Hospital La Crosse-Onalaska, WI-MN

Vernon Memorial Healthcare

Vernon Memorial Healthcare in Viroqua, WI publishes cash prices for 242 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 169 of 241 procedures and below it for 70. By typical cash price it ranks #95 of 103 Wisconsin hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

507 South Main Street, Viroqua, WI 54665 Collected Sep 27, 2026 Source price file (608) 637-2101

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 521348 · CMS hospital register NPI 1497750921

The price file shows no self-pay discount

For 616 of the 616 prices listed here, the cash price in Vernon Memorial Healthcare's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 HCHG 73610 ANKLE 3VW ROUTINE L/R	$444.00	$444.00	$96.17–$392.21	89% above	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HCHG 73610 ANKLE 3VW ROUTINE L/R	$444.00	$444.00	$96.17–$392.21	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 HCHG 78306 BONE SCAN-ROUTINE	$1,407.00	$1,407.00	$456.46–$756.75	at median	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HCHG 78306 BONE SCAN-ROUTINE	$1,407.00	$1,407.00	$456.46–$756.75	—	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HCHG 76642 US BREAST UNILATERAL LIMITED	$309.00	$309.00	$187.23	20% below	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HCHG 76642 US BREAST UNILATERAL LIMITED	$309.00	$309.00	$187.23	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HCHG 71275 CT ANGIO CHEST WO&W IV CONT	$3,442.00	$3,442.00	$636.28–$3,041.22	77% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HCHG 71275 CT ANGIO CHEST WO&W IV CONT	$3,442.00	$3,442.00	$636.28–$3,041.22	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HCHG 74176 CT ABD&PELVIS; W/O CONTRAST	$3,288.00	$3,288.00	$265.59–$2,904.72	31% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HCHG 74176 CT ABD&PELVIS; W/O CONTRAST	$3,288.00	$3,288.00	$265.59–$2,904.72	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HCHG 74177 CT ABD&PELVIS;W/CONTRAST	$4,614.00	$4,614.00	$506.53–$4,076.80	47% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HCHG 74177 CT ABD&PELVIS;W/CONTRAST	$4,614.00	$4,614.00	$506.53–$4,076.80	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HCHG 74178 CT ABD&PELVIS;W/O,W/CONTRAST	$7,188.00	$7,188.00	$669.44–$6,350.89	102% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HCHG 74178 CT ABD&PELVIS;W/O,W/CONTRAST	$7,188.00	$7,188.00	$669.44–$6,350.89	—	—
CT scan of the abdomen with contrast CPT 74160 HCHG 74160 CT ABDOMEN W/IV CONT	$3,204.00	$3,204.00	$520.77–$2,607.44	104% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 HCHG 74160 CT ABDOMEN W/IV CONT	$3,204.00	$3,204.00	$520.77–$2,607.44	—	—
CT scan of the abdomen without contrast CPT 74150 HCHG 74150 CT ABDOMEN W/O IV CONT	$2,576.00	$2,576.00	$194.99–$875.35	104% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 HCHG 74150 CT ABDOMEN W/O IV CONT	$2,576.00	$2,576.00	$194.99–$875.35	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 HCHG 70486 CT MAXILLA W/O IV CONT	$2,255.00	$2,255.00	$182.82–$1,926.32	62% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HCHG 70486 CT MAXILLA W/O IV CONT	$2,255.00	$2,255.00	$182.82–$1,926.32	—	—
CT scan of the head or brain, no contrast dye CPT 70450 HCHG 70450 CT HEAD W/O IV CONT	$2,357.00	$2,357.00	$587.41–$2,159.71	83% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HCHG 70450 CT HEAD W/O IV CONT	$2,357.00	$2,357.00	$587.41–$2,159.71	—	—
CT scan of the head with contrast CPT 70460 HCHG 70460 CT HEAD W/IV CONT	$2,551.00	$2,551.00	$833.46	65% above	—
CT scan of the head with contrast inpatient CPT 70460 HCHG 70460 CT HEAD W/IV CONT	$2,551.00	$2,551.00	$833.46	—	—
CT scan of the head without and with contrast CPT 70470 HCHG 70470 CT HEAD W&W/O IV CONT	$3,461.00	$3,461.00	$587.41–$2,956.80	88% above	—
CT scan of the head without and with contrast inpatient CPT 70470 HCHG 70470 CT HEAD W&W/O IV CONT	$3,461.00	$3,461.00	$587.41–$2,956.80	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HCHG 72131 CT SPINE L W/O IV CONT	$2,747.00	$2,747.00	$194.99–$2,346.96	87% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HCHG 72131 CT SPINE L W/O IV CONT	$2,747.00	$2,747.00	$194.99–$2,346.96	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HCHG 72125 CT SPINE C W/O IV CONT	$2,773.00	$2,773.00	$182.82–$2,442.00	89% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HCHG 72125 CT SPINE C W/O IV CONT	$2,773.00	$2,773.00	$182.82–$2,442.00	—	—
CT scan of the pelvis, with contrast dye CPT 72193 HCHG 72193 CT PELVIS W/IV CONT	$3,148.00	$3,148.00	$1,049.91–$1,116.43	101% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HCHG 72193 CT PELVIS W/IV CONT	$3,148.00	$3,148.00	$1,049.91–$1,116.43	—	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HCHG 93880 US CAROTID/DOPPLER	$1,964.00	$1,964.00	$288.43–$1,678.16	99% above	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HCHG 93880 US CAROTID/DOPPLER	$1,964.00	$1,964.00	$288.43–$1,678.16	—	—
Chest X-ray, 2 views CPT 71046 HCHG 71046 RADIOLOGIC EXAM, CHEST; 2 VIEWS	$472.00	$472.00	$58.87–$416.78	120% above	—
Chest X-ray, 2 views inpatient CPT 71046 HCHG 71046 RADIOLOGIC EXAM, CHEST; 2 VIEWS	$472.00	$472.00	$58.87–$416.78	—	—
Chest X-ray, single view CPT 71045 HCHG 71045 RADIOLOGIC EXAM, CHEST; SINGLE VIEW	$346.00	$346.00	$38.33–$329.28	114% above	—
Chest X-ray, single view inpatient CPT 71045 HCHG 71045 RADIOLOGIC EXAM, CHEST; SINGLE VIEW	$346.00	$346.00	$38.33–$329.28	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HCHG 76770 US RENAL	$1,386.00	$1,386.00	$288.43–$1,184.48	152% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HCHG 76770 US RENAL	$1,386.00	$1,386.00	$288.43–$1,184.48	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HCHG 77080 BONE DENSTOMETRY	$696.00	$696.00	$135.08–$608.79	75% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HCHG 77080 BONE DENSTOMETRY	$696.00	$696.00	$135.08–$608.79	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HCHG 77081 BONE DENSITY-PERIPHERAL	$687.00	$687.00	$56.39–$581.68	154% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HCHG 77081 BONE DENSITY-PERIPHERAL	$687.00	$687.00	$56.39–$581.68	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG 71250 CT, THORAX, DIAGNOSTIC; W/O CONTRAST	$2,803.00	$2,803.00	$182.82–$2,476.11	95% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HCHG 71250 CT, THORAX, DIAGNOSTIC; W/O CONTRAST	$2,803.00	$2,803.00	$182.82–$2,476.11	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HCHG 71260 CT, THORAX, DIAGNOSTIC; W/CONTRAST	$3,184.00	$3,184.00	$520.77–$2,842.87	103% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HCHG 71260 CT, THORAX, DIAGNOSTIC; W/CONTRAST	$3,184.00	$3,184.00	$520.77–$2,842.87	—	—
Duplex ultrasound of the leg veins, both legs CPT 93970 HCHG 93970 DUPLEX SCAN EXT VEINS BIL	$2,362.00	$2,362.00	$302.54–$1,940.40	102% above	—
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 HCHG 93970 DUPLEX SCAN EXT VEINS BIL	$2,362.00	$2,362.00	$302.54–$1,940.40	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG VMH REST ECHO W/O CONT	$3,232.00	$3,232.00	$199.12–$3,293.00	84% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG 93306 TRANSTHOR ECHO COMPLETE	$3,232.00	$3,232.00	$859.80–$3,134.56	84% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG VMH REST ECHO WITH CONTRAST	$3,669.00	$3,669.00	$144.08–$3,293.00	109% above	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG 93306 TRANSTHO ECHO W/CONTRAST	$3,669.00	$3,669.00	$859.80–$3,134.56	109% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG VMH REST ECHO W/O CONT	$3,232.00	$3,232.00	$199.12–$3,293.00	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG 93306 TRANSTHOR ECHO COMPLETE	$3,232.00	$3,232.00	$859.80–$3,134.56	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG 93306 TRANSTHO ECHO W/CONTRAST	$3,669.00	$3,669.00	$859.80–$3,134.56	—	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HCHG VMH REST ECHO WITH CONTRAST	$3,669.00	$3,669.00	$144.08–$3,293.00	—	—
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HCHG 95806 SLEEP STUDY UNATTENDED, SIMULTANEOUS RECORDING	$961.00	$961.00	$681.09–$849.03	57% above	—
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HCHG 95806 SLEEP STUDY UNATTENDED, SIMULTANEOUS RECORDING	$961.00	$961.00	$681.09–$849.03	—	—
Knee X-ray, 3 views CPT 73562 HCHG 73562 KNEE 3 VW SPCFY L/R	$448.00	$448.00	$96.17–$382.80	76% above	—
Knee X-ray, 3 views inpatient CPT 73562 HCHG 73562 KNEE 3 VW SPCFY L/R	$448.00	$448.00	$96.17–$382.80	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HCHG 76705 US ABDOMEN; LIMITED	$925.00	$925.00	$187.23–$817.18	114% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HCHG 76705 US ABDOMEN; LIMITED	$925.00	$925.00	$187.23–$817.18	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HCHG 71271 CT, THORAX, LOW DOSE FOR CA SCREENING, WO CONTRAST	$332.00	$332.00	$105.30–$300.86	25% below	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HCHG 71271 CT, THORAX, LOW DOSE FOR CA SCREENING, WO CONTRAST	$332.00	$332.00	$105.30–$300.86	—	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG 73721 MRI LOWER EXT;W/O CONTRAST	$3,246.00	$3,246.00	$413.33–$2,867.41	54% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HCHG 73721 MRI LOWER EXT;W/O CONTRAST	$3,246.00	$3,246.00	$413.33–$2,867.41	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HCHG 73723 MRI LOWER EXT;W/O,W/CONT	$3,974.00	$3,974.00	$1,273.53–$2,455.46	22% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HCHG 73723 MRI LOWER EXT;W/O,W/CONT	$3,974.00	$3,974.00	$1,273.53–$2,455.46	—	—
