Mercyhealth Hospital & Trauma Center
Mercyhealth Hospital & Trauma Center in Janesville, WI publishes cash prices for 366 common procedures listed here, from its own machine-readable price file updated Mar 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 193 of 360 procedures and below it for 167. Click a procedure to compare it with other hospitals nearby.
1000 Mineral Point Ave, Janesville, WI 53548 Collected Sep 29, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views both sides CPT 73610 HC XR ANKLE COM MIN 3V BILATERAL | $355.77 | $474.36 | — | — | 25% |
| Ankle X-ray, complete, 3 or more views CPT 73610 HC PBB PR X-RAY ANKLE 3+ VW | $66.68 | $88.91 | — | 61% below | 25% |
| Ankle X-ray, complete, 3 or more views CPT 73610 HC XR ANKLE COM MIN 3V | $355.77 | $474.36 | — | 110% above | 25% |
| Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 HC XR ANKLE COM MIN 3V BILATERAL | $355.77 | $474.36 | — | — | 25% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC PBB PR X-RAY ANKLE 3+ VW | $66.68 | $88.91 | — | — | 25% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC XR ANKLE COM MIN 3V | $355.77 | $474.36 | — | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC US ARTERIAL DOPPLER ABI-BILATERAL | $575.67 | $767.56 | — | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC US ARTERIAL DOPPLER ABI-BILATERAL | $575.67 | $767.56 | — | — | 25% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHAGRAM | $861.28 | $1,148.37 | — | 115% above | 25% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC ESOPHAGRAM | $861.28 | $1,148.37 | — | — | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC PBB BONE SCAN WHOLE BODY 78306 | $306.32 | $408.43 | — | 78% below | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC BONE SCAN WHOLE BODY | $1,591.73 | $2,122.31 | — | 15% above | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC PBB BONE SCAN WHOLE BODY 78306 | $306.32 | $408.43 | — | — | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC BONE SCAN WHOLE BODY | $1,591.73 | $2,122.31 | — | — | 25% |
| Breast ultrasound, complete, one breast one side CPT 76641 HC US BREAST UNILAT COMPLETE | $991.42 | $1,321.90 | — | 122% above | 25% |
| Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC US BREAST UNILAT COMPLETE | $991.42 | $1,321.90 | — | — | 25% |
| Breast ultrasound, limited (one breast or one area) both sides CPT 76642 HC US BREAST BILAT LIMITED | $622.02 | $829.36 | — | — | 25% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC PBB ULTRASOUND BREAST LIMITED 76642 | $66.68 | $88.91 | — | 80% below | 25% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST UNILAT LIMITED | $829.36 | $1,105.81 | — | 148% above | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 HC US BREAST BILAT LIMITED | $622.02 | $829.36 | — | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC PBB ULTRASOUND BREAST LIMITED 76642 | $66.68 | $88.91 | — | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US BREAST UNILAT LIMITED | $829.36 | $1,105.81 | — | — | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT CTA CHEST | $3,775.97 | $5,034.63 | — | 114% above | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT CTA CHEST | $3,775.97 | $5,034.63 | — | — | 25% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC CCTA CARDIAC | $2,368.96 | $3,158.62 | — | 41% above | 25% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC CCTA CARDIAC | $2,368.96 | $3,158.62 | — | — | 25% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC HEART CAL SCOR W/O CONTRAST | $352.30 | $469.74 | — | 720% above | 25% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT AORTIC VALVE CALCIUM SCORING | $352.30 | $469.74 | — | 720% above | 25% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC HEART CAL SCOR W/O CONTRAST | $352.30 | $469.74 | — | — | 25% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT AORTIC VALVE CALCIUM SCORING | $352.30 | $469.74 | — | — | 25% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABDOMEN/PELVIS W/O CONTRAST | $4,463.48 | $5,951.30 | — | 134% above | 25% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABDOMEN/PELVIS W/O CONTRAST | $4,463.48 | $5,951.30 | — | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN/PELVIS W/CONTRAST | $5,315.15 | $7,086.87 | — | 191% above | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN/PELVIS W/CONTRAST | $5,315.15 | $7,086.87 | — | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 RC CT ABDOMEN/PELVIS UROGRAPHY | $5,492.93 | $7,323.91 | — | 145% above | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABDOMEN/PELVIS W/WO CONTRAST | $8,036.40 | $10,715.20 | — | 259% above | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 RC CT ABDOMEN/PELVIS UROGRAPHY | $5,492.93 | $7,323.91 | — | — | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABDOMEN/PELVIS W/WO CONTRAST | $8,036.40 | $10,715.20 | — | — | 25% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W/ CONTRAST | $2,273.91 | $3,031.88 | — | 55% above | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W/ CONTRAST | $2,273.91 | $3,031.88 | — | — | 25% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN W/O CONTRAST | $1,909.25 | $2,545.67 | — | 83% above | 25% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN W/O CONTRAST | $1,909.25 | $2,545.67 | — | — | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFAC AREA W/O CONT. | $1,724.03 | $2,298.71 | — | 74% above | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFAC AREA W/O CONT. | $1,724.03 | $2,298.71 | — | — | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD W/O CONTRAST | $2,073.07 | $2,764.09 | — | 121% above | 25% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD W/O CONTRAST | $2,073.07 | $2,764.09 | — | — | 25% |
| CT scan of the head with contrast CPT 70460 HC CT HEAD WITH CONTRAST | $2,357.94 | $3,143.92 | — | 103% above | 25% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD WITH CONTRAST | $2,357.94 | $3,143.92 | — | — | 25% |
| CT scan of the head without and with contrast CPT 70470 HC CT HEAD W & W/O CONTRAST | $2,642.81 | $3,523.75 | — | 96% above | 25% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD W & W/O CONTRAST | $2,642.81 | $3,523.75 | — | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST | $2,305.68 | $3,074.24 | — | 112% above | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE W/O CONTRAST | $2,305.68 | $3,074.24 | — | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST | $2,402.12 | $3,202.82 | — | 121% above | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE W/O CONTRAST | $2,402.12 | $3,202.82 | — | — | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS WITH CONTRAST | $2,230.91 | $2,974.55 | — | 51% above | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 RC CT PELVIS (CYSTOGRAM W/CONT) | $2,343.41 | $3,124.55 | — | 59% above | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS WITH CONTRAST | $2,230.91 | $2,974.55 | — | — | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 RC CT PELVIS (CYSTOGRAM W/CONT) | $2,343.41 | $3,124.55 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC PBB DUPLEX SCAN EXTRACRANIAL,BILAT | $182.83 | $243.77 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC VL BILAT CAROTID DUPLEX | $894.10 | $1,192.13 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC PBB DUPLEX SCAN EXTRACRANIAL,BILAT | $182.83 | $243.77 | — | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC VL BILAT CAROTID DUPLEX | $894.10 | $1,192.13 | — | — | 25% |
| Chest X-ray, 2 views CPT 71046 HC PBB X-RAY EXAM CHEST 2 VIEWS | $66.68 | $88.91 | — | 61% below | 25% |
| Chest X-ray, 2 views CPT 71046 HC XRAY CHEST 2 VIEWS | $401.86 | $535.82 | — | 135% above | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 HC PBB X-RAY EXAM CHEST 2 VIEWS | $66.68 | $88.91 | — | — | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 HC XRAY CHEST 2 VIEWS | $401.86 | $535.82 | — | — | 25% |
| Chest X-ray, single view CPT 71045 HC PBB X-RAY EXAM CHEST 1 VIEW | $66.68 | $88.91 | — | 49% below | 25% |
| Chest X-ray, single view CPT 71045 HC XRAY CHEST 1 VIEW | $178.60 | $238.14 | — | 38% above | 25% |
| Chest X-ray, single view CPT 71045 HC XRAY CHEST 1 VIEW PORTABLE | $226.57 | $302.09 | — | 75% above | 25% |
| Chest X-ray, single view inpatient CPT 71045 HC PBB X-RAY EXAM CHEST 1 VIEW | $66.68 | $88.91 | — | — | 25% |
| Chest X-ray, single view inpatient CPT 71045 HC XRAY CHEST 1 VIEW | $178.60 | $238.14 | — | — | 25% |
| Chest X-ray, single view inpatient CPT 71045 HC XRAY CHEST 1 VIEW PORTABLE | $226.57 | $302.09 | — | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC PBB PR US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE | $80.11 | $106.81 | — | 84% below | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERITONEAL COMPLETE | $520.94 | $694.58 | — | 2% above | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC PBB PR US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE | $80.11 | $106.81 | — | — | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERITONEAL COMPLETE | $520.94 | $694.58 | — | — | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC PBB PR DXA BONE DENSITY AXIAL | $80.11 | $106.81 | — | 70% below | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL | $599.53 | $799.37 | — | 121% above | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC PBB PR DXA BONE DENSITY AXIAL | $80.11 | $106.81 | — | — | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY AXIAL | $599.53 | $799.37 | — | — | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC PBB DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL | $66.68 | $88.91 | — | 57% below | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC DXA BONE DENSITY PERIPH | $160.93 | $214.57 | — | 4% above | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC PBB DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL | $66.68 | $88.91 | — | — | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC DXA BONE DENSITY PERIPH | $160.93 | $214.57 | — | — | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC PBB PREG UTER, FET & MAT, DETAILED FET EXM | $182.83 | $243.77 | — | 69% below | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC PBB PREG UTER, FET & MAT, DETAILED FET EXM | $182.83 | $243.77 | — | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST WITHOUT CONTRAST | $2,139.95 | $2,853.27 | — | 96% above | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST WITHOUT CONTRAST | $2,139.95 | $2,853.27 | — | — | 25% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST WITH CONTRAST | $2,394.63 | $3,192.84 | — | 79% above | 25% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST WITH CONTRAST | $2,394.63 | $3,192.84 | — | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC PBB DX MAMMO INCL CAD BI | $92.34 | $123.12 | — | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 RC MM MAMMO BILAT DIAG W/IMPLANTS | $839.73 | $1,119.64 | — | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC MM MAMMO BILATERAL DIAGNOSTIC | $874.84 | $1,166.45 | — | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC PBB DX MAMMO INCL CAD BI | $92.34 | $123.12 | — | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 RC MM MAMMO BILAT DIAG W/IMPLANTS | $839.73 | $1,119.64 | — | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC MM MAMMO BILATERAL DIAGNOSTIC | $874.84 | $1,166.45 | — | — | 25% |
| Diagnostic mammogram, one breast CPT 77065 HC PBB DX MAMMO INCL CAD UNI | $72.27 | $96.36 | — | 67% below | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 HC MM MAMMO UNILAT DIAGNOSTIC | $640.83 | $854.44 | — | 191% above | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 RC MM MAMMO DIAG UNILAT W/IMPLANTS | $691.27 | $921.69 | — | 214% above | 25% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC PBB DX MAMMO INCL CAD UNI | $72.27 | $96.36 | — | — | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC MM MAMMO UNILAT DIAGNOSTIC | $640.83 | $854.44 | — | — | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 RC MM MAMMO DIAG UNILAT W/IMPLANTS | $691.27 | $921.69 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC PBB DUPLEX LO EXTREM ART BILAT 93925 | $182.83 | $243.77 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC US LEG ARTERY BILATERAL DUPLEX | $656.54 | $875.39 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC PBB DUPLEX LO EXTREM ART BILAT 93925 | $182.83 | $243.77 | — | — | 25% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC US LEG ARTERY BILATERAL DUPLEX | $656.54 | $875.39 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC PBB DUPLEX EXTREM VENOUS,BILAT | $182.83 | $243.77 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC VL BILAT VENOUS DUPLEX COMPLEX | $1,147.42 | $1,529.90 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC PBB DUPLEX EXTREM VENOUS,BILAT | $182.83 | $243.77 | — | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC VL BILAT VENOUS DUPLEX COMPLEX | $1,147.42 | $1,529.90 | — | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC PBB ECHO TTHRC R-T 2D -+M-MODE COMPL SPEC&COLOR DOP | $418.69 | $558.25 | — | 70% below | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC EC ECHO WITH BUBBLE STUDY | $1,808.93 | $2,411.91 | — | 32% above | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC 2-D M-MODE ECHO W/DOPPLER | $1,808.93 | $2,411.91 | — | 32% above | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC PBB ECHO TTHRC R-T 2D -+M-MODE COMPL SPEC&COLOR DOP | $418.69 | $558.25 | — | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC EC ECHO WITH BUBBLE STUDY | $1,808.93 | $2,411.91 | — | — | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC 2-D M-MODE ECHO W/DOPPLER | $1,808.93 | $2,411.91 | — | — | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATO T-MAX | $1,871.22 | $2,494.96 | — | 64% above | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC HEPATOBIL SCAN | $1,904.30 | $2,539.06 | — | 67% above | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATO T-MAX | $1,871.22 | $2,494.96 | — | — | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC HEPATOBIL SCAN | $1,904.30 | $2,539.06 | — | — | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY, UNATTENDED | $529.52 | $706.02 | — | 14% below | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY, UNATTENDED | $529.52 | $706.02 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC PBB POLYSOMNOGRAPHY W/CPAP | $658.00 | $877.34 | — | 81% below | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC ORAL APPLIANCE SLEEP STUDY | $5,338.21 | $7,117.61 | — | 58% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC PEDS 6-17 YRS CPAP SLEEP STUDY | $5,338.21 | $7,117.61 | — | 58% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC VPAP SLEEP STUDY | $5,338.21 | $7,117.61 | — | 58% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC SPLIT SLEEP STUDY | $5,592.59 | $7,456.79 | — | 65% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC CPAP SLEEP STUDY | $5,592.59 | $7,456.79 | — | 65% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC PBB POLYSOMNOGRAPHY W/CPAP | $658.00 | $877.34 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC VPAP SLEEP STUDY | $5,338.21 | $7,117.61 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC PEDS 6-17 YRS CPAP SLEEP STUDY | $5,338.21 | $7,117.61 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC ORAL APPLIANCE SLEEP STUDY | $5,338.21 | $7,117.61 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC CPAP SLEEP STUDY | $5,592.59 | $7,456.79 | — | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC SPLIT SLEEP STUDY | $5,592.59 | $7,456.79 | — | — | 25% |
| Knee X-ray, 3 views both sides CPT 73562 HC XR KNEE COMPLETE 3V BILATERAL | $417.15 | $556.20 | — | — | 25% |
| Knee X-ray, 3 views CPT 73562 HC PBB PR X-RAY KNEE 3 VIEW | $66.68 | $88.91 | — | 69% below | 25% |
| Knee X-ray, 3 views CPT 73562 HC XR KNEE COMPLETE 3V | $480.25 | $640.33 | — | 123% above | 25% |
| Knee X-ray, 3 views inpatient both sides CPT 73562 HC XR KNEE COMPLETE 3V BILATERAL | $417.15 | $556.20 | — | — | 25% |
| Knee X-ray, 3 views inpatient CPT 73562 HC PBB PR X-RAY KNEE 3 VIEW | $66.68 | $88.91 | — | — | 25% |
| Knee X-ray, 3 views inpatient CPT 73562 HC XR KNEE COMPLETE 3V | $480.25 | $640.33 | — | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC PBB PR SONO ABDOMEN LIMITED | $80.11 | $106.81 | — | 81% below | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ABDOMINAL LIMITED | $1,351.12 | $1,801.49 | — | 218% above | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC PBB PR SONO ABDOMEN LIMITED | $80.11 | $106.81 | — | — | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ABDOMINAL LIMITED | $1,351.12 | $1,801.49 | — | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC PBB CT LOW DOSE LUNG SCREENING 71271 | $80.11 | $106.81 | — | 78% below | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT LOW DOSE LUNG SCREENING | $1,072.30 | $1,429.74 | — | 198% above | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC PBB CT LOW DOSE LUNG SCREENING 71271 | $80.11 | $106.81 | — | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT LOW DOSE LUNG SCREENING | $1,072.30 | $1,429.74 | — | — | 25% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 HC MRI BREAST W&WO CONTRAST W/CAD BI | $9,809.40 | $13,079.20 | — | — | 25% |
| MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 HC MRI BREAST W&WO CONTRAST W/CAD BI | $9,809.40 | $13,079.20 | — | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 HC MRI EXT LOWER, JOINT WO CON BILATERAL | $3,047.02 | $4,062.69 | — | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HBB CHG MRI JT LOWER EXTREM W/O CNTRST MATRL 73721 | $182.83 | $243.77 | — | 89% below | 25% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI EXT LOWER, JOINT WO CON | $4,416.98 | $5,889.31 | — | 164% above | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 HC MRI EXT LOWER, JOINT WO CON BILATERAL | $3,047.02 | $4,062.69 | — | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HBB CHG MRI JT LOWER EXTREM W/O CNTRST MATRL 73721 | $182.83 | $243.77 | — | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI EXT LOWER, JOINT WO CON | $4,416.98 | $5,889.31 | — | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC PBB PR MRI, JOINT OF LEG. COMBO | $267.32 | $356.43 | — | 91% below | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI EXT LOWER, JOINT W/WO CON | $6,309.64 | $8,412.85 | — | 106% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC PBB PR MRI, JOINT OF LEG. COMBO | $267.32 | $356.43 | — | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI EXT LOWER, JOINT W/WO CON | $6,309.64 | $8,412.85 | — | — | 25% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN W/O CONTRAST | $5,882.44 | $7,843.26 | — | 208% above | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN W/O CONTRAST | $5,882.44 | $7,843.26 | — | — | 25% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO CONTRAST | $8,370.80 | $11,161.06 | — | 194% above | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W/WO CONTRAST | $8,370.80 | $11,161.06 | — | — | 25% |
