blood test CPT 86787 HC VARICELLA-ZOSTER ANTIBODY	$22.80	$40.00	$8.32–$24.75	69% below	43%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC CHYLAMYDIA TRACHOMATIS DNA AMP PROBE	$106.02	$186.00	$36.84–$78.87	26% below	43%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC LIPID PANEL	$50.73	$89.00	$14.06–$44.76	43% below	43%
Complete blood count (CBC) with differential CPT 85025 HC COMPLETE CBC W/AUTO DIFFERENTIAL WBC	$27.93	$49.00	$8.16–$17.47	61% below	43%
Complete blood count (CBC), no differential CPT 85027 HC COMPLETE CBC AUTOMATED	$23.37	$41.00	$6.79–$14.54	55% below	43%
Comprehensive metabolic panel (blood test) CPT 80053 HC COMPREHENSIVE METABOLIC PANEL	$78.66	$138.00	$11.09–$74.89	31% below	43%
Cortisol blood test, total CPT 82533 HC TOTAL CORTISOL	$58.14	$102.00	$17.12–$36.65	52% below	43%
Creatine kinase (CK) blood test, total CPT 82550 HC ASSAY OF CK (CPK)	$17.10	$30.00	$6.84–$21.75	73% below	43%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE - POC	$13.68	$24.00	$5.38–$17.11	57% below	43%
Creatinine blood test CPT 82565 HC ASSAY OF CREATININE	$13.68	$24.00	$5.38–$17.11	57% below	43%
Cytomegalovirus (CMV) antibody test CPT 86644 HC CMV ANTIBODY	$29.07	$51.00	$15.11–$32.36	59% below	43%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANTITATIVE - POC	$27.93	$49.00	$10.69–$19.54	65% below	43%
D-dimer blood test (blood clot marker) CPT 85379 HC FIBRIN DEGRADATION QUANTITATIVE	$27.93	$49.00	$10.69–$19.54	65% below	43%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC DEHYDROEPIANDROSTERONE-SULFATE	$53.58	$94.00	$23.34–$49.98	62% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC MECONIUM 5 DRUG SCREEN	$64.98	$114.00	$65.25–$108.91	44% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC PROPOXYPHENE, SCREEN AND CONFIRMATION, URINE	$71.82	$126.00	$65.25–$108.91	38% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC DRUG TEST PRESUMPTIVE CHEM ANALYZER	$72.39	$127.00	$65.25–$108.91	38% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC MECONIUM 10 DRUG SCREEN	$80.37	$141.00	$65.25–$108.91	31% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC LSD URINE SCREEN	$83.22	$146.00	$65.25–$108.91	28% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC URINE FENTANYL SCREEN	$103.74	$182.00	$65.25–$108.91	10% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC COTININE SCREEN URINE	$103.74	$182.00	$65.25–$108.91	10% below	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC ETHYL GLUCURONIDE	$115.71	$203.00	$65.25–$108.91	at median	43%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC UMBILICAL CORD DRUG SCREEN	$177.84	$312.00	$65.25–$108.91	53% above	43%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL	$35.91	$63.00	$7.36–$49.74	26% below	43%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC ELECTROLYTE PANEL - POC	$35.91	$63.00	$7.36–$49.74	26% below	43%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC EPSTEIN-BARR CAPSID VCA	$43.89	$77.00	$19.05–$40.79	47% below	43%
Estradiol blood test CPT 82670 HC ASSAY OF ESTRADIOL	$67.26	$118.00	$29.34–$62.80	48% below	43%
FSH (follicle-stimulating hormone) test CPT 83001 HC ASSAY OF GONADOTROPIN (FSH)	$76.95	$135.00	$19.51–$131.75	33% below	43%
Fecal calprotectin (stool inflammation test) CPT 83993 HC ASSAY FOR CALPROTECTIN FECAL	$85.50	$150.00	$20.61–$44.12	55% below	43%
Ferritin blood test (iron stores) CPT 82728 HC ASSAY OF FERRITIN	$38.76	$68.00	$14.31–$30.64	57% below	43%
Fibrinogen blood test CPT 85384 HC FIBRINOGEN ACTIVITY	$28.50	$50.00	$10.21–$19.09	58% below	43%
Folate (folic acid) blood test CPT 82746 HC ASSAY OF FOLIC ACID SERUM	$41.61	$73.00	$15.44–$33.05	58% below	43%
Free T3 thyroid hormone test CPT 84481 HC FREE ASSAY (FT-3)	$34.20	$60.00	$16.91–$32.54	65% below	43%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC ASSAY OF FREE THYROXINE	$34.20	$60.00	$9.47–$20.26	58% below	43%
Free testosterone test CPT 84402 HC ASSAY OF FREE TESTOSTERONE	$50.73	$89.00	$26.74–$57.24	57% below	43%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC ASSAY OF GGT	$23.94	$42.00	$7.56–$24.06	55% below	43%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC 80050 GENERAL HEALTH PANEL	$91.77	$161.00	$55.18–$61.92	67% below	43%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TEST	$18.81	$33.00	$4.99–$15.87	62% below	43%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC GLUCOSE TEST - POC	$18.81	$33.00	$4.99–$15.87	62% below	43%
Glucose tolerance test, 3 samples CPT 82951 HC GLUCOSE TOLERANCE TEST (GTT)	$31.92	$56.00	$13.51–$42.99	64% below	43%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC NESSERIA GONORRHOEAE DNA AMPLIFIED PROBE	$106.02	$186.00	$36.84–$78.87	26% below	43%
H. pylori antibody blood test CPT 86677 HC HELICOBACTER PYLORI ANTIBODY	$22.80	$40.00	$8.32–$27.86	76% below	43%
H. pylori stool antigen test CPT 87338 HC HPYLORI STOOL EIA	$28.50	$50.00	$15.10–$32.32	78% below	43%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC HIV-1 QUANTIFICATION&REVERSE TRANSCRIPT	$200.64	$352.00	$89.36–$191.27	48% below	43%
