SelfPayRates
Hospital

Spooner Health System

Spooner Health System in Spooner, WI publishes cash prices for 253 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 211 of 249 procedures and below it for 37. By typical cash price it ranks #100 of 103 Wisconsin hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1280 Chandler Drive, Spooner, WI 54801 Collected Sep 29, 2026 Source price file (715) 635-2111

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 5 of 5 CCN 521332 · CMS hospital register NPI 1518982628

Scans and imaging

ProcedureCash price List priceInsurers payvs WisconsinOff list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W/O & W/DYE $3,690.90 $4,101.00 $3,745.85 60% above 10%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/O & W/DYE $3,690.90 $4,101.00 $3,745.85 — 10%
Abdominal X-ray, 2 views CPT 74019 X-RAY EXAM ABDOMEN 2 VIEWS $476.10 $529.00 $143.07–$432.65 102% above 10%
Abdominal X-ray, 2 views inpatient CPT 74019 X-RAY EXAM ABDOMEN 2 VIEWS $476.10 $529.00 $143.07–$432.65 — 10%
Ankle X-ray, complete, 3 or more views CPT 73610 XRAY ANKLE MINIMUM 3 VWS $607.50 $675.00 $274.78–$616.55 158% above 10%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XRAY ANKLE MINIMUM 3 VWS $607.50 $675.00 $274.78–$616.55 — 10%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O DYE $1,499.40 $1,666.00 $712.89–$1,602.00 8% above 10%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O DYE $1,499.40 $1,666.00 $712.89–$1,602.00 — 10%
Barium swallow (esophagus X-ray with contrast) CPT 74220 CONTRAST XRAY ESOPHAGUS; INCL SCOUT & DELAY (TC) $958.50 $1,065.00 $143.11–$870.40 90% above 10%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 CONTRAST XRAY ESOPHAGUS; INCL SCOUT & DELAY (TC) $958.50 $1,065.00 $143.11–$870.40 — 10%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN, WHOLE BODY $2,194.20 $2,438.00 $2,196.33 57% above 10%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN, WHOLE BODY $2,194.20 $2,438.00 $2,196.33 — 10%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED $743.40 $826.00 $280.61–$754.30 96% above 10%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED $743.40 $826.00 $280.61–$754.30 — 10%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PELV W/O&W/DYE $4,780.80 $5,312.00 $2,273.06–$4,852.60 64% above 10%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD&PELV W/O&W/DYE $4,780.80 $5,312.00 $2,273.06–$4,852.60 — 10%
CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY, HEAD $2,270.70 $2,523.00 $1,005.77–$2,377.48 9% above 10%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY, HEAD $2,270.70 $2,523.00 $1,005.77–$2,377.48 — 10%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY, NECK $3,298.50 $3,665.00 $792.90–$3,453.52 70% above 10%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY, NECK $3,298.50 $3,665.00 $792.90–$3,453.52 — 10%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY, CHEST $4,059.00 $4,510.00 $21.82–$4,063.77 109% above 10%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY, CHEST $4,059.00 $4,510.00 $21.82–$4,063.77 — 10%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST $4,059.00 $4,510.00 $825.32–$4,120.15 62% above 10%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST $4,059.00 $4,510.00 $825.32–$4,120.15 — 10%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN&PELVIS W/CONTRAST $4,780.80 $5,312.00 $825.32–$5,108.00 52% above 10%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN&PELVIS W/CONTRAST $4,780.80 $5,312.00 $825.32–$5,108.00 — 10%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELV 1+ SECTION/REGNS $4,780.80 $5,312.00 $825.32–$4,852.60 35% above 10%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PELV 1+ SECTION/REGNS $4,780.80 $5,312.00 $825.32–$4,852.60 — 10%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/DYE $2,916.90 $3,241.00 $825.32–$2,626.79 86% above 10%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/DYE $2,916.90 $3,241.00 $825.32–$2,626.79 — 10%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIALW/O DYE $2,052.90 $2,281.00 $274.02–$2,193.00 47% above 10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIALW/O DYE $2,052.90 $2,281.00 $274.02–$2,193.00 — 10%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE $2,052.90 $2,281.00 $825.32–$2,193.00 59% above 10%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE $2,052.90 $2,281.00 $825.32–$2,193.00 — 10%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE $2,970.00 $3,300.00 $825.32 62% above 10%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/DYE $2,970.00 $3,300.00 $825.32 — 10%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE $2,458.80 $2,732.00 $273.96–$2,495.65 67% above 10%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O DYE $2,458.80 $2,732.00 $273.96–$2,495.65 — 10%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE $2,268.90 $2,521.00 $274.02–$2,424.00 54% above 10%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE $2,268.90 $2,521.00 $274.02–$2,424.00 — 10%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE $3,021.30 $3,357.00 $2,616.67 92% above 10%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE $3,021.30 $3,357.00 $2,616.67 — 10%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CV CAROTID IMAGING-BILAT $1,898.10 $2,109.00 $858.00–$1,620.37 — 10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CV CAROTID IMAGING-BILAT $1,898.10 $2,109.00 $858.00–$1,620.37 — 10%
Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS $336.60 $374.00 $143.07–$360.00 57% above 10%
Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS $336.60 $374.00 $143.07–$360.00 — 10%
Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW $270.00 $300.00 $119.44–$282.24 67% above 10%
Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW $270.00 $300.00 $119.44–$282.24 — 10%
Collarbone (clavicle) X-ray, complete CPT 73000 XRAY CLAVICLE COMPLETE $309.60 $344.00 $142.73–$281.35 51% above 10%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 XRAY CLAVICLE COMPLETE $309.60 $344.00 $142.73–$281.35 — 10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL TC $942.30 $1,047.00 $425.07–$855.95 72% above 10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL TC $942.30 $1,047.00 $425.07–$855.95 — 10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA, BONE DENSITY STUDY, HIPS/PELV/SPINE $646.20 $718.00 $194.21–$655.50 62% above 10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA, BONE DENSITY STUDY, HIPS/PELV/SPINE $646.20 $718.00 $194.21–$655.50 — 10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 DIAGNOSTIC CT THORAX W/O CONTRAST (TC) $730.80 $812.00 $273.96–$1,864.05 49% below 10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 DIAGNOSTIC CT THORAX W/O CONTRAST (TC) $730.80 $812.00 $273.96–$1,864.05 — 10%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 DIAGNOSTIC CT THORAX W/ CONTRAST (TC) $992.70 $1,103.00 $238.73–$3,425.00 37% below 10%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 DIAGNOSTIC CT THORAX W/ CONTRAST (TC) $992.70 $1,103.00 $238.73–$3,425.00 — 10%
Diagnostic mammogram, both breasts both sides CPT 77066 DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF $428.40 $476.00 $60.26–$389.30 — 10%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF $428.40 $476.00 $60.26–$389.30 — 10%
Diagnostic mammogram, one breast one side CPT 77065 DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF $323.10 $359.00 $60.26–$327.75 5% above 10%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF $323.10 $359.00 $60.26–$327.75 — 10%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ART LOWER EXTREMITY-BILAT $1,391.40 $1,546.00 $425.07–$1,188.11 — 10%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 ART LOWER EXTREMITY-BILAT $1,391.40 $1,546.00 $425.07–$1,188.11 — 10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEN DUPLEX BILATERAL $997.20 $1,108.00 $425.07–$905.25 — 10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 VEN DUPLEX BILATERAL $997.20 $1,108.00 $425.07–$905.25 — 10%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER, COMPLETE $1,654.20 $1,838.00 $765.04–$1,767.00 6% below 10%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER, COMPLETE $1,654.20 $1,838.00 $765.04–$1,767.00 — 10%