MRI of the abdomen without contrast CPT 74181 HCHG 74181 MRI-ABDOMEN W/O CONTRAST	$3,091.00	$3,091.00	$413.33	46% above	—
MRI of the abdomen without contrast inpatient CPT 74181 HCHG 74181 MRI-ABDOMEN W/O CONTRAST	$3,091.00	$3,091.00	$413.33	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 HCHG 74183 MRI-ABDOMEN WO & W/CONTRAST	$4,093.00	$4,093.00	$1,378.98–$2,461.24	25% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HCHG 74183 MRI-ABDOMEN WO & W/CONTRAST	$4,093.00	$4,093.00	$1,378.98–$2,461.24	—	—
MRI of the brain, no contrast dye CPT 70551 HCHG 70551 MRI HEAD (3 SEQ)	$3,246.00	$3,246.00	$439.00–$2,772.88	54% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 HCHG 70551 MRI HEAD (3 SEQ)	$3,246.00	$3,246.00	$439.00–$2,772.88	—	—
MRI of the brain, with and without contrast dye CPT 70553 HCHG 70553 MRI HEAD W&WO CONTRAST	$4,132.00	$4,132.00	$697.30–$3,650.92	27% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 HCHG 70553 MRI HEAD W&WO CONTRAST	$4,132.00	$4,132.00	$697.30–$3,650.92	—	—
MRI of the lower back, no contrast dye CPT 72148 HCHG 72148 MRI-LUMBAR SPINE W/O CONTRAST	$3,246.00	$3,246.00	$439.00–$2,867.41	54% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 HCHG 72148 MRI-LUMBAR SPINE W/O CONTRAST	$3,246.00	$3,246.00	$439.00–$2,867.41	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 HCHG 72158 MRI L-SPINE W&WO CONTRAST	$4,093.00	$4,093.00	$697.30–$3,125.58	25% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HCHG 72158 MRI L-SPINE W&WO CONTRAST	$4,093.00	$4,093.00	$697.30–$3,125.58	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HCHG 72146 MRI-THORACIC SPINE W/O CONTRAS	$3,215.00	$3,215.00	$250.00–$2,035.41	52% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HCHG 72146 MRI-THORACIC SPINE W/O CONTRAS	$3,215.00	$3,215.00	$250.00–$2,035.41	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 HCHG 72156 MRI C-SPINE W&WO CONTRAST	$4,093.00	$4,093.00	$697.30–$3,497.12	25% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HCHG 72156 MRI C-SPINE W&WO CONTRAST	$4,093.00	$4,093.00	$697.30–$3,497.12	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 HCHG 72141 MRI-CERVICAL SPINE W/O CONTRAS	$3,215.00	$3,215.00	$413.33–$2,746.48	52% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HCHG 72141 MRI-CERVICAL SPINE W/O CONTRAS	$3,215.00	$3,215.00	$413.33–$2,746.48	—	—
MRI of the pelvis, no contrast dye CPT 72195 HCHG 72195 MRI PELVIS W/O CONTRAST	$3,091.00	$3,091.00	$1,060.45	46% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 HCHG 72195 MRI PELVIS W/O CONTRAST	$3,091.00	$3,091.00	$1,060.45	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HCHG 73221 MRI-UP EXTRM-JOINT W/O CONTRAS	$3,215.00	$3,215.00	$413.33–$2,746.48	52% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HCHG 73221 MRI-UP EXTRM-JOINT W/O CONTRAS	$3,215.00	$3,215.00	$413.33–$2,746.48	—	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HCHG 78452 MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT); MULTIPLE STUDIES AT REST AND/OR STRESS	$2,783.00	$2,783.00	$570.19–$2,653.86	10% below	—
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HCHG 78452 MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT); MULTIPLE STUDIES AT REST AND/OR STRESS	$2,783.00	$2,783.00	$570.19–$2,653.86	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HCHG 76857 US, PELVIC (NON-OB); LIMITED	$751.00	$751.00	$93.62–$674.00	88% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HCHG 76857 US, PELVIC (NON-OB); LIMITED	$751.00	$751.00	$93.62–$674.00	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HCHG 76856 US PELVIS	$925.00	$925.00	$302.54–$790.24	79% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HCHG 76856 US PELVIS	$925.00	$925.00	$302.54–$790.24	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG 76805 US OB-AFTER 1ST TRIMESTER	$1,040.00	$1,040.00	$172.49–$888.80	81% above	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HCHG 76805 US OB-AFTER 1ST TRIMESTER	$1,040.00	$1,040.00	$172.49–$888.80	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HCHG 76801 US OB <14WKS,SNGL FETUS	$720.00	$720.00	$94.73–$591.36	56% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HCHG 76801 US OB <14WKS,SNGL FETUS	$720.00	$720.00	$94.73–$591.36	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HCHG VMH ER US OB LIMITED	$96.00	$96.00	$72.80–$493.68	74% below	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HCHG 76815 US OB-LIMITED (SINGLE)	$578.00	$578.00	$72.80–$493.68	57% above	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HCHG VMH ER US OB LIMITED	$96.00	$96.00	$72.80–$493.68	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HCHG 76815 US OB-LIMITED (SINGLE)	$578.00	$578.00	$72.80–$493.68	—	—
Screening mammogram, both breasts both sides CPT 77067 HCHG 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD	$211.00	$211.00	$40.86–$205.00	—	—
Screening mammogram, both breasts inpatient both sides CPT 77067 HCHG 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD	$211.00	$211.00	$40.86–$205.00	—	—
Shoulder X-ray, complete, 2 or more views CPT 73030 HCHG 73030 SHOULDER 2VW L/R (ROUT)	$614.00	$614.00	$96.17–$596.00	173% above	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HCHG 73030 SHOULDER 2VW L/R (ROUT)	$614.00	$614.00	$96.17–$596.00	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 HCHG 74230 SWALLOW FUNCTION W/CINE/VIDEO INCL SCOUT NECK IMAGES, CONTRAST STUDY	$1,508.00	$1,508.00	$226.07–$1,332.24	245% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HCHG 74230 SWALLOW FUNCTION W/CINE/VIDEO INCL SCOUT NECK IMAGES, CONTRAST STUDY	$1,508.00	$1,508.00	$226.07–$1,332.24	—	—
Transvaginal pelvic ultrasound CPT 76830 HCHG 76830 US PELVIS TRANSVAG	$1,040.00	$1,040.00	$187.23–$919.10	125% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 HCHG 76830 US PELVIS TRANSVAG	$1,040.00	$1,040.00	$187.23–$919.10	—	—
Transvaginal ultrasound during pregnancy CPT 76817 HCHG 76817 US OB TRANSVAGINAL	$578.00	$578.00	$129.60–$493.68	48% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HCHG 76817 US OB TRANSVAGINAL	$578.00	$578.00	$129.60–$493.68	—	—
Ultrasound of the abdomen, complete CPT 76700 HCHG 76700 US ABDOMEN (SPCFY)	$1,617.00	$1,617.00	$288.43–$1,381.60	169% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 HCHG 76700 US ABDOMEN (SPCFY)	$1,617.00	$1,617.00	$288.43–$1,381.60	—	—
Ultrasound of the scrotum and testicles CPT 76870 HCHG 76870 US TESTICULAR	$1,040.00	$1,040.00	$33.70–$888.80	116% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 HCHG 76870 US TESTICULAR	$1,040.00	$1,040.00	$33.70–$888.80	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HCHG 76536 US SOFT TISSUES HEAD AND NECK	$925.00	$925.00	$187.23–$848.24	83% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HCHG 76536 US SOFT TISSUES HEAD AND NECK	$925.00	$925.00	$187.23–$848.24	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HCHG VMH ER US EXTREM VENOUS	$96.00	$96.00	$30.53–$81.84	86% below	—
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HCHG 93971 DUPLEX SCAN EXT VEINS UNI	$1,157.00	$1,157.00	$199.72–$1,021.93	71% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HCHG VMH ER US EXTREM VENOUS	$96.00	$96.00	$30.53–$81.84	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HCHG 93971 DUPLEX SCAN EXT VEINS UNI	$1,157.00	$1,157.00	$199.72–$1,021.93	—	—
Wrist X-ray, complete, 3 or more views CPT 73110 HCHG 73110 WRIST 3VWS ROUTINE L/R	$419.00	$419.00	$48.09–$398.86	86% above	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HCHG 73110 WRIST 3VWS ROUTINE L/R	$419.00	$419.00	$48.09–$398.86	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HCHG 73502 X/R HIP, UNILATERAL, W/PELVIS WHEN PERFORMED, 2-3 VIEWS	$497.00	$497.00	$57.50–$439.53	71% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HCHG 73502 X/R HIP, UNILATERAL, W/PELVIS WHEN PERFORMED, 2-3 VIEWS	$497.00	$497.00	$57.50–$439.53	—	—
X-ray of the abdomen, 1 view CPT 74018 HCHG 74018 RADIOLOGIC EXAM, ABDOMEN; 1 VIEW	$405.00	$405.00	$52.71–$357.63	92% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 HCHG 74018 RADIOLOGIC EXAM, ABDOMEN; 1 VIEW	$405.00	$405.00	$52.71–$357.63	—	—
X-ray of the ankle, 2 views CPT 73600 HCHG 73600 ANKLE 1-2 VIEWS	$319.00	$319.00	$90.50–$272.80	60% above	—
X-ray of the ankle, 2 views inpatient CPT 73600 HCHG 73600 ANKLE 1-2 VIEWS	$319.00	$319.00	$90.50–$272.80	—	—
X-ray of the finger(s), 2 or more views CPT 73140 HCHG 73140 FINGER (SPCFY) L/R	$109.00	$109.00	$35.70–$101.83	43% below	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HCHG 73140 FINGER (SPCFY) L/R	$109.00	$109.00	$35.70–$101.83	—	—
X-ray of the foot, 2 views CPT 73620 HCHG 73620 FOOT L/R 1-2 VIEWS	$418.00	$418.00	$91.12–$375.00	121% above	—