HIV-1 and HIV-2 antibody test CPT 86703 HC HIV-1/HIV-2 1 RESULT ANTIBODY	$33.06	$58.00	$14.40–$30.81	57% below	43%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC HIV-1 AG W/HIV-1 & HIV-2 AB	$54.15	$95.00	$25.28–$54.12	47% below	43%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC HPV HIGH-RISK TYPES	$57.00	$100.00	$36.84–$78.87	60% below	43%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST - POC	$34.20	$60.00	$10.20–$32.42	50% below	43%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC GLYCOSYLATED HEMOGLOBIN TEST	$34.20	$60.00	$10.20–$32.42	50% below	43%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN - POC	$9.69	$17.00	$2.49–$16.83	45% below	43%
Hemoglobin blood test CPT 85018 HC HEMOGLOBIN	$9.69	$17.00	$2.49–$16.83	45% below	43%
Hepatitis B core antibody test (total) CPT 86704 HC HEP B CORE ANTIBODY TOTAL	$29.07	$51.00	$12.65–$27.08	64% below	43%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC HEP B SURFACE ANTIBODY	$45.03	$79.00	$11.28–$24.14	39% below	43%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC HEPATITIS B SURFACE AG EIA	$25.65	$45.00	$10.85–$23.22	61% below	43%
Hepatitis C antibody blood test (screening) CPT 86803 HC HEPATITIS C ANTIBODY TEST	$16.53	$29.00	$14.98–$27.41	79% below	43%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC HEPATITIS C REVERSE TRANSCRIPTION	$102.03	$179.00	$44.98–$96.28	57% below	43%
Herpes blood test, HSV-1 antibody CPT 86695 HC HERPES SIMPLEX TYPE 1 TEST	$58.71	$103.00	$13.85–$29.65	13% below	43%
Herpes blood test, HSV-2 antibody CPT 86696 HC HERPES SIMPLEX TYPE 2 TEST	$58.71	$103.00	$20.32–$43.51	28% below	43%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN HIGH SENSITIVITY	$18.81	$33.00	$13.60–$29.09	76% below	43%
Homocysteine blood test CPT 83090 HC ASSAY OF HOMOCYSTINE	$26.22	$46.00	$18.82–$37.92	78% below	43%
Insulin blood test CPT 83525 HC ASSAY OF INSULIN TOTAL	$27.93	$49.00	$12.00–$25.69	59% below	43%
Iron blood test (serum iron) CPT 83540 HC ASSAY OF IRON	$27.93	$49.00	$6.79–$14.55	48% below	43%
Iron-binding capacity (TIBC) test CPT 83550 HC IRON BINDING TEST	$32.49	$57.00	$9.18–$19.65	48% below	43%
Kidney function blood test panel CPT 80069 HC RENAL FUNCTION PANEL	$64.98	$114.00	$9.11–$61.56	37% below	43%
LH (luteinizing hormone) test CPT 83002 HC ASSAY OF GONADOTROPIN (LH)	$45.03	$79.00	$19.45–$61.87	54% below	43%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID - POC	$36.48	$64.00	$12.15–$35.67	48% below	43%
Lactate (lactic acid) blood test CPT 83605 HC ASSAY OF LACTIC ACID	$36.48	$64.00	$12.15–$35.67	48% below	43%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC LACTATE (LD) (LDH) ENZYME	$15.39	$27.00	$6.34–$13.56	69% below	43%
Lipase blood test (pancreas enzyme) CPT 83690 HC ASSAY OF LIPASE	$39.33	$69.00	$7.23–$15.48	42% below	43%
Liver function blood test panel CPT 80076 HC HEPATIC FUNCTION PANEL	$64.98	$114.00	$8.58–$18.36	36% below	43%
Lyme disease antibody test CPT 86618 HC LYME DISEASE ANTIBODY	$36.48	$64.00	$17.88–$56.89	56% below	43%
Magnesium blood test CPT 83735 HC ASSAY OF MAGNESIUM	$27.93	$49.00	$7.04–$15.05	47% below	43%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA ANTIBODY	$43.32	$76.00	$13.52–$28.96	47% below	43%
Measles (rubeola) antibody test CPT 86765 HC RUBEOLA IGG	$62.70	$110.00	$13.52–$28.96	24% below	43%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODY SCREEN	$22.23	$39.00	$5.44–$36.70	60% below	43%
Mono test (heterophile antibody, Monospot) CPT 86308 HC HETEROPHILE ANTIBODY SCREEN - POC	$22.23	$39.00	$5.44–$36.70	60% below	43%
Mumps immunity blood test CPT 86735 HC MUMPS	$14.82	$26.00	$13.70–$25.06	83% below	43%
Mumps immunity blood test CPT 86735 HC MUMPS ANTIBODY	$41.04	$72.00	$13.70–$29.32	52% below	43%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$44.46	$78.00	$19.31–$41.35	52% below	43%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$21.09	$37.00	$19.31–$35.33	78% below	43%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC PSA SCREENING	$64.98	$114.00	$19.31–$41.35	32% below	43%
Pap test (liquid-based, automated screening with review) CPT 88175 HC CYTOPATHOLOGY C/V AUTOMATED FLUID REDO	$138.51	$243.00	$27.94–$59.25	32% above	43%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC CYTOPATHOLOGY C/V THIN LAYER	$72.39	$127.00	$21.27–$45.54	20% below	43%
Parathyroid hormone (PTH) blood test CPT 83970 HC ASSAY OF PARATHORMONE	$97.47	$171.00	$43.34–$92.78	54% below	43%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC THROMBOPLASTIN TIME PARTIAL PLASMA OR WB	$22.80	$40.00	$6.31–$13.50	57% below	43%
Phosphorus (phosphate) blood test CPT 84100 HC ASSAY OF PHOSPHORUS	$15.39	$27.00	$4.98–$10.66	63% below	43%
Potassium blood test CPT 84132 HC ASSAY OF SERUM POTASSIUM - POC	$11.97	$21.00	$5.00–$15.36	56% below	43%
Potassium blood test CPT 84132 HC ASSAY OF SERUM POTASSIUM	$11.97	$21.00	$5.00–$15.36	56% below	43%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC FETAL CHRMOML ANEUPLOIDY	$879.51	$1,543.00	$797.00–$1,047.49	27% below	43%
Progesterone blood test CPT 84144 HC ASSAY OF PROGESTERONE	$45.03	$79.00	$21.90–$41.83	63% below	43%
Prolactin blood test CPT 84146 HC ASSAY OF PROLACTIN	$76.95	$135.00	$20.35–$43.56	36% below	43%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME	$13.68	$24.00	$4.50–$13.12	59% below	43%
Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME - POC	$13.68	$24.00	$4.50–$13.12	59% below	43%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRESUMPTIVE DIRECT OPT OBS	$50.73	$89.00	$13.23–$72.36	11% below	43%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC DRUG TEST PRESUMPTIVE DIRECT OPT OBS - POC	$78.66	$138.00	$13.23–$72.36	38% above	43%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP A ASSAY W/OPTIC - POC	$25.65	$45.00	$17.15–$40.07	44% below	43%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP A ASSAY W/OPTIC	$29.07	$51.00	$17.15–$40.07	36% below	43%
Renin blood test CPT 84244 HC ASSAY OF RENIN	$53.01	$93.00	$23.09–$49.43	64% below	43%
Rh blood typing CPT 86901 HC BLOOD TYPING RH (D)	$6.84	$12.00	$3.14–$6.15	83% below	43%
Rheumatoid factor (RF) test CPT 86431 HC RHEUMATOID FACTOR QUANTITATIVE	$23.37	$41.00	$5.95–$12.75	60% below	43%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA ANTIBODY	$35.34	$62.00	$15.11–$32.36	57% below	43%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA AB IGG	$35.34	$62.00	$15.11–$32.36	57% below	43%
Rubella antibody test (immunity check) CPT 86762 HC RUBELLA AB IGM	$35.34	$62.00	$15.11–$32.36	57% below	43%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC RBC SEDIMENTATION RATE AUTOMATED	$7.98	$14.00	$2.84–$6.07	81% below	43%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC SEMEN ANAL VLM CT MOTIL	$25.65	$45.00	$12.93–$27.08	81% below	43%
Sodium blood test CPT 84295 HC ASSAY OF SERUM SODIUM - POC	$13.11	$23.00	$5.05–$16.09	47% below	43%
Sodium blood test CPT 84295 HC ASSAY OF SERUM SODIUM	$13.11	$23.00	$5.05–$16.09	47% below	43%
Stool ova and parasites exam CPT 87177 HC OVA AND PARASITES SMEARS	$22.23	$39.00	$9.35–$20.00	66% below	43%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES - POC	$11.40	$20.00	$4.60–$7.31	46% below	43%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES	$11.40	$20.00	$4.60–$7.31	46% below	43%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC ASSAY SCREEN BLOOD FECAL 1-3	$33.06	$58.00	$16.72–$53.12	45% below	43%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$33.06	$58.00	$16.72–$53.12	45% below	43%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDUM	$17.67	$31.00	$11.32–$25.43	68% below	43%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC TREPONEMA PALLIDUM TPPA	$22.80	$40.00	$11.32–$25.43	59% below	43%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC SYPHILIS TEST NON-TREPONEMAL QUALITATIVE	$17.67	$31.00	$4.48–$9.60	55% below	43%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB TEST CELL IMMUNITY MEASURE	$71.82	$126.00	$65.08–$119.02	72% below	43%
Testosterone blood test, total (not free testosterone) CPT 84403 HC ASSAY OF TOTAL TESTOSTERONE	$84.36	$148.00	$27.10–$56.64	27% below	43%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC MICROSOMAL ANTIBODY EACH	$38.19	$67.00	$15.28–$32.70	45% below	43%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMONE-R	$59.28	$104.00	$17.64–$56.13	34% below	43%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC ASSAY THYROID STIM HORMONE	$59.28	$104.00	$17.64–$56.13	34% below	43%
Total IgE blood test CPT 82785 HC ASSAY OF IGE	$38.76	$68.00	$17.28–$37.01	62% below	43%
Total cholesterol blood test CPT 82465 HC ASSAY BLOOD/SERUM CHOLESTEROL	$11.40	$20.00	$4.57–$14.53	75% below	43%
Total thyroxine (T4) blood test CPT 84436 HC ASSAY OF TOTAL THYROXINE	$25.65	$45.00	$7.21–$15.43	51% below	43%
Total triiodothyronine (T3) blood test CPT 84480 HC ASSAY TRIIODOTHYRONINE (T3)	$35.34	$62.00	$14.89–$31.86	67% below	43%
Transferrin blood test CPT 84466 HC ASSAY OF TRANSFERRIN	$31.92	$56.00	$13.40–$28.69	66% below	43%
Trichomonas test (NAAT) CPT 87661 HC TRICHOMONAS VAGINALIS AMPLIFIED	$40.47	$71.00	$36.84–$65.32	70% below	43%
Triglycerides blood test CPT 84478 HC ASSAY OF TRIGLYCERIDES	$14.82	$26.00	$6.03–$19.20	73% below	43%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE	$59.28	$104.00	$13.09–$22.11	30% below	43%
Troponin test, quantitative CPT 84484 HC ASSAY OF TROPONIN QUANTITATIVE - POC	$59.28	$104.00	$13.09–$22.11	30% below	43%
Uric acid blood test CPT 84550 HC ASSAY OF BLOOD/URIC ACID	$17.10	$30.00	$4.75–$15.09	66% below	43%
Urinalysis with microscope exam, automated CPT 81001 HC URINALYSIS AUTOMATED W/SCOPE	$18.24	$32.00	$3.33–$7.13	49% below	43%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTOMATED W/O SCOPE	$13.68	$24.00	$2.36–$15.91	45% below	43%
Urinalysis without microscope exam, automated CPT 81003 HC URINALYSIS AUTOMATED W/O SCOPE - POC	$13.68	$24.00	$2.36–$15.91	45% below	43%
Urinalysis without microscope exam, manual CPT 81002 HC URINALYSIS NONAUTOMATED W/O SCOPE-POC	$3.99	$7.00	$3.65–$5.74	71% below	43%
Urine culture for bacteria, with colony count CPT 87086 HC URINE CULTURE/COLONY COUNT	$43.32	$76.00	$8.47–$18.15	43% below	43%
Urine microalbumin (albumin) test CPT 82043 HC MICROALBUMIN QUANTITATIVE	$21.09	$37.00	$6.07–$19.32	68% below	43%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST	$16.53	$29.00	$9.04–$14.21	67% below	43%
Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST - POC	$16.53	$29.00	$9.04–$14.21	67% below	43%
Vitamin B12 (cobalamin) blood test CPT 82607 HC VITAMIN B-12	$41.61	$73.00	$15.83–$33.89	59% below	43%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D 25 HYDROXY	$86.07	$151.00	$31.08–$66.54	44% below	43%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC VIT D 1 25-DIHYDROXY	$91.77	$161.00	$40.43–$86.53	43% below	43%