Elbow X-ray, 2 views CPT 73070 XRAY ELBOW 2 VWS $527.40 $586.00 $21.56–$253.35 179% above 10%
Elbow X-ray, 2 views inpatient CPT 73070 XRAY ELBOW 2 VWS $527.40 $586.00 $21.56–$253.35 — 10%
Elbow X-ray, complete, 3 or more views CPT 73080 XRAY ELBOW 3+VWS TC $544.50 $605.00 $258.99–$582.00 134% above 10%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 XRAY ELBOW 3+VWS TC $544.50 $605.00 $258.99–$582.00 — 10%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/EAR/FOSA W/O DYE $1,382.40 $1,536.00 $657.26 at median 10%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT/EAR/FOSA W/O DYE $1,382.40 $1,536.00 $657.26 — 10%
Facial bones X-ray, complete, 3 or more views CPT 70150 XRAY FACIAL BONES MINIMUM 3 VWS $769.50 $855.00 $365.79–$369.90 173% above 10%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XRAY FACIAL BONES MINIMUM 3 VWS $769.50 $855.00 $365.79–$369.90 — 10%
Forearm X-ray (radius and ulna), 2 views CPT 73090 XRAY FOREARM 2 VWS $554.40 $616.00 $255.27–$562.40 190% above 10%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 XRAY FOREARM 2 VWS $554.40 $616.00 $255.27–$562.40 — 10%
Hand X-ray, 2 views CPT 73120 XRAY HAND 2VWS TC $412.20 $458.00 $351.56–$374.00 119% above 10%
Hand X-ray, 2 views inpatient CPT 73120 XRAY HAND 2VWS TC $412.20 $458.00 $351.56–$374.00 — 10%
Knee X-ray, 3 views CPT 73562 XRAY KNEE 3 VWS $607.50 $675.00 $140.96–$649.00 139% above 10%
Knee X-ray, 3 views inpatient CPT 73562 XRAY KNEE 3 VWS $607.50 $675.00 $140.96–$649.00 — 10%
Knee X-ray, complete, 4 or more views CPT 73564 XRAY KNEE 4 OR MORE VWS $618.30 $687.00 $143.07–$627.95 124% above 10%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 XRAY KNEE 4 OR MORE VWS $618.30 $687.00 $143.07–$627.95 — 10%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O DYE $1,382.40 $1,536.00 $273.96–$1,245.11 3% below 10%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O DYE $1,382.40 $1,536.00 $273.96–$1,245.11 — 10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED TC $749.70 $833.00 $345.39–$760.95 73% above 10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED TC $749.70 $833.00 $345.39–$760.95 — 10%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXT NON-VASC LIMITED, REALTIME W/ IMG $90.00 $100.00 $209.99–$462.65 66% below 10%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXT NON-VASC LIMITED, REALTIME W/ IMG TC $455.40 $506.00 $209.99–$462.65 73% above 10%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXT NON-VASC LIMITED, REALTIME W/ IMG $90.00 $100.00 $209.99–$462.65 — 10%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US EXT NON-VASC LIMITED, REALTIME W/ IMG TC $455.40 $506.00 $209.99–$462.65 — 10%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT LUNG CA SCREEN WO CONTRAST $770.40 $856.00 $273.96–$705.31 73% above 10%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LOW DOSE CT LUNG CA SCREEN WO CONTRAST $770.40 $856.00 $273.96–$705.31 — 10%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 XRAY TIBIA & FIBULA 2 VWS $505.80 $562.00 $77.48–$519.00 138% above 10%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 XRAY TIBIA & FIBULA 2 VWS $505.80 $562.00 $77.48–$519.00 — 10%
MR angiography (MRA) of the head without contrast CPT 70544 MRA, HEAD W/OUT CONTRAST $4,073.40 $4,526.00 $1,849.60–$3,527.96 93% above 10%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA, HEAD W/OUT CONTRAST $4,073.40 $4,526.00 $1,849.60–$3,527.96 — 10%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JNT WO/CONT TC $3,259.80 $3,622.00 $1,532.52–$3,308.85 54% above 10%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXT JNT WO/CONT TC $3,259.80 $3,622.00 $1,532.52–$3,308.85 — 10%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O TC $3,870.00 $4,300.00 $1,840.07 83% above 10%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O TC $3,870.00 $4,300.00 $1,840.07 — 10%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI, ABDOMEN W/O+ W/CONTR $4,984.20 $5,538.00 $2,296.14–$4,254.68 53% above 10%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI, ABDOMEN W/O+ W/CONTR $4,984.20 $5,538.00 $2,296.14–$4,254.68 — 10%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST TC $4,073.40 $4,526.00 $616.80–$4,134.40 93% above 10%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST TC $4,073.40 $4,526.00 $616.80–$4,134.40 — 10%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W & WO CONTRAST $5,537.70 $6,153.00 $1,037.41–$5,620.20 70% above 10%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W & WO CONTRAST $5,537.70 $6,153.00 $1,037.41–$5,620.20 — 10%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST $3,870.90 $4,301.00 $616.80–$3,929.20 83% above 10%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST $3,870.90 $4,301.00 $616.80–$3,929.20 — 10%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W&WO CONTRAST $4,984.20 $5,538.00 $1,037.64–$4,488.98 53% above 10%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE W&WO CONTRAST $4,984.20 $5,538.00 $1,037.64–$4,488.98 — 10%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST $3,870.90 $4,301.00 $616.80–$1,861.20 83% above 10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST $3,870.90 $4,301.00 $616.80–$1,861.20 — 10%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W&WO CONTRAST $4,983.30 $5,537.00 $2,278.18–$4,525.40 53% above 10%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W&WO CONTRAST $4,983.30 $5,537.00 $2,278.18–$4,525.40 — 10%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE WO CONTRAST $3,870.90 $4,301.00 $616.80–$3,929.20 83% above 10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE WO CONTRAST $3,870.90 $4,301.00 $616.80–$3,929.20 — 10%
MRI of the pelvis without and with contrast CPT 72197 MRI, PELVIS, W/O THEN W/ $4,983.30 $5,537.00 $4,253.88–$4,488.13 53% above 10%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI, PELVIS, W/O THEN W/ $4,983.30 $5,537.00 $4,253.88–$4,488.13 — 10%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UP EXTREMITY JOINT W/O TC $3,259.80 $3,622.00 $1,505.77–$3,308.85 54% above 10%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UP EXTREMITY JOINT W/O TC $3,259.80 $3,622.00 $1,505.77–$3,308.85 — 10%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XRAY CERVICAL SPINE 4 OR 5 VWS $1,145.70 $1,273.00 $541.78 264% above 10%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XRAY CERVICAL SPINE 4 OR 5 VWS $1,145.70 $1,273.00 $541.78 — 10%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/DYE $2,158.20 $2,398.00 $825.50–$2,306.00 37% above 10%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/DYE $2,158.20 $2,398.00 $825.50–$2,306.00 — 10%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O DYE $2,052.00 $2,280.00 $273.96–$986.40 44% above 10%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O DYE $2,052.00 $2,280.00 $273.96–$986.40 — 10%
Neck soft tissue X-ray CPT 70360 XRAY NECK, SOFT TISSUE $375.30 $417.00 $143.07–$343.66 79% above 10%
Neck soft tissue X-ray inpatient CPT 70360 XRAY NECK, SOFT TISSUE $375.30 $417.00 $143.07–$343.66 — 10%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT SKULL-MID THIGH TC $7,937.10 $8,819.00 $3,690.50–$7,208.00 95% above 10%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT SKULL-MID THIGH TC $7,937.10 $8,819.00 $3,690.50–$7,208.00 — 10%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O DYE $2,138.40 $2,376.00 $985.29–$1,926.26 67% above 10%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O DYE $2,138.40 $2,376.00 $985.29–$1,926.26 — 10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US FOLLICLES-LIMITED TC $756.90 $841.00 $348.84–$768.55 89% above 10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US FOLLICLES-LIMITED TC $756.90 $841.00 $348.84–$768.55 — 10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC TC COMPLETE $1,281.60 $1,424.00 $425.07–$1,300.55 148% above 10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC TC COMPLETE $1,281.60 $1,424.00 $425.07–$1,300.55 — 10%
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 $871.20 $968.00 $784.83 52% above 10%
