Southwest Health Center
Southwest Health Center in Platteville, WI publishes cash prices for 353 common procedures listed here, from its own machine-readable price file updated Mar 27, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 240 of 349 procedures and below it for 106. By typical cash price it ranks #84 of 93 Wisconsin hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
1400 East Side Road, Platteville WI 53818 Collected Sep 27, 2026 Source price file (608) 348-2331
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 521354 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE 3+ VW | $300.00 | $400.00 | $120.00–$400.00 | 77% above | 25% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE 3+ VW | $300.00 | $400.00 | $120.00–$400.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HP ARTERIAL STUDY EXTREM BILATERAL LIMITED | $171.75 | $229.00 | $68.70–$229.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC ANKLE BRACH INDEX/SGL DOPPLER | $283.50 | $378.00 | $113.40–$378.00 | 22% below | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HP ARTERIAL STUDY EXTREM BILATERAL LIMITED | $171.75 | $229.00 | $68.70–$229.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC ANKLE BRACH INDEX/SGL DOPPLER | $283.50 | $378.00 | $113.40–$378.00 | — | 25% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC XRAY ESOPHAGUS SNGL CONTRAST | $522.00 | $696.00 | $208.80–$696.00 | 31% above | 25% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC XRAY ESOPHAGUS SNGL CONTRAST | $522.00 | $696.00 | $208.80–$696.00 | — | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE SCAN WHOLE BODY | $1,434.75 | $1,913.00 | $573.90–$1,913.00 | 3% above | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE SCAN WHOLE BODY | $1,434.75 | $1,913.00 | $573.90–$1,913.00 | — | 25% |
| Breast ultrasound, complete, one breast one side CPT 76641 HC US BREAST UNILATERAL COMPLETE | $403.50 | $538.00 | $161.40–$538.00 | 10% below | 25% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC US BREAST UNILATERAL COMPLETE | $403.50 | $538.00 | $161.40–$538.00 | — | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST UNILATERAL LIMITED | $321.00 | $428.00 | $128.40–$428.00 | 4% below | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US BREAST UNILATERAL LIMITED | $321.00 | $428.00 | $128.40–$428.00 | — | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIO CHEST W/WO CONTRAST | $2,739.00 | $3,652.00 | $1,095.60–$3,652.00 | 55% above | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIO CHEST W/WO CONTRAST | $2,739.00 | $3,652.00 | $1,095.60–$3,652.00 | — | 25% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN PELVIS WO CONTRAST | $3,164.25 | $4,219.00 | $1,265.70–$4,219.00 | 66% above | 25% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN PELVIS WO CONTRAST | $3,164.25 | $4,219.00 | $1,265.70–$4,219.00 | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST | $3,723.00 | $4,964.00 | $1,489.20–$4,964.00 | 104% above | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN PELVIS W CONTRAST | $3,723.00 | $4,964.00 | $1,489.20–$4,964.00 | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN PELVIS WWO CONTRAST | $3,192.75 | $4,257.00 | $1,277.10–$4,257.00 | 43% above | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN PELVIS WWO CONTRAST | $3,192.75 | $4,257.00 | $1,277.10–$4,257.00 | — | 25% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN WITH IV CONTRAST | $2,350.50 | $3,134.00 | $940.20–$3,134.00 | 60% above | 25% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN MULTI PHASE W CONT | $2,350.50 | $3,134.00 | $940.20–$3,134.00 | 60% above | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN WITH IV CONTRAST | $2,350.50 | $3,134.00 | $940.20–$3,134.00 | — | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN MULTI PHASE W CONT | $2,350.50 | $3,134.00 | $940.20–$3,134.00 | — | 25% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN NON IV CONTRAST | $1,453.50 | $1,938.00 | $581.40–$1,938.00 | 39% above | 25% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN NON IV CONTRAST | $1,453.50 | $1,938.00 | $581.40–$1,938.00 | — | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT SINUS FACIAL BONES NON CONTRAST | $1,698.75 | $2,265.00 | $679.50–$2,265.00 | 72% above | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT SINUS FACIAL BONES NON CONTRAST | $1,698.75 | $2,265.00 | $679.50–$2,265.00 | — | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD NON CONTRAST | $1,554.75 | $2,073.00 | $621.90–$2,073.00 | 66% above | 25% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD NON CONTRAST | $1,554.75 | $2,073.00 | $621.90–$2,073.00 | — | 25% |
| CT scan of the head with contrast CPT 70460 HC CT HEAD WITH CONTRAST | $1,624.50 | $2,166.00 | $649.80–$2,166.00 | 40% above | 25% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD WITH CONTRAST | $1,624.50 | $2,166.00 | $649.80–$2,166.00 | — | 25% |
| CT scan of the head without and with contrast CPT 70470 HC CT HEAD WITH & WITHOUT CONTRAST | $2,125.50 | $2,834.00 | $850.20–$2,834.00 | 58% above | 25% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD WITH & WITHOUT CONTRAST | $2,125.50 | $2,834.00 | $850.20–$2,834.00 | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE NON CONTRAST | $1,716.00 | $2,288.00 | $686.40–$2,288.00 | 58% above | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR POST MYELO OR DISCO | $2,350.50 | $3,134.00 | $940.20–$3,134.00 | 116% above | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE NON CONTRAST | $1,716.00 | $2,288.00 | $686.40–$2,288.00 | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR POST MYELO OR DISCO | $2,350.50 | $3,134.00 | $940.20–$3,134.00 | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL POST MYELO OR DISCO | $1,752.00 | $2,336.00 | $700.80–$2,336.00 | 61% above | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE NON CONTRAST | $1,851.00 | $2,468.00 | $740.40–$2,468.00 | 70% above | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL POST MYELO OR DISCO | $1,752.00 | $2,336.00 | $700.80–$2,336.00 | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE NON CONTRAST | $1,851.00 | $2,468.00 | $740.40–$2,468.00 | — | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS WITH IV CONTRAST | $2,178.00 | $2,904.00 | $871.20–$2,904.00 | 48% above | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS WITH IV CONTRAST | $2,178.00 | $2,904.00 | $871.20–$2,904.00 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC DUPLEX CAROTID BILAT | $1,101.75 | $1,469.00 | $440.70–$1,469.00 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC DUPLEX CAROTID BILAT | $1,101.75 | $1,469.00 | $440.70–$1,469.00 | — | 25% |
| Chest X-ray, 2 views CPT 71046 HC XRAY CHEST 2 VIEWS | $277.50 | $370.00 | $111.00–$370.00 | 62% above | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 HC XRAY CHEST 2 VIEWS | $277.50 | $370.00 | $111.00–$370.00 | — | 25% |
| Chest X-ray, single view CPT 71045 HC XRAY CHEST 1 VIEW | $236.25 | $315.00 | $94.50–$315.00 | 82% above | 25% |
| Chest X-ray, single view inpatient CPT 71045 HC XRAY CHEST 1 VIEW | $236.25 | $315.00 | $94.50–$315.00 | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE | $765.00 | $1,020.00 | $306.00–$1,020.00 | 50% above | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US KIDNEY AND BLADDER | $765.00 | $1,020.00 | $306.00–$1,020.00 | 50% above | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US KIDNEY AND BLADDER | $765.00 | $1,020.00 | $306.00–$1,020.00 | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE | $765.00 | $1,020.00 | $306.00–$1,020.00 | — | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DEXA BONE DENSITY AXIAL SKELETON | $626.25 | $835.00 | $250.50–$835.00 | 131% above | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DEXA BONE DENSITY AXIAL SKELETON | $626.25 | $835.00 | $250.50–$835.00 | — | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DEXA BONE DENSITY PERIPHERAL | $207.75 | $277.00 | $83.10–$277.00 | 34% above | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DEXA BONE DENSITY PERIPHERAL | $207.75 | $277.00 | $83.10–$277.00 | — | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB ANOMALY | $585.00 | $780.00 | $234.00–$780.00 | 1% below | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US OB ANOMALY | $585.00 | $780.00 | $234.00–$780.00 | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST NON CONTRAST | $1,751.25 | $2,335.00 | $700.50–$2,335.00 | 60% above | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST HIRES AND CHEST WO CO | $1,853.25 | $2,471.00 | $741.30–$2,471.00 | 69% above | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST NON CONTRAST | $1,751.25 | $2,335.00 | $700.50–$2,335.00 | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST HIRES AND CHEST WO CO | $1,853.25 | $2,471.00 | $741.30–$2,471.00 | — | 25% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST WITH CONTRAST | $2,049.00 | $2,732.00 | $819.60–$2,732.00 | 53% above | 25% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST WITH CONTRAST | $2,049.00 | $2,732.00 | $819.60–$2,732.00 | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MAMM DX BILATERAL INCLUDES CAD | $463.50 | $618.00 | $185.40–$618.00 | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MAMM DX BILATERAL INCLUDES CAD | $463.50 | $618.00 | $185.40–$618.00 | — | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MAMM DX UNILATERAL INCLUDES CAD | $327.00 | $436.00 | $130.80–$436.00 | 49% above | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MAMM DX UNILATERAL INCLUDES CAD | $327.00 | $436.00 | $130.80–$436.00 | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX VEIN EXTREM BILAT | $1,255.50 | $1,674.00 | $502.20–$1,674.00 | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX VEIN EXTREM BILAT | $1,255.50 | $1,674.00 | $502.20–$1,674.00 | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE 2D WO CON W DOPPLER AND COLOR CMPL | $1,777.50 | $2,370.00 | $711.00–$2,370.00 | 29% above | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE 2D WO CON W DOPPLER AND COLOR CMPL | $1,777.50 | $2,370.00 | $711.00–$2,370.00 | — | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING | $1,888.50 | $2,518.00 | $755.40–$2,518.00 | 66% above | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBILIARY SYSTEM IMAGING | $1,888.50 | $2,518.00 | $755.40–$2,518.00 | — | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATTENDED | $741.75 | $989.00 | $296.70–$989.00 | 21% above | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATTENDED | $741.75 | $989.00 | $296.70–$989.00 | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC POLYSOMN W/CPAP >=6YRS | $4,205.25 | $5,607.00 | $1,682.10–$5,607.00 | 24% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC POLYSOMN W/CPAP >=6YRS | $4,205.25 | $5,607.00 | $1,682.10–$5,607.00 | — | 25% |
| Knee X-ray, 3 views CPT 73562 HC KNEE 3 VW | $300.00 | $400.00 | $120.00–$400.00 | 39% above | 25% |
| Knee X-ray, 3 views inpatient CPT 73562 HC KNEE 3 VW | $300.00 | $400.00 | $120.00–$400.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMEN LIMITED | $472.50 | $630.00 | $189.00–$630.00 | 11% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US PANCREAS | $814.50 | $1,086.00 | $325.80–$1,086.00 | 92% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US LIVER | $814.50 | $1,086.00 | $325.80–$1,086.00 | 92% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US SPLEEN | $814.50 | $1,086.00 | $325.80–$1,086.00 | 92% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US GALLBLADDER | $1,002.75 | $1,337.00 | $401.10–$1,337.00 | 136% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMEN LIMITED | $472.50 | $630.00 | $189.00–$630.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US LIVER | $814.50 | $1,086.00 | $325.80–$1,086.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US SPLEEN | $814.50 | $1,086.00 | $325.80–$1,086.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US PANCREAS | $814.50 | $1,086.00 | $325.80–$1,086.00 | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US GALLBLADDER | $1,002.75 | $1,337.00 | $401.10–$1,337.00 | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT CHEST LOW DOSE FOR LUNG CA SCREEN | $228.00 | $304.00 | $91.20–$304.00 | 37% below | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT CHEST LOW DOSE FOR LUNG CA SCREEN | $228.00 | $304.00 | $91.20–$304.00 | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST | $2,685.75 | $3,581.00 | $1,074.30–$3,581.00 | 61% above | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOWER EXT ANY JOINT NON CONTRAST | $2,685.75 | $3,581.00 | $1,074.30–$3,581.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI KNEE W WO CONT | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | 17% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI HIP W WO CONT | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | 17% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI ANKLE W WO CONT | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | 17% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT ANY JNT W AND WO CONTRAST | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | 17% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI HIP ARTHROGRAM | $3,613.50 | $4,818.00 | $1,445.40–$4,818.00 | 18% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI ANKLE ARTHROGRAM | $3,613.50 | $4,818.00 | $1,445.40–$4,818.00 | 18% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI KNEE ARTHROGRAM | $3,613.50 | $4,818.00 | $1,445.40–$4,818.00 | 18% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI KNEE W WO CONT | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI HIP W WO CONT | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXT ANY JNT W AND WO CONTRAST | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI ANKLE W WO CONT | $3,579.75 | $4,773.00 | $1,431.90–$4,773.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI ANKLE ARTHROGRAM | $3,613.50 | $4,818.00 | $1,445.40–$4,818.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI HIP ARTHROGRAM | $3,613.50 | $4,818.00 | $1,445.40–$4,818.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI KNEE ARTHROGRAM | $3,613.50 | $4,818.00 | $1,445.40–$4,818.00 | — | 25% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W MRCP WO CONT | $3,180.75 | $4,241.00 | $1,272.30–$4,241.00 | 66% above | 25% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN NON CONTRAST | $3,211.50 | $4,282.00 | $1,284.60–$4,282.00 | 68% above | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W MRCP WO CONT | $3,180.75 | $4,241.00 | $1,272.30–$4,241.00 | — | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN NON CONTRAST | $3,211.50 | $4,282.00 | $1,284.60–$4,282.00 | — | 25% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN WITH & WITHOUT CONTRAST | $2,458.50 | $3,278.00 | $983.40–$3,278.00 | 14% below | 25% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W MRCP W WO CONT | $2,458.50 | $3,278.00 | $983.40–$3,278.00 | 14% below | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN WITH & WITHOUT CONTRAST | $2,458.50 | $3,278.00 | $983.40–$3,278.00 | — | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W MRCP W WO CONT | $2,458.50 | $3,278.00 | $983.40–$3,278.00 | — | 25% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN NON CONTRAST | $2,856.75 | $3,809.00 | $1,142.70–$3,809.00 | 76% above | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN NON CONTRAST | $2,856.75 | $3,809.00 | $1,142.70–$3,809.00 | — | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN WITH & WITHOUT CONTRAST | $3,945.75 | $5,261.00 | $1,578.30–$5,261.00 | 71% above | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN WITH & WITHOUT CONTRAST | $3,945.75 | $5,261.00 | $1,578.30–$5,261.00 | — | 25% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI SPINE LUMBAR NON CONTRAST | $3,042.75 | $4,057.00 | $1,217.10–$4,057.00 | 56% above | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI SPINE LUMBAR NON CONTRAST | $3,042.75 | $4,057.00 | $1,217.10–$4,057.00 | — | 25% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI SPINE LUMBAR WITH & WITHOUT CONTRAST | $3,606.00 | $4,808.00 | $1,442.40–$4,808.00 | 32% above | 25% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI SPINE LUMBAR WITH & WITHOUT CONTRAST | $3,606.00 | $4,808.00 | $1,442.40–$4,808.00 | — | 25% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI SPINE THORACIC NON CONTRAST | $2,994.00 | $3,992.00 | $1,197.60–$3,992.00 | 51% above | 25% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI SPINE THORACIC NON CONTRAST | $2,994.00 | $3,992.00 | $1,197.60–$3,992.00 | — | 25% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI SPINE CERVICAL WITH & WITHOUT CONTRAST | $3,410.25 | $4,547.00 | $1,364.10–$4,547.00 | 66% above | 25% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI SPINE CERVICAL WITH & WITHOUT CONTRAST | $3,410.25 | $4,547.00 | $1,364.10–$4,547.00 | — | 25% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI SPINE CERVICAL NON CONTRAST | $3,082.50 | $4,110.00 | $1,233.00–$4,110.00 | 75% above | 25% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI SPINE CERVICAL NON CONTRAST | $3,082.50 | $4,110.00 | $1,233.00–$4,110.00 | — | 25% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS WITH & WITHOUT CONTRAST | $3,313.50 | $4,418.00 | $1,325.40–$4,418.00 | 17% above | 25% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS MALE W WO CONT | $3,582.75 | $4,777.00 | $1,433.10–$4,777.00 | 27% above | 25% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS FEMALE W WO CONT | $3,616.50 | $4,822.00 | $1,446.60–$4,822.00 | 28% above | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS WITH & WITHOUT CONTRAST | $3,313.50 | $4,418.00 | $1,325.40–$4,418.00 | — | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS MALE W WO CONT | $3,582.75 | $4,777.00 | $1,433.10–$4,777.00 | — | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS FEMALE W WO CONT | $3,616.50 | $4,822.00 | $1,446.60–$4,822.00 | — | 25% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS NON CONTRAST | $2,166.00 | $2,888.00 | $866.40–$2,888.00 | 13% above | 25% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS NON CONTRAST | $2,166.00 | $2,888.00 | $866.40–$2,888.00 | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST | $2,568.00 | $3,424.00 | $1,027.20–$3,424.00 | 41% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UPPER EXT ANY JOINT NON CONTRAST | $2,568.00 | $3,424.00 | $1,027.20–$3,424.00 | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HP NM MYOCARDIAL SPEC STRESS/REST | $896.25 | $1,195.00 | $358.50–$1,195.00 | 66% below | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM MYOCARD PERFUSION SPECT STRESS AND REST | $3,948.75 | $5,265.00 | $1,579.50–$5,265.00 | 49% above | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HP NM MYOCARDIAL SPEC STRESS/REST | $896.25 | $1,195.00 | $358.50–$1,195.00 | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM MYOCARD PERFUSION SPECT STRESS AND REST | $3,948.75 | $5,265.00 | $1,579.50–$5,265.00 | — | 25% |
