Hospital Kenosha, WI

Froedtert Pleasant Prairie Hospital

Froedtert Pleasant Prairie Hospital in Pleasant Prairie, WI publishes cash prices for 361 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 304 of 359 procedures and below it for 53. By typical cash price it ranks #94 of 103 Wisconsin hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

9555 76th St, Pleasant Prairie, WI 53158 Collected Sep 29, 2026 Source price file Check a bill from this hospital (262) 656-2368

Acute care hospital Government-owned hospital Emergency department CMS star rating 2 of 5 CCN 520021 · CMS hospital register NPI 1003831132

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

Froedtert Pleasant Prairie Hospital is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

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 3 actions for a hospital named Froedtert Pleasant Prairie Hospital in Pleasant Prairie, WI:

Feb 12, 2024 Met requirements
Feb 25, 2026 Warning notice
May 27, 2026 Case closed

Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken. 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
Abdominal CT scan without and with contrast CPT 74170 CT Scan, Abdomen, With & Without Contrast	$3,768.02	$5,024.03	$135.00–$5,024.03	63% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Scan, Abdomen, With & Without Contrast	$3,768.02	$5,024.03	$135.00–$5,024.03	—	25%
Abdominal X-ray, 2 views CPT 74019 X-Ray of Abdomen, 2 Views	$505.66	$674.21	$103.82–$674.21	114% above	25%
Abdominal X-ray, 2 views inpatient CPT 74019 X-Ray of Abdomen, 2 Views	$505.66	$674.21	$103.82–$674.21	—	25%
Ankle X-ray, complete, 3 or more views CPT 73610 X-Ray of Ankle, 3 or More Views	$307.50	$410.00	$111.53–$820.00	31% above	25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-Ray of Ankle, 3 or More Views	$307.50	$410.00	$111.53–$820.00	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ltd US of Arteries of Both Arms or Legs	$755.70	$1,007.60	$135.00–$1,007.60	107% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Ltd US of Arteries of Both Arms or Legs	$755.70	$1,007.60	$135.00–$1,007.60	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT Scan of Arm, Without Contrast	$1,805.71	$2,407.62	$135.00–$2,407.62	30% above	25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT Scan of Arm, Without Contrast	$1,805.71	$2,407.62	$135.00–$2,407.62	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-Ray of Esophagus	$512.67	$683.56	$135.00–$683.56	2% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-Ray of Esophagus	$512.67	$683.56	$135.00–$683.56	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 Nuc Med Scan of Bones/Joints Whole Body	$1,559.18	$2,078.91	$135.00–$2,078.91	11% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Nuc Med Scan of Bones/Joints Whole Body	$1,559.18	$2,078.91	$135.00–$2,078.91	—	25%
Breast ultrasound, complete, one breast CPT 76641 Ultrasound of Single Breast Complete Study	$685.94	$914.59	$135.00–$914.59	29% above	25%
Breast ultrasound, complete, one breast inpatient CPT 76641 Ultrasound of Single Breast Complete Study	$685.94	$914.59	$135.00–$914.59	—	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 Ultrasound of Single Breast, Limited Study	$683.65	$911.53	$135.00–$1,823.06	80% above	25%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Ultrasound of Single Breast, Limited Study	$683.65	$911.53	$135.00–$1,823.06	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Scan, Blood Vessels in Abdomen & Pelvis	$6,861.58	$9,148.78	$135.00–$9,148.78	136% above	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Scan, Blood Vessels in Abdomen & Pelvis	$6,861.58	$9,148.78	$135.00–$9,148.78	—	25%
CT angiography (CTA) of the head CPT 70496 CT Angio Head With & Without Contrast	$4,430.49	$5,907.32	$135.00–$5,907.32	114% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head With & Without Contrast	$4,430.49	$5,907.32	$135.00–$5,907.32	—	25%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck With & Without Contrast	$3,423.04	$4,564.05	$135.00–$4,564.05	76% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck With & Without Contrast	$3,423.04	$4,564.05	$135.00–$4,564.05	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest With & Without Contrast	$3,464.41	$4,619.22	$135.00–$4,619.22	79% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest With & Without Contrast	$3,464.41	$4,619.22	$135.00–$4,619.22	—	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Heart Blood Vessels & Grafts W/Contrast	$3,201.30	$4,268.40	$135.00–$4,268.40	91% above	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Heart Blood Vessels & Grafts W/Contrast	$3,201.30	$4,268.40	$135.00–$4,268.40	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Heart With Eval of Blood Vessel Calcium	$36.75	$49.00	$18.62–$135.00	43% below	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Heart With Eval of Blood Vessel Calcium	$36.75	$49.00	$18.62–$135.00	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Scan Abdomen & Pelvis Without Contrast	$3,081.97	$4,109.30	$135.00–$4,109.30	23% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Scan Abdomen & Pelvis Without Contrast	$3,081.97	$4,109.30	$135.00–$4,109.30	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Scan, Abdomen and Pelvis, With Contrast	$7,920.38	$10,560.51	$135.00–$10,560.51	152% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Scan, Abdomen and Pelvis, With Contrast	$7,920.38	$10,560.51	$135.00–$10,560.51	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen & Pelvis W & W/O Contrast	$7,857.84	$10,477.12	$135.00–$10,477.12	121% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen & Pelvis W & W/O Contrast	$7,857.84	$10,477.12	$135.00–$10,477.12	—	25%
CT scan of the abdomen with contrast CPT 74160 CT Scan of Abdomen, With Contrast	$4,158.06	$5,544.08	$135.00–$5,544.08	165% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Scan of Abdomen, With Contrast	$4,158.06	$5,544.08	$135.00–$5,544.08	—	25%
CT scan of the abdomen without contrast CPT 74150 CT Scan of Abdomen, Without Contrast	$1,805.71	$2,407.62	$135.00–$2,407.62	43% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Scan of Abdomen, Without Contrast	$1,805.71	$2,407.62	$135.00–$2,407.62	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Scan of Face, Without Contrast	$1,754.24	$2,338.99	$135.00–$2,338.99	26% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Scan of Face, Without Contrast	$1,754.24	$2,338.99	$135.00–$2,338.99	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT Scan of Head or Brain, Without Contrast	$1,473.24	$1,964.32	$135.00–$1,964.32	14% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Scan of Head or Brain, Without Contrast	$1,473.24	$1,964.32	$135.00–$1,964.32	—	25%
CT scan of the head with contrast CPT 70460 CT Scan of Head or Brain, With Contrast	$2,635.17	$3,513.56	$135.00–$3,513.56	71% above	25%
CT scan of the head with contrast inpatient CPT 70460 CT Scan of Head or Brain, With Contrast	$2,635.17	$3,513.56	$135.00–$3,513.56	—	25%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain With & Without Contrast	$4,394.41	$5,859.22	$135.00–$5,859.22	139% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain With & Without Contrast	$4,394.41	$5,859.22	$135.00–$5,859.22	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Scan of Lower Spine, Without Contrast	$2,778.26	$3,704.35	$135.00–$3,704.35	89% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Scan of Lower Spine, Without Contrast	$2,778.26	$3,704.35	$135.00–$3,704.35	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Scan of Upper Spine, Without Contrast	$2,756.98	$3,675.98	$135.00–$3,675.98	88% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Scan of Upper Spine, Without Contrast	$2,756.98	$3,675.98	$135.00–$3,675.98	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT Scan of Pelvis, With Contrast	$4,150.56	$5,534.08	$135.00–$5,534.08	164% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Scan of Pelvis, With Contrast	$4,150.56	$5,534.08	$135.00–$5,534.08	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex Scan Extracranial Art Compl Bilat	$1,310.43	$1,747.24	$135.00–$1,747.24	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Duplex Scan Extracranial Art Compl Bilat	$1,310.43	$1,747.24	$135.00–$1,747.24	—	25%
Chest CT scan without and with contrast CPT 71270 CT Scan of Chest With and Without Contrast	$3,348.39	$4,464.52	$135.00–$4,464.52	49% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT Scan of Chest With and Without Contrast	$3,348.39	$4,464.52	$135.00–$4,464.52	—	25%
Chest X-ray, 2 views CPT 71046 X-Ray of Chest, 2 Views	$432.33	$576.44	$93.03–$576.44	102% above	25%
Chest X-ray, 2 views inpatient CPT 71046 X-Ray of Chest, 2 Views	$432.33	$576.44	$93.03–$576.44	—	25%
Chest X-ray, single view CPT 71045 X-Ray of Chest, 1 View	$412.02	$549.36	$69.90–$549.36	155% above	25%
Chest X-ray, single view inpatient CPT 71045 X-Ray of Chest, 1 View	$412.02	$549.36	$69.90–$549.36	—	25%
Collarbone (clavicle) X-ray, complete CPT 73000 Diagnostic Imaging - X-Ray of Collarbone	$349.68	$466.24	$97.65–$466.24	71% above	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Diagnostic Imaging - X-Ray of Collarbone	$349.68	$466.24	$97.65–$466.24	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Ultrasound Behind Abdom Cavity Complete	$992.55	$1,323.40	$135.00–$1,323.40	81% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Ultrasound Behind Abdom Cavity Complete	$992.55	$1,323.40	$135.00–$1,323.40	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dual-Energy X-Ray for Bone Density Study	$835.15	$1,113.54	$126.94–$1,113.54	110% above	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dual-Energy X-Ray for Bone Density Study	$835.15	$1,113.54	$126.94–$1,113.54	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Dual-Energy X-Ray for Bone Density Study	$443.41	$591.22	$94.57–$591.22	64% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Dual-Energy X-Ray for Bone Density Study	$443.41	$591.22	$94.57–$591.22	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Detailed Ultrasound Single or First Fetus	$1,676.29	$2,235.06	$135.00–$2,235.06	144% above	25%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 Detailed Ultrasound Single or First Fetus	$1,676.29	$2,235.06	$135.00–$2,235.06	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Scan of Chest, Without Contrast	$2,068.44	$2,757.92	$135.00–$2,757.92	44% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Scan of Chest, Without Contrast	$2,068.44	$2,757.92	$135.00–$2,757.92	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Scan of Chest, With Contrast	$3,202.81	$4,270.41	$135.00–$4,270.41	104% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Scan of Chest, With Contrast	$3,202.81	$4,270.41	$135.00–$4,270.41	—	25%
Diagnostic mammogram, both breasts CPT 77066 Mammogram of Both Breasts	$489.97	$653.30	$135.00–$653.30	6% below	25%
Diagnostic mammogram, both breasts inpatient CPT 77066 Mammogram of Both Breasts	$489.97	$653.30	$135.00–$653.30	—	25%
Diagnostic mammogram, one breast CPT 77065 Mammogram of Single Breast	$294.81	$393.08	$135.00–$393.08	4% below	25%
Diagnostic mammogram, one breast inpatient CPT 77065 Mammogram of Single Breast	$294.81	$393.08	$135.00–$393.08	—	25%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US Arteries & Arterial Grafts Both Legs	$1,258.09	$1,677.45	$135.00–$1,677.45	120% above	25%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US Arteries & Arterial Grafts Both Legs	$1,258.09	$1,677.45	$135.00–$1,677.45	—	25%
Duplex ultrasound of the leg veins, both legs CPT 93970 Ultrasound of Veins of Both Arms or Legs	$1,251.98	$1,669.31	$135.00–$1,669.31	7% above	25%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Ultrasound of Veins of Both Arms or Legs	$1,251.98	$1,669.31	$135.00–$1,669.31	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Tte W Doppler Compl	$2,972.14	$3,962.85	$135.00–$3,962.85	69% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Tte W Doppler Compl	$2,972.14	$3,962.85	$135.00–$3,962.85	—	25%
Elbow X-ray, 2 views CPT 73070 X-Ray of Elbow, 2 Views	$309.78	$413.04	$85.32–$413.04	64% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 X-Ray of Elbow, 2 Views	$309.78	$413.04	$85.32–$413.04	—	25%
Elbow X-ray, complete, 3 or more views CPT 73080 X-Ray of Elbow, 3 or More Views	$304.61	$406.15	$94.57–$406.15	31% above	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 X-Ray of Elbow, 3 or More Views	$304.61	$406.15	$94.57–$406.15	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Scan of Eye or Ear, Without Contrast	$1,628.63	$2,171.51	$135.00–$2,171.51	18% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Scan of Eye or Ear, Without Contrast	$1,628.63	$2,171.51	$135.00–$2,171.51	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 X-Ray of Face Bones, 3 or More Views	$548.94	$731.92	$135.00–$731.92	83% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 X-Ray of Face Bones, 3 or More Views	$548.94	$731.92	$135.00–$731.92	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 X-Ray of Forearm, 2 Views	$311.89	$415.86	$86.86–$415.86	63% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 X-Ray of Forearm, 2 Views	$311.89	$415.86	$86.86–$415.86	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nuclear Medicine Scan of Liver and Ducts	$2,405.12	$3,206.83	$135.00–$3,206.83	75% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Nuclear Medicine Scan of Liver and Ducts	$2,405.12	$3,206.83	$135.00–$3,206.83	—	25%
Hand X-ray, 2 views CPT 73120 X-Ray of Hand, 2 Views	$257.54	$343.39	$93.03–$343.39	37% above	25%
Hand X-ray, 2 views inpatient CPT 73120 X-Ray of Hand, 2 Views	$257.54	$343.39	$93.03–$343.39	—	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-Ray of Heel, 2 or More Views	$310.40	$413.87	$85.32–$413.87	62% above	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 X-Ray of Heel, 2 or More Views	$310.40	$413.87	$85.32–$413.87	—	25%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep Study Unattended Respiratory Effort	$656.56	$875.42	$135.00–$875.42	7% above	25%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep Study Unattended Respiratory Effort	$656.56	$875.42	$135.00–$875.42	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Cpap Titrat Only, Polysomnography, 4/More Addl Parametr, W/ Cpap Ther	$3,106.85	$4,142.47	$135.00–$4,142.47	15% below	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnograpy W Cpap or Bipap	$9,715.09	$12,953.46	$135.00–$12,953.46	165% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Cpap Titrat Only, Polysomnography, 4/More Addl Parametr, W/ Cpap Ther	$3,106.85	$4,142.47	$135.00–$4,142.47	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnograpy W Cpap or Bipap	$9,715.09	$12,953.46	$135.00–$12,953.46	—	25%
Knee X-ray, 3 views CPT 73562 X-Ray of Knee, 3 Views	$388.45	$517.93	$126.94–$517.93	53% above	25%
Knee X-ray, 3 views inpatient CPT 73562 X-Ray of Knee, 3 Views	$388.45	$517.93	$126.94–$517.93	—	25%
