OakLeaf Surgical Hospital
OakLeaf Surgical Hospital in Altoona, WI publishes cash prices for 311 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 241 of 308 procedures and below it for 64. By typical cash price it ranks #89 of 93 Wisconsin hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
1000 Oakleaf Way,Altoona,WI,54720 Collected Sep 27, 2026 Source price file (715) 895-9435
Acute care hospital No emergency department CCN 520196 · CMS hospital register
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named OakLeaf Surgical Hospital in Altoona, WI:
- Jan 18, 2023 Warning notice
- Apr 25, 2023 Case closed
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY OF ANKLE; MINIMUM OF 3 VIEWS | $408.86 | $454.29 | $86.20–$876.20 | 142% above | 10% |
| Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE | $421.13 | $467.92 | $86.20–$876.20 | 149% above | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $256.57 | $285.08 | $131.78–$876.20 | 29% below | 10% |
| Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY | $1,145.77 | $1,273.08 | $395.97–$876.20 | 18% below | 10% |
| Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE | $300.05 | $333.39 | $103.55–$876.20 | 33% below | 10% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 LIMITED ULTRASOUND SCAN OF 1 BREAST | $370.58 | $411.76 | $86.20–$876.20 | 11% above | 10% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED | $381.70 | $424.11 | $86.20–$876.20 | 14% above | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST | $2,289.68 | $2,544.09 | $173.73–$1,748.00 | 30% above | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST | $1,813.60 | $2,015.11 | $236.34–$1,748.00 | 5% below | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST | $1,868.00 | $2,075.56 | $236.34–$1,748.00 | 2% below | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST | $1,496.25 | $1,662.50 | $345.56–$1,748.00 | 18% below | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST | $1,541.14 | $1,712.38 | $345.56–$1,748.00 | 16% below | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST | $2,489.76 | $2,766.40 | $345.56–$1,748.00 | 11% above | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR | $2,564.45 | $2,849.39 | $345.56–$1,748.00 | 14% above | 10% |
| CT scan of the abdomen with contrast CPT 74160 CT SCAN OF ABDOMEN WITH CONTRAST | $2,112.40 | $2,347.11 | $173.73–$1,748.00 | 44% above | 10% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST | $2,175.77 | $2,417.52 | $173.73–$1,748.00 | 48% above | 10% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $1,746.70 | $1,940.78 | $103.55–$1,748.00 | 68% above | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN OF FACE WITHOUT CONTRAST | $1,305.41 | $1,450.46 | $103.55–$1,748.00 | 32% above | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE | $1,344.57 | $1,493.97 | $103.55–$1,748.00 | 36% above | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD OR BRAIN WITHOUT CONTRAST | $1,419.15 | $1,576.83 | $103.55–$1,748.00 | 51% above | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,461.72 | $1,624.13 | $103.55–$1,748.00 | 56% above | 10% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE | $2,166.07 | $2,406.74 | $173.73–$1,748.00 | 87% above | 10% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $2,761.71 | $3,068.57 | $173.73–$1,748.00 | 105% above | 10% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN OF LOWER SPINE WITHOUT CONTRAST | $1,954.04 | $2,171.15 | $103.55–$1,748.00 | 80% above | 10% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE | $2,012.65 | $2,236.28 | $103.55–$1,748.00 | 85% above | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN OF UPPER SPINE WITHOUT CONTRAST | $2,183.30 | $2,425.89 | $103.55–$1,748.00 | 101% above | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE | $2,248.80 | $2,498.67 | $103.55–$1,748.00 | 107% above | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $2,558.96 | $2,843.29 | $173.73–$1,748.00 | 73% above | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY | $697.51 | $775.01 | $236.34–$876.20 | — | 10% |
| Chest X-ray, 2 views CPT 71046 X-RAY OF CHEST; 2 VIEWS | $208.90 | $232.11 | $86.20–$876.20 | 22% above | 10% |
| Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $215.16 | $239.07 | $86.20–$876.20 | 26% above | 10% |
| Chest X-ray, single view CPT 71045 X-RAY OF CHEST; 1 VIEW | $208.90 | $232.11 | $86.20–$876.20 | 61% above | 10% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $215.16 | $239.07 | $86.20–$876.20 | 66% above | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY | $607.83 | $675.37 | $103.55–$876.20 | 19% above | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP | $626.07 | $695.63 | $103.55–$876.20 | 23% above | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN OF CHEST WITHOUT CONTRAST | $1,746.65 | $1,940.72 | $103.55–$1,748.00 | 60% above | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C- | $1,799.05 | $1,998.94 | $103.55–$1,748.00 | 64% above | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN OF CHEST WITH CONTRAST | $2,183.30 | $2,425.89 | $173.73–$1,748.00 | 63% above | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+ | $2,248.80 | $2,498.67 | $173.73–$1,748.00 | 68% above | 10% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI | $262.58 | $291.75 | $44.55–$194.00 | — | 10% |
| Diagnostic mammogram, both breasts CPT 77066 DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS | $254.93 | $283.25 | $44.55–$194.00 | at median | 10% |
| Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST | $254.93 | $283.25 | $36.18–$194.00 | 16% above | 10% |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI | $262.58 | $291.75 | $36.18–$194.00 | 19% above | 10% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 ULTRASOUND OF LEG ARTERIES OR ARTERY GRAFTS | $654.29 | $726.99 | $236.34–$876.20 | at median | 10% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY | $673.92 | $748.80 | $236.34–$876.20 | 3% above | 10% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 ULTRASOUND STUDY OF ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS | $838.06 | $931.18 | $236.34–$876.20 | 18% below | 10% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY | $863.21 | $959.12 | $236.34–$876.20 | 16% below | 10% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE | $451.52 | $501.69 | $541.21–$876.20 | 67% below | 10% |
| Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3 | $301.48 | $334.98 | $86.20–$876.20 | 40% above | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN | $1,377.85 | $1,530.94 | $103.55–$876.20 | 224% above | 10% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE | $3,970.02 | $4,411.13 | $236.34–$3,220.00 | 138% above | 10% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $3,473.41 | $3,859.34 | $236.34–$3,220.00 | 82% above | 10% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST | $3,372.24 | $3,746.93 | $345.56–$3,220.00 | 18% above | 10% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/O CNTR FLWD CNTR | $3,473.41 | $3,859.34 | $345.56–$3,220.00 | 22% above | 10% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE | $3,931.33 | $4,368.14 | $236.34–$3,220.00 | 142% above | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE | $3,261.52 | $3,623.91 | $345.56–$3,220.00 | 41% above | 10% |
