| Procedure | Fort Memorial Hospital | Beloit Health System | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $21 | $25 | $51 |
| Abdominal fluid drain (paracentesis) | $834 | $526 | $284 |
| Abdominal ultrasound | $339 | $439 | $100 |
| Abdominal ultrasound (complete) | $403 | $428 | $114 |
| Abdominal ultrasound (limited) | $275 | $450 | $86 |
| Abscess drainage (complex or multiple) | $540 | $266 | $220 |
| Abscess drainage (simple) | $1,123 | $163 | $129 |
| Abscess incision and drainage | $831 | $167 | $174 |
| Albumin blood test | $10 | $23 | $5 |
| Aldosterone test | $112 | $221 | $41 |
| Alkaline phosphatase test | $24 | $24 | $5 |
| Alpha-fetoprotein (AFP) test | $26 | $74 | $17 |
| ALT liver enzyme test | $31 | $26 | $5 |
| Ammonia blood test | $48 | $66 | $15 |
| Amylase test | $27 | $49 | $6 |
| Anal fistula repair | $2,575 | $284 | $541 |
| Anoscopy | $118 | $60 | $129 |
| Antinuclear antibody (ANA) test | $31 | $52 | $12 |
| AST liver enzyme test | $34 | $26 | $5 |
| Barium swallow study | $267 | $299 | $107 |
| Basic metabolic panel | $40 | $78 | $8 |
| Benign skin lesion removal | $616 | $174 | $171 |
| Bilirubin blood test | $16 | $40 | $5 |
| Bladder scope (cystoscopy) | $1,307 | $235 | $216 |
| Blood clotting test (PT/INR) | $16 | $32 | $4 |
| Blood glucose test | $22 | $23 | $5 |
| Blood type and screen | $49 | $66 | $10 |
| Blood type test | $22 | $33 | $3 |
| Blood type test (ABO group) | $23 | $32 | $3 |
| Blood type test (Rh/D antigen) | $21 | $35 | $3 |
| BNP (heart failure) test | $96 | $127 | $39 |
| Bone density scan (DEXA) | $292 | $220 | $39 |
| Bone scan (nuclear) | $650 | $800 | $259 |
| Breast biopsy | $1,278 | $1,362 | $478 |
| Breast MRI | $341 | $1,353 | $216 |
| Breast MRI without contrast | $341 | $703 | $216 |
| Breast ultrasound | $229 | $610 | $92 |
| Breast ultrasound (complete) | $259 | $978 | $100 |
| Breast ultrasound (limited) | $200 | $242 | $84 |
| Breathing tube insertion (intubation) | $232 | $152 | $133 |
| Bronchoscopy | $2,236 | $1,250 | $303 |
| Bunion surgery (bunionectomy) | $2,620 | $1,039 | $883 |
| Burn dressing and debridement (medium) | $199 | $94 | $166 |
| Burn dressing and debridement (small) | $352 | $38 | $93 |
| Burn treatment | $276 | $82 | $129 |
| C-reactive protein (CRP) | $32 | $41 | $5 |
| CA 19-9 tumor marker test | $61 | $113 | $21 |
| CA-125 ovarian marker test | $61 | $100 | $21 |
| Calcium blood test | $26 | $26 | $5 |
| Cardiac rehabilitation | $164 | $111 | $26 |
| Cardiac stress test | $310 | $455 | $39 |
| Cardioversion | $471 | $1,808 | $155 |
| Carotid artery ultrasound | $568 | $380 | $156 |
| Carpal tunnel release | $2,234 | $897 | $483 |
| Cataract surgery | $2,937 | $602 | $547 |
| CEA tumor marker test | $64 | $110 | $19 |
| Central line placement | $876 | $436 | $238 |
| Cervical LEEP procedure | $3,604 | $353 | $325 |
| Chest fluid drain (thoracentesis) | $998 | $681 | $311 |
| Chest tube insertion | $765 | $463 | $143 |
| Chest X-ray | $141 | $178 | $37 |
| Chest X-ray (1 view) | $123 | $145 | $25 |
| Chest X-ray (2 views) | $159 | $143 | $33 |
| Circumcision | $1,000 | $213 | $167 |
| Clotting time test (PTT) | $24 | $46 | $6 |
| Colon resection (colectomy) | $4,608 | $2,002 | $1,238 |
| Colonoscopy | $1,460 | $730 | $480 |
| Colposcopy | $302 | $165 | $161 |
| Complete blood count (CBC) | $34 | $57 | $7 |
| Complete blood count (CBC) (complete) | $40 | $63 | $8 |
| Complex wound repair | $570 | $147 | $390 |
| Comprehensive metabolic panel | $80 | $101 | $11 |
| Contraceptive implant (Nexplanon) | $277 | $138 | $115 |
| Copper blood test | $40 | $62 | $12 |
| Coronary CT angiography | $439 | $1,465 | $326 |