| OCT scan of the retina (optical coherence tomography) CPT 92134 HC CPTR OPHTH DX IMG POST SEGMT | $79.50 | $106.00 | $31.80–$106.00 | 111% above | 25% |
| OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HC CPTR OPHTH DX IMG POST SEGMT | $79.50 | $106.00 | $31.80–$106.00 | — | 25% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC NM PET/CT SKULL TO MID THIGH | $3,096.75 | $4,129.00 | $1,238.70–$4,129.00 | 16% below | 25% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC NM PET/CT SKULL TO MID THIGH | $3,096.75 | $4,129.00 | $1,238.70–$4,129.00 | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIS LIMITED | $610.50 | $814.00 | $244.20–$814.00 | 98% above | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIS LIMITED | $610.50 | $814.00 | $244.20–$814.00 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS COMPLETE | $524.25 | $699.00 | $209.70–$699.00 | 22% above | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS COMPLETE | $524.25 | $699.00 | $209.70–$699.00 | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB 14+ WKS SINGLE GEST | $643.50 | $858.00 | $257.40–$858.00 | 32% above | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB 14+ WKS SINGLE GEST | $643.50 | $858.00 | $257.40–$858.00 | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB < 14 WKS SINGLE GEST | $554.25 | $739.00 | $221.70–$739.00 | 42% above | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB < 14 WKS SINGLE GEST | $554.25 | $739.00 | $221.70–$739.00 | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB ANOMALY FOLLOW UP | $557.25 | $743.00 | $222.90–$743.00 | 52% above | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANT UTERUS LIMITED 1+ FETUSES | $557.25 | $743.00 | $222.90–$743.00 | 52% above | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANT UTERUS LIMITED 1+ FETUSES | $557.25 | $743.00 | $222.90–$743.00 | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB ANOMALY FOLLOW UP | $557.25 | $743.00 | $222.90–$743.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 HC MAMM SCREEN BILAT INCLUDES CAD | $325.50 | $434.00 | $130.20–$434.00 | — | 25% |
| Screening mammogram, both breasts one side CPT 77067 HC MAMM SCREEN UNILAT INCLUDES CAD | $335.25 | $447.00 | $134.10–$447.00 | 84% above | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC MAMM SCREEN BILAT INCLUDES CAD | $325.50 | $434.00 | $130.20–$434.00 | — | 25% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MAMM SCREEN UNILAT INCLUDES CAD | $335.25 | $447.00 | $134.10–$447.00 | — | 25% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER 2+ VW | $329.25 | $439.00 | $131.70–$439.00 | 91% above | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER 2+ VW | $329.25 | $439.00 | $131.70–$439.00 | — | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC POLYSOMN 4 OR MORE >=6YRS | $4,215.75 | $5,621.00 | $1,686.30–$5,621.00 | 25% above | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC POLYSOMN 4 OR MORE >=6YRS | $4,215.75 | $5,621.00 | $1,686.30–$5,621.00 | — | 25% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HC TTE 2D W STRESS W EKG MONITOR WO CONTRST | $1,729.50 | $2,306.00 | $691.80–$2,306.00 | 5% above | 25% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 HC TTE 2D W STRESS W EKG MONITOR WO CONTRST | $1,729.50 | $2,306.00 | $691.80–$2,306.00 | — | 25% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOW FUNCT W VIDEO W CONTRAST | $588.75 | $785.00 | $235.50–$785.00 | 69% above | 25% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC SWALLOW FUNCT W VIDEO W CONTRAST | $588.75 | $785.00 | $235.50–$785.00 | — | 25% |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB | $477.00 | $636.00 | $190.80–$636.00 | 20% above | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB | $477.00 | $636.00 | $190.80–$636.00 | — | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC US PREGNANT UTERUS TRANSVAGINAL | $378.00 | $504.00 | $151.20–$504.00 | 2% above | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US PREGNANT UTERUS TRANSVAGINAL | $378.00 | $504.00 | $151.20–$504.00 | — | 25% |
| Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE | $679.50 | $906.00 | $271.80–$906.00 | 23% above | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE | $679.50 | $906.00 | $271.80–$906.00 | — | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM AND CONTENTS | $559.50 | $746.00 | $223.80–$746.00 | 31% above | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM AND TESTICLES | $671.25 | $895.00 | $268.50–$895.00 | 57% above | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM AND CONTENTS | $559.50 | $746.00 | $223.80–$746.00 | — | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM AND TESTICLES | $671.25 | $895.00 | $268.50–$895.00 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD NECK TISSUES B - SCAN REAL TIME | $461.25 | $615.00 | $184.50–$615.00 | 8% above | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US THYROID | $615.00 | $820.00 | $246.00–$820.00 | 44% above | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US HEAD NECK TISSUES B - SCAN REAL TIME | $461.25 | $615.00 | $184.50–$615.00 | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US THYROID | $615.00 | $820.00 | $246.00–$820.00 | — | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC XRAY UPPER GI SINGLE CONTRAST | $684.75 | $913.00 | $273.90–$913.00 | 63% above | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC XRAY UPPER GI SINGLE CONTRAST | $684.75 | $913.00 | $273.90–$913.00 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT | $714.00 | $952.00 | $285.60–$952.00 | 19% above | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC DUPLEX VEIN EXTREM UNILAT | $714.00 | $952.00 | $285.60–$952.00 | — | 25% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST 3+ VW | $281.25 | $375.00 | $112.50–$375.00 | 43% above | 25% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST 3+ VW | $281.25 | $375.00 | $112.50–$375.00 | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS | $204.00 | $272.00 | $81.60–$272.00 | 2% below | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XRAY HIP UNILAT 2-3 VIEWS | $204.00 | $272.00 | $81.60–$272.00 | — | 25% |
| X-ray of the abdomen, 1 view CPT 74018 HC XRAY ABDOMEN 1 VIEW | $219.75 | $293.00 | $87.90–$293.00 | 21% above | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XRAY ABDOMEN 1 VIEW | $219.75 | $293.00 | $87.90–$293.00 | — | 25% |
| X-ray of the ankle, 2 views CPT 73600 HC ANKLE 2 VW | $237.75 | $317.00 | $95.10–$317.00 | 57% above | 25% |
| X-ray of the ankle, 2 views CPT 73600 HC ANKLE SINGLE VIEW | $329.25 | $439.00 | $131.70–$439.00 | 118% above | 25% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE 2 VW | $237.75 | $317.00 | $95.10–$317.00 | — | 25% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE SINGLE VIEW | $329.25 | $439.00 | $131.70–$439.00 | — | 25% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC FINGERS (MULTIPLE) | $210.00 | $280.00 | $84.00–$280.00 | 21% above | 25% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGERS (MULTIPLE) | $210.00 | $280.00 | $84.00–$280.00 | — | 25% |
| X-ray of the foot, 2 views CPT 73620 HC XR FOOT 1VW | $178.50 | $238.00 | $71.40–$238.00 | 1% below | 25% |
| X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VW | $231.75 | $309.00 | $92.70–$309.00 | 29% above | 25% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 1VW | $178.50 | $238.00 | $71.40–$238.00 | — | 25% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VW | $231.75 | $309.00 | $92.70–$309.00 | — | 25% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT 3+ VW | $219.75 | $293.00 | $87.90–$293.00 | 5% above | 25% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT 3+ VW | $219.75 | $293.00 | $87.90–$293.00 | — | 25% |
| X-ray of the hand, 3 or more views CPT 73130 HC HAND 3+ VW | $291.75 | $389.00 | $116.70–$389.00 | 50% above | 25% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND 3+ VW | $291.75 | $389.00 | $116.70–$389.00 | — | 25% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC PATELLA | $213.75 | $285.00 | $85.50–$285.00 | 30% above | 25% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 1 OR 2 VW | $285.00 | $380.00 | $114.00–$380.00 | 73% above | 25% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC PATELLA | $213.75 | $285.00 | $85.50–$285.00 | — | 25% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 1 OR 2 VW | $285.00 | $380.00 | $114.00–$380.00 | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBAR SPINE 2 OR 3 VW | $378.00 | $504.00 | $151.20–$504.00 | 64% above | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBAR SPINE 2 OR 3 VW | $378.00 | $504.00 | $151.20–$504.00 | — | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 HC LUMBAR SPINE 4+ VW | $546.75 | $729.00 | $218.70–$729.00 | 87% above | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBAR SPINE 4+ VW | $546.75 | $729.00 | $218.70–$729.00 | — | 25% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC THORACIC SPINE 2 VW | $243.00 | $324.00 | $97.20–$324.00 | 20% above | 25% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC THORACIC SPINE 2 VW | $243.00 | $324.00 | $97.20–$324.00 | — | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES | $330.75 | $441.00 | $132.30–$441.00 | 67% above | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES | $330.75 | $441.00 | $132.30–$441.00 | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE 2 OR 3 VW | $336.75 | $449.00 | $134.70–$449.00 | 56% above | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE 2 OR 3 VW | $336.75 | $449.00 | $134.70–$449.00 | — | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS 1 OR 2 VW | $301.50 | $402.00 | $120.60–$402.00 | 64% above | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS 1 OR 2 VW | $301.50 | $402.00 | $120.60–$402.00 | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM AND COCCYX | $329.25 | $439.00 | $131.70–$439.00 | 81% above | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM AND COCCYX | $329.25 | $439.00 | $131.70–$439.00 | — | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 LCHG ALT I | $46.50 | $62.00 | $18.60–$62.00 | 10% above | 25% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 LCHG ALT | $60.00 | $80.00 | $24.00–$80.00 | 42% above | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 LCHG ALT I | $46.50 | $62.00 | $18.60–$62.00 | — | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 LCHG ALT | $60.00 | $80.00 | $24.00–$80.00 | — | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 LCHG AST BLOOD | $54.75 | $73.00 | $21.90–$73.00 | 15% above | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 LCHG AST BLOOD | $54.75 | $73.00 | $21.90–$73.00 | — | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 LCHG HEPATITIS SCREEN ACUTE | $339.75 | $453.00 | $135.90–$453.00 | 12% above | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 LCHG HEPATITIS SCREEN ACUTE | $339.75 | $453.00 | $135.90–$453.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN INDIVIDUAL | $10.50 | $14.00 | $4.20–$14.00 | 58% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN BIRCH IGE | $12.00 | $16.00 | $4.80–$16.00 | 52% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN SPEC IGE QUANT EACH | $15.00 | $20.00 | $6.00–$20.00 | 40% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN MILK IGE | $18.00 | $24.00 | $7.20–$24.00 | 28% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN PEANUT IGE | $22.50 | $30.00 | $9.00–$30.00 | 10% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN DERM PTERONYSSINUS IGE | $22.50 | $30.00 | $9.00–$30.00 | 10% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN RAGWEED IGE | $22.50 | $30.00 | $9.00–$30.00 | 10% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 LCHG ALLERGEN DERM FARINAE IGE | $22.50 | $30.00 | $9.00–$30.00 | 10% below | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN INDIVIDUAL | $10.50 | $14.00 | $4.20–$14.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN BIRCH IGE | $12.00 | $16.00 | $4.80–$16.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN SPEC IGE QUANT EACH | $15.00 | $20.00 | $6.00–$20.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN MILK IGE | $18.00 | $24.00 | $7.20–$24.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN PEANUT IGE | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN DERM FARINAE IGE | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN RAGWEED IGE | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LCHG ALLERGEN DERM PTERONYSSINUS IGE | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP) I | $140.25 | $187.00 | $56.10–$187.00 | 75% above | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP) | $182.25 | $243.00 | $72.90–$243.00 | 128% above | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP) I | $140.25 | $187.00 | $56.10–$187.00 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 LCHG CYCLIC CITRUL PEPTIDE AB IGG (CCP) | $182.25 | $243.00 | $72.90–$243.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 LCHG ANA BLOOD SCREEN I | $22.50 | $30.00 | $9.00–$30.00 | 67% below | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 LCHG ANA BLOOD SCREEN | $114.00 | $152.00 | $45.60–$152.00 | 66% above | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 LCHG ANA I | $117.75 | $157.00 | $47.10–$157.00 | 72% above | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 LCHG ANA II | $123.75 | $165.00 | $49.50–$165.00 | 80% above | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LCHG ANA BLOOD SCREEN I | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LCHG ANA BLOOD SCREEN | $114.00 | $152.00 | $45.60–$152.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LCHG ANA I | $117.75 | $157.00 | $47.10–$157.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LCHG ANA II | $123.75 | $165.00 | $49.50–$165.00 | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LCHG PRO BRAIN NATRIURETIC PEPTIDE | $111.75 | $149.00 | $44.70–$149.00 | 19% below | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 LCHG B-TYPE NATRIURETIC PEPTIDE | $114.75 | $153.00 | $45.90–$153.00 | 17% below | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 LCHG PRO BRAIN NATRIURETIC PEPTIDE | $111.75 | $149.00 | $44.70–$149.00 | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 LCHG B-TYPE NATRIURETIC PEPTIDE | $114.75 | $153.00 | $45.90–$153.00 | — | 25% |