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 $871.20 $968.00 $784.83 — 10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS, SINGLE FETUS - RADIOLOGY, TECH $775.80 $862.00 $698.85–$776.77 69% above 10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS, SINGLE FETUS - RADIOLOGY, TECH $775.80 $862.00 $698.85–$776.77 — 10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY TC LIMITED $380.70 $423.00 $172.98–$179.08 4% above 10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANCY TC LIMITED $380.70 $423.00 $172.98–$179.08 — 10%
Rib X-ray, one side, 2 views one side CPT 71100 XRAY RIBS UNILAT 2 VWS $527.40 $586.00 $247.72–$478.55 137% above 10%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XRAY RIBS UNILAT 2 VWS $527.40 $586.00 $247.72–$478.55 — 10%
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 $675.90 $751.00 $321.29–$685.90 145% above 10%
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 $675.90 $751.00 $321.29–$685.90 — 10%
Screening mammogram, both breasts CPT 77067 DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF $333.00 $370.00 $81.79–$356.00 31% above 10%
Screening mammogram, both breasts inpatient CPT 77067 DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF $333.00 $370.00 $81.79–$356.00 — 10%
Shoulder X-ray, complete, 2 or more views CPT 73030 XRAY SHOULDER MINIMUM 2 VWS $675.00 $750.00 $143.11–$684.95 200% above 10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XRAY SHOULDER MINIMUM 2 VWS $675.00 $750.00 $143.11–$684.95 — 10%
Skull X-ray, fewer than 4 views CPT 70250 XRAY SKULL LESS THAN 4 VWS $341.10 $379.00 $306.85 40% above 10%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XRAY SKULL LESS THAN 4 VWS $341.10 $379.00 $306.85 — 10%
Swallow study (modified barium swallow, video X-ray) CPT 74230 CONTRAST XRAY SWALLOWING FUNCT INT, CINE/VID; INCLSCOUT & DELAY (TC) $1,049.40 $1,166.00 $487.86–$952.85 140% above 10%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 CONTRAST XRAY SWALLOWING FUNCT INT, CINE/VID; INCLSCOUT & DELAY (TC) $1,049.40 $1,166.00 $487.86–$952.85 — 10%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-RAY EXAM FEMUR MIN 2 VWS $543.60 $604.00 $245.74–$493.85 121% above 10%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-RAY EXAM FEMUR MIN 2 VWS $543.60 $604.00 $245.74–$493.85 — 10%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT CHEST SPINE W/O DYE $2,458.80 $2,732.00 $1,116.48–$2,495.65 67% above 10%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT CHEST SPINE W/O DYE $2,458.80 $2,732.00 $1,116.48–$2,495.65 — 10%
Toe X-ray, 2 or more views CPT 73660 XRAY TOE(S) TC $321.30 $357.00 $145.20–$325.85 59% above 10%
Toe X-ray, 2 or more views inpatient CPT 73660 XRAY TOE(S) TC $321.30 $357.00 $145.20–$325.85 — 10%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL TC $716.40 $796.00 $280.61–$726.75 55% above 10%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL TC $716.40 $796.00 $280.61–$726.75 — 10%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US, OBSTETRIC $564.30 $627.00 $565.01 44% above 10%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US, OBSTETRIC $564.30 $627.00 $565.01 — 10%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN TC $1,710.00 $1,900.00 $795.11–$1,711.90 185% above 10%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN TC $1,710.00 $1,900.00 $795.11–$1,711.90 — 10%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENTS TC $1,107.90 $1,231.00 $122.01–$1,014.69 130% above 10%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENTS TC $1,107.90 $1,231.00 $122.01–$1,014.69 — 10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD/NECK TC $1,049.40 $1,166.00 $280.67–$1,064.95 108% above 10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD/NECK TC $1,049.40 $1,166.00 $280.67–$1,064.95 — 10%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY EXAM, UPPER GI TRACT, INCL SCOUT & DELAY; SINGLE CONTRAST (TC) $1,268.10 $1,409.00 $1,151.75 94% above 10%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-RAY EXAM, UPPER GI TRACT, INCL SCOUT & DELAY; SINGLE CONTRAST (TC) $1,268.10 $1,409.00 $1,151.75 — 10%
Upper arm X-ray (humerus), 2 views CPT 73060 XRAY HUMERUS MINIMUM 2 VWS $483.30 $537.00 $224.50–$438.60 133% above 10%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 XRAY HUMERUS MINIMUM 2 VWS $483.30 $537.00 $224.50–$438.60 — 10%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DUPLEX SCAN UNI $767.70 $853.00 $280.61–$779.00 14% above 10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 VENOUS DUPLEX SCAN UNI $767.70 $853.00 $280.61–$779.00 — 10%
Wrist X-ray, 2 views CPT 73100 XRAY WRIST 2 VWS $423.00 $470.00 $203.40–$384.20 96% above 10%
Wrist X-ray, 2 views inpatient CPT 73100 XRAY WRIST 2 VWS $423.00 $470.00 $203.40–$384.20 — 10%
Wrist X-ray, complete, 3 or more views CPT 73110 XRAY WRIST MINIMUM 3 VWS $709.20 $788.00 $326.85–$758.00 228% above 10%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XRAY WRIST MINIMUM 3 VWS $709.20 $788.00 $326.85–$758.00 — 10%
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 $508.50 $565.00 $71.55–$543.00 75% above 10%
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 $508.50 $565.00 $71.55–$543.00 — 10%
X-ray of the abdomen, 1 view CPT 74018 X-RAY EXAM ABDOMEN 1 VIEW $289.80 $322.00 $131.12–$265.67 38% above 10%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-RAY EXAM ABDOMEN 1 VIEW $289.80 $322.00 $131.12–$265.67 — 10%
X-ray of the ankle, 2 views CPT 73600 XRAY ANKLE 2 VWS $375.30 $417.00 $172.91–$380.95 89% above 10%
X-ray of the ankle, 2 views inpatient CPT 73600 XRAY ANKLE 2 VWS $375.30 $417.00 $172.91–$380.95 — 10%
X-ray of the finger(s), 2 or more views CPT 73140 XRAY FINGER(S) TC $412.20 $458.00 $140.96–$423.00 114% above 10%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 XRAY FINGER(S) TC $412.20 $458.00 $140.96–$423.00 — 10%
X-ray of the foot, 2 views CPT 73620 XRAY FOOT 2 VWS $412.20 $458.00 $186.12–$401.85 120% above 10%
X-ray of the foot, 2 views inpatient CPT 73620 XRAY FOOT 2 VWS $412.20 $458.00 $186.12–$401.85 — 10%
X-ray of the foot, complete, 3 or more views CPT 73630 XRAY FOOT MINIMUM 3 VWS $667.80 $742.00 $77.48–$677.35 208% above 10%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XRAY FOOT MINIMUM 3 VWS $667.80 $742.00 $77.48–$677.35 — 10%
X-ray of the hand, 3 or more views CPT 73130 XRAY HAND 3VWS TC $577.80 $642.00 $143.11–$617.00 182% above 10%
X-ray of the hand, 3 or more views inpatient CPT 73130 XRAY HAND 3VWS TC $577.80 $642.00 $143.11–$617.00 — 10%
X-ray of the knee, 1 or 2 views CPT 73560 XRAY KNEE 1 OR 2 VWS $577.80 $642.00 $260.92–$524.45 173% above 10%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XRAY KNEE 1 OR 2 VWS $577.80 $642.00 $260.92–$524.45 — 10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XRAY LUMBOSACRAL 2 OR 3 VWS $534.60 $594.00 $143.07–$542.45 107% above 10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XRAY LUMBOSACRAL 2 OR 3 VWS $534.60 $594.00 $143.07–$542.45 — 10%
X-ray of the lower back, 4 or more views CPT 72110 XRAY LUMBOSACRAL MINIMUM 4 VWS $801.90 $891.00 $385.65 117% above 10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XRAY LUMBOSACRAL MINIMUM 4 VWS $801.90 $891.00 $385.65 — 10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XRAY THORACIC SPINE 2 VWS $675.90 $751.00 $143.07–$685.90 188% above 10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XRAY THORACIC SPINE 2 VWS $675.90 $751.00 $143.07–$685.90 — 10%
X-ray of the nasal bones, 3 or more views CPT 70160 XRAY NASAL BONES MINIMUM 3 VWS $566.10 $629.00 $266.20–$514.25 163% above 10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XRAY NASAL BONES MINIMUM 3 VWS $566.10 $629.00 $266.20–$514.25 — 10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XRAY CERVICAL SPINE 2 OR 3 VWS $675.90 $751.00 $321.29–$685.90 188% above 10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XRAY CERVICAL SPINE 2 OR 3 VWS $675.90 $751.00 $321.29–$685.90 — 10%
X-ray of the pelvis, 1 or 2 views CPT 72170 XRAY PELVIS 1 OR 2 VWS $471.60 $524.00 $222.26–$478.80 124% above 10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XRAY PELVIS 1 OR 2 VWS $471.60 $524.00 $222.26–$478.80 — 10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XRAY SACRUM/ COCCYX MINIMUM 2 VWS $238.50 $265.00 $112.20 15% above 10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XRAY SACRUM/ COCCYX MINIMUM 2 VWS $238.50 $265.00 $112.20 — 10%