| MRI of the lower back, no contrast dye CPT 72148 MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST | $3,589.60 | $3,988.44 | $236.34–$3,220.00 | 84% above | 10% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE | $3,697.28 | $4,108.09 | $236.34–$3,220.00 | 90% above | 10% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O & W/DYE | $3,261.52 | $3,623.91 | $345.56–$3,220.00 | 19% above | 10% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI CHEST SPINE W/O DYE | $3,845.20 | $4,272.44 | $236.34–$3,220.00 | 94% above | 10% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI NECK SPINE W/O & W/DYE | $3,261.52 | $3,623.91 | $345.56–$3,220.00 | 58% above | 10% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI NECK SPINE W/O DYE | $3,703.71 | $4,115.23 | $236.34–$3,220.00 | 111% above | 10% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE | $2,267.68 | $2,519.64 | $345.56–$3,220.00 | 20% below | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O DYE | $3,936.38 | $4,373.76 | $236.34–$3,220.00 | 105% above | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXTREM W/O DYE | $3,427.41 | $3,808.23 | $236.34–$3,220.00 | 89% above | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED | $439.85 | $488.72 | $103.55–$876.20 | 43% above | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 COMPLETE ULTRASOUND SCAN OF PELVIS | $1,340.68 | $1,489.64 | $103.55–$876.20 | 212% above | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE | $1,380.90 | $1,534.33 | $103.55–$876.20 | 222% above | 10% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD | $217.70 | $241.89 | $33.77–$194.00 | — | 10% |
| Screening mammogram, both breasts CPT 77067 SCREENING MAMMOGRAPHY | $211.36 | $234.84 | $33.77–$194.00 | 16% above | 10% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY OF SHOULDER; MINIMUM OF 2 VIEWS | $286.96 | $318.84 | $86.20–$876.20 | 67% above | 10% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER | $295.57 | $328.41 | $86.20–$876.20 | 72% above | 10% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB | $543.52 | $603.91 | $103.55–$876.20 | 37% above | 10% |
| Ultrasound of the abdomen, complete CPT 76700 COMPLETE ULTRASOUND SCAN OF ABDOMEN | $307.58 | $341.76 | $103.55–$876.20 | 44% below | 10% |
| Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE | $316.81 | $352.01 | $103.55–$876.20 | 43% below | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND SCAN OF SCROTUM | $412.60 | $458.44 | $103.55–$876.20 | 4% below | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM | $424.97 | $472.19 | $103.55–$876.20 | 1% below | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK | $287.65 | $319.61 | $103.55–$876.20 | 33% below | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ULTRASOUND STUDY OF ONE ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS | $525.85 | $584.28 | $103.55–$876.20 | 13% below | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY | $541.63 | $601.81 | $103.55–$876.20 | 10% below | 10% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY OF WRIST; MINIMUM OF 3 VIEWS | $292.70 | $325.22 | $86.20–$876.20 | 48% above | 10% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST | $301.48 | $334.98 | $86.20–$876.20 | 53% above | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY OF HIP; 2-3 VIEWS | $200.86 | $223.18 | $86.20–$876.20 | 3% below | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS | $206.89 | $229.88 | $86.20–$876.20 | 1% below | 10% |
| X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW | $313.53 | $348.37 | $86.20–$876.20 | 73% above | 10% |
| X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE | $295.57 | $328.41 | $86.20–$876.20 | 96% above | 10% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S) | $301.48 | $334.98 | $86.20–$876.20 | 74% above | 10% |
| X-ray of the foot, 2 views CPT 73620 X-RAY OF FOOT; 2 VIEWS | $286.96 | $318.84 | $86.20–$876.20 | 59% above | 10% |
| X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT | $295.57 | $328.41 | $86.20–$876.20 | 64% above | 10% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY OF FOOT; MINIMUM OF 3 VIEWS | $408.86 | $454.29 | $86.20–$876.20 | 95% above | 10% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT | $437.98 | $486.64 | $86.20–$876.20 | 109% above | 10% |
| X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND | $301.48 | $334.98 | $86.20–$876.20 | 55% above | 10% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-RAY OF KNEE; 1-2 VIEWS | $286.96 | $318.84 | $86.20–$876.20 | 74% above | 10% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2 | $295.57 | $328.41 | $86.20–$876.20 | 80% above | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS | $225.17 | $250.19 | $103.55–$876.20 | 2% below | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $358.38 | $398.20 | $103.55–$876.20 | 22% above | 10% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS | $225.17 | $250.19 | $103.55–$876.20 | 11% above | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY OF UPPER SPINE; 2-3 VIEWS | $257.18 | $285.76 | $86.20–$876.20 | 19% above | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW | $264.90 | $294.33 | $86.20–$876.20 | 23% above | 10% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY OF PELVIS; 1-2 VIEWS | $304.40 | $338.22 | $103.55–$876.20 | 66% above | 10% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS | $313.53 | $348.37 | $103.55–$876.20 | 71% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE | $313.53 | $348.37 | $86.20–$876.20 | 72% above | 10% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 LIVER ENZYME (SGPT); LEVEL | $48.55 | $53.94 | $5.30 | 15% above | 10% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT) | $50.00 | $55.56 | $5.30 | 18% above | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 LIVER ENZYME (SGOT); LEVEL | $47.30 | $52.56 | $5.18 | at median | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $48.73 | $54.14 | $5.18 | 3% above | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $1,628.16 | $1,809.07 | $5.22 | 6413% above | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $334.36 | $371.51 | $12.95 | 318% above | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 SCREENING TEST FOR AUTOIMMUNE DISORDER | $82.94 | $92.15 | $12.09 | 21% above | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $85.42 | $94.91 | $12.09 | 24% above | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL | $260.43 | $289.37 | $39.26 | 88% above | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $268.25 | $298.05 | $39.26 | 94% above | 10% |
| Basic metabolic panel (blood test) CPT 80048 BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) | $81.12 | $90.13 | $8.46 | 5% below | 10% |
| Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA | $83.55 | $92.83 | $8.46 | 3% below | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; INTERMEDIATE COMPLEXITY | $847.76 | $941.95 | $51.62–$876.20 | 319% above | 10% |
| Blood culture for bacteria CPT 87040 BACTERIAL BLOOD CULTURE | $61.56 | $68.40 | $10.32 | 25% below | 10% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $63.41 | $70.45 | $10.32 | 23% below | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE | $11.07 | $12.30 | $9.34 | 16% below | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $11.40 | $12.67 | $9.34 | 13% below | 10% |
| Blood glucose (sugar) test CPT 82947 BLOOD GLUCOSE (SUGAR) LEVEL | $37.96 | $42.18 | $3.93 | 69% above | 10% |
| Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $39.11 | $43.45 | $3.93 | 74% above | 10% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $23.00 | $25.56 | $12.11 | 53% below | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS | $69.40 | $77.11 | $7.52 | 42% above | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $71.48 | $79.42 | $7.52 | 47% above | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD GROUP TYPING (ABO) | $45.73 | $50.81 | $131.78–$876.20 | 14% above | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $215.08 | $238.98 | $131.78–$876.20 | 438% above | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION | $56.94 | $63.27 | $5.18 | 4% above | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $58.65 | $65.17 | $5.18 | 7% above | 10% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $319.18 | $354.64 | $37.27 | 123% above | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 19-9 | $372.01 | $413.34 | $20.81 | 238% above | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $383.17 | $425.74 | $20.81 | 248% above | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 125 | $124.56 | $138.40 | $20.81 | 6% above | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $128.30 | $142.55 | $20.81 | 9% above | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $166.02 | $184.47 | $51.31 | 24% above | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $403.74 | $448.60 | $35.09 | 182% above | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) | $76.64 | $85.16 | $13.39 | 17% below | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $83.75 | $93.05 | $13.39 | 9% below | 10% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT | $74.20 | $82.44 | $7.77 | 6% above | 10% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $76.42 | $84.91 | $7.77 | 9% above | 10% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST | $62.13 | $69.03 | $6.47 | 24% above | 10% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $63.99 | $71.10 | $6.47 | 28% above | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS | $101.39 | $112.66 | $10.56 | 11% below | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $104.44 | $116.04 | $10.56 | 8% below | 10% |
| D-dimer blood test (blood clot marker) CPT 85379 COAGULATION FUNCTION MEASUREMENT; D-DIMER; QUANTITATIVE | $98.17 | $109.08 | $10.18 | 43% above | 10% |
| D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT | $101.12 | $112.35 | $10.18 | 47% above | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE | $184.69 | $205.21 | $22.23 | 34% above | 10% |
| Estradiol blood test CPT 82670 MEASUREMENT OF TOTAL ESTRADIOL (HORMONE) | $231.62 | $257.35 | $27.94 | 92% above | 10% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $238.56 | $265.07 | $27.94 | 97% above | 10% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN; FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL | $84.23 | $93.59 | $18.58 | 27% below | 10% |
| FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $86.76 | $96.40 | $18.58 | 25% below | 10% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN (BLOOD PROTEIN) LEVEL | $139.77 | $155.30 | $13.63 | 55% above | 10% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $143.96 | $159.96 | $13.63 | 60% above | 10% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID LEVEL; SERUM | $114.07 | $126.74 | $14.70 | 15% above | 10% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $117.49 | $130.54 | $14.70 | 19% above | 10% |
| Free T3 thyroid hormone test CPT 84481 THYROID HORMONE; T3 MEASUREMENT; FREE | $48.10 | $53.44 | $16.94 | 49% below | 10% |
| Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) | $49.54 | $55.04 | $16.94 | 48% below | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE (THYROID CHEMICAL); FREE | $124.04 | $137.82 | $9.02 | 54% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $127.76 | $141.95 | $9.02 | 59% above | 10% |
| Free testosterone test CPT 84402 TESTOSTERONE (HORMONE) LEVEL; FREE | $210.07 | $233.41 | $25.47 | 83% above | 10% |
| Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE | $216.37 | $240.41 | $25.47 | 88% above | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $97.59 | $108.43 | $35.09 | 32% below | 10% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $209.54 | $232.82 | $16.85 | 148% above | 10% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $42.66 | $47.40 | $14.38 | 66% below | 10% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $128.85 | $143.17 | $13.71 | 72% above | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $104.65 | $116.28 | $24.08 | 5% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C LEVEL | $72.34 | $80.38 | $9.71 | 44% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $74.51 | $82.79 | $9.71 | 49% above | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY | $147.52 | $163.91 | $10.74 | 99% above | 10% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN | $119.29 | $132.54 | $10.33 | 83% above | 10% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $122.87 | $136.52 | $10.33 | 88% above | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY MEASUREMENT | $239.60 | $266.22 | $14.27 | 190% above | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST | $246.79 | $274.21 | $14.27 | 199% above | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $1,126.47 | $1,251.63 | $42.84 | 409% above | 10% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $40.28 | $44.75 | $13.19 | 38% below | 10% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $59.09 | $65.65 | $19.35 | 25% below | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $340.28 | $378.09 | $12.95 | 339% above | 10% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $230.10 | $255.67 | $17.92 | 95% above | 10% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN | $287.64 | $319.60 | $11.43 | 343% above | 10% |
| Iron blood test (serum iron) CPT 83540 IRON LEVEL | $22.27 | $24.74 | $6.47 | 58% below | 10% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $22.93 | $25.48 | $6.47 | 57% below | 10% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $28.92 | $32.13 | $8.74 | 53% below | 10% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $26.18 | $29.09 | $8.68 | 75% below | 10% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN; LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL | $139.46 | $154.95 | $18.52 | 47% above | 10% |
| LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH) | $143.64 | $159.60 | $18.52 | 51% above | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE (FAT ENZYME) LEVEL | $52.48 | $58.31 | $6.89 | 22% below | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $54.05 | $60.06 | $6.89 | 20% below | 10% |
| Liver function blood test panel CPT 80076 LIVER FUNCTION BLOOD TEST PANEL | $78.09 | $86.77 | $8.17 | 18% below | 10% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $80.43 | $89.37 | $8.17 | 16% below | 10% |