| Basic metabolic panel (blood test) CPT 80048 LCHG BASIC METABOLIC PANEL (CA TOTAL) | $151.50 | $202.00 | $60.60–$202.00 | 77% above | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 LCHG BASIC METABOLIC PANEL (CA TOTAL) | $151.50 | $202.00 | $60.60–$202.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LCHG PROSTATE NEEDLE BIOPSY TC | $122.25 | $163.00 | $48.90–$163.00 | 40% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LCHG SP G+M LEVEL IV NL | $129.75 | $173.00 | $51.90–$173.00 | 36% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LCHG SP G+M LEVEL IV TC NL II | $163.50 | $218.00 | $65.40–$218.00 | 19% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC TISSUE EXAM BY PATHOLOGIST LVL 4 | $193.50 | $258.00 | $77.40–$258.00 | 4% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LCHG SP G+M LEVEL IV TC | $204.75 | $273.00 | $81.90–$273.00 | 1% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 LCHG CELL BLOCK | $204.75 | $273.00 | $81.90–$273.00 | 1% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LCHG PROSTATE NEEDLE BIOPSY TC | $122.25 | $163.00 | $48.90–$163.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LCHG SP G+M LEVEL IV NL | $129.75 | $173.00 | $51.90–$173.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LCHG SP G+M LEVEL IV TC NL II | $163.50 | $218.00 | $65.40–$218.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC TISSUE EXAM BY PATHOLOGIST LVL 4 | $193.50 | $258.00 | $77.40–$258.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LCHG SP G+M LEVEL IV TC | $204.75 | $273.00 | $81.90–$273.00 | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LCHG CELL BLOCK | $204.75 | $273.00 | $81.90–$273.00 | — | 25% |
| Blood culture for bacteria CPT 87040 LCHG CULTURE BLOOD | $145.50 | $194.00 | $58.20–$194.00 | 76% above | 25% |
| Blood culture for bacteria inpatient CPT 87040 LCHG CULTURE BLOOD | $145.50 | $194.00 | $58.20–$194.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 LCHG ALCOHOL LEGAL COLLECTION | $27.00 | $36.00 | $10.80–$36.00 | 106% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 LCHG BLOOD DRAW | $27.75 | $37.00 | $11.10–$37.00 | 112% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC COLLECTION BLOOD VENIPUNCTURE | $28.50 | $38.00 | $11.40–$38.00 | 117% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LCHG ALCOHOL LEGAL COLLECTION | $27.00 | $36.00 | $10.80–$36.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LCHG BLOOD DRAW | $27.75 | $37.00 | $11.10–$37.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC COLLECTION BLOOD VENIPUNCTURE | $28.50 | $38.00 | $11.40–$38.00 | — | 25% |
| Blood glucose (sugar) test CPT 82947 LCHG GLUCOSE | $47.25 | $63.00 | $18.90–$63.00 | 110% above | 25% |
| Blood glucose (sugar) test CPT 82947 LCHG GLUCOSE I | $48.00 | $64.00 | $19.20–$64.00 | 113% above | 25% |
| Blood glucose (sugar) test CPT 82947 LCHG GLUCOSE FASTING | $54.75 | $73.00 | $21.90–$73.00 | 143% above | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 LCHG GLUCOSE | $47.25 | $63.00 | $18.90–$63.00 | — | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 LCHG GLUCOSE I | $48.00 | $64.00 | $19.20–$64.00 | — | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 LCHG GLUCOSE FASTING | $54.75 | $73.00 | $21.90–$73.00 | — | 25% |
| Blood lead test CPT 83655 LCHG LEAD CAPILLARY | $23.25 | $31.00 | $9.30–$31.00 | 53% below | 25% |
| Blood lead test CPT 83655 LCHG LEAD URINE | $23.25 | $31.00 | $9.30–$31.00 | 53% below | 25% |
| Blood lead test CPT 83655 LCHG LEAD BLOOD | $78.75 | $105.00 | $31.50–$105.00 | 60% above | 25% |
| Blood lead test inpatient CPT 83655 LCHG LEAD URINE | $23.25 | $31.00 | $9.30–$31.00 | — | 25% |
| Blood lead test inpatient CPT 83655 LCHG LEAD CAPILLARY | $23.25 | $31.00 | $9.30–$31.00 | — | 25% |
| Blood lead test inpatient CPT 83655 LCHG LEAD BLOOD | $78.75 | $105.00 | $31.50–$105.00 | — | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 LCHG HCG BLOOD QUALITATIVE | $91.50 | $122.00 | $36.60–$122.00 | 88% above | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 LCHG HCG BLOOD QUALITATIVE | $91.50 | $122.00 | $36.60–$122.00 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LCHG BLOOD TYPE ABO | $66.75 | $89.00 | $26.70–$89.00 | 67% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LCHG BLOOD TYPE ONLY REF | $89.25 | $119.00 | $35.70–$119.00 | 123% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LCHG BLOOD TYPE ABO | $66.75 | $89.00 | $26.70–$89.00 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LCHG BLOOD TYPE ONLY REF | $89.25 | $119.00 | $35.70–$119.00 | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 LCHG C-REACTIVE PROTEIN | $29.25 | $39.00 | $11.70–$39.00 | 46% below | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 LCHG C-REACTIVE PROTEIN I | $111.75 | $149.00 | $44.70–$149.00 | 105% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 LCHG C-REACTIVE PROTEIN | $29.25 | $39.00 | $11.70–$39.00 | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 LCHG C-REACTIVE PROTEIN I | $111.75 | $149.00 | $44.70–$149.00 | — | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 LCHG CLOSTRIDIUM DIFF PCR | $221.25 | $295.00 | $88.50–$295.00 | 55% above | 25% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 LCHG CLOSTRIDIUM DIFF PCR | $221.25 | $295.00 | $88.50–$295.00 | — | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 LCHG CA 19-9 | $186.75 | $249.00 | $74.70–$249.00 | 70% above | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 LCHG CA 19-9 | $186.75 | $249.00 | $74.70–$249.00 | — | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 LCHG CA 125 BLOOD | $132.75 | $177.00 | $53.10–$177.00 | 13% above | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 LCHG CA 125 BLOOD | $132.75 | $177.00 | $53.10–$177.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID19) RAPID | $30.00 | $40.00 | $12.00–$40.00 | 78% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID-19) II | $30.75 | $41.00 | $12.30–$41.00 | 77% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID19) RAPID II | $120.00 | $160.00 | $48.00–$160.00 | 10% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID-19) III | $123.75 | $165.00 | $49.50–$165.00 | 7% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID-19) | $123.75 | $165.00 | $49.50–$165.00 | 7% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 LCHG SARS-COV-2 (COVID-19) IIII | $222.75 | $297.00 | $89.10–$297.00 | 67% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID19) RAPID | $30.00 | $40.00 | $12.00–$40.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID-19) II | $30.75 | $41.00 | $12.30–$41.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID19) RAPID II | $120.00 | $160.00 | $48.00–$160.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID-19) III | $123.75 | $165.00 | $49.50–$165.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID-19) | $123.75 | $165.00 | $49.50–$165.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 LCHG SARS-COV-2 (COVID-19) IIII | $222.75 | $297.00 | $89.10–$297.00 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LCHG CHLAMYDIA DNA PROBE | $63.75 | $85.00 | $25.50–$85.00 | 55% below | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LCHG CHLAMYDIA DNA PROBE I | $139.50 | $186.00 | $55.80–$186.00 | 2% below | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LCHG CHLAMYDIA TRACHOMATIS BY PCR | $179.25 | $239.00 | $71.70–$239.00 | 25% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LCHG CHLAMYDIA DNA PROBE | $63.75 | $85.00 | $25.50–$85.00 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LCHG CHLAMYDIA DNA PROBE I | $139.50 | $186.00 | $55.80–$186.00 | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LCHG CHLAMYDIA TRACHOMATIS BY PCR | $179.25 | $239.00 | $71.70–$239.00 | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LCHG LIPID PROFILE | $156.00 | $208.00 | $62.40–$208.00 | 69% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LCHG LIPID PROFILE | $156.00 | $208.00 | $62.40–$208.00 | — | 25% |
| Complete blood count (CBC) with differential CPT 85025 LCHG CBC W AUTO DIFFERENTIAL | $101.25 | $135.00 | $40.50–$135.00 | 45% above | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 LCHG CBC W AUTO DIFFERENTIAL | $101.25 | $135.00 | $40.50–$135.00 | — | 25% |
| Complete blood count (CBC), no differential CPT 85027 LCHG CBC W/O AUTO DIFFERENTIAL | $79.50 | $106.00 | $31.80–$106.00 | 59% above | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 LCHG CBC W/O AUTO DIFFERENTIAL | $79.50 | $106.00 | $31.80–$106.00 | — | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 LCHG COMPREHENSIVE METABOLIC PANEL | $127.50 | $170.00 | $51.00–$170.00 | 12% above | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 LCHG COMPREHENSIVE METABOLIC PANEL FAST | $159.00 | $212.00 | $63.60–$212.00 | 40% above | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 LCHG COMPREHENSIVE METABOLIC PANEL | $127.50 | $170.00 | $51.00–$170.00 | — | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 LCHG COMPREHENSIVE METABOLIC PANEL FAST | $159.00 | $212.00 | $63.60–$212.00 | — | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 LCHG D-DIMER QUANTITATIVE | $94.50 | $126.00 | $37.80–$126.00 | 38% above | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 LCHG D-DIMER QUANTITITATIVE REF | $104.25 | $139.00 | $41.70–$139.00 | 52% above | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 LCHG D-DIMER QUANTITATIVE | $94.50 | $126.00 | $37.80–$126.00 | — | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 LCHG D-DIMER QUANTITITATIVE REF | $104.25 | $139.00 | $41.70–$139.00 | — | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 LCHG DHEA SULFATE | $141.00 | $188.00 | $56.40–$188.00 | 3% above | 25% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 LCHG DHEA SULFATE | $141.00 | $188.00 | $56.40–$188.00 | — | 25% |
| Estradiol blood test CPT 82670 LCHG ESTRADIOL ULTRASENSITIVE | $202.50 | $270.00 | $81.00–$270.00 | 67% above | 25% |
| Estradiol blood test CPT 82670 LCHG ESTRADIOL III | $233.25 | $311.00 | $93.30–$311.00 | 93% above | 25% |
| Estradiol blood test CPT 82670 LCHG ESTRADIOL | $240.00 | $320.00 | $96.00–$320.00 | 98% above | 25% |
| Estradiol blood test inpatient CPT 82670 LCHG ESTRADIOL ULTRASENSITIVE | $202.50 | $270.00 | $81.00–$270.00 | — | 25% |
| Estradiol blood test inpatient CPT 82670 LCHG ESTRADIOL III | $233.25 | $311.00 | $93.30–$311.00 | — | 25% |
| Estradiol blood test inpatient CPT 82670 LCHG ESTRADIOL | $240.00 | $320.00 | $96.00–$320.00 | — | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 LCHG FSH | $206.25 | $275.00 | $82.50–$275.00 | 78% above | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 LCHG FSH | $206.25 | $275.00 | $82.50–$275.00 | — | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 LCHG CALPROTECTIN FECAL | $363.00 | $484.00 | $145.20–$484.00 | 96% above | 25% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 LCHG CALPROTECTIN FECAL | $363.00 | $484.00 | $145.20–$484.00 | — | 25% |
| Ferritin blood test (iron stores) CPT 82728 LCHG FERRITIN | $121.50 | $162.00 | $48.60–$162.00 | 35% above | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 LCHG FERRITIN | $121.50 | $162.00 | $48.60–$162.00 | — | 25% |
| Folate (folic acid) blood test CPT 82746 LCHG FOLATE | $120.75 | $161.00 | $48.30–$161.00 | 22% above | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 LCHG FOLATE | $120.75 | $161.00 | $48.30–$161.00 | — | 25% |
| Free T3 thyroid hormone test CPT 84481 LCHG T3 FREE | $76.50 | $102.00 | $30.60–$102.00 | 19% below | 25% |
| Free T3 thyroid hormone test inpatient CPT 84481 LCHG T3 FREE | $76.50 | $102.00 | $30.60–$102.00 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 LCHG T4 FREE DIRECT DIALYSIS | $84.75 | $113.00 | $33.90–$113.00 | 5% above | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 LCHG T4 FREE | $103.50 | $138.00 | $41.40–$138.00 | 28% above | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 LCHG T4 FREE DIRECT DIALYSIS | $84.75 | $113.00 | $33.90–$113.00 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 LCHG T4 FREE | $103.50 | $138.00 | $41.40–$138.00 | — | 25% |
| Free testosterone test CPT 84402 LCHG TESTOSTERONE FREE I | $72.75 | $97.00 | $29.10–$97.00 | 37% below | 25% |
| Free testosterone test CPT 84402 LCHG TESTOSTERONE FREE | $147.00 | $196.00 | $58.80–$196.00 | 28% above | 25% |
| Free testosterone test inpatient CPT 84402 LCHG TESTOSTERONE FREE I | $72.75 | $97.00 | $29.10–$97.00 | — | 25% |
| Free testosterone test inpatient CPT 84402 LCHG TESTOSTERONE FREE | $147.00 | $196.00 | $58.80–$196.00 | — | 25% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 LCHG GENERAL HEALTH PANEL | $567.75 | $757.00 | $227.10–$757.00 | 122% above | 25% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 LCHG GENERAL HEALTH PANEL | $567.75 | $757.00 | $227.10–$757.00 | — | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 LCHG GTT SPEC + DOSE | $82.50 | $110.00 | $33.00–$110.00 | 76% above | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 LCHG GLUCOSE 2 HR POST PRANDIAL | $147.00 | $196.00 | $58.80–$196.00 | 214% above | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 LCHG GTT SPEC + DOSE | $82.50 | $110.00 | $33.00–$110.00 | — | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 LCHG GLUCOSE 2 HR POST PRANDIAL | $147.00 | $196.00 | $58.80–$196.00 | — | 25% |
| Glucose tolerance test, 3 samples CPT 82951 LCHG GTT 3 SPEC + DOSE | $61.50 | $82.00 | $24.60–$82.00 | 28% below | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 LCHG GTT 3 SPEC + DOSE | $61.50 | $82.00 | $24.60–$82.00 | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LCHG GC DNA PROBE I | $63.00 | $84.00 | $25.20–$84.00 | 56% below | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LCHG GC AMPLIFIED PROBE | $66.00 | $88.00 | $26.40–$88.00 | 54% below | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LCHG GC DNA PROBE I | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LCHG GC AMPLIFIED PROBE | $66.00 | $88.00 | $26.40–$88.00 | — | 25% |
| H. pylori antibody blood test CPT 86677 LCHG HELICOBACTER PYLORI ANTIBODY IGG | $114.75 | $153.00 | $45.90–$153.00 | 36% above | 25% |
| H. pylori antibody blood test inpatient CPT 86677 LCHG HELICOBACTER PYLORI ANTIBODY IGG | $114.75 | $153.00 | $45.90–$153.00 | — | 25% |
| H. pylori stool antigen test CPT 87338 LCHG HELICOBACTER PYLORI ANTIGEN STOOL | $69.75 | $93.00 | $27.90–$93.00 | 44% below | 25% |