X-ray of the foot, 2 views inpatient CPT 73620 HCHG 73620 FOOT L/R 1-2 VIEWS	$418.00	$418.00	$91.12–$375.00	—	—
X-ray of the foot, complete, 3 or more views CPT 73630 HCHG 73630 FOOT 3V ROUTINE L/R	$397.00	$397.00	$96.17–$338.80	83% above	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HCHG 73630 FOOT 3V ROUTINE L/R	$397.00	$397.00	$96.17–$338.80	—	—
X-ray of the hand, 3 or more views CPT 73130 HCHG 73130 HAND 3V ROUTINE L/R	$444.00	$444.00	$96.17–$422.38	117% above	—
X-ray of the hand, 3 or more views inpatient CPT 73130 HCHG 73130 HAND 3V ROUTINE L/R	$444.00	$444.00	$96.17–$422.38	—	—
X-ray of the knee, 1 or 2 views CPT 73560 HCHG 73560 KNEE 1-2 VIEWS SPEC	$392.00	$392.00	$101.83–$373.38	85% above	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HCHG 73560 KNEE 1-2 VIEWS SPEC	$392.00	$392.00	$101.83–$373.38	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HCHG 72100 SPINE LUMBAR (ROUT) 2-3VWS	$492.00	$492.00	$96.17–$420.64	91% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HCHG 72100 SPINE LUMBAR (ROUT) 2-3VWS	$492.00	$492.00	$96.17–$420.64	—	—
X-ray of the lower back, 4 or more views CPT 72110 HCHG 72110 SPINE LUMBAR W/OBLIQ (4 VWS)	$639.00	$639.00	$212.76	73% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 HCHG 72110 SPINE LUMBAR W/OBLIQ (4 VWS)	$639.00	$639.00	$212.76	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HCHG 72070 SPINE DORSAL AP+LAT (2VW)	$492.00	$492.00	$164.15–$420.64	109% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HCHG 72070 SPINE DORSAL AP+LAT (2VW)	$492.00	$492.00	$164.15–$420.64	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 HCHG 70160 NASAL BONES ROUTINE	$492.00	$492.00	$136.43–$404.80	129% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HCHG 70160 NASAL BONES ROUTINE	$492.00	$492.00	$136.43–$404.80	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HCHG 72040 SPINE CERV AP+LAT 3 VWS	$492.00	$492.00	$96.17–$434.98	109% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HCHG 72040 SPINE CERV AP+LAT 3 VWS	$492.00	$492.00	$96.17–$434.98	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 HCHG 72170 PELVIS 1 OR 2 VIEWS	$492.00	$492.00	$96.17–$434.98	133% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HCHG 72170 PELVIS 1 OR 2 VIEWS	$492.00	$492.00	$96.17–$434.98	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HCHG 72220 SACRUM & COCCYX	$418.00	$418.00	$48.09–$357.28	101% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HCHG 72220 SACRUM & COCCYX	$418.00	$418.00	$48.09–$357.28	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT)	$113.00	$113.00	$5.48–$107.80	151% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT)	$113.00	$113.00	$5.48–$107.80	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)	$124.00	$124.00	$5.35–$117.60	148% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)	$124.00	$124.00	$5.35–$117.60	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 RAST-DUST MITES DERM FA	$16.00	$16.00	$4.57–$18.00	36% below	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE; QUANT/SEMI-QUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH	$38.00	$38.00	$4.57–$18.00	52% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST-DUST MITES DERM FA	$16.00	$16.00	$4.57–$18.00	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE; QUANT/SEMI-QUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH	$38.00	$38.00	$4.57–$18.00	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE A	$50.00	$50.00	$13.38–$43.12	38% below	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE A	$50.00	$50.00	$13.38–$43.12	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (BNP)	$134.00	$134.00	$40.57–$127.40	4% below	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE (BNP)	$134.00	$134.00	$40.57–$127.40	—	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$208.00	$208.00	$8.74–$203.84	135% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$208.00	$208.00	$8.74–$203.84	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAM, LEVEL 4	$240.00	$240.00	$55.20–$212.03	11% above	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAM, LEVEL 4	$240.00	$240.00	$55.20–$212.03	—	—
Blood culture for bacteria CPT 87040 CULTURE, BACTERIAL; BLOOD	$377.00	$377.00	$10.66–$352.00	339% above	—
Blood culture for bacteria inpatient CPT 87040 CULTURE, BACTERIAL; BLOOD	$377.00	$377.00	$10.66–$352.00	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HCHG 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$35.00	$35.00	$4.68–$34.00	134% above	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HCHG LEGAL BLOOD/ETOH	$307.00	$307.00	$4.68–$34.00	1954% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HCHG 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$35.00	$35.00	$4.68–$34.00	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HCHG LEGAL BLOOD/ETOH	$307.00	$307.00	$4.68–$34.00	—	—
Blood glucose (sugar) test CPT 82947 GLUCOSE; QUANTITATIVE, BLOOD	$117.00	$117.00	$4.06–$111.72	379% above	—
Blood glucose (sugar) test CPT 82947 GLUCOSE; QUANT, BLOOD POCT	$117.00	$117.00	$4.06–$111.72	379% above	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE; QUANT, BLOOD POCT	$117.00	$117.00	$4.06–$111.72	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE; QUANTITATIVE, BLOOD	$117.00	$117.00	$4.06–$111.72	—	—
Blood lead test CPT 83655 LEAD	$55.00	$55.00	$12.51–$103.84	at median	—
Blood lead test CPT 83655 LEAD, BLOOD	$122.00	$122.00	$12.51–$103.84	122% above	—
Blood lead test inpatient CPT 83655 LEAD	$55.00	$55.00	$12.51–$103.84	—	—
Blood lead test inpatient CPT 83655 LEAD, BLOOD	$122.00	$122.00	$12.51–$103.84	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE, SERUM	$202.00	$202.00	$7.77–$172.48	226% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE, SERUM	$202.00	$202.00	$7.77–$172.48	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING, SEROLOGIC; ABO	$52.00	$52.00	$3.09–$50.00	30% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING, SEROLOGIC; ABO	$52.00	$52.00	$3.09–$50.00	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN; IBD PANEL	$19.00	$19.00	$5.35–$76.44	65% below	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN (CRP)	$80.00	$80.00	$5.35–$76.44	47% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN; IBD PANEL	$19.00	$19.00	$5.35–$76.44	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN (CRP)	$80.00	$80.00	$5.35–$76.44	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 INFECTIOUS AGENT ANTIGEN DETECTION; C DIFF TOXIN GENE(S) AMP PROB TECH	$134.00	$134.00	$38.51–$122.50	11% below	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INFECTIOUS AGENT ANTIGEN DETECTION; C DIFF TOXIN GENE(S) AMP PROB TECH	$134.00	$134.00	$38.51–$122.50	—	—
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9	$80.00	$80.00	$21.50–$73.45	27% below	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9	$80.00	$80.00	$21.50–$73.45	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125	$80.00	$80.00	$26.75–$73.45	32% below	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125	$80.00	$80.00	$26.75–$73.45	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDC 2019-NCOV CORONAVIRUS COVID-19	$250.00	$250.00	$29.00–$185.85	85% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDC 2019-NCOV CORONAVIRUS COVID-19	$250.00	$250.00	$29.00–$185.85	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECTIOUS AGENT ANTIGEN DETECTION; CHLAMYDIA DNA/RNA ASSAY	$146.00	$146.00	$36.26–$142.00	2% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECTIOUS AGENT ANTIGEN DETECTION; CHLAMYDIA ASSAY	$146.00	$146.00	$36.26–$142.00	2% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECTIOUS AGENT ANTIGEN DETECTION; CHLAMYDIA DNA/RNA ASSAY	$146.00	$146.00	$36.26–$142.00	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECTIOUS AGENT ANTIGEN DETECTION; CHLAMYDIA ASSAY	$146.00	$146.00	$36.26–$142.00	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL (NMR)	$53.00	$53.00	$13.84–$233.24	43% below	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$248.00	$248.00	$13.84–$233.24	168% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL (NMR)	$53.00	$53.00	$13.84–$233.24	—	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$248.00	$248.00	$13.84–$233.24	—	—
Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT; COMPLETE (CBC)	$231.00	$231.00	$8.03–$219.52	230% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT; COMPLETE (CBC)	$231.00	$231.00	$8.03–$219.52	—	—
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT; COMPLETE (CBC) AUTOMATED	$111.00	$111.00	$6.69–$105.84	122% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT; COMPLETE (CBC) AUTOMATED	$111.00	$111.00	$6.69–$105.84	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$246.00	$246.00	$10.91–$241.08	116% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$246.00	$246.00	$10.91–$241.08	—	—
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE	$258.00	$258.00	$10.52–$245.00	266% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE	$258.00	$258.00	$10.52–$245.00	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)	$85.00	$85.00	$22.97–$80.00	38% below	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)	$85.00	$85.00	$22.97–$80.00	—	—