Knee X-ray, complete, 4 or more views CPT 73564 X-Ray of Knee, 4 or More Views	$418.53	$558.04	$135.00–$1,116.08	51% above	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 X-Ray of Knee, 4 or More Views	$418.53	$558.04	$135.00–$1,116.08	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Scan of Leg, Without Contrast	$1,805.71	$2,407.62	$135.00–$2,407.62	26% above	25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Scan of Leg, Without Contrast	$1,805.71	$2,407.62	$135.00–$2,407.62	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound of Abdomen, Limited Study	$728.82	$971.76	$135.00–$971.76	68% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Ultrasound of Abdomen, Limited Study	$728.82	$971.76	$135.00–$971.76	—	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Ultrasound of Arm or Leg, Limited Study	$863.93	$1,151.91	$135.00–$1,151.91	209% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Ultrasound of Arm or Leg, Limited Study	$863.93	$1,151.91	$135.00–$1,151.91	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT, Thorax, W/O Contrast Material(S)	$665.62	$887.50	$135.00–$887.50	50% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT, Thorax, W/O Contrast Material(S)	$665.62	$887.50	$135.00–$887.50	—	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-Ray of Lower Leg, 2 Views	$310.29	$413.72	$96.11–$413.72	46% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 X-Ray of Lower Leg, 2 Views	$310.29	$413.72	$96.11–$413.72	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 Mra Head Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	7% above	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mra Head Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	—	25%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Bilat Breast With & Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	—	25%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI Bilat Breast With & Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Scan of Leg Joint, Without Contrast	$3,015.22	$4,020.29	$135.00–$4,020.29	43% above	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Scan of Leg Joint, Without Contrast	$3,015.22	$4,020.29	$135.00–$4,020.29	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Scan Leg Joint With & Without Contrast	$3,211.89	$4,282.52	$135.00–$4,282.52	2% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Scan Leg Joint With & Without Contrast	$3,211.89	$4,282.52	$135.00–$4,282.52	—	25%
MRI of the abdomen without contrast CPT 74181 MRI Scan of Abdomen, Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	7% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Scan of Abdomen, Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Scan Abdomen With & Without Contrast	$3,919.01	$5,225.35	$135.00–$5,225.35	20% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Scan Abdomen With & Without Contrast	$3,919.01	$5,225.35	$135.00–$5,225.35	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI Scan of Brain, Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	7% above	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Scan of Brain, Without Contrast	$2,249.21	$2,998.95	$135.00–$2,998.95	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI Scan, Brain, With and Without Contrast	$3,718.75	$4,958.34	$135.00–$4,958.34	14% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Scan, Brain, With and Without Contrast	$3,718.75	$4,958.34	$135.00–$4,958.34	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI Scan Lower Spinal Canal W/O Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	43% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Scan Lower Spinal Canal W/O Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Lower Spinal Canal W & W/O Contrast	$3,531.67	$4,708.90	$135.00–$4,708.90	8% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Lower Spinal Canal W & W/O Contrast	$3,531.67	$4,708.90	$135.00–$4,708.90	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spinal Canal & Thoracic W/O Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	43% above	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spinal Canal & Thoracic W/O Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Upper Spinal Canal W & W/O Contrast	$2,894.40	$3,859.20	$135.00–$3,859.20	11% below	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Upper Spinal Canal W & W/O Contrast	$2,894.40	$3,859.20	$135.00–$3,859.20	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Scan Upper Spinal Canal W/O Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	43% above	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Scan Upper Spinal Canal W/O Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI Scan, Pelvis, With & Without Contrast	$3,211.89	$4,282.52	$135.00–$4,282.52	2% below	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Scan, Pelvis, With & Without Contrast	$3,211.89	$4,282.52	$135.00–$4,282.52	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI Scan of Pelvis, Without Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	43% above	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Scan of Pelvis, Without Contrast	$3,017.72	$4,023.63	$135.00–$4,023.63	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI Scan of Arm Joint, Without Contrast	$3,022.90	$4,030.54	$135.00–$4,030.54	43% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI Scan of Arm Joint, Without Contrast	$3,022.90	$4,030.54	$135.00–$4,030.54	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-Ray of Upper Spine, 4 or 5 Views	$845.95	$1,127.93	$135.00–$1,127.93	164% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 X-Ray of Upper Spine, 4 or 5 Views	$845.95	$1,127.93	$135.00–$1,127.93	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT Scan of Neck, With Contrast	$3,738.54	$4,984.72	$135.00–$4,984.72	138% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Scan of Neck, With Contrast	$3,738.54	$4,984.72	$135.00–$4,984.72	—	25%
Neck soft tissue CT scan without contrast CPT 70490 CT Scan of Neck, Without Contrast	$1,524.79	$2,033.06	$135.00–$2,033.06	7% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Scan of Neck, Without Contrast	$1,524.79	$2,033.06	$135.00–$2,033.06	—	25%
Neck soft tissue X-ray CPT 70360 X-Ray of Soft Tissue of Neck	$410.42	$547.23	$91.48–$547.23	95% above	25%
Neck soft tissue X-ray inpatient CPT 70360 X-Ray of Soft Tissue of Neck	$410.42	$547.23	$91.48–$547.23	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial Perfusion Tomographic (Spect)	$4,854.61	$6,472.81	$135.00–$6,472.81	57% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocardial Perfusion Tomographic (Spect)	$4,854.61	$6,472.81	$135.00–$6,472.81	—	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet Scan W/CT Imaging Skull-Thigh	$6,803.82	$9,071.76	$135.00–$9,071.76	68% above	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet Scan W/CT Imaging Skull-Thigh	$6,803.82	$9,071.76	$135.00–$9,071.76	—	25%
Pelvic CT scan without contrast CPT 72192 CT Scan of Pelvis, Without Contrast	$1,650.31	$2,200.41	$135.00–$2,200.41	29% above	25%
Pelvic CT scan without contrast inpatient CPT 72192 CT Scan of Pelvis, Without Contrast	$1,650.31	$2,200.41	$135.00–$2,200.41	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Ultrasound of Female Pelvic Limited Study	$253.93	$338.58	$128.66–$338.58	37% below	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Limited Ultrasound Scan of Pelvis	$1,092.58	$1,456.78	$135.00–$1,456.78	173% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Ultrasound of Female Pelvic Limited Study	$253.93	$338.58	$128.66–$338.58	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Limited Ultrasound Scan of Pelvis	$1,092.58	$1,456.78	$135.00–$1,456.78	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound Pelvic Organs, Complete Study	$1,480.23	$1,973.64	$135.00–$1,973.64	186% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Ultrasound Pelvic Organs, Complete Study	$1,480.23	$1,973.64	$135.00–$1,973.64	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound Single/First Fetus > 14 Weeks	$1,480.23	$1,973.64	$135.00–$1,973.64	158% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ultrasound Single/First Fetus > 14 Weeks	$1,480.23	$1,973.64	$135.00–$1,973.64	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound Single/First Fetus < 14 Weeks	$987.46	$1,316.61	$135.00–$1,316.61	115% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 Ultrasound Single/First Fetus < 14 Weeks	$987.46	$1,316.61	$135.00–$1,316.61	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Limited Ultrasound of One or More Fetuses	$987.46	$1,316.61	$135.00–$1,316.61	169% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Limited Ultrasound of One or More Fetuses	$987.46	$1,316.61	$135.00–$1,316.61	—	25%
Rib X-ray, one side, 2 views CPT 71100 X-Ray of Ribs on One Side of Body, 2 Views	$472.09	$629.45	$103.82–$629.45	111% above	25%
Rib X-ray, one side, 2 views inpatient CPT 71100 X-Ray of Ribs on One Side of Body, 2 Views	$472.09	$629.45	$103.82–$629.45	—	25%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-Ray Ribs Unilat W/X-Ray Chest > 3 Views	$792.48	$1,056.64	$117.69–$1,056.64	187% above	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 X-Ray Ribs Unilat W/X-Ray Chest > 3 Views	$792.48	$1,056.64	$117.69–$1,056.64	—	25%
Screening mammogram, both breasts CPT 77067 Screening Mammogram of Both Breasts	$345.97	$461.29	$135.00–$461.29	36% above	25%
Screening mammogram, both breasts inpatient CPT 77067 Screening Mammogram of Both Breasts	$345.97	$461.29	$135.00–$461.29	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-Ray of Shoulder, 2 or More Views	$522.15	$696.20	$100.73–$1,392.40	123% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-Ray of Shoulder, 2 or More Views	$522.15	$696.20	$100.73–$1,392.40	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 X-Ray of Nasal Sinuses, 3 or More Views	$749.62	$999.49	$108.44–$999.49	180% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 X-Ray of Nasal Sinuses, 3 or More Views	$749.62	$999.49	$108.44–$999.49	—	25%
Skull X-ray, fewer than 4 views CPT 70250 X-Ray of Skull, 1 to 3 Views	$503.48	$671.31	$108.44–$671.31	106% above	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 X-Ray of Skull, 1 to 3 Views	$503.48	$671.31	$108.44–$671.31	—	25%
Sleep study in a lab (polysomnography) CPT 95810 Sleep Monitoring of Patient in Sleep Lab	$7,771.68	$10,362.24	$135.00–$10,362.24	128% above	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Monitoring of Patient in Sleep Lab	$7,771.68	$10,362.24	$135.00–$10,362.24	—	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 2d Tte WO Contrast Continous Ecg	$2,972.14	$3,962.85	$135.00–$3,962.85	45% above	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 2d Tte WO Contrast Continous Ecg	$2,972.14	$3,962.85	$135.00–$3,962.85	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Motion Recording of Swallowing Function	$1,007.24	$1,342.99	$135.00–$1,342.99	130% above	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Motion Recording of Swallowing Function	$1,007.24	$1,342.99	$135.00–$1,342.99	—	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-Ray of Upper Leg, 2 or More Views	$431.31	$575.08	$108.44–$575.08	75% above	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-Ray of Upper Leg, 2 or More Views	$431.31	$575.08	$108.44–$575.08	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Scan of Middle Spine, Without Contrast	$2,863.00	$3,817.34	$135.00–$3,817.34	95% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Scan of Middle Spine, Without Contrast	$2,863.00	$3,817.34	$135.00–$3,817.34	—	25%
Toe X-ray, 2 or more views CPT 73660 X-Ray of Toe(S), 2 or More Views	$302.20	$402.93	$91.48–$402.93	50% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 X-Ray of Toe(S), 2 or More Views	$302.20	$402.93	$91.48–$402.93	—	25%
Transvaginal pelvic ultrasound CPT 76830 Ultrasound of Pelvis Through Vagina	$689.05	$918.74	$135.00–$918.74	49% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 Ultrasound of Pelvis Through Vagina	$689.05	$918.74	$135.00–$918.74	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 Transvaginal US of Uterus, Fetus, or Cervix	$605.89	$807.86	$135.00–$807.86	55% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Transvaginal US of Uterus, Fetus, or Cervix	$605.89	$807.86	$135.00–$807.86	—	25%
Ultrasound of the abdomen, complete CPT 76700 Ultrasound of Abdomen, Complete Study	$2,399.11	$3,198.82	$135.00–$3,198.82	299% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 Ultrasound of Abdomen, Complete Study	$2,399.11	$3,198.82	$135.00–$3,198.82	—	25%
Ultrasound of the scrotum and testicles CPT 76870 Ultrasound of Scrotum	$1,250.27	$1,667.03	$135.00–$1,667.03	160% above	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Ultrasound of Scrotum	$1,250.27	$1,667.03	$135.00–$1,667.03	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound of Head and Neck	$1,316.24	$1,754.99	$135.00–$1,754.99	161% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Ultrasound of Head and Neck	$1,316.24	$1,754.99	$135.00–$1,754.99	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Rad Exam, Upper GI Tract	$667.06	$889.41	$135.00–$889.41	2% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Rad Exam, Upper GI Tract	$667.06	$889.41	$135.00–$889.41	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 X-Ray of Upper Arm, 2 or More Views	$437.62	$583.49	$97.65–$583.49	111% above	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 X-Ray of Upper Arm, 2 or More Views	$437.62	$583.49	$97.65–$583.49	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Ultrasound Veins of One Arm or Leg Ltd	$1,140.45	$1,520.60	$135.00–$1,520.60	69% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Ultrasound Veins of One Arm or Leg Ltd	$1,140.45	$1,520.60	$135.00–$1,520.60	—	25%
Wrist X-ray, 2 views CPT 73100 X-Ray of Wrist, 2 Views	$274.52	$366.03	$103.82–$366.03	27% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 X-Ray of Wrist, 2 Views	$274.52	$366.03	$103.82–$366.03	—	25%
Wrist X-ray, complete, 3 or more views CPT 73110 X-Ray of Wrist, 3 or More Views	$305.59	$407.46	$128.48–$814.92	20% above	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-Ray of Wrist, 3 or More Views	$305.59	$407.46	$128.48–$814.92	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-Ray of One Hip With Pelvis, 2 to 3 Views	$758.20	$1,010.94	$135.00–$1,010.94	160% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-Ray of One Hip With Pelvis, 2 to 3 Views	$758.20	$1,010.94	$135.00–$1,010.94	—	25%
X-ray of the abdomen, 1 view CPT 74018 X-Ray of Abdomen, 1 View	$429.51	$572.68	$85.32–$572.68	104% above	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-Ray of Abdomen, 1 View	$429.51	$572.68	$85.32–$572.68	—	25%
X-ray of the ankle, 2 views CPT 73600 X-Ray of Ankle, 2 Views	$360.65	$480.87	$99.19–$480.87	81% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 X-Ray of Ankle, 2 Views	$360.65	$480.87	$99.19–$480.87	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 X-Ray of Finger(S), 2 or More Views	$306.00	$408.00	$122.32–$408.00	25% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-Ray of Finger(S), 2 or More Views	$306.00	$408.00	$122.32–$408.00	—	25%
X-ray of the foot, 2 views CPT 73620 X-Ray of Foot, 2 Views	$295.00	$393.34	$85.32–$393.34	57% above	25%
X-ray of the foot, 2 views inpatient CPT 73620 X-Ray of Foot, 2 Views	$295.00	$393.34	$85.32–$393.34	—	25%
X-ray of the foot, complete, 3 or more views CPT 73630 X-Ray of Foot, 3 or More Views	$306.19	$408.26	$103.82–$816.52	27% above	25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-Ray of Foot, 3 or More Views	$306.19	$408.26	$103.82–$816.52	—	25%