| H. pylori stool antigen test inpatient CPT 87338 LCHG HELICOBACTER PYLORI ANTIGEN STOOL | $69.75 | $93.00 | $27.90–$93.00 | — | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 LCHG HIV-1 RNA PCR QUANT | $567.00 | $756.00 | $226.80–$756.00 | 51% above | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 LCHG HIV-1 RNA PCR QUANT | $567.00 | $756.00 | $226.80–$756.00 | — | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 LCHG HIV-1 HIV-2 ANTIBODY | $157.50 | $210.00 | $63.00–$210.00 | 110% above | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 LCHG HIV-1 HIV-2 ANTIBODY RAPID | $157.50 | $210.00 | $63.00–$210.00 | 110% above | 25% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 LCHG HIV-1 HIV-2 ANTIBODY | $157.50 | $210.00 | $63.00–$210.00 | — | 25% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 LCHG HIV-1 HIV-2 ANTIBODY RAPID | $157.50 | $210.00 | $63.00–$210.00 | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 LCHG HIV-1 AG W HIV-1+HIV-2 AB NP | $171.75 | $229.00 | $68.70–$229.00 | 72% above | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 LCHG HIV-1 AG W HIV-1+HIV-2 AB | $171.75 | $229.00 | $68.70–$229.00 | 72% above | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 LCHG HIV-1 AG W HIV-1+HIV-2 AB | $171.75 | $229.00 | $68.70–$229.00 | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 LCHG HIV-1 AG W HIV-1+HIV-2 AB NP | $171.75 | $229.00 | $68.70–$229.00 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 LCHG HPV HIGH RISK TYPES II | $98.25 | $131.00 | $39.30–$131.00 | 31% below | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 LCHG HPV HIGH RISK TYPES | $171.00 | $228.00 | $68.40–$228.00 | 20% above | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 LCHG HPV HIGH RISK TYPES II | $98.25 | $131.00 | $39.30–$131.00 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 LCHG HPV HIGH RISK TYPES | $171.00 | $228.00 | $68.40–$228.00 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 LCHG HEMOGLOBIN A1C | $102.75 | $137.00 | $41.10–$137.00 | 105% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 LCHG HEMOGLOBIN A1C | $102.75 | $137.00 | $41.10–$137.00 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 LCHG HEPATITIS B SURFACE ANTIBODY NP | $50.25 | $67.00 | $20.10–$67.00 | 32% below | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 LCHG HEPATITIS B SURFACE ANTIBODY | $53.25 | $71.00 | $21.30–$71.00 | 28% below | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 LCHG HEPATITIS B SURFACE ANTIBODY NP | $50.25 | $67.00 | $20.10–$67.00 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 LCHG HEPATITIS B SURFACE ANTIBODY | $53.25 | $71.00 | $21.30–$71.00 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN | $94.50 | $126.00 | $37.80–$126.00 | 45% above | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN NP | $105.00 | $140.00 | $42.00–$140.00 | 61% above | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN I | $105.00 | $140.00 | $42.00–$140.00 | 61% above | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN | $94.50 | $126.00 | $37.80–$126.00 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN I | $105.00 | $140.00 | $42.00–$140.00 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LCHG HEPATITIS B SURFACE ANTIGEN NP | $105.00 | $140.00 | $42.00–$140.00 | — | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 LCHG HEPATITIS C ANTIBODY | $137.25 | $183.00 | $54.90–$183.00 | 66% above | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 LCHG HEPATITIS C ANTIBODY I | $150.00 | $200.00 | $60.00–$200.00 | 82% above | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 LCHG HEPATITIS C ANTIBODY | $137.25 | $183.00 | $54.90–$183.00 | — | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 LCHG HEPATITIS C ANTIBODY I | $150.00 | $200.00 | $60.00–$200.00 | — | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 LCHG HEPATITIS C QUANTITATIVE | $255.75 | $341.00 | $102.30–$341.00 | 16% above | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 LCHG HEPATITIS C RNA PCR QUANT | $313.50 | $418.00 | $125.40–$418.00 | 42% above | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 LCHG HEPATITIS C QUANTITATIVE | $255.75 | $341.00 | $102.30–$341.00 | — | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 LCHG HEPATITIS C RNA PCR QUANT | $313.50 | $418.00 | $125.40–$418.00 | — | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 LCHG HERPES SIMPLEX 1 ANTIBODY IGG | $48.00 | $64.00 | $19.20–$64.00 | 26% below | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 LCHG HERPES SIMPLEX 1 ANTIBODY IGG | $48.00 | $64.00 | $19.20–$64.00 | — | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 LCHG HERPES SIMPLEX 2 ANTIBODY IGG | $60.00 | $80.00 | $24.00–$80.00 | 24% below | 25% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 LCHG HERPES SIMPLEX 2 ANTIBODY IGG | $60.00 | $80.00 | $24.00–$80.00 | — | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 LCHG C-REACTIVE PROTEIN SENSITIVE | $109.50 | $146.00 | $43.80–$146.00 | 41% above | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 LCHG C-REACTIVE PROTEIN SENSITIVE | $109.50 | $146.00 | $43.80–$146.00 | — | 25% |
| Homocysteine blood test CPT 83090 LCHG HOMOCYSTEINE BLOOD QUANT | $474.75 | $633.00 | $189.90–$633.00 | 301% above | 25% |
| Homocysteine blood test inpatient CPT 83090 LCHG HOMOCYSTEINE BLOOD QUANT | $474.75 | $633.00 | $189.90–$633.00 | — | 25% |
| Insulin blood test CPT 83525 LCHG INSULIN LEVEL | $21.75 | $29.00 | $8.70–$29.00 | 67% below | 25% |
| Insulin blood test inpatient CPT 83525 LCHG INSULIN LEVEL | $21.75 | $29.00 | $8.70–$29.00 | — | 25% |
| Iron blood test (serum iron) CPT 83540 LCHG IRON BLOOD | $53.25 | $71.00 | $21.30–$71.00 | at median | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 LCHG IRON BLOOD | $53.25 | $71.00 | $21.30–$71.00 | — | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 LCHG TIBC | $72.75 | $97.00 | $29.10–$97.00 | 17% above | 25% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 LCHG TIBC | $72.75 | $97.00 | $29.10–$97.00 | — | 25% |
| Kidney function blood test panel CPT 80069 LCHG RENAL FUNCTION PANEL FASTING | $124.50 | $166.00 | $49.80–$166.00 | 21% above | 25% |
| Kidney function blood test panel CPT 80069 LCHG RENAL FUNCTION PANEL | $124.50 | $166.00 | $49.80–$166.00 | 21% above | 25% |
| Kidney function blood test panel inpatient CPT 80069 LCHG RENAL FUNCTION PANEL | $124.50 | $166.00 | $49.80–$166.00 | — | 25% |
| Kidney function blood test panel inpatient CPT 80069 LCHG RENAL FUNCTION PANEL FASTING | $124.50 | $166.00 | $49.80–$166.00 | — | 25% |
| LH (luteinizing hormone) test CPT 83002 LCHG LH | $36.00 | $48.00 | $14.40–$48.00 | 62% below | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 LCHG LH | $36.00 | $48.00 | $14.40–$48.00 | — | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 LCHG LIPASE BLOOD | $88.50 | $118.00 | $35.40–$118.00 | 31% above | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 LCHG LIPASE FLUID | $108.00 | $144.00 | $43.20–$144.00 | 60% above | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LCHG LIPASE BLOOD | $88.50 | $118.00 | $35.40–$118.00 | — | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LCHG LIPASE FLUID | $108.00 | $144.00 | $43.20–$144.00 | — | 25% |
| Liver function blood test panel CPT 80076 LCHG HEPATIC FUNCTION PANEL | $88.50 | $118.00 | $35.40–$118.00 | 8% below | 25% |
| Liver function blood test panel inpatient CPT 80076 LCHG HEPATIC FUNCTION PANEL | $88.50 | $118.00 | $35.40–$118.00 | — | 25% |
| Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB SCREEN CSF | $27.00 | $36.00 | $10.80–$36.00 | 66% below | 25% |
| Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB IGM I | $108.00 | $144.00 | $43.20–$144.00 | 37% above | 25% |
| Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB IGG I | $108.00 | $144.00 | $43.20–$144.00 | 37% above | 25% |
| Lyme disease antibody test CPT 86618 LCHG LYME DISEASE AB INDEX | $220.50 | $294.00 | $88.20–$294.00 | 180% above | 25% |
| Lyme disease antibody test CPT 86618 LCHG LYME DISEASE ANTIBODY SCREEN BLOOD | $220.50 | $294.00 | $88.20–$294.00 | 180% above | 25% |
| Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB SCREEN CSF | $27.00 | $36.00 | $10.80–$36.00 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB IGM I | $108.00 | $144.00 | $43.20–$144.00 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB IGG I | $108.00 | $144.00 | $43.20–$144.00 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE ANTIBODY SCREEN BLOOD | $220.50 | $294.00 | $88.20–$294.00 | — | 25% |
| Lyme disease antibody test inpatient CPT 86618 LCHG LYME DISEASE AB INDEX | $220.50 | $294.00 | $88.20–$294.00 | — | 25% |
| Magnesium blood test CPT 83735 LCHG MAGNESIUM FECES | $51.75 | $69.00 | $20.70–$69.00 | 4% above | 25% |
| Magnesium blood test CPT 83735 LCHG MAGNESIUM URINE TIMED II | $63.00 | $84.00 | $25.20–$84.00 | 26% above | 25% |
| Magnesium blood test CPT 83735 LCHG MAGNESIUM URINE QUANT | $71.25 | $95.00 | $28.50–$95.00 | 42% above | 25% |
| Magnesium blood test CPT 83735 LCHG MAGNESIUM BLOOD | $71.25 | $95.00 | $28.50–$95.00 | 42% above | 25% |
| Magnesium blood test CPT 83735 LCHG MAGNESIUM RBC | $111.00 | $148.00 | $44.40–$148.00 | 122% above | 25% |
| Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM FECES | $51.75 | $69.00 | $20.70–$69.00 | — | 25% |
| Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM URINE TIMED II | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM BLOOD | $71.25 | $95.00 | $28.50–$95.00 | — | 25% |
| Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM URINE QUANT | $71.25 | $95.00 | $28.50–$95.00 | — | 25% |
| Magnesium blood test inpatient CPT 83735 LCHG MAGNESIUM RBC | $111.00 | $148.00 | $44.40–$148.00 | — | 25% |
| Measles (rubeola) antibody test CPT 86765 LCHG RUBEOLA ANTIBODY IGM | $29.25 | $39.00 | $11.70–$39.00 | 63% below | 25% |
| Measles (rubeola) antibody test CPT 86765 LCHG RUBEOLA ANTIBODY IGG | $142.50 | $190.00 | $57.00–$190.00 | 78% above | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 LCHG RUBEOLA ANTIBODY IGM | $29.25 | $39.00 | $11.70–$39.00 | — | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 LCHG RUBEOLA ANTIBODY IGG | $142.50 | $190.00 | $57.00–$190.00 | — | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 LCHG MONONUCLEOSIS SCREEN | $72.75 | $97.00 | $29.10–$97.00 | 32% above | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 LCHG MONONUCLEOSIS SCREEN | $72.75 | $97.00 | $29.10–$97.00 | — | 25% |
| Obstetric blood test panel CPT 80055 LCHG OBSTETRIC PANEL | $261.00 | $348.00 | $104.40–$348.00 | 36% above | 25% |
| Obstetric blood test panel inpatient CPT 80055 LCHG OBSTETRIC PANEL | $261.00 | $348.00 | $104.40–$348.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 LCHG PSA FREE | $83.25 | $111.00 | $33.30–$111.00 | 8% below | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 LCHG PSA FREE | $83.25 | $111.00 | $33.30–$111.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LCHG PROSTATE SPECIFIC ANTIGEN DIAG | $180.00 | $240.00 | $72.00–$240.00 | 100% above | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LCHG PSA TOTAL | $185.25 | $247.00 | $74.10–$247.00 | 106% above | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LCHG PSA TOTAL REFER | $185.25 | $247.00 | $74.10–$247.00 | 106% above | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LCHG PROSTATE SPECIFIC ANTIGEN DIAG | $180.00 | $240.00 | $72.00–$240.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LCHG PSA TOTAL | $185.25 | $247.00 | $74.10–$247.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LCHG PSA TOTAL REFER | $185.25 | $247.00 | $74.10–$247.00 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 LCHG CYTOPATH CERV/VAG THIN LAYER NL | $75.00 | $100.00 | $30.00–$100.00 | 14% below | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 LCHG CYTOPATH CERV/VAG THIN LAYER | $105.75 | $141.00 | $42.30–$141.00 | 21% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 LCHG CYTOPATH CERV/VAG THIN LAYER NL | $75.00 | $100.00 | $30.00–$100.00 | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 LCHG CYTOPATH CERV/VAG THIN LAYER | $105.75 | $141.00 | $42.30–$141.00 | — | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 LCHG PTH INTACT | $48.75 | $65.00 | $19.50–$65.00 | 74% below | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 LCHG PTH HORMONE | $57.00 | $76.00 | $22.80–$76.00 | 70% below | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 LCHG PTH INTACT | $48.75 | $65.00 | $19.50–$65.00 | — | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 LCHG PTH HORMONE | $57.00 | $76.00 | $22.80–$76.00 | — | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LCHG PTT INHIBITOR I | $56.25 | $75.00 | $22.50–$75.00 | 12% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LCHG PTT | $79.50 | $106.00 | $31.80–$106.00 | 59% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LCHG PTT I | $91.50 | $122.00 | $36.60–$122.00 | 83% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LCHG PTT II | $91.50 | $122.00 | $36.60–$122.00 | 83% above | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LCHG PTT INHIBITOR I | $56.25 | $75.00 | $22.50–$75.00 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LCHG PTT | $79.50 | $106.00 | $31.80–$106.00 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LCHG PTT I | $91.50 | $122.00 | $36.60–$122.00 | — | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LCHG PTT II | $91.50 | $122.00 | $36.60–$122.00 | — | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 LCHG FETAL ANEUPLOIDY DNA SEQUENCE ANALYSIS I | $2,256.00 | $3,008.00 | $902.40–$3,008.00 | 87% above | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 LCHG FETAL ANEUPLOIDY DNA SEQUENCE ANALYSIS I | $2,256.00 | $3,008.00 | $902.40–$3,008.00 | — | 25% |
| Progesterone blood test CPT 84144 LCHG PROGESTERONE | $67.50 | $90.00 | $27.00–$90.00 | 44% below | 25% |
| Progesterone blood test CPT 84144 LCHG PROGESTERONE I | $67.50 | $90.00 | $27.00–$90.00 | 44% below | 25% |
| Progesterone blood test inpatient CPT 84144 LCHG PROGESTERONE I | $67.50 | $90.00 | $27.00–$90.00 | — | 25% |
| Progesterone blood test inpatient CPT 84144 LCHG PROGESTERONE | $67.50 | $90.00 | $27.00–$90.00 | — | 25% |
| Prolactin blood test CPT 84146 LCHG PROLACTIN MACROADENOMA | $37.50 | $50.00 | $15.00–$50.00 | 69% below | 25% |
| Prolactin blood test CPT 84146 LCHG PROLACTIN I | $117.00 | $156.00 | $46.80–$156.00 | 3% below | 25% |
| Prolactin blood test CPT 84146 LCHG PROLACTIN | $213.75 | $285.00 | $85.50–$285.00 | 77% above | 25% |
| Prolactin blood test inpatient CPT 84146 LCHG PROLACTIN MACROADENOMA | $37.50 | $50.00 | $15.00–$50.00 | — | 25% |
| Prolactin blood test inpatient CPT 84146 LCHG PROLACTIN I | $117.00 | $156.00 | $46.80–$156.00 | — | 25% |
| Prolactin blood test inpatient CPT 84146 LCHG PROLACTIN | $213.75 | $285.00 | $85.50–$285.00 | — | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LCHG PT-INR | $41.25 | $55.00 | $16.50–$55.00 | 30% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LCHG PT POCT | $43.50 | $58.00 | $17.40–$58.00 | 37% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LCHG PT I | $57.75 | $77.00 | $23.10–$77.00 | 82% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LCHG PT II | $57.75 | $77.00 | $23.10–$77.00 | 82% above | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LCHG PT-INR | $41.25 | $55.00 | $16.50–$55.00 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LCHG PT POCT | $43.50 | $58.00 | $17.40–$58.00 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LCHG PT I | $57.75 | $77.00 | $23.10–$77.00 | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LCHG PT II | $57.75 | $77.00 | $23.10–$77.00 | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 LCHG DRUG SCREEN MULTI CLASS A NON-TLC V | $34.50 | $46.00 | $13.80–$46.00 | 32% below | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 LCHG DRUG SCREEN MULTI CLASS A NON-TLC II | $74.25 | $99.00 | $29.70–$99.00 | 46% above | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 LCHG DRUG SCREEN MULTI CLASS A NON-TLC V | $34.50 | $46.00 | $13.80–$46.00 | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 LCHG DRUG SCREEN MULTI CLASS A NON-TLC II | $74.25 | $99.00 | $29.70–$99.00 | — | 25% |
| Rheumatoid factor (RF) test CPT 86431 LCHG RHEUMATOID FACTOR II | $24.75 | $33.00 | $9.90–$33.00 | 57% below | 25% |
| Rheumatoid factor (RF) test CPT 86431 LCHG RHEUMATOID FACTOR BLOOD QUANT | $78.75 | $105.00 | $31.50–$105.00 | 37% above | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 LCHG RHEUMATOID FACTOR II | $24.75 | $33.00 | $9.90–$33.00 | — | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 LCHG RHEUMATOID FACTOR BLOOD QUANT | $78.75 | $105.00 | $31.50–$105.00 | — | 25% |
| Rubella antibody test (immunity check) CPT 86762 LCHG RUBELLA IMMUNE STATUS | $87.75 | $117.00 | $35.10–$117.00 | 10% above | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 LCHG RUBELLA IMMUNE STATUS | $87.75 | $117.00 | $35.10–$117.00 | — | 25% |
| Stool ova and parasites exam CPT 87177 LCHG O+P | $162.00 | $216.00 | $64.80–$216.00 | 159% above | 25% |