| MRI of the brain, no contrast dye CPT 70551 HC PBB PR MRI BRAIN | $182.83 | $243.77 | — | 89% below | 25% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN W/O CONTRAST | $4,713.19 | $6,284.25 | — | 191% above | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC PBB PR MRI BRAIN | $182.83 | $243.77 | — | — | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN W/O CONTRAST | $4,713.19 | $6,284.25 | — | — | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W/WO CONTRAST | $4,878.56 | $6,504.75 | — | 111% above | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 RC MRI BRAIN W/WO CONTRAST W STEALT | $6,559.97 | $8,746.63 | — | 184% above | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W/WO CONTRAST | $4,878.56 | $6,504.75 | — | — | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 RC MRI BRAIN W/WO CONTRAST W STEALT | $6,559.97 | $8,746.63 | — | — | 25% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST | $5,379.62 | $7,172.82 | — | 176% above | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI LUMBAR SPINE W/O CONTRAST | $5,379.62 | $7,172.82 | — | — | 25% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST | $7,535.38 | $10,047.18 | — | 175% above | 25% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI LUMBAR SPINE W/WO CONTRAST | $7,535.38 | $10,047.18 | — | — | 25% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST | $5,480.02 | $7,306.69 | — | 176% above | 25% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI THORACIC SPINE W/O CONTRAST | $5,480.02 | $7,306.69 | — | — | 25% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST | $7,277.22 | $9,702.96 | — | 254% above | 25% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI CERVICAL SPINE W/WO CONTRAST | $7,277.22 | $9,702.96 | — | — | 25% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST | $5,231.86 | $6,975.81 | — | 198% above | 25% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI CERVICAL SPINE W/O CONTRAST | $5,231.86 | $6,975.81 | — | — | 25% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W & W/O CONTRAST | $6,375.42 | $8,500.56 | — | 125% above | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W & W/O CONTRAST | $6,375.42 | $8,500.56 | — | — | 25% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS W/O CONTRAST | $4,293.83 | $5,725.11 | — | 123% above | 25% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS W/O CONTRAST | $4,293.83 | $5,725.11 | — | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 HC MRI EXT UPPER, JOINT WO CON BILATERAL | $3,560.19 | $4,746.92 | — | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC PBB PR MRI, JOINT UPPER EXTREM | $182.83 | $243.77 | — | 90% below | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI EXT UPPER, JOINT WO CON | $4,746.92 | $6,329.23 | — | 161% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 HC MRI EXT UPPER, JOINT WO CON BILATERAL | $3,560.19 | $4,746.92 | — | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC PBB PR MRI, JOINT UPPER EXTREM | $182.83 | $243.77 | — | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI EXT UPPER, JOINT WO CON | $4,746.92 | $6,329.23 | — | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 PBB HT MUSCLE IMAGE SPECT MULT 78452 | $992.02 | $1,322.69 | — | 63% below | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC MYOC PERF SPECT MULT W/M & EF | $3,994.64 | $5,326.18 | — | 51% above | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 PBB HT MUSCLE IMAGE SPECT MULT 78452 | $992.02 | $1,322.69 | — | — | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC MYOC PERF SPECT MULT W/M & EF | $3,994.64 | $5,326.18 | — | — | 25% |
| OCT scan of the retina (optical coherence tomography) CPT 92134 HC PBB SCANNING OPHTHAL IMAG 92134 | $45.20 | $60.27 | — | 20% above | 25% |
| OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 HC PBB SCANNING OPHTHAL IMAG 92134 | $45.20 | $60.27 | — | — | 25% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC PET CT TUMOR IMAGING MIDTHIGH | $5,200.22 | $6,933.62 | — | 42% above | 25% |
| PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 HC PET CT TUMOR IMAGING MIDTHIGH | $5,200.22 | $6,933.62 | — | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC PBB LIMITED FOLLOW-UP PELVIC US | $80.11 | $106.81 | — | 74% below | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US SUPERFICIAL PELVIS LTD | $451.48 | $601.97 | — | 47% above | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC PBB LIMITED FOLLOW-UP PELVIC US | $80.11 | $106.81 | — | — | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US SUPERFICIAL PELVIS LTD | $451.48 | $601.97 | — | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC PBB COMPLETE PELVIC ULTRASOUND | $80.11 | $106.81 | — | 81% below | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIS | $1,324.66 | $1,766.21 | — | 208% above | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC PBB COMPLETE PELVIC ULTRASOUND | $80.11 | $106.81 | — | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIS | $1,324.66 | $1,766.21 | — | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC PBB PREG UTER, FETAL & MAT, 2-3 TRIMESTER | $80.11 | $106.81 | — | 84% below | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US FETAL>14 WEEKS | $1,055.92 | $1,407.89 | — | 116% above | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC PBB PREG UTER, FETAL & MAT, 2-3 TRIMESTER | $80.11 | $106.81 | — | — | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US FETAL>14 WEEKS | $1,055.92 | $1,407.89 | — | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC PBB PREG UTER,FETAL & MAT, 1ST TRIMEST | $80.11 | $106.81 | — | 79% below | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US FETAL < 14 WKS | $1,055.92 | $1,407.89 | — | 171% above | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC PBB PREG UTER,FETAL & MAT, 1ST TRIMEST | $80.11 | $106.81 | — | — | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US FETAL < 14 WKS | $1,055.92 | $1,407.89 | — | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC PBB PR US,PREGNANT UTERUS,LIMITED, 1/> FETUSES | $80.11 | $106.81 | — | 78% below | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC L/D ULTRASOUND-FETAL POS | $97.62 | $130.16 | — | 73% below | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US FETAL LIMITD/FHB/PLAC/AFI/POS | $562.28 | $749.70 | — | 53% above | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC PBB PR US,PREGNANT UTERUS,LIMITED, 1/> FETUSES | $80.11 | $106.81 | — | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC L/D ULTRASOUND-FETAL POS | $97.62 | $130.16 | — | — | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US FETAL LIMITD/FHB/PLAC/AFI/POS | $562.28 | $749.70 | — | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 HC PBB SCR MAMMO BI INCL CAD | $76.34 | $101.78 | — | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 RC MAMMO BILAT SCREEN W/IMPLANTS | $839.73 | $1,119.64 | — | — | 25% |
| Screening mammogram, both breasts CPT 77067 RC MAMMO UNI SCREEN W/IMPLANTS | $419.87 | $559.83 | — | 130% above | 25% |
| Screening mammogram, both breasts CPT 77067 RC MM MAMMO BIL SCREEN-PHYS REFER | $812.82 | $1,083.76 | — | 345% above | 25% |
| Screening mammogram, both breasts one side CPT 77067 HC MAMMO SCREENING UNILATERAL | $386.09 | $514.79 | — | 112% above | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC PBB SCR MAMMO BI INCL CAD | $76.34 | $101.78 | — | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 RC MAMMO BILAT SCREEN W/IMPLANTS | $839.73 | $1,119.64 | — | — | 25% |
| Screening mammogram, both breasts inpatient CPT 77067 RC MAMMO UNI SCREEN W/IMPLANTS | $419.87 | $559.83 | — | — | 25% |
| Screening mammogram, both breasts inpatient CPT 77067 RC MM MAMMO BIL SCREEN-PHYS REFER | $812.82 | $1,083.76 | — | — | 25% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC MAMMO SCREENING UNILATERAL | $386.09 | $514.79 | — | — | 25% |
| Shoulder X-ray, complete, 2 or more views both sides CPT 73030 HC XR SHOULDER COM MIN 2V BILATERAL | $383.78 | $511.71 | — | — | 25% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC PBB PR X-RAY SHOULDER 2+ VW | $66.68 | $88.91 | — | 61% below | 25% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC XR SHOULDER COM MIN 2V | $383.78 | $511.71 | — | 123% above | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 HC XR SHOULDER COM MIN 2V BILATERAL | $383.78 | $511.71 | — | — | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC PBB PR X-RAY SHOULDER 2+ VW | $66.68 | $88.91 | — | — | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC XR SHOULDER COM MIN 2V | $383.78 | $511.71 | — | — | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PBB POLYSOMNOGRAPHY, 4 OR MORE | $658.00 | $877.34 | — | 81% below | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PARTIAL SLEEP STUDY | $2,902.64 | $3,870.19 | — | 14% below | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PEDS 6-17 YRS PSG SLEEP STUDY | $5,118.41 | $6,824.55 | — | 51% above | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC COMPLETE PSG SLEEP STUDY | $5,362.32 | $7,149.76 | — | 58% above | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PBB POLYSOMNOGRAPHY, 4 OR MORE | $658.00 | $877.34 | — | — | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PARTIAL SLEEP STUDY | $2,902.64 | $3,870.19 | — | — | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PEDS 6-17 YRS PSG SLEEP STUDY | $5,118.41 | $6,824.55 | — | — | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC COMPLETE PSG SLEEP STUDY | $5,362.32 | $7,149.76 | — | — | 25% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC VIDEO SWALLOWING STUDY | $892.76 | $1,190.35 | — | 156% above | 25% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC VIDEO SWALLOWING STUDY | $892.76 | $1,190.35 | — | — | 25% |
| Transvaginal pelvic ultrasound CPT 76830 HC PBB PR ECHOGRAPHY,TRANSVAGINAL | $80.11 | $106.81 | — | 80% below | 25% |
| Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL NON OB | $925.28 | $1,233.70 | — | 132% above | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC PBB PR ECHOGRAPHY,TRANSVAGINAL | $80.11 | $106.81 | — | — | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL NON OB | $925.28 | $1,233.70 | — | — | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC PBB PR US,PREGNANT UTERUS,TRANSVAGINAL | $80.11 | $106.81 | — | 78% below | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC US TRANSVAGINAL OB | $436.59 | $582.12 | — | 18% above | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC PBB PR US,PREGNANT UTERUS,TRANSVAGINAL | $80.11 | $106.81 | — | — | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US TRANSVAGINAL OB | $436.59 | $582.12 | — | — | 25% |
| Ultrasound of the abdomen, complete CPT 76700 HC PBB PR US,ABDOM,B-SCAN &/OR REAL TIME,COMPLETE | $80.11 | $106.81 | — | 85% below | 25% |
| Ultrasound of the abdomen, complete CPT 76700 HC US ABDOMEN COMPLETE | $1,389.98 | $1,853.30 | — | 152% above | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC PBB PR US,ABDOM,B-SCAN &/OR REAL TIME,COMPLETE | $80.11 | $106.81 | — | — | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US ABDOMEN COMPLETE | $1,389.98 | $1,853.30 | — | — | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 HC PBB PR ECHO,SCROTUM & CONTENTS | $80.11 | $106.81 | — | 81% below | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM | $716.90 | $955.87 | — | 68% above | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC PBB PR ECHO,SCROTUM & CONTENTS | $80.11 | $106.81 | — | — | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM | $716.90 | $955.87 | — | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC PBB PR US,HEAD/NECK TISSUES,B-SCAN/REAL TIME | $80.11 | $106.81 | — | 81% below | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC IR US HEAD/NECK | $1,170.86 | $1,561.14 | — | 174% above | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US HEAD / NECK | $1,170.86 | $1,561.14 | — | 174% above | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC PBB PR US,HEAD/NECK TISSUES,B-SCAN/REAL TIME | $80.11 | $106.81 | — | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC IR US HEAD/NECK | $1,170.86 | $1,561.14 | — | — | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US HEAD / NECK | $1,170.86 | $1,561.14 | — | — | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RC SP UGI | $914.58 | $1,219.44 | — | 117% above | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC UPPER GI SERIES | $1,052.05 | $1,402.73 | — | 150% above | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RC SP UGI | $914.58 | $1,219.44 | — | — | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC UPPER GI SERIES | $1,052.05 | $1,402.73 | — | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC PBB UNILAT L/EXT VENOUS DUPLX MAP | $80.11 | $106.81 | — | 87% below | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC VL UNILATERAL VENOUS DUPLEX COMP | $1,028.81 | $1,371.75 | — | 71% above | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC PBB UNILAT L/EXT VENOUS DUPLX MAP | $80.11 | $106.81 | — | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC VL UNILATERAL VENOUS DUPLEX COMP | $1,028.81 | $1,371.75 | — | — | 25% |
| Wrist X-ray, complete, 3 or more views both sides CPT 73110 HC XR WRIST COM MIN 3V BILATERAL | $396.22 | $528.30 | — | — | 25% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC PBB PR X-RAY WRIST 3+ VW | $66.68 | $88.91 | — | 66% below | 25% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC XR WRIST COM MIN 3V | $396.22 | $528.30 | — | 101% above | 25% |
| Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 HC XR WRIST COM MIN 3V BILATERAL | $396.22 | $528.30 | — | — | 25% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC PBB PR X-RAY WRIST 3+ VW | $66.68 | $88.91 | — | — | 25% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC XR WRIST COM MIN 3V | $396.22 | $528.30 | — | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included both sides CPT 73502 HC XR HIP 2-3V W/PELVIS, BILAT | $662.10 | $882.80 | — | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC PBB X-RAY EXAM HIP UNI 2-3 VIEWS 73502 | $66.68 | $88.91 | — | 68% below | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC XR HIP UNILAT 2-3V W/PELVIS | $761.33 | $1,015.11 | — | 266% above | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient both sides CPT 73502 HC XR HIP 2-3V W/PELVIS, BILAT | $662.10 | $882.80 | — | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC PBB X-RAY EXAM HIP UNI 2-3 VIEWS 73502 | $66.68 | $88.91 | — | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HC XR HIP UNILAT 2-3V W/PELVIS | $761.33 | $1,015.11 | — | — | 25% |
| X-ray of the abdomen, 1 view CPT 74018 HC PBB X-RAY EXAM ABDOMEN 1 VIEW | $66.68 | $88.91 | — | 63% below | 25% |
| X-ray of the abdomen, 1 view CPT 74018 HC XR TORSO 1V (STILLBORN EVAL) | $206.00 | $274.66 | — | 14% above | 25% |
| X-ray of the abdomen, 1 view CPT 74018 HC XRAY ABDOMEN ONE VIEW | $267.64 | $356.85 | — | 48% above | 25% |
| X-ray of the abdomen, 1 view CPT 74018 HC XR ABDOMEN 1V PORTABLE | $432.49 | $576.65 | — | 138% above | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC PBB X-RAY EXAM ABDOMEN 1 VIEW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR TORSO 1V (STILLBORN EVAL) | $206.00 | $274.66 | — | — | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XRAY ABDOMEN ONE VIEW | $267.64 | $356.85 | — | — | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC XR ABDOMEN 1V PORTABLE | $432.49 | $576.65 | — | — | 25% |
| X-ray of the ankle, 2 views both sides CPT 73600 HC XR ANKLE 2 VIEWS BILATERAL | $286.30 | $381.73 | — | — | 25% |
| X-ray of the ankle, 2 views CPT 73600 HC PBB PR X-RAY ANKLE 2 VW | $66.68 | $88.91 | — | 56% below | 25% |
| X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 1 VIEW | $286.30 | $381.73 | — | 90% above | 25% |
| X-ray of the ankle, 2 views CPT 73600 HC XR ANKLE 2 VIEWS | $328.80 | $438.40 | — | 118% above | 25% |
| X-ray of the ankle, 2 views inpatient both sides CPT 73600 HC XR ANKLE 2 VIEWS BILATERAL | $286.30 | $381.73 | — | — | 25% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC PBB PR X-RAY ANKLE 2 VW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 1 VIEW | $286.30 | $381.73 | — | — | 25% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC XR ANKLE 2 VIEWS | $328.80 | $438.40 | — | — | 25% |
| X-ray of the finger(s), 2 or more views both sides CPT 73140 HC XR FINGER(S) MIN 2V BILATERAL | $273.37 | $364.49 | — | — | 25% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC PBB PR X-RAY EXAM OF FINGER(S) | $66.68 | $88.91 | — | 62% below | 25% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC XR FINGER(S) MIN 2V | $314.29 | $419.05 | — | 81% above | 25% |
| X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 HC XR FINGER(S) MIN 2V BILATERAL | $273.37 | $364.49 | — | — | 25% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC PBB PR X-RAY EXAM OF FINGER(S) | $66.68 | $88.91 | — | — | 25% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC XR FINGER(S) MIN 2V | $314.29 | $419.05 | — | — | 25% |
| X-ray of the foot, 2 views both sides CPT 73620 HC XR FOOT 2V BILATERAL | $280.06 | $373.41 | — | — | 25% |
| X-ray of the foot, 2 views CPT 73620 HC PBB PR X-RAY FOOT 2 VW | $66.68 | $88.91 | — | 63% below | 25% |
| X-ray of the foot, 2 views CPT 73620 HC XR FOOT 2V | $280.06 | $373.41 | — | 56% above | 25% |
| X-ray of the foot, 2 views inpatient both sides CPT 73620 HC XR FOOT 2V BILATERAL | $280.06 | $373.41 | — | — | 25% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC PBB PR X-RAY FOOT 2 VW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC XR FOOT 2V | $280.06 | $373.41 | — | — | 25% |
| X-ray of the foot, complete, 3 or more views both sides CPT 73630 HC XR FOOT COM MIN 3V BILATERAL | $328.94 | $438.59 | — | — | 25% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC PBB X-RAY FOOT 3+ VW | $66.68 | $88.91 | — | 68% below | 25% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC XR FOOT COM MIN 3V | $378.58 | $504.78 | — | 80% above | 25% |
| X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 HC XR FOOT COM MIN 3V BILATERAL | $328.94 | $438.59 | — | — | 25% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC PBB X-RAY FOOT 3+ VW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC XR FOOT COM MIN 3V | $378.58 | $504.78 | — | — | 25% |
| X-ray of the hand, 3 or more views both sides CPT 73130 HC XR HAND COM MIN 3V BILATERAL | $301.06 | $401.41 | — | — | 25% |
| X-ray of the hand, 3 or more views CPT 73130 HC PBB PR X-RAY HAND 3+ VW | $66.68 | $88.91 | — | 66% below | 25% |
| X-ray of the hand, 3 or more views CPT 73130 HC XR HAND COM MIN 3V | $401.41 | $535.21 | — | 107% above | 25% |
| X-ray of the hand, 3 or more views inpatient both sides CPT 73130 HC XR HAND COM MIN 3V BILATERAL | $301.06 | $401.41 | — | — | 25% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC PBB PR X-RAY HAND 3+ VW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC XR HAND COM MIN 3V | $401.41 | $535.21 | — | — | 25% |