Lab tests

ProcedureCash price List priceInsurers payvs WisconsinOff list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT) $181.80 $202.00 $85.55–$184.30 304% above 10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT) $181.80 $202.00 $85.55–$184.30 — 10%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT) $215.10 $239.00 $101.43–$218.50 330% above 10%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT) $215.10 $239.00 $101.43–$218.50 — 10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL $663.30 $737.00 $311.96–$673.55 109% above 10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL $663.30 $737.00 $311.96–$673.55 — 10%
Albumin blood test CPT 82040 ALBUMIN, BLOOD $131.40 $146.00 $5.11–$118.02 250% above 10%
Albumin blood test inpatient CPT 82040 ALBUMIN, BLOOD $131.40 $146.00 $5.11–$118.02 — 10%
Alkaline phosphatase (ALP) blood test CPT 84075 ASSAY ALKALINE PHOSPHATASE $274.50 $305.00 $131.85–$278.35 452% above 10%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE, ALKALINE - REF $276.30 $307.00 $131.85–$278.35 456% above 10%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ASSAY ALKALINE PHOSPHATASE $274.50 $305.00 $131.85–$278.35 — 10%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE, ALKALINE - REF $276.30 $307.00 $131.85–$278.35 — 10%
Allergy blood test, specific IgE, per allergen CPT 86003 LAB IGE, ISOCYAN HDI $57.60 $64.00 $49.54 130% above 10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE, EA - REF $57.60 $64.00 $49.54 130% above 10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE, EA - REF $57.60 $64.00 $49.54 — 10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 LAB IGE, ISOCYAN HDI $57.60 $64.00 $49.54 — 10%
Ammonia blood test CPT 82140 AMMONIA $154.80 $172.00 $15.06–$150.58 72% above 10%
Ammonia blood test inpatient CPT 82140 AMMONIA $154.80 $172.00 $15.06–$150.58 — 10%
Amylase blood test CPT 82150 ASSAY OF AMYLASE $315.00 $350.00 $6.70–$337.00 410% above 10%
Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE $315.00 $350.00 $6.70–$337.00 — 10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIESANA - REF $73.80 $82.00 $67.15 8% above 10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES $73.80 $82.00 $67.15 8% above 10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIESANA - REF $73.80 $82.00 $67.15 — 10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES $73.80 $82.00 $67.15 — 10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE $420.30 $467.00 $40.56–$449.00 200% above 10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE $420.30 $467.00 $40.56–$449.00 — 10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 LAB CULTURE BACTERIA $181.80 $202.00 $8.91–$184.30 135% above 10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 ID AEROBIC ISOLATE, OTHER - REF $181.80 $202.00 $8.91–$184.30 135% above 10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 ID AEROBIC ISOLATE, OTHER - REF $181.80 $202.00 $8.91–$184.30 — 10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 LAB CULTURE BACTERIA $181.80 $202.00 $8.91–$184.30 — 10%
Basic metabolic panel (blood test) CPT 80048 LAB BASIC METABOLIC PANEL $286.20 $318.00 $8.74–$306.00 224% above 10%
Basic metabolic panel (blood test) inpatient CPT 80048 LAB BASIC METABOLIC PANEL $286.20 $318.00 $8.74–$306.00 — 10%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL $176.40 $196.00 $150.21 277% above 10%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL $176.40 $196.00 $150.21 — 10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION , TECH $486.00 $540.00 $215.17–$493.05 125% above 10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH LEVEL IV - REF $486.00 $540.00 $215.17–$493.05 125% above 10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST $486.00 $540.00 $215.17–$493.05 125% above 10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PATH LEVEL IV - REF $486.00 $540.00 $215.17–$493.05 — 10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST $486.00 $540.00 $215.17–$493.05 — 10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION , TECH $486.00 $540.00 $215.17–$493.05 — 10%
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA $276.30 $307.00 $10.66–$471.41 222% above 10%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA $276.30 $307.00 $10.66–$471.41 — 10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LEGAL BLOOD ALCHOL DRAW $39.60 $44.00 $18.26–$43.00 165% above 10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE, LAB $40.50 $45.00 $18.26–$43.00 171% above 10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE $40.50 $45.00 $18.26–$43.00 171% above 10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LEGAL BLOOD ALCHOL DRAW $39.60 $44.00 $18.26–$43.00 — 10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE $40.50 $45.00 $18.26–$43.00 — 10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE, LAB $40.50 $45.00 $18.26–$43.00 — 10%
Blood glucose (sugar) test CPT 82947 ASSAY, GLUCOSE, BLOOD QUANT $178.20 $198.00 $161.50–$180.50 630% above 10%
Blood glucose (sugar) test inpatient CPT 82947 ASSAY, GLUCOSE, BLOOD QUANT $178.20 $198.00 $161.50–$180.50 — 10%
Blood lead test CPT 83655 LEAD - REF $90.00 $100.00 $81.60 64% above 10%
Blood lead test CPT 83655 LEAD $90.00 $100.00 $81.60 64% above 10%
Blood lead test inpatient CPT 83655 LEAD - REF $90.00 $100.00 $81.60 — 10%
Blood lead test inpatient CPT 83655 LEAD $90.00 $100.00 $81.60 — 10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO $116.10 $129.00 $2.81–$105.40 190% above 10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO $116.10 $129.00 $2.81–$105.40 — 10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN $160.20 $178.00 $5.35–$171.00 193% above 10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN $160.20 $178.00 $5.35–$171.00 — 10%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY, CA 125 $108.90 $121.00 $98.60 7% below 10%
CA-125 blood test (ovarian cancer marker) CPT 86304 TUMOR ANTIGEN, CA-125 $108.90 $121.00 $98.60 7% below 10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY, CA 125 $108.90 $121.00 $98.60 — 10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 TUMOR ANTIGEN, CA-125 $108.90 $121.00 $98.60 — 10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB $176.40 $196.00 $51.30–$171.95 31% above 10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ $176.40 $196.00 $51.30–$171.95 31% above 10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ $176.40 $196.00 $51.30–$171.95 — 10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB $176.40 $196.00 $51.30–$171.95 — 10%
Calcium blood test, total CPT 82310 CALCIUM - REF $54.90 $61.00 $82.91–$84.60 10% above 10%
Calcium blood test, total CPT 82310 CALCIUM TOTAL $176.40 $196.00 $82.91–$84.60 253% above 10%
Calcium blood test, total inpatient CPT 82310 CALCIUM - REF $54.90 $61.00 $82.91–$84.60 — 10%
Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL $176.40 $196.00 $82.91–$84.60 — 10%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN - REF $387.90 $431.00 $351.90 186% above 10%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN $387.90 $431.00 $351.90 186% above 10%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN - REF $387.90 $431.00 $351.90 — 10%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CARCINOEMBRYONIC ANTIGEN $387.90 $431.00 $351.90 — 10%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY - REF $138.60 $154.00 $8.17 84% above 10%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY $225.90 $251.00 $8.17 200% above 10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER ANTIBODY - REF $138.60 $154.00 $8.17 — 10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA-ZOSTER ANTIBODY $225.90 $251.00 $8.17 — 10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS DNA, AMP PROBE $102.60 $114.00 $36.26–$94.27 28% below 10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS DNA, AMP PROBE $102.60 $114.00 $36.26–$94.27 — 10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE $231.30 $257.00 $106.51–$234.65 150% above 10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE $231.30 $257.00 $106.51–$234.65 — 10%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC $276.30 $307.00 $8.03–$295.00 295% above 10%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC $276.30 $307.00 $8.03–$295.00 — 10%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED $139.50 $155.00 $6.69–$149.00 179% above 10%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED $139.50 $155.00 $6.69–$149.00 — 10%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL $310.50 $345.00 $10.91–$332.00 173% above 10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL $310.50 $345.00 $10.91–$332.00 — 10%