Estradiol blood test CPT 82670 ESTRADIOL; TOTAL	$274.00	$274.00	$28.87–$234.08	114% above	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL; TOTAL	$274.00	$274.00	$28.87–$234.08	—	—
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN; FOLLCLE STIMULATING HORMONE (FSH)	$159.00	$159.00	$19.20–$154.00	36% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN; FOLLCLE STIMULATING HORMONE (FSH)	$159.00	$159.00	$19.20–$154.00	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL	$75.00	$75.00	$20.28–$61.60	62% below	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL	$75.00	$75.00	$20.28–$61.60	—	—
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$196.00	$196.00	$14.08–$186.20	118% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$196.00	$196.00	$14.08–$186.20	—	—
Folate (folic acid) blood test CPT 82746 FOLIC ACID; SERUM	$124.00	$124.00	$15.19–$120.00	14% above	—
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID; SERUM	$124.00	$124.00	$15.19–$120.00	—	—
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE T3; FREE	$65.00	$65.00	$16.62–$60.00	32% below	—
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3; FREE	$65.00	$65.00	$16.62–$60.00	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE; FREE (FT4)	$199.00	$199.00	$9.32–$175.63	146% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE; FREE (FT4)	$199.00	$199.00	$9.32–$175.63	—	—
Free testosterone test CPT 84402 TESTOSTERONE FREE	$97.00	$97.00	$26.32–$94.00	19% below	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$97.00	$97.00	$26.32–$94.00	—	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$597.00	$597.00	$13.62–$697.97	117% above	—
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$597.00	$597.00	$13.62–$697.97	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE; POST GLUCOSE DOSE (1HR DEXICOLA)	$117.00	$117.00	$4.91–$100.32	137% above	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE; POST GLUCOSE DOSE (GLU2)	$117.00	$117.00	$4.91–$100.32	137% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE; POST GLUCOSE DOSE (1HR DEXICOLA)	$117.00	$117.00	$4.91–$100.32	—	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE; POST GLUCOSE DOSE (GLU2)	$117.00	$117.00	$4.91–$100.32	—	—
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE; TOLERANCE TEST (GTT)	$116.00	$116.00	$13.30–$113.00	29% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE; TOLERANCE TEST (GTT)	$116.00	$116.00	$13.30–$113.00	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECTIOUS AGENT ANTIGEN DETECTION; GC-DNA	$146.00	$146.00	$36.26–$142.00	2% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECTIOUS AGENT ANTIGEN DETECTION; GC-DNA/RNA	$146.00	$146.00	$36.26–$142.00	2% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECTIOUS AGENT ANTIGEN DETECTION; GC-DNA/RNA	$146.00	$146.00	$36.26–$142.00	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECTIOUS AGENT ANTIGEN DETECTION; GC-DNA	$146.00	$146.00	$36.26–$142.00	—	—
H. pylori antibody blood test CPT 86677 ANTIBODY; H PYLORI	$183.00	$183.00	$58.65	90% above	—
H. pylori antibody blood test inpatient CPT 86677 ANTIBODY; H PYLORI	$183.00	$183.00	$58.65	—	—
H. pylori stool antigen test CPT 87338 INFECTIOUS AGENT ANTIGEN DETECTION; H PYLORI ANTIGEN, STOOL	$59.00	$59.00	$14.86–$50.16	53% below	—
H. pylori stool antigen test inpatient CPT 87338 INFECTIOUS AGENT ANTIGEN DETECTION; H PYLORI ANTIGEN, STOOL	$59.00	$59.00	$14.86–$50.16	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 INFECTIOUS AGENT ANTIGEN DETECTION; HIV RNA DETECTION AND QUANT, PLASMA	$274.00	$274.00	$90.62–$234.08	27% below	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 INFECTIOUS AGENT ANTIGEN DETECTION; HIV RNA DETECTION AND QUANT, PLASMA	$274.00	$274.00	$90.62–$234.08	—	—
HIV-1 and HIV-2 antibody test CPT 86703 ANTIBODY; HIV-1 AND HIV-2, SINGLE RESULT	$164.00	$164.00	$14.17–$147.00	119% above	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 ANTIBODY; HIV-1 AND HIV-2, SINGLE RESULT	$164.00	$164.00	$14.17–$147.00	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECTIOUS AGENT ANTIGEN DETECTION; HPV HIGH-RISK TYPES, POOLED RESULT	$203.00	$203.00	$36.26–$179.27	42% above	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECTIOUS AGENT ANTIGEN DETECTION; HPV HIGH-RISK TYPES, POOLED RESULT	$203.00	$203.00	$36.26–$179.27	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN; GLYCOSYLTED (A1C)	$156.00	$156.00	$2.84–$137.41	142% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN; GLYCOSYLTED (A1C)	$156.00	$156.00	$2.84–$137.41	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY	$45.00	$45.00	$11.10–$44.00	39% below	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY	$45.00	$45.00	$11.10–$44.00	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECTIOUS AGENT ANTIGEN DETECTION; HEPATITIS B SURFACE ANTIGEN	$63.00	$63.00	$10.67–$53.68	8% below	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECTIOUS AGENT ANTIGEN DETECTION; HEPATITIS B SURFACE ANTIGEN	$63.00	$63.00	$10.67–$53.68	—	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$151.00	$151.00	$14.75–$133.77	83% above	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$151.00	$151.00	$14.75–$133.77	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECTIOUS AGENT ANTIGEN DETECTION; HEPATITIS C QUANT, PCR	$164.00	$164.00	$44.27–$159.00	32% below	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECTIOUS AGENT ANTIGEN DETECTION; HEPATITIS C QUANT, PCR	$164.00	$164.00	$44.27–$159.00	—	—
Herpes blood test, HSV-1 antibody CPT 86695 ANTIBODY; HERPES SIMPLEX (HSV TYPE 1 AB)	$56.00	$56.00	$13.63–$49.00	17% below	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 ANTIBODY; HERPES SIMPLEX (HSV TYPE 1 AB)	$56.00	$56.00	$13.63–$49.00	—	—
Herpes blood test, HSV-2 antibody CPT 86696 ANTIBODY; HERPES SIMPLEX, TYPE 2	$75.00	$75.00	$19.99–$64.24	11% below	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 ANTIBODY; HERPES SIMPLEX, TYPE 2	$75.00	$75.00	$19.99–$64.24	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN; HIGH SENSITIVITY	$59.00	$59.00	$13.38–$41.36	24% below	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN; HIGH SENSITIVITY	$59.00	$59.00	$13.38–$41.36	—	—
Homocysteine blood test CPT 83090 VMH UW HOMOCYSTEINE, BLOOD	$22.00	$22.00	$18.52–$35.74	81% below	—
Homocysteine blood test CPT 83090 HOMOCYSTINE, BLOOD	$64.00	$64.00	$18.52–$35.74	46% below	—
Homocysteine blood test inpatient CPT 83090 VMH UW HOMOCYSTEINE, BLOOD	$22.00	$22.00	$18.52–$35.74	—	—
Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE, BLOOD	$64.00	$64.00	$18.52–$35.74	—	—
Insulin blood test CPT 83525 INSULIN; TOTAL	$44.00	$44.00	$11.81–$43.00	32% below	—
Insulin blood test inpatient CPT 83525 INSULIN; TOTAL	$44.00	$44.00	$11.81–$43.00	—	—
Iron blood test (serum iron) CPT 83540 IRON	$93.00	$93.00	$6.69–$88.20	74% above	—
Iron blood test (serum iron) inpatient CPT 83540 IRON	$93.00	$93.00	$6.69–$88.20	—	—
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$107.00	$107.00	$9.03–$101.92	55% above	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$107.00	$107.00	$9.03–$101.92	—	—
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$365.00	$365.00	$8.97–$321.20	255% above	—
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$365.00	$365.00	$8.97–$321.20	—	—
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN; LUTEINIZING HORMONE (LH)	$158.00	$158.00	$19.14–$147.00	62% above	—
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN; LUTEINIZING HORMONE (LH)	$158.00	$158.00	$19.14–$147.00	—	—
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$57.00	$57.00	$7.12–$55.00	17% below	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$57.00	$57.00	$7.12–$55.00	—	—
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$190.00	$190.00	$8.44–$187.30	86% above	—
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$190.00	$190.00	$8.44–$187.30	—	—
Lyme disease antibody test CPT 86618 ANTIBODY; BORRELIA BURGDORFERI (LYME IGG/IGM SCREEN)	$232.00	$232.00	$17.60–$212.48	174% above	—
Lyme disease antibody test inpatient CPT 86618 ANTIBODY; BORRELIA BURGDORFERI (LYME IGG/IGM SCREEN)	$232.00	$232.00	$17.60–$212.48	—	—
Magnesium blood test CPT 83735 MAGNESIUM, RBC ARUP	$26.00	$26.00	$6.92–$148.96	48% below	—
Magnesium blood test CPT 83735 MAGNESIUM	$160.00	$160.00	$6.92–$148.96	220% above	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM, RBC ARUP	$26.00	$26.00	$6.92–$148.96	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$160.00	$160.00	$6.92–$148.96	—	—
Measles (rubeola) antibody test CPT 86765 ANTIBODY; RUBEOLA	$49.00	$49.00	$13.31–$48.00	39% below	—