| X-ray of the knee, 1 or 2 views both sides CPT 73560 HC XR KNEE 1 OR 2 VIEWS BILATERAL | $376.82 | $502.43 | — | — | 25% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC PBB PR X-RAY KNEE 1 OR 2 VIEW | $66.68 | $88.91 | — | 59% below | 25% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC XR KNEE 1 OR 2 VIEWS | $433.57 | $578.09 | — | 163% above | 25% |
| X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 HC XR KNEE 1 OR 2 VIEWS BILATERAL | $376.82 | $502.43 | — | — | 25% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC PBB PR X-RAY KNEE 1 OR 2 VIEW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC XR KNEE 1 OR 2 VIEWS | $433.57 | $578.09 | — | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC PBB PR X-RAY LUMBAR SPINE 2/3 VW | $80.11 | $106.81 | — | 65% below | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC XR LUMBAR SPINE 2V OR 3V | $311.17 | $414.89 | — | 35% above | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC PBB PR X-RAY LUMBAR SPINE 2/3 VW | $80.11 | $106.81 | — | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC XR LUMBAR SPINE 2V OR 3V | $311.17 | $414.89 | — | — | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 HC PBB PR X-RAY LUMBAR SPINE 4 VW | $80.11 | $106.81 | — | 73% below | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 HC XR LUMBAR SPINE MIN 4V | $642.04 | $856.06 | — | 119% above | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC PBB PR X-RAY LUMBAR SPINE 4 VW | $80.11 | $106.81 | — | — | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC XR LUMBAR SPINE MIN 4V | $642.04 | $856.06 | — | — | 25% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC PBB PR X-RAY THORACIC SPINE 2 VW | $80.11 | $106.81 | — | 60% below | 25% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC XR THORACIC SPINE 2V | $353.69 | $471.59 | — | 74% above | 25% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC PBB PR X-RAY THORACIC SPINE 2 VW | $80.11 | $106.81 | — | — | 25% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC XR THORACIC SPINE 2V | $353.69 | $471.59 | — | — | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC PBB PR X-RAY NASAL BONES | $66.68 | $88.91 | — | 66% below | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC XR NASAL BONES COM MIN 3V | $318.44 | $424.58 | — | 61% above | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC PBB PR X-RAY NASAL BONES | $66.68 | $88.91 | — | — | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC XR NASAL BONES COM MIN 3V | $318.44 | $424.58 | — | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC PBB CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS | $66.68 | $88.91 | — | 69% below | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC XR CERVICAL SPINE 2V OR 3V | $318.08 | $424.11 | — | 48% above | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC PBB CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS | $66.68 | $88.91 | — | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC XR CERVICAL SPINE 2V OR 3V | $318.08 | $424.11 | — | — | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC PBB PR X-RAY PELVIS 1/2 VW | $80.11 | $106.81 | — | 56% below | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC XR PELVIS 1 OR 2 VIEWS | $442.90 | $590.53 | — | 142% above | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PBB PR X-RAY PELVIS 1/2 VW | $80.11 | $106.81 | — | — | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC XR PELVIS 1 OR 2 VIEWS | $442.90 | $590.53 | — | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC PBB PR X-RAY SACRUM/COCCYX 2+ VW | $66.68 | $88.91 | — | 63% below | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC XR SACRUM/COCCYX MIN 2V | $418.01 | $557.35 | — | 129% above | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC PBB PR X-RAY SACRUM/COCCYX 2+ VW | $66.68 | $88.91 | — | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC XR SACRUM/COCCYX MIN 2V | $418.01 | $557.35 | — | — | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 CHG TRANSFERASE ALANINE AMINO ALT SGPT | $79.65 | $106.20 | — | 89% above | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 CHG TRANSFERASE ALANINE AMINO ALT SGPT | $79.65 | $106.20 | — | — | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 CHG TRANSFERASE ASPARTATE AMINO AST SGOT | $79.65 | $106.20 | — | 68% above | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 CHG TRANSFERASE ASPARTATE AMINO AST SGOT | $79.65 | $106.20 | — | — | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 CHG ACUTE HEPATITIS PANEL | $635.82 | $847.76 | — | 109% above | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 CHG ACUTE HEPATITIS PANEL | $635.82 | $847.76 | — | — | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 CHG ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $46.19 | $61.59 | — | 85% above | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHG ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH | $46.19 | $61.59 | — | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY | $189.66 | $252.88 | — | 137% above | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CHG CYCLIC CITRULLINATED PEPTIDE ANTIBODY | $189.66 | $252.88 | — | — | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 CHG ANTINUCLEAR ANTIBODIES ANA | $111.20 | $148.26 | — | 62% above | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CHG ANTINUCLEAR ANTIBODIES ANA | $111.20 | $148.26 | — | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 CHG NATRIURETIC PEPTIDE | $257.65 | $343.53 | — | 86% above | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 CHG NATRIURETIC PEPTIDE | $257.65 | $343.53 | — | — | 25% |
| Basic metabolic panel (blood test) CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $135.88 | $181.17 | — | 58% above | 25% |
| Basic metabolic panel (blood test) inpatient CPT 80048 CHG BASIC METABOLIC PANEL CALCIUM TOTAL | $135.88 | $181.17 | — | — | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | $374.44 | $499.25 | — | 85% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 CHG LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM | $374.44 | $499.25 | — | — | 25% |
| Blood culture for bacteria CPT 87040 CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | $144.22 | $192.29 | — | 75% above | 25% |
| Blood culture for bacteria inpatient CPT 87040 CHG CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | $144.22 | $192.29 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC PBB COLLECTION VENOUS BLOOD,VENIPUNCTURE | $20.87 | $27.83 | — | 59% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC VENIPUNCTURE | $37.21 | $49.61 | — | 184% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE | $37.21 | $49.61 | — | 184% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 RC CT ISTAT BLOOD DRAW | $37.21 | $49.61 | — | 184% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC PBB COLLECTION VENOUS BLOOD,VENIPUNCTURE | $20.87 | $27.83 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE | $37.21 | $49.61 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 RC CT ISTAT BLOOD DRAW | $37.21 | $49.61 | — | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC VENIPUNCTURE | $37.21 | $49.61 | — | — | 25% |
| Blood glucose (sugar) test CPT 82947 HC GLUCOSE | $72.42 | $96.56 | — | 222% above | 25% |
| Blood glucose (sugar) test CPT 82947 CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $75.02 | $100.02 | — | 233% above | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 HC GLUCOSE | $72.42 | $96.56 | — | — | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP | $75.02 | $100.02 | — | — | 25% |
| Blood lead test CPT 83655 CHG ASSAY OF LEAD | $92.62 | $123.49 | — | 88% above | 25% |
| Blood lead test inpatient CPT 83655 CHG ASSAY OF LEAD | $92.62 | $123.49 | — | — | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHG GONADOTROPIN CHORIONIC QUALITATIVE | $162.07 | $216.09 | — | 232% above | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHG GONADOTROPIN CHORIONIC QUALITATIVE | $162.07 | $216.09 | — | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO | $70.38 | $93.84 | — | 76% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CHG BLOOD TYPING SEROLOGIC ABO | $70.38 | $93.84 | — | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CHG C-REACTIVE PROTEIN | $73.22 | $97.62 | — | 34% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CHG C-REACTIVE PROTEIN | $73.22 | $97.62 | — | — | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE | $190.84 | $254.46 | — | 33% above | 25% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CHG INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE | $190.84 | $254.46 | — | — | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 | $201.18 | $268.24 | — | 83% above | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 | $201.18 | $268.24 | — | — | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 | $195.86 | $261.14 | — | 67% above | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CHG IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 | $195.86 | $261.14 | — | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $135.00 | $180.00 | — | 1% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ | $135.00 | $180.00 | — | — | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $224.91 | $299.88 | — | 57% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ | $224.91 | $299.88 | — | — | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CHG LIPID PANEL | $155.60 | $207.46 | — | 68% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CHG LIPID PANEL | $155.60 | $207.46 | — | — | 25% |
| Complete blood count (CBC) with differential CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $124.86 | $166.48 | — | 78% above | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CHG BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC | $124.86 | $166.48 | — | — | 25% |
| Complete blood count (CBC), no differential CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $89.19 | $118.92 | — | 78% above | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CHG BLOOD COUNT COMPLETE AUTOMATED | $89.19 | $118.92 | — | — | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $164.92 | $219.90 | — | 45% above | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHG COMPREHENSIVE METABOLIC PANEL | $164.92 | $219.90 | — | — | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE | $153.59 | $204.79 | — | 124% above | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 CHG FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE | $153.59 | $204.79 | — | — | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 CHG DEHYDROEPIANDROSTERONE-SULFATE | $345.32 | $460.42 | — | 151% above | 25% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 CHG DEHYDROEPIANDROSTERONE-SULFATE | $345.32 | $460.42 | — | — | 25% |
| Estradiol blood test CPT 82670 CHG ASSAY OF TOTAL ESTRADIOL | $223.50 | $298.00 | — | 85% above | 25% |
| Estradiol blood test inpatient CPT 82670 CHG ASSAY OF TOTAL ESTRADIOL | $223.50 | $298.00 | — | — | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE | $315.11 | $420.15 | — | 172% above | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 CHG GONADOTROPIN FOLLICLE STIMULATING HORMONE | $315.11 | $420.15 | — | — | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CHG ASSAY OF CALPROTECTIN FECAL | $312.09 | $416.12 | — | 68% above | 25% |
| Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CHG ASSAY OF CALPROTECTIN FECAL | $312.09 | $416.12 | — | — | 25% |
| Ferritin blood test (iron stores) CPT 82728 CHG ASSAY OF FERRITIN | $169.48 | $225.97 | — | 88% above | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 CHG ASSAY OF FERRITIN | $169.48 | $225.97 | — | — | 25% |
| Folate (folic acid) blood test CPT 82746 CHG ASSAY OF FOLIC ACID SERUM | $170.40 | $227.20 | — | 72% above | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 CHG ASSAY OF FOLIC ACID SERUM | $170.40 | $227.20 | — | — | 25% |
| Free T3 thyroid hormone test CPT 84481 CHG ASSAY OF TRIIODOTHYRONINE T3 FREE | $337.10 | $449.47 | — | 255% above | 25% |
| Free T3 thyroid hormone test inpatient CPT 84481 CHG ASSAY OF TRIIODOTHYRONINE T3 FREE | $337.10 | $449.47 | — | — | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 CHG ASSAY OF FREE THYROXINE | $149.63 | $199.51 | — | 86% above | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 CHG ASSAY OF FREE THYROXINE | $149.63 | $199.51 | — | — | 25% |
| Free testosterone test CPT 84402 CHG ASSAY OF TESTOSTERONE FREE | $236.59 | $315.45 | — | 106% above | 25% |
| Free testosterone test inpatient CPT 84402 CHG ASSAY OF TESTOSTERONE FREE | $236.59 | $315.45 | — | — | 25% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 CHG GENERAL HEALTH PANEL | $348.81 | $465.08 | — | 36% above | 25% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 CHG GENERAL HEALTH PANEL | $348.81 | $465.08 | — | — | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 CHG GLUCOSE POST GLUCOSE DOSE | $118.80 | $158.40 | — | 154% above | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 CHG GLUCOSE POST GLUCOSE DOSE | $118.80 | $158.40 | — | — | 25% |
| Glucose tolerance test, 3 samples CPT 82951 CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS | $201.34 | $268.46 | — | 135% above | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS | $201.34 | $268.46 | — | — | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $179.61 | $239.48 | — | 26% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ | $179.61 | $239.48 | — | — | 25% |
| H. pylori antibody blood test CPT 86677 CHG ANTIBODY HELICOBACTER PYLORI | $243.44 | $324.58 | — | 188% above | 25% |
| H. pylori antibody blood test inpatient CPT 86677 CHG ANTIBODY HELICOBACTER PYLORI | $243.44 | $324.58 | — | — | 25% |
| H. pylori stool antigen test CPT 87338 CHG IAAD IA HPYLORI STOOL | $286.28 | $381.70 | — | 129% above | 25% |
| H. pylori stool antigen test inpatient CPT 87338 CHG IAAD IA HPYLORI STOOL | $286.28 | $381.70 | — | — | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION | $866.09 | $1,154.79 | — | 131% above | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 CHG IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION | $866.09 | $1,154.79 | — | — | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 CHG ANTIBODY HIV-1&HIV-2 SINGLE RESULT | $116.10 | $154.80 | — | 55% above | 25% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 CHG ANTIBODY HIV-1&HIV-2 SINGLE RESULT | $116.10 | $154.80 | — | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE | $168.10 | $224.14 | — | 68% above | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE | $168.10 | $224.14 | — | — | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 CHG IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT | $211.68 | $282.24 | — | 48% above | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 CHG IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT | $211.68 | $282.24 | — | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CHG HEMOGLOBIN GLYCOSYLATED A1C | $125.85 | $167.80 | — | 151% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CHG HEMOGLOBIN GLYCOSYLATED A1C | $125.85 | $167.80 | — | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 CHG HEPATITIS B SURF ANTIBODY HBSAB | $121.41 | $161.88 | — | 64% above | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 CHG HEPATITIS B SURF ANTIBODY HBSAB | $121.41 | $161.88 | — | — | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 CHG IAAD IA HEPATITIS B SURFACE ANTIGEN | $108.82 | $145.10 | — | 66% above | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 CHG IAAD IA HEPATITIS B SURFACE ANTIGEN | $108.82 | $145.10 | — | — | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 CHG HEPATITIS C ANTIBODY | $180.28 | $240.38 | — | 119% above | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 CHG HEPATITIS C ANTIBODY | $180.28 | $240.38 | — | — | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 CHG IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION | $789.33 | $1,052.44 | — | 257% above | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 CHG IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION | $789.33 | $1,052.44 | — | — | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 CHG ANTIBODY HERPES SMPLX TYPE 1 | $122.30 | $163.07 | — | 88% above | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 CHG ANTIBODY HERPES SMPLX TYPE 1 | $122.30 | $163.07 | — | — | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 CHG ANTIBODY HERPES SMPLX TYPE 2 | $171.04 | $228.06 | — | 117% above | 25% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 CHG ANTIBODY HERPES SMPLX TYPE 2 | $171.04 | $228.06 | — | — | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 CHG C-REACTIVE PROTEIN HIGH SENSITIVITY | $148.00 | $197.34 | — | 91% above | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CHG C-REACTIVE PROTEIN HIGH SENSITIVITY | $148.00 | $197.34 | — | — | 25% |
| Homocysteine blood test CPT 83090 CHG ASSAY OF HOMOCYSTEINE | $221.48 | $295.31 | — | 87% above | 25% |
| Homocysteine blood test inpatient CPT 83090 CHG ASSAY OF HOMOCYSTEINE | $221.48 | $295.31 | — | — | 25% |
| Insulin blood test CPT 83525 CHG ASSAY OF INSULIN TOTAL | $177.19 | $236.25 | — | 173% above | 25% |
| Insulin blood test inpatient CPT 83525 CHG ASSAY OF INSULIN TOTAL | $177.19 | $236.25 | — | — | 25% |
| Iron blood test (serum iron) CPT 83540 CHG ASSAY OF IRON | $137.06 | $182.75 | — | 157% above | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 CHG ASSAY OF IRON | $137.06 | $182.75 | — | — | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 CHG IRON BINDING CAPACITY | $133.36 | $177.81 | — | 115% above | 25% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 CHG IRON BINDING CAPACITY | $133.36 | $177.81 | — | — | 25% |
| Kidney function blood test panel CPT 80069 CHG RENAL FUNCTION PANEL | $158.69 | $211.59 | — | 55% above | 25% |
| Kidney function blood test panel inpatient CPT 80069 CHG RENAL FUNCTION PANEL | $158.69 | $211.59 | — | — | 25% |
| LH (luteinizing hormone) test CPT 83002 CHG GONADOTROPIN LUTEINIZING HORMONE | $231.56 | $308.74 | — | 144% above | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 CHG GONADOTROPIN LUTEINIZING HORMONE | $231.56 | $308.74 | — | — | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 CHG ASSAY OF LIPASE | $155.59 | $207.45 | — | 130% above | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 CHG ASSAY OF LIPASE | $155.59 | $207.45 | — | — | 25% |
| Liver function blood test panel CPT 80076 CHG HEPATIC FUNCTION PANEL | $163.88 | $218.51 | — | 71% above | 25% |
| Liver function blood test panel inpatient CPT 80076 CHG HEPATIC FUNCTION PANEL | $163.88 | $218.51 | — | — | 25% |
| Lyme disease antibody test CPT 86618 CHG ANTIBODY BORRELIA BURGDORFERI LYME DISEASE | $140.03 | $186.71 | — | 78% above | 25% |
| Lyme disease antibody test inpatient CPT 86618 CHG ANTIBODY BORRELIA BURGDORFERI LYME DISEASE | $140.03 | $186.71 | — | — | 25% |
| Magnesium blood test CPT 83735 CHG ASSAY OF MAGNESIUM | $37.66 | $50.21 | — | 25% below | 25% |
