Fort Memorial Hospital
Listed in its price file as “Fort Healthcare Inc.”.
Fort Memorial Hospital in Fort Atkinson, WI publishes cash prices for 254 common procedures listed here, from its own machine-readable price file updated Jun 17, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Wisconsin median for 178 of 248 procedures and above it for 69. By typical cash price it ranks #11 of 93 Wisconsin hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
611 Sherman Avenue East, Fort Atkinson, WI, 53538 Collected Sep 27, 2026 Source price file (920) 568-5000
Acute care hospital Emergency department CMS star rating 4 of 5 CCN 520071 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 WCT TcPO2/ABI,BIL,LIMTD,1-2 LEVLS | $173.12 | $541.00 | $215.86–$508.54 | 52% below | 68% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US UE Art Study WO Exercise Unilat | $176.32 | $551.00 | $219.85–$517.94 | 51% below | 68% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 FL Esophagus | $211.20 | $660.00 | $263.34–$620.40 | 47% below | 68% |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body | $649.60 | $2,030.00 | $809.97–$1,908.20 | 53% below | 68% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Techincal CT Angiography Chest w/Contrast | $1,472.00 | $4,600.00 | $1,835.40–$4,324.00 | 17% below | 68% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST W/ CONTRAST | $1,494.08 | $4,669.00 | $1,862.93–$4,388.86 | 15% below | 68% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest | $1,494.08 | $4,669.00 | $1,862.93–$4,388.86 | 15% below | 68% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest/Abdomen/Pelvis | $1,494.08 | $4,669.00 | $1,862.93–$4,388.86 | 15% below | 68% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA PE Chest | $1,494.08 | $4,669.00 | $1,862.93–$4,388.86 | 15% below | 68% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA Coronary Arteries w/ Quantitative Ca | $438.72 | $1,371.00 | $547.03–$1,288.74 | 74% below | 68% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA Coronary Arteries | $438.72 | $1,371.00 | $547.03–$1,288.74 | 74% below | 68% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart Calcium Scoring w/o | $70.40 | $220.00 | $87.78–$206.80 | 64% above | 68% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen/Pelvis w/o Contrast | $1,461.76 | $4,568.00 | $1,822.63–$4,293.92 | 23% below | 68% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Renal Stone Protocol | $1,461.76 | $4,568.00 | $1,822.63–$4,293.92 | 23% below | 68% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST | $1,747.52 | $5,461.00 | $2,178.94–$5,133.34 | 8% below | 68% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W/ CONTRAST | $1,140.48 | $3,564.00 | $1,422.04–$3,350.16 | 38% below | 68% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w/ Contrast | $1,299.20 | $4,060.00 | $1,619.94–$3,816.40 | 29% below | 68% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd/Pelvis IV Contrast/No Oral/ED Onl | $1,299.20 | $4,060.00 | $1,619.94–$3,816.40 | 29% below | 68% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Enterography | $1,299.20 | $4,060.00 | $1,619.94–$3,816.40 | 29% below | 68% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen/Pelvis w/wo Contrast | $1,688.96 | $5,278.00 | $2,105.92–$4,961.32 | 25% below | 68% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Urogram | $1,688.96 | $5,278.00 | $2,105.92–$4,961.32 | 25% below | 68% |
| CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast | $1,248.64 | $3,902.00 | $1,556.90–$3,667.88 | 15% below | 68% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST | $1,248.64 | $3,902.00 | $1,556.90–$3,667.88 | 15% below | 68% |
| CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast | $844.48 | $2,639.00 | $1,052.96–$2,480.66 | 19% below | 68% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $970.24 | $3,032.00 | $1,209.77–$2,850.08 | 7% below | 68% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast | $760.32 | $2,376.00 | $948.02–$2,233.44 | 23% below | 68% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST | $760.32 | $2,376.00 | $948.02–$2,233.44 | 23% below | 68% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinuses Limited | $760.32 | $2,376.00 | $948.02–$2,233.44 | 23% below | 68% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast | $634.24 | $1,982.00 | $790.82–$1,863.08 | 32% below | 68% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD OR BRAIN W/O CONTRAST | $634.24 | $1,982.00 | $790.82–$1,863.08 | 32% below | 68% |
| CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Contrast | $882.88 | $2,759.00 | $1,100.84–$2,593.46 | 24% below | 68% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD OR BRAIN W/WO CONTRAST | $1,058.56 | $3,308.00 | $1,319.89–$3,109.52 | 21% below | 68% |
| CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/wo Contrast | $1,058.56 | $3,308.00 | $1,319.89–$3,109.52 | 21% below | 68% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast | $893.44 | $2,792.00 | $1,114.01–$2,624.48 | 18% below | 68% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast | $974.40 | $3,045.00 | $1,214.96–$2,862.30 | 10% below | 68% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CONTRAST | $974.40 | $3,045.00 | $1,214.96–$2,862.30 | 10% below | 68% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST | $964.80 | $3,015.00 | $1,202.99–$2,834.10 | 35% below | 68% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast | $984.32 | $3,076.00 | $1,227.32–$2,891.44 | 33% below | 68% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral | $568.32 | $1,776.00 | $708.62–$1,669.44 | — | 68% |
| Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS | $159.04 | $497.00 | $198.30–$467.18 | 7% below | 68% |
| Chest X-ray, 2 views CPT 71046 XR Chest 2 Views | $159.04 | $497.00 | $198.30–$467.18 | 7% below | 68% |
| Chest X-ray, single view CPT 71045 XR Chest 1 View Frontal | $122.88 | $384.00 | $153.22–$360.96 | 5% below | 68% |
| Chest X-ray, single view CPT 71045 XR Babygram | $122.88 | $384.00 | $153.22–$360.96 | 5% below | 68% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Aorta Complete | $333.44 | $1,042.00 | $415.76–$979.48 | 35% below | 68% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete Renal | $333.44 | $1,042.00 | $415.76–$979.48 | 35% below | 68% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton | $292.48 | $914.00 | $364.69–$859.16 | 8% above | 68% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density Limited Peripheral | $178.88 | $559.00 | $223.04–$525.46 | 16% above | 68% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Thorax w/o Contrast | $779.52 | $2,436.00 | $971.96–$2,289.84 | 29% below | 68% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o (Dynamic Airway) | $779.52 | $2,436.00 | $971.96–$2,289.84 | 29% below | 68% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Thorax w/o (High-Res) | $779.52 | $2,436.00 | $971.96–$2,289.84 | 29% below | 68% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST | $860.80 | $2,690.00 | $1,073.31–$2,528.60 | 21% below | 68% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Thorax w/ Contrast | $925.76 | $2,893.00 | $1,154.31–$2,719.42 | 31% below | 68% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST | $1,169.28 | $3,654.00 | $1,457.95–$3,434.76 | 13% below | 68% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Diagnostic Bilateral | $181.12 | $566.00 | $225.83–$532.04 | — | 68% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Voucher Mammogram Diagnostic Bilat | $181.12 | $566.00 | $225.83–$532.04 | — | 68% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Diag Bilat w/Tomosynthesis | $181.12 | $566.00 | $225.83–$532.04 | — | 68% |