| Lyme disease antibody test CPT 86618 ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA) | $74.56 | $82.84 | $17.03 | 5% below | 10% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $76.80 | $85.33 | $17.03 | 2% below | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM LEVEL | $88.02 | $97.80 | $6.70 | 76% above | 10% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $90.66 | $100.73 | $6.70 | 81% above | 10% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $102.16 | $113.51 | $12.88 | 28% above | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $20.39 | $22.66 | $5.18 | 63% below | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL | $94.31 | $104.79 | $18.39 | 5% above | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $97.14 | $107.93 | $18.39 | 8% above | 10% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER | $115.76 | $128.62 | $20.26 | 32% above | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) LEVEL | $287.39 | $319.32 | $41.28 | 54% above | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $296.01 | $328.90 | $41.28 | 58% above | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD | $31.14 | $34.60 | $6.01 | 38% below | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $32.08 | $35.64 | $6.01 | 36% below | 10% |
| Progesterone blood test CPT 84144 PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL | $139.79 | $155.32 | $20.86 | 16% above | 10% |
| Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE | $143.98 | $159.98 | $20.86 | 20% above | 10% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $95.00 | $105.56 | $19.38 | 21% below | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 BLOOD TEST; CLOTTING TIME | $36.23 | $40.26 | $4.29 | 14% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $37.03 | $41.14 | $4.29 | 17% above | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR LEVEL | $105.70 | $117.44 | $5.67 | 84% above | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $108.86 | $120.96 | $5.67 | 89% above | 10% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $111.57 | $123.97 | $14.39 | 39% above | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $19.61 | $21.79 | $2.70 | 48% below | 10% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANAL VOL/COUNT/MOT | $188.63 | $209.59 | $12.31 | 104% above | 10% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $19.14 | $21.27 | $4.38 | 5% below | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $223.32 | $248.13 | $61.98 | 12% below | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST; GAMMA INTERFERON | $439.04 | $487.82 | $61.98 | 74% above | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $101.80 | $113.11 | $25.81 | 10% below | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH | $253.47 | $281.63 | $14.55 | 276% above | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 BLOOD TEST; THYROID STIMULATING HORMONE (TSH) | $87.12 | $96.80 | $16.80 | at median | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $89.73 | $99.70 | $16.80 | 3% above | 10% |
| Uric acid blood test CPT 84550 URIC ACID LEVEL; BLOOD | $58.67 | $65.19 | $4.52 | 26% above | 10% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $60.44 | $67.15 | $4.52 | 30% above | 10% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE | $15.76 | $17.51 | $3.17 | 61% below | 10% |
| Urinalysis with microscope exam, manual CPT 81000 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; NON-AUTOMATED | $33.24 | $36.93 | $4.02 | 122% above | 10% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE | $34.24 | $38.04 | $4.02 | 128% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $27.44 | $30.49 | $2.25 | 15% above | 10% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $29.77 | $33.08 | $3.48 | 98% above | 10% |
| Urine culture for bacteria, with colony count CPT 87086 BACTERIAL COLONY COUNT; URINE | $71.29 | $79.21 | $8.07 | 5% below | 10% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT | $73.43 | $81.59 | $8.07 | 3% below | 10% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $60.40 | $67.11 | $8.61 | 2% above | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B-12) LEVEL | $78.28 | $86.98 | $15.08 | 22% below | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $80.63 | $89.59 | $15.08 | 19% below | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D-3 LEVEL | $280.43 | $311.59 | $29.60 | 87% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $288.85 | $320.94 | $29.60 | 93% above | 10% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $287.97 | $319.97 | $11.39 | 272% above | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL | $39.66 | $44.07 | $15.05 | 65% below | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $40.85 | $45.39 | $15.05 | 64% below | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 PRIMARY REMOVAL OF ADENOIDS (YOUNGER THAN 12 YEARS) | $3,655.91 | $4,062.12 | $3,283.91–$5,342.00 | 162% above | 10% |
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS | $3,765.58 | $4,183.98 | $3,283.91–$5,342.00 | 170% above | 10% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 FUSION OF UPPER SPINE BONE WITH REMOVAL OF DISC AND RELEASE OF SPINAL CORD OR NERVE; 1 DISC | $32,542.62 | $36,158.47 | $10,671.69–$19,373.00 | 281% above | 10% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRD ANT NTRBDY CERVICAL | $32,777.12 | $36,419.02 | $10,671.69–$19,373.00 | 284% above | 10% |
| Appendectomy, open surgery CPT 44950 APPENDECTOMY | $2,426.63 | $2,696.25 | $6,283.00–$9,999.00 | 1% below | 10% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY | $18,374.08 | $20,415.64 | $7,187.17–$16,543.00 | 259% above | 10% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE | $3,623.99 | $4,026.65 | $7,187.17–$16,543.00 | 31% below | 10% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR | $7,465.41 | $8,294.90 | $7,187.17–$16,543.00 | 42% above | 10% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 NSL/SINS NDSC SURG MAX SINS | $8,222.18 | $9,135.75 | $6,990.31–$12,749.00 | 329% above | 10% |
| Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE | $788.43 | $876.03 | $304.03–$2,245.00 | 26% above | 10% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC | $4,241.91 | $4,713.23 | $1,635.88–$5,342.00 | 134% above | 10% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 COR HLX VLGS DSTL MTAR OSTEO | $13,170.09 | $14,633.43 | $3,240.86–$9,999.00 | 193% above | 10% |
| Bunion correction with removal of part of the big toe joint CPT 28292 CORRECTION OF BUNION | $11,308.48 | $12,564.98 | $3,240.86–$9,999.00 | 221% above | 10% |
| Bunion correction with removal of part of the big toe joint CPT 28292 COR HLX VLGS RSC PRX PHLX BS | $11,647.74 | $12,941.93 | $3,240.86–$9,999.00 | 231% above | 10% |
| Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO | $11,924.93 | $13,249.92 | $3,211.09–$9,999.00 | 20% above | 10% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 INSERTION OF TUBE IN LEFT LOWER HEART CHAMBER AND CORONARY ARTERY FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST | $11,577.60 | $12,864.00 | $3,211.09–$9,999.00 | 16% above | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT | $1,724.50 | $1,916.11 | $654.66–$876.20 | 99% above | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,776.23 | $1,973.59 | $654.66–$876.20 | 105% above | 10% |
| Carpal tunnel release, open surgery CPT 64721 RELEASE AND/OR RELOCATION OF HAND NERVE | $3,037.74 | $3,375.27 | $1,934.15–$5,342.00 | 63% above | 10% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY | $3,128.88 | $3,476.53 | $1,934.15–$5,342.00 | 68% above | 10% |
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL W/O ECP | $862.40 | $958.22 | $2,285.86–$5,342.00 | 79% below | 10% |