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY; RUBEOLA	$49.00	$49.00	$13.31–$48.00	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES; SCREENING (MONOTEST)	$110.00	$110.00	$5.35–$94.16	99% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES; SCREENING (MONOTEST)	$110.00	$110.00	$5.35–$94.16	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC ANTIGEN (PSA); TOTAL	$166.00	$166.00	$19.00–$146.51	75% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATIC SPECIFIC ANTIGEN (PSA); TOTAL	$166.00	$166.00	$19.00–$146.51	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATHOLOGY, CERVICAL/VAGINAL, FLUID BASED; AUTOMATED SCREEN	$147.00	$147.00	$27.50–$130.13	40% above	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATHOLOGY, CERVICAL/VAGINAL, FLUID BASED; AUTOMATED SCREEN	$147.00	$147.00	$27.50–$130.13	—	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATHOLOGY, CERVICAL/VAGINAL, LIQUID BASED PREP; MANUAL SCREENING	$67.00	$67.00	$20.30–$55.00	23% below	—
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATHOLOGY, CERVICAL/VAGINAL, LIQUID BASED PREP; MANUAL SCREENING	$67.00	$67.00	$20.30–$55.00	—	—
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE)	$156.00	$156.00	$42.65–$405.72	28% below	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PARATHYROID HORMONE)	$156.00	$156.00	$42.65–$405.72	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD	$39.00	$39.00	$6.21–$148.96	22% below	—
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT)	$163.00	$163.00	$6.21–$148.96	226% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD	$39.00	$39.00	$6.21–$148.96	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PARTIAL (PTT)	$163.00	$163.00	$6.21–$148.96	—	—
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY	$1,716.00	$1,716.00	$607.24	42% above	—
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 FETAL CHROMOSOMAL ANEUPLOIDY	$1,716.00	$1,716.00	$607.24	—	—
Progesterone blood test CPT 84144 PROGESTERONE	$152.00	$152.00	$21.55–$144.94	27% above	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$152.00	$152.00	$21.55–$144.94	—	—
Prolactin blood test CPT 84146 PROLACTIN	$164.00	$164.00	$20.03–$159.00	36% above	—
Prolactin blood test inpatient CPT 84146 PROLACTIN	$164.00	$164.00	$20.03–$159.00	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$118.00	$118.00	$4.43–$101.20	243% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$118.00	$118.00	$4.43–$101.20	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 INFECTIOUS AGENT ANTIGEN DETECTION; SCREEN-B STREP GRP A	$124.00	$124.00	$16.86–$104.65	166% above	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 INFECTIOUS AGENT ANTIGEN DETECTION; SCREEN-B STREP GRP A	$124.00	$124.00	$16.86–$104.65	—	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR; QUANTITATIVE	$55.00	$55.00	$5.86–$53.00	4% below	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR; QUANTITATIVE	$55.00	$55.00	$5.86–$53.00	—	—
Rubella antibody test (immunity check) CPT 86762 ANTIBODY; RUBELLA	$80.00	$80.00	$14.87–$117.00	at median	—
Rubella antibody test (immunity check) CPT 86762 ANTIBODY; RUBELLA, IMMM STATUS	$131.00	$131.00	$14.87–$117.00	64% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY; RUBELLA	$80.00	$80.00	$14.87–$117.00	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY; RUBELLA, IMMM STATUS	$131.00	$131.00	$14.87–$117.00	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED (ESR)	$62.00	$62.00	$2.79–$56.84	49% above	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED (ESR)	$62.00	$62.00	$2.79–$56.84	—	—
Stool ova and parasites exam CPT 87177 OVA AND PARASITES, DIRECT SMEARS ARUP	$34.00	$34.00	$9.20–$33.00	46% below	—
Stool ova and parasites exam CPT 87177 OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND ID	$35.00	$35.00	$9.20–$33.00	44% below	—
Stool ova and parasites exam CPT 87177 OVA AND PARASITES, DIRECT SMEARS MCLAB	$35.00	$35.00	$9.20–$33.00	44% below	—
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES, DIRECT SMEARS ARUP	$34.00	$34.00	$9.20–$33.00	—	—
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND ID	$35.00	$35.00	$9.20–$33.00	—	—
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES, DIRECT SMEARS MCLAB	$35.00	$35.00	$9.20–$33.00	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY; FECES (HEMOCCULT SLIDE)	$68.00	$68.00	$3.66–$53.46	222% above	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY; FECES (HEMOCCULT SLIDE)	$68.00	$68.00	$3.66–$53.46	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 BLOOD, OCCULT, QUAL, FECES, 1-3 DETERMINATIONS, BY IMMUNOASSAY, QUAL	$68.00	$68.00	$16.45–$61.74	12% above	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 BLOOD, OCCULT, QUAL, FECES, 1-3 DETERMINATIONS, BY IMMUNOASSAY, QUAL	$68.00	$68.00	$16.45–$61.74	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (RPR, RESPONSE TO THERAPY, S) MCLAB	$16.00	$16.00	$4.41–$17.00	57% below	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (VDRL) MCLAB	$38.00	$38.00	$4.41–$17.00	1% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (RPR, RESPONSE TO THERAPY, S) MCLAB	$16.00	$16.00	$4.41–$17.00	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (VDRL) MCLAB	$38.00	$38.00	$4.41–$17.00	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INERFERON	$215.00	$215.00	$64.04–$184.01	15% below	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INERFERON	$215.00	$215.00	$64.04–$184.01	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$100.00	$100.00	$26.67–$196.00	13% below	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE; TOTAL	$202.00	$202.00	$26.67–$196.00	77% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$100.00	$100.00	$26.67–$196.00	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE; TOTAL	$202.00	$202.00	$26.67–$196.00	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES, LIVER/KIDNEY	$56.00	$56.00	$15.03–$52.00	17% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES, THYROPEROXIDASE	$56.00	$56.00	$15.03–$52.00	17% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES, ANTI-THYROID PEROXIDASE AUTOAB	$56.00	$56.00	$15.03–$52.00	17% below	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES, THYROPEROXIDASE	$56.00	$56.00	$15.03–$52.00	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES, LIVER/KIDNEY	$56.00	$56.00	$15.03–$52.00	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES, ANTI-THYROID PEROXIDASE AUTOAB	$56.00	$56.00	$15.03–$52.00	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH)	$289.00	$289.00	$17.36–$264.60	206% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH)	$289.00	$289.00	$17.36–$264.60	—	—
Trichomonas test (NAAT) CPT 87661 INFECTIOUS AGENT ANTIGEN DETECTION; TRICHOMONAS RNA	$83.00	$83.00	$29.16–$81.00	41% below	—
Trichomonas test (NAAT) inpatient CPT 87661 INFECTIOUS AGENT ANTIGEN DETECTION; TRICHOMONAS RNA	$83.00	$83.00	$29.16–$81.00	—	—
Uric acid blood test CPT 84550 URIC ACID; BLOOD	$85.00	$85.00	$4.67–$73.04	70% above	—
Uric acid blood test inpatient CPT 84550 URIC ACID; BLOOD	$85.00	$85.00	$4.67–$73.04	—	—
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS; AUTOMATED WITH MICROSCOPY	$106.00	$106.00	$3.28–$100.94	163% above	—
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS; AUTOMATED WITH MICROSCOPY	$106.00	$106.00	$3.28–$100.94	—	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (UA DIP ONLY)	$52.00	$52.00	$2.32–$49.00	108% above	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS; AUTOMATED WO MICROSCOPY (UA DIP ONLY)	$52.00	$52.00	$2.32–$49.00	—	—
Urine culture for bacteria, with colony count CPT 87086 CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE	$232.00	$232.00	$8.34–$204.75	208% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE	$232.00	$232.00	$8.34–$204.75	—	—
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$196.00	$196.00	$8.90–$178.36	220% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$196.00	$196.00	$8.90–$178.36	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B12)	$128.00	$128.00	$15.58–$121.52	28% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN (VITAMIN B12)	$128.00	$128.00	$15.58–$121.52	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D; 25 HYDROXY	$111.00	$111.00	$30.59–$105.84	26% below	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D; 25 HYDROXY	$111.00	$111.00	$30.59–$105.84	—	—
Zinc blood test CPT 84630 ZINC,BLOOD	$54.00	$54.00	$11.77–$71.28	30% below	—
Zinc blood test CPT 84630 ZINC ARUP	$91.00	$91.00	$11.77–$71.28	17% above	—
Zinc blood test inpatient CPT 84630 ZINC,BLOOD	$54.00	$54.00	$11.77–$71.28	—	—
Zinc blood test inpatient CPT 84630 ZINC ARUP	$91.00	$91.00	$11.77–$71.28	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE	$249.00	$249.00	$15.55–$233.00	121% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE	$249.00	$249.00	$15.55–$233.00	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HCHG 54150 CIRCUMCISION, CLAMP/OTH DEVICE W/REGIONAL	$247.00	$247.00	$170.40–$231.00	23% above	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HCHG 54150 CIRCUMCISION, CLAMP/OTH DEVICE W/REGIONAL	$247.00	$247.00	$170.40–$231.00	—	—
Colonoscopy with polyp removal CPT 45385 HCHG VMH COLON/TUMOR/SNARE	$4,231.00	$4,231.00	$1,409.04–$3,615.04	92% above	—
Colonoscopy with polyp removal inpatient CPT 45385 HCHG VMH COLON/TUMOR/SNARE	$4,231.00	$4,231.00	$1,409.04–$3,615.04	—	—
Colonoscopy with tissue sample CPT 45380 HCHG VMH COLON SPLENIC BX	$3,838.00	$3,838.00	$1,205.64–$3,706.70	98% above	—
Colonoscopy with tissue sample inpatient CPT 45380 HCHG VMH COLON SPLENIC BX	$3,838.00	$3,838.00	$1,205.64–$3,706.70	—	—
