Hospital

Tamarack Health Ashland Medical Center

Listed in its price file as “Memorial Medical Center INC”.

Tamarack Health Ashland Medical Center in Ashland, WI publishes cash prices for 301 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Wisconsin median for 242 of 297 procedures and below it for 53. By typical cash price it ranks #93 of 103 Wisconsin hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1615 Maple Lane, Ashland, WI 54806 Collected Sep 29, 2026 Source price file (715) 685-5500

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 3 of 5 CCN 521359 · CMS hospital register NPI 1437179231

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen W/O & W/Dye	$3,307.99	$3,482.09	$471.67–$3,279.25	44% above	5%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen W/O & W/Dye	$3,307.99	$3,482.09	$471.67–$3,279.25	—	5%
Abdominal X-ray, 2 views CPT 74019 X-Ray Exam Abdomen 2 Views	$508.35	$535.11	$223.39–$503.94	116% above	5%
Abdominal X-ray, 2 views inpatient CPT 74019 X-Ray Exam Abdomen 2 Views	$508.35	$535.11	$223.39–$503.94	—	5%
Ankle X-ray, complete, 3 or more views CPT 73610 Xray Ankle Minimum 3 Vws	$429.12	$451.71	$80.54–$425.39	82% above	5%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Xray Ankle Minimum 3 Vws	$429.12	$451.71	$80.54–$425.39	—	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Extremity Study	$398.16	$419.12	$383.21	10% above	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Extremity Study - Vascular Diagnostics	$399.25	$420.26	$383.21	10% above	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Extremity Study	$398.16	$419.12	$383.21	—	5%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Extremity Study - Vascular Diagnostics	$399.25	$420.26	$383.21	—	5%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT Upper Extremity W/O Dye	$1,845.25	$1,942.37	$156.57–$1,829.23	33% above	5%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT Upper Extremity W/O Dye	$1,845.25	$1,942.37	$156.57–$1,829.23	—	5%
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Scan, Whole Body	$3,108.21	$3,271.80	$1,300.51–$3,081.21	122% above	5%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone Scan, Whole Body	$3,108.21	$3,271.80	$1,300.51–$3,081.21	—	5%
Breast ultrasound, complete, one breast CPT 76641 Ultrasound Breast Complete	$878.08	$924.29	$378.15–$870.45	66% above	5%
Breast ultrasound, complete, one breast inpatient CPT 76641 Ultrasound Breast Complete	$878.08	$924.29	$378.15–$870.45	—	5%
Breast ultrasound, limited (one breast or one area) CPT 76642 Ultrasound Breast Limited	$670.82	$706.13	$160.37–$665.00	77% above	5%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Ultrasound Breast Limited	$670.82	$706.13	$160.37–$665.00	—	5%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abd&Pelv W/O&W/Dye	$5,948.64	$6,261.73	$2,561.84–$5,896.97	104% above	5%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abd&Pelv W/O&W/Dye	$5,948.64	$6,261.73	$2,561.84–$5,896.97	—	5%
CT angiography (CTA) of the head CPT 70496 CT Angiography, Head	$3,102.92	$3,266.23	$548.46–$3,075.97	50% above	5%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angiography, Head	$3,102.92	$3,266.23	$548.46–$3,075.97	—	5%
CT angiography (CTA) of the neck CPT 70498 CT Angiography, Neck	$3,102.92	$3,266.23	$548.46–$3,012.55	60% above	5%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angiography, Neck	$3,102.92	$3,266.23	$548.46–$3,012.55	—	5%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angiography, Chest	$3,895.16	$4,100.17	$300.35–$3,901.14	101% above	5%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angiography, Chest	$3,895.16	$4,100.17	$300.35–$3,901.14	—	5%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd & Pelvis W/O Contrast	$3,386.83	$3,565.08	$448.89–$3,392.02	35% above	5%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd & Pelvis W/O Contrast	$3,386.83	$3,565.08	$448.89–$3,392.02	—	5%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen&Pelvis W/Contrast	$5,284.16	$5,562.27	$448.89–$5,238.26	68% above	5%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen&Pelvis W/Contrast	$5,284.16	$5,562.27	$448.89–$5,238.26	—	5%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd&Pelv 1+ Section/Regns	$5,479.66	$5,768.06	$471.67–$5,432.06	54% above	5%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd&Pelv 1+ Section/Regns	$5,479.66	$5,768.06	$471.67–$5,432.06	—	5%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W/Dye	$2,937.89	$3,092.52	$1,253.45–$2,852.33	87% above	5%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W/Dye	$2,937.89	$3,092.52	$1,253.45–$2,852.33	—	5%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen W/O Dye	$2,911.85	$3,065.10	$1,279.61–$2,916.31	131% above	5%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen W/O Dye	$2,911.85	$3,065.10	$1,279.61–$2,916.31	—	5%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacialw/O Dye	$1,719.96	$1,810.48	$157.59–$1,705.02	24% above	5%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacialw/O Dye	$1,719.96	$1,810.48	$157.59–$1,705.02	—	5%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head/Brain W/O Dye	$2,127.00	$2,238.95	$448.89–$2,108.53	65% above	5%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head/Brain W/O Dye	$2,127.00	$2,238.95	$448.89–$2,108.53	—	5%
CT scan of the head without and with contrast CPT 70470 CT Head/Brain W/O & W/Dye	$2,647.32	$2,786.65	$471.67	44% above	5%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head/Brain W/O & W/Dye	$2,647.32	$2,786.65	$471.67	—	5%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumbar Spine W/O Dye	$2,647.32	$2,786.65	$157.59–$2,705.49	80% above	5%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lumbar Spine W/O Dye	$2,647.32	$2,786.65	$157.59–$2,705.49	—	5%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Neck Spine W/O Dye	$3,036.92	$3,196.76	$157.59–$3,010.54	107% above	5%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Neck Spine W/O Dye	$3,036.92	$3,196.76	$157.59–$3,010.54	—	5%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W/Dye	$2,268.44	$2,387.83	$464.59–$2,115.71	44% above	5%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W/Dye	$2,268.44	$2,387.83	$464.59–$2,115.71	—	5%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Cv Carotid Imaging-Bilat	$3,003.53	$3,161.61	$248.62–$2,977.43	—	5%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Cv Carotid Imaging-Bilat	$3,003.53	$3,161.61	$248.62–$2,977.43	—	5%
Chest CT scan without and with contrast CPT 71270 Diagnostic CT Thorax W&WO Contrast	$3,233.77	$3,403.97	$1,401.13–$3,205.69	44% above	5%
Chest CT scan without and with contrast inpatient CPT 71270 Diagnostic CT Thorax W&WO Contrast	$3,233.77	$3,403.97	$1,401.13–$3,205.69	—	5%
Chest X-ray, 2 views CPT 71046 X-Ray Exam Chest 2 Views	$402.73	$423.93	$81.77–$411.58	88% above	5%
Chest X-ray, 2 views inpatient CPT 71046 X-Ray Exam Chest 2 Views	$402.73	$423.93	$81.77–$411.58	—	5%
Chest X-ray, single view CPT 71045 X-Ray Exam Chest 1 View	$356.50	$375.26	$153.53–$357.04	120% above	5%
Chest X-ray, single view inpatient CPT 71045 X-Ray Exam Chest 1 View	$356.50	$375.26	$153.53–$357.04	—	5%
Collarbone (clavicle) X-ray, complete CPT 73000 Xray Clavicle Complete	$419.88	$441.98	$181.57–$416.24	105% above	5%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Xray Clavicle Complete	$419.88	$441.98	$181.57–$416.24	—	5%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Tc	$669.61	$704.85	$242.93–$663.79	22% above	5%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Tc	$669.61	$704.85	$242.93–$663.79	—	5%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Diagnostic CT Thorax W/O Contrast	$2,013.61	$2,119.59	$157.59–$2,016.69	40% above	5%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Diagnostic CT Thorax W/O Contrast	$2,013.61	$2,119.59	$157.59–$2,016.69	—	5%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Diagnostic CT Thorax W/ Contrast	$2,572.01	$2,707.38	$448.89–$2,586.46	64% above	5%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Diagnostic CT Thorax W/ Contrast	$2,572.01	$2,707.38	$448.89–$2,586.46	—	5%
Diagnostic mammogram, both breasts both sides CPT 77066 Digital Mamm, Diag, Bilat, Tc W/Cad Perf	$367.40	$386.74	$34.44–$356.71	—	5%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Digital Mamm, Diag, Bilat, Tc W/Cad Perf	$367.40	$386.74	$34.44–$356.71	—	5%
Diagnostic mammogram, one breast one side CPT 77065 Digital Mamm, Diag, Unilat, Tc W/Cad Perf	$328.49	$345.78	$34.44–$325.64	7% above	5%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Digital Mamm, Diag, Unilat, Tc W/Cad Perf	$328.49	$345.78	$34.44–$325.64	—	5%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Art Lower Extremity-Bilat	$831.48	$875.24	$359.54–$824.26	—	5%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Art Lower Extremity-Bilat	$831.48	$875.24	$359.54–$824.26	—	5%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Ven Duplex Bilateral	$2,215.04	$2,331.62	$194.69–$248.62	—	5%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Ven Duplex Bilateral	$2,215.04	$2,331.62	$194.69–$248.62	—	5%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Tte W/Doppler, Complete	$3,315.29	$3,489.78	$639.45–$3,320.38	89% above	5%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Tte W/Doppler, Complete	$3,315.29	$3,489.78	$639.45–$3,320.38	—	5%
Elbow X-ray, 2 views CPT 73070 Xray Elbow 2 Vws	$389.51	$410.01	$357.49–$386.13	106% above	5%
Elbow X-ray, 2 views inpatient CPT 73070 Xray Elbow 2 Vws	$389.51	$410.01	$357.49–$386.13	—	5%
Elbow X-ray, complete, 3 or more views CPT 73080 Xray Elbow 3+Vws Tc	$468.74	$493.41	$196.79–$469.46	101% above	5%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 Xray Elbow 3+Vws Tc	$468.74	$493.41	$196.79–$469.46	—	5%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit/Ear/Fosa W/O Dye	$1,845.25	$1,942.37	$1,791.51–$1,829.23	33% above	5%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit/Ear/Fosa W/O Dye	$1,845.25	$1,942.37	$1,791.51–$1,829.23	—	5%
Forearm X-ray (radius and ulna), 2 views CPT 73090 Xray Forearm 2 Vws	$376.32	$396.13	$147.23–$384.59	97% above	5%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 Xray Forearm 2 Vws	$376.32	$396.13	$147.23–$384.59	—	5%
Hand X-ray, 2 views CPT 73120 Xray Hand 2vws Tc	$389.51	$410.01	$177.17	107% above	5%
Hand X-ray, 2 views inpatient CPT 73120 Xray Hand 2vws Tc	$389.51	$410.01	$177.17	—	5%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Xray Calcaneus Minimum 2 Vws	$343.31	$361.38	$340.32–$340.33	79% above	5%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 Xray Calcaneus Minimum 2 Vws	$343.31	$361.38	$340.32–$340.33	—	5%
Knee X-ray, 3 views CPT 73562 Xray Knee 3 Vws	$429.12	$451.71	$185.56–$429.78	69% above	5%
Knee X-ray, 3 views inpatient CPT 73562 Xray Knee 3 Vws	$429.12	$451.71	$185.56–$429.78	—	5%