| Cervical biopsy CPT 57500 BIOPSY OF CERVIX | $2,272.68 | $2,525.20 | $912.29–$2,471.47 | 283% above | 10% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 REMOVAL OF FORESKIN (OLDER THAN 28 DAYS) | $6,496.25 | $7,218.05 | $2,070.49–$5,342.00 | 541% above | 10% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER | $6,691.13 | $7,434.59 | $2,070.49–$5,342.00 | 560% above | 10% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 REMOVAL OF FORESKIN USING CLAMP OR DEVICE | $5,447.56 | $6,052.84 | $2,070.49–$5,342.00 | 3033% above | 10% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $5,610.99 | $6,234.43 | $2,070.49–$5,342.00 | 3127% above | 10% |
| Colonoscopy with polyp removal CPT 45385 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE | $2,837.34 | $3,152.60 | $1,185.25–$5,342.00 | 37% above | 10% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL | $2,922.46 | $3,247.18 | $1,185.25–$5,342.00 | 41% above | 10% |
| Colonoscopy with tissue sample CPT 45380 BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $2,786.80 | $3,096.44 | $1,185.25–$5,342.00 | 45% above | 10% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $2,870.40 | $3,189.33 | $1,185.25–$5,342.00 | 49% above | 10% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $2,786.80 | $3,096.44 | $921.10–$2,471.47 | 80% above | 10% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $2,870.40 | $3,189.33 | $921.10–$2,471.47 | 86% above | 10% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BIOPSY OF CERVIX USING AN ENDOSCOPE WITH LOOP ELECTRODE | $4,385.85 | $4,873.17 | $3,206.32–$5,342.00 | 410% above | 10% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP | $4,517.43 | $5,019.37 | $3,206.32–$5,342.00 | 425% above | 10% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BIOPSY AND SCRAPING OF CERVIX USING AN ENDOSCOPE | $1,256.70 | $1,396.33 | $301.83–$2,245.00 | 177% above | 10% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE | $1,294.40 | $1,438.22 | $301.83–$2,245.00 | 186% above | 10% |
| Complex cataract surgery with lens implant CPT 66982 XCAPSL CTRC RMVL CPLX WO ECP | $862.40 | $958.22 | $2,285.86–$5,342.00 | 80% below | 10% |
| Coronary stent placement, one artery CPT 92928 INSERTION OF STENTS WITH BALLOON DILATION OF CORONARY ARTERY OR BRANCH; SINGLE ARTERY OR BRANCH | $19,586.30 | $21,762.56 | $10,671.69–$19,373.00 | 150% above | 10% |
| Coronary stent placement, one artery CPT 92928 PRQ TCAT PLMT NTRAC ST 1 LES | $26,161.50 | $29,068.33 | $10,671.69–$19,373.00 | 234% above | 10% |
| Cystoscopy with ureteral stent placement CPT 52332 INSERTION OF STENT IN URETER USING AN ENDOSCOPE | $7,018.90 | $7,798.78 | $3,491.44–$9,999.00 | 235% above | 10% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT | $14,458.94 | $16,065.49 | $3,491.44–$9,999.00 | 589% above | 10% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 DIAGNOSTIC EXAM OF BLADDER AND URETHRA USING AN ENDOSCOPE | $4,037.44 | $4,486.04 | $690.66–$2,471.47 | 518% above | 10% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $4,158.56 | $4,620.62 | $690.66–$2,471.47 | 536% above | 10% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND SCRAPING OF UTERUS | $8,617.10 | $9,574.55 | $3,206.32–$5,342.00 | 585% above | 10% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE | $8,875.61 | $9,861.79 | $3,206.32–$5,342.00 | 605% above | 10% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION | $270.42 | $300.47 | $198.72–$2,245.00 | 31% above | 10% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING | $1,692.66 | $1,880.73 | $1,536.82–$5,342.00 | 177% above | 10% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 CREATE EARDRUM OPENING | $2,672.64 | $2,969.60 | $534.20–$2,245.00 | 411% above | 10% |
| Earwax removal with instruments, one ear CPT 69210 REMOVAL OF IMPACTED EAR WAX | $97.03 | $107.81 | $58.43–$2,245.00 | 16% above | 10% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI | $199.87 | $222.08 | $58.43–$2,245.00 | 138% above | 10% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF LINING OF UTERUS | $271.76 | $301.96 | $200.24–$2,245.00 | at median | 10% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING | $559.84 | $622.04 | $200.24–$2,245.00 | 106% above | 10% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT | $8,589.03 | $9,543.37 | $6,990.31–$12,749.00 | 52% above | 10% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 NSL/SINS NDSC FRNT TISS RMVL | $17,972.00 | $19,968.89 | $6,990.31–$12,749.00 | 306% above | 10% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 EXPLORATION MAXILLARY SINUS | $12,270.02 | $13,633.36 | $3,692.87–$9,999.00 | 517% above | 10% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDOSCOPY MAXILLARY SINUS | $17,972.00 | $19,968.89 | $6,990.31–$12,749.00 | 341% above | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION OF SUBSTANCE INTO MIDDLE OR UPPER SPINE CANAL USING IMAGING GUIDANCE | $1,904.47 | $2,116.08 | $699.17–$2,471.47 | 126% above | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC | $1,961.60 | $2,179.56 | $699.17–$2,471.47 | 133% above | 10% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 INJECTION EYE DRUG | $3,403.83 | $3,782.03 | $327.16–$2,245.00 | 741% above | 10% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $1,069.51 | $1,188.34 | $876.06–$2,471.47 | 20% above | 10% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJECTION OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE; SINGLE LEVEL | $1,557.54 | $1,730.60 | $876.06–$2,471.47 | 74% above | 10% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM; REDUCIBLE | $10,998.60 | $12,220.67 | $6,412.22–$9,999.00 | 227% above | 10% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC | $11,328.56 | $12,587.29 | $6,412.22–$9,999.00 | 237% above | 10% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM; REDUCIBLE | $10,998.60 | $12,220.67 | $6,412.22–$9,999.00 | 72% above | 10% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC | $11,328.56 | $12,587.29 | $6,412.22–$9,999.00 | 77% above | 10% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM; REDUCIBLE | $7,549.65 | $8,388.50 | $3,546.33–$9,999.00 | 255% above | 10% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC | $15,552.28 | $17,280.31 | $3,546.33–$9,999.00 | 631% above | 10% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC EXAM OF LOWER PORTION OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,143.39 | $1,270.43 | $921.10–$2,471.47 | 37% above | 10% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY | $1,177.69 | $1,308.54 | $921.10–$2,471.47 | 41% above | 10% |
| Gallbladder removal, laparoscopic CPT 47562 REMOVAL OF GALLBLADDER USING AN ENDOSCOPE | $19,372.02 | $21,524.47 | $5,988.00–$11,874.00 | 378% above | 10% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $19,953.18 | $22,170.20 | $5,988.00–$11,874.00 | 392% above | 10% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE | $17,955.79 | $19,950.88 | $5,988.00–$11,874.00 | 262% above | 10% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH | $18,494.47 | $20,549.41 | $5,988.00–$11,874.00 | 273% above | 10% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY | $3,234.92 | $3,594.36 | $897.41–$9,999.00 | 15% above | 10% |
| Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE | $8,048.29 | $8,942.54 | $3,240.86–$9,999.00 | 196% above | 10% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $1,283.39 | $1,425.99 | $921.10–$2,471.47 | at median | 10% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVAL OF SINGLE EXTERNAL AND INTERNAL HEMORRHOID GROUP | $5,884.14 | $6,537.93 | $2,749.25–$5,342.00 | 164% above | 10% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP | $6,060.66 | $6,734.07 | $2,749.25–$5,342.00 | 172% above | 10% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY | $9,627.73 | $10,697.48 | $12,716.51–$24,978.00 | 18% above | 10% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY | $13,189.69 | $14,655.21 | $843.67–$11,874.00 | 247% above | 10% |
| Hysterectomy through an abdominal incision (total) CPT 58150 REMOVAL OF UTERUS AND CERVIX THROUGH ABDOMEN | $13,586.68 | $15,096.31 | $843.67–$11,874.00 | 258% above | 10% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY | $178.62 | $198.47 | $48.08 | 31% below | 10% |
| Hysteroscopy with endometrial ablation CPT 58563 EXAM OF UTERUS WITH DESTRUCTION OF LINING OF UTERUS USING AN ENDOSCOPE | $8,646.98 | $9,607.76 | $4,954.85–$11,249.00 | 81% above | 10% |
| Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY ABLATION | $8,906.39 | $9,895.99 | $4,954.85–$11,249.00 | 87% above | 10% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE | $11,702.83 | $13,003.14 | $3,206.32–$5,342.00 | 224% above | 10% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BIOPSY | $12,053.91 | $13,393.23 | $3,206.32–$5,342.00 | 234% above | 10% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF IUD FOR PREGNANCY PREVENTION | $628.42 | $698.24 | $2,245.00 | 107% above | 10% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE | $1,294.53 | $1,438.37 | $2,245.00 | 326% above | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS | $259.20 | $288.00 | $198.72–$2,245.00 | 16% below | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $266.98 | $296.64 | $198.72–$2,245.00 | 13% below | 10% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) | $12,150.40 | $13,500.44 | $3,546.33–$9,999.00 | 349% above | 10% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR | $12,514.91 | $13,905.45 | $3,546.33–$9,999.00 | 362% above | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION INTO TENDON OR LIGAMENT | $687.83 | $764.26 | $304.03–$2,245.00 | 167% above | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $708.47 | $787.19 | $304.03–$2,245.00 | 175% above | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT | $1,129.22 | $1,254.69 | $304.03–$2,245.00 | 227% above | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $1,163.10 | $1,292.33 | $304.03–$2,245.00 | 237% above | 10% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION DRUG DLVR IMPLANT | $341.05 | $378.94 | $131.78–$2,245.00 | 38% above | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $1,698.16 | $1,886.84 | $304.03–$2,245.00 | 481% above | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $1,188.69 | $1,320.77 | $304.03–$2,245.00 | 326% above | 10% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY | $9,118.80 | $10,132.00 | $3,240.86–$9,999.00 | 152% above | 10% |
| Knee arthroscopy with meniscus trim CPT 29881 REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE | $6,946.36 | $7,718.18 | $3,240.86–$9,999.00 | 144% above | 10% |
| Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY | $7,154.76 | $7,949.73 | $3,240.86–$9,999.00 | 151% above | 10% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE | $6,810.15 | $7,566.83 | $3,240.86–$9,999.00 | 130% above | 10% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY | $7,014.45 | $7,793.83 | $3,240.86–$9,999.00 | 137% above | 10% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY | $7,998.67 | $8,887.41 | $3,240.86–$9,999.00 | 158% above | 10% |
| Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y | $17,566.88 | $19,518.76 | $1,424.66–$11,874.00 | 137% above | 10% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 REMOVAL OF APPENDIX USING AN ENDOSCOPE | $9,259.09 | $10,287.88 | $5,988.00–$11,874.00 | 153% above | 10% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY | $9,536.87 | $10,596.52 | $5,988.00–$11,874.00 | 160% above | 10% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLASTY | $22,963.68 | $25,515.20 | $10,528.69–$19,373.00 | 737% above | 10% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE | $23,406.50 | $26,007.22 | $10,528.69–$19,373.00 | 754% above | 10% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 REMOVAL OF UTERUS THROUGH ABDOMEN USING AN ENDOSCOPE; 250.0 G OR LESS | $12,411.04 | $13,790.04 | $10,528.69–$19,373.00 | 310% above | 10% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 TLH UTERUS 250 G OR LESS | $12,783.37 | $14,203.74 | $10,528.69–$19,373.00 | 322% above | 10% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 REMOVAL OF UTERUS; TUBES; AND/OR OVARIES THROUGH ABDOMEN USING AN ENDOSCOPE; 250.0 G OR LESS | $12,731.25 | $14,145.83 | $10,528.69–$19,373.00 | 208% above | 10% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 TLH W/T/O 250 G OR LESS | $13,113.18 | $14,570.20 | $10,528.69–$19,373.00 | 217% above | 10% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 REPAIR OF GROIN HERNIA USING AN ENDOSCOPE | $19,706.58 | $21,896.20 | $5,988.00–$11,874.00 | 778% above | 10% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT | $20,297.78 | $22,553.09 | $5,988.00–$11,874.00 | 805% above | 10% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR | $20,297.78 | $22,553.09 | $5,988.00–$11,874.00 | 593% above | 10% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE | $4,680.47 | $5,200.52 | $5,988.00–$11,874.00 | 45% above | 10% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA | $9,641.76 | $10,713.07 | $5,988.00–$11,874.00 | 199% above | 10% |
| Laparoscopic sleeve gastrectomy for weight loss CPT 43775 PARTIAL REMOVAL OF STOMACH FOR WEIGHT LOSS USING AN ENDOSCOPE | $12,495.73 | $13,884.14 | $871.70–$11,874.00 | 46% above | 10% |
| Laparoscopic sleeve gastrectomy for weight loss CPT 43775 LAP SLEEVE GASTRECTOMY | $12,742.67 | $14,158.52 | $871.70–$11,874.00 | 49% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS | $439.43 | $488.26 | $402.65–$2,245.00 | 11% below | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $905.24 | $1,005.82 | $402.65–$2,245.00 | 83% above | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE | $1,152.91 | $1,281.01 | $699.17–$2,471.47 | 95% above | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC | $1,187.50 | $1,319.44 | $699.17–$2,471.47 | 101% above | 10% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC | $1,730.37 | $1,922.63 | $876.06–$2,471.47 | 147% above | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE; SINGLE LEVEL | $1,271.93 | $1,413.26 | $876.06–$2,471.47 | 64% above | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 | $1,310.09 | $1,455.66 | $876.06–$2,471.47 | 68% above | 10% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF LOWER SPINAL CORD OR NERVES AND/OR REMOVAL OF DISC | $13,630.45 | $15,144.94 | $7,187.17–$16,543.00 | 157% above | 10% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISK SURGERY | $14,039.36 | $15,599.29 | $7,187.17–$16,543.00 | 164% above | 10% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF LOWER SPINAL CORD AND/OR NERVES; 1 SEGMENT | $13,903.06 | $15,447.84 | $7,187.17–$16,543.00 | 14% above | 10% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 LAM FACETEC & FORAMOT LUMBAR | $14,320.15 | $15,911.28 | $7,187.17–$16,543.00 | 18% above | 10% |