Zinc blood test CPT 84630 HC ASSAY OF ZINC	$25.65	$45.00	$11.96–$23.28	68% below	43%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC CHORIONIC GONADOTROPIN TEST	$61.56	$108.00	$15.80–$33.84	48% below	43%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STRTCTC	$4,377.03	$7,679.00	$168.47–$2,222.59	72% above	43%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC LHC W CORONARY ANGIO/LT VENT	$10,947.99	$19,207.00	$290.49–$3,472.54	12% above	43%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC ELECTIVE CARDIOVERSION	$1,136.01	$1,993.00	$113.16–$524.58	15% above	43%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION EXTERNAL	$1,190.16	$2,088.00	$113.16–$524.58	21% above	43%
Carpal tunnel release, open surgery CPT 64721 HC SONEX CARPAL TUNNEL	$2,584.95	$4,535.00	$461.42–$1,563.41	16% above	43%
Catheter ablation for atrial fibrillation CPT 93656 HC ABLATE AF W EP/AR INDUCT	$39,318.03	$68,979.00	$924.88–$16,158.00	122% above	43%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION W/REGIONL BLOCK	$92.34	$162.00	$99.13	55% below	43%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PRO CIRCUMCISION, NEWBORN	$543.78	$954.00	$99.13–$557.03	167% above	43%
Coronary stent placement, one artery CPT 92928 HC STENT 1ST ART/BRANCH	$23,213.82	$40,726.00	$573.01–$22,700.00	196% above	43%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE IMPACTED EAR WAX UNI	$83.22	$146.00	$16.89–$50.51	10% below	43%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC UC CERUMEN REMOVAL	$123.69	$217.00	$16.89–$50.51	34% above	43%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC NJX INTERLAMINAR CRV/THRC W IMG	$1,946.55	$3,415.00	$112.86–$944.74	47% above	43%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV	$1,340.07	$2,351.00	$95.27–$632.63	17% below	43%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC CATHETER FOR HYSTEROGRAPHY	$665.19	$1,167.00	$59.87–$706.13	98% above	43%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SIMPLE/SINGLE	$283.29	$497.00	$113.81–$439.20	3% below	43%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$542.64	$952.00	$40.26–$197.89	59% above	43%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC INJECT/ASP MAJOR JOINT	$662.91	$1,163.00	$46.76–$222.60	53% above	43%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC INJECT/ASP MEDIUM JOINT	$561.45	$985.00	$38.24–$188.44	75% above	43%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC INJECT/ASP SMALL JOINT	$532.95	$935.00	$37.13–$181.88	44% above	43%
Left heart catheterization, diagnostic one side CPT 93452 HC LT HEART CATH W/ VENT	$4,457.40	$7,820.00	$233.20–$2,963.14	35% below	43%
Lower-back epidural injection, with imaging guidance CPT 62323 HC NJX INTERLAMINAR LMBR/SAC W IMG	$1,946.55	$3,415.00	$104.29–$933.45	70% above	43%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ AA&/STRD TRANSFORAMINAL EPIDURAL L/S	$1,337.22	$2,346.00	$117.30–$862.20	25% above	43%
Lumpectomy (partial mastectomy) CPT 19301 HC PRO MASTECTOMY PARTIAL	$1,279.08	$2,244.00	$667.57–$849.20	60% below	43%
Mastectomy (total removal of the breast) CPT 19303 HC PRO MASTECTOMY SIMPLE COMPLETE	$1,851.36	$3,248.00	$966.47–$1,232.56	74% below	43%
Miscarriage treatment with D&C, first trimester CPT 59820 HC DELIVERY LABOR & DELIVERY =/<12 WKS	$1,026.00	$1,800.00	$393.39–$1,444.61	12% below	43%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PRO EXC TR-EXT B9+MARG 0.5 CM<	$278.16	$488.00	$89.62–$455.40	20% below	43%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC TR-EXT B9+MARG 0.5 CM<	$1,069.89	$1,877.00	$89.62–$455.40	207% above	43%
Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PLATE PARTIAL/COMPLETE INITIAL	$312.93	$549.00	$56.67–$402.90	33% above	43%
Pacemaker implant (dual chamber) CPT 33208 HC PERM PACE/ELECTRODES AV	$30,829.02	$54,086.00	$512.72–$26,705.00	386% above	43%
Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W/IMAGING	$977.55	$1,715.00	$109.86–$1,097.93	24% below	43%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JNT	$3,148.11	$5,523.00	$203.01–$1,513.20	27% above	43%
Removal of a breast lump, open surgery CPT 19120 HC PRO EXC BREAST TISSUE 1/> LESN	$1,283.07	$2,251.00	$426.88–$1,787.78	36% below	43%
Short arm cast (elbow to hand) CPT 29075 HC PT APPLICATION OF FOREARM CAST	$367.65	$645.00	$65.17–$306.38	46% above	43%
Short arm splint (forearm and hand) CPT 29125 HC APPLY FOREARM SPLINT	$131.67	$231.00	$42.23–$229.58	25% below	43%
Short leg splint (calf to foot) CPT 29515 HC APPLICATION SHORT LEG SPLINT CALF FOOT	$207.48	$364.00	$52.12–$253.88	at median	43%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SIMP REP SCALP/NECK/AX/GEN/TRUNK/E 2.5<CM	$304.38	$534.00	$45.42–$324.41	6% below	43%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION	$288.42	$506.00	$48.59–$456.60	20% above	43%
Skin biopsy, punch, one lesion CPT 11104 HC PRO PUNCH BX SKIN SINGLE LESION	$310.65	$545.00	$48.59–$456.60	29% above	43%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC PRO EXCSN MAL LESION TRK/ARM/LEG 0.5 CM/<	$510.15	$895.00	$128.78–$713.96	39% above	43%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC MAL LESION TR-EXT 0.5 CM/<	$1,069.89	$1,877.00	$128.78–$713.96	191% above	43%
Skin tag removal, up to 15 tags CPT 11200 HC REMOVAL SKIN TAG(S) 1-15	$179.55	$315.00	$81.63–$120.51	27% above	43%