| Diagnostic mammogram, one breast one side CPT 77065 MA Post-Procedure Mammogram Unilateral | $147.52 | $461.00 | $183.94–$433.34 | 33% below | 68% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 93925 - Exam Bilat Duplex | $553.60 | $1,730.00 | $690.27–$1,626.20 | — | 68% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE Art Duplex Bilat | $561.92 | $1,756.00 | $700.64–$1,650.64 | — | 68% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Incompetency Bilateral | $617.28 | $1,929.00 | $769.67–$1,813.26 | — | 68% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Duplex Bilateral | $617.28 | $1,929.00 | $769.67–$1,813.26 | — | 68% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UE Venous Duplex Bilateral | $617.28 | $1,929.00 | $769.67–$1,813.26 | — | 68% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Post Ablation Bilateral | $617.28 | $1,929.00 | $769.67–$1,813.26 | — | 68% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Complete with Bubble Study | $974.40 | $3,045.00 | $1,214.96–$2,862.30 | 29% below | 68% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echo Complete | $974.40 | $3,045.00 | $1,214.96–$2,862.30 | 29% below | 68% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 zzMisc Rad Order | $1,533.44 | $4,792.00 | $1,912.01–$4,504.48 | 12% above | 68% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Duct System Imaging | $747.20 | $2,335.00 | $931.67–$2,194.90 | 34% below | 68% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Lab-Home Study | $453.76 | $1,418.00 | $565.78–$1,332.92 | 26% below | 68% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Lab-Sleep Study CPAP/BPAP | $1,834.88 | $5,734.00 | $2,287.87–$5,389.96 | 46% below | 68% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pyloric Stenosis Infant Abdomen | $268.16 | $838.00 | $334.36–$787.72 | 37% below | 68% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited-30 | $268.16 | $838.00 | $334.36–$787.72 | 37% below | 68% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound, abdominal, limited -> Yes | $274.56 | $858.00 | $342.34–$806.52 | 35% below | 68% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Thorax w/o (Screening Low Dose) | $487.36 | $1,523.00 | $607.68–$1,431.62 | 36% above | 68% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Breast w/wo Contrast Bilateral | $427.52 | $1,336.00 | $533.06–$1,255.84 | — | 68% |
| MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast | $1,449.60 | $4,530.00 | $1,807.47–$4,258.20 | 24% below | 68% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/WO CONTRAST | $1,449.60 | $4,530.00 | $1,807.47–$4,258.20 | 24% below | 68% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Enterography | $1,461.76 | $4,568.00 | $1,822.63–$4,293.92 | 49% below | 68% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/wo Contrast | $1,461.76 | $4,568.00 | $1,822.63–$4,293.92 | 49% below | 68% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O CONTRAST | $2,095.04 | $6,547.00 | $2,612.25–$6,154.18 | 26% below | 68% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast | $1,364.16 | $4,263.00 | $1,700.94–$4,007.22 | 16% below | 68% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $1,631.68 | $5,099.00 | $2,034.50–$4,793.06 | 1% above | 68% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST | $1,652.16 | $5,163.00 | $2,060.04–$4,853.22 | 28% below | 68% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/wo Contrast | $2,312.96 | $7,228.00 | $2,883.97–$6,794.32 | at median | 68% |
| MRI of the lower back, no contrast dye CPT 72148 72148-Exam MRI Spine Lumbar w/o Contrast | $1,440.00 | $4,500.00 | $1,795.50–$4,230.00 | 26% below | 68% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast | $1,461.76 | $4,568.00 | $1,822.63–$4,293.92 | 25% below | 68% |
| MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST | $1,551.36 | $4,848.00 | $1,934.35–$4,557.12 | 20% below | 68% |
| MRI of the lower back, without and then with contrast dye CPT 72158 72158-Exam MRI Spine Lumbar w/wo Contrast | $1,600.00 | $5,000.00 | $1,995.00–$4,700.00 | 42% below | 68% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR W/WO CONTRAST | $1,702.72 | $5,321.00 | $2,123.08–$5,001.74 | 38% below | 68% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/wo Contrast | $1,702.72 | $5,321.00 | $2,123.08–$5,001.74 | 38% below | 68% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 72146-Exam MRI Spine Thoracic w/o Contrast | $1,408.00 | $4,400.00 | $1,755.60–$4,136.00 | 29% below | 68% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast | $1,429.12 | $4,466.00 | $1,781.93–$4,198.04 | 28% below | 68% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORACIC W/O CONTRAST | $1,521.60 | $4,755.00 | $1,897.25–$4,469.70 | 23% below | 68% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Total w/wo Contrast | $1,751.36 | $5,473.00 | $2,183.73–$5,144.62 | 15% below | 68% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERVICAL W/WO CONTRAST | $1,751.36 | $5,473.00 | $2,183.73–$5,144.62 | 15% below | 68% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/wo Contrast | $1,751.36 | $5,473.00 | $2,183.73–$5,144.62 | 15% below | 68% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICAL W/O CONTRAST | $1,146.24 | $3,582.00 | $1,429.22–$3,367.08 | 35% below | 68% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast | $1,250.56 | $3,908.00 | $1,559.29–$3,673.52 | 29% below | 68% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Total w/o Contrast | $1,250.56 | $3,908.00 | $1,559.29–$3,673.52 | 29% below | 68% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Prostrate | $2,095.04 | $6,547.00 | $2,612.25–$6,154.18 | 26% below | 68% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST | $2,095.04 | $6,547.00 | $2,612.25–$6,154.18 | 26% below | 68% |
| MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/wo Contrast | $2,095.04 | $6,547.00 | $2,612.25–$6,154.18 | 26% below | 68% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast | $1,499.52 | $4,686.00 | $1,869.71–$4,404.84 | 22% below | 68% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast Limited | $1,499.52 | $4,686.00 | $1,869.71–$4,404.84 | 22% below | 68% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST | $1,499.52 | $4,686.00 | $1,869.71–$4,404.84 | 22% below | 68% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Spect Multi R/S Part 2 | $2,127.68 | $6,649.00 | $2,652.95–$6,250.06 | 20% below | 68% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET/CT Skull Base-Mid Thigh | $2,937.60 | $9,180.00 | $3,662.82–$8,629.20 | 20% below | 68% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Transabdominal US in OB - non OB -> Yes | $269.44 | $842.00 | $335.96–$791.48 | 12% below | 68% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 UC bedside pelvic non-OB US, limited -> Yes | $270.08 | $844.00 | $336.76–$793.36 | 12% below | 68% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ED bedside pelvic non-OB US, limited -> Yes | $270.08 | $844.00 | $336.76–$793.36 | 12% below | 68% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED | $281.28 | $879.00 | $350.72–$826.26 | 9% below | 68% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non-OB Limited | $282.24 | $882.00 | $351.92–$829.08 | 8% below | 68% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Complete | $352.96 | $1,103.00 | $440.10–$1,036.82 | 18% below | 68% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Pregnancy After 1st Trimester | $324.80 | $1,015.00 | $404.99–$954.10 | 33% below | 68% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Fetal > 14 weeks Twins | $324.80 | $1,015.00 | $404.99–$954.10 | 33% below | 68% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Fetal 1st Trimester Twins | $284.48 | $889.00 | $354.71–$835.66 | 27% below | 68% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Pregnancy 1st Trimester | $284.48 | $889.00 | $354.71–$835.66 | 27% below | 68% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 POC Ultrasound | $47.04 | $147.00 | $58.65–$138.18 | 87% below | 68% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 UC Pregnant US, limited -> Yes | $175.04 | $547.00 | $218.25–$514.18 | 52% below | 68% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ED Pregnant US, limited -> Yes | $176.96 | $553.00 | $220.65–$519.82 | 52% below | 68% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Limited | $259.84 | $812.00 | $323.99–$763.28 | 29% below | 68% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES | $266.24 | $832.00 | $331.97–$782.08 | 28% below | 68% |
| Screening mammogram, both breasts both sides CPT 77067 MA Voucher Mammogram Screening Bilat | $144.64 | $452.00 | $180.35–$424.88 | — | 68% |
| Screening mammogram, both breasts both sides CPT 77067 MA Mammogram Screen Bilat w/Tomosynthesi | $144.64 | $452.00 | $180.35–$424.88 | — | 68% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Latency Testing | $696.96 | $2,178.00 | $869.02–$2,047.32 | 79% below | 68% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Study, Attended | $1,393.92 | $4,356.00 | $1,738.04–$4,094.64 | 59% below | 68% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 FL Swallowing Video Study w/ Esophagus | $322.56 | $1,008.00 | $402.19–$947.52 | 8% below | 68% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 FL Swallowing Function w/ Video | $322.56 | $1,008.00 | $402.19–$947.52 | 8% below | 68% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON-OB | $321.28 | $1,004.00 | $400.60–$943.76 | 19% below | 68% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG | $361.60 | $1,130.00 | $450.87–$1,062.20 | 3% below | 68% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $402.56 | $1,258.00 | $501.94–$1,182.52 | 27% below | 68% |
| Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents) | $303.68 | $949.00 | $378.65–$892.06 | 29% below | 68% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue of head or neck | $203.84 | $637.00 | $254.16–$598.78 | 52% below | 68% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 UC Neck ST US -> Yes | $208.64 | $652.00 | $260.15–$612.88 | 51% below | 68% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ER Neck ST US -> Yes | $208.64 | $652.00 | $260.15–$612.88 | 51% below | 68% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid | $250.24 | $782.00 | $312.02–$735.08 | 41% below | 68% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 FL Upper GI | $284.48 | $889.00 | $354.71–$835.66 | 32% below | 68% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 FL Upper GI w/ Air w/ Small Bowel | $284.48 | $889.00 | $354.71–$835.66 | 32% below | 68% |
| X-ray of the abdomen, 1 view CPT 74018 XR Abdomen AP | $129.92 | $406.00 | $161.99–$381.64 | 28% below | 68% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views | $162.88 | $509.00 | $203.09–$478.46 | 29% below | 68% |
| X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views | $294.72 | $921.00 | $367.48–$865.74 | 1% above | 68% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views | $130.88 | $409.00 | $163.19–$384.46 | 35% below | 68% |
| X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Minimum 3 Views | $150.08 | $469.00 | $187.13–$440.86 | 24% below | 68% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views | $146.24 | $457.00 | $182.34–$429.58 | 32% below | 68% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views | $113.92 | $356.00 | $142.04–$334.64 | 38% below | 68% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx Minimum 2 Views | $123.52 | $386.00 | $154.01–$362.84 | 32% below | 68% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase | $30.72 | $96.00 | $38.30–$90.24 | 27% below | 68% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase | $33.92 | $106.00 | $42.29–$99.64 | 29% below | 68% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Green Bean | $12.16 | $38.00 | $15.16–$35.72 | 51% below | 68% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 zzVenipunture MC | $13.12 | $41.00 | $16.36–$38.54 | at median | 68% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 .Venipuncture | $13.12 | $41.00 | $16.36–$38.54 | at median | 68% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw | $13.12 | $41.00 | $16.36–$38.54 | at median | 68% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venous Draw | $13.12 | $41.00 | $16.36–$38.54 | at median | 68% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ER LEGAL SPECIMEN -> Yes | $29.44 | $92.00 | $36.71–$86.48 | 125% above | 68% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 ED Legal Blood Draw Charge | $29.44 | $92.00 | $36.71–$86.48 | 125% above | 68% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh | $24.64 | $77.00 | $30.72–$72.38 | 38% below | 68% |
| C. difficile toxin gene test (stool PCR) CPT 87493 zClostridium difficile Toxin by PCR | $99.20 | $310.00 | $123.69–$291.40 | 31% below | 68% |
| C. difficile toxin gene test (stool PCR) CPT 87493 87493 Clostridium difficile A/B | $99.20 | $310.00 | $123.69–$291.40 | 31% below | 68% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 | $60.80 | $190.00 | $75.81–$178.60 | 48% below | 68% |
| Complete blood count (CBC), no differential CPT 85027 Hematology Profile with Auto Diff and ANC | $28.80 | $90.00 | $35.91–$84.60 | 42% below | 68% |
| Glucose tolerance test, 3 samples CPT 82951 _Glucose Tolerance 2 Hour | $43.20 | $135.00 | $53.87–$126.90 | 50% below | 68% |
| Lyme disease antibody test CPT 86618 86618 - Lyme Disease Antibody IgM | $24.96 | $78.00 | $31.12–$73.32 | 68% below | 68% |
| Measles (rubeola) antibody test CPT 86765 Rubeola Antibody | $40.00 | $125.00 | $49.88–$117.50 | 50% below | 68% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Thin Prep Pap Smear HPV Reflex | $52.48 | $164.00 | $65.44–$154.16 | 40% below | 68% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Thin Prep Pap Smear | $52.48 | $164.00 | $65.44–$154.16 | 40% below | 68% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 .88142 Thin Prep Pap Smear | $57.60 | $180.00 | $71.82–$169.20 | 34% below | 68% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Beta Strep Screen,POC | $40.00 | $125.00 | $49.88–$117.50 | 12% below | 68% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 POC Beta Strep Screen | $43.52 | $136.00 | $54.26–$127.84 | 5% below | 68% |
| Rubella antibody test (immunity check) CPT 86762 Rubella Antibody | $43.20 | $135.00 | $53.87–$126.90 | 46% below | 68% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL Titer Cerebrospinal Fluid | $33.28 | $104.00 | $41.50–$97.76 | 11% below | 68% |
| Uric acid blood test CPT 84550 Uric Acid | $33.92 | $106.00 | $42.29–$99.64 | 27% below | 68% |
| Urinalysis with microscope exam, manual CPT 81000 zzLM - Urinalysis | $24.96 | $78.00 | $31.12–$73.32 | 66% above | 68% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis with Microscopic if Indicated | $16.00 | $50.00 | $19.95–$47.00 | 33% below | 68% |