X-ray of the hand, 3 or more views CPT 73130 X-Ray of Hand, 3 or More Views	$304.61	$406.15	$111.53–$812.30	30% above	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 X-Ray of Hand, 3 or More Views	$304.61	$406.15	$111.53–$812.30	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 X-Ray of Knee, 1 or 2 Views	$402.23	$536.31	$106.90–$536.31	90% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-Ray of Knee, 1 or 2 Views	$402.23	$536.31	$106.90–$536.31	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-Ray of Lower Spine 2 or 3 Views	$684.15	$912.20	$114.61–$912.20	135% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-Ray of Lower Spine 2 or 3 Views	$684.15	$912.20	$114.61–$912.20	—	25%
X-ray of the lower back, 4 or more views CPT 72110 X-Ray of Lower Spine > 4 Views	$985.85	$1,314.47	$135.00–$1,314.47	167% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-Ray of Lower Spine > 4 Views	$985.85	$1,314.47	$135.00–$1,314.47	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-Ray of Middle Spine, 2 Views	$550.33	$733.78	$91.48–$733.78	134% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-Ray of Middle Spine, 2 Views	$550.33	$733.78	$91.48–$733.78	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 X-Ray of Nose Bones, 3 or More Views	$548.94	$731.92	$117.69–$731.92	126% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-Ray of Nose Bones, 3 or More Views	$548.94	$731.92	$117.69–$731.92	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-Ray of Upper Spine, 2 or 3 Views	$415.63	$554.18	$114.61–$554.18	77% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-Ray of Upper Spine, 2 or 3 Views	$415.63	$554.18	$114.61–$554.18	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-Ray of Pelvis, 1 or 2 Views	$527.15	$702.87	$83.77–$702.87	138% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-Ray of Pelvis, 1 or 2 Views	$527.15	$702.87	$83.77–$702.87	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-Ray of Sacrum & Tailbone 2 or More Views	$456.61	$608.81	$96.11–$608.81	119% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-Ray of Sacrum & Tailbone 2 or More Views	$456.61	$608.81	$96.11–$608.81	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
ACTH blood test CPT 82024 Lab - Pituitarty Hormone Level	$279.52	$372.70	$42.91–$372.70	32% above	25%
ACTH blood test inpatient CPT 82024 Lab - Pituitarty Hormone Level	$279.52	$372.70	$42.91–$372.70	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Lab - Liver Enzyme Level (Alt, Sgpt)	$82.04	$109.39	$5.89–$135.00	82% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Lab - Liver Enzyme Level (Alt, Sgpt)	$82.04	$109.39	$5.89–$135.00	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 Lab - Liver Enzyme Level (Ast, Sgot)	$83.04	$110.72	$5.75–$135.00	66% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Lab - Liver Enzyme Level (Ast, Sgot)	$83.04	$110.72	$5.75–$135.00	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Lab - Acute Hepatitis Panel	$950.07	$1,266.76	$52.93–$1,266.76	200% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Lab - Acute Hepatitis Panel	$950.07	$1,266.76	$52.93–$1,266.76	—	25%
Albumin blood test CPT 82040 Lab - Albumin Protein Level in Blood	$50.47	$67.29	$5.50–$135.00	35% above	25%
Albumin blood test CPT 82040 Albumin Blood	$50.47	$67.29	$5.50–$135.00	35% above	25%
Albumin blood test CPT 82040 Lyme Alb/CSF	$54.66	$72.88	$5.50–$135.00	46% above	25%
Albumin blood test inpatient CPT 82040 Lab - Albumin Protein Level in Blood	$50.47	$67.29	$5.50–$135.00	—	25%
Albumin blood test inpatient CPT 82040 Albumin Blood	$50.47	$67.29	$5.50–$135.00	—	25%
Albumin blood test inpatient CPT 82040 Lyme Alb/CSF	$54.66	$72.88	$5.50–$135.00	—	25%
Aldosterone blood test CPT 82088 Aldosterone Urine	$367.86	$490.48	$45.28–$490.48	85% above	25%
Aldosterone blood test CPT 82088 Aldosterone Blood	$430.72	$574.29	$45.28–$574.29	116% above	25%
Aldosterone blood test inpatient CPT 82088 Aldosterone Urine	$367.86	$490.48	$45.28–$490.48	—	25%
Aldosterone blood test inpatient CPT 82088 Aldosterone Blood	$430.72	$574.29	$45.28–$574.29	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 Lab - Alkaline Phosphatase Level (Serum)	$50.47	$67.29	$5.75–$135.00	2% above	25%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkptase,Bone	$143.31	$191.08	$5.75–$191.08	188% above	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Lab - Alkaline Phosphatase Level (Serum)	$50.47	$67.29	$5.75–$135.00	—	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkptase,Bone	$143.31	$191.08	$5.75–$191.08	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Other---Adult Food Panel	$38.97	$51.96	$4.42–$135.00	56% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Shrimp	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Corn	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Roughmarshelder	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Mokld,Alternata	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Scallop	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Clam, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$40.46	$53.95	$4.42–$135.00	62% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Walnut	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Potato	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Brazilnut, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Pecan	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Carrott	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Almond	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Chicken	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Pistachio	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Beef, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$50.47	$67.29	$4.42–$135.00	102% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Penicill.	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Rat Serum	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Rat Epi.	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Ragweed,Long	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Cow	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.D.Farinae	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.D.Pteronys	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Dog	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Egg White	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Egg Yolk	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Fire Ant	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Grass Ju/Ken	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Grass Orchard	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Greer	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Guinea Pig	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Hollister	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Honey Bee	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Horse	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Milk	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Clado Her, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Rast 1-12 Allergens	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Mouse	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Mouse Urine	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Mouse,Serum	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Yellow Jacket	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Yellow Hornet	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,White Oak	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,White Ash	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Mucor.	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.a.Tenuis	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Wheat	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Other	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Wh.Hornet	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Wh.Faced Hornet	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Asp.Fumi.	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Other---Respiratory Profile	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Wasp	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Birch	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Storage Mite	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Boxelder	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Paper Wasp	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Peanut	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg.Soybean	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Short Ragweed	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Rat Urine	$60.36	$80.48	$4.42–$135.00	141% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Other---Pediatric Panel	$60.65	$80.87	$4.42–$135.00	143% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Other---Adult Environ Panel	$60.65	$80.87	$4.42–$135.00	143% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,Red Oak	$159.79	$213.06	$4.42–$213.06	539% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Other---Adult Food Panel	$38.97	$51.96	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clam, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Corn	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Roughmarshelder	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Shrimp	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Mokld,Alternata	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Scallop	$40.46	$53.95	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Carrott	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Beef, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Pistachio	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Chicken	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Pecan	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Walnut	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Almond	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Potato	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Brazilnut, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$50.47	$67.29	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Clado Her, Allerg Specifc Ige, Quant/Semiquant, Crude Allerg Extract, Ea	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Rast 1-12 Allergens	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Yellow Jacket	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Yellow Hornet	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,White Oak	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,White Ash	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Wheat	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Wh.Hornet	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Wh.Faced Hornet	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Wasp	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Storage Mite	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Soybean	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Short Ragweed	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Rat Urine	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Rat Serum	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Rat Epi.	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Ragweed,Long	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Penicill.	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Peanut	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Paper Wasp	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Other---Respiratory Profile	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Other	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Mucor.	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Mouse,Serum	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Mouse Urine	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Mouse	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Milk	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Horse	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Honey Bee	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Hollister	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Guinea Pig	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Greer	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Grass Orchard	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Grass Ju/Ken	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Fire Ant	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Egg Yolk	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Egg White	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Dog	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.D.Pteronys	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.D.Farinae	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Cow	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Boxelder	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Birch	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.Asp.Fumi.	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg.a.Tenuis	$60.36	$80.48	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Other---Adult Environ Panel	$60.65	$80.87	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Other---Pediatric Panel	$60.65	$80.87	$4.42–$135.00	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen,Red Oak	$159.79	$213.06	$4.42–$213.06	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alph-Fetopro,Ms-Afp	$74.65	$99.54	$18.64–$135.00	14% below	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 Maternal Afp	$118.83	$158.44	$18.64–$158.44	37% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 Lab - Alpha-Fetoprotein Level in Blood	$304.61	$406.15	$18.64–$406.15	251% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alph-Fetopro,Ms-Afp	$74.65	$99.54	$18.64–$135.00	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Maternal Afp	$118.83	$158.44	$18.64–$158.44	—	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Lab - Alpha-Fetoprotein Level in Blood	$304.61	$406.15	$18.64–$406.15	—	25%
Ammonia blood test CPT 82140 Ammonium Urine	$135.21	$180.28	$16.19–$180.28	51% above	25%
Ammonia blood test CPT 82140 Ammonia Blood	$245.03	$326.71	$16.19–$326.71	173% above	25%
Ammonia blood test inpatient CPT 82140 Ammonium Urine	$135.21	$180.28	$16.19–$180.28	—	25%
Ammonia blood test inpatient CPT 82140 Ammonia Blood	$245.03	$326.71	$16.19–$326.71	—	25%
Amylase blood test CPT 82150 Amylase Duodenal	$50.47	$67.29	$7.20–$135.00	18% below	25%
Amylase blood test CPT 82150 Amylase 2 Hr Urine	$60.36	$80.48	$7.20–$135.00	2% below	25%
Amylase blood test CPT 82150 Amylase 24 Hr Urine	$60.36	$80.48	$7.20–$135.00	2% below	25%
Amylase blood test CPT 82150 Amylase Random UR	$60.36	$80.48	$7.20–$135.00	2% below	25%
Amylase blood test CPT 82150 Lab - Amylase Enzyme Level	$114.63	$152.84	$7.20–$152.84	86% above	25%
Amylase blood test CPT 82150 Amylase Blood	$114.63	$152.84	$7.20–$152.84	86% above	25%
Amylase blood test inpatient CPT 82150 Amylase Duodenal	$50.47	$67.29	$7.20–$135.00	—	25%
Amylase blood test inpatient CPT 82150 Amylase Random UR	$60.36	$80.48	$7.20–$135.00	—	25%
Amylase blood test inpatient CPT 82150 Amylase 2 Hr Urine	$60.36	$80.48	$7.20–$135.00	—	25%