Knee X-ray, complete, 4 or more views CPT 73564 Xray Knee 4 or More Vws	$706.53	$743.72	$296.01–$710.51	156% above	5%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 Xray Knee 4 or More Vws	$706.53	$743.72	$296.01–$710.51	—	5%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Lower Extremity W/O Dye	$1,845.25	$1,942.37	$156.57–$1,829.23	29% above	5%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Lower Extremity W/O Dye	$1,845.25	$1,942.37	$156.57–$1,829.23	—	5%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited Tc	$485.21	$510.75	$160.37–$481.00	12% above	5%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited Tc	$485.21	$510.75	$160.37–$481.00	—	5%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Ext Non-Vasc Img Lmtd	$998.74	$1,051.31	$157.96–$990.07	278% above	5%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US Ext Non-Vasc Img Lmtd	$998.74	$1,051.31	$157.96–$990.07	—	5%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Low Dose CT Lung Ca Screen WO Contrast	$702.30	$739.26	$157.59–$696.20	58% above	5%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Low Dose CT Lung Ca Screen WO Contrast	$702.30	$739.26	$157.59–$696.20	—	5%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Xray Tibia & Fibula 2 Vws	$463.32	$487.71	$199.54–$464.03	118% above	5%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 Xray Tibia & Fibula 2 Vws	$463.32	$487.71	$199.54–$464.03	—	5%
MR angiography (MRA) of the head without contrast CPT 70544 Mra, Head W/Out Contrast	$3,367.01	$3,544.22	$726.04–$3,337.77	60% above	5%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mra, Head W/Out Contrast	$3,367.01	$3,544.22	$726.04–$3,337.77	—	5%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Low Ext Jnt WO/Cont Tc	$3,168.94	$3,335.73	$352.50–$3,141.42	50% above	5%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Low Ext Jnt WO/Cont Tc	$3,168.94	$3,335.73	$352.50–$3,141.42	—	5%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI,Lwrext,Jnt W/O+W/Cont	$3,935.58	$4,142.72	$1,789.82–$3,670.62	21% above	5%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI,Lwrext,Jnt W/O+W/Cont	$3,935.58	$4,142.72	$1,789.82–$3,670.62	—	5%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen W/O Tc	$3,686.01	$3,880.01	$356.28–$3,578.65	75% above	5%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen W/O Tc	$3,686.01	$3,880.01	$356.28–$3,578.65	—	5%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI, Abdomen W/O+ W/Contr	$3,234.94	$3,405.20	$1,428.33–$3,206.84	1% below	5%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI, Abdomen W/O+ W/Contr	$3,234.94	$3,405.20	$1,428.33–$3,206.84	—	5%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO Contrast Tc	$3,644.23	$3,836.03	$356.28–$3,612.58	73% above	5%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain WO Contrast Tc	$3,644.23	$3,836.03	$356.28–$3,612.58	—	5%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain W & WO Contrast	$4,638.80	$4,882.95	$584.00–$4,598.51	42% above	5%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain W & WO Contrast	$4,638.80	$4,882.95	$584.00–$4,598.51	—	5%
MRI of the lower back, no contrast dye CPT 72148 MRI L Spine WO Contrast	$4,357.31	$4,586.64	$352.50–$4,319.46	107% above	5%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L Spine WO Contrast	$4,357.31	$4,586.64	$352.50–$4,319.46	—	5%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L Spine W&WO Contrast	$4,357.31	$4,586.64	$601.06–$4,453.05	33% above	5%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L Spine W&WO Contrast	$4,357.31	$4,586.64	$601.06–$4,453.05	—	5%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T Spine WO Contrast	$4,022.20	$4,233.89	$356.28–$3,987.25	91% above	5%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T Spine WO Contrast	$4,022.20	$4,233.89	$356.28–$3,987.25	—	5%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C Spine W&WO Contrast	$4,357.31	$4,586.64	$601.06–$4,319.46	33% above	5%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C Spine W&WO Contrast	$4,357.31	$4,586.64	$601.06–$4,319.46	—	5%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-Spine WO Contrast	$3,686.01	$3,880.01	$356.28–$3,653.99	75% above	5%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-Spine WO Contrast	$3,686.01	$3,880.01	$356.28–$3,653.99	—	5%
MRI of the pelvis without and with contrast CPT 72197 MRI, Pelvis, W/O Then W/	$4,627.99	$4,871.57	$601.06–$4,729.68	42% above	5%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI, Pelvis, W/O Then W/	$4,627.99	$4,871.57	$601.06–$4,729.68	—	5%
MRI of the pelvis, no contrast dye CPT 72195 MRI,Pelvis W/Out Contrast	$3,686.01	$3,880.01	$1,619.81–$3,578.65	74% above	5%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI,Pelvis W/Out Contrast	$3,686.01	$3,880.01	$1,619.81–$3,578.65	—	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI Up Extremity Joint W/O Tc	$3,446.23	$3,627.61	$356.28–$3,451.51	63% above	5%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI Up Extremity Joint W/O Tc	$3,446.23	$3,627.61	$356.28–$3,451.51	—	5%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck W/Dye	$2,104.85	$2,215.63	$448.89–$2,108.08	34% above	5%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck W/Dye	$2,104.85	$2,215.63	$448.89–$2,108.08	—	5%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck W/O Dye	$1,845.25	$1,942.37	$814.74–$1,791.51	30% above	5%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tissue Neck W/O Dye	$1,845.25	$1,942.37	$814.74–$1,791.51	—	5%
Neck soft tissue X-ray CPT 70360 Xray Neck, Soft Tissue	$337.63	$355.40	$141.17–$334.70	61% above	5%
Neck soft tissue X-ray inpatient CPT 70360 Xray Neck, Soft Tissue	$337.63	$355.40	$141.17–$334.70	—	5%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Ht Muscle Image Spect, Mult	$4,233.92	$4,456.76	$1,317.94–$4,197.15	37% above	5%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Ht Muscle Image Spect, Mult	$4,233.92	$4,456.76	$1,317.94–$4,197.15	—	5%
OCT scan of the retina (optical coherence tomography) CPT 92134 Comput Ophth Dx Img Post Segmt	$52.17	$54.92	$21.94–$52.25	22% above	5%
OCT scan of the retina (optical coherence tomography) inpatient CPT 92134 Comput Ophth Dx Img Post Segmt	$52.17	$54.92	$21.94–$52.25	—	5%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet/CT Skull-Mid Thigh Tc	$7,377.50	$7,765.79	$2,021.57–$7,313.42	82% above	5%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet/CT Skull-Mid Thigh Tc	$7,377.50	$7,765.79	$2,021.57–$7,313.42	—	5%
Pelvic CT scan without contrast CPT 72192 CT Pelvis W/O Dye	$2,173.26	$2,287.64	$154.22–$1,994.60	70% above	5%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis W/O Dye	$2,173.26	$2,287.64	$154.22–$1,994.60	—	5%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Follicles-Limited Tc	$606.53	$638.45	$160.37–$601.26	51% above	5%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Follicles-Limited Tc	$606.53	$638.45	$160.37–$601.26	—	5%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Tc Complete	$542.22	$570.76	$227.64–$543.06	5% above	5%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Tc Complete	$542.22	$570.76	$227.64–$543.06	—	5%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US,Preg. Uterus,Fetal/Mat.Eval.,>1st Trim.(>/= 14 Wks 0 Dys),Transabd;Single/First Gest., Tech	$608.96	$641.01	$144.84–$603.67	6% above	5%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US,Preg. Uterus,Fetal/Mat.Eval.,>1st Trim.(>/= 14 Wks 0 Dys),Transabd;Single/First Gest., Tech	$608.96	$641.01	$144.84–$603.67	—	5%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 Wks, Single Fetus - Radiology, Tech	$608.96	$641.01	$147.05–$603.67	32% above	5%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 Wks, Single Fetus - Radiology, Tech	$608.96	$641.01	$147.05–$603.67	—	5%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Pregnancy Tc Limited	$485.21	$510.75	$144.84–$480.99	32% above	5%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Pregnancy Tc Limited	$485.21	$510.75	$144.84–$480.99	—	5%
Rib X-ray, one side, 2 views one side CPT 71100 Xray Ribs Unilat 2 Vws	$356.50	$375.26	$153.53–$346.11	60% above	5%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Xray Ribs Unilat 2 Vws	$356.50	$375.26	$153.53–$346.11	—	5%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xray Ribs Unilat 2 Vws With Pa Chest	$403.14	$424.36	$172.00–$403.76	46% above	5%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Xray Ribs Unilat 2 Vws With Pa Chest	$403.14	$424.36	$172.00–$403.76	—	5%
Screening mammogram, both breasts CPT 77067 Digital Mammogram, Screen Bil, Tc W/Cad Perf	$283.89	$298.83	$34.44–$284.33	11% above	5%
Screening mammogram, both breasts inpatient CPT 77067 Digital Mammogram, Screen Bil, Tc W/Cad Perf	$283.89	$298.83	$34.44–$284.33	—	5%
Shoulder X-ray, complete, 2 or more views CPT 73030 Xray Shoulder Minimum 2 Vws	$491.13	$516.98	$82.90–$491.88	119% above	5%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Xray Shoulder Minimum 2 Vws	$491.13	$516.98	$82.90–$491.88	—	5%
Sinus X-ray, complete, 3 or more views CPT 70220 Xray Sinuses Minimum 3 Vws	$561.18	$590.72	$241.68–$562.04	115% above	5%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Xray Sinuses Minimum 3 Vws	$561.18	$590.72	$241.68–$562.04	—	5%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Contrast Xray Swallowing Funct Int, Cine/Vid; Inclscout & Delay (Tc)	$1,172.19	$1,233.88	$494.76–$1,173.98	168% above	5%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Contrast Xray Swallowing Funct Int, Cine/Vid; Inclscout & Delay (Tc)	$1,172.19	$1,233.88	$494.76–$1,173.98	—	5%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-Ray Exam Femur Min 2 Vws	$512.38	$539.35	$216.27–$507.93	108% above	5%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-Ray Exam Femur Min 2 Vws	$512.38	$539.35	$216.27–$507.93	—	5%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Chest Spine W/O Dye	$2,647.32	$2,786.65	$157.59–$2,705.49	80% above	5%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Chest Spine W/O Dye	$2,647.32	$2,786.65	$157.59–$2,705.49	—	5%
Toe X-ray, 2 or more views CPT 73660 Xray Toe(S) Tc	$310.29	$326.62	$289.40–$307.60	54% above	5%
Toe X-ray, 2 or more views inpatient CPT 73660 Xray Toe(S) Tc	$310.29	$326.62	$289.40–$307.60	—	5%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Tc	$619.87	$652.49	$584.29–$614.49	34% above	5%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Tc	$619.87	$652.49	$584.29–$614.49	—	5%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Tc	$679.31	$715.06	$299.93–$673.41	13% above	5%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Tc	$679.31	$715.06	$299.93–$673.41	—	5%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum & Contents Tc	$909.80	$957.68	$161.39–$901.90	89% above	5%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum & Contents Tc	$909.80	$957.68	$161.39–$901.90	—	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Tc	$498.58	$524.82	$161.39–$494.25	1% below	5%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Tc	$498.58	$524.82	$161.39–$494.25	—	5%