Cortisol blood test, total CPT 82533 CORTISOL SERUM - REF $172.80 $192.00 $81.40–$158.55 47% above 10%
Cortisol blood test, total CPT 82533 TOTAL CORTISOL $173.70 $193.00 $81.40–$158.55 48% above 10%
Cortisol blood test, total inpatient CPT 82533 CORTISOL SERUM - REF $172.80 $192.00 $81.40–$158.55 — 10%
Cortisol blood test, total inpatient CPT 82533 TOTAL CORTISOL $173.70 $193.00 $81.40–$158.55 — 10%
Creatine kinase (CK) blood test, total CPT 82550 ASSAY OF CK (CPK) $215.10 $239.00 $6.73–$218.50 244% above 10%
Creatine kinase (CK) blood test, total inpatient CPT 82550 ASSAY OF CK (CPK) $215.10 $239.00 $6.73–$218.50 — 10%
Creatinine blood test CPT 82565 CREATININE, BLOOD $54.90 $61.00 $5.29–$142.00 73% above 10%
Creatinine blood test CPT 82565 CREATININE; BLOOD $133.20 $148.00 $5.29–$142.00 320% above 10%
Creatinine blood test inpatient CPT 82565 CREATININE, BLOOD $54.90 $61.00 $5.29–$142.00 — 10%
Creatinine blood test inpatient CPT 82565 CREATININE; BLOOD $133.20 $148.00 $5.29–$142.00 — 10%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY - REF $144.90 $161.00 $128.14 105% above 10%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV ANTIBODY - REF $144.90 $161.00 $128.14 — 10%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT $194.40 $216.00 $10.52–$208.00 176% above 10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT $194.40 $216.00 $10.52–$208.00 — 10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S - REF $107.10 $119.00 $96.10 22% below 10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE $107.10 $119.00 $96.10 22% below 10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S - REF $107.10 $119.00 $96.10 — 10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE $107.10 $119.00 $96.10 — 10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ACETAMINOPHEN $270.90 $301.00 $63.39–$289.00 139% above 10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG SCREEN $270.90 $301.00 $63.39–$289.00 139% above 10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 SALICYLATE $270.90 $301.00 $63.39–$289.00 139% above 10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL $270.90 $301.00 $63.39–$289.00 139% above 10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN CLASS LIST A - REF $666.00 $740.00 $63.39–$289.00 487% above 10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ACETAMINOPHEN $270.90 $301.00 $63.39–$289.00 — 10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 URINE DRUG SCREEN $270.90 $301.00 $63.39–$289.00 — 10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL $270.90 $301.00 $63.39–$289.00 — 10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 SALICYLATE $270.90 $301.00 $63.39–$289.00 — 10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN CLASS LIST A - REF $666.00 $740.00 $63.39–$289.00 — 10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL $80.10 $89.00 $37.08 64% above 10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL $80.10 $89.00 $37.08 — 10%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV, VIRAL CAPSID AB - REF $72.00 $80.00 $61.52 16% below 10%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV, VIRAL CAPSID AB - REF $72.00 $80.00 $61.52 — 10%
Estradiol blood test CPT 82670 ENDOCRINE E2 $78.30 $87.00 $84.00 39% below 10%
Estradiol blood test CPT 82670 ESTRADIOL - REF $78.30 $87.00 $84.00 39% below 10%
Estradiol blood test inpatient CPT 82670 ESTRADIOL - REF $78.30 $87.00 $84.00 — 10%
Estradiol blood test inpatient CPT 82670 ENDOCRINE E2 $78.30 $87.00 $84.00 — 10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH - REF $80.10 $89.00 $73.70 31% below 10%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING HORMONE $81.00 $90.00 $73.70 31% below 10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH - REF $80.10 $89.00 $73.70 — 10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING HORMONE $81.00 $90.00 $73.70 — 10%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN $286.20 $318.00 $14.08–$260.10 218% above 10%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN $286.20 $318.00 $14.08–$260.10 — 10%
Folate (folic acid) blood test CPT 82746 FOLIC ACID (FOLATE), SERUM $216.90 $241.00 $15.19–$198.82 100% above 10%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID (FOLATE), SERUM $216.90 $241.00 $15.19–$198.82 — 10%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE T3, FREE (FREE T3) $150.30 $167.00 $135.72 58% above 10%
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) - REF $150.30 $167.00 $135.72 58% above 10%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3, FREE (FREE T3) $150.30 $167.00 $135.72 — 10%
Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3) - REF $150.30 $167.00 $135.72 — 10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE - REF $218.70 $243.00 $9.32–$230.85 171% above 10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXIN, FREE (FREE T4) $227.70 $253.00 $9.32–$230.85 182% above 10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE - REF $218.70 $243.00 $9.32–$230.85 — 10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXIN, FREE (FREE T4) $227.70 $253.00 $9.32–$230.85 — 10%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GGT - REF $181.80 $202.00 $87.30–$164.90 241% above 10%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GGT - REF $181.80 $202.00 $87.30–$164.90 — 10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE DNA, AMP PROBE $102.60 $114.00 $36.26–$94.27 28% below 10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE DNA, AMP PROBE $102.60 $114.00 $36.26–$94.27 — 10%
H. pylori stool antigen test CPT 87338 HPYLORI STOOL EIA $164.70 $183.00 $140.62–$149.60 32% above 10%
H. pylori stool antigen test inpatient CPT 87338 HPYLORI STOOL EIA $164.70 $183.00 $140.62–$149.60 — 10%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1/2 AG AND AB SCREEN $176.40 $196.00 $223.94 76% above 10%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 ANTIGENS W/HIV 1/2 ANTIB $270.90 $301.00 $223.94 171% above 10%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1/2 AG AND AB SCREEN $176.40 $196.00 $223.94 — 10%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 ANTIGENS W/HIV 1/2 ANTIB $270.90 $301.00 $223.94 — 10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST $192.60 $214.00 $10.03–$206.00 199% above 10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST $192.60 $214.00 $10.03–$206.00 — 10%
Hemoglobin blood test CPT 85018 HEMOGLOBIN $56.70 $63.00 $2.45–$56.05 224% above 10%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN $56.70 $63.00 $2.45–$56.05 — 10%
Hepatitis B core antibody test (total) CPT 86704 HEP BC AB, TOTAL $135.00 $150.00 $136.80 74% above 10%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY, TOTAL $135.00 $150.00 $136.80 74% above 10%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY, TOTAL $135.00 $150.00 $136.80 — 10%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEP BC AB, TOTAL $135.00 $150.00 $136.80 — 10%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY $223.20 $248.00 $56.89–$122.55 201% above 10%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY $223.20 $248.00 $56.89–$122.55 — 10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN $104.40 $116.00 $104.53 52% above 10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B S AG, BY EIA - REF $116.10 $129.00 $104.53 69% above 10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN $104.40 $116.00 $104.53 — 10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B S AG, BY EIA - REF $116.10 $129.00 $104.53 — 10%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY $234.90 $261.00 $211.59 185% above 10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY $234.90 $261.00 $211.59 — 10%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON $162.90 $181.00 $6.69–$147.90 206% above 10%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON $162.90 $181.00 $6.69–$147.90 — 10%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST $164.70 $183.00 $9.03–$149.60 139% above 10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST $164.70 $183.00 $9.03–$149.60 — 10%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL $263.70 $293.00 $119.24–$121.60 157% above 10%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL $263.70 $293.00 $119.24–$121.60 — 10%
Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID $112.50 $125.00 $11.96–$120.00 59% above 10%
Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY OF LACTIC ACID $112.50 $125.00 $11.96–$120.00 — 10%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH - REF $213.30 $237.00 $98.31–$102.60 349% above 10%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE (LD) (LDH) ENZYME $213.30 $237.00 $98.31–$102.60 349% above 10%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH - REF $213.30 $237.00 $98.31–$102.60 — 10%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE (LD) (LDH) ENZYME $213.30 $237.00 $98.31–$102.60 — 10%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE $169.20 $188.00 $7.12–$177.38 148% above 10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE $169.20 $188.00 $7.12–$177.38 — 10%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL $291.60 $324.00 $8.44–$296.40 186% above 10%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL $291.60 $324.00 $8.44–$296.40 — 10%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY $162.90 $181.00 $17.60–$165.30 93% above 10%
Lyme disease antibody test CPT 86618 LYME DISEASE, ANTIBODY - REF $162.90 $181.00 $17.60–$165.30 93% above 10%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY $162.90 $181.00 $17.60–$165.30 — 10%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE, ANTIBODY - REF $162.90 $181.00 $17.60–$165.30 — 10%
Magnesium blood test CPT 83735 MAGNESIUM $192.60 $214.00 $6.92–$201.88 285% above 10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM $192.60 $214.00 $6.92–$201.88 — 10%
Measles (rubeola) antibody test CPT 86765 RUBEOLA (MEASLES) ANTIBODY - REF $138.60 $154.00 $13.31 73% above 10%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA (MEASLES) ANTIBODY - REF $138.60 $154.00 $13.31 — 10%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES $236.70 $263.00 $209.41–$240.35 328% above 10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES $236.70 $263.00 $209.41–$240.35 — 10%
Mumps immunity blood test CPT 86735 MUMPS ANTIBODY - REF $139.50 $155.00 $123.41 64% above 10%
Mumps immunity blood test inpatient CPT 86735 MUMPS ANTIBODY - REF $139.50 $155.00 $123.41 — 10%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL $237.60 $264.00 $111.76–$214.12 150% above 10%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL - REF $237.60 $264.00 $111.76–$214.12 150% above 10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL - REF $237.60 $264.00 $111.76–$214.12 — 10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL $237.60 $264.00 $111.76–$214.12 — 10%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE - REF $387.00 $430.00 $367.38–$730.16 79% above 10%
Parathyroid hormone (PTH) blood test CPT 83970 LAB PTH IMMUNOCH PART 1 $797.40 $886.00 $367.38–$730.16 269% above 10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE - REF $387.00 $430.00 $367.38–$730.16 — 10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 LAB PTH IMMUNOCH PART 1 $797.40 $886.00 $367.38–$730.16 — 10%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL $215.10 $239.00 $6.21–$216.58 330% above 10%
Partial thromboplastin time (PTT) clotting test CPT 85730 L (PTT), PLASMA OR WB - REF $215.10 $239.00 $6.21–$216.58 330% above 10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL $215.10 $239.00 $6.21–$216.58 — 10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 L (PTT), PLASMA OR WB - REF $215.10 $239.00 $6.21–$216.58 — 10%
Phosphorus (phosphate) blood test CPT 84100 PO4 INORGANIC (PHOSPHATE) - REF $77.40 $86.00 $4.90–$190.00 86% above 10%
Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS $178.20 $198.00 $4.90–$190.00 328% above 10%
Phosphorus (phosphate) blood test inpatient CPT 84100 PO4 INORGANIC (PHOSPHATE) - REF $77.40 $86.00 $4.90–$190.00 — 10%
Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS $178.20 $198.00 $4.90–$190.00 — 10%
Potassium blood test CPT 84132 POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD $133.20 $148.00 $58.86–$226.92 359% above 10%
Potassium blood test inpatient CPT 84132 POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD $133.20 $148.00 $58.86–$226.92 — 10%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE $98.10 $109.00 $105.00 18% below 10%
Progesterone blood test CPT 84144 PROGESTERONE $98.10 $109.00 $105.00 18% below 10%
Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE $98.10 $109.00 $105.00 — 10%
Progesterone blood test inpatient CPT 84144 PROGESTERONE $98.10 $109.00 $105.00 — 10%
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN - REF $393.30 $437.00 $357.00 225% above 10%
Prolactin blood test CPT 84146 PROLACTIN $393.30 $437.00 $357.00 225% above 10%
Prolactin blood test inpatient CPT 84146 PROLACTIN $393.30 $437.00 $357.00 — 10%
Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN - REF $393.30 $437.00 $357.00 — 10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT/INR) $122.40 $136.00 $4.43–$128.38 255% above 10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT/INR) $122.40 $136.00 $4.43–$128.38 — 10%
Rh blood typing CPT 86901 BLOOD TYPING RH (D) $116.10 $129.00 $2.81–$105.40 193% above 10%
Rh blood typing inpatient CPT 86901 BLOOD TYPING RH (D) $116.10 $129.00 $2.81–$105.40 — 10%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM - REF $142.20 $158.00 $117.82–$128.14 171% above 10%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM $178.20 $198.00 $117.82–$128.14 239% above 10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM - REF $142.20 $158.00 $117.82–$128.14 — 10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM $178.20 $198.00 $117.82–$128.14 — 10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL - REF $114.30 $127.00 $103.70–$104.55 at median 10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL - REF $114.30 $127.00 $103.70–$104.55 — 10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE $215.10 $239.00 $17.36–$230.00 128% above 10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE - REF $215.10 $239.00 $17.36–$230.00 128% above 10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE - REF $215.10 $239.00 $17.36–$230.00 — 10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE $215.10 $239.00 $17.36–$230.00 — 10%
Total IgE blood test CPT 82785 GAMMAGLOBULIN; IGE - REF $148.50 $165.00 $127.04 46% above 10%
Total IgE blood test inpatient CPT 82785 GAMMAGLOBULIN; IGE - REF $148.50 $165.00 $127.04 — 10%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODOTHYRONINE T3, TOTAL TT3 $133.20 $148.00 $120.70 27% above 10%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODOTHYRONINE T3, TOT - REF $133.20 $148.00 $120.70 27% above 10%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODOTHYRONINE T3, TOTAL TT3 $133.20 $148.00 $120.70 — 10%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODOTHYRONINE T3, TOT - REF $133.20 $148.00 $120.70 — 10%
Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES $135.00 $150.00 $62.09 150% above 10%
Triglycerides blood test CPT 84478 TRIGLYCERIDES - REF $135.00 $150.00 $62.09 150% above 10%
Triglycerides blood test inpatient CPT 84478 ASSAY OF TRIGLYCERIDES $135.00 $150.00 $62.09 — 10%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES - REF $135.00 $150.00 $62.09 — 10%
Troponin test, quantitative CPT 84484 TROPONIN, QUANTITATIVE $330.30 $367.00 $12.89–$353.00 291% above 10%
Troponin test, quantitative inpatient CPT 84484 TROPONIN, QUANTITATIVE $330.30 $367.00 $12.89–$353.00 — 10%
Uric acid blood test CPT 84550 URIC ACID; BLOOD $178.20 $198.00 $4.67–$178.03 256% above 10%