| Cortisol test | $45 | $55 | $16 |
| COVID-19 PCR test | $80 | $58 | $51 |
| CPAP titration study | $243 | $182 | $69 |
| Creatine kinase (CK) test | $24 | $34 | $7 |
| CT angiography of the chest | $1,472 | $1,992 | $281 |
| CT angiography of the head | $1,363 | $1,509 | $274 |
| CT scan of the abdomen | $1,180 | $990 | $230 |
| CT scan of the abdomen and pelvis | $1,689 | $1,827 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $1,689 | $2,368 | $338 |
| CT scan of the abdomen and pelvis with contrast | $1,140 | $1,827 | $300 |
| CT scan of the abdomen and pelvis without contrast | $1,748 | $1,561 | $183 |
| CT scan of the abdomen with and without contrast | $1,180 | $1,334 | $259 |
| CT scan of the abdomen with contrast | $1,249 | $990 | $230 |
| CT scan of the abdomen without contrast | $970 | $785 | $136 |
| CT scan of the arm | $685 | $2,507 | $199 |
| CT scan of the arm with contrast | $685 | $2,507 | $199 |
| CT scan of the arm without contrast | $637 | $2,129 | $161 |
| CT scan of the chest | $1,169 | $1,006 | $167 |
| CT scan of the chest with and without contrast | $1,354 | $1,119 | $196 |
| CT scan of the chest with contrast | $1,169 | $1,006 | $167 |
| CT scan of the chest without contrast | $861 | $848 | $133 |
| CT scan of the head | $883 | $918 | $148 |
| CT scan of the head with and without contrast | $1,059 | $1,009 | $173 |
| CT scan of the head with contrast | $883 | $918 | $148 |
| CT scan of the head without contrast | $634 | $709 | $107 |
| CT scan of the leg | $654 | $1,721 | $166 |
| CT scan of the leg with contrast | $654 | $1,721 | $166 |
| CT scan of the leg without contrast | $465 | $1,551 | $130 |
| CT scan of the lower back (lumbar spine) | $974 | $1,175 | $169 |
| CT scan of the lower back (lumbar spine) with and without contrast | $1,345 | $1,544 | $197 |
| CT scan of the lower back (lumbar spine) with contrast | $974 | $1,175 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $893 | $959 | $130 |
| CT scan of the neck | $897 | $994 | $183 |
| CT scan of the neck (cervical spine) | $974 | $1,285 | $168 |
| CT scan of the neck (cervical spine) with and without contrast | $1,287 | $1,544 | $196 |
| CT scan of the neck (cervical spine) with contrast | $685 | $1,285 | $168 |
| CT scan of the neck (cervical spine) without contrast | $974 | $1,001 | $131 |
| CT scan of the neck with and without contrast | $1,077 | $1,053 | $220 |
| CT scan of the neck with contrast | $897 | $994 | $183 |
| CT scan of the neck without contrast | $759 | $809 | $150 |
| CT scan of the pelvis | $965 | $949 | $226 |
| CT scan of the pelvis with and without contrast | $1,024 | $1,328 | $251 |
| CT scan of the pelvis with contrast | $965 | $949 | $226 |
| CT scan of the pelvis without contrast | $837 | $875 | $133 |
| CT scan of the sinuses | $873 | $944 | $152 |
| CT scan of the sinuses with and without contrast | $1,048 | $1,165 | $184 |
| CT scan of the sinuses with contrast | $873 | $944 | $152 |
| CT scan of the sinuses without contrast | $760 | $784 | $128 |
| D-dimer test | $48 | $94 | $10 |
| DHEA-sulfate test | $72 | $52 | $22 |
| Diagnostic mammogram | $164 | $157 | $140 |
| Dilation and curettage (D&C) | $2,893 | $494 | $298 |
| Drug screen (urine) | $146 | $50 | $17 |
| Ear tubes (myringotomy) | $853 | $163 | $174 |
| Echocardiogram | $790 | $457 | $138 |
| Echocardiogram with and without contrast | $605 | $457 | $101 |
| EEG (awake and asleep) | $183 | $437 | $482 |
| EKG / ECG (tracing only) | $82 | $110 | $7 |
| Electrocardiogram (EKG) | $82 | $110 | $8 |
| Electroencephalogram (EEG) | $183 | $437 | $448 |
| Electrolyte panel | $48 | $71 | $7 |