Upper arm X-ray (humerus), 2 views CPT 73060 Xray Humerus Minimum 2 Vws	$442.33	$465.61	$190.49–$438.49	114% above	5%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 Xray Humerus Minimum 2 Vws	$442.33	$465.61	$190.49–$438.49	—	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Venous Duplex Scan Uni	$1,519.96	$1,599.96	$641.55–$1,522.29	125% above	5%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 Venous Duplex Scan Uni	$1,519.96	$1,599.96	$641.55–$1,522.29	—	5%
Wrist X-ray, 2 views CPT 73100 Xray Wrist 2 Vws	$395.78	$416.61	$178.74–$392.35	83% above	5%
Wrist X-ray, 2 views inpatient CPT 73100 Xray Wrist 2 Vws	$395.78	$416.61	$178.74–$392.35	—	5%
Wrist X-ray, complete, 3 or more views CPT 73110 Xray Wrist Minimum 3 Vws	$480.09	$505.36	$82.90–$480.83	122% above	5%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Xray Wrist Minimum 3 Vws	$480.09	$505.36	$82.90–$480.83	—	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-Ray Exam Hip,Unilat W/Pelvis 2-3 Vws	$512.38	$539.35	$81.77–$513.40	76% above	5%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-Ray Exam Hip,Unilat W/Pelvis 2-3 Vws	$512.38	$539.35	$81.77–$513.40	—	5%
X-ray of the abdomen, 1 view CPT 74018 X-Ray Exam Abdomen 1 View	$369.70	$389.16	$157.74–$370.27	76% above	5%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-Ray Exam Abdomen 1 View	$369.70	$389.16	$157.74–$370.27	—	5%
X-ray of the ankle, 2 views CPT 73600 Xray Ankle 2 Vws	$369.70	$389.16	$355.83	86% above	5%
X-ray of the ankle, 2 views inpatient CPT 73600 Xray Ankle 2 Vws	$369.70	$389.16	$355.83	—	5%
X-ray of the finger(s), 2 or more views CPT 73140 Xray Finger(S) Tc	$332.01	$349.48	$146.59–$329.13	72% above	5%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Xray Finger(S) Tc	$332.01	$349.48	$146.59–$329.13	—	5%
X-ray of the foot, 2 views CPT 73620 Xray Foot 2 Vws	$363.10	$382.21	$160.32–$352.53	93% above	5%
X-ray of the foot, 2 views inpatient CPT 73620 Xray Foot 2 Vws	$363.10	$382.21	$160.32–$352.53	—	5%
X-ray of the foot, complete, 3 or more views CPT 73630 Xray Foot Minimum 3 Vws	$389.51	$410.01	$40.89–$390.11	80% above	5%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Xray Foot Minimum 3 Vws	$389.51	$410.01	$40.89–$390.11	—	5%
X-ray of the hand, 3 or more views CPT 73130 Xray Hand 3vws Tc	$382.92	$403.07	$40.89–$383.50	87% above	5%
X-ray of the hand, 3 or more views inpatient CPT 73130 Xray Hand 3vws Tc	$382.92	$403.07	$40.89–$383.50	—	5%
X-ray of the knee, 1 or 2 views CPT 73560 Xray Knee 1 or 2 Vws	$422.51	$444.75	$178.33–$418.85	99% above	5%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Xray Knee 1 or 2 Vws	$422.51	$444.75	$178.33–$418.85	—	5%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xray Lumbosacral 2 or 3 Vws	$561.18	$590.72	$81.77–$556.31	117% above	5%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Xray Lumbosacral 2 or 3 Vws	$561.18	$590.72	$81.77–$556.31	—	5%
X-ray of the lower back, 4 or more views CPT 72110 Xray Lumbosacral Minimum 4 Vws	$1,002.71	$1,055.48	$84.25–$994.00	171% above	5%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Xray Lumbosacral Minimum 4 Vws	$1,002.71	$1,055.48	$84.25–$994.00	—	5%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xray Thoracic Spine 2 Vws	$633.76	$667.12	$84.25–$628.26	170% above	5%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Xray Thoracic Spine 2 Vws	$633.76	$667.12	$84.25–$628.26	—	5%
X-ray of the nasal bones, 3 or more views CPT 70160 Xray Nasal Bones Minimum 3 Vws	$336.70	$354.42	$324.06–$338.42	57% above	5%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Xray Nasal Bones Minimum 3 Vws	$336.70	$354.42	$324.06–$338.42	—	5%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xray Cervical Spine 2 or 3 Vws	$501.47	$527.86	$80.54–$497.12	113% above	5%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Xray Cervical Spine 2 or 3 Vws	$501.47	$527.86	$80.54–$497.12	—	5%
X-ray of the pelvis, 1 or 2 views CPT 72170 Xray Pelvis 1 or 2 Vws	$363.10	$382.21	$151.82–$363.66	72% above	5%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Xray Pelvis 1 or 2 Vws	$363.10	$382.21	$151.82–$363.66	—	5%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xray Sacrum/ Coccyx Minimum 2 Vws	$480.09	$505.36	$82.90–$475.92	131% above	5%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Xray Sacrum/ Coccyx Minimum 2 Vws	$480.09	$505.36	$82.90–$475.92	—	5%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; Alanine Amino (Alt) (Sgpt)	$149.34	$157.20	$5.48–$148.04	232% above	5%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Amino (Alt) (Sgpt)	$149.34	$157.20	$5.48–$148.04	232% above	5%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Amino (Alt) (Sgpt)	$149.34	$157.20	$5.48–$148.04	—	5%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Transferase; Alanine Amino (Alt) (Sgpt)	$149.34	$157.20	$5.48–$148.04	—	5%
AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase (Ast) (Sgot)	$149.34	$157.20	$5.35–$148.04	198% above	5%
AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase; Aspartate Amino (Ast) (Sgot)	$149.34	$157.20	$5.35–$148.04	198% above	5%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Transferase; Aspartate Amino (Ast) (Sgot)	$149.34	$157.20	$5.35–$148.04	—	5%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Transferase (Ast) (Sgot)	$149.34	$157.20	$5.35–$148.04	—	5%
Albumin blood test CPT 82040 Albumin	$107.32	$112.97	$5.11–$106.49	186% above	5%
Albumin blood test CPT 82040 Albumin, Blood	$107.32	$112.97	$5.11–$106.49	186% above	5%
Albumin blood test inpatient CPT 82040 Albumin, Blood	$107.32	$112.97	$5.11–$106.49	—	5%
Albumin blood test inpatient CPT 82040 Albumin	$107.32	$112.97	$5.11–$106.49	—	5%
Aldosterone blood test CPT 82088 Assay of Aldosterone	$233.97	$246.28	$280.94	17% above	5%
Aldosterone blood test inpatient CPT 82088 Assay of Aldosterone	$233.97	$246.28	$280.94	—	5%
Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase, Alkaline - Ref	$133.84	$140.88	$58.82	169% above	5%
Alkaline phosphatase (ALP) blood test CPT 84075 Assay Alkaline Phosphatase	$133.84	$140.88	$58.82	169% above	5%
Alkaline phosphatase (ALP) blood test CPT 84075 Assay Alkal Phosphatase	$133.84	$140.88	$58.82	169% above	5%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Phosphatase, Alkaline - Ref	$133.84	$140.88	$58.82	—	5%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Assay Alkal Phosphatase	$133.84	$140.88	$58.82	—	5%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Assay Alkaline Phosphatase	$133.84	$140.88	$58.82	—	5%
Ammonia blood test CPT 82140 Assay of Ammonia	$277.54	$292.15	$15.06–$277.97	209% above	5%
Ammonia blood test CPT 82140 Assay of ammonia	$277.54	$292.15	$15.06–$277.97	209% above	5%
Ammonia blood test inpatient CPT 82140 Assay of ammonia	$277.54	$292.15	$15.06–$277.97	—	5%
Ammonia blood test inpatient CPT 82140 Assay of Ammonia	$277.54	$292.15	$15.06–$277.97	—	5%
Amylase blood test CPT 82150 Assay of Amylase	$211.73	$222.87	$6.70–$209.89	243% above	5%
Amylase blood test inpatient CPT 82150 Assay of Amylase	$211.73	$222.87	$6.70–$209.89	—	5%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibody	$102.13	$107.50	$135.84	28% above	5%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP, Antibody - Ref	$102.13	$107.50	$135.84	28% above	5%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP, Antibody - Ref	$102.13	$107.50	$135.84	—	5%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibody	$102.13	$107.50	$135.84	—	5%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies	$199.44	$209.94	$12.30–$109.18	191% above	5%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Aby Scree	$199.44	$209.94	$12.30–$109.18	191% above	5%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Aby Scree	$199.44	$209.94	$12.30–$109.18	—	5%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibodies	$199.44	$209.94	$12.30–$109.18	—	5%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Assay of Natriuretic Peptide	$310.29	$326.62	$40.57–$310.77	121% above	5%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Assay of Natriuretic Peptide	$310.29	$326.62	$40.57–$310.77	—	5%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Lab Sputum Culture	$59.70	$62.84	$8.78–$90.56	23% below	5%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Lab Culture Bacteria	$249.56	$262.69	$8.78–$90.56	223% above	5%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Lab Sputum Culture	$59.70	$62.84	$8.78–$90.56	—	5%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Lab Culture Bacteria	$249.56	$262.69	$8.78–$90.56	—	5%
Basic metabolic panel (blood test) CPT 80048 Lab Basic Metabolic Panel	$212.06	$223.22	$8.74–$212.39	140% above	5%
Basic metabolic panel (blood test) inpatient CPT 80048 Lab Basic Metabolic Panel	$212.06	$223.22	$8.74–$212.39	—	5%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$112.09	$117.99	$4.24–$112.26	140% above	5%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$112.09	$117.99	$4.24–$112.26	—	5%
Blood culture for bacteria CPT 87040 Blood Culture for Bacteria	$363.69	$382.83	$10.66–$364.25	324% above	5%
Blood culture for bacteria inpatient CPT 87040 Blood Culture for Bacteria	$363.69	$382.83	$10.66–$364.25	—	5%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture, Lab	$29.03	$30.56	$3.96–$29.67	94% above	5%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture, Lab	$29.03	$30.56	$3.96–$29.67	—	5%
Blood glucose (sugar) test CPT 82947 Assay, Glucose, Blood Quant	$112.09	$117.99	$4.06–$111.11	359% above	5%
Blood glucose (sugar) test CPT 82947 Assay Quantitative, Glucose	$112.09	$117.99	$4.06–$111.11	359% above	5%
Blood glucose (sugar) test inpatient CPT 82947 Assay Quantitative, Glucose	$112.09	$117.99	$4.06–$111.11	—	5%
Blood glucose (sugar) test inpatient CPT 82947 Assay, Glucose, Blood Quant	$112.09	$117.99	$4.06–$111.11	—	5%
Blood lead test CPT 83655 LEAD	$80.67	$84.92	$12.51–$122.69	47% above	5%
Blood lead test inpatient CPT 83655 LEAD	$80.67	$84.92	$12.51–$122.69	—	5%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin, Chorionic (Hcg), Qualitative	$138.65	$145.95	$7.77–$137.45	123% above	5%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Chorionic Gonadotropin Assay	$138.65	$145.95	$7.77–$137.45	123% above	5%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Gonadotropin, Chorionic (Hcg), Qualitative	$138.65	$145.95	$7.77–$137.45	—	5%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Chorionic Gonadotropin Assay	$138.65	$145.95	$7.77–$137.45	—	5%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Lab Abo Group	$77.11	$81.17	$3.09–$76.45	93% above	5%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing Abo	$77.11	$81.17	$3.09–$76.45	93% above	5%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Lab Abo Group	$77.11	$81.17	$3.09–$76.45	—	5%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Typing Abo	$77.11	$81.17	$3.09–$76.45	—	5%
C-peptide blood test CPT 84681 Assay of C-Peptide	$119.13	$125.40	$123.86	36% above	5%