| Magnesium blood test inpatient CPT 83735 CHG ASSAY OF MAGNESIUM | $37.66 | $50.21 | — | — | 25% |
| Measles (rubeola) antibody test CPT 86765 CHG ANTIBODY RUBEOLA | $210.04 | $280.05 | — | 163% above | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 CHG ANTIBODY RUBEOLA | $210.04 | $280.05 | — | — | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 CHG HETEROPHILE ANTIBODIES SCREEN | $102.81 | $137.08 | — | 87% above | 25% |
| Mono test (heterophile antibody, Monospot) inpatient CPT 86308 CHG HETEROPHILE ANTIBODIES SCREEN | $102.81 | $137.08 | — | — | 25% |
| Obstetric blood test panel CPT 80055 CHG OBSTETRIC PANEL | $544.54 | $726.06 | — | 184% above | 25% |
| Obstetric blood test panel inpatient CPT 80055 CHG OBSTETRIC PANEL | $544.54 | $726.06 | — | — | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $231.53 | $308.71 | — | 157% above | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE | $231.53 | $308.71 | — | — | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $147.64 | $196.86 | — | 64% above | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CHG ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL | $147.64 | $196.86 | — | — | 25% |
| Pap test (liquid-based, automated screening with review) CPT 88175 CHG CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $154.63 | $206.17 | — | 47% above | 25% |
| Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CHG CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS | $154.63 | $206.17 | — | — | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN | $147.99 | $197.32 | — | 69% above | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN | $147.99 | $197.32 | — | — | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 CHG ASSAY OF PARATHORMONE | $323.05 | $430.73 | — | 73% above | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 CHG ASSAY OF PARATHORMONE | $323.05 | $430.73 | — | — | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $95.13 | $126.84 | — | 90% above | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 CHG THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD | $95.13 | $126.84 | — | — | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 CHG FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS | $2,507.08 | $3,342.78 | — | 108% above | 25% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 CHG FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS | $2,507.08 | $3,342.78 | — | — | 25% |
| Progesterone blood test CPT 84144 CHG ASSAY OF PROGESTERONE | $287.93 | $383.91 | — | 140% above | 25% |
| Progesterone blood test inpatient CPT 84144 CHG ASSAY OF PROGESTERONE | $287.93 | $383.91 | — | — | 25% |
| Prolactin blood test CPT 84146 CHG ASSAY OF PROLACTIN | $248.66 | $331.55 | — | 106% above | 25% |
| Prolactin blood test inpatient CPT 84146 CHG ASSAY OF PROLACTIN | $248.66 | $331.55 | — | — | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $56.48 | $75.31 | — | 78% above | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 CHG PROTHROMBIN TIME | $61.45 | $81.93 | — | 94% above | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $56.48 | $75.31 | — | — | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CHG PROTHROMBIN TIME | $61.45 | $81.93 | — | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE | $131.73 | $175.64 | — | 160% above | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE | $131.73 | $175.64 | — | — | 25% |
| Rapid flu test (influenza antigen) CPT 87804 CHG IAADIADOO INFLUENZA | $54.47 | $72.63 | — | 3% above | 25% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 CHG IAADIADOO INFLUENZA | $54.47 | $72.63 | — | — | 25% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A | $138.97 | $185.29 | — | 205% above | 25% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 CHG IAADIADOO STREPTOCOCCUS GROUP A | $138.97 | $185.29 | — | — | 25% |
| Rheumatoid factor (RF) test CPT 86431 CHG RHEUMATOID FACTOR QUANTITATIVE | $114.62 | $152.82 | — | 99% above | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 CHG RHEUMATOID FACTOR QUANTITATIVE | $114.62 | $152.82 | — | — | 25% |
| Rubella antibody test (immunity check) CPT 86762 CHG ANTIBODY RUBELLA | $91.29 | $121.72 | — | 14% above | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 CHG ANTIBODY RUBELLA | $91.29 | $121.72 | — | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 CHG SEDIMENTATION RATE RBC AUTOMATED | $66.39 | $88.52 | — | 75% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 CHG SEDIMENTATION RATE RBC AUTOMATED | $66.39 | $88.52 | — | — | 25% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 CHG SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT | $287.31 | $383.08 | — | 211% above | 25% |
| Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 CHG SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT | $287.31 | $383.08 | — | — | 25% |
| Stool ova and parasites exam CPT 87177 CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID | $142.10 | $189.46 | — | 127% above | 25% |
| Stool ova and parasites exam inpatient CPT 87177 CHG OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID | $142.10 | $189.46 | — | — | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | $50.34 | $67.12 | — | 150% above | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER | $50.34 | $67.12 | — | — | 25% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 | $62.42 | $83.23 | — | 16% above | 25% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CHG BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 | $62.42 | $83.23 | — | — | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL | $74.42 | $99.22 | — | 98% above | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 CHG SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL | $74.42 | $99.22 | — | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $347.41 | $463.21 | — | 38% above | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON | $347.41 | $463.21 | — | — | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 CHG ASSAY OF TESTOSTERONE TOTAL | $298.00 | $397.33 | — | 165% above | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 CHG ASSAY OF TESTOSTERONE TOTAL | $298.00 | $397.33 | — | — | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 CHG MICROSOMAL ANTIBODIES EACH | $269.42 | $359.22 | — | 299% above | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 CHG MICROSOMAL ANTIBODIES EACH | $269.42 | $359.22 | — | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $206.52 | $275.36 | — | 138% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CHG ASSAY OF THYROID STIMULATING HORMONE TSH | $206.52 | $275.36 | — | — | 25% |
| Trichomonas test (NAAT) CPT 87661 CHG IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $236.49 | $315.32 | — | 73% above | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 CHG IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH | $236.49 | $315.32 | — | — | 25% |
| Uric acid blood test CPT 84550 CHG ASSAY OF BLOOD/URIC ACID | $73.16 | $97.55 | — | 57% above | 25% |
| Uric acid blood test inpatient CPT 84550 CHG ASSAY OF BLOOD/URIC ACID | $73.16 | $97.55 | — | — | 25% |
| Urinalysis with microscope exam, automated CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $94.27 | $125.69 | — | 135% above | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY | $94.27 | $125.69 | — | — | 25% |
| Urinalysis without microscope exam, automated CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $55.40 | $73.87 | — | 132% above | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY | $55.40 | $73.87 | — | — | 25% |
| Urinalysis without microscope exam, manual CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $53.75 | $71.67 | — | 258% above | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP | $53.75 | $71.67 | — | — | 25% |
| Urine culture for bacteria, with colony count CPT 87086 CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE | $112.36 | $149.82 | — | 49% above | 25% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE | $112.36 | $149.82 | — | — | 25% |
| Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY TEST | $61.94 | $82.58 | — | 4% above | 25% |
| Urine pregnancy test, read by color change CPT 81025 CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS | $104.50 | $139.34 | — | 76% above | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY TEST | $61.94 | $82.58 | — | — | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS | $104.50 | $139.34 | — | — | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CHG CYANOCOBALAMIN VITAMIN B-12 | $170.40 | $227.20 | — | 70% above | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CHG CYANOCOBALAMIN VITAMIN B-12 | $170.40 | $227.20 | — | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED | $316.73 | $422.31 | — | 111% above | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CHG 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED | $316.73 | $422.31 | — | — | 25% |
| Zinc blood test CPT 84630 CHG ASSAY OF ZINC | $177.19 | $236.25 | — | 129% above | 25% |
| Zinc blood test inpatient CPT 84630 CHG ASSAY OF ZINC | $177.19 | $236.25 | — | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHG GONADOTROPIN CHORIONIC QUANTITATIVE | $194.23 | $258.97 | — | 73% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHG GONADOTROPIN CHORIONIC QUANTITATIVE | $194.23 | $258.97 | — | — | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 HC PBB NSL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS | $5,407.74 | $7,210.32 | — | 182% above | 25% |
| Balloon dilation of the maxillary sinus opening, one side inpatient CPT 31295 HC PBB NSL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS | $5,407.74 | $7,210.32 | — | — | 25% |
| Botox injections for chronic migraine CPT 64615 HC PBB CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | $235.20 | $313.60 | — | 63% below | 25% |
| Botox injections for chronic migraine CPT 64615 HC CHEMODENERVATION FACIAL/TRIGEMINAL/CERVICAL, BIL | $641.74 | $855.65 | — | 2% above | 25% |
| Botox injections for chronic migraine inpatient CPT 64615 HC PBB CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE | $235.20 | $313.60 | — | — | 25% |
| Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODENERVATION FACIAL/TRIGEMINAL/CERVICAL, BIL | $641.74 | $855.65 | — | — | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC PBB PR BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE | $1,265.53 | $1,687.37 | — | 30% below | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BREAST BIOPSY, FIRST, STEREO | $3,526.94 | $4,702.59 | — | 94% above | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC PBB PR BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE | $1,265.53 | $1,687.37 | — | — | 25% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BREAST BIOPSY, FIRST, STEREO | $3,526.94 | $4,702.59 | — | — | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC PBB CLOSED RX DIST FIBULA FX | $189.01 | $252.01 | — | 66% below | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC CLOSED RX DIST FIBULA FX | $626.27 | $835.03 | — | 13% above | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC PBB CLOSED RX DIST FIBULA FX | $189.01 | $252.01 | — | — | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC CLOSED RX DIST FIBULA FX | $626.27 | $835.03 | — | — | 25% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC PBB TREAT METATARSAL FRACTURE | $189.01 | $252.01 | — | 68% below | 25% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC PBB TREAT METATARSAL FRACTURE | $189.01 | $252.01 | — | — | 25% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HC PBB CORRECT BUNION,METATARSAL OSTEOTOMY | $2,507.15 | $3,342.87 | — | 44% below | 25% |
| Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HC PBB CORRECT BUNION,METATARSAL OSTEOTOMY | $2,507.15 | $3,342.87 | — | — | 25% |
| Bunion correction with removal of part of the big toe joint CPT 28292 HC PBB CORRECT BUNION,KELLER/MCBRIDE/MAYO | $2,507.15 | $3,342.87 | — | 29% below | 25% |
| Bunion correction with removal of part of the big toe joint inpatient CPT 28292 HC PBB CORRECT BUNION,KELLER/MCBRIDE/MAYO | $2,507.15 | $3,342.87 | — | — | 25% |
| Cardiac catheterization with coronary angiogram CPT 93458 HC PBB CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | $2,484.11 | $3,312.15 | — | 75% below | 25% |
| Cardiac catheterization with coronary angiogram CPT 93458 HC LHC - CORONARY AND LV | $10,345.39 | $13,793.85 | — | 4% above | 25% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC PBB CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I | $2,484.11 | $3,312.15 | — | — | 25% |
| Cardiac catheterization with coronary angiogram inpatient CPT 93458 HC LHC - CORONARY AND LV | $10,345.39 | $13,793.85 | — | — | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION | $319.47 | $425.96 | — | 63% below | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC PBB CARDIOVERSION, ELECTIVE;EXTERN | $506.44 | $675.26 | — | 42% below | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC ELECTIVE CARDIOVERSION | $1,422.04 | $1,896.06 | — | 64% above | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CC CARDIOVERSION ELECTIVE | $1,586.90 | $2,115.87 | — | 83% above | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION | $319.47 | $425.96 | — | — | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC PBB CARDIOVERSION, ELECTIVE;EXTERN | $506.44 | $675.26 | — | — | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC ELECTIVE CARDIOVERSION | $1,422.04 | $1,896.06 | — | — | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CC CARDIOVERSION ELECTIVE | $1,586.90 | $2,115.87 | — | — | 25% |
| Carpal tunnel release, open surgery CPT 64721 HC PBB REVISE MEDIAN N/CARPAL TUNNEL SURG | $1,496.26 | $1,995.02 | — | 20% below | 25% |
| Carpal tunnel release, open surgery inpatient CPT 64721 HC PBB REVISE MEDIAN N/CARPAL TUNNEL SURG | $1,496.26 | $1,995.02 | — | — | 25% |
| Cataract surgery with lens implant CPT 66984 HC PBB CATARACT REMOVAL, INSERTION OF LENS | $1,768.36 | $2,357.81 | — | 57% below | 25% |
| Cataract surgery with lens implant inpatient CPT 66984 HC PBB CATARACT REMOVAL, INSERTION OF LENS | $1,768.36 | $2,357.81 | — | — | 25% |
| Catheter ablation for atrial fibrillation CPT 93656 HC EP ABLATION BY PULMONARY VEIN ISOLATION | $44,100.52 | $58,800.70 | — | 149% above | 25% |
| Catheter ablation for atrial fibrillation inpatient CPT 93656 HC EP ABLATION BY PULMONARY VEIN ISOLATION | $44,100.52 | $58,800.70 | — | — | 25% |
| Cervical biopsy CPT 57500 HC PBB BIOPSY/EXCIS CERVICAL LESN | $705.75 | $941.00 | — | 19% above | 25% |
| Cervical biopsy CPT 57500 HC BIOPSY OF CERVIX | $902.50 | $1,203.33 | — | 52% above | 25% |
| Cervical biopsy inpatient CPT 57500 HC PBB BIOPSY/EXCIS CERVICAL LESN | $705.75 | $941.00 | — | — | 25% |
| Cervical biopsy inpatient CPT 57500 HC BIOPSY OF CERVIX | $902.50 | $1,203.33 | — | — | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC PBB CIRCUMCISION,OTHR | $1,601.74 | $2,135.66 | — | 58% above | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 HC PBB CIRCUMCISION,OTHR | $1,601.74 | $2,135.66 | — | — | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC PBB CIRCUMCISION,CLAMP,NEWBORN | $1,601.74 | $2,135.66 | — | 821% above | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HC PBB CIRCUMCISION,CLAMP,NEWBORN | $1,601.74 | $2,135.66 | — | — | 25% |
| Circumcision, surgical, older than a newborn CPT 54160 HC PBB CIRCUMCISION,OTHR,NEWBORN | $534.30 | $712.40 | — | 28% below | 25% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 HC PBB CIRCUMCISION,OTHR,NEWBORN | $534.30 | $712.40 | — | — | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC PBB TREAT FRCTR RADIUS/ULNA | $189.01 | $252.01 | — | 69% below | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC TX FX DISTAL RADIUS/ULNA | $368.22 | $490.96 | — | 40% below | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC PBB TREAT FRCTR RADIUS/ULNA | $189.01 | $252.01 | — | — | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 HC TX FX DISTAL RADIUS/ULNA | $368.22 | $490.96 | — | — | 25% |
| Colonoscopy with polyp removal CPT 45385 HC PBB COLONOSCOPY,REMV LESN,SNARE | $916.92 | $1,222.56 | — | 56% below | 25% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC PBB COLONOSCOPY,REMV LESN,SNARE | $916.92 | $1,222.56 | — | — | 25% |
| Colonoscopy with tissue sample CPT 45380 HC PBB COLONOSCOPY,BIOPSY | $916.92 | $1,222.56 | — | 52% below | 25% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC PBB COLONOSCOPY,BIOPSY | $916.92 | $1,222.56 | — | — | 25% |
| Colonoscopy, diagnostic CPT 45378 HC PBB COLONOSCOPY,DIAGNOSTIC | $712.58 | $950.10 | — | 54% below | 25% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC PBB COLONOSCOPY,DIAGNOSTIC | $712.58 | $950.10 | — | — | 25% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC PBB COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX | $2,480.43 | $3,307.24 | — | 188% above | 25% |
| Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 HC PBB COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX | $2,480.43 | $3,307.24 | — | — | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC PBB COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG | $233.50 | $311.33 | — | 48% below | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC PBB COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG | $233.50 | $311.33 | — | — | 25% |
| Coronary stent placement, one artery CPT 92928 HC CC TRANSCATH INTRASTENT SINGLE | $16,936.10 | $22,581.47 | — | 116% above | 25% |
| Coronary stent placement, one artery inpatient CPT 92928 HC CC TRANSCATH INTRASTENT SINGLE | $16,936.10 | $22,581.47 | — | — | 25% |
| Cystoscopy with ureteral stent placement CPT 52332 HC PBB CYSTOSCOPY,INSERT URETERAL STENT | $2,701.00 | $3,601.33 | — | 29% above | 25% |
| Cystoscopy with ureteral stent placement CPT 52332 HC CYSTOSCOPY & TREATMENT | $3,717.14 | $4,956.18 | — | 77% above | 25% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 HC PBB CYSTOSCOPY,INSERT URETERAL STENT | $2,701.00 | $3,601.33 | — | — | 25% |