| Urinalysis without microscope exam, automated CPT 81003 UA Auto, No micro | $16.00 | $50.00 | $19.95–$47.00 | 33% below | 68% |
| Urinalysis without microscope exam, automated CPT 81003 zzUrinalysis | $22.08 | $69.00 | $27.53–$64.86 | 8% below | 68% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis,POC | $13.12 | $41.00 | $16.36–$38.54 | 13% below | 68% |
| Urinalysis without microscope exam, manual CPT 81002 POC Urine DipStick | $36.16 | $113.00 | $45.09–$106.22 | 141% above | 68% |
| Urine pregnancy test, read by color change CPT 81025 U BhCG Qlt,POC | $35.84 | $112.00 | $44.69–$105.28 | 40% below | 68% |
| Urine pregnancy test, read by color change CPT 81025 POC Urine Pregnancy Test | $41.28 | $129.00 | $51.47–$121.26 | 31% below | 68% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 Adenoidectomy Prim Under Age 12 | $1,038.40 | $3,245.00 | $1,294.76–$3,050.30 | 25% below | 68% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 | $5,088.00 | $15,900.00 | $6,344.10–$14,946.00 | 40% below | 68% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 Appendectomy For Rupture | $4,999.68 | $15,624.00 | $6,233.98–$14,686.56 | 3% above | 68% |
| Appendectomy, open surgery CPT 44950 Appendectomy Not Laparo | $3,373.76 | $10,543.00 | $4,206.66–$9,910.42 | 38% above | 68% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj | $5,939.20 | $18,560.00 | $7,405.44–$17,446.40 | 16% above | 68% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscopy Shoulder Rotator Cuff Repair | $7,040.00 | $22,000.00 | $8,778.00–$20,680.00 | 34% above | 68% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 Nsl/Sinus Ndsc Surg W/Dilat Maxillary Sinus | $1,262.40 | $3,945.00 | $1,574.06–$3,708.30 | 34% below | 68% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx, breast, with placement of breast localization device(s) per | $1,572.16 | $4,913.00 | $1,960.29–$4,618.22 | 13% below | 68% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Cltx Dstl Fibular Fx Lat Malls W/O Mnpj | $253.44 | $792.00 | $316.01–$744.48 | 54% below | 68% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed Tx of Metatarsal Fx | $224.32 | $701.00 | $279.70–$658.94 | 63% below | 68% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Corrj Hallux Valgus +-Sesmdc W/Metar Osteot Bunion | $2,432.00 | $7,600.00 | $3,032.40–$7,144.00 | 46% below | 68% |
| Bunion correction with removal of part of the big toe joint CPT 28292 Keller/Mcbride/Mayo Procedure Correction Bunion | $2,109.44 | $6,592.00 | $2,630.21–$6,196.48 | 40% below | 68% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION | $471.04 | $1,472.00 | $587.33–$1,383.68 | 46% below | 68% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion elective electrical conversion of arrhythmia exter | $714.24 | $2,232.00 | $890.57–$2,098.08 | 18% below | 68% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 ER CARDIOVERSION -> Yes | $844.80 | $2,640.00 | $1,053.36–$2,481.60 | 3% below | 68% |
| Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel Surgery | $2,233.92 | $6,981.00 | $2,785.42–$6,562.14 | 20% above | 68% |
| Cataract surgery with lens implant CPT 66984 CATARACT REMOVAL INSERTION OF LENS | $2,851.20 | $8,910.00 | $3,555.09–$8,375.40 | 31% below | 68% |
| Cervical biopsy CPT 57500 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX | $840.64 | $2,627.00 | $1,048.17–$2,469.38 | 42% above | 68% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision Greater Than 28 Days | $1,802.56 | $5,633.00 | $2,247.57–$5,295.02 | 78% above | 68% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 OB Circumcision Charge -> Yes | $198.08 | $619.00 | $246.98–$581.86 | 14% above | 68% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision W/Clamp/Oth Dev W/Block | $1,917.12 | $5,991.00 | $2,390.41–$5,631.54 | 1003% above | 68% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DSTL RDL FX/EPIPHYSL SEP W/O MANJ | $202.88 | $634.00 | $252.97–$595.96 | 67% below | 68% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy W/Tumor Removal Snare | $1,787.20 | $5,585.00 | $2,228.42–$5,249.90 | 14% below | 68% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy | $1,459.84 | $4,562.00 | $1,820.24–$4,288.28 | 24% below | 68% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy Flexible | $1,328.00 | $4,150.00 | $1,655.85–$3,901.00 | 14% below | 68% |
| Complex cataract surgery with lens implant CPT 66982 XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG | $3,023.04 | $9,447.00 | $3,769.35–$8,880.18 | 29% below | 68% |
| Cystoscopy with ureteral stent placement CPT 52332 Scope Bladder And Ureter Insert Stent Into Ureter | $1,797.76 | $5,618.00 | $2,241.58–$5,280.92 | 14% below | 68% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy Separate | $1,306.56 | $4,083.00 | $1,629.12–$3,838.02 | 100% above | 68% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION & CURETTAGE DX&/THER NONOBSTETRIC | $2,893.12 | $9,041.00 | $3,607.36–$8,498.54 | 130% above | 68% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION PREMALIGNANT LESION 1ST | $302.08 | $944.00 | $376.66–$887.36 | 46% above | 68% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Tmpst Anes | $853.12 | $2,666.00 | $1,063.73–$2,506.04 | 40% above | 68% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 UC CERUMEN REMOVAL -> Irrigation | $82.56 | $258.00 | $102.94–$242.52 | 44% above | 68% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 ER CERUMEN REMOVAL -> Irrigation | $109.44 | $342.00 | $136.46–$321.48 | 91% above | 68% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 WCT Cerumen removal irrigation/lav Unilateral | $54.40 | $170.00 | $67.83–$159.80 | 5% below | 68% |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Cerumen remov using irrig/lavage, unilateral | $98.56 | $308.00 | $122.89–$289.52 | 72% above | 68% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE EAR WAX IMPACTED | $63.36 | $198.00 | $79.00–$186.12 | 24% below | 68% |
| Earwax removal with instruments, one ear CPT 69210 Remove Impacted Ear Wax | $65.60 | $205.00 | $81.80–$192.70 | 22% below | 68% |
| Earwax removal with instruments, one ear CPT 69210 UC CERUMEN REMOVAL -> Curettage | $82.56 | $258.00 | $102.94–$242.52 | 2% below | 68% |
| Earwax removal with instruments, one ear CPT 69210 WCT Removal impacted cerumen, one or both ears | $88.96 | $278.00 | $110.92–$261.32 | 6% above | 68% |
| Earwax removal with instruments, one ear CPT 69210 ER CERUMEN REMOVAL -> Curettage | $137.60 | $430.00 | $171.57–$404.20 | 64% above | 68% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy Of Uterus Lining | $396.80 | $1,240.00 | $494.76–$1,165.60 | 46% above | 68% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 Nasal/Sinus Endoscopy W/Ethmoidectomy Total | $2,274.88 | $7,109.00 | $2,836.49–$6,682.46 | 60% below | 68% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Nasal/Sinus Endo W/Frntl Expl W/Wo | $400.32 | $1,251.00 | $499.15–$1,175.94 | 91% below | 68% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Exploration Maxillary Sinus | $1,764.80 | $5,515.00 | $2,200.49–$5,184.10 | 11% below | 68% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Endoscopy, Maxillary Sinus | $1,306.56 | $4,083.00 | $1,629.12–$3,838.02 | 68% below | 68% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN | $635.20 | $1,985.00 | $792.02–$1,865.90 | 25% below | 68% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL | $855.68 | $2,674.00 | $1,066.93–$2,513.56 | 4% below | 68% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE | $3,373.76 | $10,543.00 | $4,206.66–$9,910.42 | at median | 68% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE | $3,373.76 | $10,543.00 | $4,206.66–$9,910.42 | 47% below | 68% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HERNIA 1ST < 3 CM REDUCIBLE | $3,373.76 | $10,543.00 | $4,206.66–$9,910.42 | 59% above | 68% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic Sigmoidoscopy | $416.00 | $1,300.00 | $518.70–$1,222.00 | 50% below | 68% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopic Cholecystectomy | $5,236.48 | $16,364.00 | $6,529.24–$15,382.16 | 29% above | 68% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laparo Cholecystectomy/Graph | $5,249.92 | $16,406.00 | $6,545.99–$15,421.64 | 6% above | 68% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 Removal Of Gallbladder | $5,008.32 | $15,651.00 | $6,244.75–$14,711.94 | 78% above | 68% |