Colonoscopy, diagnostic CPT 45378 HCHG VMH COLONOSCOPY/SPLENIC	$3,293.00	$3,293.00	$1,688.18–$2,813.36	105% above	—
Colonoscopy, diagnostic inpatient CPT 45378 HCHG VMH COLONOSCOPY/SPLENIC	$3,293.00	$3,293.00	$1,688.18–$2,813.36	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 HCHG VMH REMOVAL IMPACTED CERUMEN/IRRIGATION	$115.00	$115.00	$40.01–$98.56	57% above	—
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HCHG VMH REMOVAL IMPACTED CERUMEN/IRRIGATION	$115.00	$115.00	$40.01–$98.56	—	—
Earwax removal with instruments, one ear CPT 69210 HCHG VMH REM IMPACTED EAR WAX	$100.00	$100.00	$68.87–$85.36	19% above	—
Earwax removal with instruments, one ear inpatient CPT 69210 HCHG VMH REM IMPACTED EAR WAX	$100.00	$100.00	$68.87–$85.36	—	—
Hemorrhoid banding (rubber band ligation) CPT 46221 HCHG 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)	$2,905.00	$2,905.00	$994.90–$1,240.80	161% above	—
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HCHG 46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)	$2,905.00	$2,905.00	$994.90–$1,240.80	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 HCHG VMH I&D ABSCESS SIMPLE	$96.00	$96.00	$31.90–$66.03	68% below	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HCHG VMH I&D ABSCESS SIMPLE	$96.00	$96.00	$31.90–$66.03	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HCHG 20550 INJ SGL TEND SHEATH OR LIG, APO	$359.00	$359.00	$119.80	3% above	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HCHG 20550 INJ SGL TEND SHEATH OR LIG, APO	$359.00	$359.00	$119.80	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG VMH UC DRAIN/INJ JOINT/BURSA W/O US	$71.00	$71.00	$51.45	84% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG VMH I/R MAJOR JOINT/BURS	$161.00	$161.00	$51.45–$136.50	63% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG 20610 ARTHROCENTESIS, ASP/INJ, LRG JNT	$968.00	$968.00	$310.97–$827.20	123% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HCHG VMH UC DRAIN/INJ JOINT/BURSA W/O US	$71.00	$71.00	$51.45	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HCHG VMH I/R MAJOR JOINT/BURS	$161.00	$161.00	$51.45–$136.50	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HCHG 20610 ARTHROCENTESIS, ASP/INJ, LRG JNT	$968.00	$968.00	$310.97–$827.20	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG VMH ASPIRAT JOINT/BURSA	$96.00	$96.00	$30.53	70% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HCHG VMH ASPIRAT JOINT/BURSA	$96.00	$96.00	$30.53	—	—
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 HCHG 58661 LAPAROSCOPY, SURGICAL; W/REMOVAL OF ADNEXAL STRUCTURES	$988.00	$988.00	$7,424.10	60% below	—
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 HCHG 58661 LAPAROSCOPY, SURGICAL; W/REMOVAL OF ADNEXAL STRUCTURES	$988.00	$988.00	$7,424.10	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HCHG VMH LAYER CLOSURE WOUND	$1,010.00	$1,010.00	$336.24	98% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HCHG VMH LAYER CLOSURE WOUND	$1,010.00	$1,010.00	$336.24	—	—
Nail removal (partial or complete), one nail CPT 11730 HCHG VMH UC AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE	$139.00	$139.00	$95.85	38% below	—
Nail removal (partial or complete), one nail CPT 11730 HCHG VMH REMOVE NAIL PLATE	$161.00	$161.00	$109.50	28% below	—
Nail removal (partial or complete), one nail inpatient CPT 11730 HCHG VMH UC AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE	$139.00	$139.00	$95.85	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 HCHG VMH REMOVE NAIL PLATE	$161.00	$161.00	$109.50	—	—
Paracentesis with imaging guidance CPT 49083 HCHG VMH PARACENTISIS W/IMAGI	$2,996.00	$2,996.00	$997.79	133% above	—
Paracentesis with imaging guidance inpatient CPT 49083 HCHG VMH PARACENTISIS W/IMAGI	$2,996.00	$2,996.00	$997.79	—	—
Removal of a foreign object under the skin, simple CPT 10120 HCHG VMH I/R FB SIMPLE	$161.00	$161.00	$54.00–$110.76	52% below	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 HCHG VMH I/R FB SIMPLE	$161.00	$161.00	$54.00–$110.76	—	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HCHG VMH COLONOSCOPY SCREEN	$3,620.00	$3,620.00	$1,205.64–$1,696.89	108% above	—
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HCHG VMH COLONOSCOPY SCREEN	$3,620.00	$3,620.00	$1,205.64–$1,696.89	—	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HCHG VMH COLONOSCOPY SCREEN	$3,106.00	$3,106.00	$1,004.93–$2,860.00	78% above	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HCHG VMH COLONOSCOPY SCREEN	$3,106.00	$3,106.00	$1,004.93–$2,860.00	—	—
Short arm splint (forearm and hand) CPT 29125 HCHG VMH APPLY SHORT ARM SPLI	$161.00	$161.00	$52.92–$137.28	8% below	—
Short arm splint (forearm and hand) inpatient CPT 29125 HCHG VMH APPLY SHORT ARM SPLI	$161.00	$161.00	$52.92–$137.28	—	—
Short leg splint (calf to foot) CPT 29515 HCHG VMH APPLY SHORT LEG SPLI	$161.00	$161.00	$51.45–$110.76	22% below	—
Short leg splint (calf to foot) inpatient CPT 29515 HCHG VMH APPLY SHORT LEG SPLI	$161.00	$161.00	$51.45–$110.76	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HCHG VMH REPAIR WOUND SIMPLE	$97.00	$97.00	$30.53–$93.00	70% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HCHG VMH REPAIR WOUND SIMPLE	$97.00	$97.00	$30.53–$93.00	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 HCHG VMH SPINAL PUNCTURE	$222.00	$222.00	$65.73	62% below	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HCHG VMH SPINAL PUNCTURE	$222.00	$222.00	$65.73	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HCHG VMH REPAIR WOUND SIMPLE	$97.00	$97.00	$32.81–$93.00	52% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HCHG VMH REPAIR WOUND SIMPLE	$97.00	$97.00	$32.81–$93.00	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HCHG VMH REPAIR WOUND OF FACE	$65.00	$65.00	$40.00–$57.33	79% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HCHG VMH REPAIR WOUND	$97.00	$97.00	$31.40–$81.84	69% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HCHG VMH REPAIR WOUND OF FACE	$65.00	$65.00	$40.00–$57.33	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HCHG VMH REPAIR WOUND	$97.00	$97.00	$31.40–$81.84	—	—
Thoracentesis with imaging guidance CPT 32555 HCHG VMH THORACENTESIS, NEEDLE OR CATH; ASPIRATION OF PLEURAL SPACE; W/IMAGAING GUIDANCE	$497.00	$497.00	$169.05–$170.40	57% below	—
Thoracentesis with imaging guidance CPT 32555 HCHG VMH ER THORACENTESIS, NEEDLE OR CATH, ASPIRATION OF PLEURAL SPACE;W/IMAGING GUIDANCE	$1,147.00	$1,147.00	$377.85	at median	—
Thoracentesis with imaging guidance inpatient CPT 32555 HCHG VMH THORACENTESIS, NEEDLE OR CATH; ASPIRATION OF PLEURAL SPACE; W/IMAGAING GUIDANCE	$497.00	$497.00	$169.05–$170.40	—	—
Thoracentesis with imaging guidance inpatient CPT 32555 HCHG VMH ER THORACENTESIS, NEEDLE OR CATH, ASPIRATION OF PLEURAL SPACE;W/IMAGING GUIDANCE	$1,147.00	$1,147.00	$377.85	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 HCHG VMH INJ TRIGGER PT	$65.00	$65.00	$43.80–$51.03	82% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 HCHG VMH INJ TRIGGER POINT	$96.00	$96.00	$30.53–$66.03	73% below	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HCHG VMH INJ TRIGGER PT	$65.00	$65.00	$43.80–$51.03	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HCHG VMH INJ TRIGGER POINT	$96.00	$96.00	$30.53–$66.03	—	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HCHG VMH EGD W/BALLOON DILAT	$3,589.00	$3,589.00	$1,208.95–$1,219.40	35% above	—
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HCHG VMH EGD W/BALLOON DILAT	$3,589.00	$3,589.00	$1,208.95–$1,219.40	—	—
Upper endoscopy (EGD) with biopsy CPT 43239 HCHG VMH EGD W/BIOPSY	$3,804.00	$3,804.00	$1,270.70–$3,650.00	141% above	—
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HCHG VMH EGD W/BIOPSY	$3,804.00	$3,804.00	$1,270.70–$3,650.00	—	—
Upper endoscopy (EGD), diagnostic CPT 43235 HCHG VMH EGD	$3,180.00	$3,180.00	$1,039.00–$3,375.00	117% above	—
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HCHG VMH EGD	$3,180.00	$3,180.00	$1,039.00–$3,375.00	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HCHG VMH BLOOD TRANS 3-4 UNIT	$152.00	$152.00	$51.45–$188.65	74% below	—
Blood transfusion (giving blood or blood components) CPT 36430 HCHG VMH BLOOD TRANS 1-2 UNIT	$163.00	$163.00	$51.45–$188.65	72% below	—
Blood transfusion (giving blood or blood components) CPT 36430 HCHG VMH BLOOD TRAS 1-2 UNITS	$576.00	$576.00	$51.45–$188.65	1% below	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HCHG VMH BLOOD TRANS 3-4 UNIT	$152.00	$152.00	$51.45–$188.65	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HCHG VMH BLOOD TRANS 1-2 UNIT	$163.00	$163.00	$51.45–$188.65	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HCHG VMH BLOOD TRAS 1-2 UNITS	$576.00	$576.00	$51.45–$188.65	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG VMH MDI SUBSEQUENT	$68.00	$68.00	$44.14–$306.00	21% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG VMH HHN SUBSEQUENT	$68.00	$68.00	$44.14–$306.00	21% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG VMH MDI INITIAL	$164.00	$164.00	$44.14–$306.00	90% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG VMH HHN, INITIAL	$164.00	$164.00	$44.14–$306.00	90% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HCHG 94640 SPUTUM INDUCTION	$166.00	$166.00	$53.24	92% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG VMH MDI SUBSEQUENT	$68.00	$68.00	$44.14–$306.00	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG VMH HHN SUBSEQUENT	$68.00	$68.00	$44.14–$306.00	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG VMH HHN, INITIAL	$164.00	$164.00	$44.14–$306.00	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG VMH MDI INITIAL	$164.00	$164.00	$44.14–$306.00	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG 94640 SPUTUM INDUCTION	$166.00	$166.00	$53.24	—	—