| Emergency department visit | $247 | $341 | $69 |
| Emergency department visit (level 1) | $139 | $68 | $11 |
| Emergency department visit (level 2) | $143 | $189 | $40 |
| Emergency department visit (level 3) | $247 | $341 | $69 |
| Emergency department visit (level 4) | $398 | $530 | $118 |
| Emergency department visit (level 5) | $490 | $947 | $171 |
| Endometrial biopsy | $397 | $113 | $98 |
| Epidural steroid injection | $635 | $320 | $275 |
| Estradiol (estrogen) test | $140 | $202 | $28 |
| Facet joint injection (spine) | $450 | $210 | $99 |
| Fallopian tube X-ray (HSG) | $433 | $305 | $164 |
| Fecal occult blood (stool) test | $13 | $44 | $10 |
| Feeding tube (PEG) placement | $1,665 | $325 | $178 |
| Ferritin (iron) test | $51 | $74 | $14 |
| Flexible sigmoidoscopy | $602 | $166 | $323 |
| Folate (folic acid) test | $54 | $59 | $15 |
| Foreign body removal (skin) | $572 | $107 | $157 |
| Free T4 thyroid test | $32 | $89 | $9 |
| FSH hormone test | $58 | $98 | $19 |
| Gallbladder scan (HIDA) | $861 | $694 | $334 |
| GGT liver test | $34 | $35 | $7 |
| Glucose tolerance test | $33 | $43 | $8 |
| H. pylori test | $184 | $112 | $67 |
| Hammertoe repair | $2,396 | $686 | $548 |
| HDL cholesterol test | $29 | $39 | $8 |
| Hematocrit test | $13 | $17 | $2 |
| Hemoglobin A1c (diabetes test) | $42 | $72 | $10 |
| Hemorrhoid removal | $589 | $208 | $338 |
| Hepatitis C test | $48 | $101 | $14 |
| HIV test | $41 | $80 | $19 |
| HIV test (antibody) | $11 | $80 | $14 |
| Holter heart monitor | $199 | $420 | $26 |
| Hysteroscopy | $3,613 | $1,103 | $1,270 |
| Iron blood test | $29 | $41 | $6 |
| IUD insertion | $1,095 | $286 | — |
| IV infusion therapy | $169 | $133 | $44 |
| IV infusion therapy (each additional) | $94 | $79 | $21 |
| IV infusion therapy (initial) | $244 | $187 | $67 |
| IVC filter placement | $4,736 | $5,276 | $1,885 |
| Joint aspiration (small/intermediate) | $396 | $104 | $57 |
| Joint aspiration or injection (mid-size joint) | $420 | $104 | $57 |
| Joint aspiration or injection (small joint) | $373 | $148 | $56 |
| Kidney biopsy | $630 | $547 | $492 |
| Kidney scan (nuclear) | $893 | $823 | $172 |
| Kidney stone shock-wave (lithotripsy) | $9,012 | $2,954 | $760 |
| Kidney ultrasound | $220 | $426 | $84 |
| Kidney ultrasound (limited) | $107 | $471 | $61 |
| Knee joint injection | $771 | $184 | $69 |
| Lactate test | $40 | $57 | $12 |
| Laryngoscopy | $871 | $107 | $189 |
| LDH test | $26 | $43 | $6 |
| LDL cholesterol test | $40 | $78 | $11 |
| Leg vein ultrasound (Doppler) | $471 | $481 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $325 | $370 | $116 |
| LH hormone test | $54 | $104 | $19 |
| Lipase test | $26 | $68 | $7 |
| Lipid (cholesterol) panel | $64 | $95 | $13 |
| Liver biopsy | $1,147 | $326 | $288 |
| Liver function panel | $40 | $84 | $8 |
| Lung function test (PFT) | $91 | $130 | $37 |
| Lung scan (V/Q) | $1,074 | $1,000 | $291 |
| Magnesium blood test | $32 | $40 | $7 |
| MRA of the brain | $1,571 | $1,790 | $226 |
| MRA of the neck | $1,656 | $1,509 | $245 |
| MRA of the neck with contrast | $1,766 | $1,509 | $245 |
| MRI of the abdomen | $1,723 | $1,467 | $300 |
| MRI of the abdomen with contrast | $1,723 | $1,467 | $300 |
| MRI of the abdomen without contrast | $1,450 | $1,204 | $194 |
| MRI of the ankle | $1,758 | $2,884 | $261 |
| MRI of the ankle with contrast | $1,495 | $2,884 | $261 |
| MRI of the ankle without contrast | $1,758 | $2,743 | $222 |
| MRI of the brain | $1,652 | $1,824 | $269 |
| MRI of the brain with contrast | $1,842 | $1,824 | $269 |
| MRI of the brain without contrast | $1,632 | $1,308 | $195 |