Amylase blood test inpatient CPT 82150 Amylase 24 Hr Urine	$60.36	$80.48	$7.20–$135.00	—	25%
Amylase blood test inpatient CPT 82150 Amylase Blood	$114.63	$152.84	$7.20–$152.84	—	25%
Amylase blood test inpatient CPT 82150 Lab - Amylase Enzyme Level	$114.63	$152.84	$7.20–$152.84	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Lab - Cyclic Citrullinated Peptide (CCP)	$28.69	$38.25	$14.39–$135.00	64% below	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Lab - Cyclic Citrullinated Peptide (CCP)	$28.69	$38.25	$14.39–$135.00	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana W/R 11ab Cascade, Antinuclear Ab (Ana)	$43.78	$58.37	$13.43–$135.00	36% below	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Lab - Antinuclear Antibodies Analysis	$383.24	$510.99	$13.43–$510.99	458% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Ana W/R 11ab Cascade, Antinuclear Ab (Ana)	$43.78	$58.37	$13.43–$135.00	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Lab - Antinuclear Antibodies Analysis	$383.24	$510.99	$13.43–$510.99	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic Peptide B-Type	$338.57	$451.43	$39.26–$451.43	141% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Natriuretic Peptide B-Type	$338.57	$451.43	$39.26–$451.43	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture CSF	$170.78	$227.71	$9.57–$227.71	121% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Cerv Vag Urethra	$190.96	$254.62	$9.57–$254.62	147% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Eye Ear Nose	$190.96	$254.62	$9.57–$254.62	147% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Cath Tip	$190.96	$254.62	$9.57–$254.62	147% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture,Sputum	$190.96	$254.62	$9.57–$254.62	147% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture,Wound	$190.96	$254.62	$9.57–$254.62	147% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Aerobic	$313.48	$417.97	$9.57–$417.97	305% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture CSF	$170.78	$227.71	$9.57–$227.71	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Cerv Vag Urethra	$190.96	$254.62	$9.57–$254.62	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture,Wound	$190.96	$254.62	$9.57–$254.62	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture,Sputum	$190.96	$254.62	$9.57–$254.62	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Eye Ear Nose	$190.96	$254.62	$9.57–$254.62	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Cath Tip	$190.96	$254.62	$9.57–$254.62	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Aerobic	$313.48	$417.97	$9.57–$417.97	—	25%
Basic metabolic panel (blood test) CPT 80048 Metabolic Panel Total Ca	$150.19	$200.26	$9.40–$200.26	70% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 Metabolic Panel Total Ca	$150.19	$200.26	$9.40–$200.26	—	25%
Bilirubin blood test, total CPT 82247 Lab - Bilirubin Level in Blood (Total)	$50.47	$67.29	$5.57–$135.00	8% above	25%
Bilirubin blood test, total CPT 82247 Bilirubin Total Blood	$60.36	$80.48	$5.57–$135.00	29% above	25%
Bilirubin blood test, total inpatient CPT 82247 Lab - Bilirubin Level in Blood (Total)	$50.47	$67.29	$5.57–$135.00	—	25%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total Blood	$60.36	$80.48	$5.57–$135.00	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Cell Block,Aspir	$173.59	$231.45	$65.52–$231.45	20% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Cell Block, Fluid	$173.59	$231.45	$65.52–$231.45	20% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Gross&Micro Lv-IV	$489.77	$653.03	$65.52–$653.03	127% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Lab - Surg Path Gross & Microscopic Exam	$2,939.16	$3,918.88	$135.00–$3,918.88	1262% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Cell Block, Fluid	$173.59	$231.45	$65.52–$231.45	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Cell Block,Aspir	$173.59	$231.45	$65.52–$231.45	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Gross&Micro Lv-IV	$489.77	$653.03	$65.52–$653.03	—	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Lab - Surg Path Gross & Microscopic Exam	$2,939.16	$3,918.88	$135.00–$3,918.88	—	25%
Blood culture for bacteria CPT 87040 Lab - Bacterial Blood Culture (Aerobic)	$193.67	$258.23	$11.47–$258.23	126% above	25%
Blood culture for bacteria inpatient CPT 87040 Lab - Bacterial Blood Culture (Aerobic)	$193.67	$258.23	$11.47–$258.23	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Lab - Collect Venous Blood Venipuncture	$23.48	$31.31	$11.90–$135.00	57% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Lab - Legal Blood Draw	$48.75	$65.00	$24.70–$135.00	226% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Lab - Collect Venous Blood Venipuncture	$23.48	$31.31	$11.90–$135.00	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Lab - Legal Blood Draw	$48.75	$65.00	$24.70–$135.00	—	25%
Blood glucose (sugar) test CPT 82947 Lab - Glucose Level in Blood	$51.87	$69.16	$4.37–$135.00	112% above	25%
Blood glucose (sugar) test CPT 82947 Sugar 24 Hr Urine, Glucose, Quant, Blood	$127.62	$170.16	$4.37–$170.16	423% above	25%
Blood glucose (sugar) test inpatient CPT 82947 Lab - Glucose Level in Blood	$51.87	$69.16	$4.37–$135.00	—	25%
Blood glucose (sugar) test inpatient CPT 82947 Sugar 24 Hr Urine, Glucose, Quant, Blood	$127.62	$170.16	$4.37–$170.16	—	25%
Blood lead test CPT 83655 Lab - Lead Level	$127.01	$169.35	$13.45–$169.35	131% above	25%
Blood lead test CPT 83655 Urine, Lead	$179.19	$238.92	$13.45–$238.92	226% above	25%
Blood lead test inpatient CPT 83655 Lab - Lead Level	$127.01	$169.35	$13.45–$169.35	—	25%
Blood lead test inpatient CPT 83655 Urine, Lead	$179.19	$238.92	$13.45–$238.92	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Lab - Pregnancy Hormone Identification	$148.60	$198.14	$8.36–$198.14	140% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Lab - Pregnancy Hormone Identification	$148.60	$198.14	$8.36–$198.14	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Group Abo	$104.24	$138.99	$3.32–$138.99	161% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Group Abo	$104.24	$138.99	$3.32–$138.99	—	25%
Blood urea nitrogen (BUN) test CPT 84520 Lab - Urea Nitrogen Level in Blood	$50.47	$67.29	$4.39–$135.00	96% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Lab - Urea Nitrogen Level in Blood	$50.47	$67.29	$4.39–$135.00	—	25%
C-peptide blood test CPT 84681 Lab - C-Peptide Protein Level	$216.15	$288.20	$7.10–$288.20	147% above	25%
C-peptide blood test inpatient CPT 84681 Lab - C-Peptide Protein Level	$216.15	$288.20	$7.10–$288.20	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Crp High Sensitive	$111.01	$148.02	$5.75–$148.02	103% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Ibd Sgi Diag Crp	$206.97	$275.96	$5.75–$275.96	279% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Crp High Sensitive	$111.01	$148.02	$5.75–$148.02	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 Ibd Sgi Diag Crp	$206.97	$275.96	$5.75–$275.96	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 Lab - Detection Test Clostridium Difficile	$163.78	$218.38	$38.99–$218.38	9% above	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Lab - Detection Test Clostridium Difficile	$163.78	$218.38	$38.99–$218.38	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 Cancer Antigen 19-9 Immunoassay	$91.74	$122.32	$23.13–$135.00	17% below	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Cancer Antigen 19-9 Immunoassay	$91.74	$122.32	$23.13–$135.00	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 Hcg Tumor Quant	$145.49	$193.99	$23.13–$193.99	24% above	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay Tumor Ca 125	$246.84	$329.12	$23.13–$329.12	110% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Hcg Tumor Quant	$145.49	$193.99	$23.13–$193.99	—	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay Tumor Ca 125	$246.84	$329.12	$23.13–$329.12	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 2019-Ncov Coronavirus, Sars-Cov-2/2019-Ncov (Covid-19), Naat	$131.71	$175.61	$66.73–$282.21	2% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 Cdc 2019 Novel Coronavirus (2019-Ncov) Real-Time Rt-Pcr Diagnostic Panel	$73.25	$97.67	$37.11–$282.21	46% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 2019-Ncov Coronavirus, Sars-Cov-2/2019-Ncov (Covid-19), Naat	$131.71	$175.61	$66.73–$282.21	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 Cdc 2019 Novel Coronavirus (2019-Ncov) Real-Time Rt-Pcr Diagnostic Panel	$73.25	$97.67	$37.11–$282.21	—	25%
Calcium blood test, total CPT 82310 Lab - Calcium Level (Total)	$50.47	$67.29	$5.73–$135.00	1% above	25%
Calcium blood test, total CPT 82310 Calcium Ca Blood	$50.47	$67.29	$5.73–$135.00	1% above	25%
Calcium blood test, total CPT 82310 Calcium Random UR	$60.36	$80.48	$5.73–$135.00	21% above	25%
Calcium blood test, total inpatient CPT 82310 Lab - Calcium Level (Total)	$50.47	$67.29	$5.73–$135.00	—	25%
Calcium blood test, total inpatient CPT 82310 Calcium Ca Blood	$50.47	$67.29	$5.73–$135.00	—	25%
Calcium blood test, total inpatient CPT 82310 Calcium Random UR	$60.36	$80.48	$5.73–$135.00	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen (Cea)---Ca 19-9	$91.74	$122.32	$21.07–$135.00	32% below	25%
Carcinoembryonic antigen (CEA) test CPT 82378 Lab - Protein Tumor Marker Level	$398.23	$530.98	$21.07–$530.98	193% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen (Cea)---Ca 19-9	$91.74	$122.32	$21.07–$135.00	—	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Lab - Protein Tumor Marker Level	$398.23	$530.98	$21.07–$530.98	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Is Acif	$100.73	$134.31	$7.91–$135.00	34% above	25%
Chickenpox (varicella) immunity blood test CPT 86787 Lab - Varicella-Zoster Antibody Analysis	$100.73	$134.31	$7.91–$135.00	34% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Lab - Varicella-Zoster Antibody Analysis	$100.73	$134.31	$7.91–$135.00	—	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Is Acif	$100.73	$134.31	$7.91–$135.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Lab - Detection Test Chlamydia Trachomatis	$131.21	$174.95	$38.99–$193.00	8% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Lab - Detection Test Chlamydia Trachomatis	$131.21	$174.95	$38.99–$193.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lab - Lipid Panel	$221.75	$295.67	$14.88–$295.67	140% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lab - Lipid Panel	$221.75	$295.67	$14.88–$295.67	—	25%
Complete blood count (CBC) with differential CPT 85025 Lab - Compl Cbc W/Auto Diff Wbc	$193.98	$258.64	$8.63–$258.64	177% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 Lab - Compl Cbc W/Auto Diff Wbc	$193.98	$258.64	$8.63–$258.64	—	25%
Complete blood count (CBC), no differential CPT 85027 Compl Cbc Automated	$127.01	$169.35	$7.18–$169.35	154% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 Compl Cbc Automated	$127.01	$169.35	$7.18–$169.35	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehen Metabolic Panel	$332.29	$443.05	$11.74–$443.05	192% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen Metabolic Panel	$332.29	$443.05	$11.74–$443.05	—	25%
Cortisol blood test, total CPT 82533 Lab - Adrenal Hormone Level	$201.77	$269.03	$18.11–$269.03	72% above	25%
Cortisol blood test, total inpatient CPT 82533 Lab - Adrenal Hormone Level	$201.77	$269.03	$18.11–$269.03	—	25%
Creatine kinase (CK) blood test, total CPT 82550 Lab - Creatine Kinase Enzyme Level (Total)	$50.47	$67.29	$7.23–$135.00	19% below	25%
Creatine kinase (CK) blood test, total CPT 82550 CPK	$50.47	$67.29	$7.23–$135.00	19% below	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK	$50.47	$67.29	$7.23–$135.00	—	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Lab - Creatine Kinase Enzyme Level (Total)	$50.47	$67.29	$7.23–$135.00	—	25%
Creatinine blood test CPT 82565 Creatinine Blood	$83.35	$111.14	$5.69–$135.00	163% above	25%
Creatinine blood test inpatient CPT 82565 Creatinine Blood	$83.35	$111.14	$5.69–$135.00	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 Lab - Cytomegalovirus Antibody Analysis	$161.30	$215.07	$15.99–$215.07	129% above	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Lab - Cytomegalovirus Antibody Analysis	$161.30	$215.07	$15.99–$215.07	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 Lab - Steroid Hormone Level	$365.15	$486.87	$24.71–$486.87	166% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Lab - Steroid Hormone Level	$365.15	$486.87	$24.71–$486.87	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Lab - Drug Test by Chemical Analysis	$31.37	$41.83	$15.90–$341.77	72% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Cocaine Bl & UR, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$31.37	$41.83	$15.90–$341.77	72% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Propoxyphene UR, Drg Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$52.66	$70.22	$26.68–$341.77	54% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethanol(Alcohol), Drug Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$68.86	$91.82	$34.89–$341.77	39% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Salicylate, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$68.86	$91.82	$34.89–$341.77	39% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Lab - Drug Testing by Chemical Analysis	$68.86	$91.82	$34.89–$341.77	39% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetaminophen, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$68.86	$91.82	$34.89–$341.77	39% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Salicylates Blood	$131.02	$174.69	$66.38–$341.77	15% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Nicotine	$136.42	$181.89	$69.12–$341.77	20% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Methodone Screen	$141.40	$188.54	$71.65–$341.77	25% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Methadone Plas	$165.49	$220.66	$83.85–$341.77	46% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Blood, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$206.66	$275.55	$104.71–$341.77	82% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Alcohol Blood Clinical	$247.04	$329.39	$125.17–$341.77	118% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug Screen	$320.59	$427.46	$135.00–$427.46	182% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$333.38	$444.51	$135.00–$444.51	194% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Lab - Initial Drug Test by Chemical Anlys	$344.68	$459.57	$135.00–$459.57	204% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetaminophen Bl Quant	$352.47	$469.96	$135.00–$469.96	210% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Nortri	$389.55	$519.40	$135.00–$519.40	243% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Blood and Urine, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$551.23	$734.98	$135.00–$734.98	386% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Blood & Alcohol, Drg Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$591.82	$789.09	$135.00–$789.09	421% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug and Urine, Drug Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$665.26	$887.01	$135.00–$887.01	486% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cocaine Bl & UR, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$31.37	