Uric acid blood test inpatient CPT 84550 URIC ACID; BLOOD $178.20 $198.00 $4.67–$178.03 — 10%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, AUTO, W/SCOPE $89.10 $99.00 $3.28–$93.10 121% above 10%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, AUTO, W/SCOPE $89.10 $99.00 $3.28–$93.10 — 10%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO W/O SCOPE $73.80 $82.00 $2.32–$77.42 195% above 10%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, AUTO W/O SCOPE $73.80 $82.00 $2.32–$77.42 — 10%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT $139.50 $155.00 $8.33–$141.55 85% above 10%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT $139.50 $155.00 $8.33–$141.55 — 10%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN QUANTITATIVE $99.00 $110.00 $45.71–$100.70 58% above 10%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN QUANTITATIVE $99.00 $110.00 $45.71–$100.70 — 10%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST $266.40 $296.00 $8.90–$270.75 336% above 10%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST $266.40 $296.00 $8.90–$270.75 — 10%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 $189.90 $211.00 $15.58–$190.21 90% above 10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 $189.90 $211.00 $15.58–$190.21 — 10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25 HYDROXY $82.80 $92.00 $39.60–$88.00 45% below 10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OH - REF $82.80 $92.00 $39.60–$88.00 45% below 10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-OH - REF $82.80 $92.00 $39.60–$88.00 — 10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25 HYDROXY $82.80 $92.00 $39.60–$88.00 — 10%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIHYDROXY $81.00 $90.00 $73.34 48% below 10%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 DIHYDROXYVITAMIN D - REF $81.00 $90.00 $73.34 48% below 10%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25-DIHYDROXY $81.00 $90.00 $73.34 — 10%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 DIHYDROXYVITAMIN D - REF $81.00 $90.00 $73.34 — 10%
Zinc blood test CPT 84630 ZINC, SERUM - REF $122.40 $136.00 $111.35–$112.27 58% above 10%
Zinc blood test inpatient CPT 84630 ZINC, SERUM - REF $122.40 $136.00 $111.35–$112.27 — 10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPINC, CHORIONIC (HCG), QUANT $146.70 $163.00 $15.55–$149.15 30% above 10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPINC, CHORIONIC (HCG), QUANT $146.70 $163.00 $15.55–$149.15 — 10%

Surgery and procedures

ProcedureCash price List priceInsurers payvs WisconsinOff list
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION, ELECTIVE;EXTERN $227.70 $253.00 $206.55 77% below 10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION, ELECTIVE;EXTERN $227.70 $253.00 $206.55 — 10%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY,REMV LESN,SNARE $3,040.20 $3,378.00 $1,400.54–$3,183.04 38% above 10%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY,REMV LESN,SNARE $3,040.20 $3,378.00 $1,400.54–$3,183.04 — 10%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY,BIOPSY $2,892.60 $3,214.00 $1,371.96–$2,852.10 49% above 10%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY,BIOPSY $2,892.60 $3,214.00 $1,371.96–$2,852.10 — 10%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY,FLEX,DIAGNOSTIC $2,491.20 $2,768.00 $1,152.54–$2,531.38 54% above 10%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY,FLEX,DIAGNOSTIC $2,491.20 $2,768.00 $1,152.54–$2,531.38 — 10%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY $494.10 $549.00 $234.96–$448.80 31% below 10%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY $494.10 $549.00 $234.96–$448.80 — 10%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ LUMBAR/SACRAL WITH IMAGE GUIDANCE $1,469.70 $1,633.00 $1,254.43 28% above 10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ LUMBAR/SACRAL WITH IMAGE GUIDANCE $1,469.70 $1,633.00 $1,254.43 — 10%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE $202.50 $225.00 $97.20 10% below 10%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE $202.50 $225.00 $97.20 — 10%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING(T) $221.40 $246.00 $201.45 83% below 10%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING(T) $221.40 $246.00 $201.45 — 10%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY,SCREEN PREV $2,493.00 $2,770.00 $1,129.19–$2,244.91 43% above 10%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLONOSCOPY,SCREEN PREV $2,493.00 $2,770.00 $1,129.19–$2,244.91 — 10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY,FLEX,SCREEN $3,040.20 $3,378.00 $1,432.37–$2,738.06 74% above 10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLONOSCOPY,FLEX,SCREEN $3,040.20 $3,378.00 $1,432.37–$2,738.06 — 10%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING $1,070.10 $1,189.00 $514.35 7% below 10%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING $1,070.10 $1,189.00 $514.35 — 10%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY,BIOPSY $3,160.80 $3,512.00 $1,497.16–$3,441.46 100% above 10%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY,BIOPSY $3,160.80 $3,512.00 $1,497.16–$3,441.46 — 10%
Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY,DIAGNOSIS $2,327.40 $2,586.00 $1,052.26–$2,096.54 59% above 10%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GI ENDOSCOPY,DIAGNOSIS $2,327.40 $2,586.00 $1,052.26–$2,096.54 — 10%

Doctor visits and therapy

ProcedureCash price List priceInsurers payvs WisconsinOff list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE $953.10 $1,059.00 $430.76–$865.30 63% above 10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION SERVICE $953.10 $1,059.00 $430.76–$865.30 — 10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT $181.80 $202.00 $82.28–$190.12 110% above 10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT $181.80 $202.00 $82.28–$190.12 — 10%
Chemotherapy IV infusion, first hour CPT 96413 CHEMOTHERAPY, IV INFUSION, 1 HOUR $701.10 $779.00 $333.30–$711.55 23% above 10%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMOTHERAPY, IV INFUSION, 1 HOUR $701.10 $779.00 $333.30–$711.55 — 10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD, TRACING ONLY $288.90 $321.00 $130.68–$293.55 100% above 10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD, TRACING ONLY $288.90 $321.00 $130.68–$293.55 — 10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 FACILITY EMERGENCY LEVEL 1 VISIT $227.70 $253.00 $106.58–$227.69 30% above 10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 FACILITY EMERGENCY LEVEL 1 VISIT $227.70 $253.00 $106.58–$227.69 — 10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 FACILITY EMERGENCY LEVEL II VISIT $375.30 $417.00 $174.71–$400.90 24% above 10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 FACILITY EMERGENCY LEVEL II VISIT $375.30 $417.00 $174.71–$400.90 — 10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 FACILITY EMERGENCY LEVEL III VISIT $689.40 $766.00 $311.96–$724.76 27% above 10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 FACILITY EMERGENCY LEVEL III VISIT $689.40 $766.00 $311.96–$724.76 — 10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 FACILITY EMERGENCY LEVEL IV VISIT $1,151.10 $1,279.00 $520.30–$1,207.90 42% above 10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 FACILITY EMERGENCY LEVEL IV VISIT $1,151.10 $1,279.00 $520.30–$1,207.90 — 10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 FACILITY EMERGENCY LEVEL V VISIT $1,762.20 $1,958.00 $433.62–$1,847.84 22% above 10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 FACILITY EMERGENCY LEVEL V VISIT $1,762.20 $1,958.00 $433.62–$1,847.84 — 10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 FIRST HOUR IV HYDRATION <1 HOUR $282.60 $314.00 $127.60–$295.96 1% below 10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 FIRST HOUR IV HYDRATION <1 HOUR $282.60 $314.00 $127.60–$295.96 — 10%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY, 1 HOUR $420.30 $467.00 $190.08–$449.00 34% above 10%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY, 1 HOUR $420.30 $467.00 $190.08–$449.00 — 10%