| Lumbar spinal fusion (posterior), one level CPT 22612 ARTHRD PST TQ 1NTRSPC LUMBAR | $41,774.77 | $46,416.41 | $10,671.69–$19,373.00 | 452% above | 10% |
| Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY | $3,106.05 | $3,451.17 | $3,878.17–$9,999.00 | 26% above | 10% |
| Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE | $11,517.60 | $12,797.33 | $6,576.98–$12,749.00 | 201% above | 10% |
| Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER | $4,393.62 | $4,881.80 | $3,206.32–$5,342.00 | 197% above | 10% |
| Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE | $4,525.43 | $5,028.25 | $3,206.32–$5,342.00 | 206% above | 10% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 MOHS 1 STAGE H/N/HF/G | $1,712.53 | $1,902.81 | $732.04–$2,245.00 | 28% above | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS | $388.40 | $431.56 | $701.40–$2,471.47 | 11% above | 10% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM< | $800.10 | $889.00 | $701.40–$2,471.47 | 130% above | 10% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 REMOVAL OF NONCANCER SKIN GROWTH OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 0.5 CM OR LESS | $388.40 | $431.56 | $701.40–$2,471.47 | 25% below | 10% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/< | $800.10 | $889.00 | $701.40–$2,471.47 | 55% above | 10% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $190.20 | $211.33 | $198.72–$2,245.00 | 15% below | 10% |
| Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV | $555.46 | $617.18 | $304.03–$2,245.00 | 24% above | 10% |
| Pacemaker implant (dual chamber) CPT 33208 INSERTION OF PACEMAKER AND UPPER AND LOWER HEART CHAMBER ELECTRODE | $15,406.85 | $17,118.72 | $10,352.54–$19,373.00 | 143% above | 10% |
| Pacemaker implant (dual chamber) CPT 33208 INSRT HEART PM ATRIAL & VENT | $15,869.05 | $17,632.28 | $10,352.54–$19,373.00 | 150% above | 10% |
| Paracentesis with imaging guidance CPT 49083 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE | $2,590.82 | $2,878.69 | $898.36–$2,471.47 | 110% above | 10% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $2,668.55 | $2,965.05 | $898.36–$2,471.47 | 116% above | 10% |
| Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT | $8,223.63 | $9,137.37 | $10,671.69–$19,373.00 | 41% above | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED | $1,165.85 | $1,295.39 | $402.65–$2,245.00 | 257% above | 10% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE | $2,542.06 | $2,824.51 | $5,204.68–$5,342.00 | 110% above | 10% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 SURGICAL REMOVAL OF PROSTATE AND SURROUNDING LYMPH NODES USING AN ENDOSCOPE | $22,833.81 | $25,370.90 | $10,528.69–$19,373.00 | 277% above | 10% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPS SURG PRST8ECT RPBIC RAD | $23,518.83 | $26,132.03 | $10,528.69–$19,373.00 | 288% above | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT | $2,530.58 | $2,811.75 | $1,934.15–$5,342.00 | 37% above | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE; SINGLE FACET JOINT | $3,685.30 | $4,094.78 | $1,934.15–$5,342.00 | 100% above | 10% |
| Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION | $8,457.26 | $9,396.96 | $3,878.17–$9,999.00 | 293% above | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FOREIGN BODY FROM TISSUE; ACCESSED BENEATH THE SKIN; SIMPLE | $498.23 | $553.59 | $402.65–$2,245.00 | 73% above | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $513.18 | $570.20 | $402.65–$2,245.00 | 78% above | 10% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REMOVAL OF THYROID | $10,045.66 | $11,161.84 | $5,988.00–$11,874.00 | 162% above | 10% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK | $946.59 | $1,051.77 | $921.10–$2,471.47 | 27% below | 10% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND | $1,949.99 | $2,166.65 | $921.10–$2,471.47 | 51% above | 10% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK | $965.53 | $1,072.81 | $921.10–$2,471.47 | 41% below | 10% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND | $1,988.98 | $2,209.98 | $921.10–$2,471.47 | 22% above | 10% |
| Septoplasty to straighten the nasal septum CPT 30520 RESHAPING OF NASAL CARTILAGE | $4,204.75 | $4,671.94 | $3,283.91–$5,342.00 | 17% above | 10% |
| Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM | $8,661.78 | $9,624.20 | $3,283.91–$5,342.00 | 141% above | 10% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE | $15,573.50 | $17,303.89 | $3,491.44–$14,233.00 | 70% above | 10% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST | $825.92 | $917.69 | $277.03–$2,245.00 | 251% above | 10% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT | $393.26 | $436.95 | $131.78–$2,245.00 | 124% above | 10% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST | $648.41 | $720.45 | $277.03–$2,245.00 | 188% above | 10% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHO ARTHRS SRG DSTL CLAVICLC | $5,813.67 | $6,459.63 | $3,240.86–$9,999.00 | 73% above | 10% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE | $7,118.44 | $7,909.38 | $132.95–$3,623.00 | 206% above | 10% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESSION | $7,331.99 | $8,146.66 | $132.95–$3,623.00 | 215% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $1,319.08 | $1,465.64 | $198.72–$2,245.00 | 305% above | 10% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $242.94 | $269.93 | $402.65–$2,245.00 | 9% above | 10% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 REMOVAL OF CANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS | $2,245.27 | $2,494.74 | $701.40–$2,471.47 | 511% above | 10% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/< | $2,312.62 | $2,569.58 | $701.40–$2,471.47 | 530% above | 10% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAG; 1-15 SKIN TAGS | $92.33 | $102.59 | $198.72–$2,245.00 | 35% below | 10% |
| Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS UP TO&INC 15 | $190.20 | $211.33 | $198.72–$2,245.00 | 34% above | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $1,731.07 | $1,923.41 | $699.17–$2,471.47 | 198% above | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $1,319.08 | $1,465.64 | $198.72–$2,245.00 | 553% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS | $1,280.66 | $1,422.95 | $198.72–$2,245.00 | 314% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $1,319.08 | $1,465.64 | $198.72–$2,245.00 | 326% above | 10% |
| TURP (transurethral resection of the prostate) CPT 52601 REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE | $13,690.10 | $15,211.22 | $5,310.78–$11,249.00 | 258% above | 10% |
| TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP) | $14,100.80 | $15,667.56 | $5,310.78–$11,249.00 | 268% above | 10% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $234.86 | $260.96 | $402.65–$2,245.00 | 2% above | 10% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS | $3,765.58 | $4,183.98 | $3,283.91–$5,342.00 | 89% above | 10% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVAL OF TONSILS AND ADENOID GLANDS (12 YEARS OR OLDER) | $7,311.82 | $8,124.24 | $3,283.91–$5,342.00 | 268% above | 10% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS) | $2,868.48 | $3,187.20 | $5,863.50–$11,249.00 | 51% above | 10% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS | $2,954.54 | $3,282.82 | $5,863.50–$11,249.00 | 55% above | 10% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS (12 YEARS OR OLDER) | $3,462.35 | $3,847.05 | $3,283.91–$5,342.00 | 107% above | 10% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS | $3,566.21 | $3,962.46 | $3,283.91–$5,342.00 | 113% above | 10% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REMOVAL OF TONSILS | $2,954.54 | $3,282.82 | $5,863.50–$11,249.00 | 68% above | 10% |