$41.83	$15.90–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Lab - Drug Test by Chemical Analysis	$31.37	$41.83	$15.90–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Propoxyphene UR, Drg Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$52.66	$70.22	$26.68–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Salicylate, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$68.86	$91.82	$34.89–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Acetaminophen, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$68.86	$91.82	$34.89–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Ethanol(Alcohol), Drug Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$68.86	$91.82	$34.89–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Lab - Drug Testing by Chemical Analysis	$68.86	$91.82	$34.89–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Salicylates Blood	$131.02	$174.69	$66.38–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Nicotine	$136.42	$181.89	$69.12–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Methodone Screen	$141.40	$188.54	$71.65–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Methadone Plas	$165.49	$220.66	$83.85–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Blood, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$206.66	$275.55	$104.71–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Alcohol Blood Clinical	$247.04	$329.39	$125.17–$341.77	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium Drug Screen	$320.59	$427.46	$135.00–$427.46	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$333.38	$444.51	$135.00–$444.51	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Lab - Initial Drug Test by Chemical Anlys	$344.68	$459.57	$135.00–$459.57	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Acetaminophen Bl Quant	$352.47	$469.96	$135.00–$469.96	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Nortri	$389.55	$519.40	$135.00–$519.40	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Blood and Urine, Drug Test, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$551.23	$734.98	$135.00–$734.98	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Blood & Alcohol, Drg Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$591.82	$789.09	$135.00–$789.09	—	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Meconium Drug and Urine, Drug Tst, Presump, Any Num Drg Cl, Chem Anlyz, per Dos	$665.26	$887.01	$135.00–$887.01	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$135.21	$180.28	$7.79–$180.28	177% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$135.21	$180.28	$7.79–$180.28	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 Lab - Epstein-Barr Antibody Analysis	$175.78	$234.38	$20.16–$234.38	105% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Viral Capsid (Vca) Igm Antibody	$175.78	$234.38	$20.16–$234.38	105% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Lab - Epstein-Barr Antibody Analysis	$175.78	$234.38	$20.16–$234.38	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Viral Capsid (Vca) Igm Antibody	$175.78	$234.38	$20.16–$234.38	—	25%
Estradiol blood test CPT 82670 Lab - Estrogen Steroid & Sex Hormone Level	$243.34	$324.46	$31.04–$324.46	90% above	25%
Estradiol blood test inpatient CPT 82670 Lab - Estrogen Steroid & Sex Hormone Level	$243.34	$324.46	$31.04–$324.46	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 Lab - Gonadotropin Fsh	$293.21	$390.95	$20.65–$390.95	151% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Lab - Gonadotropin Fsh	$293.21	$390.95	$20.65–$390.95	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool	$292.29	$389.72	$21.81–$389.72	49% above	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool	$292.29	$389.72	$21.81–$389.72	—	25%
Ferritin blood test (iron stores) CPT 82728 Lab - Ferritin Protein Level	$573.32	$764.43	$15.15–$764.43	537% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 Lab - Ferritin Protein Level	$573.32	$764.43	$15.15–$764.43	—	25%
Fibrinogen blood test CPT 85384 Lab - Blood Clotting Activity Measurement	$99.85	$133.13	$9.72–$135.00	54% above	25%
Fibrinogen blood test inpatient CPT 85384 Lab - Blood Clotting Activity Measurement	$99.85	$133.13	$9.72–$135.00	—	25%
Folate (folic acid) blood test CPT 82746 Lab - Folic Acid Level (Serum)	$175.68	$234.24	$16.34–$234.24	62% above	25%
Folate (folic acid) blood test inpatient CPT 82746 Lab - Folic Acid Level (Serum)	$175.68	$234.24	$16.34–$234.24	—	25%
Free T3 thyroid hormone test CPT 84481 Lab - Thyroid Hormone Level (T3 Free)	$313.21	$417.61	$16.08–$417.61	230% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 Lab - Thyroid Hormone Level (T3 Free)	$313.21	$417.61	$16.08–$417.61	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Lab - Thyroxine Level (Free)	$222.55	$296.74	$10.02–$296.74	176% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Lab - Thyroxine Level (Free)	$222.55	$296.74	$10.02–$296.74	—	25%
Free testosterone test CPT 84402 Lab - Testosterone Level (Free)	$187.98	$250.64	$28.30–$250.64	57% above	25%
Free testosterone test inpatient CPT 84402 Lab - Testosterone Level (Free)	$187.98	$250.64	$28.30–$250.64	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Lab - Glutamyltransferase Enzyme Level	$50.47	$67.29	$8.00–$135.00	5% below	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Lab - Glutamyltransferase Enzyme Level	$50.47	$67.29	$8.00–$135.00	—	25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$771.50	$1,028.67	$51.44–$1,028.67	180% above	25%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$771.50	$1,028.67	$51.44–$1,028.67	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Lab - Post Glucose Dose	$142.20	$189.60	$5.27–$189.60	188% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Lab - Post Glucose Dose	$142.20	$189.60	$5.27–$189.60	—	25%
Glucose tolerance test, 3 samples CPT 82951 Lab - Glucose Tolerance Test, 3 Specimens	$151.60	$202.13	$14.30–$202.13	69% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 Lab - Glucose Tolerance Test, 3 Specimens	$151.60	$202.13	$14.30–$202.13	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Lab - Detection Test for Gonorrhea	$131.21	$174.95	$38.99–$193.00	8% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Lab - Detection Test for Gonorrhea	$131.21	$174.95	$38.99–$193.00	—	25%
H. pylori antibody blood test CPT 86677 Lab - Helicobacter Pylori Antibody	$196.05	$261.40	$7.91–$261.40	103% above	25%
H. pylori antibody blood test inpatient CPT 86677 Lab - Helicobacter Pylori Antibody	$196.05	$261.40	$7.91–$261.40	—	25%
H. pylori stool antigen test CPT 87338 Lab - Stool Specimen Analysis Helicobacter	$311.60	$415.47	$15.98–$415.47	149% above	25%
H. pylori stool antigen test inpatient CPT 87338 Lab - Stool Specimen Analysis Helicobacter	$311.60	$415.47	$15.98–$415.47	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Lab - Detection Test for Hiv-1	$855.83	$1,141.11	$94.55–$1,141.11	128% above	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Lab - Detection Test for Hiv-1	$855.83	$1,141.11	$94.55–$1,141.11	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Lab - Specimen Analysis for Hiv-1 & Hiv-2	$72.92	$97.23	$36.95–$135.00	27% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Lab - Specimen Analysis for Hiv-1 & Hiv-2	$72.92	$97.23	$36.95–$135.00	—	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV	$247.43	$329.91	$38.30–$329.91	73% above	25%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV	$247.43	$329.91	$38.30–$329.91	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Lab - Hemoglobin A1c Level	$174.49	$232.65	$10.79–$232.65	171% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Lab - Hemoglobin A1c Level	$174.49	$232.65	$10.79–$232.65	—	25%
Hemoglobin blood test CPT 85018 H.Elect.Hgb	$20.08	$26.77	$2.63–$135.00	15% above	25%
Hemoglobin blood test CPT 85018 Arterial Blood Gas, Blood Count, Hemoglobin	$27.78	$37.04	$2.63–$135.00	59% above	25%
Hemoglobin blood test CPT 85018 Lab - Hemoglobin Count	$70.96	$94.61	$2.63–$135.00	305% above	25%
Hemoglobin blood test inpatient CPT 85018 H.Elect.Hgb	$20.08	$26.77	$2.63–$135.00	—	25%
Hemoglobin blood test inpatient CPT 85018 Arterial Blood Gas, Blood Count, Hemoglobin	$27.78	$37.04	$2.63–$135.00	—	25%
Hemoglobin blood test inpatient CPT 85018 Lab - Hemoglobin Count	$70.96	$94.61	$2.63–$135.00	—	25%
Hepatitis B core antibody test (total) CPT 86704 Lab - Hep B Core Antibody Measurement	$217.05	$289.40	$13.39–$289.40	180% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 Lab - Hep B Core Antibody Measurement	$217.05	$289.40	$13.39–$289.40	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surf Antibody Hbsab	$94.84	$126.46	$11.93–$135.00	28% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surf Antibody Hbsab	$94.84	$126.46	$11.93–$135.00	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Lab - Analysis for Hep B Surface Antigen	$37.96	$50.61	$11.48–$135.00	45% below	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Lab - Analysis for Hep B Surface Antigen	$37.96	$50.61	$11.48–$135.00	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 Lab - Hepatitis C Antibody Measurement	$47.81	$63.75	$15.85–$135.00	42% below	25%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab Scrn	$401.05	$534.73	$15.85–$534.73	386% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Lab - Hepatitis C Antibody Measurement	$47.81	$63.75	$15.85–$135.00	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab Scrn	$401.05	$534.73	$15.85–$534.73	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Lab - Detection Test for Hep C Virus	$131.71	$175.61	$47.60–$235.62	45% below	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Lab - Detection Test for Hep C Virus	$131.71	$175.61	$47.60–$235.62	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 Lab - Herpes Simplex Antibody Analysis	$102.83	$137.11	$14.65–$137.11	52% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Type 1 Igm Antibody Simplex Test	$153.60	$204.80	$14.65–$204.80	126% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Lab - Herpes Simplex Antibody Analysis	$102.83	$137.11	$14.65–$137.11	—	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Type 1 Igm Antibody Simplex Test	$153.60	$204.80	$14.65–$204.80	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 Lab - Herpes Simplex Antibody Analysis	$102.83	$137.11	$21.51–$137.11	22% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Type 2 Igm Antibody Simplex Test	$225.45	$300.60	$21.51–$300.60	168% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Lab - Herpes Simplex Antibody Analysis	$102.83	$137.11	$21.51–$137.11	—	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Type 2 Igm Antibody Simplex Test	$225.45	$300.60	$21.51–$300.60	—	25%
Homocysteine blood test CPT 83090 Homocyst Cardiac	$319.39	$425.85	$18.74–$425.85	170% above	25%
Homocysteine blood test CPT 83090 Lab - Homocysteine Amino Acid Level	$553.53	$738.04	$18.74–$738.04	368% above	25%
Homocysteine blood test inpatient CPT 83090 Homocyst Cardiac	$319.39	$425.85	$18.74–$425.85	—	25%
Homocysteine blood test inpatient CPT 83090 Lab - Homocysteine Amino Acid Level	$553.53	$738.04	$18.74–$738.04	—	25%
Insulin blood test CPT 83525 Lab - Insulin Measurement (Total)	$205.47	$273.96	$12.70–$273.96	216% above	25%
Insulin blood test inpatient CPT 83525 Lab - Insulin Measurement (Total)	$205.47	$273.96	$12.70–$273.96	—	25%
Iron blood test (serum iron) CPT 83540 Lab - Iron Level	$133.21	$177.62	$7.19–$177.62	150% above	25%
Iron blood test (serum iron) CPT 83540 Assay of Iron	$624.28	$832.38	$7.19–$832.38	1071% above	25%
Iron blood test (serum iron) inpatient CPT 83540 Lab - Iron Level	$133.21	$177.62	$7.19–$177.62	—	25%
Iron blood test (serum iron) inpatient CPT 83540 Assay of Iron	$624.28	$832.38	$7.19–$832.38	—	25%
Iron-binding capacity (TIBC) test CPT 83550 Lab - Iron Binding Capacity	$133.21	$177.62	$9.71–$177.62	93% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Lab - Iron Binding Capacity	$133.21	$177.62	$9.71–$177.62	—	25%
Kidney function blood test panel CPT 80069 Lab - Kidney Function Panel	$252.03	$336.04	$9.65–$336.04	145% above	25%
Kidney function blood test panel inpatient CPT 80069 Lab - Kidney Function Panel	$252.03	$336.04	$9.65–$336.04	—	25%
LH (luteinizing hormone) test CPT 83002 Lab - Luteinizing Hormone Level	$293.21	$390.95	$20.57–$390.95	201% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 Lab - Luteinizing Hormone Level	$293.21	$390.95	$20.57–$390.95	—	25%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid Blood Art	$238.44	$317.92	$11.87–$317.92	236% above	25%
Lactate (lactic acid) blood test CPT 83605 Blood, Lactic Acid	$238.44	$317.92	$11.87–$317.92	236% above	25%
Lactate (lactic acid) blood test inpatient CPT 83605 Blood, Lactic Acid	$238.44	$317.92	$11.87–$317.92	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid Blood Art	$238.44	$317.92	$11.87–$317.92	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 Ldh Cavity Fluid	$50.47	$67.29	$6.71–$135.00	6% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase Blood	$50.47	$67.29	$6.71–$135.00	6% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lab - Lactate Dehydrogenase Enzyme Level	$60.36	$80.48	$6.71–$135.00	27% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase Blood	$50.47	$67.29	$6.71–$135.00	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Ldh Cavity Fluid	$50.47	$67.29	$6.71–$135.00	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lab - Lactate Dehydrogenase Enzyme Level	$60.36	$80.48	$6.71–$135.00	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Serum	$64.55	$86.07	$7.65–$135.00	6% below	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Blood	$458.99	$611.99	$7.65–$611.99	572% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Serum	$64.55	$86.07	$7.65–$135.00	—	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Blood	$458.99	$611.99	$7.65–$611.99	—	25%
Liver function blood test panel CPT 80076 Lab - Liver Function Panel	$313.48	$417.97	$9.08–$417.97	207% above	25%
Liver function blood test panel inpatient CPT 80076 Lab - Liver Function Panel	$313.48	$417.97	$9.08–$417.97	—	25%
Lyme disease antibody test CPT 86618 Lyme Screen Igg, Ab, Borrelia Burgdorferi (Lyme Disease)	$38.48	$51.31	$18.92–$135.00	54% below	25%
Lyme disease antibody test CPT 86618 Lyme Screen Igm, Ab, Borrelia Burgdorferi (Lyme Disease)	$38.48	$51.31	$18.92–$135.00	54% below	25%
Lyme disease antibody test CPT 86618 Igg Lyme CSF	$197.27	$263.03	$18.92–$263.03	133% above	25%
Lyme disease antibody test CPT 86618 Igm Lyme CSF	$197.27	$263.03	$18.92–$263.03	133% above	25%
Lyme disease antibody test CPT 86618 Igm Lyme Bld	$197.27	$263.03	$18.92–$263.03	133% above	25%
Lyme disease antibody test CPT 86618 Igg Lyme Bld	$197.27	$263.03	$18.92–$263.03	133% above	25%
Lyme disease antibody test inpatient CPT 86618 Lyme Screen Igm, Ab, Borrelia Burgdorferi (Lyme Disease)	$38.48	$51.31	$18.92–$135.00	—	25%
Lyme disease antibody test inpatient CPT 86618 Lyme Screen Igg, Ab, Borrelia Burgdorferi (Lyme Disease)	$38.48	$51.31	$18.92–$135.00	—	25%
Lyme disease antibody test inpatient CPT 86618 Igm Lyme Bld	$197.27	$263.03	$18.92–$263.03	—	25%
Lyme disease antibody test inpatient CPT 86618 Igg Lyme CSF	$197.27	$263.03	$18.92–$263.03	—	25%