| Stool ova and parasites exam inpatient CPT 87177 LCHG O+P | $162.00 | $216.00 | $64.80–$216.00 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 LCHG OCCULT BLOOD FECES | $55.50 | $74.00 | $22.20–$74.00 | 176% above | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 LCHG OCCULT BLOOD FECES 1-3 SCREEN | $55.50 | $74.00 | $22.20–$74.00 | 176% above | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 LCHG OCCULT BLOOD FECES | $55.50 | $74.00 | $22.20–$74.00 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 LCHG OCCULT BLOOD FECES 1-3 SCREEN | $55.50 | $74.00 | $22.20–$74.00 | — | 25% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 LCHG OCCULT BLOOD FECES 1-3 IMMUNO | $80.25 | $107.00 | $32.10–$107.00 | 49% above | 25% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 LCHG OCCULT BLOOD FECES 1-3 IMMUNO | $80.25 | $107.00 | $32.10–$107.00 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG VDRL CSF | $19.50 | $26.00 | $7.80–$26.00 | 48% below | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG RPR W REFLEX CONFIRM | $26.25 | $35.00 | $10.50–$35.00 | 30% below | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG RPR REFER | $81.00 | $108.00 | $32.40–$108.00 | 116% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG RPR | $81.00 | $108.00 | $32.40–$108.00 | 116% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LCHG RPR I | $97.50 | $130.00 | $39.00–$130.00 | 160% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG VDRL CSF | $19.50 | $26.00 | $7.80–$26.00 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG RPR W REFLEX CONFIRM | $26.25 | $35.00 | $10.50–$35.00 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG RPR REFER | $81.00 | $108.00 | $32.40–$108.00 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG RPR | $81.00 | $108.00 | $32.40–$108.00 | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LCHG RPR I | $97.50 | $130.00 | $39.00–$130.00 | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 LCHG QUANTIFERON TB-GOLD | $145.50 | $194.00 | $58.20–$194.00 | 42% below | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 LCHG QUANTIFERON TB-GOLD | $145.50 | $194.00 | $58.20–$194.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 LCHG TESTOSTERONE TOTAL I | $30.75 | $41.00 | $12.30–$41.00 | 73% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 LCHG TESTOSTERONE TOTAL II | $93.00 | $124.00 | $37.20–$124.00 | 17% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 LCHG TESTOSTERONE TOTAL | $176.25 | $235.00 | $70.50–$235.00 | 57% above | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 LCHG TESTOSTERONE TOTAL I | $30.75 | $41.00 | $12.30–$41.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 LCHG TESTOSTERONE TOTAL II | $93.00 | $124.00 | $37.20–$124.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 LCHG TESTOSTERONE TOTAL | $176.25 | $235.00 | $70.50–$235.00 | — | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LCHG MICROSOMAL ANTIBODY LIVER/KIDNEY | $42.00 | $56.00 | $16.80–$56.00 | 38% below | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LCHG THYROID PEROXIDASE ANTIBODY | $43.50 | $58.00 | $17.40–$58.00 | 36% below | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LCHG MICROSOMAL ANTIBODY LIVER/KIDNEY | $42.00 | $56.00 | $16.80–$56.00 | — | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LCHG THYROID PEROXIDASE ANTIBODY | $43.50 | $58.00 | $17.40–$58.00 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 LCHG TSH | $162.75 | $217.00 | $65.10–$217.00 | 87% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 LCHG TSH | $162.75 | $217.00 | $65.10–$217.00 | — | 25% |
| Trichomonas test (NAAT) CPT 87661 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE I | $285.75 | $381.00 | $114.30–$381.00 | 109% above | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 LCHG TRICHOMONAS VAGINALIS AMPLIFIED PROBE I | $285.75 | $381.00 | $114.30–$381.00 | — | 25% |
| Uric acid blood test CPT 84550 LCHG URIC ACID BLOOD | $57.00 | $76.00 | $22.80–$76.00 | 22% above | 25% |
| Uric acid blood test inpatient CPT 84550 LCHG URIC ACID BLOOD | $57.00 | $76.00 | $22.80–$76.00 | — | 25% |
| Urinalysis with microscope exam, automated CPT 81001 LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC | $54.75 | $73.00 | $21.90–$73.00 | 36% above | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC | $54.75 | $73.00 | $21.90–$73.00 | — | 25% |
| Urinalysis with microscope exam, manual CPT 81000 HC URINALYSIS DIP W MICRO NONAUTO | $56.25 | $75.00 | $22.50–$75.00 | 275% above | 25% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC URINALYSIS DIP W MICRO NONAUTO | $56.25 | $75.00 | $22.50–$75.00 | — | 25% |
| Urinalysis without microscope exam, automated CPT 81003 LCHG URINALYSIS DIPSTICK AUTO | $27.75 | $37.00 | $11.10–$37.00 | 16% above | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 LCHG URINALYSIS DIPSTICK AUTO | $27.75 | $37.00 | $11.10–$37.00 | — | 25% |
| Urine culture for bacteria, with colony count CPT 87086 LCHG CULTURE URINE | $81.00 | $108.00 | $32.40–$108.00 | 7% above | 25% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 LCHG CULTURE URINE | $81.00 | $108.00 | $32.40–$108.00 | — | 25% |
| Urine pregnancy test, read by color change CPT 81025 LCHG HCG URINE QUALITATIVE | $69.00 | $92.00 | $27.60–$92.00 | 16% above | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 LCHG HCG URINE QUALITATIVE | $69.00 | $92.00 | $27.60–$92.00 | — | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 LCHG VITAMIN B12 | $114.00 | $152.00 | $45.60–$152.00 | 14% above | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 LCHG VITAMIN B12 | $114.00 | $152.00 | $45.60–$152.00 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 LCHG VITAMIN D 25-HYDROXY | $74.25 | $99.00 | $29.70–$99.00 | 50% below | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 LCHG VITAMIN D 25-HYDROXY D2+D3 | $76.50 | $102.00 | $30.60–$102.00 | 49% below | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 LCHG VITAMIN D 25-HYDROXY | $74.25 | $99.00 | $29.70–$99.00 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 LCHG VITAMIN D 25-HYDROXY D2+D3 | $76.50 | $102.00 | $30.60–$102.00 | — | 25% |
| Zinc blood test CPT 84630 LCHG ZINC BLOOD | $114.00 | $152.00 | $45.60–$152.00 | 47% above | 25% |
| Zinc blood test inpatient CPT 84630 LCHG ZINC BLOOD | $114.00 | $152.00 | $45.60–$152.00 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LCHG HCG BETA BLOOD QUANTITATIVE | $112.50 | $150.00 | $45.00–$150.00 | at median | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LCHG HCG BETA BLOOD TUMOR MARKER | $112.50 | $150.00 | $45.00–$150.00 | at median | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LCHG HCG QUANTITATIVE I | $168.75 | $225.00 | $67.50–$225.00 | 50% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 LCHG HCG BETA BLOOD TUMOR MARKER | $112.50 | $150.00 | $45.00–$150.00 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 LCHG HCG BETA BLOOD QUANTITATIVE | $112.50 | $150.00 | $45.00–$150.00 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 LCHG HCG QUANTITATIVE I | $168.75 | $225.00 | $67.50–$225.00 | — | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 HC APPENDECTOMY RUPTURED W INFECTION | $1,492.50 | $1,990.00 | $597.00–$1,990.00 | 69% below | 25% |
| Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 HC APPENDECTOMY RUPTURED W INFECTION | $1,492.50 | $1,990.00 | $597.00–$1,990.00 | — | 25% |
| Appendectomy, open surgery CPT 44950 HC APPENDECTOMY OPEN | $1,107.00 | $1,476.00 | $442.80–$1,476.00 | 55% below | 25% |
| Appendectomy, open surgery inpatient CPT 44950 HC APPENDECTOMY OPEN | $1,107.00 | $1,476.00 | $442.80–$1,476.00 | — | 25% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC ENDO SINUS W BALLOON DIL MAXILLARY | $3,731.25 | $4,975.00 | $1,492.50–$4,975.00 | 95% above | 25% |
| Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC ENDO SINUS W BALLOON DIL MAXILLARY | $3,731.25 | $4,975.00 | $1,492.50–$4,975.00 | — | 25% |
| Botox injections for chronic migraine CPT 64615 HC CHEMODENERV MUSC BY FAC,TRIG,CERV,BIL | $658.50 | $878.00 | $263.40–$878.00 | 5% above | 25% |
| Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODENERV MUSC BY FAC,TRIG,CERV,BIL | $658.50 | $878.00 | $263.40–$878.00 | — | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST PERC 1ST LESN STEREOTCT | $2,387.25 | $3,183.00 | $954.90–$3,183.00 | 32% above | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST PERC 1ST LESN STEREOTCT | $2,387.25 | $3,183.00 | $954.90–$3,183.00 | — | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC TX FX FIBULA DISTAL CLSD W/O MANIP | $636.00 | $848.00 | $254.40–$848.00 | 15% above | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC TX FX FIBULA DISTAL CLSD W/O MANIP | $636.00 | $848.00 | $254.40–$848.00 | — | 25% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC TX FX METATARSAL CLSD EA W/O MANIP | $567.00 | $756.00 | $226.80–$756.00 | 5% below | 25% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC TX FX METATARSAL CLSD EA W/O MANIP | $567.00 | $756.00 | $226.80–$756.00 | — | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION ELECTIVE EXTERNAL | $1,437.00 | $1,916.00 | $574.80–$1,916.00 | 66% above | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC ED CARDIOVERSION ELECTIVE EXTERNAL | $1,437.00 | $1,916.00 | $574.80–$1,916.00 | 66% above | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION ELECTIVE EXTERNAL | $1,437.00 | $1,916.00 | $574.80–$1,916.00 | — | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC ED CARDIOVERSION ELECTIVE EXTERNAL | $1,437.00 | $1,916.00 | $574.80–$1,916.00 | — | 25% |
| Carpal tunnel release, open surgery one side CPT 64721 HC CARPAL TUNNEL RELEASE UNILAT | $3,552.75 | $4,737.00 | $1,421.10–$4,737.00 | 91% above | 25% |
| Carpal tunnel release, open surgery inpatient one side CPT 64721 HC CARPAL TUNNEL RELEASE UNILAT | $3,552.75 | $4,737.00 | $1,421.10–$4,737.00 | — | 25% |
| Cataract surgery with lens implant CPT 66984 HC REMV CATARACT EXTRACAP INSERT LENS | $4,115.25 | $5,487.00 | $1,646.10–$5,487.00 | at median | 25% |
| Cataract surgery with lens implant inpatient CPT 66984 HC REMV CATARACT EXTRACAP INSERT LENS | $4,115.25 | $5,487.00 | $1,646.10–$5,487.00 | — | 25% |
| Cervical biopsy CPT 57500 HC CERVICAL BIOPSY | $140.25 | $187.00 | $56.10–$187.00 | 76% below | 25% |
| Cervical biopsy inpatient CPT 57500 HC CERVICAL BIOPSY | $140.25 | $187.00 | $56.10–$187.00 | — | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC CIRCUMCISION > 28 DAYS | $5,199.75 | $6,933.00 | $2,079.90–$6,933.00 | 413% above | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC CIRCUMCISION > 28 DAYS | $5,199.75 | $6,933.00 | $2,079.90–$6,933.00 | — | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION CLAMP WO REGIONAL ANS | $399.75 | $533.00 | $159.90–$533.00 | 130% above | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC CIRCUMCISION CLAMP W REGIONAL ANS | $399.75 | $533.00 | $159.90–$533.00 | 130% above | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION CLAMP WO REGIONAL ANS | $399.75 | $533.00 | $159.90–$533.00 | — | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC CIRCUMCISION CLAMP W REGIONAL ANS | $399.75 | $533.00 | $159.90–$533.00 | — | 25% |
| Circumcision, surgical, older than a newborn CPT 54160 HC CIRCUMCISION SURGICAL NEWBORN | $399.75 | $533.00 | $159.90–$533.00 | 46% below | 25% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 HC CIRCUMCISION SURGICAL NEWBORN | $399.75 | $533.00 | $159.90–$533.00 | — | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC TX FX RADIAL DISTAL CLSD W/O MANIP | $711.00 | $948.00 | $284.40–$948.00 | 16% above | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC TX FX RADIAL DISTAL CLSD W/O MANIP | $711.00 | $948.00 | $284.40–$948.00 | — | 25% |
| Colonoscopy with polyp removal CPT 45385 HC COLONOSCOPY WITH POLYPECTOMY | $2,973.00 | $3,964.00 | $1,189.20–$3,964.00 | 43% above | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC COLONOSCOPY WITH POLYPECTOMY | $2,973.00 | $3,964.00 | $1,189.20–$3,964.00 | — | 25% |
| Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY FLEX WITH BIOPSY | $2,837.25 | $3,783.00 | $1,134.90–$3,783.00 | 47% above | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY FLEX WITH BIOPSY | $2,837.25 | $3,783.00 | $1,134.90–$3,783.00 | — | 25% |
| Colonoscopy, diagnostic CPT 45378 HC COLONOSCOPY FLEX DIAGNOSTIC | $2,305.50 | $3,074.00 | $922.20–$3,074.00 | 49% above | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC COLONOSCOPY FLEX DIAGNOSTIC | $2,305.50 | $3,074.00 | $922.20–$3,074.00 | — | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC COLPOSCOPY BX CURRETAGE CERVIX | $227.25 | $303.00 | $90.90–$303.00 | 50% below | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC COLPOSCOPY BX CURRETAGE CERVIX | $227.25 | $303.00 | $90.90–$303.00 | — | 25% |
| Complex cataract surgery with lens implant CPT 66982 HC REMV CAT EXTRACAP INSRT LENS COMPLX | $4,414.50 | $5,886.00 | $1,765.80–$5,886.00 | 3% above | 25% |
| Complex cataract surgery with lens implant inpatient CPT 66982 HC REMV CAT EXTRACAP INSRT LENS COMPLX | $4,414.50 | $5,886.00 | $1,765.80–$5,886.00 | — | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC CYSTOURETHROSCOPY | $1,275.75 | $1,701.00 | $510.30–$1,701.00 | 95% above | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC CYSTOURETHROSCOPY | $1,275.75 | $1,701.00 | $510.30–$1,701.00 | — | 25% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 HC DILATATION & CURETTAGE | $6,333.75 | $8,445.00 | $2,533.50–$8,445.00 | 403% above | 25% |
| D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 HC DILATATION & CURETTAGE | $6,333.75 | $8,445.00 | $2,533.50–$8,445.00 | — | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC DESTRUCT PREMALIGNANT LESION 1ST | $162.75 | $217.00 | $65.10–$217.00 | 21% below | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC DESTRUCT PREMALIGNANT LESION 1ST | $162.75 | $217.00 | $65.10–$217.00 | — | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC TYMPANOSTOMY WITH LOCAL | $120.00 | $160.00 | $48.00–$160.00 | 77% below | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC TYMPANOSTOMY WITH LOCAL | $120.00 | $160.00 | $48.00–$160.00 | — | 25% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE CERUMEN IMPACTED W LAVAGE UNI | $207.75 | $277.00 | $83.10–$277.00 | 263% above | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOVE CERUMEN IMPACTED W LAVAGE UNI | $207.75 | $277.00 | $83.10–$277.00 | — | 25% |
| Earwax removal with instruments, one ear CPT 69210 HC REMOVE CERUMEN IMPACTED W INSTRUMENT UNI | $116.25 | $155.00 | $46.50–$155.00 | 39% above | 25% |
| Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVE CERUMEN IMPACTED W INSTRUMENT UNI | $116.25 | $155.00 | $46.50–$155.00 | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BX ENDOMET W/WO CERVICAL DILITATION | $135.75 | $181.00 | $54.30–$181.00 | 50% below | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC BX ENDOMET W/WO CERVICAL DILITATION | $135.75 | $181.00 | $54.30–$181.00 | — | 25% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 HC ENDO NASAL SINUS ANTROSTOMY MAXILL | $4,793.25 | $6,391.00 | $1,917.30–$6,391.00 | 141% above | 25% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 HC ENDO NASAL SINUS ANTROSTOMY MAXILL | $4,793.25 | $6,391.00 | $1,917.30–$6,391.00 | — | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 HC NASAL SCOPY,RMV TISS MAXILL SINUS | $3,778.50 | $5,038.00 | $1,511.40–$5,038.00 | 7% below | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 HC NASAL SCOPY,RMV TISS MAXILL SINUS | $3,778.50 | $5,038.00 | $1,511.40–$5,038.00 | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ EPIDURAL CERVICAL THOR W IMG | $1,527.00 | $2,036.00 | $610.80–$2,036.00 | 81% above | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ EPIDURAL CERVICAL THOR W IMG | $1,527.00 | $2,036.00 | $610.80–$2,036.00 | — | 25% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 HC INJECT INTRAVITREAL PHARMCOLOGIC | $747.75 | $997.00 | $299.10–$997.00 | 85% above | 25% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC INJECT INTRAVITREAL PHARMCOLOGIC | $747.75 | $997.00 | $299.10–$997.00 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ FACET JNT L/S SNGL LVL | $993.00 | $1,324.00 | $397.20–$1,324.00 | 11% above | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC IR FACET LUMBAR SINGLE LEVEL | $2,293.50 | $3,058.00 | $917.40–$3,058.00 | 157% above | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ FACET JNT L/S SNGL LVL | $993.00 | $1,324.00 | $397.20–$1,324.00 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC IR FACET LUMBAR SINGLE LEVEL | $2,293.50 | $3,058.00 | $917.40–$3,058.00 | — | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC SIGMOIDOSCOPY FLEX DIAGNOSTIC | $1,932.75 | $2,577.00 | $773.10–$2,577.00 | 131% above | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC SIGMOIDOSCOPY FLEX DIAGNOSTIC | $1,932.75 | $2,577.00 | $773.10–$2,577.00 | — | 25% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC LIGATION OF HEMORRHOIDS | $464.25 | $619.00 | $185.70–$619.00 | 64% below | 25% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC LIGATION OF HEMORRHOIDS | $464.25 | $619.00 | $185.70–$619.00 | — | 25% |
| Hysterectomy through an abdominal incision (total) CPT 58150 HC HYSTERECTOMY TOTAL ABDOMINAL | $1,626.00 | $2,168.00 | $650.40–$2,168.00 | 57% below | 25% |