| Cystoscopy with ureteral stent placement inpatient CPT 52332 HC CYSTOSCOPY & TREATMENT | $3,717.14 | $4,956.18 | — | — | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC PBB CYSTOSCOPY | $534.30 | $712.40 | — | 18% below | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 HC PBB CYSTOSCOPY | $534.30 | $712.40 | — | — | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 HC PBB DESTR ANY METH W OR W/O CURET | $153.74 | $204.98 | — | 25% below | 25% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 HC PBB DESTR ANY METH W OR W/O CURET | $153.74 | $204.98 | — | — | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 HC PBB CREATE EARDRUM OPENING,GEN ANESTH | $1,188.89 | $1,585.19 | — | 95% above | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 HC PBB CREATE EARDRUM OPENING,GEN ANESTH | $1,188.89 | $1,585.19 | — | — | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 HC PBB CREATE EARDRUM OPENING,LOCAL ANESTH | $413.26 | $551.01 | — | 21% below | 25% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 HC PBB CREATE EARDRUM OPENING,LOCAL ANESTH | $413.26 | $551.01 | — | — | 25% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC PBB REMOVE IMPACTED EAR WAX UNI 69209 | $45.20 | $60.27 | — | 21% below | 25% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC EAR IMPACTED CERUMEN IRR/LAVAGE | $119.28 | $159.04 | — | 109% above | 25% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC EAR IMPACTED CERUMEN IRR/LAVAGE 69209 | $119.28 | $159.04 | — | 109% above | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC PBB REMOVE IMPACTED EAR WAX UNI 69209 | $45.20 | $60.27 | — | — | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC EAR IMPACTED CERUMEN IRR/LAVAGE | $119.28 | $159.04 | — | — | 25% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC EAR IMPACTED CERUMEN IRR/LAVAGE 69209 | $119.28 | $159.04 | — | — | 25% |
| Earwax removal with instruments, one ear CPT 69210 HC PBB REMOVE IMPACTED EAR WAX UNI | $45.20 | $60.27 | — | 46% below | 25% |
| Earwax removal with instruments, one ear one side CPT 69210 HC REMOVAL IMPACT CERUMEN UNILATERAL | $192.93 | $257.24 | — | 130% above | 25% |
| Earwax removal with instruments, one ear inpatient CPT 69210 HC PBB REMOVE IMPACTED EAR WAX UNI | $45.20 | $60.27 | — | — | 25% |
| Earwax removal with instruments, one ear inpatient one side CPT 69210 HC REMOVAL IMPACT CERUMEN UNILATERAL | $192.93 | $257.24 | — | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC PBB BIOPSY OF UTERUS LINING | $154.91 | $206.55 | — | 43% below | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC BIOPSY OF UTERUS LINING 58100 | $545.21 | $726.95 | — | 101% above | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC PBB BIOPSY OF UTERUS LINING | $154.91 | $206.55 | — | — | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC BIOPSY OF UTERUS LINING 58100 | $545.21 | $726.95 | — | — | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 HC PBB NASAL SCOPY,RMV TISS MAXILL SINUS | $5,407.74 | $7,210.32 | — | 33% above | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 HC PBB NASAL SCOPY,RMV TISS MAXILL SINUS | $5,407.74 | $7,210.32 | — | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC PBB NJX INTERLAMINAR CRV/THRC | $540.88 | $721.17 | — | 36% below | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC EPIDURAL INJ CERV/THOR W/IMAGE GUIDANCE | $2,539.14 | $3,385.52 | — | 201% above | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC PBB NJX INTERLAMINAR CRV/THRC | $540.88 | $721.17 | — | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC EPIDURAL INJ CERV/THOR W/IMAGE GUIDANCE | $2,539.14 | $3,385.52 | — | — | 25% |
| Eye injection into the vitreous (intravitreal injection) CPT 67028 HC PBB INJ EYE DRUG | $253.10 | $337.46 | — | 37% below | 25% |
| Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 HC PBB INJ EYE DRUG | $253.10 | $337.46 | — | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV BILATERAL | $2,287.10 | $3,049.46 | — | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC PBB NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL | $677.72 | $903.63 | — | 24% below | 25% |
| Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV UNILATERAL | $2,161.59 | $2,882.12 | — | 142% above | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV BILATERAL | $2,287.10 | $3,049.46 | — | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC PBB NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL | $677.72 | $903.63 | — | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV UNILATERAL | $2,161.59 | $2,882.12 | — | — | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC PBB SIGMOIDOSCOPY,DIAGNOSTIC | $712.58 | $950.10 | — | 15% below | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 HC PBB SIGMOIDOSCOPY,DIAGNOSTIC | $712.58 | $950.10 | — | — | 25% |
| Hammertoe correction surgery CPT 28285 HC PBB REPAIR OF HAMMERTOE,ONE | $2,507.15 | $3,342.87 | — | 8% below | 25% |
| Hammertoe correction surgery inpatient CPT 28285 HC PBB REPAIR OF HAMMERTOE,ONE | $2,507.15 | $3,342.87 | — | — | 25% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC PBB LIGATION OF HEMORRHOID(S) | $712.58 | $950.10 | — | 44% below | 25% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC PBB LIGATION OF HEMORRHOID(S) | $712.58 | $950.10 | — | — | 25% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 HC PBB HEMORRHOIDECTOMY,INT/EXT,SIMPLE | $2,126.84 | $2,835.78 | — | 4% below | 25% |
| Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HC PBB HEMORRHOIDECTOMY,INT/EXT,SIMPLE | $2,126.84 | $2,835.78 | — | — | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 RC US HYSTEROSONOGRAPHY CATH & INJ | $404.53 | $539.37 | — | 56% above | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC HYSTEROSONOGRAPHY CATH & INJ | $404.53 | $539.37 | — | 56% above | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC PBB CATH/INJECT HYSTEROSALPINGOGRAM | $598.06 | $797.42 | — | 131% above | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC HYSTEROSONOGRAPHY CATH & INJ | $404.53 | $539.37 | — | — | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 RC US HYSTEROSONOGRAPHY CATH & INJ | $404.53 | $539.37 | — | — | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC PBB CATH/INJECT HYSTEROSALPINGOGRAM | $598.06 | $797.42 | — | — | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 HC INSERTION INTRAUTERINE DEVICE IUD | $229.61 | $306.15 | — | 25% below | 25% |
| IUD insertion (the device itself billed separately) inpatient CPT 58300 HC INSERTION INTRAUTERINE DEVICE IUD | $229.61 | $306.15 | — | — | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC PBB DRAINAGE OF SKIN ABSCESS | $153.74 | $204.98 | — | 50% below | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC DRAINAGE OF SKIN ABSCESS I&C 10060 | $238.94 | $318.58 | — | 22% below | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC SIMPLE SKIN ABSCESS I & D 10060 | $238.94 | $318.58 | — | 22% below | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC PBB DRAINAGE OF SKIN ABSCESS | $153.74 | $204.98 | — | — | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC DRAINAGE OF SKIN ABSCESS I&C 10060 | $238.94 | $318.58 | — | — | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC SIMPLE SKIN ABSCESS I & D 10060 | $238.94 | $318.58 | — | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC PBB INJ TENDON/LIGAMENT/CYST | $235.20 | $313.60 | — | 9% below | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ TENDON SHEATH/LIGAMENT | $535.22 | $713.62 | — | 108% above | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC PBB INJ TENDON/LIGAMENT/CYST | $235.20 | $313.60 | — | — | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ TENDON SHEATH/LIGAMENT | $535.22 | $713.62 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 HC SP LARGE JOINT INJ/ASP BILAT | $366.04 | $488.06 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 HC INTRA ARTICULAR, MAJOR JOINT BILATERAL | $366.04 | $488.06 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC PBB DRAIN/INJECT JOINT/BURSA | $235.20 | $313.60 | — | 32% below | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC INJ LARGE JOINT ASPIRATION | $488.06 | $650.74 | — | 41% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC LARGE JOINT INJ ASP UNI | $488.06 | $650.74 | — | 41% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 RC FL INJECT LARGE JOINT ASPIRATION | $488.06 | $650.74 | — | 41% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC IR ARTHROCENTESIS ASPIR/INJECT LG JOINT | $488.06 | $650.74 | — | 41% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC ARTHROCENTESIS-MAJ JT/BURS 20610 | $488.06 | $650.74 | — | 41% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 HC SP LARGE JOINT INJ/ASP BILAT | $366.04 | $488.06 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 HC INTRA ARTICULAR, MAJOR JOINT BILATERAL | $366.04 | $488.06 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC PBB DRAIN/INJECT JOINT/BURSA | $235.20 | $313.60 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC LARGE JOINT INJ ASP UNI | $488.06 | $650.74 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC INJ LARGE JOINT ASPIRATION | $488.06 | $650.74 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 RC FL INJECT LARGE JOINT ASPIRATION | $488.06 | $650.74 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC ARTHROCENTESIS-MAJ JT/BURS 20610 | $488.06 | $650.74 | — | — | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC IR ARTHROCENTESIS ASPIR/INJECT LG JOINT | $488.06 | $650.74 | — | — | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC PBB INSERTION DRUG IMPLANT DEVICE | $101.95 | $135.93 | — | 59% below | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC INSERTION DRUG IMPLANT DEVICE | $316.65 | $422.20 | — | 28% above | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC PBB INSERTION DRUG IMPLANT DEVICE | $101.95 | $135.93 | — | — | 25% |
| Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC INSERTION DRUG IMPLANT DEVICE | $316.65 | $422.20 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 HC SP INTERMEDIATE JT INJ/ASP BILAT | $350.56 | $467.42 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC PBB DRAIN/INJECT JOINT/BRSA | $235.20 | $313.60 | — | 20% below | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHRCNTSIS-INTM JT/BRSA 20605 | $467.42 | $623.22 | — | 60% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC IR INTERMED JT INJ/ASP W/O US | $467.42 | $623.22 | — | 60% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC ARTHROCNTESIS-INTM JT/BURS 20605 | $467.42 | $623.22 | — | 60% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 RC FL INJECT INTERMED JOINT/ASPIRATI | $467.42 | $623.22 | — | 60% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 HC SP INTERMEDIATE JT INJ/ASP BILAT | $350.56 | $467.42 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC PBB DRAIN/INJECT JOINT/BRSA | $235.20 | $313.60 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHROCNTESIS-INTM JT/BURS 20605 | $467.42 | $623.22 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC ARTHRCNTSIS-INTM JT/BRSA 20605 | $467.42 | $623.22 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC IR INTERMED JT INJ/ASP W/O US | $467.42 | $623.22 | — | — | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 RC FL INJECT INTERMED JOINT/ASPIRATI | $467.42 | $623.22 | — | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC PBB DRAIN/INJECT JOINT/BRSA 20600 | $235.20 | $313.60 | — | 16% below | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHRCNTESIS.SM JT/BURSA | $619.90 | $826.53 | — | 122% above | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC ARTHROCENTESIS OR INJ SM JOINT | $619.90 | $826.53 | — | 122% above | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC PBB DRAIN/INJECT JOINT/BRSA 20600 | $235.20 | $313.60 | — | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHRCNTESIS.SM JT/BURSA | $619.90 | $826.53 | — | — | 25% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC ARTHROCENTESIS OR INJ SM JOINT | $619.90 | $826.53 | — | — | 25% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC PBB ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING | $2,507.15 | $3,342.87 | — | 15% below | 25% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HC PBB ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING | $2,507.15 | $3,342.87 | — | — | 25% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 HC PBB AFTER CATARACT LASER | $421.43 | $561.91 | — | 64% below | 25% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 HC PBB AFTER CATARACT LASER | $421.43 | $561.91 | — | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC LAYER CLOSURE 2.5 OR < | $310.42 | $413.90 | — | 37% below | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC PBB LAYER CLOSURE OF WOUND | $311.49 | $415.32 | — | 37% below | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC LAYER CLOSURE 2.5 OR < | $310.42 | $413.90 | — | — | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC PBB LAYER CLOSURE OF WOUND | $311.49 | $415.32 | — | — | 25% |
| Left heart catheterization, diagnostic one side CPT 93452 HC LT CATH W/WO LV ANGIOGRAPHY | $8,676.70 | $11,568.93 | — | 39% above | 25% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC LT CATH W/WO LV ANGIOGRAPHY | $8,676.70 | $11,568.93 | — | — | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC PBB NJX INTERLAMINAR LMBR/SAC | $540.88 | $721.17 | — | 9% below | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC EPIDURAL INJ LUMBAR/SAC W/IMAGE GUIDANCE | $2,024.19 | $2,698.92 | — | 242% above | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC PBB NJX INTERLAMINAR LMBR/SAC | $540.88 | $721.17 | — | — | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC EPIDURAL INJ LUMBAR/SAC W/IMAGE GUIDANCE | $2,024.19 | $2,698.92 | — | — | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC INJ INTERLAMINAR, LUMBAR/SACRAL W/O GUIDANCE | $1,375.91 | $1,834.55 | — | 96% above | 25% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC INJ INTERLAMINAR, LUMBAR/SACRAL W/O GUIDANCE | $1,375.91 | $1,834.55 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 HC INJ TRANSFORAMINAL EPI LUMBAR/SAC BILAT | $1,268.54 | $1,691.38 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 HC SP TRANS EPI LUMBAR BILAT | $2,139.45 | $2,852.60 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC PBB NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL | $677.72 | $903.63 | — | 13% below | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ TRANSFORAMINAL EPI LUMBAR/SAC UNI | $1,268.54 | $1,691.38 | — | 63% above | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC SP TRANSFOR EPI LUMBAR UNI | $6,034.62 | $8,046.16 | — | 676% above | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 HC INJ TRANSFORAMINAL EPI LUMBAR/SAC BILAT | $1,268.54 | $1,691.38 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 HC SP TRANS EPI LUMBAR BILAT | $2,139.45 | $2,852.60 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC PBB NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL | $677.72 | $903.63 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ TRANSFORAMINAL EPI LUMBAR/SAC UNI | $1,268.54 | $1,691.38 | — | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC SP TRANSFOR EPI LUMBAR UNI | $6,034.62 | $8,046.16 | — | — | 25% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 HC PBB LAMINEC/FACETECT/FORAMIN,LUMBAR | $5,560.04 | $7,413.38 | — | 54% below | 25% |
| Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 HC PBB LAMINEC/FACETECT/FORAMIN,LUMBAR | $5,560.04 | $7,413.38 | — | — | 25% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals CPT 17311 HC PBB MOHS N/N/HF/G 1ST STGE 17311 | $566.31 | $755.08 | — | 58% below | 25% |
| Mohs surgery for skin cancer, first stage, head, neck, hands, feet or genitals inpatient CPT 17311 HC PBB MOHS N/N/HF/G 1ST STGE 17311 | $566.31 | $755.08 | — | — | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC PBB REMOVAL OF SKIN LESION 11400 | $542.60 | $723.47 | — | 56% above | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC PBB REMOVAL OF SKIN LESION 11400 | $542.60 | $723.47 | — | — | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC PBB REMOVAL OF SKIN LESION 11440 | $542.60 | $723.47 | — | 5% above | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 HC PBB REMOVAL OF SKIN LESION 11440 | $542.60 | $723.47 | — | — | 25% |
| Nail removal (partial or complete), one nail CPT 11730 HC PBB REMOVAL OF NAIL PLATE | $153.74 | $204.98 | — | 32% below | 25% |
| Nail removal (partial or complete), one nail CPT 11730 HC REMOVAL OF NAIL PLATE 11730 | $183.27 | $244.36 | — | 19% below | 25% |
| Nail removal (partial or complete), one nail CPT 11730 HC REMOVAL OF NAIL PLATE | $183.27 | $244.36 | — | 19% below | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC PBB REMOVAL OF NAIL PLATE | $153.74 | $204.98 | — | — | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC REMOVAL OF NAIL PLATE | $183.27 | $244.36 | — | — | 25% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC REMOVAL OF NAIL PLATE 11730 | $183.27 | $244.36 | — | — | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 HC PBB N BLOCK INJ OCCIPITAL | $235.20 | $313.60 | — | 47% below | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 HC OCCIPITAL NERVE BLOCK W/O PHENOL | $579.82 | $773.09 | — | 30% above | 25% |
| Occipital nerve block (injection for headaches) CPT 64405 HC INJ NERVE BLOCK OCCIPITAL | $579.82 | $773.09 | — | 30% above | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC PBB N BLOCK INJ OCCIPITAL | $235.20 | $313.60 | — | — | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC OCCIPITAL NERVE BLOCK W/O PHENOL | $579.82 | $773.09 | — | — | 25% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ NERVE BLOCK OCCIPITAL | $579.82 | $773.09 | — | — | 25% |
| Pacemaker implant (dual chamber) CPT 33208 HC PACER - PERM DUAL | $15,526.92 | $20,702.56 | — | 145% above | 25% |
| Pacemaker implant (dual chamber) inpatient CPT 33208 HC PACER - PERM DUAL | $15,526.92 | $20,702.56 | — | — | 25% |
| Paracentesis with imaging guidance CPT 49083 HC PARACENTESIS W/IMAGING | $1,492.88 | $1,990.50 | — | 21% above | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC PARACENTESIS W/IMAGING | $1,492.88 | $1,990.50 | — | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC TC EX NAIL & MATRIX 11750 | $275.91 | $367.88 | — | 15% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC PBB REMOVAL OF NAIL BED | $311.49 | $415.32 | — | 5% below | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC TC EX NAIL & MATRIX 11750 | $275.91 | $367.88 | — | — | 25% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC PBB REMOVAL OF NAIL BED | $311.49 | $415.32 | — | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 HC DESTROY LUMB/SAC FACET JNT BILAT SNGL | $2,801.00 | $3,734.66 | — | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JT UNI | $2,697.29 | $3,596.39 | — | 46% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JT BIL | $2,801.00 | $3,734.66 | — | 52% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JNT | $2,801.13 | $3,734.84 | — | 52% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient both sides CPT 64635 HC DESTROY LUMB/SAC FACET JNT BILAT SNGL | $2,801.00 | $3,734.66 | — | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JT UNI | $2,697.29 | $3,596.39 | — | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JT BIL | $2,801.00 | $3,734.66 | — | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JNT | $2,801.13 | $3,734.84 | — | — | 25% |