Lyme disease antibody test inpatient CPT 86618 Igg Lyme Bld	$197.27	$263.03	$18.92–$263.03	—	25%
Lyme disease antibody test inpatient CPT 86618 Igm Lyme CSF	$197.27	$263.03	$18.92–$263.03	—	25%
Magnesium blood test CPT 83735 Lab - Magnesium Level	$48.67	$64.89	$7.44–$135.00	3% below	25%
Magnesium blood test CPT 83735 Magnesium Mg Blood	$117.79	$157.05	$7.44–$157.05	136% above	25%
Magnesium blood test inpatient CPT 83735 Lab - Magnesium Level	$48.67	$64.89	$7.44–$135.00	—	25%
Magnesium blood test inpatient CPT 83735 Magnesium Mg Blood	$117.79	$157.05	$7.44–$157.05	—	25%
Measles (rubeola) antibody test CPT 86765 Measles Igm Diag, Ab, Rubeola	$126.11	$168.15	$14.31–$168.15	58% above	25%
Measles (rubeola) antibody test CPT 86765 Measles Igg Diag, Ab, Rubeola	$126.11	$168.15	$14.31–$168.15	58% above	25%
Measles (rubeola) antibody test CPT 86765 Lab - Rubeola Antibody Analysis	$191.77	$255.69	$14.31–$255.69	140% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Igg Diag, Ab, Rubeola	$126.11	$168.15	$14.31–$168.15	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Igm Diag, Ab, Rubeola	$126.11	$168.15	$14.31–$168.15	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 Lab - Rubeola Antibody Analysis	$191.77	$255.69	$14.31–$255.69	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Monospot	$58.76	$78.35	$5.75–$135.00	6% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile Antibodies	$58.76	$78.35	$5.75–$135.00	6% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Monospot	$58.76	$78.35	$5.75–$135.00	—	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile Antibodies	$58.76	$78.35	$5.75–$135.00	—	25%
Mumps immunity blood test CPT 86735 Mumps Antibody---Meningo Encephalitis Serum	$138.41	$184.55	$14.50–$184.55	63% above	25%
Mumps immunity blood test CPT 86735 Lab - Mumps Antibody Analysis	$138.50	$184.67	$14.50–$184.67	63% above	25%
Mumps immunity blood test CPT 86735 Measles Igm Diag, Ab, Mumps	$204.46	$272.62	$14.50–$272.62	141% above	25%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibody---Meningo Encephalitis Serum	$138.41	$184.55	$14.50–$184.55	—	25%
Mumps immunity blood test inpatient CPT 86735 Lab - Mumps Antibody Analysis	$138.50	$184.67	$14.50–$184.67	—	25%
Mumps immunity blood test inpatient CPT 86735 Measles Igm Diag, Ab, Mumps	$204.46	$272.62	$14.50–$272.62	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 Lab - Prostate Specific Antigen Level	$127.01	$169.35	$20.44–$169.35	41% above	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Lab - Prostate Specific Antigen Level	$127.01	$169.35	$20.44–$169.35	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 Screen, Prostate Specific Antigen (Psa), Total	$239.66	$319.55	$20.44–$319.55	152% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Diagnostic---Free Psa	$239.66	$319.55	$20.44–$319.55	152% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Screen, Prostate Specific Antigen (Psa), Total	$239.66	$319.55	$20.44–$319.55	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Psa Diagnostic---Free Psa	$239.66	$319.55	$20.44–$319.55	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap Diag Cytec	$192.17	$256.23	$29.44–$256.23	83% above	25%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap Smear,Thin Prep,Diag	$193.28	$257.71	$29.44–$257.71	84% above	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Diag Cytec	$192.17	$256.23	$29.44–$256.23	—	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Pap Smear,Thin Prep,Diag	$193.28	$257.71	$29.44–$257.71	—	25%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Screen	$193.28	$257.71	$22.51–$257.71	121% above	25%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Pap Screen	$193.28	$257.71	$22.51–$257.71	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 Lab - Parathyroid Hormone Level	$271.33	$361.77	$45.86–$361.77	26% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Lab - Parathyroid Hormone Level	$271.33	$361.77	$45.86–$361.77	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Aptt Baseline---Thrombophilia Panel	$80.95	$107.93	$6.67–$135.00	62% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Lab - Clotting Time Test	$104.63	$139.51	$6.67–$139.51	109% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Aptt Baseline---Thrombophilia Panel	$80.95	$107.93	$6.67–$135.00	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lab - Clotting Time Test	$104.63	$139.51	$6.67–$139.51	—	25%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Inorg P Blood	$50.47	$67.29	$5.27–$135.00	21% above	25%
Phosphorus (phosphate) blood test CPT 84100 Lab - Phosphate Level in Blood	$50.47	$67.29	$5.27–$135.00	21% above	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 Lab - Phosphate Level in Blood	$50.47	$67.29	$5.27–$135.00	—	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Inorg P Blood	$50.47	$67.29	$5.27–$135.00	—	25%
Potassium blood test CPT 84132 Potassium K Blood	$50.47	$67.29	$5.11–$135.00	74% above	25%
Potassium blood test CPT 84132 Potassium	$50.47	$67.29	$5.11–$135.00	74% above	25%
Potassium blood test inpatient CPT 84132 Potassium K Blood	$50.47	$67.29	$5.11–$135.00	—	25%
Potassium blood test inpatient CPT 84132 Potassium	$50.47	$67.29	$5.11–$135.00	—	25%
Progesterone blood test CPT 84144 Lab - Progesterone Reproductive Hormone	$316.78	$422.38	$23.18–$422.38	164% above	25%
Progesterone blood test inpatient CPT 84144 Lab - Progesterone Reproductive Hormone	$316.78	$422.38	$23.18–$422.38	—	25%
Prolactin blood test CPT 84146 Lab - Prolactin Hormone Level	$210.55	$280.74	$21.53–$280.74	74% above	25%
Prolactin blood test inpatient CPT 84146 Lab - Prolactin Hormone Level	$210.55	$280.74	$21.53–$280.74	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time---Stroke Panel	$74.25	$99.00	$4.37–$135.00	116% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Lab - Clotting Time Test	$74.25	$99.00	$4.37–$135.00	116% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time---Stroke Panel	$74.25	$99.00	$4.37–$135.00	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Lab - Clotting Time Test	$74.25	$99.00	$4.37–$135.00	—	25%
Rapid flu test (influenza antigen) CPT 87804 Influenza B, Infc Agnt Ag Detect by Ia W/ Dir Optical Obsv, Influenza	$102.73	$136.97	$16.32–$136.97	95% above	25%
Rapid flu test (influenza antigen) CPT 87804 Influenza a, Infc Agnt Ag Detect by Ia W/ Dir Optical Obsv, Influenza	$102.73	$136.97	$16.32–$136.97	95% above	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza B, Infc Agnt Ag Detect by Ia W/ Dir Optical Obsv, Influenza	$102.73	$136.97	$16.32–$136.97	—	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza a, Infc Agnt Ag Detect by Ia W/ Dir Optical Obsv, Influenza	$102.73	$136.97	$16.32–$136.97	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Lab - Specimen Analysis Strep Group A	$136.61	$182.15	$16.32–$182.15	193% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Lab - Specimen Analysis Strep Group A	$136.61	$182.15	$16.32–$182.15	—	25%
Renin blood test CPT 84244 Lab - Renin Enzyme Level	$182.69	$243.59	$24.44–$243.59	28% above	25%
Renin blood test inpatient CPT 84244 Lab - Renin Enzyme Level	$182.69	$243.59	$24.44–$243.59	—	25%
Rh blood typing CPT 86901 Rh Factor Rh D	$40.43	$53.91	$3.32–$135.00	2% above	25%
Rh blood typing inpatient CPT 86901 Rh Factor Rh D	$40.43	$53.91	$3.32–$135.00	—	25%
Rheumatoid factor (RF) test CPT 86431 Lab - Rheumatoid Factor Measurement	$77.95	$103.93	$6.30–$135.00	36% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 Lab - Rheumatoid Factor Measurement	$77.95	$103.93	$6.30–$135.00	—	25%
Rubella antibody test (immunity check) CPT 86762 Lab - Rubella Antibody Analysis	$91.42	$121.90	$15.99–$135.00	14% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 Lab - Rubella Antibody Analysis	$91.42	$121.90	$15.99–$135.00	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Lab - RBC Sedimentation Rate (Automated)	$42.88	$57.17	$3.00–$135.00	3% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Lab - RBC Sedimentation Rate (Automated)	$42.88	$57.17	$3.00–$135.00	—	25%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Lab - Semen Anlys for Vol, Count, Motility	$344.17	$458.90	$13.39–$458.90	189% above	25%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Lab - Semen Anlys for Vol, Count, Motility	$344.17	$458.90	$13.39–$458.90	—	25%
Sodium blood test CPT 84295 Sodium Na Blood	$50.47	$67.29	$5.35–$135.00	103% above	25%
Sodium blood test CPT 84295 Sodium	$50.47	$67.29	$5.35–$135.00	103% above	25%
Sodium blood test inpatient CPT 84295 Sodium Na Blood	$50.47	$67.29	$5.35–$135.00	—	25%
Sodium blood test inpatient CPT 84295 Sodium	$50.47	$67.29	$5.35–$135.00	—	25%
Stool ova and parasites exam CPT 87177 Lab - Smear for Parasites	$131.11	$174.81	$9.89–$174.81	110% above	25%
Stool ova and parasites exam inpatient CPT 87177 Lab - Smear for Parasites	$131.11	$174.81	$9.89–$174.81	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Ifobt Screen	$67.54	$90.06	$17.67–$135.00	12% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Ifobt Diagnosis	$67.54	$90.06	$17.67–$135.00	12% above	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Ifobt Diagnosis	$67.54	$90.06	$17.67–$135.00	—	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Ifobt Screen	$67.54	$90.06	$17.67–$135.00	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 Lab - Treponema Pallidum Antibody Analysis	$69.75	$93.00	$10.77–$135.00	33% above	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 Fta Abs	$224.86	$299.81	$10.77–$299.81	328% above	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Lab - Treponema Pallidum Antibody Analysis	$69.75	$93.00	$10.77–$135.00	—	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Fta Abs	$224.86	$299.81	$10.77–$299.81	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL	$75.84	$101.12	$4.75–$135.00	102% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr Qualitative	$75.84	$101.12	$4.75–$135.00	102% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Qualitative CSF	$85.34	$113.79	$4.75–$135.00	128% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL	$75.84	$101.12	$4.75–$135.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rpr Qualitative	$75.84	$101.12	$4.75–$135.00	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Vdrl Qualitative CSF	$85.34	$113.79	$4.75–$135.00	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Lab - Tuberculosis Antigen Analysis	$318.28	$424.38	$68.87–$424.38	26% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Lab - Tuberculosis Antigen Analysis	$318.28	$424.38	$68.87–$424.38	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Assay---Free Testosterone	$161.30	$215.07	$28.68–$215.07	41% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Lab - Testosterone Level (Total)	$360.26	$480.35	$28.68–$480.35	215% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total Assay---Free Testosterone	$161.30	$215.07	$28.68–$215.07	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Lab - Testosterone Level (Total)	$360.26	$480.35	$28.68–$480.35	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Lab - Microsomal Antibodies Measurement	$66.15	$88.20	$16.17–$135.00	2% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Microsomal Antib	$143.11	$190.81	$16.17–$190.81	112% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Ab	$143.11	$190.81	$16.17–$190.81	112% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Lab - Microsomal Antibodies Measurement	$66.15	$88.20	$16.17–$135.00	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Microsomal Antib	$143.11	$190.81	$16.17–$190.81	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Ab	$143.11	$190.81	$16.17–$190.81	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Lab - Thyroid Stimulating Hormone Level	$245.03	$326.71	$18.67–$326.71	160% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Lab - Thyroid Stimulating Hormone Level	$245.03	$326.71	$18.67–$326.71	—	25%
Total IgE blood test CPT 82785 Ige, Allergen	$76.34	$101.79	$18.29–$135.00	25% below	25%
Total IgE blood test CPT 82785 LAB - GAMMAGLOBULIN LEVEL (IgE)	$257.33	$343.11	$18.29–$343.11	152% above	25%
Total IgE blood test inpatient CPT 82785 Ige, Allergen	$76.34	$101.79	$18.29–$135.00	—	25%
Total IgE blood test inpatient CPT 82785 LAB - GAMMAGLOBULIN LEVEL (IgE)	$257.33	$343.11	$18.29–$343.11	—	25%
Total cholesterol blood test CPT 82465 Lab - Cholesterol Level	$50.47	$67.29	$4.84–$135.00	9% above	25%
Total cholesterol blood test inpatient CPT 82465 Lab - Cholesterol Level	$50.47	$67.29	$4.84–$135.00	—	25%
Total thyroxine (T4) blood test CPT 84436 Thyroxine Assay Total---Infant Metabolic Screen	$35.06	$46.75	$7.63–$135.00	33% below	25%
Total thyroxine (T4) blood test CPT 84436 Lab - Thyroxine Level (Total)	$78.25	$104.33	$7.63–$135.00	50% above	25%
Total thyroxine (T4) blood test CPT 84436 T4 Blood	$141.40	$188.54	$7.63–$188.54	172% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine Assay Total---Infant Metabolic Screen	$35.06	$46.75	$7.63–$135.00	—	25%
Total thyroxine (T4) blood test inpatient CPT 84436 Lab - Thyroxine Level (Total)	$78.25	$104.33	$7.63–$135.00	—	25%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 Blood	$141.40	$188.54	$7.63–$188.54	—	25%
Total triiodothyronine (T3) blood test CPT 84480 T3 Blood	$141.40	$188.54	$15.75–$188.54	35% above	25%
Total triiodothyronine (T3) blood test CPT 84480 Lab - Thyroid Hormone Level (T3 Total)	$217.96	$290.61	$15.75–$290.61	108% above	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Blood	$141.40	$188.54	$15.75–$188.54	—	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Lab - Thyroid Hormone Level (T3 Total)	$217.96	$290.61	$15.75–$290.61	—	25%
Transferrin blood test CPT 84466 Transferrin in House	$31.67	$42.23	$14.18–$135.00	66% below	25%
Transferrin blood test CPT 84466 Transferrin Blood	$193.48	$257.97	$14.18–$257.97	109% above	25%
Transferrin blood test inpatient CPT 84466 Transferrin in House	$31.67	$42.23	$14.18–$135.00	—	25%
Transferrin blood test inpatient CPT 84466 Transferrin Blood	$193.48	$257.97	$14.18–$257.97	—	25%
Trichomonas test (NAAT) CPT 87661 Lab - Detect Test Trichomonas Vaginalis	$131.11	$174.81	$66.43–$193.00	8% below	25%
Trichomonas test (NAAT) inpatient CPT 87661 Lab - Detect Test Trichomonas Vaginalis	$131.11	$174.81	$66.43–$193.00	—	25%
Triglycerides blood test CPT 84478 Lab - Triglycerides Level	$50.47	$67.29	$6.38–$135.00	6% below	25%
Triglycerides blood test inpatient CPT 84478 Lab - Triglycerides Level	$50.47	$67.29	$6.38–$135.00	—	25%
Troponin test, quantitative CPT 84484 Troponin-I	$93.25	$124.33	$12.47–$135.00	10% above	25%
Troponin test, quantitative inpatient CPT 84484 Troponin-I	$93.25	$124.33	$12.47–$135.00	—	25%
Uric acid blood test CPT 84550 Lab - Uric Acid Level in Blood	$50.47	$67.29	$5.02–$135.00	1% above	25%
Uric acid blood test inpatient CPT 84550 Lab - Uric Acid Level in Blood	$50.47	$67.29	$5.02–$135.00	—	25%
Urinalysis with microscope exam, automated CPT 81001 Lab - Anlys of Urine Auto W/O Microscope	$50.47	$67.29	$3.52–$135.00	25% above	25%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto W Scope---Culture, Ped Cath	$85.04	$113.39	$3.52–$135.00	111% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 Lab - Anlys of Urine Auto W/O Microscope	$50.47	$67.29	$3.52–$135.00	—	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto W Scope---Culture, Ped Cath	$85.04	$113.39	$3.52–$135.00	—	25%