| MRI of the chest | $1,963 | $2,237 | $371 |
| MRI of the chest without contrast | $1,819 | $2,737 | $466 |
| MRI of the knee | $1,495 | $3,051 | $315 |
| MRI of the knee with contrast | $1,495 | $3,051 | $315 |
| MRI of the knee without contrast | $1,213 | $2,714 | $204 |
| MRI of the lower back (lumbar spine) | $1,551 | $1,824 | $270 |
| MRI of the lower back (lumbar spine) with contrast | $1,458 | $1,824 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $1,551 | $1,393 | $192 |
| MRI of the mid-back (thoracic spine) | $1,751 | $1,824 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $1,751 | $1,871 | $319 |
| MRI of the mid-back (thoracic spine) with contrast | $1,766 | $1,824 | $271 |
| MRI of the mid-back (thoracic spine) without contrast | $1,522 | $1,388 | $190 |
| MRI of the neck (cervical spine) | $1,751 | $1,824 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $1,751 | $1,871 | $318 |
| MRI of the neck (cervical spine) with contrast | $1,880 | $1,824 | $274 |
| MRI of the neck (cervical spine) without contrast | $1,146 | $1,390 | $191 |
| MRI of the pelvis | $1,749 | $1,824 | $268 |
| MRI of the pelvis with contrast | $1,749 | $1,824 | $268 |
| MRI of the pelvis without contrast | $1,500 | $1,373 | $227 |
| MRI of the shoulder | $1,495 | $2,813 | $313 |
| MRI of the shoulder with contrast | $1,495 | $2,813 | $313 |
| MRI of the shoulder without contrast | $1,495 | $2,737 | $205 |
| MRI of the wrist | $1,495 | $3,097 | $330 |
| MRI of the wrist with contrast | $1,495 | $3,097 | $330 |
| MRI of the wrist without contrast | $1,135 | $2,832 | $303 |
| Nuclear cardiac stress test | $2,128 | $2,021 | $428 |
| Occupational therapy evaluation | $136 | $197 | $101 |
| Occupational therapy evaluation (high complexity) | $160 | $245 | $101 |
| Occupational therapy evaluation (low complexity) | $112 | $125 | $101 |
| Occupational therapy evaluation (moderate complexity) | $136 | $197 | $101 |
| Office visit (established patient) | $82 | $1,142 | $115 |
| Office visit (new patient) | $79 | $104 | $177 |
| Office visit, established patient (level 3) | $78 | $1,142 | $95 |
| Office visit, established patient (level 4) | $87 | $1,414 | $136 |
| Office visit, new patient (level 3) | $68 | $104 | $118 |
| Office visit, new patient (level 4) | $79 | $105 | $177 |
| Office visit, new patient (level 5) | $89 | $165 | $237 |
| Orthopedic hardware removal | $2,712 | $719 | $632 |
| Pap smear (cervical screening) | $52 | $38 | $20 |
| Parathyroid hormone (PTH) test | $120 | $160 | $41 |
| Pelvic ultrasound | $312 | $399 | $78 |
| Pelvic ultrasound (complete) | $353 | $454 | $105 |
| Pelvic ultrasound (limited) | $270 | $343 | $51 |
| PET scan | $2,978 | $2,613 | — |
| Phosphorus blood test | $22 | $25 | $5 |
| Physical therapy evaluation | $125 | $192 | $98 |
| Physical therapy evaluation (high complexity) | $168 | $211 | $98 |
| Physical therapy evaluation (moderate complexity) | $125 | $192 | $98 |
| Pilonidal cyst removal | $2,695 | $495 | $541 |
| Platelet count | $24 | $26 | $4 |
| Pregnancy blood test (hCG) | $26 | $42 | $8 |
| Pregnancy ultrasound | $305 | $513 | $126 |
| Pregnancy ultrasound (first trimester) | $284 | $513 | $117 |
| Pregnancy ultrasound (second or third trimester) | $325 | $513 | $136 |
| Procalcitonin test | $88 | $93 | $27 |
| Prolactin test | $47 | $113 | $19 |
| Prostate test (PSA) | $58 | $92 | $18 |
| Pulmonary rehabilitation | $57 | $71 | $87 |
| Radiofrequency nerve ablation | $1,826 | $426 | $462 |
| Sacroiliac joint injection | $260 | $192 | $176 |
| Scoliosis spine X-ray | $187 | $184 | $58 |
| Scoliosis spine X-ray (3 views) | $187 | $188 | $72 |