| Hysterectomy through an abdominal incision (total) inpatient CPT 58150 HC HYSTERECTOMY TOTAL ABDOMINAL | $1,626.00 | $2,168.00 | $650.40–$2,168.00 | — | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJECTION HYSTEROSALPINGOGRAM | $637.50 | $850.00 | $255.00–$850.00 | 146% above | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJECTION HYSTEROSALPINGOGRAM | $637.50 | $850.00 | $255.00–$850.00 | — | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HC HYSTEROCOPY W ENDO BX | $5,554.50 | $7,406.00 | $2,221.80–$7,406.00 | 54% above | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HC HYSTEROCOPY W ENDO BX | $5,554.50 | $7,406.00 | $2,221.80–$7,406.00 | — | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 HC INSERTION INTRAUTERINE DEVICE | $225.00 | $300.00 | $90.00–$300.00 | 26% below | 25% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERTION INTRAUTERINE DEVICE | $225.00 | $300.00 | $90.00–$300.00 | — | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSCESS SMPL SNGL | $259.50 | $346.00 | $103.80–$346.00 | 15% below | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSCESS SMPL SNGL | $259.50 | $346.00 | $103.80–$346.00 | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TNDN LIGMNT SNGL APNUROS | $654.00 | $872.00 | $261.60–$872.00 | 154% above | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TNDN LIGMNT SNGL APNUROS | $654.00 | $872.00 | $261.60–$872.00 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ED ARTHROCENTESIS JOINT MAJOR WO US | $654.00 | $872.00 | $261.60–$872.00 | 89% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS JOINT MAJOR WO US | $654.00 | $872.00 | $261.60–$872.00 | 89% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ED ARTHROCENTESIS JOINT MAJOR WO US | $654.00 | $872.00 | $261.60–$872.00 | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS JOINT MAJOR WO US | $654.00 | $872.00 | $261.60–$872.00 | — | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERT DRUG IMPLANT | $120.00 | $160.00 | $48.00–$160.00 | 52% below | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERT DRUG IMPLANT | $120.00 | $160.00 | $48.00–$160.00 | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ED ARTHROCENTESIS JOINT INTERMED WO US | $659.25 | $879.00 | $263.70–$879.00 | 125% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCENTESIS JOINT INTERMED WO US | $659.25 | $879.00 | $263.70–$879.00 | 125% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCENTESIS JOINT INTERMED WO US | $659.25 | $879.00 | $263.70–$879.00 | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ED ARTHROCENTESIS JOINT INTERMED WO US | $659.25 | $879.00 | $263.70–$879.00 | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS JOINT SMALL WO US | $654.00 | $872.00 | $261.60–$872.00 | 134% above | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ED DRAIN/INJECT SMALL JOINT/BURSA | $654.00 | $872.00 | $261.60–$872.00 | 134% above | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCENTESIS JOINT SMALL WO US | $654.00 | $872.00 | $261.60–$872.00 | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ED DRAIN/INJECT SMALL JOINT/BURSA | $654.00 | $872.00 | $261.60–$872.00 | — | 25% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 HC LAP SURG HYST TOTAL UTERUS 250GM OR LESS | $1,591.50 | $2,122.00 | $636.60–$2,122.00 | 47% below | 25% |
| Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 HC LAP SURG HYST TOTAL UTERUS 250GM OR LESS | $1,591.50 | $2,122.00 | $636.60–$2,122.00 | — | 25% |
| Laser treatment of clouding after cataract surgery (YAG) both sides CPT 66821 HC YAG BILATERAL LASER SURGERY | $1,957.50 | $2,610.00 | $783.00–$2,610.00 | — | 25% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC YAG LASER SURGERY | $1,948.50 | $2,598.00 | $779.40–$2,598.00 | 66% above | 25% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient both sides CPT 66821 HC YAG BILATERAL LASER SURGERY | $1,957.50 | $2,610.00 | $783.00–$2,610.00 | — | 25% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC YAG LASER SURGERY | $1,948.50 | $2,598.00 | $779.40–$2,598.00 | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC WND RPR INT SC AX TK XT <2.5CM | $405.00 | $540.00 | $162.00–$540.00 | 18% below | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC WND RPR INT SC AX TK XT <2.5CM | $405.00 | $540.00 | $162.00–$540.00 | — | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ EPIDURAL LUMBAR SACRAL W IMG | $1,773.75 | $2,365.00 | $709.50–$2,365.00 | 200% above | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ EPIDURAL LUMBAR SACRAL W IMG | $1,773.75 | $2,365.00 | $709.50–$2,365.00 | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ TRANSFORAM NERVE L/S SNGL | $2,282.25 | $3,043.00 | $912.90–$3,043.00 | 193% above | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ TRANSFORAM NERVE L/S SNGL | $2,282.25 | $3,043.00 | $912.90–$3,043.00 | — | 25% |
| Mastectomy (total removal of the breast) CPT 19303 HC MASTECTOMY SMPL COMPL | $1,844.25 | $2,459.00 | $737.70–$2,459.00 | 52% below | 25% |
| Mastectomy (total removal of the breast) inpatient CPT 19303 HC MASTECTOMY SMPL COMPL | $1,844.25 | $2,459.00 | $737.70–$2,459.00 | — | 25% |
| Miscarriage treatment with D&C, first trimester CPT 59820 HC TX ABORTION MISSED SURG 1ST TRI | $3,454.50 | $4,606.00 | $1,381.80–$4,606.00 | 134% above | 25% |
| Miscarriage treatment with D&C, first trimester inpatient CPT 59820 HC TX ABORTION MISSED SURG 1ST TRI | $3,454.50 | $4,606.00 | $1,381.80–$4,606.00 | — | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC EXC SKIN BENIGN <=0.5CM TRUNK/ARM/LEG | $1,553.25 | $2,071.00 | $621.30–$2,071.00 | 346% above | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC EXC SKIN BENIGN <=0.5CM TRUNK/ARM/LEG | $1,553.25 | $2,071.00 | $621.30–$2,071.00 | — | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC REMV LESN BENIGN FACE <= 0.5CM | $1,526.25 | $2,035.00 | $610.50–$2,035.00 | 196% above | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC REMV LESN BENIGN FACE <= 0.5CM | $1,526.25 | $2,035.00 | $610.50–$2,035.00 | — | 25% |
| Nail removal (partial or complete), one nail CPT 11730 HC AVULSION NAIL PLATE SIMPLE SINGLE | $152.25 | $203.00 | $60.90–$203.00 | 32% below | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC AVULSION NAIL PLATE SIMPLE SINGLE | $152.25 | $203.00 | $60.90–$203.00 | — | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 HC INJ AA STRD NERVE GR OCCIPITAL | $930.75 | $1,241.00 | $372.30–$1,241.00 | 108% above | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 HC ED INJ AA STRD GREATER OCCIPITAL NERVE | $969.75 | $1,293.00 | $387.90–$1,293.00 | 117% above | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ AA STRD NERVE GR OCCIPITAL | $930.75 | $1,241.00 | $372.30–$1,241.00 | — | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC ED INJ AA STRD GREATER OCCIPITAL NERVE | $969.75 | $1,293.00 | $387.90–$1,293.00 | — | 25% |
| Paracentesis with imaging guidance CPT 49083 HC PARACENTESIS ABD W GUIDANCE | $1,973.25 | $2,631.00 | $789.30–$2,631.00 | 60% above | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC PARACENTESIS ABD W GUIDANCE | $1,973.25 | $2,631.00 | $789.30–$2,631.00 | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL NAIL FINGER OR TOE | $867.75 | $1,157.00 | $347.10–$1,157.00 | 166% above | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVAL NAIL FINGER OR TOE | $867.75 | $1,157.00 | $347.10–$1,157.00 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTRUCT FACET JNT W IMG L/S SNG LVL BIL | $2,233.50 | $2,978.00 | $893.40–$2,978.00 | 21% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTRUCT FACET JNT W IMG L/S SNG LVL | $4,671.75 | $6,229.00 | $1,868.70–$6,229.00 | 154% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTRUCT FACET JNT W IMG L/S SNG LVL BIL | $2,233.50 | $2,978.00 | $893.40–$2,978.00 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTRUCT FACET JNT W IMG L/S SNG LVL | $4,671.75 | $6,229.00 | $1,868.70–$6,229.00 | — | 25% |
| Removal of a breast lump, open surgery CPT 19120 HC BREAST MASS BIOPSY/EXCISION | $7,044.75 | $9,393.00 | $2,817.90–$9,393.00 | 227% above | 25% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC BREAST MASS BIOPSY/EXCISION | $7,044.75 | $9,393.00 | $2,817.90–$9,393.00 | — | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 HC FOR BODY REMOV SUBCUTANEOUS SIMPL | $224.25 | $299.00 | $89.70–$299.00 | 22% below | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 HC ED REMOVAL FOREIGN BODY SUBQ SIMPLE | $224.25 | $299.00 | $89.70–$299.00 | 22% below | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC ED REMOVAL FOREIGN BODY SUBQ SIMPLE | $224.25 | $299.00 | $89.70–$299.00 | — | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC FOR BODY REMOV SUBCUTANEOUS SIMPL | $224.25 | $299.00 | $89.70–$299.00 | — | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC COLON CA SCRN NOT HI RSK IND | $1,983.75 | $2,645.00 | $793.50–$2,645.00 | 53% above | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC COLON CA SCRN NOT HI RSK IND | $1,983.75 | $2,645.00 | $793.50–$2,645.00 | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC COLONOSCOPY SCRN HIGH RISK | $1,983.75 | $2,645.00 | $793.50–$2,645.00 | 22% above | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC COLONOSCOPY SCRN HIGH RISK | $1,983.75 | $2,645.00 | $793.50–$2,645.00 | — | 25% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC LITHOTRIPSY ESWL | $9,362.25 | $12,483.00 | $3,744.90–$12,483.00 | 2% above | 25% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 HC LITHOTRIPSY ESWL | $9,362.25 | $12,483.00 | $3,744.90–$12,483.00 | — | 25% |
| Short arm cast (elbow to hand) CPT 29075 HC APPLICATION CAST ELBOW TO FINGER | $224.25 | $299.00 | $89.70–$299.00 | 5% below | 25% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLICATION CAST ELBOW TO FINGER | $224.25 | $299.00 | $89.70–$299.00 | — | 25% |
| Short arm splint (forearm and hand) CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC | $123.75 | $165.00 | $49.50–$165.00 | 30% below | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLIC SPLINT SHORT ARM STATIC | $123.75 | $165.00 | $49.50–$165.00 | — | 25% |
| Short leg cast (below the knee) CPT 29405 HC APPLIC CAST SHORT LEG | $186.75 | $249.00 | $74.70–$249.00 | 17% below | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 HC APPLIC CAST SHORT LEG | $186.75 | $249.00 | $74.70–$249.00 | — | 25% |
| Short leg splint (calf to foot) CPT 29515 HC APPLIC SPLINT SHORT LEG | $132.75 | $177.00 | $53.10–$177.00 | 36% below | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC APPLIC SPLINT SHORT LEG | $132.75 | $177.00 | $53.10–$177.00 | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM | $395.25 | $527.00 | $158.10–$527.00 | 21% above | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM | $395.25 | $527.00 | $158.10–$527.00 | — | 25% |
| Skin biopsy, punch, one lesion CPT 11104 HC BIOPSY SKIN PUNCH SNGL LSN | $513.00 | $684.00 | $205.20–$684.00 | 131% above | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC BIOPSY SKIN PUNCH SNGL LSN | $513.00 | $684.00 | $205.20–$684.00 | — | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC EXC SKIN MALIG TRNK/EXTRM <=0.5CM | $1,264.50 | $1,686.00 | $505.80–$1,686.00 | 244% above | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC EXC SKIN MALIG TRNK/EXTRM <=0.5CM | $1,264.50 | $1,686.00 | $505.80–$1,686.00 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC LUMBAR PUNCTURE | $1,527.00 | $2,036.00 | $610.80–$2,036.00 | 163% above | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC ED LUMBAR PUNCTURE DX WO CT FL | $1,527.00 | $2,036.00 | $610.80–$2,036.00 | 163% above | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC LUMBAR PUNCTURE | $1,527.00 | $2,036.00 | $610.80–$2,036.00 | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC ED LUMBAR PUNCTURE DX WO CT FL | $1,527.00 | $2,036.00 | $610.80–$2,036.00 | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM | $454.50 | $606.00 | $181.80–$606.00 | 125% above | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC RPR SCLP/TRNK/EXTRM SMPL 2.6-7.5 CM | $454.50 | $606.00 | $181.80–$606.00 | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC WND RPR SIM FACE 1-2.5CM | $490.50 | $654.00 | $196.20–$654.00 | 59% above | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC WND RPR SIM FACE 1-2.5CM | $490.50 | $654.00 | $196.20–$654.00 | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC BIOPSY SKIN TANGENTIAL SNGL LSN | $441.75 | $589.00 | $176.70–$589.00 | 92% above | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC BIOPSY SKIN TANGENTIAL SNGL LSN | $441.75 | $589.00 | $176.70–$589.00 | — | 25% |
| Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS W IMAGING | $1,224.75 | $1,633.00 | $489.90–$1,633.00 | 6% above | 25% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS W IMAGING | $1,224.75 | $1,633.00 | $489.90–$1,633.00 | — | 25% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 HC REMOVE TONSILS/ADENOIDS AGE 12 OR MORE | $6,630.00 | $8,840.00 | $2,652.00–$8,840.00 | 233% above | 25% |
| Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 HC REMOVE TONSILS/ADENOIDS AGE 12 OR MORE | $6,630.00 | $8,840.00 | $2,652.00–$8,840.00 | — | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 HC REMOVE TONSILS UNDER AGE 12 | $6,555.00 | $8,740.00 | $2,622.00–$8,740.00 | 272% above | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 HC REMOVE TONSILS UNDER AGE 12 | $6,555.00 | $8,740.00 | $2,622.00–$8,740.00 | — | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINT 1 OR 2 MUSC | $459.75 | $613.00 | $183.90–$613.00 | 77% above | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER POINT 1 OR 2 MUSC | $459.75 | $613.00 | $183.90–$613.00 | — | 25% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 HC LAP W DESTRUCTION OF OVIDUCTS | $675.00 | $900.00 | $270.00–$900.00 | 52% below | 25% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 HC LAP W DESTRUCTION OF OVIDUCTS | $675.00 | $900.00 | $270.00–$900.00 | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST PERC 1ST LESN US | $2,441.25 | $3,255.00 | $976.50–$3,255.00 | 33% above | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST PERC 1ST LESN US | $2,441.25 | $3,255.00 | $976.50–$3,255.00 | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC EGD W BALLOON DILATION ESOPHAGUS<30MM | $2,937.75 | $3,917.00 | $1,175.10–$3,917.00 | 78% above | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC EGD W BALLOON DILATION ESOPHAGUS<30MM | $2,937.75 | $3,917.00 | $1,175.10–$3,917.00 | — | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC EGD FLEX TRANSORAL W BX SNGL OR MULT | $3,104.25 | $4,139.00 | $1,241.70–$4,139.00 | 96% above | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC EGD FLEX TRANSORAL W BX SNGL OR MULT | $3,104.25 | $4,139.00 | $1,241.70–$4,139.00 | — | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC EGD FLEX TRANSORAL DX | $2,603.25 | $3,471.00 | $1,041.30–$3,471.00 | 77% above | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC EGD FLEX TRANSORAL DX | $2,603.25 | $3,471.00 | $1,041.30–$3,471.00 | — | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 HC ROUT OB CARE AFTER VAG DELIV | $4,083.00 | $5,444.00 | $1,633.20–$5,444.00 | 21% below | 25% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 HC ROUT OB CARE AFTER VAG DELIV | $4,083.00 | $5,444.00 | $1,633.20–$5,444.00 | — | 25% |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 HC VASECTOMY UNILAT OR BILAT | $358.50 | $478.00 | $143.40–$478.00 | — | 25% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 HC VASECTOMY UNILAT OR BILAT | $358.50 | $478.00 | $143.40–$478.00 | — | 25% |
| Wart removal, up to 14 warts CPT 17110 HC DESTR BENIGN LESION OTHER SKIN TAG <14 | $282.00 | $376.00 | $112.80–$376.00 | 46% above | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC DESTR BENIGN LESION OTHER SKIN TAG <14 | $282.00 | $376.00 | $112.80–$376.00 | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS | $867.75 | $1,157.00 | $347.10–$1,157.00 | 91% above | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SUBQ TISSUE 1ST 20 CM OR LESS | $867.75 | $1,157.00 | $347.10–$1,157.00 | — | 25% |
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 >4 HOURS | $647.25 | $863.00 | $258.90–$863.00 | 11% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 1-2 HOURS | $1,461.00 | $1,948.00 | $584.40–$1,948.00 | 150% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD TRANSFUSION 3-4 HOURS | $1,925.25 | $2,567.00 | $770.10–$2,567.00 | 230% above | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION >4 HOURS | $647.25 | $863.00 | $258.90–$863.00 | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 1-2 HOURS | $1,461.00 | $1,948.00 | $584.40–$1,948.00 | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD TRANSFUSION 3-4 HOURS | $1,925.25 | $2,567.00 | $770.10–$2,567.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC NEBULIZER VIBRATING MESH TREATMENT | $120.00 | $160.00 | $48.00–$160.00 | 79% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT W/MED | $135.75 | $181.00 | $54.30–$181.00 | 103% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALATION TREATMENT W/MED SUBSEQUENT | $158.25 | $211.00 | $63.30–$211.00 | 136% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC SVN MDI OR IPPB | $162.75 | $217.00 | $65.10–$217.00 | 143% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC HAND HELD NEBULIZER | $162.75 | $217.00 | $65.10–$217.00 | 143% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI TREATMENT SUBSEQ | $162.75 | $217.00 | $65.10–$217.00 | 143% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC NEBULIZER VIBRATING MESH TREATMENT | $120.00 | $160.00 | $48.00–$160.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT W/MED | $135.75 | $181.00 | $54.30–$181.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALATION TREATMENT W/MED SUBSEQUENT | $158.25 | $211.00 | $63.30–$211.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI TREATMENT SUBSEQ | $162.75 | $217.00 | $65.10–$217.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC HAND HELD NEBULIZER | $162.75 | $217.00 | $65.10–$217.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC SVN MDI OR IPPB | $162.75 | $217.00 | $65.10–$217.00 | — | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 HC IV INF CHEMO 1 HR | $630.00 | $840.00 | $252.00–$840.00 | 16% above | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC IV INF CHEMO 1 HR | $630.00 | $840.00 | $252.00–$840.00 | — | 25% |
| Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC EYE EXAM NEW PATIENT COMPR | $141.00 | $188.00 | $56.40–$188.00 | 6% below | 25% |
| Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC EYE EXAM NEW PATIENT COMPR | $141.00 | $188.00 | $56.40–$188.00 | — | 25% |
| Comprehensive eye exam, returning patient CPT 92014 HC EYE EXAM ESTAB PATIENT COMPR | $118.50 | $158.00 | $47.40–$158.00 | at median | 25% |
| Comprehensive eye exam, returning patient inpatient CPT 92014 HC EYE EXAM ESTAB PATIENT COMPR | $118.50 | $158.00 | $47.40–$158.00 | — | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC AUDIOMETRY COMPREHENSIVE | $262.50 | $350.00 | $105.00–$350.00 | 78% above | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC AUDIOMETRY COMPREHENSIVE | $262.50 | $350.00 | $105.00–$350.00 | — | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 HC EMERG CRITICAL CARE 30 TO 74 MINUTES | $1,755.75 | $2,341.00 | $702.30–$2,341.00 | 27% above | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC EMERG CRITICAL CARE 30 TO 74 MINUTES | $1,755.75 | $2,341.00 | $702.30–$2,341.00 | — | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG RECORD AWAKE & DROWSY | $1,085.25 | $1,447.00 | $434.10–$1,447.00 | 60% above | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG RECORD AWAKE & DROWSY | $1,085.25 | $1,447.00 | $434.10–$1,447.00 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG 12 LEAD | $237.75 | $317.00 | $95.10–$317.00 | 70% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG 12 LEAD | $237.75 | $317.00 | $95.10–$317.00 | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY DEPT VISIT LEVEL 1 | $239.25 | $319.00 | $95.70–$319.00 | 117% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY DEPT VISIT LEVEL 1 | $239.25 | $319.00 | $95.70–$319.00 | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY DEPT VISIT LEVEL 2 | $350.25 | $467.00 | $140.10–$467.00 | 32% above | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY DEPT VISIT LEVEL 2 | $350.25 | $467.00 | $140.10–$467.00 | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY DEPT VISIT LEVEL 3 | $517.50 | $690.00 | $207.00–$690.00 | 29% above | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY DEPT VISIT LEVEL 3 | $517.50 | $690.00 | $207.00–$690.00 | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY DEPT VISIT LEVEL 4 | $795.75 | $1,061.00 | $318.30–$1,061.00 | 34% above | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY DEPT VISIT LEVEL 4 | $795.75 | $1,061.00 | $318.30–$1,061.00 | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY DEPT VISIT LEVEL 5 | $1,657.50 | $2,210.00 | $663.00–$2,210.00 | 64% above | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY DEPT VISIT LEVEL 5 | $1,657.50 | $2,210.00 | $663.00–$2,210.00 | — | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CARD STRESS TEST ROUTINE | $771.75 | $1,029.00 | $308.70–$1,029.00 | 3% below | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CARD STRESS TEST ROUTINE | $771.75 | $1,029.00 | $308.70–$1,029.00 | — | 25% |
| Eye exam, returning patient, intermediate CPT 92012 HC EYE EXAM ESTAB PATIENT INTERMED | $74.25 | $99.00 | $29.70–$99.00 | 25% below | 25% |
| Eye exam, returning patient, intermediate inpatient CPT 92012 HC EYE EXAM ESTAB PATIENT INTERMED | $74.25 | $99.00 | $29.70–$99.00 | — | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC OP FAMILY PSYCHOTHERAPY W PT 50 MIN | $289.50 | $386.00 | $115.80–$386.00 | 53% above | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC OP FAMILY PSYCHOTHERAPY W PT 50 MIN | $289.50 | $386.00 | $115.80–$386.00 | — | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC FAMILY PSYCHOTHERAPY WO PT 50 MIN | $330.75 | $441.00 | $132.30–$441.00 | 86% above | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC FAMILY PSYCHOTHERAPY WO PT 50 MIN | $330.75 | $441.00 | $132.30–$441.00 | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INF HYDRATION INIT 31 MIN TO 1HR | $324.00 | $432.00 | $129.60–$432.00 | 14% above | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION HYDRATION 1ST HR | $468.00 | $624.00 | $187.20–$624.00 | 64% above | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INF HYDRATION INIT 31 MIN TO 1HR | $324.00 | $432.00 | $129.60–$432.00 | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSION HYDRATION 1ST HR | $468.00 | $624.00 | $187.20–$624.00 | — | 25% |
| IV infusion of a medicine, first hour CPT 96365 HC IV INF THER/PROPH/DIAG 1ST HR | $329.25 | $439.00 | $131.70–$439.00 | 5% above | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INF THER/PROPH/DIAG 1ST HR | $329.25 | $439.00 | $131.70–$439.00 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJ THER/PROPH/DIAG SUBQ/IM | $97.50 | $130.00 | $39.00–$130.00 | 23% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJ THER/PROPH/DIAG SUBQ/IM | $97.50 | $130.00 | $39.00–$130.00 | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC EVALUATION PSYCH ADULT | $72.75 | $97.00 | $29.10–$97.00 | 67% below | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC INTERVIEW PSYCH DX | $89.25 | $119.00 | $35.70–$119.00 | 59% below | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC EVALUATION PSYCH ADULT | $72.75 | $97.00 | $29.10–$97.00 | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC INTERVIEW PSYCH DX | $89.25 | $119.00 | $35.70–$119.00 | — | 25% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NRV CONDUCTION 7-8 STUDIES | $900.00 | $1,200.00 | $360.00–$1,200.00 | 102% above | 25% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NRV CONDUCTION 7-8 STUDIES | $900.00 | $1,200.00 | $360.00–$1,200.00 | — | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN PT | $122.25 | $163.00 | $48.90–$407.50 | 30% above | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN OT | $150.00 | $200.00 | $60.00–$500.00 | 60% above | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN PT | $122.25 | $163.00 | $48.90–$407.50 | — | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC REEDUCAT 1+ AREAS EA 15 MIN OT | $150.00 | $200.00 | $60.00–$500.00 | — | 25% |
| New patient office visit, about 30 minutes CPT 99203 HC FACLTY OP NEW LEVEL 3 | $181.50 | $242.00 | $72.60–$242.00 | 8% below | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC FACLTY OP NEW LEVEL 3 | $181.50 | $242.00 | $72.60–$242.00 | — | 25% |
| New patient office visit, about 45 minutes CPT 99204 HC FACLTY OP NEW LEVEL 4 | $283.50 | $378.00 | $113.40–$378.00 | 38% above | 25% |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE OUTPT VISIT NEW LEVEL 4 | $283.50 | $378.00 | $113.40–$378.00 | 38% above | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC FACLTY OP NEW LEVEL 4 | $283.50 | $378.00 | $113.40–$378.00 | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE OUTPT VISIT NEW LEVEL 4 | $283.50 | $378.00 | $113.40–$378.00 | — | 25% |
| New patient office visit, about 60 minutes CPT 99205 HC FACLTY OP NEW LEVEL 5 | $323.25 | $431.00 | $129.30–$431.00 | 6% above | 25% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC FACLTY OP NEW LEVEL 5 | $323.25 | $431.00 | $129.30–$431.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HP OFFICE/OUTPT VISIT NEW LEVL II | $95.25 | $127.00 | $38.10–$127.00 | 27% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HP OFFICE/OUTPATIENT VISIT NEW LVL II | $95.25 | $127.00 | $38.10–$127.00 | 27% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE OUTPT VISIT NEW LEVEL 2 | $163.50 | $218.00 | $65.40–$218.00 | 25% above | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OP TREATMENT ROOM | $222.00 | $296.00 | $88.80–$296.00 | 70% above | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC LACTATION SERVICES | $353.25 | $471.00 | $141.30–$471.00 | 170% above | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC BLOOD ALCOHOL PER POLICE | $367.50 | $490.00 | $147.00–$490.00 | 181% above | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HP OFFICE/OUTPATIENT VISIT NEW LVL II | $95.25 | $127.00 | $38.10–$127.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HP OFFICE/OUTPT VISIT NEW LEVL II | $95.25 | $127.00 | $38.10–$127.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OFFICE OUTPT VISIT NEW LEVEL 2 | $163.50 | $218.00 | $65.40–$218.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OP TREATMENT ROOM | $222.00 | $296.00 | $88.80–$296.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC LACTATION SERVICES | $353.25 | $471.00 | $141.30–$471.00 | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC BLOOD ALCOHOL PER POLICE | $367.50 | $490.00 | $147.00–$490.00 | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT INIT INDIV EA 15 MIN | $63.00 | $84.00 | $25.20–$84.00 | 10% above | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT INIT INDIV EA 15 MIN | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEXITY | $177.75 | $237.00 | $71.10–$592.50 | at median | 25% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEXITY | $177.75 | $237.00 | $71.10–$592.50 | — | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEXITY | $363.75 | $485.00 | $145.50–$1,212.50 | 25% above | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEXITY | $363.75 | $485.00 | $145.50–$1,212.50 | — | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEXITY | $247.50 | $330.00 | $99.00–$825.00 | 39% above | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEXITY | $247.50 | $330.00 | $99.00–$825.00 | — | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEXITY | $308.25 | $411.00 | $123.30–$1,027.50 | 28% above | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEXITY | $308.25 | $411.00 | $123.30–$1,027.50 | — | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT | $107.25 | $143.00 | $42.90–$357.50 | 23% above | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THER TECH 1+REGIONS EA 15 MIN OT | $107.25 | $143.00 | $42.90–$357.50 | 23% above | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THER TECH 1+REGIONS EA 15 MIN OT | $107.25 | $143.00 | $42.90–$357.50 | — | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT | $107.25 | $143.00 | $42.90–$357.50 | — | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISE EA 15 MIN OT | $114.00 | $152.00 | $45.60–$380.00 | 30% above | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THER EXERCISE EA 15 MIN PT | $129.75 | $173.00 | $51.90–$432.50 | 48% above | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISE EA 15 MIN OT | $114.00 | $152.00 | $45.60–$380.00 | — | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THER EXERCISE EA 15 MIN PT | $129.75 | $173.00 | $51.90–$432.50 | — | 25% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PHYSCN PREVENT NEW PT 18-39YRS | $61.50 | $82.00 | $24.60–$82.00 | 56% below | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PHYSCN PREVENT NEW PT 18-39YRS | $61.50 | $82.00 | $24.60–$82.00 | — | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PHYSCN PREVENT NEW PT 40-64YRS | $65.25 | $87.00 | $26.10–$87.00 | 78% below | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PHYSCN PREVENT NEW PT 40-64YRS | $65.25 | $87.00 | $26.10–$87.00 | — | 25% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC INIT PM E/M NEW PAT 65 AND OVER | $138.75 | $185.00 | $55.50–$185.00 | 56% below | 25% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC INIT PM E/M NEW PAT 65 AND OVER | $138.75 | $185.00 | $55.50–$185.00 | — | 25% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PHYSCN PREVENT ESTAB PT 18-39YRS | $58.50 | $78.00 | $23.40–$78.00 | 62% below | 25% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PHYSCN PREVENT ESTAB PT 18-39YRS | $58.50 | $78.00 | $23.40–$78.00 | — | 25% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PHYSCN PREVENT ESTAB PT 40-64YRS | $60.75 | $81.00 | $24.30–$81.00 | 64% below | 25% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PHYSCN PREVENT ESTAB PT 40-64YRS | $60.75 | $81.00 | $24.30–$81.00 | — | 25% |
| Psychiatric evaluation with medical services CPT 90792 HC PSYCH DIAG EVAL W MED SRVCS | $379.50 | $506.00 | $151.80–$506.00 | 37% above | 25% |
| Psychiatric evaluation with medical services inpatient CPT 90792 HC PSYCH DIAG EVAL W MED SRVCS | $379.50 | $506.00 | $151.80–$506.00 | — | 25% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $429.00 | $572.00 | $171.60–$572.00 | 46% above | 25% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYCHOTHERAPY FOR CRISIS INITIAL 60 MIN | $429.00 | $572.00 | $171.60–$572.00 | — | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN | $242.25 | $323.00 | $96.90–$323.00 | 128% above | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYCHOTHERAPY W PT 30 MIN | $242.25 | $323.00 | $96.90–$323.00 | — | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN | $212.25 | $283.00 | $84.90–$283.00 | 50% above | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYCHOTHERAPY W PT 45 MIN | $212.25 | $283.00 | $84.90–$283.00 | — | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN | $152.25 | $203.00 | $60.90–$203.00 | 28% below | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYCHOTHERAPY W PT 60 MIN | $152.25 | $203.00 | $60.90–$203.00 | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC COUNSEL SMOKING/TOBACCO INTERMED 3-10MIN | $63.00 | $84.00 | $25.20–$84.00 | 131% above | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC COUNSEL SMOKING/TOBACCO INTERMED 3-10MIN | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE OUTPT VISIT EST LEVEL 5 | $105.75 | $141.00 | $42.30–$141.00 | 63% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE OUTPT VISIT EST LEVEL 5 | $105.75 | $141.00 | $42.30–$141.00 | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OFFICE OUTPT VISIT EST LEVEL 3 | $60.75 | $81.00 | $24.30–$81.00 | 62% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OFFICE OUTPT VISIT EST LEVEL 3 | $60.75 | $81.00 | $24.30–$81.00 | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE OUTPT VISIT EST LEVEL 4 | $63.00 | $84.00 | $25.20–$84.00 | 65% below | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE OUTPT VISIT EST LEVEL 4 | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC FACLTY OP EST PT LEVEL 2 | $57.00 | $76.00 | $22.80–$76.00 | 42% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC FACLTY OP EST PT LEVEL 2 | $57.00 | $76.00 | $22.80–$76.00 | — | 25% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC FACLTY CONSULT OP MODERT 40MIN | $87.75 | $117.00 | $35.10–$117.00 | 56% below | 25% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC FACLTY CONSULT OP MODERT 40MIN | $87.75 | $117.00 | $35.10–$117.00 | — | 25% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC FACLTY CONSULT OP MOD-HI 60MIN | $321.00 | $428.00 | $128.40–$428.00 | at median | 25% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC FACLTY CONSULT OP MOD-HI 60MIN | $321.00 | $428.00 | $128.40–$428.00 | — | 25% |
| Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND PROD W LANG | $504.75 | $673.00 | $201.90–$673.00 | 48% above | 25% |
| Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND PROD W LANG | $504.75 | $673.00 | $201.90–$673.00 | — | 25% |
| Speech therapy session, individual CPT 92507 HC TREATMENT SP LANG DYSPH | $281.25 | $375.00 | $112.50–$375.00 | 11% above | 25% |
| Speech therapy session, individual inpatient CPT 92507 HC TREATMENT SP LANG DYSPH | $281.25 | $375.00 | $112.50–$375.00 | — | 25% |
| Spirometry (breathing test) CPT 94010 HC SPIROMETRY | $293.25 | $391.00 | $117.30–$391.00 | 70% above | 25% |
| Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY | $293.25 | $391.00 | $117.30–$391.00 | — | 25% |