C-peptide blood test inpatient CPT 84681 Assay of C-Peptide	$119.13	$125.40	$123.86	—	5%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$156.13	$164.35	$5.35–$159.56	186% above	5%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP	$156.13	$164.35	$5.35–$159.56	186% above	5%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP	$156.13	$164.35	$5.35–$159.56	—	5%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$156.13	$164.35	$5.35–$159.56	—	5%
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Amplified Probe	$361.86	$380.90	$38.51–$362.41	140% above	5%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff Amplified Probe	$361.86	$380.90	$38.51–$362.41	—	5%
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9	$127.54	$134.25	$93.01	16% above	5%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Ca 19-9	$127.54	$134.25	$93.01	—	5%
CA-125 blood test (ovarian cancer marker) CPT 86304 Tumor Antigen, Ca-125	$98.64	$103.83	$97.17	16% below	5%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Tumor Antigen, Ca-125	$98.64	$103.83	$97.17	—	5%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Iadna Sars-Cov-2 Covid-19 Amplified Probe Tq	$126.64	$133.31	$51.31–$123.15	6% below	5%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Iadna Sars-Cov-2 Covid-19 Amplified Probe Tq	$126.64	$133.31	$51.31–$123.15	—	5%
Calcium blood test, total CPT 82310 Calcium Total	$44.70	$47.05	$5.25–$44.31	11% below	5%
Calcium blood test, total CPT 82310 Occ Med, Calcium, Total	$112.09	$117.99	$5.25–$44.31	124% above	5%
Calcium blood test, total inpatient CPT 82310 Calcium Total	$44.70	$47.05	$5.25–$44.31	—	5%
Calcium blood test, total inpatient CPT 82310 Occ Med, Calcium, Total	$112.09	$117.99	$5.25–$44.31	—	5%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis Dna, Amp Probe	$250.69	$263.88	$36.26–$256.61	75% above	5%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia Trachomatis Dna, Amp Probe	$250.69	$263.88	$36.26–$256.61	—	5%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Profile	$355.83	$374.56	$13.84–$356.38	285% above	5%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Profile	$355.83	$374.56	$13.84–$356.38	—	5%
Complete blood count (CBC) with differential CPT 85025 Lab Hemogram/Diff	$176.08	$185.35	$8.03–$179.95	152% above	5%
Complete blood count (CBC) with differential CPT 85025 Complete Cbc W/Auto Diff Wbc	$176.08	$185.35	$8.03–$179.95	152% above	5%
Complete blood count (CBC) with differential inpatient CPT 85025 Lab Hemogram/Diff	$176.08	$185.35	$8.03–$179.95	—	5%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Cbc W/Auto Diff Wbc	$176.08	$185.35	$8.03–$179.95	—	5%
Complete blood count (CBC), no differential CPT 85027 Complete Cbc Automated	$116.19	$122.31	$6.69–$116.37	132% above	5%
Complete blood count (CBC), no differential CPT 85027 Lab Hemogram	$133.36	$140.38	$6.69–$116.37	167% above	5%
Complete blood count (CBC), no differential inpatient CPT 85027 Complete Cbc Automated	$116.19	$122.31	$6.69–$116.37	—	5%
Complete blood count (CBC), no differential inpatient CPT 85027 Lab Hemogram	$133.36	$140.38	$6.69–$116.37	—	5%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$287.33	$302.45	$10.91–$293.64	153% above	5%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$287.33	$302.45	$10.91–$293.64	—	5%
Cortisol blood test, total CPT 82533 Cortisol, Am	$116.46	$122.59	$73.96–$166.85	1% below	5%
Cortisol blood test, total CPT 82533 Total Cortisol	$116.46	$122.59	$73.96–$166.85	1% below	5%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Am	$116.46	$122.59	$73.96–$166.85	—	5%
Cortisol blood test, total inpatient CPT 82533 Total Cortisol	$116.46	$122.59	$73.96–$166.85	—	5%
Creatine kinase (CK) blood test, total CPT 82550 Assay CK (Cpk)	$144.06	$151.64	$6.73–$147.22	130% above	5%
Creatine kinase (CK) blood test, total CPT 82550 Assay of CK (Cpk)	$144.06	$151.64	$6.73–$147.22	130% above	5%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Assay CK (Cpk)	$144.06	$151.64	$6.73–$147.22	—	5%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Assay of CK (Cpk)	$144.06	$151.64	$6.73–$147.22	—	5%
Creatinine blood test CPT 82565 Assay of creatinine	$122.27	$128.70	$5.29–$122.45	286% above	5%
Creatinine blood test CPT 82565 Assay Creatinine	$122.27	$128.70	$5.29–$122.45	286% above	5%
Creatinine blood test inpatient CPT 82565 Assay of creatinine	$122.27	$128.70	$5.29–$122.45	—	5%
Creatinine blood test inpatient CPT 82565 Assay Creatinine	$122.27	$128.70	$5.29–$122.45	—	5%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$172.39	$181.46	$10.52–$172.65	145% above	5%
D-dimer blood test (blood clot marker) CPT 85379 Fibrin Degradation Quant	$172.39	$181.46	$10.52–$172.65	145% above	5%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrin Degradation Quant	$172.39	$181.46	$10.52–$172.65	—	5%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$172.39	$181.46	$10.52–$172.65	—	5%
Epstein-Barr virus (EBV) antibody test CPT 86665 Ebv, Viral Capsid Ab - Ref	$86.22	$90.76	$18.74–$181.03	1% above	5%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-barr antibody	$86.22	$90.76	$18.74–$181.03	1% above	5%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Ebv, Viral Capsid Ab - Ref	$86.22	$90.76	$18.74–$181.03	—	5%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-barr antibody	$86.22	$90.76	$18.74–$181.03	—	5%
Estradiol blood test CPT 82670 Estradiol	$113.03	$118.98	$28.87–$296.31	12% below	5%
Estradiol blood test inpatient CPT 82670 Estradiol	$113.03	$118.98	$28.87–$296.31	—	5%
Ferritin blood test (iron stores) CPT 82728 Ferritin - Ref	$140.10	$147.47	$14.08–$148.03	56% above	5%
Ferritin blood test (iron stores) CPT 82728 Assay of Ferritin	$147.20	$154.95	$14.08–$148.03	64% above	5%
Ferritin blood test (iron stores) CPT 82728 Assay Ferritin	$147.20	$154.95	$14.08–$148.03	64% above	5%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin - Ref	$140.10	$147.47	$14.08–$148.03	—	5%
Ferritin blood test (iron stores) inpatient CPT 82728 Assay of Ferritin	$147.20	$154.95	$14.08–$148.03	—	5%
Ferritin blood test (iron stores) inpatient CPT 82728 Assay Ferritin	$147.20	$154.95	$14.08–$148.03	—	5%
Folate (folic acid) blood test CPT 82746 Folic Acid (Folate), Serum	$144.30	$151.89	$15.19–$143.05	33% above	5%
Folate (folic acid) blood test CPT 82746 Blood Folic Acid Serum	$271.68	$285.98	$15.19–$143.05	150% above	5%
Folate (folic acid) blood test inpatient CPT 82746 Folic Acid (Folate), Serum	$144.30	$151.89	$15.19–$143.05	—	5%
Folate (folic acid) blood test inpatient CPT 82746 Blood Folic Acid Serum	$271.68	$285.98	$15.19–$143.05	—	5%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Assay, Free Thyroxine	$310.04	$326.36	$9.32–$307.34	284% above	5%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxin, Free (Free T4)	$310.04	$326.36	$9.32–$307.34	284% above	5%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Assay, Free Thyroxine	$310.04	$326.36	$9.32–$307.34	—	5%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxin, Free (Free T4)	$310.04	$326.36	$9.32–$307.34	—	5%
Free testosterone test CPT 84402 Testosterone,Free - Ref	$269.90	$284.10	$26.32–$267.56	125% above	5%
Free testosterone test inpatient CPT 84402 Testosterone,Free - Ref	$269.90	$284.10	$26.32–$267.56	—	5%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Assay of Ggt	$196.94	$207.31	$7.44–$191.21	269% above	5%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Assay of Ggt	$196.94	$207.31	$7.44–$191.21	—	5%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Dna, Amp Probe	$249.56	$262.69	$36.26–$247.39	74% above	5%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Gonorrhoeae Dna, Amp Probe	$249.56	$262.69	$36.26–$247.39	—	5%
H. pylori stool antigen test CPT 87338 Lab H Pylori Stool Ag	$218.27	$229.76	$67.06–$140.05	75% above	5%
H. pylori stool antigen test inpatient CPT 87338 Lab H Pylori Stool Ag	$218.27	$229.76	$67.06–$140.05	—	5%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv-1 Antigens W/Hiv 1/2 Antib	$145.20	$152.84	$24.88–$145.42	45% above	5%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hiv-1 Antigens W/Hiv 1/2 Antib	$145.20	$152.84	$24.88–$145.42	—	5%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High-Risk Types	$208.45	$219.42	$36.26–$368.41	46% above	5%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hpv High-Risk Types	$208.45	$219.42	$36.26–$368.41	—	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin; Glycosylated(A1c)	$103.65	$109.11	$10.03–$167.54	61% above	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated Hemoglobin Test	$167.29	$176.09	$10.03–$167.54	160% above	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 A1C	$167.29	$176.09	$10.03–$167.54	160% above	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin; Glycosylated(A1c)	$103.65	$109.11	$10.03–$167.54	—	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated Hemoglobin Test	$167.29	$176.09	$10.03–$167.54	—	5%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 A1C	$167.29	$176.09	$10.03–$167.54	—	5%
Hemoglobin blood test CPT 85018 Hemoglobin	$69.58	$73.24	$2.41–$68.98	298% above	5%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$69.58	$73.24	$2.41–$68.98	—	5%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody, Total	$199.30	$209.79	$12.45–$126.58	157% above	5%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Antibody, Total	$199.30	$209.79	$12.45–$126.58	—	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab Test	$106.15	$111.74	$11.10–$113.33	43% above	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$106.15	$111.74	$11.10–$113.33	43% above	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody	$106.15	$111.74	$11.10–$113.33	—	5%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab Test	$106.15	$111.74	$11.10–$113.33	—	5%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag, Eia	$240.97	$253.65	$10.67–$109.09	251% above	5%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$240.97	$253.65	$10.67–$109.09	251% above	5%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag, Eia	$240.97	$253.65	$10.67–$109.09	—	5%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen	$240.97	$253.65	$10.67–$109.09	—	5%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody	$130.84	$137.73	$14.75–$150.25	59% above	5%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab Test	$130.84	$137.73	$14.75–$150.25	59% above	5%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab Test	$130.84	$137.73	$14.75–$150.25	—	5%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody	$130.84	$137.73	$14.75–$150.25	—	5%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Rna Quantification - Ref	$542.10	$570.63	$44.27–$188.18	126% above	5%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Rna Quant	$542.10	$570.63	$44.27–$188.18	126% above	5%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Rna Quant	$542.10	$570.63	$44.27–$188.18	—	5%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Rna Quantification - Ref	$542.10	$570.63	$44.27–$188.18	—	5%
Herpes blood test, HSV-1 antibody CPT 86695 Lab Hsv Igm Titer Pt 1	$207.98	$218.93	$13.43–$138.92	207% above	5%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Lab Hsv Igm Titer Pt 1	$207.98	$218.93	$13.43–$138.92	—	5%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2	$272.35	$286.68	$19.69–$202.73	224% above	5%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Type 2	$272.35	$286.68	$19.69–$202.73	—	5%