Urinalysis without microscope exam, automated CPT 81003 Ketones Urine	$31.57	$42.10	$2.49–$135.00	26% above	25%
Urinalysis without microscope exam, automated CPT 81003 Lab - Anlys of Urine Auto W/O Microscope	$36.28	$48.37	$2.49–$135.00	45% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Ketones Urine	$31.57	$42.10	$2.49–$135.00	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Lab - Anlys of Urine Auto W/O Microscope	$36.28	$48.37	$2.49–$135.00	—	25%
Urinalysis without microscope exam, manual CPT 81002 Lab - Urinalysis Non-Auto W/O Miscroscope	$20.78	$27.71	$3.48–$135.00	39% above	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 Lab - Urinalysis Non-Auto W/O Miscroscope	$20.78	$27.71	$3.48–$135.00	—	25%
Urine culture for bacteria, with colony count CPT 87086 Lab - Bacterial Urine Culture Colony Count	$128.92	$171.89	$8.97–$171.89	71% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 Lab - Bacterial Urine Culture Colony Count	$128.92	$171.89	$8.97–$171.89	—	25%
Urine microalbumin (albumin) test CPT 82043 Microalbu.Random UR	$119.23	$158.97	$6.42–$158.97	91% above	25%
Urine microalbumin (albumin) test CPT 82043 Microalbu.24hr.Quan	$143.31	$191.08	$6.42–$191.08	129% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbu.Random UR	$119.23	$158.97	$6.42–$158.97	—	25%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbu.24hr.Quan	$143.31	$191.08	$6.42–$191.08	—	25%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test, by Visual Color Comparison Methods	$33.28	$44.37	$8.61–$135.00	46% below	25%
Urine pregnancy test, read by color change CPT 81025 Lab - Urine Pregnancy Test	$263.43	$351.24	$8.61–$351.24	331% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test, by Visual Color Comparison Methods	$33.28	$44.37	$8.61–$135.00	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 Lab - Urine Pregnancy Test	$263.43	$351.24	$8.61–$351.24	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Lab - Vitamin B-12 Level	$199.17	$265.56	$16.75–$265.56	99% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Lab - Vitamin B-12 Level	$199.17	$265.56	$16.75–$265.56	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Lab - Vitamin D-3 Level	$434.01	$578.68	$32.89–$578.68	189% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Lab - Vitamin D-3 Level	$434.01	$578.68	$32.89–$578.68	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Lab - Vitamin D Level (1,25-Dihydroxy)	$498.88	$665.17	$42.78–$665.17	218% above	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Lab - Vitamin D Level (1,25-Dihydroxy)	$498.88	$665.17	$42.78–$665.17	—	25%
Zinc blood test CPT 84630 Lab - Zinc Level	$187.98	$250.64	$12.65–$250.64	143% above	25%
Zinc blood test inpatient CPT 84630 Lab - Zinc Level	$187.98	$250.64	$12.65–$250.64	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin Chorionic (Hcg) Quantitative Assay---Quad Maker	$70.75	$94.34	$16.73–$135.00	37% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Lab - Pregnancy Hormone Level	$446.62	$595.49	$16.73–$595.49	297% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Gonadotropin Chorionic (Hcg) Quantitative Assay---Quad Maker	$70.75	$94.34	$16.73–$135.00	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Lab - Pregnancy Hormone Level	$446.62	$595.49	$16.73–$595.49	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx Breast Stereotactic Guide 1st Lesion	$2,906.79	$3,875.72	$135.00–$7,426.00	10% above	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Bx Breast Stereotactic Guide 1st Lesion	$2,906.79	$3,875.72	$135.00–$7,426.00	—	25%
Cardiac catheterization with coronary angiogram CPT 93458 L Hrt Artery Ventricle Angio	$9,652.45	$12,869.93	$135.00–$22,454.00	at median	25%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L Hrt Artery Ventricle Angio	$9,652.45	$12,869.93	$135.00–$22,454.00	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Electrical Cardioversion	$985.66	$1,314.21	$135.00–$1,314.21	at median	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Electrical Cardioversion	$985.66	$1,314.21	$135.00–$1,314.21	—	25%
Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel Surgery	$8,356.71	$11,142.28	$135.00–$22,284.56	275% above	25%
Carpal tunnel release, open surgery inpatient CPT 64721 Carpal Tunnel Surgery	$8,356.71	$11,142.28	$135.00–$22,284.56	—	25%
Catheter ablation for atrial fibrillation CPT 93656 Comprhnsv Ep Eval Transsept Cath Tx	$67,124.11	$89,498.81	$135.00–$89,498.81	279% above	25%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Comprhnsv Ep Eval Transsept Cath Tx	$67,124.11	$89,498.81	$135.00–$89,498.81	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Using Clamp or Other Device	$203.87	$271.83	$103.30–$7,426.00	3% above	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision Using Clamp or Other Device	$203.87	$271.83	$103.30–$7,426.00	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Tx Broken Lwr Forearm W/O Incision	$927.19	$1,236.25	$135.00–$5,941.00	51% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Tx Broken Lwr Forearm W/O Incision	$927.19	$1,236.25	$135.00–$5,941.00	—	25%
Coronary stent placement, one artery CPT 92928 Trncath Plc Intrcor Stnt Sgl Maj Brnch	$47,204.62	$62,939.50	$135.00–$62,939.50	503% above	25%
Coronary stent placement, one artery inpatient CPT 92928 Trncath Plc Intrcor Stnt Sgl Maj Brnch	$47,204.62	$62,939.50	$135.00–$62,939.50	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystoscopy	$1,269.57	$1,692.76	$135.00–$5,941.00	28% above	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 Cystoscopy	$1,269.57	$1,692.76	$135.00–$5,941.00	—	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Removal of Impacted Ear Wax From One Ear	$117.52	$156.69	$59.54–$11,882.00	20% above	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Removal of Impacted Ear Wax From One Ear	$117.52	$156.69	$59.54–$11,882.00	—	25%
Earwax removal with instruments, one ear CPT 69210 Removal of Impacted Ear Wax From One Ear	$89.85	$119.80	$45.52–$11,882.00	7% above	25%
Earwax removal with instruments, one ear inpatient CPT 69210 Removal of Impacted Ear Wax From One Ear	$89.85	$119.80	$45.52–$11,882.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy of Uterine Lining	$783.46	$1,044.62	$135.00–$5,941.00	188% above	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Biopsy of Uterine Lining	$783.46	$1,044.62	$135.00–$5,941.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inj Dx/Ther Subst Cervical/Thoracic	$1,346.21	$1,794.95	$135.00–$5,941.00	3% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inj Dx/Ther Subst Cervical/Throacic	$1,680.79	$2,241.05	$135.00–$5,941.00	28% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Inj Dx/Ther Subst Cervical/Thoracic	$1,346.21	$1,794.95	$135.00–$5,941.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Inj Dx/Ther Subst Cervical/Throacic	$1,680.79	$2,241.05	$135.00–$5,941.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj L-Spine Facet Jt Single Level	$977.55	$1,303.40	$135.00–$11,882.00	35% below	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj L-Spine Facet Jt Single Level	$977.55	$1,303.40	$135.00–$11,882.00	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Saline/Contrast for Hysterosalpingography	$1,090.78	$1,454.37	$135.00–$17,638.00	311% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Saline/Contrast for Hysterosalpingography	$1,090.78	$1,454.37	$135.00–$17,638.00	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 Drainage of Abscess, Simple or Single	$603.30	$804.40	$135.00–$5,941.00	103% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Drainage of Abscess, Simple or Single	$603.30	$804.40	$135.00–$5,941.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament/Mus Membrane	$1,016.13	$1,354.84	$135.00–$5,941.00	197% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament/Mus Membrane	$1,016.13	$1,354.84	$135.00–$5,941.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspir/Inj of Large Joint or Joint Capsule	$657.37	$876.49	$135.00–$11,882.00	52% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Aspir/Inj of Large Joint or Joint Capsule	$657.37	$876.49	$135.00–$11,882.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspir or Inj Medium Joint or Joint Cap	$657.37	$876.49	$135.00–$11,882.00	102% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Aspir or Inj Medium Joint or Joint Cap	$657.37	$876.49	$135.00–$11,882.00	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspir/Inj of Small Joint or Joint Capsule	$657.37	$876.49	$135.00–$5,941.00	66% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Aspir/Inj of Small Joint or Joint Capsule	$657.37	$876.49	$135.00–$5,941.00	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Int Repr Wd Sclp/Nk/Underarm/Trnk/Extrm	$541.45	$721.93	$135.00–$5,941.00	at median	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Int Repr Wd Sclp/Nk/Underarm/Trnk/Extrm	$541.45	$721.93	$135.00–$5,941.00	—	25%
Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath W Ventrclgrphy	$8,548.66	$11,398.22	$135.00–$22,454.00	25% above	25%
Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath W Ventrclgrphy	$8,548.66	$11,398.22	$135.00–$22,454.00	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 Inj Dx/Ther Subst Lumbar/Sacral	$2,424.70	$3,232.94	$135.00–$5,941.00	111% above	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj Dx/Ther Subst Lumbar/Sacral	$2,424.70	$3,232.94	$135.00–$5,941.00	—	25%
Lower-back epidural injection, without imaging guidance CPT 62322 Inj Subs Spinal Canal of Lwr Back/Sacrum	$1,407.97	$1,877.30	$135.00–$5,941.00	71% above	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Inj Subs Spinal Canal of Lwr Back/Sacrum	$1,407.97	$1,877.30	$135.00–$5,941.00	—	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Anes/Steroid Lower Spine Nerve Root	$1,277.26	$1,703.02	$135.00–$11,882.00	19% above	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Inj Anes/Steroid Lower Spine Nerve Root	$1,277.26	$1,703.02	$135.00–$11,882.00	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Removal of Growth of the Trunk, Arms/Legs	$2,962.63	$3,950.18	$135.00–$5,941.00	750% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Removal of Growth of the Trunk, Arms/Legs	$2,962.63	$3,950.18	$135.00–$5,941.00	—	25%
Nail removal (partial or complete), one nail CPT 11730 Separation of Nail Plate From Nail Bed	$326.89	$435.85	$135.00–$5,941.00	45% above	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 Separation of Nail Plate From Nail Bed	$326.89	$435.85	$135.00–$5,941.00	—	25%
Pacemaker implant (dual chamber) CPT 33208 Insert Repl Pm W Transven Elctrd Atr Ventr	$34,207.88	$45,610.51	$135.00–$45,610.51	440% above	25%
Pacemaker implant (dual chamber) inpatient CPT 33208 Insert Repl Pm W Transven Elctrd Atr Ventr	$34,207.88	$45,610.51	$135.00–$45,610.51	—	25%
Paracentesis with imaging guidance CPT 49083 Rem Fluid From Abd Cavity W/Imaging Guide	$1,607.05	$2,142.73	$135.00–$5,941.00	25% above	25%
Paracentesis with imaging guidance inpatient CPT 49083 Rem Fluid From Abd Cavity W/Imaging Guide	$1,607.05	$2,142.73	$135.00–$5,941.00	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent Removal of Nail	$921.99	$1,229.32	$135.00–$11,882.00	183% above	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent Removal of Nail	$921.99	$1,229.32	$135.00–$11,882.00	—	25%
Prostate biopsy CPT 55700 Biopsy of Prostate Gland	$1,214.70	$1,619.60	$135.00–$7,426.00	16% below	25%
Prostate biopsy inpatient CPT 55700 Biopsy of Prostate Gland	$1,214.70	$1,619.60	$135.00–$7,426.00	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destr by Neurolyt Agent Pv Facet Jt Nrv(S)	$5,957.68	$7,943.57	$135.00–$7,943.57	141% above	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destr by Neurolyt Agent Pv Facet Jt Nrv(S)	$5,957.68	$7,943.57	$135.00–$7,943.57	—	25%
Removal of a foreign object under the skin, simple CPT 10120 Removal FB From Tissue Under Skin, Simple	$797.37	$1,063.16	$135.00–$5,941.00	114% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Removal FB From Tissue Under Skin, Simple	$797.37	$1,063.16	$135.00–$5,941.00	—	25%
Short arm cast (elbow to hand) CPT 29075 Application of Cast, Elbow to Finger	$363.65	$484.87	$135.00–$5,941.00	35% above	25%
Short arm cast (elbow to hand) inpatient CPT 29075 Application of Cast, Elbow to Finger	$363.65	$484.87	$135.00–$5,941.00	—	25%
Short arm splint (forearm and hand) CPT 29125 Appl Non-Moveable, Short Arm Splint	$211.47	$281.96	$107.14–$11,882.00	20% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 Appl Non-Moveable, Short Arm Splint	$211.47	$281.96	$107.14–$11,882.00	—	25%
Short leg cast (below the knee) CPT 29405 Application of Short Leg Cast	$363.65	$484.87	$135.00–$5,941.00	62% above	25%
Short leg cast (below the knee) inpatient CPT 29405 Application of Short Leg Cast	$363.65	$484.87	$135.00–$5,941.00	—	25%
Short leg splint (calf to foot) CPT 29515 Application of Short Leg Splint	$231.94	$309.26	$117.52–$5,941.00	12% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 Application of Short Leg Splint	$231.94	$309.26	$117.52–$5,941.00	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Sim Repr Wd Sclp/Nk/Underarms/Trnk/Extrm	$511.36	$681.81	$135.00–$5,941.00	57% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Sim Repr Wd Sclp/Nk/Underarms/Trnk/Extrm	$511.36	$681.81	$135.00–$5,941.00	—	25%
Skin biopsy, punch, one lesion CPT 11104 Biopsy of Single Skin Lesion, Punch	$1,036.88	$1,382.51	$135.00–$5,941.00	351% above	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 Biopsy of Single Skin Lesion, Punch	$1,036.88	$1,382.51	$135.00–$5,941.00	—	25%
Skin tag removal, up to 15 tags CPT 11200 Removal of 1-15 Skin Tags	$855.26	$1,140.35	$135.00–$5,941.00	504% above	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of 1-15 Skin Tags	$855.26	$1,140.35	$135.00–$5,941.00	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Tap for Diagnosis	$835.45	$1,113.93	$135.00–$5,941.00	39% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Tap for Diagnosis	$835.45	$1,113.93	$135.00–$5,941.00	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Sim Repr Wd Sclp/Nk/Underarms/Trnk/Extrm	$525.55	$700.74	$135.00–$5,941.00	160% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Sim Repr Wd Sclp/Nk/Underarms/Trnk/Extrm	$525.55	$700.74	$135.00–$5,941.00	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Sim Repr Suprf Wnd Face/Ear/Eyld/Nose/Lip	$529.16	$705.55	$135.00–$5,941.00	71% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Sim Repr Suprf Wnd Face/Ear/Eyld/Nose/Lip	$529.16	$705.55	$135.00–$5,941.00	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Biopsy of Single Skin Lesion, Tangential	$446.29	$595.06	$135.00–$5,941.00	94% above	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Biopsy of Single Skin Lesion, Tangential	$446.29	$595.06	$135.00–$5,941.00	—	25%
Thoracentesis with imaging guidance CPT 32555 Rem Fluid Chest Cavity W/Imaging Guide	$1,660.10	$2,213.47	$135.00–$11,882.00	43% above	25%