| Hammertoe correction surgery CPT 28285 Repair Of Hammertoe | $2,395.84 | $7,487.00 | $2,987.31–$7,037.78 | 12% below | 68% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoid Banding | $589.12 | $1,841.00 | $734.56–$1,730.54 | 54% below | 68% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Internal Or External | $1,779.84 | $5,562.00 | $2,219.24–$5,228.28 | 20% below | 68% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT | $1,773.44 | $5,542.00 | $2,211.26–$5,209.48 | 78% below | 68% |
| Hysterectomy through an abdominal incision (total) CPT 58150 Total Hysterectomy | $3,797.12 | $11,866.00 | $4,734.53–$11,154.04 | at median | 68% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 US Sonohysterogram | $584.64 | $1,827.00 | $728.97–$1,717.38 | 126% above | 68% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Cath/Contrast Insert for HSG | $584.64 | $1,827.00 | $728.97–$1,717.38 | 126% above | 68% |
| Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy, Ablation | $5,027.52 | $15,711.00 | $6,268.69–$14,768.34 | 5% above | 68% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy, Biopsy | $3,613.44 | $11,292.00 | $4,505.51–$10,614.48 | at median | 68% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERTION INTRAUTERINE DEVICE IUD | $1,094.72 | $3,421.00 | $1,364.98–$3,215.74 | 260% above | 68% |
| Incision and drainage of a simple or single skin abscess CPT 10060 WCT I & D of abscess, simple | $1,106.56 | $3,458.00 | $1,379.74–$3,250.52 | 261% above | 68% |
| Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $1,122.88 | $3,509.00 | $1,400.09–$3,298.46 | 266% above | 68% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Drainage Of Skin Abscess | $1,122.88 | $3,509.00 | $1,400.09–$3,298.46 | 266% above | 68% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair Initial Hernia 5 Yrs Or Over | $5,019.52 | $15,686.00 | $6,258.71–$14,744.84 | 85% above | 68% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection single tendon sheathor liagament aponerous | $278.72 | $871.00 | $347.53–$818.74 | 8% above | 68% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER ARTHROCENTESIS -> Major Joint | $263.68 | $824.00 | $328.78–$774.56 | 24% below | 68% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 FL ARTHROCENTESIS OF MAJOR JOINT BURSAE | $770.56 | $2,408.00 | $960.79–$2,263.52 | 123% above | 68% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Major Joint | $770.56 | $2,408.00 | $960.79–$2,263.52 | 123% above | 68% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 FL ARTHROCENTESIS INTERMEDIATE JOINT | $770.56 | $2,408.00 | $960.79–$2,263.52 | 123% above | 68% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj joint/bursa w/o us | $770.56 | $2,408.00 | $960.79–$2,263.52 | 123% above | 68% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Aspir And Injection Major Jt/Bursa | $770.56 | $2,408.00 | $960.79–$2,263.52 | 123% above | 68% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT | $123.20 | $385.00 | $153.62–$361.90 | 50% below | 68% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER ARTHROCENTESIS -> Interm Joint | $239.68 | $749.00 | $298.85–$704.06 | 18% below | 68% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Aspir And Injection Interm Jt/Bursa | $419.84 | $1,312.00 | $523.49–$1,233.28 | 44% above | 68% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Intermediate Joint | $419.84 | $1,312.00 | $523.49–$1,233.28 | 44% above | 68% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 ER ARTHROCENTESIS -> Small Joint | $240.00 | $750.00 | $299.25–$705.00 | 14% below | 68% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Aspir And Injection Small Jt/Bursa | $372.80 | $1,165.00 | $464.84–$1,095.10 | 34% above | 68% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis Small Joint | $372.80 | $1,165.00 | $464.84–$1,095.10 | 34% above | 68% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthroscopy Knee W/Meniscus Rpr Medial Or Lateral | $3,100.16 | $9,688.00 | $3,865.51–$9,106.72 | 14% below | 68% |
| Knee arthroscopy with meniscus trim CPT 29881 Arthrs Kne Surg W/Meniscectomy Med/Lat W/Shvg | $1,526.08 | $4,769.00 | $1,902.83–$4,482.86 | 46% below | 68% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthrs Knee W/Meniscectomy Med And Lat W/Shaving | $4,015.68 | $12,549.00 | $5,007.05–$11,796.06 | 36% above | 68% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthrs Knee Debridement/Shaving Artclr Crtlg | $3,126.72 | $9,771.00 | $3,898.63–$9,184.74 | 1% above | 68% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopy, Appendectomy | $3,048.00 | $9,525.00 | $3,800.48–$8,953.50 | 17% below | 68% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Laparscpy, Esophagogastric | $5,110.40 | $15,970.00 | $6,372.03–$15,011.80 | 86% above | 68% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g | $5,949.12 | $18,591.00 | $7,417.81–$17,475.54 | 96% above | 68% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Lap surgical, w/total hysterectomy with removal of tubes and or | $6,018.24 | $18,807.00 | $7,503.99–$17,678.58 | 45% above | 68% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA | $4,800.00 | $15,000.00 | $5,985.00–$14,100.00 | 114% above | 68% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAPS SURG RPR RECURRENT INGUINAL HERNIA | $4,800.00 | $15,000.00 | $5,985.00–$14,100.00 | 64% above | 68% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy, Remove Adnexa | $3,779.84 | $11,812.00 | $4,712.99–$11,103.28 | 17% above | 68% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair Intermediate S/A/T/E 2.5 Cm/Less Than | $476.16 | $1,488.00 | $593.71–$1,398.72 | 4% below | 68% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN | $635.20 | $1,985.00 | $792.02–$1,865.90 | 7% above | 68% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL | $480.32 | $1,501.00 | $598.90–$1,410.94 | 38% below | 68% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR | $2,987.20 | $9,335.00 | $3,724.67–$8,774.90 | 44% below | 68% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR | $3,290.24 | $10,282.00 | $4,102.52–$9,665.08 | 73% below | 68% |
| Lumbar spinal fusion (posterior), one level CPT 22612 ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR | $4,918.40 | $15,370.00 | $6,132.63–$14,447.80 | 35% below | 68% |
| Mastectomy (total removal of the breast) CPT 19303 Mast.,Simple, Complete | $5,613.12 | $17,541.00 | $6,998.86–$16,488.54 | 46% above | 68% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Care Of Miscarriage | $3,644.16 | $11,388.00 | $4,543.81–$10,704.72 | 146% above | 68% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Tr-Ext B9Marg 0.5 Cm Less Than Cm | $840.64 | $2,627.00 | $1,048.17–$2,469.38 | 141% above | 68% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Exc Face-Mm B9Marg 0.5 Less Than Cm | $754.88 | $2,359.00 | $941.24–$2,217.46 | 47% above | 68% |