High-sensitivity CRP (hs-CRP) test CPT 86141 High Sens Crp	$130.73	$137.61	$131.64	69% above	5%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 High Sens Crp	$130.73	$137.61	$131.64	—	5%
Homocysteine blood test CPT 83090 Homocysteine	$169.85	$178.79	$18.24–$220.72	44% above	5%
Homocysteine blood test inpatient CPT 83090 Homocysteine	$169.85	$178.79	$18.24–$220.72	—	5%
Insulin blood test CPT 83525 Assay of Insulin,Total	$212.30	$223.47	$116.68–$117.92	227% above	5%
Insulin blood test inpatient CPT 83525 Assay of Insulin,Total	$212.30	$223.47	$116.68–$117.92	—	5%
Iron blood test (serum iron) CPT 83540 Assay of Iron	$132.16	$139.12	$6.69–$132.91	148% above	5%
Iron blood test (serum iron) CPT 83540 Assay Iron	$132.16	$139.12	$6.69–$132.91	148% above	5%
Iron blood test (serum iron) inpatient CPT 83540 Assay of Iron	$132.16	$139.12	$6.69–$132.91	—	5%
Iron blood test (serum iron) inpatient CPT 83540 Assay Iron	$132.16	$139.12	$6.69–$132.91	—	5%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Test	$170.21	$179.17	$9.03–$168.74	147% above	5%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Test	$170.21	$179.17	$9.03–$168.74	—	5%
Kidney function blood test panel CPT 80069 Renal Function Panel	$258.87	$272.49	$113.76–$251.32	152% above	5%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$258.87	$272.49	$113.76–$251.32	—	5%
Lactate (lactic acid) blood test CPT 83605 Lactate (Lactic Acid)	$176.86	$186.17	$11.96–$177.13	150% above	5%
Lactate (lactic acid) blood test CPT 83605 Assay of Lactic Acid	$176.86	$186.17	$11.96–$177.13	150% above	5%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate (Lactic Acid)	$176.86	$186.17	$11.96–$177.13	—	5%
Lactate (lactic acid) blood test inpatient CPT 83605 Assay of Lactic Acid	$176.86	$186.17	$11.96–$177.13	—	5%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate (Ld) (Ldh) Enzyme	$137.93	$145.19	$6.24–$138.14	190% above	5%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate (Ld) (Ldh) Enzyme	$137.93	$145.19	$6.24–$138.14	—	5%
Lipase blood test (pancreas enzyme) CPT 83690 Assay of Lipase	$158.47	$166.81	$7.12–$157.10	132% above	5%
Lipase blood test (pancreas enzyme) CPT 83690 Assay Lipase	$158.47	$166.81	$7.12–$157.10	132% above	5%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Assay Lipase	$158.47	$166.81	$7.12–$157.10	—	5%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Assay of Lipase	$158.47	$166.81	$7.12–$157.10	—	5%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$258.87	$272.49	$8.44–$256.62	154% above	5%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$258.87	$272.49	$8.44–$256.62	—	5%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody	$206.77	$217.65	$17.60–$179.07	145% above	5%
Lyme disease antibody test CPT 86618 Lyme Screen	$206.77	$217.65	$17.60–$179.07	145% above	5%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Antibody	$206.77	$217.65	$17.60–$179.07	—	5%
Lyme disease antibody test inpatient CPT 86618 Lyme Screen	$206.77	$217.65	$17.60–$179.07	—	5%
Magnesium blood test CPT 83735 Lab Magnesium	$145.25	$152.89	$6.92–$145.48	190% above	5%
Magnesium blood test CPT 83735 Magnesium	$145.26	$152.90	$6.92–$145.48	191% above	5%
Magnesium blood test inpatient CPT 83735 Lab Magnesium	$145.25	$152.89	$6.92–$145.48	—	5%
Magnesium blood test inpatient CPT 83735 Magnesium	$145.26	$152.90	$6.92–$145.48	—	5%
Measles (rubeola) antibody test CPT 86765 Rubeola Antibody	$78.18	$82.29	$133.04–$135.84	2% below	5%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Antibody	$78.18	$82.29	$133.04–$135.84	—	5%
Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile Antibodies	$99.76	$105.01	$5.35–$98.90	81% above	5%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO	$99.76	$105.01	$5.35–$98.90	81% above	5%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO	$99.76	$105.01	$5.35–$98.90	—	5%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Heterophile Antibodies	$99.76	$105.01	$5.35–$98.90	—	5%
Mumps immunity blood test CPT 86735 Mumps	$73.69	$77.57	$134.05–$136.87	13% below	5%
Mumps immunity blood test inpatient CPT 86735 Mumps	$73.69	$77.57	$134.05–$136.87	—	5%
PSA (prostate-specific antigen) blood test, free CPT 84154 Psa, Free - Ref	$191.67	$201.76	$87.95–$193.47	113% above	5%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Psa, Free - Ref	$191.67	$201.76	$87.95–$193.47	—	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 Assay of Psa Total	$184.86	$194.59	$19.00–$193.47	94% above	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 Lab Psa Screening	$184.86	$194.59	$19.00–$193.47	94% above	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 Psa, Total - Ref	$230.49	$242.62	$19.00–$193.47	142% above	5%
PSA (prostate-specific antigen) blood test, total CPT 84153 Lab Psa Diagnostic	$280.39	$295.15	$19.00–$193.47	195% above	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Lab Psa Screening	$184.86	$194.59	$19.00–$193.47	—	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Assay of Psa Total	$184.86	$194.59	$19.00–$193.47	—	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Psa, Total - Ref	$230.49	$242.62	$19.00–$193.47	—	5%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Lab Psa Diagnostic	$280.39	$295.15	$19.00–$193.47	—	5%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap Screen Thin Layer Prep	$153.28	$161.35	$20.93–$153.52	75% above	5%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Pap Screen Thin Layer Prep	$153.28	$161.35	$20.93–$153.52	—	5%
Parathyroid hormone (PTH) blood test CPT 83970 Lab Pth Immunoch Part 1	$262.24	$276.04	$42.01–$433.24	21% above	5%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Lab Pth Immunoch Part 1	$262.24	$276.04	$42.01–$433.24	—	5%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplas Time Partial	$144.06	$151.64	$6.21–$144.28	188% above	5%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin Time Partial	$144.06	$151.64	$6.21–$144.28	188% above	5%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplas Time Partial	$144.06	$151.64	$6.21–$144.28	—	5%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplastin Time Partial	$144.06	$151.64	$6.21–$144.28	—	5%
Phosphorus (phosphate) blood test CPT 84100 Po4 Inorganic (Phosphate) - Ref	$21.53	$22.66	$4.83–$112.26	48% below	5%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus	$112.09	$117.99	$4.83–$112.26	169% above	5%
Phosphorus (phosphate) blood test CPT 84100 Assay of Phosphorus	$112.09	$117.99	$4.83–$112.26	169% above	5%
Phosphorus (phosphate) blood test inpatient CPT 84100 Po4 Inorganic (Phosphate) - Ref	$21.53	$22.66	$4.83–$112.26	—	5%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus	$112.09	$117.99	$4.83–$112.26	—	5%
Phosphorus (phosphate) blood test inpatient CPT 84100 Assay of Phosphorus	$112.09	$117.99	$4.83–$112.26	—	5%
Potassium blood test CPT 84132 Assay Serum Potassium	$112.09	$117.99	$49.26–$114.55	286% above	5%
Potassium blood test CPT 84132 Potassium; Serum, Plasma or Whole Blood	$112.09	$117.99	$49.26–$114.55	286% above	5%
Potassium blood test inpatient CPT 84132 Assay Serum Potassium	$112.09	$117.99	$49.26–$114.55	—	5%
Potassium blood test inpatient CPT 84132 Potassium; Serum, Plasma or Whole Blood	$112.09	$117.99	$49.26–$114.55	—	5%
Progesterone blood test CPT 84144 Progesterone	$87.83	$92.45	$21.55–$197.54	27% below	5%
Progesterone blood test CPT 84144 Assay Progesterone	$87.83	$92.45	$21.55–$197.54	27% below	5%
Progesterone blood test inpatient CPT 84144 Progesterone	$87.83	$92.45	$21.55–$197.54	—	5%
Progesterone blood test inpatient CPT 84144 Assay Progesterone	$87.83	$92.45	$21.55–$197.54	—	5%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time (Pt/Inr)	$45.35	$47.74	$4.43–$45.42	32% above	5%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Warfarin	$81.99	$86.30	$4.43–$45.42	138% above	5%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time (Pt/Inr)	$45.35	$47.74	$4.43–$45.42	—	5%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time Warfarin	$81.99	$86.30	$4.43–$45.42	—	5%
Renin blood test CPT 84244 Assay of Renin	$100.55	$105.84	$198.61	29% below	5%
Renin blood test inpatient CPT 84244 Assay of Renin	$100.55	$105.84	$198.61	—	5%
Rh blood typing CPT 86901 Lab Rh Factor	$69.58	$73.24	$3.09–$68.98	75% above	5%
Rh blood typing CPT 86901 Blood Typing Rh (D)	$69.58	$73.24	$3.09–$68.98	75% above	5%
Rh blood typing inpatient CPT 86901 Lab Rh Factor	$69.58	$73.24	$3.09–$68.98	—	5%
Rh blood typing inpatient CPT 86901 Blood Typing Rh (D)	$69.58	$73.24	$3.09–$68.98	—	5%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor, Quant	$89.93	$94.66	$5.77–$59.69	56% above	5%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant	$89.93	$94.66	$5.77–$59.69	56% above	5%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor, Quant	$89.93	$94.66	$5.77–$59.69	—	5%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quant	$89.93	$94.66	$5.77–$59.69	—	5%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibody	$132.16	$139.12	$148.15–$151.28	65% above	5%
Rubella antibody test (immunity check) CPT 86762 Mmr Ab Panel Is-Pt 3	$132.16	$139.12	$148.15–$151.28	65% above	5%
Rubella antibody test (immunity check) CPT 86762 Rubella Screen	$132.16	$139.12	$148.15–$151.28	65% above	5%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Screen	$132.16	$139.12	$148.15–$151.28	—	5%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibody	$132.16	$139.12	$148.15–$151.28	—	5%
Rubella antibody test (immunity check) inpatient CPT 86762 Mmr Ab Panel Is-Pt 3	$132.16	$139.12	$148.15–$151.28	—	5%
Sodium blood test CPT 84295 Sodium; Serum, Plasma or Whole Blood	$112.09	$117.99	$49.26–$112.26	351% above	5%
Sodium blood test CPT 84295 Assay Serum Sodium	$112.09	$117.99	$49.26–$112.26	351% above	5%
Sodium blood test inpatient CPT 84295 Sodium; Serum, Plasma or Whole Blood	$112.09	$117.99	$49.26–$112.26	—	5%
Sodium blood test inpatient CPT 84295 Assay Serum Sodium	$112.09	$117.99	$49.26–$112.26	—	5%
Stool ova and parasites exam CPT 87177 Ova and Parasites Smears	$218.33	$229.82	$29.23–$67.92	249% above	5%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites Smears	$218.33	$229.82	$29.23–$67.92	—	5%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema Pallidum	$188.44	$198.36	$11.13–$83.35	259% above	5%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema Pallidum	$188.44	$198.36	$11.13–$83.35	—	5%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Test, Cell Immun Measure	$231.87	$244.07	$64.04–$229.86	8% below	5%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Test, Cell Immunity Measure	$231.87	$244.07	$64.04–$229.86	8% below	5%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Test, Cell Immun Measure	$231.87	$244.07	$64.04–$229.86	—	5%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Test, Cell Immunity Measure	$231.87	$244.07	$64.04–$229.86	—	5%