Thoracentesis with imaging guidance inpatient CPT 32555 Rem Fluid Chest Cavity W/Imaging Guide	$1,660.10	$2,213.47	$135.00–$11,882.00	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj of Trigger Points in 1 or 2 Muscles	$380.54	$507.39	$135.00–$5,941.00	7% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj of Trigger Points in 1 or 2 Muscles	$380.54	$507.39	$135.00–$5,941.00	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx Breast US Guide 1st Lesion	$1,861.77	$2,482.36	$135.00–$7,426.00	12% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Bx Breast US Guide 1st Lesion	$1,861.77	$2,482.36	$135.00–$7,426.00	—	25%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd, Flex, Transoral, W/ Bx, Single or Mult	$8,548.66	$11,398.22	$135.00–$11,398.22	441% above	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd, Flex, Transoral, W/ Bx, Single or Mult	$8,548.66	$11,398.22	$135.00–$11,398.22	—	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Gastroscopy Basic	$2,135.30	$2,847.07	$135.00–$5,941.00	45% above	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC Gastroscopy Basic	$2,135.30	$2,847.07	$135.00–$5,941.00	—	25%
Vein ablation, radiofrequency, first vein CPT 36475 Endovenous Ablation Therapy, Extremity	$7,120.81	$9,494.42	$135.00–$17,815.00	87% above	25%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 Endovenous Ablation Therapy, Extremity	$7,120.81	$9,494.42	$135.00–$17,815.00	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Rem Tissue Beneath the Skin Init Amount	$1,036.88	$1,382.51	$135.00–$5,941.00	94% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Rem Tissue Beneath the Skin Init Amount	$1,036.88	$1,382.51	$135.00–$5,941.00	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Infusion Fee	$78.15	$104.20	$39.60–$135.00	87% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion of Blood or Blood Products	$203.76	$271.68	$103.24–$271.68	65% below	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Infusion Fee	$78.15	$104.20	$39.60–$135.00	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion of Blood or Blood Products	$203.76	$271.68	$103.24–$271.68	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ezpap Treatment Initial	$65.35	$87.14	$33.11–$135.00	24% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ezpap Treatment Subseq	$65.35	$87.14	$33.11–$135.00	24% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hhn Treatment Initial per Day	$132.72	$176.96	$67.24–$176.96	54% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Hhn Treatment Subseq per Day	$132.72	$176.96	$67.24–$176.96	54% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ezpap Treatment Subseq	$65.35	$87.14	$33.11–$135.00	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ezpap Treatment Initial	$65.35	$87.14	$33.11–$135.00	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hhn Treatment Initial per Day	$132.72	$176.96	$67.24–$176.96	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Hhn Treatment Subseq per Day	$132.72	$176.96	$67.24–$176.96	—	25%
Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy Infusion Into a Vein 1 Hr	$318.59	$424.79	$135.00–$424.79	44% below	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemotherapy Infusion Into a Vein 1 Hr	$318.59	$424.79	$135.00–$424.79	—	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive Hearing Test	$208.66	$278.22	$105.72–$278.22	25% above	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Comprehensive Hearing Test	$208.66	$278.22	$105.72–$278.22	—	25%
Critical care, first 30 to 74 minutes CPT 99291 Emergency Room Critical Care	$1,930.33	$2,573.77	$135.00–$10,503.00	8% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emergency Room Critical Care	$1,930.33	$2,573.77	$135.00–$10,503.00	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Meas Brain Wave Activity Awake & Drowsy	$1,646.91	$2,195.88	$135.00–$2,195.88	144% above	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Meas Brain Wave Activity Awake & Drowsy	$1,646.91	$2,195.88	$135.00–$2,195.88	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Routine Ekg at Least 12 Leads Trac Only	$382.03	$509.38	$135.00–$509.38	165% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Routine Ekg at Least 12 Leads Trac Only	$382.03	$509.38	$135.00–$509.38	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Department Visit Level 1	$202.77	$270.36	$102.74–$1,688.00	16% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency Department Visit Level 1	$202.77	$270.36	$102.74–$1,688.00	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Department Visit Level 2	$316.98	$422.64	$135.00–$1,688.00	2% below	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency Department Visit Level 2	$316.98	$422.64	$135.00–$1,688.00	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Department Visit Level 3	$485.67	$647.56	$135.00–$2,838.00	18% below	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Department Visit Level 3	$485.67	$647.56	$135.00–$2,838.00	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Department Visit Level 4	$710.41	$947.21	$135.00–$5,437.00	22% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Department Visit Level 4	$710.41	$947.21	$135.00–$5,437.00	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Department Visit Level 5	$1,428.99	$1,905.32	$135.00–$5,437.00	1% below	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency Department Visit Level 5	$1,428.99	$1,905.32	$135.00–$5,437.00	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovasc Stress Test Tracing WO Int&Rpt	$1,779.43	$2,372.57	$135.00–$2,372.57	125% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovasc Stress Test Tracing WO Int&Rpt	$1,779.43	$2,372.57	$135.00–$2,372.57	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion Therapy - Hydration	$313.21	$417.61	$135.00–$417.61	10% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Infusion Therapy - Hydration	$313.21	$417.61	$135.00–$417.61	—	25%
IV infusion of a medicine, first hour CPT 96365 Infusion Therapy - Infusion Into a Vein	$313.21	$417.61	$135.00–$417.61	at median	25%
IV infusion of a medicine, first hour inpatient CPT 96365 Infusion Therapy - Infusion Into a Vein	$313.21	$417.61	$135.00–$417.61	—	25%
IV push of a medicine, first drug CPT 96374 Infusion Therapy - Infusion Into a Vein	$313.21	$417.61	$135.00–$417.61	90% above	25%
IV push of a medicine, first drug inpatient CPT 96374 Infusion Therapy - Infusion Into a Vein	$313.21	$417.61	$135.00–$417.61	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Infusion Therapy - Under the Skin	$126.01	$168.02	$63.85–$168.02	56% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Dx Inj, Subq or Intramuscular	$135.70	$180.94	$68.76–$180.94	68% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Infusion Therapy - Under the Skin	$126.01	$168.02	$63.85–$168.02	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Dx Inj, Subq or Intramuscular	$135.70	$180.94	$68.76–$180.94	—	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nerve Transmission Studies, 7 to 8 Studies	$3,824.47	$5,099.30	$135.00–$5,099.30	298% above	25%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Nerve Transmission Studies, 7 to 8 Studies	$3,824.47	$5,099.30	$135.00–$5,099.30	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 Pt, Neuromuscular Re-Education	$166.62	$222.16	$29.39–$222.16	74% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 Ot Neuromuscular Re-Education	$166.62	$222.16	$29.39–$222.16	74% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Ot Neuromuscular Re-Education	$166.62	$222.16	$29.39–$222.16	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pt, Neuromuscular Re-Education	$166.62	$222.16	$29.39–$222.16	—	25%
New patient office visit, about 30 minutes CPT 99203 New Patient, Facility E&M Level 3	$370.65	$494.20	$135.00–$494.20	95% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 New Patient, Facility E&M Level 3	$370.65	$494.20	$135.00–$494.20	—	25%
New patient office visit, about 45 minutes CPT 99204 New Patient, Facility E&M Level 4	$564.83	$753.11	$135.00–$753.11	158% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 New Patient, Facility E&M Level 4	$564.83	$753.11	$135.00–$753.11	—	25%
New patient office visit, about 60 minutes CPT 99205 New Patient, Facility E&M Level 5	$710.94	$947.92	$135.00–$947.92	133% above	25%
New patient office visit, about 60 minutes inpatient CPT 99205 New Patient, Facility E&M Level 5	$710.94	$947.92	$135.00–$947.92	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Patient, Facility E&M Level 2	$257.63	$343.51	$130.53–$343.51	97% above	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Patient, Facility E&M Level 2	$257.63	$343.51	$130.53–$343.51	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Med Nutrition Ther Init Indiv	$54.97	$73.29	$27.85–$135.00	4% below	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Med Nutrition Ther Init Indiv	$54.97	$73.29	$27.85–$135.00	—	25%
Occupational therapy evaluation, low complexity CPT 97165 Evaluation Occupational Therapy	$283.39	$377.85	$143.58–$377.85	60% above	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Evaluation Occupational Therapy	$283.39	$377.85	$143.58–$377.85	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Eval of Physical Therapy	$494.47	$659.29	$250.53–$659.29	60% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Eval of Physical Therapy	$494.47	$659.29	$250.53–$659.29	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Eval of Physical Therapy	$360.96	$481.28	$182.89–$481.28	103% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Eval of Physical Therapy	$360.96	$481.28	$182.89–$481.28	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Eval of Physical Therapy	$393.65	$524.87	$199.45–$524.87	64% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Eval of Physical Therapy	$393.65	$524.87	$199.45–$524.87	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Ot, Manual Therapy	$137.24	$182.99	$25.53–$182.99	42% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pt, Manual Therapy	$137.24	$182.99	$25.53–$182.99	42% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Ot, Manual Therapy	$137.24	$182.99	$25.53–$182.99	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Pt, Manual Therapy	$137.24	$182.99	$25.53–$182.99	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot, Therapeutic Exercises, Each 15 Min	$163.94	$218.59	$29.89–$218.59	69% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pt Therapeutic Exercises, Each 15 Min	$163.94	$218.59	$29.89–$218.59	69% above	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot, Therapeutic Exercises, Each 15 Min	$163.94	$218.59	$29.89–$218.59	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pt Therapeutic Exercises, Each 15 Min	$163.94	$218.59	$29.89–$218.59	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 Init Comprehensive Preventive E&M, New Patient, 18-39 Yrs	$196.06	$261.42	$99.34–$261.42	40% above	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Init Comprehensive Preventive E&M, New Patient, 18-39 Yrs	$196.06	$261.42	$99.34–$261.42	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Facility E&M Level 5	$1,188.13	$1,584.17	$135.00–$1,584.17	321% above	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Facility E&M Level 5	$1,188.13	$1,584.17	$135.00–$1,584.17	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Facility E&M Level 3	$599.51	$799.35	$135.00–$799.35	265% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Facility E&M Level 3	$599.51	$799.35	$135.00–$799.35	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Facility E&M Level 4	$883.30	$1,177.74	$135.00–$1,177.74	384% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Facility E&M Level 4	$883.30	$1,177.74	$135.00–$1,177.74	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Facility E&M Level 2	$356.88	$475.84	$135.00–$475.84	249% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Facility E&M Level 2	$356.88	$475.84	$135.00–$475.84	—	25%
Speech and language evaluation CPT 92523 Eval Speech Sound Prod W/Lang Comp	$104.69	$139.59	$53.04–$139.59	69% below	25%
Speech and language evaluation CPT 92523 Eval Speech Sound Prod, Lang Compreh &Expr	$239.03	$318.71	$121.11–$318.71	30% below	25%
Speech and language evaluation inpatient CPT 92523 Eval Speech Sound Prod W/Lang Comp	$104.69	$139.59	$53.04–$139.59	—	25%
Speech and language evaluation inpatient CPT 92523 Eval Speech Sound Prod, Lang Compreh &Expr	$239.03	$318.71	$121.11–$318.71	—	25%
Speech therapy session, individual CPT 92507 Indiv Tx Speech, Lang, Hear Process Disord	$316.78	$422.37	$47.91–$422.37	25% above	25%
Speech therapy session, individual CPT 92507 Speech Language Therapy	$526.20	$701.60	$47.91–$701.60	108% above	25%
Speech therapy session, individual inpatient CPT 92507 Indiv Tx Speech, Lang, Hear Process Disord	$316.78	$422.37	$47.91–$422.37	—	25%
Speech therapy session, individual inpatient CPT 92507 Speech Language Therapy	$526.20	$701.60	$47.91–$701.60	—	25%
Spirometry (breathing test) CPT 94010 Spirometry	$329.38	$439.17	$135.00–$439.17	24% above	25%
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$329.38	$439.17	$135.00–$439.17	—	25%
Spirometry before and after a bronchodilator CPT 94060 Spirometry W Bd	$475.78	$634.38	$135.00–$634.38	2% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 Spirometry W Bd	$475.78	$634.38	$135.00–$634.38	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot, Therapeutic Activities	$174.94	$233.25	$31.37–$233.25	100% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pt Therapeutic Activities Each 15 Min	$174.94	$233.25	$31.37–$233.25	100% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pt Therapeutic Activities Each 15 Min	$174.94	$233.25	$31.37–$233.25	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ot, Therapeutic Activities	$174.94	$233.25	$31.37–$233.25	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$312.49	$416.65	$135.00–$416.65	56% above	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy	$312.49	$416.65	$135.00–$416.65	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Pfizer Tris Sucrose Vaccine	$147.18	$196.24	$74.57–$631.39	13% below	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Pfizer Tris Sucrose Vaccine	$147.18	$196.24	$74.57–$631.39	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluzone 0.5 Ml	$20.43	$27.24	$10.35–$135.00	34% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fluzone 0.5 Ml	$20.43	$27.24	$10.35–$135.00	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High Dose Qiv 0.7ml	$50.22	$66.96	$25.44–$368.10	37% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High Dose Qiv 0.7ml	$50.22	$66.96	$25.44–$368.10	—	25%
Nasal spray flu vaccine, live (FluMist) CPT 90660 Flumist (Intranasal)	$20.43	$27.24	$10.35–$135.00	47% below	25%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 Flumist (Intranasal)	$20.43	$27.24	$10.35–$135.00	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration Vaccine by Injection, 1 Vac	$68.25	$91.00	$34.58–$135.00	76% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration Vaccine by Injection, 1 Vac	$68.25	$91.00	$34.58–$135.00	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Admin Vaccine Inj Each Addtl Vaccine	$33.58	$44.77	$17.01–$135.00	3% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Admin Vaccine Inj Each Addtl Vaccine	$33.58	$44.77	$17.01–$135.00	—	25%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://fscms.blob.core.windows.net/cmsmrf/machine-readable-files/390816845_froedtert-pleasant-prairie-hospital_standardcharges.csv