| Nail removal (partial or complete), one nail CPT 11730 WCT Avulsion of nail plate, partial or complete, simiple; single | $583.04 | $1,822.00 | $726.98–$1,712.68 | 159% above | 68% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SMPL 1 | $592.00 | $1,850.00 | $738.15–$1,739.00 | 163% above | 68% |
| Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $615.04 | $1,922.00 | $766.88–$1,806.68 | 173% above | 68% |
| Occipital nerve block (injection for headaches) CPT 64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE | $800.00 | $2,500.00 | $997.50–$2,350.00 | 79% above | 68% |
| Paracentesis with imaging guidance CPT 49083 US Paracentesis | $273.28 | $854.00 | $340.75–$802.76 | 78% below | 68% |
| Paracentesis with imaging guidance CPT 49083 US, guided paracentesis | $833.92 | $2,606.00 | $1,039.79–$2,449.64 | 32% below | 68% |
| Partial knee replacement (one compartment) CPT 27446 Revision Of Knee Joint | $4,783.36 | $14,948.00 | $5,964.25–$14,051.12 | 18% below | 68% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 WCT Excision of nail and nail matrix | $398.08 | $1,244.00 | $496.36–$1,169.36 | 22% above | 68% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excisionof nail and nail matrix | $419.84 | $1,312.00 | $523.49–$1,233.28 | 29% above | 68% |
| Prostate biopsy CPT 55700 Biopsy Of Prostate | $1,280.00 | $4,000.00 | $1,596.00–$3,760.00 | 6% above | 68% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL | $1,825.60 | $5,705.00 | $2,276.30–$5,362.70 | 1% below | 68% |
| Removal of a breast lump, open surgery CPT 19120 Removal Of Breast Lesion | $2,001.28 | $6,254.00 | $2,495.35–$5,878.76 | 7% below | 68% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $2,001.28 | $6,254.00 | $2,495.35–$5,878.76 | 7% below | 68% |
| Removal of a foreign object under the skin, simple CPT 10120 Incision And Removal Foreign Body Subq Tiss Smpl | $571.84 | $1,787.00 | $713.01–$1,679.78 | 98% above | 68% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 Partial Removal Of Thyroid | $5,159.68 | $16,124.00 | $6,433.48–$15,156.56 | 34% above | 68% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colorectal Cancer Screen | $1,328.00 | $4,150.00 | $1,655.85–$3,901.00 | 3% above | 68% |
| Septoplasty to straighten the nasal septum CPT 30520 Repair Of Nasal Septum | $1,932.48 | $6,039.00 | $2,409.56–$5,676.66 | 46% below | 68% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Fragmenting Of Kidney Stone | $9,012.16 | $28,163.00 | $11,237.04–$26,473.22 | 2% below | 68% |
| Short arm splint (forearm and hand) CPT 29125 APPL SHORT ARM SPLINT FOREARM-HAND STATIC | $110.72 | $346.00 | $138.05–$325.24 | 37% below | 68% |
| Short leg cast (below the knee) CPT 29405 Apply Short Leg Cast | $195.20 | $610.00 | $243.39–$573.40 | 13% below | 68% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthroscopy Shoulder Distal Claviculectomy | $3,091.84 | $9,662.00 | $3,855.14–$9,082.28 | 8% below | 68% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shoulder Scope Bone Shaving | $1,190.72 | $3,721.00 | $1,484.68–$3,497.74 | 49% below | 68% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WCT Simple Closure | $545.92 | $1,706.00 | $680.69–$1,603.64 | 68% above | 68% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Superficial Wounds Simple | $575.68 | $1,799.00 | $717.80–$1,691.06 | 77% above | 68% |
| Skin biopsy, punch, one lesion CPT 11104 WCT Punch biopsy of skin, single lesion | $188.16 | $588.00 | $234.61–$552.72 | 15% below | 68% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $191.36 | $598.00 | $238.60–$562.12 | 14% below | 68% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION | $198.40 | $620.00 | $247.38–$582.80 | 11% below | 68% |
| Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy skin single lesion | $198.40 | $620.00 | $247.38–$582.80 | 11% below | 68% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< | $755.20 | $2,360.00 | $941.64–$2,218.40 | 106% above | 68% |
| Skin tag removal, up to 15 tags CPT 11200 WCT Removal of Skin Tags | $222.72 | $696.00 | $277.70–$654.24 | 57% above | 68% |
| Skin tag removal, up to 15 tags CPT 11200 Remvl of skin tags | $673.60 | $2,105.00 | $839.90–$1,978.70 | 376% above | 68% |
| Skin tag removal, up to 15 tags CPT 11200 Removal Of Skin Tags | $673.60 | $2,105.00 | $839.90–$1,978.70 | 376% above | 68% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 ER LUMBAR PUNCTURE -> Yes | $89.60 | $280.00 | $111.72–$263.20 | 85% below | 68% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WCT SMPL REPR SCALP/NCK/AX/GENIT/TRK 2.3-7.5CM | $164.80 | $515.00 | $205.49–$484.10 | 18% below | 68% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $174.72 | $546.00 | $217.85–$513.24 | 13% below | 68% |
| TURP (transurethral resection of the prostate) CPT 52601 Prostatectomy Turp | $4,213.44 | $13,167.00 | $5,253.63–$12,376.98 | 10% above | 68% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 WCT Tangential Biopsy Skin Single Lesion | $180.80 | $565.00 | $225.44–$531.10 | 21% below | 68% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL Bx SKIN SINGLE LESION | $183.36 | $573.00 | $228.63–$538.62 | 20% below | 68% |
| Thoracentesis with imaging guidance CPT 32555 THORACENTESIS NDLE/CATH PLEURA W/IMAGING | $998.40 | $3,120.00 | $1,244.88–$2,932.80 | 13% below | 68% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy And Adenoidectomy Age 12 And Over | $2,428.48 | $7,589.00 | $3,028.01–$7,133.66 | 22% above | 68% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy And Adenoidectomy Under Age 12 | $2,312.64 | $7,227.00 | $2,883.57–$6,793.38 | 22% above | 68% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy 1/2 Age 12 And Greater | $1,265.60 | $3,955.00 | $1,578.05–$3,717.70 | 24% below | 68% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 Tonsillectomy 1/2 Under Age 12 | $2,239.68 | $6,999.00 | $2,792.60–$6,579.06 | 27% above | 68% |
| Total hip replacement CPT 27130 Total Hip Arthroplasty And Prosth | $3,109.44 | $9,717.00 | $3,877.08–$9,133.98 | 49% below | 68% |
| Total knee replacement CPT 27447 Total Knee Arthroplasty | $5,278.08 | $16,494.00 | $6,581.11–$15,504.36 | 16% below | 68% |
| Total shoulder replacement CPT 23472 Arthplsty Glenohumeral Jnt;Total Shoulde | $5,597.44 | $17,492.00 | $6,979.31–$16,442.48 | 7% below | 68% |
| Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy, total or complete | $3,431.04 | $10,722.00 | $4,278.08–$10,078.68 | 1% above | 68% |
| Trigger finger release surgery CPT 26055 Incise Finger Tendon Sheath | $1,958.08 | $6,119.00 | $2,441.48–$5,751.86 | 21% below | 68% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $416.00 | $1,300.00 | $518.70–$1,222.00 | 60% above | 68% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Lap, surgical; w/fulguration of oviducts | $3,627.20 | $11,335.00 | $4,522.67–$10,654.90 | 159% above | 68% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Upper Gi Endoscopy W/Esophag | $1,191.04 | $3,722.00 | $1,485.08–$3,498.68 | 28% below | 68% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd W/Biopsy | $1,148.16 | $3,588.00 | $1,431.61–$3,372.72 | 27% below | 68% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD with biopsy | $1,148.16 | $3,588.00 | $1,431.61–$3,372.72 | 27% below | 68% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Upper Gi Endoscopy W/Lesion | $1,670.72 | $5,221.00 | $2,083.18–$4,907.74 | 5% below | 68% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd | $1,235.20 | $3,860.00 | $1,540.14–$3,628.40 | 16% below | 68% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystouretero W/Lithotripsy | $4,186.56 | $13,083.00 | $5,220.12–$12,298.02 | 134% above | 68% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lit | $4,211.84 | $13,162.00 | $5,251.64–$12,372.28 | 102% above | 68% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal Of Sperm Ducts | $1,978.56 | $6,183.00 | $2,467.02–$5,812.02 | 119% above | 68% |