Chemotherapy IV infusion, first hour CPT 96413 HCHG VMH CHEMO IV INFUS, 1 HR	$793.00	$793.00	$254.40–$686.00	39% above	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 HCHG VMH CHEMO IV INFUS, 1 HR	$793.00	$793.00	$254.40–$686.00	—	—
Critical care, first 30 to 74 minutes CPT 99291 HCHG VMH BASIC ER LEVEL VI	$2,612.00	$2,612.00	$820.46–$2,231.68	63% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 HCHG VMH BASIC ER LEVEL VI	$2,612.00	$2,612.00	$820.46–$2,231.68	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HCHG 93005 ELECTROCARDIOGRAM, ROUTINE ECG, TRACING ONLY	$235.00	$235.00	$44.03–$207.48	63% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HCHG 93005 ELECTROCARDIOGRAM, ROUTINE ECG, TRACING ONLY	$235.00	$235.00	$44.03–$207.48	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HCHG VMH ER LEVEL I	$317.00	$317.00	$101.85–$308.00	81% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HCHG VMH ER LEVEL I	$317.00	$317.00	$101.85–$308.00	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HCHG VMH ER LEVEL II	$568.00	$568.00	$180.76–$501.41	88% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HCHG VMH ER LEVEL II	$568.00	$568.00	$180.76–$501.41	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HCHG VMH ER LEVEL III	$907.00	$907.00	$270.92–$832.46	67% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HCHG VMH ER LEVEL III	$907.00	$907.00	$270.92–$832.46	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HCHG VMH BASIC ER LEVEL IV	$1,363.00	$1,363.00	$270.92–$1,225.44	68% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HCHG VMH BASIC ER LEVEL IV	$1,363.00	$1,363.00	$270.92–$1,225.44	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HCHG VMH BASIC ER LEVEL V	$1,930.00	$1,930.00	$368.64–$1,839.02	33% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HCHG VMH BASIC ER LEVEL V	$1,930.00	$1,930.00	$368.64–$1,839.02	—	—
Exercise stress test, tracing only, the hospital charge CPT 93017 HCHG 93017 CARDIOVASCULAR STRESS TEST, TREADMILL/BICYCLE, CONT MONITORING (GXT); TRACING ONLY	$2,336.00	$2,336.00	$283.87–$1,995.84	195% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 HCHG VMH BIKE STRESS TEST	$2,336.00	$2,336.00	$283.87–$1,995.84	195% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 HCHG VMH DOBI GXT C/O INTERP	$2,336.00	$2,336.00	$283.87–$1,995.84	195% above	—
Exercise stress test, tracing only, the hospital charge CPT 93017 HCHG VMH TREADMILL GXT	$2,336.00	$2,336.00	$283.87–$1,995.84	195% above	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HCHG VMH BIKE STRESS TEST	$2,336.00	$2,336.00	$283.87–$1,995.84	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HCHG VMH TREADMILL GXT	$2,336.00	$2,336.00	$283.87–$1,995.84	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HCHG VMH DOBI GXT C/O INTERP	$2,336.00	$2,336.00	$283.87–$1,995.84	—	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HCHG 93017 CARDIOVASCULAR STRESS TEST, TREADMILL/BICYCLE, CONT MONITORING (GXT); TRACING ONLY	$2,336.00	$2,336.00	$283.87–$1,995.84	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HCHG VMH INTRAVENOUS INFUSION, HYDRATION;INITIAL, 31 MIN TO 1 HOUR	$302.00	$302.00	$158.47–$489.02	6% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HCHG VMH IV INFUS/HYDRATE >31M	$500.00	$500.00	$158.47–$489.02	75% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HCHG VMH IV INFUS/HYDRATE >31	$503.00	$503.00	$158.47–$489.02	76% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HCHG VMH IV INFUS/HYDRATE>31	$514.00	$514.00	$158.47–$489.02	80% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG VMH INTRAVENOUS INFUSION, HYDRATION;INITIAL, 31 MIN TO 1 HOUR	$302.00	$302.00	$158.47–$489.02	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG VMH IV INFUS/HYDRATE >31M	$500.00	$500.00	$158.47–$489.02	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG VMH IV INFUS/HYDRATE >31	$503.00	$503.00	$158.47–$489.02	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG VMH IV INFUS/HYDRATE>31	$514.00	$514.00	$158.47–$489.02	—	—
IV infusion of a medicine, first hour CPT 96365 HCHG VMH IV THER/PROPH/DX 1	$503.00	$503.00	$158.47–$489.02	60% above	—
IV infusion of a medicine, first hour CPT 96365 HCHG VMH IV THER/PROPHY/DX 1'	$514.00	$514.00	$158.47–$489.02	64% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 HCHG VMH IV THER/PROPH/DX 1	$503.00	$503.00	$158.47–$489.02	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 HCHG VMH IV THER/PROPHY/DX 1'	$514.00	$514.00	$158.47–$489.02	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HCHG VMH INJECTION SUBQ/IM	$67.00	$67.00	$15.86–$103.88	17% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HCHG VMH INJECTION/SUBQ/IM	$67.00	$67.00	$15.86–$103.88	17% below	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HCHG VMH INJECTION SUBQ/IM	$67.00	$67.00	$15.86–$103.88	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HCHG VMH INJECTION/SUBQ/IM	$67.00	$67.00	$15.86–$103.88	—	—
Neuromuscular re-education, 15 minutes CPT 97112 HCHG VMH NEUROMUSCULAR RE-ED	$272.00	$272.00	$35.16–$239.00	184% above	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG VMH NEUROMUSCULAR RE-ED	$272.00	$272.00	$35.16–$239.00	—	—
New patient office visit, about 30 minutes CPT 99203 HCHG VMH URGENT CARE DET NEW	$210.00	$210.00	$66.54–$204.00	11% above	—
New patient office visit, about 30 minutes inpatient CPT 99203 HCHG VMH URGENT CARE DET NEW	$210.00	$210.00	$66.54–$204.00	—	—
New patient office visit, about 45 minutes CPT 99204 HCHG VMH UC 99204 MODERATE-NEW	$365.00	$365.00	$115.59–$328.38	72% above	—
New patient office visit, about 45 minutes inpatient CPT 99204 HCHG VMH UC 99204 MODERATE-NEW	$365.00	$365.00	$115.59–$328.38	—	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HCHG VMH URGENT CARE EXP NEW	$129.00	$129.00	$88.75–$125.00	1% below	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HCHG VMH URGENT CARE EXP NEW	$129.00	$129.00	$88.75–$125.00	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HCHG VMH MNT INIT ASSESS	$96.00	$96.00	$30.53–$218.41	67% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HCHG VMH MNT INIT ASSESS	$96.00	$96.00	$30.53–$218.41	—	—
Occupational therapy evaluation, low complexity CPT 97165 HCHG VMH OT EVALUATION, LOW COMPLEXITY	$512.00	$512.00	$111.28–$467.64	188% above	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG VMH OT EVALUATION, LOW COMPLEXITY	$512.00	$512.00	$111.28–$467.64	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HCHG VMH PT EVALUATION, HIGH COMPLEXITY	$528.00	$528.00	$109.91–$466.83	70% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG VMH PT EVALUATION, HIGH COMPLEXITY	$528.00	$528.00	$109.91–$466.83	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HCHG VMH PT EVALUATION, LOW COMPLEXITY	$460.00	$460.00	$72.99–$426.83	159% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG VMH PT EVALUATION, LOW COMPLEXITY	$460.00	$460.00	$72.99–$426.83	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HCHG VMH PT EVALUATION, MODERATE COMPLEXITY	$495.00	$495.00	$110.21–$481.00	106% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG VMH PT EVALUATION, MODERATE COMPLEXITY	$495.00	$495.00	$110.21–$481.00	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG VMH MANUAL THERAPY TECH	$261.00	$261.00	$20.22–$222.64	169% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG VMH MANUAL THERAPY	$263.00	$263.00	$19.91–$232.00	172% above	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HCHG VMH OT MAN PLS	$289.00	$289.00	$20.22–$222.64	198% above	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG VMH MANUAL THERAPY TECH	$261.00	$261.00	$20.22–$222.64	—	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG VMH MANUAL THERAPY	$263.00	$263.00	$19.91–$232.00	—	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG VMH OT MAN PLS	$289.00	$289.00	$20.22–$222.64	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG VMH THERAPEUTIC EXERCISE	$205.00	$205.00	$21.34–$175.12	112% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG VMH THER EXER DIRECT	$216.00	$216.00	$25.12–$510.30	123% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG VMH OT THE PLS	$235.00	$235.00	$21.34–$175.12	143% above	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HCHG VMH 3X10=0 BOARD THER EX	$377.00	$377.00	$21.34–$322.08	289% above	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG VMH THERAPEUTIC EXERCISE	$205.00	$205.00	$21.34–$175.12	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG VMH THER EXER DIRECT	$216.00	$216.00	$25.12–$510.30	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG VMH OT THE PLS	$235.00	$235.00	$21.34–$175.12	—	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG VMH 3X10=0 BOARD THER EX	$377.00	$377.00	$21.34–$322.08	—	—