| Spirometry before and after a bronchodilator CPT 94060 HC BRONCHODILATOR PRE/POST TEST | $584.25 | $779.00 | $233.70–$779.00 | 65% above | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC BRONCHODILATOR PRE/POST TEST | $584.25 | $779.00 | $233.70–$779.00 | — | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THER ACTIVITIES EA 15 MIN PT | $114.75 | $153.00 | $45.90–$382.50 | 36% above | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THER ACTIVITIES EA 15 MIN OT | $143.25 | $191.00 | $57.30–$477.50 | 69% above | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THER ACTIVITIES EA 15 MIN PT | $114.75 | $153.00 | $45.90–$382.50 | — | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THER ACTIVITIES EA 15 MIN OT | $143.25 | $191.00 | $57.30–$477.50 | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY THER | $243.00 | $324.00 | $97.20–$324.00 | 22% above | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY THER | $243.00 | $324.00 | $97.20–$324.00 | — | 25% |
| Visual field test, extended CPT 92083 HC EXAM VISUAL FIELD EXTENDED | $133.50 | $178.00 | $53.40–$178.00 | 35% above | 25% |
| Visual field test, extended inpatient CPT 92083 HC EXAM VISUAL FIELD EXTENDED | $133.50 | $178.00 | $53.40–$178.00 | — | 25% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARS COVID19 VACC 50MCG | $190.50 | $254.00 | $76.20–$254.00 | 14% above | 25% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARS COVID19 VACC 50MCG | $190.50 | $254.00 | $76.20–$254.00 | 14% above | 25% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARS COVID19 VACC 50MCG | $190.50 | $254.00 | $76.20–$254.00 | — | 25% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARS COVID19 VACC 50MCG | $190.50 | $254.00 | $76.20–$254.00 | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC VARICELLA (CHICKEN POX) VACCINE | $147.00 | $196.00 | $58.80–$196.00 | 10% below | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC VARICELLA (CHICKEN POX) VACCINE | $147.00 | $196.00 | $58.80–$196.00 | 10% below | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC VARICELLA (CHICKEN POX) VACCINE | $147.00 | $196.00 | $58.80–$196.00 | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 HC VARICELLA (CHICKEN POX) VACCINE | $147.00 | $196.00 | $58.80–$196.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC VACC FLUARIX TRIVALENT 0.5 ML IM SUSY | $26.25 | $35.00 | $10.50–$35.00 | 7% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC VACC FLUARIX TRIVALENT 0.5 ML IM SUSY | $26.25 | $35.00 | $10.50–$35.00 | 7% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC VACC FLUZONE TRIVALENT 0.5 ML IM SUSY | $27.75 | $37.00 | $11.10–$37.00 | 2% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC VACC FLUZONE TRIVALENT 0.5 ML IM SUSY | $27.75 | $37.00 | $11.10–$37.00 | 2% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC VACC FLUARIX TRIVALENT 0.5 ML IM SUSY | $26.25 | $35.00 | $10.50–$35.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC VACC FLUARIX TRIVALENT 0.5 ML IM SUSY | $26.25 | $35.00 | $10.50–$35.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC VACC FLUZONE TRIVALENT 0.5 ML IM SUSY | $27.75 | $37.00 | $11.10–$37.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC VACC FLUZONE TRIVALENT 0.5 ML IM SUSY | $27.75 | $37.00 | $11.10–$37.00 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY | $102.95 | $137.27 | $41.18–$137.27 | 67% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY | $102.95 | $137.27 | $41.18–$137.27 | 67% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $217.67 | $290.22 | $87.07–$290.22 | 30% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $217.67 | $290.22 | $87.07–$290.22 | 30% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC HPV VIRUS VACCINE 9 VAL IM | $236.25 | $315.00 | $94.50–$315.00 | 25% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC HPV VIRUS VACCINE 9 VAL IM | $236.25 | $315.00 | $94.50–$315.00 | 25% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY | $102.95 | $137.27 | $41.18–$137.27 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY | $102.95 | $137.27 | $41.18–$137.27 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $217.67 | $290.22 | $87.07–$290.22 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $217.67 | $290.22 | $87.07–$290.22 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC HPV VIRUS VACCINE 9 VAL IM | $236.25 | $315.00 | $94.50–$315.00 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HC HPV VIRUS VACCINE 9 VAL IM | $236.25 | $315.00 | $94.50–$315.00 | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC HEP A HEP B VACC ADULT IM | $72.75 | $97.00 | $29.10–$97.00 | 62% below | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC HEP A HEP B VACC ADULT IM | $72.75 | $97.00 | $29.10–$97.00 | 62% below | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC HEP A HEP B VACC ADULT IM | $72.75 | $97.00 | $29.10–$97.00 | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC HEP A HEP B VACC ADULT IM | $72.75 | $97.00 | $29.10–$97.00 | — | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPARIN (PORCINE) LOCK FLUSH 10 UNIT/ML SOLN SSM SO | $22.50 | $30.00 | $9.00–$30.00 | 83% below | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPARIN (PORCINE) LOCK FLUSH 10 UNIT/ML SOLN SSM SO | $22.50 | $30.00 | $9.00–$30.00 | 83% below | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 HC HEPA VACCINE ADULT IM | $125.25 | $167.00 | $50.10–$167.00 | 5% below | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 HC HEPA VACCINE ADULT IM | $125.25 | $167.00 | $50.10–$167.00 | 5% below | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPARIN (PORCINE) LOCK FLUSH 10 UNIT/ML SOLN SSM SO | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPARIN (PORCINE) LOCK FLUSH 10 UNIT/ML SOLN SSM SO | $22.50 | $30.00 | $9.00–$30.00 | — | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HC HEPA VACCINE ADULT IM | $125.25 | $167.00 | $50.10–$167.00 | — | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 HC HEPA VACCINE ADULT IM | $125.25 | $167.00 | $50.10–$167.00 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $115.43 | $153.90 | $46.17–$153.90 | 5% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $115.43 | $153.90 | $46.17–$153.90 | 5% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEPATITIS B VACCINE ADULT IM | $380.25 | $507.00 | $152.10–$507.00 | 212% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEPATITIS B VACCINE ADULT IM | $380.25 | $507.00 | $152.10–$507.00 | 212% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $115.43 | $153.90 | $46.17–$153.90 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SSM SO - HYPERHEP B | $115.43 | $153.90 | $46.17–$153.90 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEPATITIS B VACCINE ADULT IM | $380.25 | $507.00 | $152.10–$507.00 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEPATITIS B VACCINE ADULT IM | $380.25 | $507.00 | $152.10–$507.00 | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC FLU VACC PRSV FREE INC ANTIG IM | $37.50 | $50.00 | $15.00–$50.00 | 53% below | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC FLU VACC PRSV FREE INC ANTIG IM | $37.50 | $50.00 | $15.00–$50.00 | 53% below | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC FLU VACC PRSV FREE HI DOSE 0.5ML IM SUSY | $98.25 | $131.00 | $39.30–$131.00 | 24% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC FLU VACC PRSV FREE HI DOSE 0.5ML IM SUSY | $98.25 | $131.00 | $39.30–$131.00 | 24% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLIXIMAB 100 MG IV SOLR | $1,524.00 | $2,032.00 | $609.60–$2,032.00 | 1821% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLIXIMAB 100 MG IV SOLR | $1,524.00 | $2,032.00 | $609.60–$2,032.00 | 1821% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC FLU VACC PRSV FREE INC ANTIG IM | $37.50 | $50.00 | $15.00–$50.00 | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC FLU VACC PRSV FREE INC ANTIG IM | $37.50 | $50.00 | $15.00–$50.00 | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC FLU VACC PRSV FREE HI DOSE 0.5ML IM SUSY | $98.25 | $131.00 | $39.30–$131.00 | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC FLU VACC PRSV FREE HI DOSE 0.5ML IM SUSY | $98.25 | $131.00 | $39.30–$131.00 | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLIXIMAB 100 MG IV SOLR | $1,524.00 | $2,032.00 | $609.60–$2,032.00 | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLIXIMAB 100 MG IV SOLR | $1,524.00 | $2,032.00 | $609.60–$2,032.00 | — | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 HC MEASLES MUMPS RUBELLA MMR VACCINE | $96.75 | $129.00 | $38.70–$129.00 | 37% below | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 HC MEASLES MUMPS RUBELLA MMR VACCINE | $96.75 | $129.00 | $38.70–$129.00 | 37% below | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC MEASLES MUMPS RUBELLA MMR VACCINE | $96.75 | $129.00 | $38.70–$129.00 | — | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC MEASLES MUMPS RUBELLA MMR VACCINE | $96.75 | $129.00 | $38.70–$129.00 | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC MENINGOCOCCAL VACCINE IM | $156.00 | $208.00 | $62.40–$208.00 | 32% below | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC MENINGOCOCCAL VACCINE IM | $156.00 | $208.00 | $62.40–$208.00 | 32% below | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC MENINGOCOCCAL VACCINE IM | $156.00 | $208.00 | $62.40–$208.00 | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC MENINGOCOCCAL VACCINE IM | $156.00 | $208.00 | $62.40–$208.00 | — | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC MENINGOCOCCAL RP W OMV VACCINE IM | $140.25 | $187.00 | $56.10–$187.00 | 39% below | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 HC MENINGOCOCCAL RP W OMV VACCINE IM | $140.25 | $187.00 | $56.10–$187.00 | 39% below | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC MENINGOCOCCAL RP W OMV VACCINE IM | $140.25 | $187.00 | $56.10–$187.00 | — | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 HC MENINGOCOCCAL RP W OMV VACCINE IM | $140.25 | $187.00 | $56.10–$187.00 | — | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PCV20 VACCINE IM | $741.75 | $989.00 | $296.70–$989.00 | 154% above | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 HC PCV20 VACCINE IM | $741.75 | $989.00 | $296.70–$989.00 | 154% above | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PCV20 VACCINE IM | $741.75 | $989.00 | $296.70–$989.00 | — | 25% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 HC PCV20 VACCINE IM | $741.75 | $989.00 | $296.70–$989.00 | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PNEUMO POLYSAC VACCINE >=2YRS SUBQ IM | $63.00 | $84.00 | $25.20–$84.00 | 55% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PNEUMO POLYSAC VACCINE >=2YRS SUBQ IM | $63.00 | $84.00 | $25.20–$84.00 | 55% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PNEUMO POLYSAC VACCINE >=2YRS SUBQ IM | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PNEUMO POLYSAC VACCINE >=2YRS SUBQ IM | $63.00 | $84.00 | $25.20–$84.00 | — | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC VAC RSV MONOCLONAL ANTIBODY 0.5 ML | $705.75 | $941.00 | $282.30–$941.00 | 31% below | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HC VAC RSV MONOCLONAL ANTIBODY 0.5 ML | $705.75 | $941.00 | $282.30–$941.00 | 31% below | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC VAC RSV MONOCLONAL ANTIBODY 0.5 ML | $705.75 | $941.00 | $282.30–$941.00 | — | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HC VAC RSV MONOCLONAL ANTIBODY 0.5 ML | $705.75 | $941.00 | $282.30–$941.00 | — | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC VAC RSV PREF BIVALENT IM | $396.00 | $528.00 | $158.40–$528.00 | 29% below | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 HC VAC RSV PREF BIVALENT IM | $396.00 | $528.00 | $158.40–$528.00 | 29% below | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC VAC RSV PREF BIVALENT IM | $396.00 | $528.00 | $158.40–$528.00 | — | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 HC VAC RSV PREF BIVALENT IM | $396.00 | $528.00 | $158.40–$528.00 | — | 25% |
| Rabies vaccine, one dose CPT 90675 HC RABIES VACCINE IM | $346.50 | $462.00 | $138.60–$462.00 | 36% below | 25% |
| Rabies vaccine, one dose CPT 90675 HC RABIES VACCINE IM | $346.50 | $462.00 | $138.60–$462.00 | 36% below | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 HC RABIES VACCINE IM | $346.50 | $462.00 | $138.60–$462.00 | — | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 HC RABIES VACCINE IM | $346.50 | $462.00 | $138.60–$462.00 | — | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC ZOSTER VACCINE RECOMBINANT IM | $226.50 | $302.00 | $90.60–$302.00 | 14% above | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HC ZOSTER VACCINE RECOMBINANT IM | $226.50 | $302.00 | $90.60–$302.00 | 14% above | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC ZOSTER VACCINE RECOMBINANT IM | $226.50 | $302.00 | $90.60–$302.00 | — | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 HC ZOSTER VACCINE RECOMBINANT IM | $226.50 | $302.00 | $90.60–$302.00 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN | $25.13 | $33.50 | $10.05–$33.50 | 39% below | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN | $25.13 | $33.50 | $10.05–$33.50 | 39% below | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC TD PRESERVE FREE 7 YRS AND OLDER | $63.75 | $85.00 | $25.50–$85.00 | 54% above | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC TD PRESERVE FREE 7 YRS AND OLDER | $63.75 | $85.00 | $25.50–$85.00 | 54% above | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN | $25.13 | $33.50 | $10.05–$33.50 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN | $25.13 | $33.50 | $10.05–$33.50 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC TD PRESERVE FREE 7 YRS AND OLDER | $63.75 | $85.00 | $25.50–$85.00 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC TD PRESERVE FREE 7 YRS AND OLDER | $63.75 | $85.00 | $25.50–$85.00 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TERBUTALINE SULFATE 1 MG/ML IJ SOLN | $25.71 | $34.28 | $10.28–$34.28 | 67% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TERBUTALINE SULFATE 1 MG/ML IJ SOLN | $25.71 | $34.28 | $10.28–$34.28 | 67% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TERBINAFINE HCL 1 % EX CREA | $37.81 | $50.41 | $15.12–$50.41 | 51% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TERBINAFINE HCL 1 % EX CREA | $37.81 | $50.41 | $15.12–$50.41 | 51% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TERBINAFINE HCL 250 MG PO TABS | $40.31 | $53.75 | $16.13–$53.75 | 48% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TERBINAFINE HCL 250 MG PO TABS | $40.31 | $53.75 | $16.13–$53.75 | 48% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC TDAP VACCINE > 7 YRS IM | $74.25 | $99.00 | $29.70–$99.00 | 4% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC TDAP VACCINE > 7 YRS IM | $74.25 | $99.00 | $29.70–$99.00 | 4% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TERBUTALINE SULFATE 1 MG/ML IJ SOLN | $25.71 | $34.28 | $10.28–$34.28 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TERBUTALINE SULFATE 1 MG/ML IJ SOLN | $25.71 | $34.28 | $10.28–$34.28 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TERBINAFINE HCL 1 % EX CREA | $37.81 | $50.41 | $15.12–$50.41 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TERBINAFINE HCL 1 % EX CREA | $37.81 | $50.41 | $15.12–$50.41 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TERBINAFINE HCL 250 MG PO TABS | $40.31 | $53.75 | $16.13–$53.75 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TERBINAFINE HCL 250 MG PO TABS | $40.31 | $53.75 | $16.13–$53.75 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC TDAP VACCINE > 7 YRS IM | $74.25 | $99.00 | $29.70–$99.00 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC TDAP VACCINE > 7 YRS IM | $74.25 | $99.00 | $29.70–$99.00 | — | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC VACCINE TYPHOID VICPS IM | $187.50 | $250.00 | $75.00–$250.00 | 34% above | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 HC VACCINE TYPHOID VICPS IM | $187.50 | $250.00 | $75.00–$250.00 | 34% above | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC VACCINE TYPHOID VICPS IM | $187.50 | $250.00 | $75.00–$250.00 | — | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 HC VACCINE TYPHOID VICPS IM | $187.50 | $250.00 | $75.00–$250.00 | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID | $15.00 | $20.00 | $6.00–$20.00 | 60% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID | $15.00 | $20.00 | $6.00–$20.00 | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZ ADMIN EA ADDL SNGL/COMB VAC | $15.00 | $20.00 | $6.00–$20.00 | 54% below | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZ ADMIN EA ADDL SNGL/COMB VAC | $15.00 | $20.00 | $6.00–$20.00 | — | 25% |
Source file: https://southwesthealth.pt.panaceainc.com/MRFDownload/southwesthealth/southwesthealth