IV push of a medicine, first drug CPT 96374 IV PUSH, SINGLE/1ST DRUG $225.90 $251.00 $102.08–$236.18 37% above 10%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH, SINGLE/1ST DRUG $225.90 $251.00 $102.08–$236.18 — 10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION, SUBQ/IM $39.60 $44.00 $18.11–$41.16 51% below 10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION, SUBQ/IM $39.60 $44.00 $18.11–$41.16 — 10%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUCATION $211.50 $235.00 $88.54–$214.70 121% above 10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUCATION $211.50 $235.00 $88.54–$214.70 — 10%
New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPT VISIT,NEW,LEVL III $173.70 $193.00 $144.45–$178.95 9% below 10%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OUTPT VISIT,NEW,LEVL III $173.70 $193.00 $144.45–$178.95 — 10%
New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPT VISIT,NEW,LEVL IV $297.00 $330.00 $269.45–$317.00 45% above 10%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPT VISIT,NEW,LEVL IV $297.00 $330.00 $269.45–$317.00 — 10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OUTPT VISIT,NEW,LEVL II $116.10 $129.00 $99.08–$123.97 11% below 10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OUTPT VISIT,NEW,LEVL II $116.10 $129.00 $99.08–$123.97 — 10%
Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX $180.00 $200.00 $82.79–$163.20 1% above 10%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX $180.00 $200.00 $82.79–$163.20 — 10%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX $504.00 $560.00 $223.75–$511.10 63% above 10%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX $504.00 $560.00 $223.75–$511.10 — 10%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX $273.60 $304.00 $125.91–$277.40 54% above 10%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX $273.60 $304.00 $125.91–$277.40 — 10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX $431.10 $479.00 $199.58–$437.95 80% above 10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX $431.10 $479.00 $199.58–$437.95 — 10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THER TECH,1+REGIONS,EA 15 MIN $197.10 $219.00 $90.98–$200.45 104% above 10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THER TECH,1+REGIONS,EA 15 MIN $197.10 $219.00 $90.98–$200.45 — 10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES $207.90 $231.00 $96.13–$210.90 115% above 10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES $207.90 $231.00 $96.13–$210.90 — 10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMKING CESS 4-10 MIN $19.80 $22.00 $17.85 32% below 10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMKING CESS 4-10 MIN $19.80 $22.00 $17.85 — 10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPT VISIT,EST,LEVL III $118.80 $132.00 $101.47–$120.65 28% below 10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPT VISIT,EST,LEVL III $118.80 $132.00 $101.47–$120.65 — 10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OUTPT VISIT,EST,LEVL IV $181.80 $202.00 $193.96 at median 10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OUTPT VISIT,EST,LEVL IV $181.80 $202.00 $193.96 — 10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPT VISIT,EST,LEVL II $57.60 $64.00 $52.70 44% below 10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPT VISIT,EST,LEVL II $57.60 $64.00 $52.70 — 10%
Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN $819.00 $910.00 $363.24–$743.75 141% above 10%
Speech and language evaluation inpatient CPT 92523 SPEECH SOUND LANG COMPREHEN $819.00 $910.00 $363.24–$743.75 — 10%
Speech therapy session, individual CPT 92507 SPEECH/HEARING THERAPY $342.90 $381.00 $158.46–$311.10 35% above 10%
Speech therapy session, individual inpatient CPT 92507 SPEECH/HEARING THERAPY $342.90 $381.00 $158.46–$311.10 — 10%
Spirometry (breathing test) CPT 94010 SPIROMETRY INCL GRAPH REC TC $225.00 $250.00 $202.32 15% below 10%
Spirometry (breathing test) CPT 94010 SPIROMETRY $225.00 $250.00 $202.32 15% below 10%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY $225.00 $250.00 $202.32 — 10%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY INCL GRAPH REC TC $225.00 $250.00 $202.32 — 10%
Spirometry before and after a bronchodilator CPT 94060 BRONCHO RESPONSE PRE & POST TC $174.60 $194.00 $81.38–$177.65 63% below 10%
Spirometry before and after a bronchodilator CPT 94060 BRONCH EVAL B/A BRONCH $174.60 $194.00 $81.38–$177.65 63% below 10%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCH EVAL B/A BRONCH $174.60 $194.00 $81.38–$177.65 — 10%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHO RESPONSE PRE & POST TC $174.60 $194.00 $81.38–$177.65 — 10%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES $221.40 $246.00 $102.20–$225.15 153% above 10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES $221.40 $246.00 $102.20–$225.15 — 10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY $146.70 $163.00 $70.65 27% below 10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY $146.70 $163.00 $70.65 — 10%

Vaccines

ProcedureCash price List priceInsurers payvs WisconsinOff list
Flu shot, recombinant, egg-free (Flublok) CPT 90673 FLUBLOK VACCINE, INJ $68.40 $76.00 $32.19–$69.35 8% below 10%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 FLUBLOK VACCINE, INJ $68.40 $76.00 $32.19–$69.35 — 10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Virus Vaccine Split PF Susp Pref Syringe 0.5 ML $22.41 $24.90 $21.92–$24.70 28% below 10%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE, NO PRESERV, IM .5ML $24.30 $27.00 $21.92–$24.70 22% below 10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza Virus Vaccine Split PF Susp Pref Syringe 0.5 ML $22.41 $24.90 $21.92–$24.70 — 10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE, NO PRESERV, IM .5ML $24.30 $27.00 $21.92–$24.70 — 10%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE HIGH DOSE 65+ $68.40 $76.00 $30.18–$96.20 14% below 10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE HIGH DOSE 65+ $68.40 $76.00 $30.18–$96.20 — 10%
Rabies vaccine, one dose CPT 90675 Rabies Virus Vaccine HDC For Inj Susp $755.69 $839.66 $370.44–$696.33 31% above 10%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Virus Vaccine HDC For Inj Susp $755.69 $839.66 $370.44–$696.33 — 10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML $79.01 $87.79 $65.11–$151.00 91% above 10%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML $79.01 $87.79 $65.11–$151.00 — 10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP, TETANUS, DIPHTHERIA, PERTUSSIS 7+ YRS, BOOSTRIX $23.40 $26.00 $19.63–$92.00 71% below 10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2-15.5 LF-MCG/0.5ML $87.28 $96.98 $19.63–$92.00 7% above 10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP, TETANUS, DIPHTHERIA, PERTUSSIS 7+ YRS, BOOSTRIX $23.40 $26.00 $19.63–$92.00 — 10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2-15.5 LF-MCG/0.5ML $87.28 $96.98 $19.63–$92.00 — 10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TO* $15.30 $17.00 $6.90–$15.20 60% below 10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN - INFLUENZA $15.30 $17.00 $6.90–$15.20 60% below 10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) $15.30 $17.00 $6.90–$15.20 60% below 10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEP B $15.30 $17.00 $6.90–$15.20 60% below 10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) $15.30 $17.00 $6.90–$15.20 — 10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEP B $15.30 $17.00 $6.90–$15.20 — 10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN - INFLUENZA $15.30 $17.00 $6.90–$15.20 — 10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION; ONE VACCINE (SINGLE OR COMBINATION VACCINE/TO* $15.30 $17.00 $6.90–$15.20 — 10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION; EACH ADD'L VACCINE (SINGLE OR COMBO VACCINE/T* $42.30 $47.00 $19.40–$45.00 30% above 10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMINISTRATION; EACH ADD'L VACCINE (SINGLE OR COMBO VACCINE/T* $42.30 $47.00 $19.40–$45.00 — 10%

Source file: https://hospitalpricetransparencyfiles.com/spooner-health-system-inc/390892183_Spooner-Health-System%2C-Inc_standardcharges.csv