Preventive checkup, returning patient aged 18–39 CPT 99395 PR VMH PHYSICAL,OTHER 99395	$251.00	$251.00	$216.71–$344.63	62% above	—
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PR VMH PHYSICAL,OTHER 99395	$251.00	$251.00	$216.71–$344.63	—	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HCHG VMH URGENT CARE EXP EST	$129.00	$129.00	$40.82–$125.00	22% below	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HCHG VMH URGENT CARE EXP EST	$129.00	$129.00	$40.82–$125.00	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HCHG VMH URGENT CARE DET EST	$210.00	$210.00	$66.54–$194.00	15% above	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HCHG VMH URGENT CARE DET EST	$210.00	$210.00	$66.54–$194.00	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HCHG VMH URGENT CARE BRIEF ES	$81.00	$81.00	$27.00–$79.00	21% below	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HCHG VMH URGENT CARE BRIEF ES	$81.00	$81.00	$27.00–$79.00	—	—
Speech and language evaluation CPT 92523 HCHG VMH EVAL SPEECH/LANGUAGE	$645.00	$645.00	$215.32–$536.40	90% above	—
Speech and language evaluation inpatient CPT 92523 HCHG VMH EVAL SPEECH/LANGUAGE	$645.00	$645.00	$215.32–$536.40	—	—
Speech therapy session, individual CPT 92507 HCHG VMH SPEECH TREATMENT	$390.00	$390.00	$84.21–$361.00	54% above	—
Speech therapy session, individual inpatient CPT 92507 HCHG VMH SPEECH TREATMENT	$390.00	$390.00	$84.21–$361.00	—	—
Spirometry (breathing test) CPT 94010 HCHG VMH PULM FUNCTION TEST	$352.00	$352.00	$112.22	33% above	—
Spirometry (breathing test) inpatient CPT 94010 HCHG VMH PULM FUNCTION TEST	$352.00	$352.00	$112.22	—	—
Spirometry before and after a bronchodilator CPT 94060 HCHG VMH PULM FUNCTION B/A	$670.00	$670.00	$193.90–$591.50	43% above	—
Spirometry before and after a bronchodilator inpatient CPT 94060 HCHG VMH PULM FUNCTION B/A	$670.00	$670.00	$193.90–$591.50	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 HCHG VMH THERAPEUTIC ACTIVITY	$218.00	$218.00	$24.61–$343.44	149% above	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG VMH THERAPEUTIC ACTIVITY	$218.00	$218.00	$24.61–$343.44	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HCHG VMH PHLEBOTOMY THERAPEUTIC	$983.00	$983.00	$130.79–$868.14	391% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HCHG VMH PHLEBOTOMY THERAPEUTIC	$983.00	$983.00	$130.79–$868.14	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARS-COV-2 VACC, 50MCG/0.5ML, MRNA LNP, IM	$20.83	$20.83	$159.87	88% below	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 PR SARS-COV-2 VACC, 50MCG/0.5ML, MRNA LNP, IM	$20.83	$20.83	$159.87	—	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMA VIRUS 9 VACCINE WRAPPER ORDERABLE	$992.28	$992.28	$187.61	211% above	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG	$992.28	$992.28	$187.61	211% above	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMA VIRUS 9 VACCINE WRAPPER ORDERABLE	$992.28	$992.28	$187.61	—	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG	$992.28	$992.28	$187.61	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PR HEPATITIS B VACCINE (HEPB), ADULT, 3 DOSE SCHEDULE FOR IM USE	$106.00	$106.00	$70.38	10% below	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/0.5 ML IM SUSP	$313.10	$313.10	$70.38	166% above	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYRG	$467.44	$467.44	$70.38	297% above	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 PR HEPATITIS B VACCINE (HEPB), ADULT, 3 DOSE SCHEDULE FOR IM USE	$106.00	$106.00	$70.38	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/0.5 ML IM SUSP	$313.10	$313.10	$70.38	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYRG	$467.44	$467.44	$70.38	—	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN	$785.88	$785.88	$122.64	242% above	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN	$785.88	$785.88	$122.64	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG	$902.41	$902.41	$14.91–$309.60	209% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG	$902.41	$902.41	$14.91–$309.60	—	—
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 PR RESPIRATORY SYNCYTIAL VIRUS VACCINE, PREF, RECOMBINANT, SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE	$332.00	$332.00	$322.00	39% below	—
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSVPREF3 ANTIGEN-AS01E (PF) 120 MCG/0.5 ML IM SUSR	$968.80	$968.80	$322.00	78% above	—
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 PR RESPIRATORY SYNCYTIAL VIRUS VACCINE, PREF, RECOMBINANT, SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE	$332.00	$332.00	$322.00	—	—
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSVPREF3 ANTIGEN-AS01E (PF) 120 MCG/0.5 ML IM SUSR	$968.80	$968.80	$322.00	—	—
Rabies vaccine, one dose CPT 90675 PR RABIES VACCINE, FOR IM USE	$460.00	$460.00	$312.03–$330.00	21% below	—
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR	$1,432.13	$1,432.13	$192.82–$1,303.24	147% above	—
Rabies vaccine, one dose inpatient CPT 90675 PR RABIES VACCINE, FOR IM USE	$460.00	$460.00	$312.03–$330.00	—	—
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR	$1,432.13	$1,432.13	$192.82–$1,303.24	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG	$293.37	$293.37	$27.78	608% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2-2 LF UNIT/0.5 ML IM SUSP	$392.91	$392.91	$27.78	848% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG	$293.37	$293.37	$27.78	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS-TD 2-2 LF UNIT/0.5 ML IM SUSP	$392.91	$392.91	$27.78	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP)(ADECEL/BOOSTRIX) > 7YRS IM USE	$20.83	$20.83	$39.71–$114.32	74% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS AND DIPHTHER. TOX (PF) 5 LF UNIT- 2 LF UNIT/0.5ML IM SUSP	$293.37	$293.37	$36.47–$279.34	260% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHERIA/PERTUSSIS(ACEL)/TETANUS (BOOSTRIX) VACCINE WRAPPER ORDERABLE	$306.97	$306.97	$36.47–$279.34	276% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 PR TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP)(ADECEL/BOOSTRIX) > 7YRS IM USE	$20.83	$20.83	$39.71–$114.32	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS AND DIPHTHER. TOX (PF) 5 LF UNIT- 2 LF UNIT/0.5ML IM SUSP	$293.37	$293.37	$36.47–$279.34	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTHERIA/PERTUSSIS(ACEL)/TETANUS (BOOSTRIX) VACCINE WRAPPER ORDERABLE	$306.97	$306.97	$36.47–$279.34	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HCHG 90471/G0009 ADMIN PNEUMOCCOCCAL VACCINE	$11.00	$11.00	$10.76–$30.00	72% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR PNEUMOVAX ADMINISTRATION	$12.00	$12.00	$10.76–$30.00	69% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR HEPATITIS B VAC ADMINISTRATION	$24.00	$24.00	$10.76–$30.00	38% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR FLU SHOT ADMINISTRATION	$25.00	$25.00	$10.76–$30.00	35% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR IMMUNIZATION ADMINISTRATION; 1 VACCINE	$30.00	$30.00	$10.76–$30.00	22% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HCHG 90471 IMMUNIZATION ADMIN	$32.00	$32.00	$10.76–$30.00	17% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HCHG 90471/G0009 ADMIN PNEUMOCCOCCAL VACCINE	$11.00	$11.00	$10.76–$30.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR PNEUMOVAX ADMINISTRATION	$12.00	$12.00	$10.76–$30.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR HEPATITIS B VAC ADMINISTRATION	$24.00	$24.00	$10.76–$30.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR FLU SHOT ADMINISTRATION	$25.00	$25.00	$10.76–$30.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR IMMUNIZATION ADMINISTRATION; 1 VACCINE	$30.00	$30.00	$10.76–$30.00	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HCHG 90471 IMMUNIZATION ADMIN	$32.00	$32.00	$10.76–$30.00	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PR 90472/G0009 ADMIN PNEUMOCCAL VACCINE	$12.00	$12.00	$10.78–$26.40	63% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PR IMMUNIZATION ADMINISTRATION; EA ADDL VACCINE	$24.00	$24.00	$21.30–$26.40	26% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PR 90472/G0010 ADMIN HEPATITIS B VACCINE	$24.00	$24.00	$21.30–$26.40	26% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HCHG 90472 IMMUN ADMIN EA ADDL	$31.00	$31.00	$21.30–$26.40	5% below	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PR 90472/G0009 ADMIN PNEUMOCCAL VACCINE	$12.00	$12.00	$10.78–$26.40	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PR IMMUNIZATION ADMINISTRATION; EA ADDL VACCINE	$24.00	$24.00	$21.30–$26.40	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PR 90472/G0010 ADMIN HEPATITIS B VACCINE	$24.00	$24.00	$21.30–$26.40	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HCHG 90472 IMMUN ADMIN EA ADDL	$31.00	$31.00	$21.30–$26.40	—	—

Source file: https://hospitalpricetransparencyfiles.com/vernon-memorial-healthcare-inc/390806404_Vernon-Memorial-Healthcare-Inc_standardcharges.csv