Testosterone blood test, total (not free testosterone) CPT 84403 Assay of Total Testosterone	$119.31	$125.59	$26.67–$164.65	4% above	5%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total - Ref	$166.09	$174.83	$26.67–$164.65	45% above	5%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Assay of Total Testosterone	$119.31	$125.59	$26.67–$164.65	—	5%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total - Ref	$166.09	$174.83	$26.67–$164.65	—	5%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Antibody	$115.55	$121.63	$15.03–$150.17	71% above	5%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal Antibody	$115.55	$121.63	$15.03–$150.17	—	5%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Assay Thyroid Stim Hormone	$231.06	$243.22	$17.10–$231.42	145% above	5%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Assay Thyroid Stim Hormone	$231.06	$243.22	$17.10–$231.42	—	5%
Total cholesterol blood test CPT 82465 Cholesterol	$125.90	$132.53	$122.24	173% above	5%
Total cholesterol blood test CPT 82465 Assay Bld/Serum Cholesterol	$125.90	$132.53	$122.24	173% above	5%
Total cholesterol blood test inpatient CPT 82465 Assay Bld/Serum Cholesterol	$125.90	$132.53	$122.24	—	5%
Total cholesterol blood test inpatient CPT 82465 Cholesterol	$125.90	$132.53	$122.24	—	5%
Triglycerides blood test CPT 84478 Assay of Triglycerides	$192.65	$202.79	$185.07–$190.98	257% above	5%
Triglycerides blood test CPT 84478 Assay Triglycerides	$192.65	$202.79	$185.07–$190.98	257% above	5%
Triglycerides blood test inpatient CPT 84478 Assay of Triglycerides	$192.65	$202.79	$185.07–$190.98	—	5%
Triglycerides blood test inpatient CPT 84478 Assay Triglycerides	$192.65	$202.79	$185.07–$190.98	—	5%
Troponin test, quantitative CPT 84484 Troponin, Quantitative	$216.96	$228.38	$12.89–$217.30	157% above	5%
Troponin test, quantitative CPT 84484 Assay Troponin, Quant	$216.96	$228.38	$12.89–$217.30	157% above	5%
Troponin test, quantitative inpatient CPT 84484 Assay Troponin, Quant	$216.96	$228.38	$12.89–$217.30	—	5%
Troponin test, quantitative inpatient CPT 84484 Troponin, Quantitative	$216.96	$228.38	$12.89–$217.30	—	5%
Uric acid blood test CPT 84550 Uric Acid; Blood	$112.09	$117.99	$4.67–$112.26	124% above	5%
Uric acid blood test CPT 84550 Assay Blood Uric Acid	$112.09	$117.99	$4.67–$112.26	124% above	5%
Uric acid blood test inpatient CPT 84550 Assay Blood Uric Acid	$112.09	$117.99	$4.67–$112.26	—	5%
Uric acid blood test inpatient CPT 84550 Uric Acid; Blood	$112.09	$117.99	$4.67–$112.26	—	5%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis, Auto, W/Scope	$129.80	$136.63	$3.28–$132.65	222% above	5%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis, Auto, W/Scope	$129.80	$136.63	$3.28–$132.65	—	5%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis, Auto W/O Scope	$37.43	$39.40	$2.32–$37.48	50% above	5%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis, Auto, W/O Scope	$37.43	$39.40	$2.32–$37.48	50% above	5%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis, Auto W/O Scope	$37.43	$39.40	$2.32–$37.48	—	5%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis, Auto, W/O Scope	$37.43	$39.40	$2.32–$37.48	—	5%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture/Colony Count	$158.47	$166.81	$8.34–$88.05	110% above	5%
Urine culture for bacteria, with colony count CPT 87086 Lab Urine Culture	$158.47	$166.81	$8.34–$88.05	110% above	5%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture/Colony Count	$158.47	$166.81	$8.34–$88.05	—	5%
Urine culture for bacteria, with colony count inpatient CPT 87086 Lab Urine Culture	$158.47	$166.81	$8.34–$88.05	—	5%
Urine microalbumin (albumin) test CPT 82043 Microalbumin, Random	$146.72	$154.44	$5.07–$82.13	135% above	5%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Quantitative	$146.72	$154.44	$5.07–$82.13	135% above	5%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Quantitative	$146.72	$154.44	$5.07–$82.13	—	5%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin, Random	$146.72	$154.44	$5.07–$82.13	—	5%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B-12	$271.68	$285.98	$15.35–$140.36	172% above	5%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B-12	$271.68	$285.98	$15.35–$140.36	—	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25 Hydroxy	$83.05	$87.42	$30.59–$84.87	45% below	5%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25 Hydroxy	$83.05	$87.42	$30.59–$84.87	—	5%
Zinc blood test CPT 84630 ZINC	$74.80	$78.74	$105.71	3% below	5%
Zinc blood test inpatient CPT 84630 ZINC	$74.80	$78.74	$105.71	—	5%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg, Quantitative - Ref	$157.81	$166.12	$15.55–$374.54	40% above	5%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg,Quant,Serum	$377.82	$397.70	$15.55–$374.54	236% above	5%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Chorionic gonadotropin test	$377.82	$397.70	$15.55–$374.54	236% above	5%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg, Quantitative - Ref	$157.81	$166.12	$15.55–$374.54	—	5%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Chorionic gonadotropin test	$377.82	$397.70	$15.55–$374.54	—	5%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg,Quant,Serum	$377.82	$397.70	$15.55–$374.54	—	5%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Botox injections for chronic migraine CPT 64615 Chemodenerv Musc Migraine	$296.89	$312.52	$133.81	59% below	5%
Botox injections for chronic migraine inpatient CPT 64615 Chemodenerv Musc Migraine	$296.89	$312.52	$133.81	—	5%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion, Elective;Extern	$1,238.93	$1,304.14	$1,228.18	26% above	5%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion, Elective;Extern	$1,238.93	$1,304.14	$1,228.18	—	5%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision,Clamp,Newborn	$730.94	$769.41	$670.85–$703.49	264% above	5%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision,Clamp,Newborn	$730.94	$769.41	$670.85–$703.49	—	5%
Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy Flex Prox to Splenic Flexure W Endoscopic Ultrasound Exam	$679.08	$714.82	$659.28	73% below	5%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy Flex Prox to Splenic Flexure W Endoscopic Ultrasound Exam	$679.08	$714.82	$659.28	—	5%
Colonoscopy with polyp removal CPT 45385 Colonoscopy,Remv Lesn,Snare	$2,443.81	$2,572.43	$1,052.45–$2,447.55	11% above	5%
Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy,Remv Lesn,Snare	$2,443.81	$2,572.43	$1,052.45–$2,447.55	—	5%
Colonoscopy with tissue sample CPT 45380 Colonoscopy,Biopsy	$2,084.45	$2,194.16	$877.75–$3,274.33	7% above	5%
Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy,Biopsy	$2,084.45	$2,194.16	$877.75–$3,274.33	—	5%
Colonoscopy, diagnostic CPT 45378 Colonoscopy,Flex,Diagnostic	$2,084.45	$2,194.16	$916.01–$2,066.35	29% above	5%
Colonoscopy, diagnostic inpatient CPT 45378 Colonoscopy,Flex,Diagnostic	$2,084.45	$2,194.16	$916.01–$2,066.35	—	5%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruc Benign/Premal,1st Lesion	$73.35	$77.21	$32.23–$73.76	59% below	5%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruc Benign/Premal,1st Lesion	$73.35	$77.21	$32.23–$73.76	—	5%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Fac/Create Erdrum Openi,Loc Anesth	$362.92	$382.02	$163.19–$301.59	31% below	5%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 Fac/Create Erdrum Openi,Loc Anesth	$362.92	$382.02	$163.19–$301.59	—	5%
Earwax removal with instruments, one ear CPT 69210 Remove Impacted Ear Wax	$62.92	$66.23	$56.00–$129.35	25% below	5%
Earwax removal with instruments, one ear inpatient CPT 69210 Remove Impacted Ear Wax	$62.92	$66.23	$56.00–$129.35	—	5%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Fac/Biopsy of Uterus Lining	$259.60	$273.26	$114.08	4% below	5%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Fac/Biopsy of Uterus Lining	$259.60	$273.26	$114.08	—	5%
Eye injection into the vitreous (intravitreal injection) CPT 67028 Inject Intravitreal Pharmcologic	$513.96	$541.01	$82.66–$767.28	27% above	5%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 Inject Intravitreal Pharmcologic	$513.96	$541.01	$82.66–$767.28	—	5%
Incision and drainage of a simple or single skin abscess CPT 10060 Drain Skin Abscess Simple	$267.99	$282.09	$199.35–$243.77	10% below	5%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Drain Skin Abscess Simple	$267.99	$282.09	$199.35–$243.77	—	5%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon/Ligament/Cyst	$118.89	$125.15	$51.48–$110.17	65% below	5%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon/Ligament/Cyst	$118.89	$125.15	$51.48–$110.17	—	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/Inject Large Joint/Bursa	$222.43	$234.14	$94.90–$209.67	49% below	5%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Drain/Inject Large Joint/Bursa	$222.43	$234.14	$94.90–$209.67	—	5%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insert Drug Implant Device	$302.36	$318.27	$243.77	22% above	5%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insert Drug Implant Device	$302.36	$318.27	$243.77	—	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inject Medium Joint/Bursa	$235.03	$247.40	$80.80–$82.12	27% below	5%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inject Medium Joint/Bursa	$235.03	$247.40	$80.80–$82.12	—	5%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inject Small Joint/Bursa	$192.78	$202.93	$63.82–$134.89	44% below	5%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/Inject Small Joint/Bursa	$192.78	$202.93	$63.82–$134.89	—	5%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Fac/Discission 2nd Cataract Laser	$331.49	$348.94	$139.92–$332.00	72% below	5%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Fac/Discission 2nd Cataract Laser	$331.49	$348.94	$139.92–$332.00	—	5%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal of Nail Bed	$784.23	$825.51	$105.99–$235.21	140% above	5%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal of Nail Bed	$784.23	$825.51	$105.99–$235.21	—	5%
Prostate biopsy CPT 55700 Biopsy of Prostate,Needle/Punch	$1,591.07	$1,674.81	$227.18	10% above	5%
Prostate biopsy inpatient CPT 55700 Biopsy of Prostate,Needle/Punch	$1,591.07	$1,674.81	$227.18	—	5%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colonoscopy,Screen Prev	$2,084.44	$2,194.15	$871.53–$939.44	20% above	5%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 Colonoscopy,Screen Prev	$2,084.44	$2,194.15	$871.53–$939.44	—	5%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colonoscopy,Flex,Screen	$702.34	$739.31	$299.65–$316.54	60% below	5%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 Colonoscopy,Flex,Screen	$702.34	$739.31	$299.65–$316.54	—	5%
Short arm splint (forearm and hand) CPT 29125 Apply Forearm Splint,Static	$155.15	$163.32	$46.18–$46.60	12% below	5%