Skin tag removal, up to 15 tags CPT 11200 HC PRO REMOVAL OF SKIN TAGS <W/15	$202.92	$356.00	$81.63–$321.68	43% above	43%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PRO SPINAL LUMBAR PUNCTURE	$514.71	$903.00	$63.44–$504.71	15% below	43%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE	$851.01	$1,493.00	$63.44–$504.71	41% above	43%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC FAC SIMP REP FACE < 2.5 CM	$271.89	$477.00	$56.04–$394.13	12% below	43%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION	$288.42	$506.00	$39.38–$362.51	20% above	43%
Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS W IMAGING	$1,288.20	$2,260.00	$112.68–$1,136.18	7% above	43%
Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINT 1/2 MUSCL	$384.18	$674.00	$38.44–$201.11	8% above	43%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC PRO BX BREAST W/DEVICE 1ST LESION ULTRASOUND GU	$1,012.32	$1,776.00	$158.89–$737.01	50% below	43%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG	$4,377.03	$7,679.00	$158.89–$2,198.18	117% above	43%
Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD DIAGNOSTIC	$1,588.59	$2,787.00	$126.80–$1,017.26	8% above	43%
Vein ablation, radiofrequency, first vein CPT 36475 HC RF ENDOVENOUS 1ST VEIN	$5,187.00	$9,100.00	$272.44–$4,945.73	33% above	43%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PRO DEB SUBQ TISSUE 20 SQ CM/<	$233.70	$410.00	$63.16–$283.62	56% below	43%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN/TISSUE 20 SQ CM/<	$634.98	$1,114.00	$63.16–$455.29	19% above	43%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION SERVICE	$387.60	$680.00	$44.61–$125.44	34% below	43%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT	$165.30	$290.00	$8.33–$57.12	91% above	43%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT-RESP	$165.30	$290.00	$8.33–$57.12	91% above	43%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INFUSION INITIAL UP TO 1 HR	$672.03	$1,179.00	$137.25–$468.16	20% above	43%
Critical care, first 30 to 74 minutes CPT 99291 HC ER CRITICAL CARE 1ST HOUR	$1,386.24	$2,432.00	$222.55–$1,957.00	22% below	43%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE/DROWSY	$669.18	$1,174.00	$60.15–$1,000.21	at median	43%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG	$144.21	$253.00	$6.55–$27.01	2% below	43%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ER CARE LEVEL I	$263.34	$462.00	$11.83–$444.00	40% above	43%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ER CARE LEVEL II	$461.13	$809.00	$43.40–$778.00	43% above	43%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ER CARE LEVEL III	$790.02	$1,386.00	$73.88–$1,333.00	33% above	43%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER CARE LEVEL IV	$1,252.29	$2,197.00	$125.71–$1,442.00	36% above	43%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER CARE LEVEL V	$1,564.65	$2,745.00	$182.14–$1,957.00	7% above	43%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC SEXUAL ASSAULT FACILITY	$1,957.38	$3,434.00	$182.14–$3,383.00	33% above	43%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARDIOVASCULAR STRESS TEST	$501.60	$880.00	$39.85–$109.21	37% below	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 37-42 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 43-48 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 49-54 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 61-66 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 67-72 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 73-74 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC AODA OUTPT FAMILY PSYTX W/PT 50 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC MH OUTPT FAMILY PSYTX W/ PT 50MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 26-29 MI	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 30 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 45 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 60 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 45 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 60 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 26-30 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy with the patient, 50 minutes CPT 90847 HC PHP FAMILY PSYTX W/PT 31-36 MIN	$725.04	$1,272.00	$111.39–$352.47	282% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 45 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 26-29 M	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 45 MI	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 60 MI	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 60 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 30 MI	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 26-29	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 30 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 26-30 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 31-36 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 37-42 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 43-48 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 49-54 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 55-60 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 61-66 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 67-72 