| Total hip replacement CPT 27130 REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS | $7,273.55 | $8,081.72 | $12,716.51–$26,174.83 | 20% above | 10% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY | $7,491.75 | $8,324.17 | $12,716.51–$26,174.83 | 24% above | 10% |
| Total knee replacement CPT 27447 REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE | $7,527.78 | $8,364.20 | $12,716.51–$26,174.83 | 20% above | 10% |
| Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY | $7,753.62 | $8,615.13 | $12,716.51–$26,174.83 | 24% above | 10% |
| Total shoulder replacement CPT 23472 PROSTHETIC REPAIR OF SHOULDER JOINT; TOTAL SHOULDER | $7,673.67 | $8,526.30 | $16,543.00–$17,366.97 | 27% above | 10% |
| Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT | $7,873.80 | $8,748.67 | $16,543.00–$17,366.97 | 30% above | 10% |
| Total thyroid removal (thyroidectomy) CPT 60240 REMOVAL OF THYROID | $10,261.10 | $11,401.22 | $5,988.00–$11,874.00 | 202% above | 10% |
| Trigger finger release surgery CPT 26055 INCISION OF TENDON COVERING OF FINGER | $6,062.62 | $6,736.24 | $1,592.69–$5,342.00 | 144% above | 10% |
| Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH | $6,244.50 | $6,938.33 | $1,592.69–$5,342.00 | 152% above | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL | $763.06 | $847.84 | $304.03–$2,245.00 | 193% above | 10% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CAUTERY | $9,569.99 | $10,633.32 | $5,988.00–$11,874.00 | 583% above | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG | $4,129.84 | $4,588.71 | $1,635.88–$5,342.00 | 126% above | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 BALLOON DILATION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE; LESS THAN 3.0 CM | $2,460.89 | $2,734.32 | $1,900.65–$5,342.00 | 49% above | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM | $2,534.72 | $2,816.35 | $1,900.65–$5,342.00 | 54% above | 10% |
| Upper endoscopy (EGD) with biopsy CPT 43239 BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $2,460.89 | $2,734.32 | $898.36–$2,471.47 | 56% above | 10% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $2,534.72 | $2,816.35 | $898.36–$2,471.47 | 60% above | 10% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 INJECTION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $1,325.06 | $1,472.29 | $898.36–$2,471.47 | 13% below | 10% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $1,364.81 | $1,516.46 | $898.36–$2,471.47 | 10% below | 10% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE | $1,552.30 | $1,724.78 | $1,900.65–$5,342.00 | 12% below | 10% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE | $1,598.87 | $1,776.52 | $1,900.65–$5,342.00 | 9% below | 10% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE | $2,460.89 | $2,734.32 | $898.36–$2,471.47 | 76% above | 10% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDE WIRE INSERTION | $2,534.72 | $2,816.35 | $898.36–$2,471.47 | 81% above | 10% |
| Upper endoscopy (EGD), diagnostic CPT 43235 DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $1,325.08 | $1,472.31 | $898.36–$2,471.47 | 10% below | 10% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $1,364.83 | $1,516.48 | $898.36–$2,471.47 | 7% below | 10% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CRUSHING OF STONE OF URETER USING AN ENDOSCOPE | $8,352.23 | $9,280.25 | $5,310.78–$11,249.00 | 367% above | 10% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY | $8,602.79 | $9,558.66 | $5,310.78–$11,249.00 | 381% above | 10% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CRUSHING OF STONE OF URETER WITH INSERTION OF STENT USING AN ENDOSCOPE | $12,051.59 | $13,390.65 | $5,310.78–$11,249.00 | 478% above | 10% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY | $12,413.13 | $13,792.37 | $5,310.78–$11,249.00 | 495% above | 10% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT | $8,842.80 | $9,825.33 | $2,070.49–$5,342.00 | 879% above | 10% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S) | $9,108.08 | $10,120.09 | $2,070.49–$5,342.00 | 908% above | 10% |
| Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN | $12,678.39 | $14,087.10 | $3,127.44–$9,999.00 | 270% above | 10% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS | $262.55 | $291.72 | $198.72–$2,245.00 | 36% above | 10% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14 | $270.42 | $300.47 | $198.72–$2,245.00 | 40% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS | $462.64 | $514.04 | $402.65–$2,245.00 | 2% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $953.03 | $1,058.92 | $402.65–$2,245.00 | 110% above | 10% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DST RD XARTC FX/EPI SEP | $9,430.07 | $10,477.86 | $7,187.17–$16,543.00 | 142% above | 10% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS | $1,067.66 | $1,186.29 | $436.98–$876.20 | 83% above | 10% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT | $1,099.69 | $1,221.88 | $436.98–$876.20 | 88% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT FOR AIRWAY OBSTRUCTION OR SPUTUM PRODUCTION | $537.99 | $597.77 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $554.13 | $615.70 | — | — | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $908.71 | $1,009.68 | $327.16–$876.20 | 67% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING | $110.57 | $122.86 | $58.43–$876.20 | 21% below | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $113.90 | $126.55 | $58.43–$876.20 | 19% below | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $448.76 | $498.62 | $210.68–$876.20 | 57% above | 10% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS | $882.24 | $980.27 | $210.68–$876.20 | 181% above | 10% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $908.71 | $1,009.68 | $210.68–$876.20 | 189% above | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $201.92 | $224.36 | $71.32–$876.20 | 155% above | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION | $134.97 | $149.97 | $31.84–$194.00 | 44% above | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN | $156.84 | $174.27 | $98.26–$194.00 | 12% below | 10% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN | $110.83 | $123.14 | — | — | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES | $142.88 | $158.75 | $34.00–$194.00 | 69% above | 10% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $41.00 | $45.56 | $20.15 | 45% above | 10% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 IIV NO PRSV INCREASED AG IM | $41.00 | $45.56 | $100.62 | 48% below | 10% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $41.00 | $45.56 | — | 71% below | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD | $20.51 | $22.79 | — | 37% below | 10% |
Source file: https://apim.services.craneware.com/api-pricing-transparency/api/public/9b6eb97fb433de65f56684ef2ab01f4c/charges/mrf