Short arm splint (forearm and hand) inpatient CPT 29125 Apply Forearm Splint,Static	$155.15	$163.32	$46.18–$46.60	—	5%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy of Skin (Including Simple Closure, When Performed); Single Lesion	$183.55	$193.21	$145.71–$157.07	20% below	5%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy of Skin (Including Simple Closure, When Performed); Single Lesion	$183.55	$193.21	$145.71–$157.07	—	5%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion	$99.44	$104.67	$16.58–$61.11	57% below	5%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Biopsy of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion	$99.44	$104.67	$16.58–$61.11	—	5%
Thoracentesis with imaging guidance CPT 32555 Aspirate Pleura W/ Imaging	$1,393.01	$1,466.33	$612.16–$1,380.91	21% above	5%
Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate Pleura W/ Imaging	$1,393.01	$1,466.33	$612.16–$1,380.91	—	5%
Trigger point injections, 1 or 2 muscles CPT 20552 Inject Trigger Point, 1 or 2	$256.41	$269.90	$110.88	28% below	5%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inject Trigger Point, 1 or 2	$256.41	$269.90	$110.88	—	5%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Up GI Endoscopy,Ball Dil,30mm	$3,405.29	$3,584.52	$1,496.45–$3,375.72	28% above	5%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Up GI Endoscopy,Ball Dil,30mm	$3,405.29	$3,584.52	$1,496.45–$3,375.72	—	5%
Upper endoscopy (EGD) with biopsy CPT 43239 Upper GI Endoscopy,Biopsy	$2,653.57	$2,793.23	$1,147.44–$4,201.56	68% above	5%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Upper GI Endoscopy,Biopsy	$2,653.57	$2,793.23	$1,147.44–$4,201.56	—	5%
Upper endoscopy (EGD), diagnostic CPT 43235 Upper GI Endoscopy,Diagnosis	$2,653.57	$2,793.23	$1,852.48–$2,630.52	81% above	5%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Upper GI Endoscopy,Diagnosis	$2,653.57	$2,793.23	$1,852.48–$2,630.52	—	5%
Wart removal, up to 14 warts CPT 17110 Destruct Benign Lesion, 1-14	$233.48	$245.77	$4.30–$75.04	19% above	5%
Wart removal, up to 14 warts inpatient CPT 17110 Destruct Benign Lesion, 1-14	$233.48	$245.77	$4.30–$75.04	—	5%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin/Tissue	$205.58	$216.40	$73.75–$179.53	61% below	5%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin/Tissue	$205.58	$216.40	$73.75–$179.53	—	5%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion Service	$485.10	$510.63	$208.92–$480.89	17% below	5%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion Service	$485.10	$510.63	$208.92–$480.89	—	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment	$78.57	$82.70	$33.83–$77.95	9% below	5%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment	$78.57	$82.70	$33.83–$77.95	—	5%
Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy, IV Infusion, 1 Hour	$921.92	$970.44	$314.59–$746.46	62% above	5%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemotherapy, IV Infusion, 1 Hour	$921.92	$970.44	$314.59–$746.46	—	5%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 Fac/Eye Exam, New Pat,Comprehesv	$23.75	$25.00	$10.75–$25.00	82% below	5%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 Fac/Eye Exam, New Pat,Comprehesv	$23.75	$25.00	$10.75–$25.00	—	5%
Comprehensive eye exam, returning patient CPT 92014 Fac/Eye Exam & Treatment	$23.75	$25.00	$10.58–$25.00	77% below	5%
Comprehensive eye exam, returning patient inpatient CPT 92014 Fac/Eye Exam & Treatment	$23.75	$25.00	$10.58–$25.00	—	5%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ecg 12 Lead, Tracing Only	$183.86	$193.54	$79.18–$187.90	27% above	5%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ecg 12 Lead, Tracing Only	$183.86	$193.54	$79.18–$187.90	—	5%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Facility Emergency Level II Visit	$262.37	$276.18	$112.99–$268.14	13% below	5%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Facility Emergency Level II Visit	$262.37	$276.18	$112.99–$268.14	—	5%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Facility Emergency Level III Visit	$543.22	$571.81	$233.53–$878.86	at median	5%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Facility Emergency Level III Visit	$543.22	$571.81	$233.53–$878.86	—	5%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Facility Emergency Level IV Visit	$812.05	$854.79	$253.44–$815.49	at median	5%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Facility Emergency Level IV Visit	$812.05	$854.79	$253.44–$815.49	—	5%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Facility Emergency Level V Visit	$1,221.39	$1,285.67	$182.62–$1,248.22	16% below	5%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Facility Emergency Level V Visit	$1,221.39	$1,285.67	$182.62–$1,248.22	—	5%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Tst,Tracing Only	$855.02	$900.02	$251.32–$856.33	8% above	5%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Stress Tst,Tracing Only	$855.02	$900.02	$251.32–$856.33	—	5%
Eye exam, returning patient, intermediate CPT 92012 Fac/Eye Exam Established Pt	$23.75	$25.00	$10.63–$25.00	75% below	5%
Eye exam, returning patient, intermediate inpatient CPT 92012 Fac/Eye Exam Established Pt	$23.75	$25.00	$10.63–$25.00	—	5%
Family therapy with the patient, 50 minutes CPT 90847 Conjoint/Family Psychotherapy Masters	$400.41	$421.48	$396.93	111% above	5%
Family therapy with the patient, 50 minutes CPT 90847 Conjoint/Family Psychothrpy Phd	$500.49	$526.83	$396.93	164% above	5%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Conjoint/Family Psychotherapy Masters	$400.41	$421.48	$396.93	—	5%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Conjoint/Family Psychothrpy Phd	$500.49	$526.83	$396.93	—	5%
Group psychotherapy session CPT 90853 Group Therapy Masters 1 Hr	$107.61	$113.27	$106.77	29% above	5%
Group psychotherapy session CPT 90853 Group Therapy Phd 1/2 Hr	$143.25	$150.79	$106.77	72% above	5%
Group psychotherapy session inpatient CPT 90853 Group Therapy Masters 1 Hr	$107.61	$113.27	$106.77	—	5%
Group psychotherapy session inpatient CPT 90853 Group Therapy Phd 1/2 Hr	$143.25	$150.79	$106.77	—	5%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 First Hour IV Hydration <1 Hour	$488.55	$514.26	$206.21–$484.74	71% above	5%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 First Hour IV Hydration <1 Hour	$488.55	$514.26	$206.21–$484.74	—	5%
IV infusion of a medicine, first hour CPT 96365 IV Infusion Therapy, 1 Hour	$660.46	$695.22	$277.27–$661.47	110% above	5%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Infusion Therapy, 1 Hour	$660.46	$695.22	$277.27–$661.47	—	5%
IV push of a medicine, first drug CPT 96374 IV Push, Single/1st Drug	$199.10	$209.58	$67.42–$199.41	21% above	5%
IV push of a medicine, first drug inpatient CPT 96374 IV Push, Single/1st Drug	$199.10	$209.58	$67.42–$199.41	—	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Im/Sq Non Chemo Injection	$132.92	$139.92	$34.19–$131.76	65% above	5%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection, Subq/Im	$145.25	$152.89	$53.28–$144.12	80% above	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Im/Sq Non Chemo Injection	$132.92	$139.92	$34.19–$131.76	—	5%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection, Subq/Im	$145.25	$152.89	$53.28–$144.12	—	5%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psychiatric Diag Eval Masters	$448.47	$472.07	$203.95–$831.11	104% above	5%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psychiatric Diag Eval Phd	$838.38	$882.51	$203.95–$831.11	282% above	5%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psychiatric Diag Eval Masters	$448.47	$472.07	$203.95–$831.11	—	5%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psychiatric Diag Eval Phd	$838.38	$882.51	$203.95–$831.11	—	5%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Re-Education	$109.16	$114.91	$12.99–$109.33	14% above	5%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Re-Education	$109.16	$114.91	$12.99–$109.33	—	5%
New patient office visit, about 30 minutes CPT 99203 Office/Outpt Visit,New,Levl III	$113.44	$119.41	$10.58–$25.00	40% below	5%
New patient office visit, about 30 minutes inpatient CPT 99203 Office/Outpt Visit,New,Levl III	$113.44	$119.41	$10.58–$25.00	—	5%
New patient office visit, about 45 minutes CPT 99204 Office/Outpt Visit,New,Levl IV	$174.37	$183.55	$10.58–$25.00	15% below	5%
New patient office visit, about 45 minutes inpatient CPT 99204 Office/Outpt Visit,New,Levl IV	$174.37	$183.55	$10.58–$25.00	—	5%
New patient office visit, about 60 minutes CPT 99205 Office/Outpt Visit,New,Levl V	$218.42	$229.92	$10.58–$25.00	28% below	5%
New patient office visit, about 60 minutes inpatient CPT 99205 Office/Outpt Visit,New,Levl V	$218.42	$229.92	$10.58–$25.00	—	5%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office/Outpt Visit,New,Levl II	$82.24	$86.57	$10.58–$25.00	37% below	5%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office/Outpt Visit,New,Levl II	$82.24	$86.57	$10.58–$25.00	—	5%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition Thrpy, 15 Min	$46.74	$49.20	$44.99–$46.81	19% below	5%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutrition Thrpy, 15 Min	$46.74	$49.20	$44.99–$46.81	—	5%
Occupational therapy evaluation, low complexity CPT 97165 Occupational Therapy Eval Low Complex	$212.41	$223.59	$91.85–$212.74	20% above	5%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Occupational Therapy Eval Low Complex	$212.41	$223.59	$91.85–$212.74	—	5%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Physical Therapy Evaluation High Complex	$327.52	$344.76	$139.38	6% above	5%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Physical Therapy Evaluation High Complex	$327.52	$344.76	$139.38	—	5%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical Therapy Evaluation Low Complex	$254.74	$268.15	$107.32–$255.13	44% above	5%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Physical Therapy Evaluation Low Complex	$254.74	$268.15	$107.32–$255.13	—	5%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Physical Therapy Evaluation Mod Complex	$272.94	$287.30	$116.45–$524.86	14% above	5%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Physical Therapy Evaluation Mod Complex	$272.94	$287.30	$116.45–$524.86	—	5%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Ther Tech,1+Regions,Ea 15 Min	$133.43	$140.45	$26.60–$133.63	38% above	5%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Ther Tech,1+Regions,Ea 15 Min	$133.43	$140.45	$26.60–$133.63	—	5%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises	$145.57	$153.23	$17.73–$145.80	50% above	5%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises	$145.57	$153.23	$17.73–$145.80	—	5%
Psychotherapy session, 30 minutes CPT 90832 Ind Psychotherapy 30 Masters	$200.45	$211.00	$91.16–$248.29	88% above	5%
Psychotherapy session, 30 minutes CPT 90832 Ind Psychotherapy 30 Phd	$250.47	$263.65	$91.16–$248.29	135% above	5%
Psychotherapy session, 30 minutes inpatient CPT 90832 Ind Psychotherapy 30 Masters	$200.45	$211.00	$91.16–$248.29	—	5%
Psychotherapy session, 30 minutes inpatient CPT 90832 Ind Psychotherapy 30 Phd	$250.47	$263.65	$91.16–$248.29	—	5%
Psychotherapy session, 45 minutes CPT 90834 Rec Serv Alcohol Ind 45 Counse	$285.92	$300.97	$283.43–$283.44	102% above	5%