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Family therapy without the patient, 50 minutes CPT 90846 HC PHP FAMILY PSYTX W/O PT 73-74 MIN	$725.04	$1,272.00	$106.57–$340.30	297% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 16-18 MIN	$33.63	$59.00	$26.22–$37.39	55% below	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 30 MI	$58.14	$102.00	$26.22–$92.44	23% below	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 19-24 MIN	$67.26	$118.00	$26.22–$92.44	11% below	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 31-36 MIN	$67.26	$118.00	$26.22–$92.44	11% below	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 25-30 MIN	$67.26	$118.00	$26.22–$92.44	11% below	43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 45 MIN	$71.25	$125.00	$26.22–$92.44	6% below	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 45 MI	$71.25	$125.00	$26.22–$92.44	6% below	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 60 MIN	$94.62	$166.00	$26.22–$92.44	25% above	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 60 MI	$94.62	$166.00	$26.22–$92.44	25% above	43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 60 MIN	$94.62	$166.00	$26.22–$92.44	25% above	43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 60 MIN	$94.62	$166.00	$26.22–$92.44	25% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 43-48 MIN	$100.32	$176.00	$26.22–$92.44	33% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 37-42 MIN	$100.32	$176.00	$26.22–$92.44	33% above	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 90 MIN	$110.01	$193.00	$26.22–$92.44	46% above	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 120 MIN	$125.97	$221.00	$26.22–$92.44	67% above	43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 90 MIN	$132.24	$232.00	$26.22–$92.44	75% above	43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 90 MIN	$132.24	$232.00	$26.22–$92.44	75% above	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 90 MI	$132.24	$232.00	$26.22–$92.44	75% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 49-54 MIN	$133.95	$235.00	$26.22–$92.44	77% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 55-60 MIN	$133.95	$235.00	$26.22–$92.44	77% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 61-66 MIN	$133.95	$235.00	$26.22–$92.44	77% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 67-72 MIN	$167.58	$294.00	$26.22–$92.44	122% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 73-78 MIN	$167.58	$294.00	$26.22–$92.44	122% above	43%
Group psychotherapy session CPT 90853 HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 120 M	$176.70	$310.00	$26.22–$92.44	134% above	43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 120 MIN	$176.70	$310.00	$26.22–$92.44	134% above	43%
Group psychotherapy session CPT 90853 HC AODA OUTPT GROUP PSYCHOTHERAPY 120 MIN	$176.70	$310.00	$26.22–$92.44	134% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 85-90 MIN	$201.21	$353.00	$26.22–$92.44	167% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 91-96 MIN	$201.21	$353.00	$26.22–$92.44	167% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 79-84 MIN	$201.21	$353.00	$26.22–$92.44	167% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 103-108 MIN	$234.84	$412.00	$26.22–$92.44	211% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 97-102 MIN	$234.84	$412.00	$26.22–$92.44	211% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 109-114 MIN	$267.90	$470.00	$26.22–$92.44	255% above	43%
Group psychotherapy session CPT 90853 HC PHP GROUP PSYCHOTHERAPY 115-120 MIN	$267.90	$470.00	$26.22–$92.44	255% above	43%
Group psychotherapy session CPT 90853 HC IOP AODA GROUP PSYCHOTHERAPY 180 MIN	$359.10	$630.00	$92.44	376% above	43%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INITIAL HYDRATION 31 MIN-1 HR	$275.31	$483.00	$34.65–$110.66	4% below	43%
IV infusion of a medicine, first hour CPT 96365 HC IV INITIAL INFUS 1ST HR THER/PROPH/DIAG	$271.89	$477.00	$66.48–$229.00	14% below	43%
IV push of a medicine, first drug CPT 96374 HC INJ INITIAL IV PUSH THER/PROPH/DIAG	$120.27	$211.00	$39.07–$128.10	27% below	43%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PRO SC/IM THER/PROPJ/DIAG	$67.26	$118.00	$15.38–$46.61	17% below	43%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ SC/IM THER/PROPH/DIAG	$79.23	$139.00	$15.38–$46.61	2% below	43%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC TH MH/AODA OUPT PSYCH DIAG EVAL EA ADTL 15 MIN	$119.13	$209.00	$161.88	46% below	43%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC TELEHEALTH MH/AODA OUTPT PSYCH DIAGNOSTIC EVAL	$286.14	$502.00	$161.88–$476.78	30% above	43%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC MH/AODA OUTPT PSYCH DIAGNOSTIC EVAL 30 MIN	$286.14	$502.00	$161.88–$476.78	30% above	43%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC TELHLTH MH/AODA OUTPT PSYCH DIAG EVAL 30-60 MIN	$599.64	$1,052.00	$161.88–$476.78	173% above	43%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC MH/AODA OUTPT PSYCH DIAGNOSTIC EVAL 60 MIN	$599.64	$1,052.00	$161.88–$476.78	173% above	43%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC MH/AODA OUTPT PSYCH DIAGNOSTIC EVAL 90 MIN	$837.90	$1,470.00	$161.88–$476.78	282% above	43%
Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEUROMUSCULAR REEDUCATION / 15 MIN	$69.54	$122.00	$43.05–$67.56	27% below	43%
Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEUROMUSCULAR REEDUCATION / 15 MIN	$69.54	$122.00	$43.05–$67.56	27% below	43%
New patient office visit, about 30 minutes CPT 99203 HC PRO OFFICE O/P NEW LOW 30 MIN OR >	$200.07	$351.00	$85.89–$233.80	1% above	43%
New patient office visit, about 45 minutes CPT 99204 HC PRO OFFICE O/P NEW MOD 45 MIN OR >	$306.09	$537.00	$140.21–$357.24	36% above	43%
New patient office visit, about 60 minutes CPT 99205 HC PRO OFFICE O/P NEW HI 60 MIN OR >	$380.76	$668.00	$190.58–$451.68	25% above	43%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PRO OFFICE O/P NEW SF 15 MIN OR >	$139.08	$244.00	$49.93–$164.91	6% above	43%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT INITL INDIV 15MIN	$51.30	$90.00	$35.44–$50.57	14% below	43%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX	$153.33	$269.00	$110.00–$110.91	17% below	43%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX	$215.46	$378.00	$104.53–$108.93	32% below	43%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX	$153.33	$269.00	$104.53–$108.93	17% below	43%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX	$184.11	$323.00	$104.53–$108.93	26% below	43%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PT MANUAL THERAPY 1 OR MORE REGIONS/15 MIN	$74.10	$130.00	$34.40–$60.72	23% below	43%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUAL THERAPY 1 OR MORE REGIONS/15 MIN	$74.10	$130.00	$34.40–$60.72	23% below	43%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PT THERAPEUTIC EXERCISES / 15 MIN	$74.10	$130.00	$37.41–$64.83	23% below	43%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISES / 15 MIN	$74.10	$130.00	$37.41–$64.83	23% below	43%
Psychiatric evaluation with medical services CPT 90792 HC MD/NP PSYCH DIAG EVAL W/MED SRVCS	$454.86	$798.00	$183.95–$528.09	65% above	43%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC MH OUTPT PSYTX CRISIS INITIAL 30-74 MIN.	$738.72	$1,296.00	$141.00–$484.52	151% above	43%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC AODA OUTPT PSYTX CRISIS INITIAL 30-74 MIN	$738.72	$1,296.00	$141.00–$484.52	151% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC TELEHEALTH MH OUTPT PSYTX W PT 30 MIN	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC MH OUTPT PSYTX W PT 30 MIN	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC AODA OUTPT PSYTX W/PT 30 MIN	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 31-36 MINUTES	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 25-30 MINUTES	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 19-24 MINUTES	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC PHP PSYTX W PT 16-18 MINUTES	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC AODA IOP PSYTX W/PT 30 MIN	$314.07	$551.00	$232.78	195% above	43%
Psychotherapy session, 30 minutes CPT 90832 HC TELEHEALTH AODA OUTPT PSYTX W/PT 30 MIN	$314.07	$551.00	$74.83–$232.78	195% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC AODA OUTPT PSYTX W/PT 45 MIN	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC MH OUTPT PSYTX W PT 45 MIN	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC AODA IOP PSYTX W/PT 45 MIN	$440.61	$773.00	$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC TELEHEALTH AODA OUTPT PSYTX W/PT 45 MIN	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC TELEHEALTH MH OUTPT PSYTX W PT 45 MIN	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYTX W PT 37-42 MINUTES	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYTX W PT 43-48 MINUTES	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 45 minutes CPT 90834 HC PHP PSYTX W PT 49-54 MINUTES	$440.61	$773.00	$99.06–$309.61	211% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 85-90 MINUTES	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 73-78 MINUTES	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 79-84 MINUTES	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 61-66 MINUTES	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 67-72 MINUTES	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC PHP PSYTX W PT 55-60 MINUTES	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC AODA IOP PSYTX W/PT 60 MIN	$507.30	$890.00	$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC MH OUTPT PSYTX W PT 60 MIN	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC TELEHEALTH MH OUTPT PSYTX W PT 60 MIN	$507.30	$890.00	$146.18–$464.04	138% above	43%
Psychotherapy session, 60 minutes CPT 90837 HC AODA OUTPT PSYTX W/PT 60 MIN	$507.30	$890.00	$146.18–$464.04	138% above	43%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PRO BEHAV CHNG SMOKING 3-10 MIN	$29.07	$51.00	$12.74–$33.27	1% above	43%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN	$64.41	$113.00	$12.74–$33.27	123% above	43%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE/OUTPATIENT VISIT EST LEV 5	$242.82	$426.00	$152.42–$319.23	18% below	43%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC URGENT CARE LEVEL 5	$259.35	$455.00	$152.42–$319.23	12% below	43%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC PRO OFFICE O/P EST HI 40 MIN OR >	$267.33	$469.00	$152.42–$319.23	9% below	43%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PRO OFFICE O/P EST LOW 20 MIN OR >	$135.09	$237.00	