| Removal of a breast lump, open surgery CPT 19120 HC PBB EXC CYST | $3,000.18 | $4,000.24 | — | 39% above | 25% |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC PBB EXC CYST | $3,000.18 | $4,000.24 | — | — | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 HC REMOVE FOREIGN BODY 10120 | $310.42 | $413.90 | — | 7% above | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 HC PBB REMOVE FOREIGN BODY | $311.49 | $415.32 | — | 8% above | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC REMOVE FOREIGN BODY 10120 | $310.42 | $413.90 | — | — | 25% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC PBB REMOVE FOREIGN BODY | $311.49 | $415.32 | — | — | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC COLORECTAL SCRN, HI RISK IND | $1,911.45 | $2,548.60 | — | 18% above | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC COLORECTAL SCRN, HI RISK IND | $1,911.45 | $2,548.60 | — | — | 25% |
| Septoplasty to straighten the nasal septum CPT 30520 HC PBB REPAIR OF NASAL SEPTUM | $2,540.45 | $3,387.27 | — | 29% below | 25% |
| Septoplasty to straighten the nasal septum inpatient CPT 30520 HC PBB REPAIR OF NASAL SEPTUM | $2,540.45 | $3,387.27 | — | — | 25% |
| Short arm cast (elbow to hand) CPT 29075 HC PBB APPLICATION OF FOREARM CAST | $214.31 | $285.75 | — | 9% below | 25% |
| Short arm cast (elbow to hand) CPT 29075 HC APPLICATION OF FOREARM CAST | $618.19 | $824.25 | — | 162% above | 25% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC PBB APPLICATION OF FOREARM CAST | $214.31 | $285.75 | — | — | 25% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLICATION OF FOREARM CAST | $618.19 | $824.25 | — | — | 25% |
| Short arm splint (forearm and hand) CPT 29125 HC PBB APPLY SHORT ARM SPLINT | $101.95 | $135.93 | — | 42% below | 25% |
| Short arm splint (forearm and hand) CPT 29125 HC FOREARM SPLINT | $286.28 | $381.70 | — | 63% above | 25% |
| Short arm splint (forearm and hand) CPT 29125 HC FOREARM SPLINT APPLY | $286.28 | $381.70 | — | 63% above | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC PBB APPLY SHORT ARM SPLINT | $101.95 | $135.93 | — | — | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC FOREARM SPLINT | $286.28 | $381.70 | — | — | 25% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC FOREARM SPLINT APPLY | $286.28 | $381.70 | — | — | 25% |
| Short leg cast (below the knee) CPT 29405 HC PBB APPLY SHORT LEG CAST | $214.31 | $285.75 | — | 5% below | 25% |
| Short leg cast (below the knee) CPT 29405 HC APPLY SHORT LEG CAST | $450.44 | $600.59 | — | 100% above | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 HC PBB APPLY SHORT LEG CAST | $214.31 | $285.75 | — | — | 25% |
| Short leg cast (below the knee) inpatient CPT 29405 HC APPLY SHORT LEG CAST | $450.44 | $600.59 | — | — | 25% |
| Short leg splint (calf to foot) CPT 29515 HC PBB APPL SHRT LEG SPLINT | $124.52 | $166.02 | — | 40% below | 25% |
| Short leg splint (calf to foot) CPT 29515 HC APPLY SHORT LEG SPLINT | $150.03 | $200.04 | — | 28% below | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC PBB APPL SHRT LEG SPLINT | $124.52 | $166.02 | — | — | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SHORT LEG SPLINT | $150.03 | $200.04 | — | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC PBB REPAIR SUPERFICIAL WOUND(S) | $153.74 | $204.98 | — | 53% below | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC REPR WOUND 2.5 OR < 12001 | $575.11 | $766.81 | — | 77% above | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC PBB REPAIR SUPERFICIAL WOUND(S) | $153.74 | $204.98 | — | — | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC REPR WOUND 2.5 OR < 12001 | $575.11 | $766.81 | — | — | 25% |
| Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION | $251.42 | $335.22 | — | 13% above | 25% |
| Skin biopsy, punch, one lesion CPT 11104 HC PBB PUNCH BIOPSY SKIN SINGLE LESION | $311.49 | $415.32 | — | 40% above | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BIOPSY SKIN SINGLE LESION | $251.42 | $335.22 | — | — | 25% |
| Skin biopsy, punch, one lesion inpatient CPT 11104 HC PBB PUNCH BIOPSY SKIN SINGLE LESION | $311.49 | $415.32 | — | — | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC PBB REMOVAL OF SKIN LESION 11600 | $542.60 | $723.47 | — | 48% above | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 HC PBB REMOVAL OF SKIN LESION 11600 | $542.60 | $723.47 | — | — | 25% |
| Skin tag removal, up to 15 tags CPT 11200 HC EXCISION OF SKIN TAGS <16 | $85.62 | $114.16 | — | 40% below | 25% |
| Skin tag removal, up to 15 tags CPT 11200 HC PBB REMOVAL OF SKIN TAGS UP TO 15 LESIONS | $153.74 | $204.98 | — | 9% above | 25% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HC EXCISION OF SKIN TAGS <16 | $85.62 | $114.16 | — | — | 25% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 HC PBB REMOVAL OF SKIN TAGS UP TO 15 LESIONS | $153.74 | $204.98 | — | — | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC PBB SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC | $540.88 | $721.17 | — | 7% below | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC | $1,316.43 | $1,755.24 | — | 127% above | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL FLUID TAP DIAG | $1,316.43 | $1,755.24 | — | 127% above | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC PBB SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC | $540.88 | $721.17 | — | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL FLUID TAP DIAG | $1,316.43 | $1,755.24 | — | — | 25% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC | $1,316.43 | $1,755.24 | — | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC PBB REPAIR SUPERFICL WOUNDS 12002 | $153.74 | $204.98 | — | 24% below | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPAIR SUPERFICIAL WOUND(S) 12002 | $590.11 | $786.81 | — | 192% above | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC REPR WOUND 2.6 - 7.5 12002 | $590.11 | $786.81 | — | 192% above | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC PBB REPAIR SUPERFICL WOUNDS 12002 | $153.74 | $204.98 | — | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPR WOUND 2.6 - 7.5 12002 | $590.11 | $786.81 | — | — | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC REPAIR SUPERFICIAL WOUND(S) 12002 | $590.11 | $786.81 | — | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC PBB LACERATION REPAIR 12011 | $153.74 | $204.98 | — | 50% below | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPR WOUND 2.5 OR < 12011 | $575.11 | $766.81 | — | 86% above | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC REPR WOUND 2.5 OR < | $575.11 | $766.81 | — | 86% above | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC PBB LACERATION REPAIR 12011 | $153.74 | $204.98 | — | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC REPR WOUND 2.5 OR < 12011 | $575.11 | $766.81 | — | — | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC REPR WOUND 2.5 OR < | $575.11 | $766.81 | — | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC PBB TANGENTIAL BIOPSY SKIN SINGLE LESION | $311.49 | $415.32 | — | 35% above | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION | $453.09 | $604.12 | — | 97% above | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC PBB TANGENTIAL BIOPSY SKIN SINGLE LESION | $311.49 | $415.32 | — | — | 25% |
| Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC TANGENTIAL BIOPSY SKIN SINGLE LESION | $453.09 | $604.12 | — | — | 25% |
| Thoracentesis with imaging guidance CPT 32555 HC THORACENTESIS W/IMAGING | $1,688.28 | $2,251.04 | — | 47% above | 25% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC THORACENTESIS W/IMAGING | $1,688.28 | $2,251.04 | — | — | 25% |
| Tonsil and adenoid removal, child under 12 CPT 42820 HC PBB REMOVE TONSILS/ADENOIDS,<12 Y/O | $4,536.04 | $6,048.05 | — | 138% above | 25% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 HC PBB REMOVE TONSILS/ADENOIDS,<12 Y/O | $4,536.04 | $6,048.05 | — | — | 25% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 HC PBB REMOVAL OF TONSILS,12+ Y/O | $2,540.45 | $3,387.27 | — | 52% above | 25% |
| Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 HC PBB REMOVAL OF TONSILS,12+ Y/O | $2,540.45 | $3,387.27 | — | — | 25% |
| Trigger finger release surgery CPT 26055 HC PBB INCISE FINGER TENDON SHEATH | $1,232.12 | $1,642.82 | — | 50% below | 25% |
| Trigger finger release surgery inpatient CPT 26055 HC PBB INCISE FINGER TENDON SHEATH | $1,232.12 | $1,642.82 | — | — | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC PBB INJECTION SINGLE/MULTA TRIGGR | $235.20 | $313.60 | — | 10% below | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC TC INJ, TRIGGER PT, 1 OR 2 MUSCL | $821.40 | $1,095.20 | — | 216% above | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER PTS SGL/MULT 1-2 | $821.40 | $1,095.20 | — | 216% above | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC PBB INJECTION SINGLE/MULTA TRIGGR | $235.20 | $313.60 | — | — | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER PTS SGL/MULT 1-2 | $821.40 | $1,095.20 | — | — | 25% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC TC INJ, TRIGGER PT, 1 OR 2 MUSCL | $821.40 | $1,095.20 | — | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 HC BREAST BIOPSY, FIRST, BILAT | $2,482.90 | $3,310.54 | — | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC PBB BX BREAST 1ST LESION US IMAG 19083 | $1,265.53 | $1,687.37 | — | 31% below | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BREAST BIOPSY, UNI | $2,940.37 | $3,920.49 | — | 61% above | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient both sides CPT 19083 HC BREAST BIOPSY, FIRST, BILAT | $2,482.90 | $3,310.54 | — | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC PBB BX BREAST 1ST LESION US IMAG 19083 | $1,265.53 | $1,687.37 | — | — | 25% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BREAST BIOPSY, UNI | $2,940.37 | $3,920.49 | — | — | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC PBB PR EDG BALLOON DILATION ESOPHAGUS <30 MM DIAM | $1,470.35 | $1,960.47 | — | 11% below | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC PBB PR EDG BALLOON DILATION ESOPHAGUS <30 MM DIAM | $1,470.35 | $1,960.47 | — | — | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC PBB PR EDG TRANSORAL BIOPSY SINGLE/MULTIPLE | $694.97 | $926.63 | — | 56% below | 25% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC PBB PR EDG TRANSORAL BIOPSY SINGLE/MULTIPLE | $694.97 | $926.63 | — | — | 25% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC PBB PR EDG REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $1,470.35 | $1,960.47 | — | 16% below | 25% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 HC PBB PR EDG REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH | $1,470.35 | $1,960.47 | — | — | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC PBB PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $694.97 | $926.63 | — | 53% below | 25% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC PBB PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $694.97 | $926.63 | — | — | 25% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 HC PBB PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $4,108.45 | $5,477.93 | — | 97% above | 25% |
| Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 HC PBB PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $4,108.45 | $5,477.93 | — | — | 25% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 HC PBB REMOVAL OF SPERM DUCT(S) | $1,601.74 | $2,135.66 | — | 77% above | 25% |
| Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 HC PBB REMOVAL OF SPERM DUCT(S) | $1,601.74 | $2,135.66 | — | — | 25% |
| Vein ablation, radiofrequency, first vein CPT 36475 HC PBB ENDO ABLATION THERAPY 36475 | $2,419.40 | $3,225.87 | — | 29% below | 25% |
| Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC PBB ENDO ABLATION THERAPY 36475 | $2,419.40 | $3,225.87 | — | — | 25% |
| Wart removal, up to 14 warts CPT 17110 HC DESTRUCTION OF WARTS | $38.38 | $51.17 | — | 80% below | 25% |
| Wart removal, up to 14 warts CPT 17110 HC PBB DESTRUCT B9 LESION 1-14 | $153.74 | $204.98 | — | 20% below | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC DESTRUCTION OF WARTS | $38.38 | $51.17 | — | — | 25% |
| Wart removal, up to 14 warts inpatient CPT 17110 HC PBB DESTRUCT B9 LESION 1-14 | $153.74 | $204.98 | — | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC PBB DEBRIDE SKIN/TISSUE | $311.49 | $415.32 | — | 31% below | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC CLEANSING OF SKIN/TISSUE | $927.94 | $1,237.25 | — | 105% above | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC PBB DEBRIDE SKIN/TISSUE | $311.49 | $415.32 | — | — | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC CLEANSING OF SKIN/TISSUE | $927.94 | $1,237.25 | — | — | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 HC PBB BLOOD TRANSFUSION SERVICE | $338.05 | $450.73 | — | 42% below | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLD TRANSFUSION 0-2 HRS | $724.00 | $965.33 | — | 24% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLD TRANSFUSION 2-4 HRS | $870.24 | $1,160.32 | — | 49% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLD TRANSFUSION 4-6 HRS | $1,013.38 | $1,351.17 | — | 74% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLD TRANSFUSION 6-8 HRS | $1,534.06 | $2,045.42 | — | 163% above | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 HC BLD TRANSFUSION > 8 HOURS | $1,763.30 | $2,351.06 | — | 202% above | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC PBB BLOOD TRANSFUSION SERVICE | $338.05 | $450.73 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLD TRANSFUSION 0-2 HRS | $724.00 | $965.33 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLD TRANSFUSION 2-4 HRS | $870.24 | $1,160.32 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLD TRANSFUSION 4-6 HRS | $1,013.38 | $1,351.17 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLD TRANSFUSION 6-8 HRS | $1,534.06 | $2,045.42 | — | — | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLD TRANSFUSION > 8 HOURS | $1,763.30 | $2,351.06 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL TRTMNT W/BRONCHODILATORS | $52.90 | $70.54 | — | 21% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT | $75.72 | $100.96 | — | 13% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AEROSOL DAILY | $91.28 | $121.70 | — | 36% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INDUCED SPUTUM | $100.82 | $134.42 | — | 51% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC NEBULIZER | $119.28 | $159.04 | — | 78% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC INHALER | $121.36 | $161.81 | — | 81% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC BRONCHOSCOPY PREP | $142.10 | $189.46 | — | 112% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC PBB AIRWAY INHALATION TREATMENT | $167.79 | $223.72 | — | 151% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL TRTMNT W/BRONCHODILATORS | $52.90 | $70.54 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT | $75.72 | $100.96 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AEROSOL DAILY | $91.28 | $121.70 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INDUCED SPUTUM | $100.82 | $134.42 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC NEBULIZER | $119.28 | $159.04 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC INHALER | $121.36 | $161.81 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC BRONCHOSCOPY PREP | $142.10 | $189.46 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC PBB AIRWAY INHALATION TREATMENT | $167.79 | $223.72 | — | — | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 HC PBB CHEMO ADMIN IV INFUSE UP 1 HR | $253.10 | $337.46 | — | 54% below | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO INIT INFU 16-90MIN | $668.79 | $891.72 | — | 23% above | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO IV INFUSION 1 HR | $668.79 | $891.72 | — | 23% above | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC PBB CHEMO ADMIN IV INFUSE UP 1 HR | $253.10 | $337.46 | — | — | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO INIT INFU 16-90MIN | $668.79 | $891.72 | — | — | 25% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO IV INFUSION 1 HR | $668.79 | $891.72 | — | — | 25% |
| Comprehensive eye exam by an eye doctor, new patient CPT 92004 HC PBB EYE EXAM, NEW PATIENT | $102.02 | $136.02 | — | 32% below | 25% |
| Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 HC PBB EYE EXAM, NEW PATIENT | $102.02 | $136.02 | — | — | 25% |
| Comprehensive eye exam, returning patient CPT 92014 HC PBB EYE EXAM AND TRTMNT 92014 | $102.02 | $136.02 | — | 14% below | 25% |
| Comprehensive eye exam, returning patient inpatient CPT 92014 HC PBB EYE EXAM AND TRTMNT 92014 | $102.02 | $136.02 | — | — | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC PBB COMP HEARING TEST 92557 | $98.60 | $131.46 | — | 33% below | 25% |
| Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 HC PBB COMP HEARING TEST 92557 | $98.60 | $131.46 | — | — | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 HC PBB CRITICAL CARE FIRST HOUR | $632.94 | $843.92 | — | 54% below | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 1ST 30-74 MIN | $1,890.00 | $2,520.00 | — | 36% above | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC PBB CRITICAL CARE FIRST HOUR | $632.94 | $843.92 | — | — | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 1ST 30-74 MIN | $1,890.00 | $2,520.00 | — | — | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC PBB ELECTROENCEPHALOGRAM (EEG) | $165.45 | $220.60 | — | 76% below | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE & DROWSY | $639.15 | $852.20 | — | 6% below | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HE EEG AWAKE & DROWSY | $908.82 | $1,211.76 | — | 34% above | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC PED EEG AWAKE & DROWSY | $1,066.24 | $1,421.65 | — | 57% above | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC PBB ELECTROENCEPHALOGRAM (EEG) | $165.45 | $220.60 | — | — | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE & DROWSY | $639.15 | $852.20 | — | — | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HE EEG AWAKE & DROWSY | $908.82 | $1,211.76 | — | — | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC PED EEG AWAKE & DROWSY | $1,066.24 | $1,421.65 | — | — | 25% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC PBB ELECTROCARDIOGRAM, COMPLETE | $97.75 | $130.33 | — | 84% above | 25% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC PBB ELECTROCARDIOGRAM, COMPLETE | $97.75 | $130.33 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC PBB ELECTROCARDIOGRAM TRACING | $45.20 | $60.27 | — | 68% below | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC EKG RESTING | $227.92 | $303.89 | — | 63% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge one side CPT 93005 HC RT EKG | $227.92 | $303.89 | — | 63% above | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC PBB ELECTROCARDIOGRAM TRACING | $45.20 | $60.27 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC EKG RESTING | $227.92 | $303.89 | — | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient one side CPT 93005 HC RT EKG | $227.92 | $303.89 | — | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMTALA EMERGENCY MEDICAL SCREENING SERVICE | $126.00 | $168.00 | — | 14% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC LEVEL I ER ASSES & PREP | $236.25 | $315.00 | — | 114% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC EMERGENCY ROOM LEVEL 1 | $295.31 | $393.75 | — | 167% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMTALA EMERGENCY MEDICAL SCREENING SERVICE | $126.00 | $168.00 | — | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC LEVEL I ER ASSES & PREP | $236.25 | $315.00 | — | — | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC EMERGENCY ROOM LEVEL 1 | $295.31 | $393.75 | — | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC SA VICTIM EXAM FOLLOW UP | $275.62 | $367.50 | — | 4% above | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC EMERGENCY ROOM LEVEL 2 | $673.31 | $897.75 | — | 154% above | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC SA VICTIM EXAM FOLLOW UP | $275.62 | $367.50 | — | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC EMERGENCY ROOM LEVEL 2 | $673.31 | $897.75 | — | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC EMERGENCY ROOM LEVEL 3 | $905.62 | $1,207.50 | — | 125% above | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC EMERGENCY ROOM LEVEL 3 | $905.62 | $1,207.50 | — | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC SA SUSPECT EXAM | $767.81 | $1,023.75 | — | 29% above | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC EMERGENCY ROOM LEVEL 4 | $1,323.00 | $1,764.00 | — | 122% above | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC SA SUSPECT EXAM | $767.81 | $1,023.75 | — | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC EMERGENCY ROOM LEVEL 4 | $1,323.00 | $1,764.00 | — | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC SA VICTIM EXAM | $874.12 | $1,165.50 | — | 14% below | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC EMERGENCY ROOM LEVEL 5 | $2,008.12 | $2,677.50 | — | 98% above | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC SA VICTIM EXAM | $874.12 | $1,165.50 | — | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC EMERGENCY ROOM LEVEL 5 | $2,008.12 | $2,677.50 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC PBB CARDIAC STRESS TST,TRACING ONLY | $165.45 | $220.60 | — | 79% below | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST-LIMITED | $1,060.20 | $1,413.60 | — | 34% above | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST COMPLETE | $1,357.73 | $1,810.31 | — | 71% above | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC NUCLEAR CHEMICAL TEST | $1,357.73 | $1,810.31 | — | 71% above | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS ECHO TREADMILL | $1,373.30 | $1,831.07 | — | 73% above | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC NUCLEAR STRESS TEST TREADMILL | $2,293.33 | $3,057.77 | — | 189% above | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC PBB CARDIAC STRESS TST,TRACING ONLY | $165.45 | $220.60 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST-LIMITED | $1,060.20 | $1,413.60 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST COMPLETE | $1,357.73 | $1,810.31 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC NUCLEAR CHEMICAL TEST | $1,357.73 | $1,810.31 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS ECHO TREADMILL | $1,373.30 | $1,831.07 | — | — | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC NUCLEAR STRESS TEST TREADMILL | $2,293.33 | $3,057.77 | — | — | 25% |
| Eye exam, returning patient, intermediate CPT 92012 HC PBB EYE EXAM ESTAB PT 92012 | $102.02 | $136.02 | — | 4% above | 25% |
| Eye exam, returning patient, intermediate inpatient CPT 92012 HC PBB EYE EXAM ESTAB PT 92012 | $102.02 | $136.02 | — | — | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC PBB FAMILY PSYCHOTHERAPY W PHYS | $136.00 | $181.34 | — | 28% below | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC IOP-FAMILY PSYCHOTHERAPY W/PATIEN | $257.00 | $342.66 | — | 35% above | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY PSYCHOTHERAPY W PATIENT | $257.00 | $342.66 | — | 35% above | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC PBB FAMILY PSYCHOTHERAPY W PHYS | $136.00 | $181.34 | — | — | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC IOP-FAMILY PSYCHOTHERAPY W/PATIEN | $257.00 | $342.66 | — | — | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY PSYCHOTHERAPY W PATIENT | $257.00 | $342.66 | — | — | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PBB FAMILY PSYCHOTHERAPY,NO PT | $136.00 | $181.34 | — | 23% below | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC PSYCHOTHERAPY FAMILY ONLY | $257.00 | $342.66 | — | 45% above | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PBB FAMILY PSYCHOTHERAPY,NO PT | $136.00 | $181.34 | — | — | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC PSYCHOTHERAPY FAMILY ONLY | $257.00 | $342.66 | — | — | 25% |
| Group psychotherapy session CPT 90853 HC PBB GROUP PSYCHOTHERAPY 90853 | $77.84 | $103.79 | — | 6% above | 25% |
| Group psychotherapy session CPT 90853 HC CHILD/ADOL DAY TREATMENT IOP PER HR | $269.84 | $359.79 | — | 269% above | 25% |
| Group psychotherapy session CPT 90853 HC IOP - GROUP THERAPY | $269.84 | $359.79 | — | 269% above | 25% |
| Group psychotherapy session CPT 90853 HC CHILD/ADOL DAY TREATMENT PER HR | $269.84 | $359.79 | — | 269% above | 25% |
| Group psychotherapy session CPT 90853 HC EC - GROUP THERAPY | $269.84 | $359.79 | — | 269% above | 25% |
| Group psychotherapy session CPT 90853 HC CHILD/ADOL DAY TREATMENT EC PER HR | $271.67 | $362.23 | — | 271% above | 25% |
| Group psychotherapy session CPT 90853 HC GROUP THERAPY | $283.52 | $378.02 | — | 288% above | 25% |
| Group psychotherapy session inpatient CPT 90853 HC PBB GROUP PSYCHOTHERAPY 90853 | $77.84 | $103.79 | — | — | 25% |
| Group psychotherapy session inpatient CPT 90853 HC CHILD/ADOL DAY TREATMENT IOP PER HR | $269.84 | $359.79 | — | — | 25% |
| Group psychotherapy session inpatient CPT 90853 HC CHILD/ADOL DAY TREATMENT PER HR | $269.84 | $359.79 | — | — | 25% |
| Group psychotherapy session inpatient CPT 90853 HC IOP - GROUP THERAPY | $269.84 | $359.79 | — | — | 25% |
| Group psychotherapy session inpatient CPT 90853 HC EC - GROUP THERAPY | $269.84 | $359.79 | — | — | 25% |
| Group psychotherapy session inpatient CPT 90853 HC CHILD/ADOL DAY TREATMENT EC PER HR | $271.67 | $362.23 | — | — | 25% |
| Group psychotherapy session inpatient CPT 90853 HC GROUP THERAPY | $283.52 | $378.02 | — | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC PBB IV INFUSION HYDRATION,INTL HR | $162.98 | $217.31 | — | 43% below | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION HYDRATION, INITIAL HR | $412.50 | $550.00 | — | 45% above | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC IV INFUSION HYDRATION INITIAL HR | $412.50 | $550.00 | — | 45% above | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC PBB IV INFUSION HYDRATION,INTL HR | $162.98 | $217.31 | — | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSION HYDRATION, INITIAL HR | $412.50 | $550.00 | — | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC IV INFUSION HYDRATION INITIAL HR | $412.50 | $550.00 | — | — | 25% |
| IV infusion of a medicine, first hour CPT 96365 HC PBB INFUSION FOR THERAPY UP 1HR | $162.98 | $217.31 | — | 48% below | 25% |
| IV infusion of a medicine, first hour CPT 96365 HC IV INFUSION 1ST HOUR | $422.81 | $563.75 | — | 35% above | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC PBB INFUSION FOR THERAPY UP 1HR | $162.98 | $217.31 | — | — | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC IV INFUSION 1ST HOUR | $422.81 | $563.75 | — | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC PBB THER PROP OR DIAG INJ | $55.17 | $73.56 | — | 30% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC INJECTION SQ/IM ADMIN | $138.92 | $185.22 | — | 75% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC IM/SUBQ INJECTION | $138.92 | $185.22 | — | 75% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC PBB THER PROP OR DIAG INJ | $55.17 | $73.56 | — | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC INJECTION SQ/IM ADMIN | $138.92 | $185.22 | — | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC IM/SUBQ INJECTION | $138.92 | $185.22 | — | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PBB PSYCHIATRIC DIAGNOSTIC EVALUATION | $136.00 | $181.34 | — | 38% below | 25% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION | $250.73 | $334.31 | — | 14% above | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PBB PSYCHIATRIC DIAGNOSTIC EVALUATION | $136.00 | $181.34 | — | — | 25% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION | $250.73 | $334.31 | — | — | 25% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC PBB NRV COND TST 7-8 STUDIES | $285.93 | $381.24 | — | 36% below | 25% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 HC NERVE CONDUCTION STUDIES; 7-8 STUDIES | $761.97 | $1,015.96 | — | 71% above | 25% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC PBB NRV COND TST 7-8 STUDIES | $285.93 | $381.24 | — | — | 25% |
| Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 HC NERVE CONDUCTION STUDIES; 7-8 STUDIES | $761.97 | $1,015.96 | — | — | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC PBB NEUROMUSCULAR REDUCATION | $42.85 | $57.13 | — | 54% below | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC OT NEURO RE-ED BALANCE 15 MIN | $116.94 | $155.92 | — | 25% above | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC PT NEURO RE-ED BALANCE | $147.64 | $196.86 | — | 58% above | 25% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEURO RE-ED BALANCE 15 MIN | $154.58 | $206.11 | — | 65% above | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PBB NEUROMUSCULAR REDUCATION | $42.85 | $57.13 | — | — | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC OT NEURO RE-ED BALANCE 15 MIN | $116.94 | $155.92 | — | — | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC PT NEURO RE-ED BALANCE | $147.64 | $196.86 | — | — | 25% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEURO RE-ED BALANCE 15 MIN | $154.58 | $206.11 | — | — | 25% |
| New patient office visit, about 30 minutes CPT 99203 HC URGENT CARE LEVEL 3NP | $114.64 | $152.85 | — | 42% below | 25% |
| New patient office visit, about 30 minutes CPT 99203 HC NEW PATIENT LEVEL III | $253.22 | $337.62 | — | 28% above | 25% |
| New patient office visit, about 30 minutes CPT 99203 HC OFFICE/OP VISIT, NEW LEVEL III | $253.22 | $337.62 | — | 28% above | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC URGENT CARE LEVEL 3NP | $114.64 | $152.85 | — | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC OFFICE/OP VISIT, NEW LEVEL III | $253.22 | $337.62 | — | — | 25% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC NEW PATIENT LEVEL III | $253.22 | $337.62 | — | — | 25% |
| New patient office visit, about 45 minutes CPT 99204 HC NEW PATIENT LEVEL IV | $360.52 | $480.69 | — | 76% above | 25% |
| New patient office visit, about 45 minutes CPT 99204 HC OFFICE/OP VISIT, NEW LEVEL IV | $360.64 | $480.86 | — | 76% above | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC NEW PATIENT LEVEL IV | $360.52 | $480.69 | — | — | 25% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC OFFICE/OP VISIT, NEW LEVEL IV | $360.64 | $480.86 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PATIENT LEVEL II | $99.22 | $132.30 | — | 24% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC PAIN CLINIC NEW LEVEL II | $99.53 | $132.71 | — | 24% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC URGENT CARE LEVEL 2NP | $99.53 | $132.71 | — | 24% below | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC OFFICE/OP VISIT, NEW LEVEL II | $193.46 | $257.94 | — | 48% above | 25% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC NEW PATIENT-ENHANCED LEVEL II | $1,076.25 | $1,435.00 | — | 724% above | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW PATIENT LEVEL II | $99.22 | $132.30 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC PAIN CLINIC NEW LEVEL II | $99.53 | $132.71 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC URGENT CARE LEVEL 2NP | $99.53 | $132.71 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC OFFICE/OP VISIT, NEW LEVEL II | $193.46 | $257.94 | — | — | 25% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC NEW PATIENT-ENHANCED LEVEL II | $1,076.25 | $1,435.00 | — | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC PBB MEDICAL NUTRITION INDIV IN 97802 | $43.85 | $58.47 | — | 24% below | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC HIP NUTRITION ASSESS EMPL 15 MIN | $49.42 | $65.90 | — | 14% below | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC HIP NUTRITION ASSESSMENT 15 MIN | $54.94 | $73.25 | — | 4% below | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC MNT-OP INI, IND ASSESS/INT QTR HR | $64.31 | $85.75 | — | 12% above | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC PBB MEDICAL NUTRITION INDIV IN 97802 | $43.85 | $58.47 | — | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC HIP NUTRITION ASSESS EMPL 15 MIN | $49.42 | $65.90 | — | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC HIP NUTRITION ASSESSMENT 15 MIN | $54.94 | $73.25 | — | — | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC MNT-OP INI, IND ASSESS/INT QTR HR | $64.31 | $85.75 | — | — | 25% |
| Occupational therapy evaluation, low complexity CPT 97165 HC PBB OT EVAL LOW COMPLEX 30 MIN | $59.80 | $79.73 | — | 66% below | 25% |
| Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX | $285.39 | $380.52 | — | 61% above | 25% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC PBB OT EVAL LOW COMPLEX 30 MIN | $59.80 | $79.73 | — | — | 25% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX | $285.39 | $380.52 | — | — | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PBB PT EVAL HIGH COMPLEX 45 MIN | $61.69 | $82.25 | — | 79% below | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX | $428.08 | $570.77 | — | 47% above | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PBB PT EVAL HIGH COMPLEX 45 MIN | $61.69 | $82.25 | — | — | 25% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX | $428.08 | $570.77 | — | — | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PBB PT EVAL LOW COMPLEX 20 MIN | $61.69 | $82.25 | — | 65% below | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX | $324.14 | $432.19 | — | 83% above | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PBB PT EVAL LOW COMPLEX 20 MIN | $61.69 | $82.25 | — | — | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX | $324.14 | $432.19 | — | — | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PBB PT EVAL MOD COMPLEX 30 MIN | $61.69 | $82.25 | — | 74% below | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX | $385.47 | $513.96 | — | 61% above | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PBB PT EVAL MOD COMPLEX 30 MIN | $61.69 | $82.25 | — | — | 25% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX | $385.47 | $513.96 | — | — | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC PBB MANUAL THERAPY 97140 | $44.76 | $59.68 | — | 49% below | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY | $151.61 | $202.15 | — | 73% above | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC OT MANUAL THERAPY | $151.61 | $202.15 | — | 73% above | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC PBB MANUAL THERAPY 97140 | $44.76 | $59.68 | — | — | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC OT MANUAL THERAPY | $151.61 | $202.15 | — | — | 25% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY | $151.61 | $202.15 | — | — | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC PBB THERAPEUTIC EXERCISES 97110 | $44.32 | $59.09 | — | 49% below | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC OT THERAPEUTIC EXERCISE | $147.64 | $196.86 | — | 69% above | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAPEUTIC EXERCISES | $147.64 | $196.86 | — | 69% above | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC PBB THERAPEUTIC EXERCISES 97110 | $44.32 | $59.09 | — | — | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC OT THERAPEUTIC EXERCISE | $147.64 | $196.86 | — | — | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAPEUTIC EXERCISES | $147.64 | $196.86 | — | — | 25% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC PBB PREVENTIVE VISIT | $24.97 | $33.29 | — | 82% below | 25% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC PBB PREVENTIVE VISIT | $24.97 | $33.29 | — | — | 25% |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC PBB PREVENTATIVE VISIT | $25.22 | $33.62 | — | 91% below | 25% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC PBB PREVENTATIVE VISIT | $25.22 | $33.62 | — | — | 25% |
| Preventive checkup, new patient aged 65 or older CPT 99387 HC PBB PREVENTATIVE VISIT NEW 65> | $27.79 | $37.05 | — | 91% below | 25% |
| Preventive checkup, new patient aged 65 or older inpatient CPT 99387 HC PBB PREVENTATIVE VISIT NEW 65> | $27.79 | $37.05 | — | — | 25% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 HC PBB PREVENTIVE VISIT | $21.36 | $28.48 | — | 86% below | 25% |
| Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 HC PBB PREVENTIVE VISIT | $21.36 | $28.48 | — | — | 25% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 HC PBB PREVENTIVE VISIT | $21.36 | $28.48 | — | 87% below | 25% |
| Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 HC PBB PREVENTIVE VISIT | $21.36 | $28.48 | — | — | 25% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 HC PBB PREVENTIVE VISIT | $24.44 | $32.59 | — | 91% below | 25% |
| Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 HC PBB PREVENTIVE VISIT | $24.44 | $32.59 | — | — | 25% |
| Psychiatric evaluation with medical services CPT 90792 PBB PSYCH DIAG EVAL W/MED SRVCS 90792 | $136.00 | $181.34 | — | 51% below | 25% |
| Psychiatric evaluation with medical services inpatient CPT 90792 PBB PSYCH DIAG EVAL W/MED SRVCS 90792 | $136.00 | $181.34 | — | — | 25% |
| Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC PBB PSYCL TST EVAL PHYS/QHP 1ST | $165.45 | $220.60 | — | 34% below | 25% |
| Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 HC PBB PSYCL TST EVAL PHYS/QHP 1ST | $165.45 | $220.60 | — | — | 25% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PBB PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES | $136.00 | $181.34 | — | 54% below | 25% |
| Psychotherapy for crisis, first 60 minutes CPT 90839 HC PSYCHOTHERAPY FOR CRISIS,FRST 60M | $433.24 | $577.66 | — | 47% above | 25% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PBB PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES | $136.00 | $181.34 | — | — | 25% |
| Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC PSYCHOTHERAPY FOR CRISIS,FRST 60M | $433.24 | $577.66 | — | — | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC INDIVIDUAL 20-30 MIN | $129.02 | $172.02 | — | 21% above | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC EC - INDIVIDUAL 16-37 MIN | $129.36 | $172.48 | — | 22% above | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC IOP - INDIVIDUAL 16-37 MIN | $129.36 | $172.48 | — | 22% above | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC INDIVIDUAL 16-37 MIN | $129.36 | $172.48 | — | 22% above | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC PBB PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | $136.00 | $181.34 | — | 28% above | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC INDIVIDUAL 20-30 MIN | $129.02 | $172.02 | — | — | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC INDIVIDUAL 16-37 MIN | $129.36 | $172.48 | — | — | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC EC - INDIVIDUAL 16-37 MIN | $129.36 | $172.48 | — | — | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC IOP - INDIVIDUAL 16-37 MIN | $129.36 | $172.48 | — | — | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PBB PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES | $136.00 | $181.34 | — | — | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC PBB PSYTX PT&FAMILY 45 MINUTES | $136.00 | $181.34 | — | 4% below | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSYTX PT&/FAMILY 45 MINUTES | $250.73 | $334.31 | — | 77% above | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC INDIVIDUAL 38-52 MIN | $257.00 | $342.66 | — | 82% above | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC EC - INDIVIDUAL 38-52 MIN | $257.00 | $342.66 | — | 82% above | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC IOP - INDIVIDUAL 38-52 MINS | $257.00 | $342.66 | — | 82% above | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC INDIVIDUAL 45-50 MIN | $257.23 | $342.97 | — | 82% above | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PBB PSYTX PT&FAMILY 45 MINUTES | $136.00 | $181.34 | — | — | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYTX PT&/FAMILY 45 MINUTES | $250.73 | $334.31 | — | — | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC IOP - INDIVIDUAL 38-52 MINS | $257.00 | $342.66 | — | — | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC EC - INDIVIDUAL 38-52 MIN | $257.00 | $342.66 | — | — | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC INDIVIDUAL 38-52 MIN | $257.00 | $342.66 | — | — | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC INDIVIDUAL 45-50 MIN | $257.23 | $342.97 | — | — | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC PBB PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES | $136.00 | $181.34 | — | 36% below | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC IOP - INDIVIDUAL 53+ MINSN | $385.49 | $513.99 | — | 81% above | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC INDIVIDUAL 53+ MINS | $385.49 | $513.99 | — | 81% above | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC EC - INDIVIDUAL 53+ MIN | $385.49 | $513.99 | — | 81% above | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PBB PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES | $136.00 | $181.34 | — | — | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC IOP - INDIVIDUAL 53+ MINSN | $385.49 | $513.99 | — | — | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC EC - INDIVIDUAL 53+ MIN | $385.49 | $513.99 | — | — | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC INDIVIDUAL 53+ MINS | $385.49 | $513.99 | — | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC PBB TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES | $28.71 | $38.28 | — | 5% above | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN | $35.29 | $47.05 | — | 29% above | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC PBB TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES | $28.71 | $38.28 | — | — | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC BEHAV CHNG SMOKING 3-10 MIN | $35.29 | $47.05 | — | — | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC OFFICE/OP VISIT, ESTAB LEVEL V | $354.73 | $472.97 | — | 26% above | 25% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC OFFICE/OP VISIT, ESTAB LEVEL V | $354.73 | $472.97 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC EST PATIENT LEVEL III | $99.53 | $132.71 | — | 37% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC URGENT CARE LEVEL 3EP | $99.53 | $132.71 | — | 37% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC VISIT, ESTAB LEVEL III | $164.55 | $219.40 | — | 4% above | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC VISIT, ESTAB LEVEL II | $164.60 | $219.47 | — | 4% above | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC PNC OFFICE O/P EST 15 MIN | $164.60 | $219.47 | — | 4% above | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC OSTOMY CARE - 45 | $251.37 | $335.16 | — | 59% above | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC URGENT CARE LEVEL 3EP | $99.53 | $132.71 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC EST PATIENT LEVEL III | $99.53 | $132.71 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC VISIT, ESTAB LEVEL III | $164.55 | $219.40 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC VISIT, ESTAB LEVEL II | $164.60 | $219.47 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC PNC OFFICE O/P EST 15 MIN | $164.60 | $219.47 | — | — | 25% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC OSTOMY CARE - 45 | $251.37 | $335.16 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OFFICE/OP VISIT, ESTAB LEVEL IV | $238.79 | $318.39 | — | 31% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OTPT CARE ASSESSM LEVEL IV | $238.79 | $318.39 | — | 31% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC OSTOMY CARE - EXT | $238.96 | $318.62 | — | 31% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC EST PATIENT LEVEL IV | $238.96 | $318.62 | — | 31% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OTPT CARE ASSESSM LEVEL IV | $238.79 | $318.39 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OFFICE/OP VISIT, ESTAB LEVEL IV | $238.79 | $318.39 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC EST PATIENT LEVEL IV | $238.96 | $318.62 | — | — | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC OSTOMY CARE - EXT | $238.96 | $318.62 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC URGENT CARE LEVEL 2EP | $99.53 | $132.71 | — | 2% above | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OFFICE/OP VISIT, LEVEL II | $128.80 | $171.74 | — | 32% above | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OTPT CARE ASSESSM LEVEL II | $128.80 | $171.74 | — | 32% above | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC EST PATIENT LEVEL II | $128.99 | $171.99 | — | 32% above | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC OSTOMY CARE - 30 | $196.80 | $262.40 | — | 102% above | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC EST PATIENT-ENHANCED LEVEL II | $1,076.25 | $1,435.00 | — | 1004% above | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC URGENT CARE LEVEL 2EP | $99.53 | $132.71 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OFFICE/OP VISIT, LEVEL II | $128.80 | $171.74 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OTPT CARE ASSESSM LEVEL II | $128.80 | $171.74 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC EST PATIENT LEVEL II | $128.99 | $171.99 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC OSTOMY CARE - 30 | $196.80 | $262.40 | — | — | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC EST PATIENT-ENHANCED LEVEL II | $1,076.25 | $1,435.00 | — | — | 25% |
| Speech and language evaluation CPT 92523 HC PBB EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION 92523 | $101.28 | $135.04 | — | 70% below | 25% |
| Speech and language evaluation CPT 92523 HC ST SPEECH SOUND LANG COMP EVAL | $633.14 | $844.19 | — | 86% above | 25% |
| Speech and language evaluation inpatient CPT 92523 HC PBB EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION 92523 | $101.28 | $135.04 | — | — | 25% |
| Speech and language evaluation inpatient CPT 92523 HC ST SPEECH SOUND LANG COMP EVAL | $633.14 | $844.19 | — | — | 25% |
| Speech therapy session, individual CPT 92507 HC PBB TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND 92507 | $97.57 | $130.09 | — | 62% below | 25% |
| Speech therapy session, individual CPT 92507 HC ST SPEECH LANGUAGE THERAPY VISIT | $314.09 | $418.79 | — | 24% above | 25% |
| Speech therapy session, individual inpatient CPT 92507 HC PBB TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND 92507 | $97.57 | $130.09 | — | — | 25% |
| Speech therapy session, individual inpatient CPT 92507 HC ST SPEECH LANGUAGE THERAPY VISIT | $314.09 | $418.79 | — | — | 25% |
| Spirometry (breathing test) CPT 94010 HC PBB BREATHING CAPACITY TST 94010 | $165.45 | $220.60 | — | 4% below | 25% |
| Spirometry (breathing test) CPT 94010 HC SPIROMETRY NO BRONCHO | $308.06 | $410.74 | — | 78% above | 25% |
| Spirometry (breathing test) inpatient CPT 94010 HC PBB BREATHING CAPACITY TST 94010 | $165.45 | $220.60 | — | — | 25% |
| Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY NO BRONCHO | $308.06 | $410.74 | — | — | 25% |
| Spirometry before and after a bronchodilator CPT 94060 HC PBB EVALUATION OF WHEEZING | $285.93 | $381.24 | — | 19% below | 25% |
| Spirometry before and after a bronchodilator CPT 94060 HC SPIROMETRY PRE POST | $795.56 | $1,060.74 | — | 124% above | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC PBB EVALUATION OF WHEEZING | $285.93 | $381.24 | — | — | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC SPIROMETRY PRE POST | $795.56 | $1,060.74 | — | — | 25% |
| TMS (transcranial magnetic stimulation), first session with mapping CPT 90867 HC REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M | $703.39 | $937.85 | — | 75% above | 25% |
| TMS (transcranial magnetic stimulation), first session with mapping inpatient CPT 90867 HC REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M | $703.39 | $937.85 | — | — | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC PBB THERAPEUTIC ACTIVITIES | $41.91 | $55.88 | — | 51% below | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC J2H INTAKE | $85.62 | $114.16 | — | 1% above | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACTIVITY - 15 MIN. | $123.43 | $164.57 | — | 46% above | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC OT THERAPEUTIC ACTIV/TRANSFERS | $131.73 | $175.64 | — | 56% above | 25% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC EXERCISE FOLLOW-UP | $151.93 | $202.57 | — | 79% above | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC PBB THERAPEUTIC ACTIVITIES | $41.91 | $55.88 | — | — | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC J2H INTAKE | $85.62 | $114.16 | — | — | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACTIVITY - 15 MIN. | $123.43 | $164.57 | — | — | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC OT THERAPEUTIC ACTIV/TRANSFERS | $131.73 | $175.64 | — | — | 25% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC EXERCISE FOLLOW-UP | $151.93 | $202.57 | — | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PBB PHLEBOTOMY | $128.62 | $171.49 | — | 35% below | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPEUTIC PHLEBOTOMY | $339.94 | $453.25 | — | 71% above | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC THERAPUTIC PHLEBOTOMY 1 UNIT | $597.44 | $796.59 | — | 200% above | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PBB PHLEBOTOMY | $128.62 | $171.49 | — | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPEUTIC PHLEBOTOMY | $339.94 | $453.25 | — | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC THERAPUTIC PHLEBOTOMY 1 UNIT | $597.44 | $796.59 | — | — | 25% |
| Visual field test, extended CPT 92083 HC PBB VISUAL FIELD EXAM | $101.95 | $135.93 | — | 3% above | 25% |
| Visual field test, extended inpatient CPT 92083 HC PBB VISUAL FIELD EXAM | $101.95 | $135.93 | — | — | 25% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Wisconsin | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE | $268.55 | $358.07 | — | 61% above | 25% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE | $268.55 | $358.07 | — | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine (live) 1,350 unit/0.5 mL Susr 1 each Vial | $701.17 | $934.89 | — | 328% above | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine (live) 1,350 unit/0.5 mL Susr 1 each Vial | $701.17 | $934.89 | — | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL Syrg 0.5 mL Syringe | $127.54 | $170.05 | — | 352% above | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 flu vac ts 2025-26(6mos up)-PF 45 mcg (15 mcg x 3)/0.5 mL Syrg 0.5 mL Syringe | $127.54 | $170.05 | — | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HC PBB HEP A & B ADULT IM 90636 | $35.43 | $47.24 | — | 82% below | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HC PBB HEP A & B ADULT IM 90636 | $35.43 | $47.24 | — | — | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 hepatitis A vaccine 720 EL unit/0.5 mL Syrg 0.5 mL Syringe | $209.69 | $279.59 | — | 59% above | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A vaccine 720 EL unit/0.5 mL Syrg 0.5 mL Syringe | $209.69 | $279.59 | — | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEPATITIS B VACCINE,ADULT,IM | $80.42 | $107.22 | — | 34% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B vaccine rec PF 20 mcg/mL Syrg 1 mL Syringe | $324.36 | $432.48 | — | 166% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B vaccine rec PF 20 mcg/mL Susp 1 mL Vial | $324.36 | $432.48 | — | 166% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEPATITIS B VACCINE,ADULT,IM | $80.42 | $107.22 | — | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B vaccine rec PF 20 mcg/mL Syrg 1 mL Syringe | $324.36 | $432.48 | — | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B vaccine rec PF 20 mcg/mL Susp 1 mL Vial | $324.36 | $432.48 | — | — | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL Syrg 0.5 mL Syringe | $432.65 | $576.87 | — | 445% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 flu vacc ts2025-26(65yr up)-PF 180 mcg/0.5 mL Syrg 0.5 mL Syringe | $432.65 | $576.87 | — | — | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 measles, mumps and rubella vaccine 1,000-12,500 TCID50/0.5 mL Solr 1 each Vial | $454.28 | $605.70 | — | 196% above | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles, mumps and rubella vaccine 1,000-12,500 TCID50/0.5 mL Solr 1 each Vial | $454.28 | $605.70 | — | — | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal B vaccine 0.5 mL Syrg 0.5 mL Syringe | $622.81 | $830.41 | — | 169% above | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 meningococcal B vaccine 0.5 mL Syrg 0.5 mL Syringe | $622.81 | $830.41 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PBB PNEUMOCOCCAL IMMUNIZATION | $67.10 | $89.46 | — | 52% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC PNEUMOCOCCAL VACCINE | $195.86 | $261.14 | — | 39% above | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-Val PS Vaccine 25 mcg/0.5 mL Syrg 0.5 mL Syringe | $569.12 | $758.82 | — | 303% above | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 20-val conj vaccine 0.5 mL Syrg 0.5 mL Syringe | $875.33 | $1,167.11 | — | 521% above | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PBB PNEUMOCOCCAL IMMUNIZATION | $67.10 | $89.46 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 HC PNEUMOCOCCAL VACCINE | $195.86 | $261.14 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-Val PS Vaccine 25 mcg/0.5 mL Syrg 0.5 mL Syringe | $569.12 | $758.82 | — | — | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 20-val conj vaccine 0.5 mL Syrg 0.5 mL Syringe | $875.33 | $1,167.11 | — | — | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 nirsevimab-alip 50 mg/0.5 mL Syrg 0.5 mL Syringe | $2,013.91 | $2,685.21 | — | 97% above | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 nirsevimab-alip 50 mg/0.5 mL Syrg 0.5 mL Syringe | $2,013.91 | $2,685.21 | — | — | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE | $576.47 | $768.63 | — | 4% above | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE | $576.47 | $768.63 | — | — | 25% |
| Rabies vaccine, one dose CPT 90675 rabies vaccine, PCEC 2.5 unit Susr 1 each KIT | $1,488.78 | $1,985.04 | — | 175% above | 25% |
| Rabies vaccine, one dose CPT 90675 rabies vaccine, PCEC 2.5 unit Susr 1 each Vial | $1,488.78 | $1,985.04 | — | 175% above | 25% |
| Rabies vaccine, one dose CPT 90675 rabies vaccine human diploid 2.5 unit Solr 1 each Vial | $1,634.71 | $2,179.61 | — | 202% above | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, PCEC 2.5 unit Susr 1 each KIT | $1,488.78 | $1,985.04 | — | — | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, PCEC 2.5 unit Susr 1 each Vial | $1,488.78 | $1,985.04 | — | — | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine human diploid 2.5 unit Solr 1 each Vial | $1,634.71 | $2,179.61 | — | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus and diphther toxoids adsorbed 2-2 Lf unit/0.5 mL Susp 0.5 mL Vial | $168.14 | $224.19 | — | 306% above | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus & diphtheria toxoids (adult) 5-2 Lf unit/0.5 mL Syrg 0.5 mL Syringe | $289.46 | $385.94 | — | 599% above | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus and diphther toxoids adsorbed 2-2 Lf unit/0.5 mL Susp 0.5 mL Vial | $168.14 | $224.19 | — | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus & diphtheria toxoids (adult) 5-2 Lf unit/0.5 mL Syrg 0.5 mL Syringe | $289.46 | $385.94 | — | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap 2.5-8-5 Lf-mcg-Lf/0.5mL Syrg 0.5 mL Syringe | $265.29 | $353.72 | — | 243% above | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap 2.5-8-5 Lf-mcg-Lf/0.5mL Susp 0.5 mL Vial | $265.29 | $353.72 | — | 243% above | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap 2.5-8-5 Lf-mcg-Lf/0.5mL Susp 0.5 mL Vial | $265.29 | $353.72 | — | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap 2.5-8-5 Lf-mcg-Lf/0.5mL Syrg 0.5 mL Syringe | $265.29 | $353.72 | — | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC PBB IMMUNIZATION ADMIN | $55.17 | $73.56 | — | 48% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC UC IMMUNIZATION ADMIN | $81.86 | $109.15 | — | 119% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMIN | $81.86 | $109.15 | — | 119% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC PBB IMMUNIZATION ADMIN | $55.17 | $73.56 | — | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMIN | $81.86 | $109.15 | — | — | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC UC IMMUNIZATION ADMIN | $81.86 | $109.15 | — | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC PBB IMMUNIZATION ADMIN EACH ADD | $14.80 | $19.73 | — | 54% below | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADMIN, EACH ADD | $52.92 | $70.56 | — | 63% above | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC PBB IMMUNIZATION ADMIN EACH ADD | $14.80 | $19.73 | — | — | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADMIN, EACH ADD | $52.92 | $70.56 | — | — | 25% |
Source file: https://www.mercyhealthsystem.org/clientfiles/getfile/390816848-mercyjanesvillehospital-standardcharges.json