| Vein ablation, radiofrequency, first vein CPT 36475 US Endovenous Ablation | $2,977.92 | $9,306.00 | $3,713.09–$8,747.64 | 13% below | 68% |
| Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1st VEIN | $2,977.92 | $9,306.00 | $3,713.09–$8,747.64 | 13% below | 68% |
| Wart removal, up to 14 warts CPT 17110 WCT Destruction of benign lesion 1-14 | $172.48 | $539.00 | $215.06–$506.66 | 11% below | 68% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14 | $1,400.32 | $4,376.00 | $1,746.02–$4,113.44 | 625% above | 68% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 WCT Debridement, skin, and subcutaneous tissue | $430.72 | $1,346.00 | $537.05–$1,265.24 | 5% below | 68% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin/Tissue | $443.20 | $1,385.00 | $552.62–$1,301.90 | 2% below | 68% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRI SKIN/AND SUB TISSUE | $443.20 | $1,385.00 | $552.62–$1,301.90 | 2% below | 68% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Perq Skel Fixj Distal Radial Fx/Epiphysl Sep | $3,924.16 | $12,263.00 | $4,892.94–$11,527.22 | 1% above | 68% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 1st hour -> 1st hour | $152.00 | $475.00 | $189.53–$446.50 | 74% below | 68% |
| Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion 1st hour | $152.00 | $475.00 | $189.53–$446.50 | 74% below | 68% |
| Blood transfusion (giving blood or blood components) CPT 36430 ER TRANSFUSE BLOOD PRODUCT -> Yes | $1,085.44 | $3,392.00 | $1,353.41–$3,188.48 | 86% above | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Respiratory Therapy Equipment Charge -> IPPB initial charge | $47.68 | $149.00 | $59.45–$140.06 | 29% below | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Sputum Induction | $52.16 | $163.00 | $65.04–$153.22 | 22% below | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Respiratory Therapy Equipment Charge -> Nebulizer initial set-up | $52.80 | $165.00 | $65.84–$155.10 | 21% below | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Respiratory Therapy Equipment Charge -> Sputum induction initial | $52.80 | $165.00 | $65.84–$155.10 | 21% below | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Respiratory Therapy Equipment Charge -> Flutter valve | $52.80 | $165.00 | $65.84–$155.10 | 21% below | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Respiratory Therapy Equipment Charge -> Metered dose inhaler ini | $56.64 | $177.00 | $70.62–$166.38 | 15% below | 68% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Flutter Valve | $56.96 | $178.00 | $71.02–$167.32 | 15% below | 68% |
| Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care - Lynx Visit Level | $611.84 | $1,912.00 | $762.89–$1,797.28 | 56% below | 68% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG , Awake/Drowsy | $182.72 | $571.00 | $227.83–$536.74 | 73% below | 68% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Awake/Drowsy | $190.08 | $594.00 | $237.01–$558.36 | 72% below | 68% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram | $81.92 | $256.00 | $102.14–$240.64 | 54% above | 68% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG-EMERGENCY DEPT | $79.36 | $248.00 | $98.95–$233.12 | 43% below | 68% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG-EMERGENCY DEPT -> EKG 2 | $81.92 | $256.00 | $102.14–$240.64 | 41% below | 68% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG Acquisition | $81.92 | $256.00 | $102.14–$240.64 | 41% below | 68% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram | $81.92 | $256.00 | $102.14–$240.64 | 41% below | 68% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG-EMERGENCY DEPT -> EKG 1 | $81.92 | $256.00 | $102.14–$240.64 | 41% below | 68% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG-EMERGENCY DEPT -> EKG 3 | $81.92 | $256.00 | $102.14–$240.64 | 41% below | 68% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1 - Lynx Visit Level | $139.20 | $435.00 | $173.57–$408.90 | 26% above | 68% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2 - Lynx Visit Level | $142.72 | $446.00 | $177.95–$419.24 | 46% below | 68% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3 - Lynx Visit Level | $246.72 | $771.00 | $307.63–$724.74 | 39% below | 68% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4 - Lynx Visit Level | $398.08 | $1,244.00 | $496.36–$1,169.36 | 33% below | 68% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5 - Lynx Visit Level | $490.24 | $1,532.00 | $611.27–$1,440.08 | 52% below | 68% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Acquisition | $320.96 | $1,003.00 | $400.20–$942.82 | 59% below | 68% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Electrocardiogram Stress | $333.76 | $1,043.00 | $416.16–$980.42 | 58% below | 68% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Electrocardiogram Stress Exercise | $333.76 | $1,043.00 | $416.16–$980.42 | 58% below | 68% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test w/ Meds | $333.76 | $1,043.00 | $416.16–$980.42 | 58% below | 68% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OBS IV HYDRATION 31-60 MIN -> 31-60 min | $145.28 | $454.00 | $181.15–$426.76 | 49% below | 68% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration 1st Hr | $145.28 | $454.00 | $181.15–$426.76 | 49% below | 68% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 UC IV for Hydration, 1st Hr. | $180.48 | $564.00 | $225.04–$530.16 | 37% below | 68% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER IV FOR HYDRATION, 1ST HR. | $294.72 | $921.00 | $367.48–$865.74 | 3% above | 68% |
| IV infusion of a medicine, first hour CPT 96365 IV Therapy, 1st hr | $159.68 | $499.00 | $199.10–$469.06 | 49% below | 68% |
| IV infusion of a medicine, first hour CPT 96365 IV THRPY OBS W/MEDS 15-90 MIN -> 15-90 min | $159.68 | $499.00 | $199.10–$469.06 | 49% below | 68% |
| IV infusion of a medicine, first hour CPT 96365 UC IV Therapy -> Proph, DX 1st HR, Initial Infusion | $180.16 | $563.00 | $224.64–$529.22 | 43% below | 68% |
| IV infusion of a medicine, first hour CPT 96365 UC IV Therapy -> Proph DX 1st HR, Initial Sep Site | $180.16 | $563.00 | $224.64–$529.22 | 43% below | 68% |
| IV infusion of a medicine, first hour CPT 96365 ER IV THERAPY -> Proph, DX 1st HR, Initial Infusion | $243.52 | $761.00 | $303.64–$715.34 | 22% below | 68% |
| IV infusion of a medicine, first hour CPT 96365 ER IV THERAPY -> Proph, DX 1st HR Initial Sep Site | $243.52 | $761.00 | $303.64–$715.34 | 22% below | 68% |
| IV infusion of a medicine, first hour CPT 96365 Proph, DX 1st HR, Initial Infusion - ER IV THERAPY | $293.76 | $918.00 | $366.28–$862.92 | 6% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM or SQ injection-WH only | $35.52 | $111.00 | $44.29–$104.34 | 55% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM or SQ injection | $38.72 | $121.00 | $48.28–$113.74 | 51% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 OBS IM/SQ | $38.72 | $121.00 | $48.28–$113.74 | 51% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 WCT Therapeutic, prophylactic or diagnostic injection | $51.20 | $160.00 | $63.84–$150.40 | 35% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 FT IMMUNOTHERAPY INJECTION | $52.48 | $164.00 | $65.44–$154.16 | 34% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 UC IM OR SC INJECTION | $52.48 | $164.00 | $65.44–$154.16 | 34% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER IMMUNOTHERAPY INJECTION | $67.84 | $212.00 | $84.59–$199.28 | 14% below | 68% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER IM OR SC INJECTION | $77.12 | $241.00 | $96.16–$226.54 | 3% below | 68% |
| Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Units AT | $61.44 | $192.00 | $76.61–$180.48 | 34% below | 68% |
| New patient office visit, about 30 minutes CPT 99203 MC TechFee Outpt/Office Visit, 99203 | $68.48 | $214.00 | $85.39–$201.16 | 65% below | 68% |
| New patient office visit, about 30 minutes CPT 99203 WCT New patient office visit, level 3 | $191.68 | $599.00 | $239.00–$563.06 | 3% below | 68% |
| New patient office visit, about 45 minutes CPT 99204 MC TechFee Outpt/Office Visit, 99204 | $78.72 | $246.00 | $98.15–$231.24 | 62% below | 68% |
| New patient office visit, about 45 minutes CPT 99204 WCT New patient office visit, level 4 | $246.72 | $771.00 | $307.63–$724.74 | 20% above | 68% |
| New patient office visit, about 60 minutes CPT 99205 MC TechFee Outpt/Office Visit, 99205 | $88.96 | $278.00 | $110.92–$261.32 | 71% below | 68% |
| New patient office visit, about 60 minutes CPT 99205 WCT New patient office visit, level 5 | $324.80 | $1,015.00 | $404.99–$954.10 | 7% above | 68% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 WCT New patient office visit, level 2 | $144.64 | $452.00 | $180.35–$424.88 | 11% above | 68% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Bariatric Initial Evaluation | $24.64 | $77.00 | $30.72–$72.38 | 57% below | 68% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 BARI, Initial Eval, EA 15 min | $26.56 | $83.00 | $33.12–$78.02 | 54% below | 68% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrit Thrpy, Initial EA 15 min | $27.52 | $86.00 | $34.31–$80.84 | 52% below | 68% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT Initial Assessment | $28.48 | $89.00 | $35.51–$83.66 | 50% below | 68% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Units AT | $52.80 | $165.00 | $65.84–$155.10 | 40% below | 68% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 MS-Home Instruction Units | $66.88 | $209.00 | $83.39–$196.46 | 24% below | 68% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Home Instruction Units AT | $81.60 | $255.00 | $101.75–$239.70 | 7% below | 68% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Units AT | $81.60 | $255.00 | $101.75–$239.70 | 7% below | 68% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pre-Op Instruction Units AT | $81.60 | $255.00 | $101.75–$239.70 | 7% below | 68% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 MC TechFee Outpt/Office Visit, 99215 | $98.24 | $307.00 | $122.49–$288.58 | 65% below | 68% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 MC TechFee Consutation Up to 80" | $173.76 | $543.00 | $216.66–$510.42 | 38% below | 68% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 WCT Established patient office visit, level 5 | $246.72 | $771.00 | $307.63–$724.74 | 13% below | 68% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Urgent Care Service Levels -> Est. Patient Visit Level 5 | $391.04 | $1,222.00 | $487.58–$1,148.68 | 38% above | 68% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 MC TechFee Outpt/Office Visit, 99213 | $43.84 | $137.00 | $54.66–$128.78 | 72% below | 68% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Facility-MD Level 3 | $78.08 | $244.00 | $97.36–$229.36 | 51% below | 68% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 MC TechFee Consutation Up to 40" | $107.52 | $336.00 | $134.06–$315.84 | 32% below | 68% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 WCT Established patient office visit, level 3 | $144.64 | $452.00 | $180.35–$424.88 | 8% below | 68% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Lynx Visit Level -> 99294-FT Level 3 | $165.44 | $517.00 | $206.28–$485.98 | 5% above | 68% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Urgent Care Service Levels -> Est. Patient Visit Level 3 | $165.44 | $517.00 | $206.28–$485.98 | 5% above | 68% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 MC TechFee Outpt/Office Visit, 99214 | $61.12 | $191.00 | $76.21–$179.54 | 67% below | 68% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Facility-MD Level 4 | $86.72 | $271.00 | $108.13–$254.74 | 52% below | 68% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 MC TechFee Consutation Up to 60" | $140.16 | $438.00 | $174.76–$411.72 | 23% below | 68% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 WCT Established patient office visit, level 4 | $191.68 | $599.00 | $239.00–$563.06 | 5% above | 68% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Urgent Care Service Levels -> Est. Patient Visit Level 4 | $276.16 | $863.00 | $344.34–$811.22 | 51% above | 68% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Facility-MD Level 2 | $63.04 | $197.00 | $78.60–$185.18 | 35% below | 68% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 MC TechFee Consutation Up to 30" | $87.68 | $274.00 | $109.33–$257.56 | 10% below | 68% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Lynx Visit Level -> 99293-FT Level 2 | $101.44 | $317.00 | $126.48–$297.98 | 4% above | 68% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Urgent Care Service Levels -> Est. Patient Visit Level 2 | $101.44 | $317.00 | $126.48–$297.98 | 4% above | 68% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WCT Established patient office visit, level 2 | $144.64 | $452.00 | $180.35–$424.88 | 48% above | 68% |
| Spirometry (breathing test) CPT 94010 Pulmonary screen | $68.48 | $214.00 | $85.39–$201.16 | 60% below | 68% |
| Spirometry (breathing test) CPT 94010 Spirometry | $70.40 | $220.00 | $87.78–$206.80 | 59% below | 68% |
| Spirometry before and after a bronchodilator CPT 94060 Spirometry Pre-Post Bronchodilator | $113.92 | $356.00 | $142.04–$334.64 | 68% below | 68% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Units AT | $60.80 | $190.00 | $75.81–$178.60 | 28% below | 68% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy | $44.16 | $138.00 | $55.06–$129.72 | 78% below | 68% |
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 Administration Vaccine | $17.92 | $56.00 | $22.34–$52.64 | 52% below | 68% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration -> 1st admin | $19.52 | $61.00 | $24.34–$57.34 | 48% below | 68% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER TETANUS/VACCINE INJECTION -> Yes | $47.04 | $147.00 | $58.65–$138.18 | 26% above | 68% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 FT TOXOID/VACCINE INJECTION -> Yes | $52.48 | $164.00 | $65.44–$154.16 | 40% above | 68% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Administration Addt'l | $17.92 | $56.00 | $22.34–$52.64 | 45% below | 68% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration add'l Vaccine | $20.48 | $64.00 | $25.54–$60.16 | 37% below | 68% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 UC EACH ADDT'L VACCINATION | $23.36 | $73.00 | $29.13–$68.62 | 28% below | 68% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ER EACH ADDT'L VACCINATION | $25.60 | $80.00 | $31.92–$75.20 | 21% below | 68% |
Source file: https://fortmemorial.pt.panaceainc.com/MRFDownload/fortmemorial/fortmemorial