$69.68–$163.26	18% below	43%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE/OUTPATIENT VISIT EST LEV 3	$191.52	$336.00	$69.68–$163.26	17% above	43%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC URGENT CARE LEVEL 3	$210.33	$369.00	$69.68–$163.26	28% above	43%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC PRO OFFICE O/P EST MOD 30 MIN OR >	$200.07	$351.00	$102.92–$237.46	7% above	43%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE/OUTPATIENT VISIT EST LEV 4	$215.46	$378.00	$102.92–$237.46	16% above	43%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC URGENT CARE LEVEL 4	$224.01	$393.00	$102.92–$237.46	20% above	43%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC PRO OFFICE O/P EST SF 10 MIN OR >	$88.92	$156.00	$37.18–$98.51	8% below	43%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE/OUTPATIENT VISIT EST LEV 2	$171.00	$300.00	$37.18–$98.51	77% above	43%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC URGENT CARE LEVEL 2	$193.80	$340.00	$37.18–$98.51	101% above	43%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC L&D EVALUATION	$562.02	$986.00	$37.18–$98.51	482% above	43%
Specialist consultation, low complexity or 30+ minutes CPT 99243 HC PRO OFFICE CONSULT NEW/EST LOW	$251.37	$441.00	$93.80–$270.30	26% above	43%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC PRO OFFICE CONSULT NEW/EST MOD	$373.35	$655.00	$142.94–$404.59	17% above	43%
Speech and language evaluation CPT 92523 HC SPEECH SOUND LANGUAGE COMPREHENSION	$320.34	$562.00	$247.87–$552.93	10% below	43%
Speech therapy session, individual CPT 92507 HC SPEECH/HEARING THERAPY INDIVIDUAL	$156.18	$274.00	$83.09–$264.72	38% below	43%
Spirometry (breathing test) CPT 94010 HC SPIROMETRY	$203.49	$357.00	$8.60–$115.29	27% below	43%
Spirometry before and after a bronchodilator CPT 94060 HC BRONCHOSPASM EVAL	$354.54	$622.00	$10.82–$192.69	27% below	43%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THERAPEUTIC ACTIVITIES / 15 MIN	$69.54	$122.00	$48.01–$70.93	23% below	43%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC PT THERAPEUTIC ACTIVITIES / 15 MIN	$69.54	$122.00	$48.01–$70.93	23% below	43%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY	$372.78	$654.00	$101.00–$325.33	87% above	43%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACCINE LIVE/PF 1350UNIT/0.5 ML SUSPENSI	$314.05	$550.97	$316.54	92% above	43%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUSS(ACELL),TET PED/PF SYRINGE 1	$42.39	$74.37	$64.94	3% above	43%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 HEP B VACCINE/DP(A)T-POLIO/PF SYRINGE 1	$170.19	$298.58	$182.18	23% above	43%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC TS2024-25(6MOS UP)/PF SYRINGE 1	$49.98	$87.69	$21.25	57% above	43%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VIRUS VACCINE/PF SYRINGE 1	$149.73	$262.69	$98.11–$262.69	14% above	43%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VIRUS VACCINE/PF 50UNIT/ML SYRINGE 1	$149.77	$262.76	$98.11–$262.76	14% above	43%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE/PF 20MCG/ML SYRINGE 1	$125.34	$219.90	$98.53–$219.90	9% above	43%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE/PF 10MCG/0.5 ML SYRINGE	$53.96	$94.66	$41.86–$94.66	4% below	43%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HAEMPH B POLYSAC CONJ-MENIN/PF 7.5MCG/0.5 ML SOLUT	$70.51	$123.71	$56.91	40% above	43%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACC TS2024-25(65YR UP)/PF 180MCG/0.5 ML SYRIN	$143.20	$251.23	$102.76–$251.23	81% above	43%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACC/PF RECON SOLN 1	$172.80	$303.15	$177.19	13% above	43%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING VAC A,C,Y,W-135 DIP/PF KIT 1	$282.88	$496.28	$294.28	23% above	43%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING C,Y,W-135 VAC 1 OF 2/PF RECON SOLN 1	$318.37	$558.55	$294.28	39% above	43%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B VACCINE,4-COMP SYRINGE 1	$404.35	$709.39	$398.79	75% above	43%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PNEUMOC 13-VAL CONJ-DIP CRM/PF 0.5ML SYRINGE 1	$445.09	$780.86	$361.19–$780.86	52% above	43%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOC 20-VAL CONJ-DIP CRM/PF 0.5ML SYRINGE 1	$358.95	$629.74	$404.12–$629.74	23% above	43%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23-VAL P-SAC VAC 25MCG/0.5 ML SOLUTIO	$195.69	$343.31	$186.86–$343.31	39% above	43%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE (PCEC)/PF 2.5UNIT SUSPENSION FOR RE	$770.67	$1,352.05	$459.97–$1,352.05	33% above	43%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS/PF SYRINGE 1	$91.34	$160.25	$40.11–$160.25	120% above	43%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUSS(ACELL),TET VAC SUSPENSION 1	$106.72	$187.22	$54.14–$187.22	31% above	43%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN	$70.11	$123.00	$22.16–$48.27	81% above	43%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN EACH ADD	$43.32	$76.00	$15.71–$43.33	33% above	43%

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://healthcare.ascension.org/-/media/project/ascension/healthcare/price-transparency-files/wi-csv/390816818-1407803638_ascension-ne-wisconsin-inc-fka-st-elizabeth-hospital-inc_standardcharges.csv