Psychotherapy session, 45 minutes CPT 90834 Rec Serv Drug Ind 45 Counselor	$285.92	$300.97	$283.44	102% above	5%
Psychotherapy session, 45 minutes CPT 90834 Rec Serv Drug Ind 45 Masters	$400.41	$421.48	$283.44	183% above	5%
Psychotherapy session, 45 minutes CPT 90834 Ind Psychotherapy 45 Masters	$400.41	$421.48	$79.46–$409.20	183% above	5%
Psychotherapy session, 45 minutes CPT 90834 Ind Psychotherapy 45 Phd	$550.22	$579.18	$79.46–$409.20	289% above	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 Rec Serv Drug Ind 45 Counselor	$285.92	$300.97	$283.44	—	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 Rec Serv Alcohol Ind 45 Counse	$285.92	$300.97	$283.43–$283.44	—	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 Rec Serv Drug Ind 45 Masters	$400.41	$421.48	$283.44	—	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 Ind Psychotherapy 45 Masters	$400.41	$421.48	$79.46–$409.20	—	5%
Psychotherapy session, 45 minutes inpatient CPT 90834 Ind Psychotherapy 45 Phd	$550.22	$579.18	$79.46–$409.20	—	5%
Psychotherapy session, 60 minutes CPT 90837 Ind Psychotherapy 60 Masters	$448.47	$472.07	$203.95–$662.33	111% above	5%
Psychotherapy session, 60 minutes CPT 90837 Ind Psychotherapy 60 Phd	$668.13	$703.29	$203.95–$662.33	214% above	5%
Psychotherapy session, 60 minutes inpatient CPT 90837 Ind Psychotherapy 60 Masters	$448.47	$472.07	$203.95–$662.33	—	5%
Psychotherapy session, 60 minutes inpatient CPT 90837 Ind Psychotherapy 60 Phd	$668.13	$703.29	$203.95–$662.33	—	5%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smking Cess 4-10 Min	$40.47	$42.60	$21.94–$23.60	39% above	5%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smking Cess 4-10 Min	$40.47	$42.60	$21.94–$23.60	—	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/Outpt Visit,Est,Levl V	$163.72	$172.34	$10.58–$25.00	42% below	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Fac/Office Consultation,Level V	$271.29	$285.57	$10.58–$25.00	4% below	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Established - Comprehensive, Problem Focused 40 Min Np	$438.63	$461.72	$221.20–$244.39	55% above	5%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office/Outpt Visit, Est Level V Np	$486.40	$512.00	$221.20–$244.39	72% above	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office/Outpt Visit,Est,Levl V	$163.72	$172.34	$10.58–$25.00	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Fac/Office Consultation,Level V	$271.29	$285.57	$10.58–$25.00	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Established - Comprehensive, Problem Focused 40 Min Np	$438.63	$461.72	$221.20–$244.39	—	5%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office/Outpt Visit, Est Level V Np	$486.40	$512.00	$221.20–$244.39	—	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office/Outpt Visit,Est,Levl III	$70.49	$74.20	$10.58–$25.00	57% below	5%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Fac/Office Consultation,Level III	$161.89	$170.41	$10.58–$25.00	2% below	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office/Outpt Visit,Est,Levl III	$70.49	$74.20	$10.58–$25.00	—	5%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Fac/Office Consultation,Level III	$161.89	$170.41	$10.58–$25.00	—	5%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office/Outpt Visit,Est,Levl IV	$107.57	$113.23	$10.58–$25.00	41% below	5%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office/Outpt Visit,Est,Levl IV	$107.57	$113.23	$10.58–$25.00	—	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/Outpt Visit,Est,Levl II	$47.36	$49.85	$10.58–$25.00	54% below	5%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Fac/Office Consultation,Level II	$128.86	$135.64	$10.58–$25.00	26% above	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office/Outpt Visit,Est,Levl II	$47.36	$49.85	$10.58–$25.00	—	5%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Fac/Office Consultation,Level II	$128.86	$135.64	$10.58–$25.00	—	5%
Speech and language evaluation CPT 92523 Speech Sound Lang Comprehen	$493.10	$519.05	$210.38–$488.82	45% above	5%
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comprehen	$493.10	$519.05	$210.38–$488.82	—	5%
Speech therapy session, individual CPT 92507 Speech/Hearing Therapy	$163.86	$172.48	$69.16–$164.11	35% below	5%
Speech therapy session, individual inpatient CPT 92507 Speech/Hearing Therapy	$163.86	$172.48	$69.16–$164.11	—	5%
Spirometry (breathing test) CPT 94010 Spirometry	$347.01	$365.27	$85.13–$344.00	31% above	5%
Spirometry (breathing test) CPT 94010 Spirometry Incl Graph Rec Tc	$347.01	$365.27	$85.13–$344.00	31% above	5%
Spirometry (breathing test) inpatient CPT 94010 Spirometry Incl Graph Rec Tc	$347.01	$365.27	$85.13–$344.00	—	5%
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$347.01	$365.27	$85.13–$344.00	—	5%
Spirometry before and after a bronchodilator CPT 94060 Broncho Response & Spirometry	$512.38	$539.35	$152.37–$519.37	10% above	5%
Spirometry before and after a bronchodilator inpatient CPT 94060 Broncho Response & Spirometry	$512.38	$539.35	$152.37–$519.37	—	5%
Therapeutic activities (functional training), 15 minutes CPT 97530 Ot Individ Therapy 1/4 Hr Incr	$93.36	$98.27	$17.32–$97.19	7% above	5%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities	$97.04	$102.15	$40.57–$97.19	11% above	5%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Ot Individ Therapy 1/4 Hr Incr	$93.36	$98.27	$17.32–$97.19	—	5%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities	$97.04	$102.15	$40.57–$97.19	—	5%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy	$122.20	$128.63	$40.18–$94.88	39% below	5%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy	$122.20	$128.63	$40.18–$94.88	—	5%
Visual field test, extended CPT 92083 Visual Field Exam (S), Tc	$116.84	$122.99	$50.53–$119.41	15% above	5%
Visual field test, extended inpatient CPT 92083 Visual Field Exam (S), Tc	$116.84	$122.99	$50.53–$119.41	—	5%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wisconsin	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vacc split PF 0.5 ML suspension prefilled syringe 0.5 mL Syringe	$23.66	$24.90	$21.90–$50.00	24% below	5%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vacc split PF 0.5 ML suspension prefilled syringe 0.5 mL Syringe	$23.66	$24.90	$21.90–$50.00	—	5%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Hpv, Gardasil 9, 2 or 3 Dose, Im	$695.21	$731.80	$689.18	118% above	5%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Hpv, Gardasil 9, 2 or 3 Dose, Im	$695.21	$731.80	$689.18	—	5%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A vaccine 1440 EL U/ML suspension prefilled syringe 1 mL Syringe	$196.14	$206.46	$37.40–$280.03	49% above	5%
Hepatitis A vaccine, adult dose CPT 90632 Hepa Vaccine Adult Im	$207.37	$218.28	$37.40–$280.03	57% above	5%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A vaccine 1440 EL U/ML suspension prefilled syringe 1 mL Syringe	$196.14	$206.46	$37.40–$280.03	—	5%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepa Vaccine Adult Im	$207.37	$218.28	$37.40–$280.03	—	5%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine, Over 20	$184.03	$193.72	$37.40–$242.26	56% above	5%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine, Over 20	$184.03	$193.72	$37.40–$242.26	—	5%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza vac split high-dose 0.5 ML suspension prefilled syringe 0.5 mL Syringe	$196.32	$206.65	$39.69–$88.20	148% above	5%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza vac split high-dose 0.5 ML suspension prefilled syringe 0.5 mL Syringe	$196.32	$206.65	$39.69–$88.20	—	5%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal Vaccine, Menveo	$338.30	$356.10	$329.39–$338.30	47% above	5%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal Vaccine, Menveo	$338.30	$356.10	$329.39–$338.30	—	5%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-val conj vacc 0.5 ML suspension prefilled syringe 0.5 mL Syringe	$645.43	$679.40	$585.25	121% above	5%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-val conj vacc 0.5 ML suspension prefilled syringe 0.5 mL Syringe	$645.43	$679.40	$585.25	—	5%
Rabies vaccine, one dose CPT 90675 rabies vaccine, pcec Recon Susp 1 Each Vial	$580.85	$611.42	$420.15–$963.60	at median	5%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, pcec Recon Susp 1 Each Vial	$580.85	$611.42	$420.15–$963.60	—	5%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphtheria toxoids 5-2 LF/0.5ML Suspension 0.5 mL Syringe	$156.17	$164.39	$31.44	277% above	5%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphtheria toxoids 5-2 LF/0.5ML Suspension 0.5 mL Syringe	$156.17	$164.39	$31.44	—	5%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 suspension prefilled syringe 0.5 mL Syringe	$165.43	$174.14	$31.44–$164.41	103% above	5%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap, Tetanus, Diphtheria, Pertussis 7+ Yrs, Boostrix	$165.84	$174.57	$31.44–$164.41	103% above	5%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus-diphth-acell pertussis 5-2.5-18.5 LF-MCG/0.5 suspension prefilled syringe 0.5 mL Syringe	$165.43	$174.14	$31.44–$164.41	—	5%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap, Tetanus, Diphtheria, Pertussis 7+ Yrs, Boostrix	$165.84	$174.57	$31.44–$164.41	—	5%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin - Influenza	$44.35	$46.68	$19.10–$198.83	15% above	5%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Hep B,Adult 19+	$45.68	$48.08	$19.10–$198.83	18% above	5%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immun Admin;Initial-Mn Vfc	$45.68	$48.08	$19.10–$198.83	18% above	5%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration; One Vaccine (Single or Combination Vaccine/To*	$75.22	$79.18	$19.10–$198.83	94% above	5%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration; One Vaccine (Single or Combination Vaccine/Toxoid)	$206.98	$217.87	$19.10–$198.83	435% above	5%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin - Influenza	$44.35	$46.68	$19.10–$198.83	—	5%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Hep B,Adult 19+	$45.68	$48.08	$19.10–$198.83	—	5%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immun Admin;Initial-Mn Vfc	$45.68	$48.08	$19.10–$198.83	—	5%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Administration; One Vaccine (Single or Combination Vaccine/To*	$75.22	$79.18	$19.10–$198.83	—	5%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Administration; One Vaccine (Single or Combination Vaccine/Toxoid)	$206.98	$217.87	$19.10–$198.83	—	5%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Administration; Each Add'l Vaccine (Single or Combo Vaccine/T*	$206.98	$217.87	$16.68–$207.29	537% above	5%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Administration; Each Add'l Vaccine (Single or Combo Vaccine/T*	$206.98	$217.87	$16.68–$207.29	—	5%

Source file: https://hospitalpricetransparencyfiles.com/memorial-medical-center-inc/237013497_Memorial-Medical-Center-Inc_standardcharges.csv