| Screening mammogram | $145 | $149 | $126 |
| Scrotal ultrasound | $304 | $386 | $99 |
| Sedimentation rate (ESR) test | $16 | $32 | $3 |
| Sex hormone binding globulin test | $67 | $89 | $22 |
| Simple laceration repair (small, up to 2.5 cm) | $576 | $151 | $114 |
| Simple wound stitches | $375 | $151 | $127 |
| Skin biopsy | $188 | $65 | $121 |
| Skin biopsy (punch) | $188 | $65 | $121 |
| Skin cancer lesion removal | $670 | $227 | $240 |
| Skin graft | $2,432 | $950 | $898 |
| Skin lesion freezing (cryotherapy) | $302 | $40 | $36 |
| Skin tag removal | $674 | $95 | $92 |
| Sleep study (polysomnography) | $1,266 | $2,321 | $691 |
| Soft tissue ultrasound | $179 | $338 | $64 |
| Speech therapy | $128 | $172 | $76 |
| Spirometry (lung function test) | $68 | $130 | $30 |
| Spirometry with bronchodilator | $114 | $161 | $43 |
| Strep throat test | $40 | $38 | $17 |
| Swallow study | $184 | $159 | $85 |
| T3 thyroid test | $43 | $70 | $14 |
| Testosterone test | $72 | $98 | $26 |
| Thyroid test (TSH) | $64 | $89 | $17 |
| Thyroid ultrasound | $204 | $313 | $109 |
| Thyroid uptake scan | $376 | $442 | $145 |
| Tilt table test | $300 | $677 | $168 |
| Total IgE allergy test | $87 | $73 | $16 |
| Total protein test | $18 | $41 | $4 |
| Transesophageal echocardiogram (TEE) | $1,169 | $1,181 | $239 |
| Transesophageal echocardiogram (TEE) with and without contrast | $1,169 | $962 | $239 |
| Transvaginal ultrasound | $321 | $309 | $118 |
| Trigger finger release | $1,958 | $448 | $630 |
| Trigger point injection | $416 | $99 | $56 |
| Trigger point injection (1-2 muscles) | $416 | $99 | $52 |
| Triglycerides test | $24 | $34 | $6 |
| Troponin (heart) test | $53 | $68 | $12 |
| Upper GI endoscopy (EGD) | $1,192 | $405 | $371 |
| Upper GI series (barium) | $290 | $340 | $128 |
| Ureteral stent placement | $1,798 | $737 | $373 |
| Uric acid (gout) test | $34 | $25 | $5 |
| Urinalysis | $21 | $33 | $3 |
| Urine microalbumin test | $23 | $38 | $5 |
| Urine pregnancy test | $36 | $50 | $9 |
| Vaccine administration | $19 | $24 | $19 |
| Vaccine administration (each additional) | $20 | $17 | $16 |
| Varicose vein ablation | $2,978 | $2,757 | $1,018 |
| Vasectomy | $1,979 | $464 | $347 |
| Vitamin B12 test | $56 | $65 | $15 |
| Vitamin D test | $96 | $104 | $30 |
| Wart removal | $1,400 | $44 | $121 |
| Wound debridement | $874 | $281 | $186 |
| X-ray of the abdomen | $130 | $159 | $36 |
| X-ray of the ankle | $125 | $321 | $37 |
| X-ray of the collarbone | $125 | $330 | $33 |
| X-ray of the elbow | $147 | $166 | $33 |
| X-ray of the facial bones | $187 | $179 | $39 |
| X-ray of the foot | $125 | $155 | $34 |
| X-ray of the forearm | $125 | $152 | $29 |
| X-ray of the hand | $138 | $153 | $38 |
| X-ray of the hip | $130 | $206 | $49 |
| X-ray of the hip (1 view) | $125 | $186 | $34 |
| X-ray of the hip (3 views) | $134 | $225 | $49 |
| X-ray of the knee | $146 | $176 | $42 |
| X-ray of the knee (2 views) | $125 | $158 | $34 |
| X-ray of the knee (3 views) | $146 | $176 | $42 |
| X-ray of the knee (4+ views) | $163 | $228 | $49 |
| X-ray of the lower back (lumbar spine) | $229 | $243 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $163 | $203 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $295 | $282 | $53 |
| X-ray of the lower leg | $125 | $169 | $31 |
| X-ray of the mid-back (thoracic spine) | $131 | $200 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $131 | $178 | $33 |
| X-ray of the neck (cervical spine) | $176 | $210 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $146 | $185 | $40 |
| X-ray of the pelvis | $119 | $183 | $36 |
| X-ray of the pelvis (1 view) | $114 | $161 | $28 |
| X-ray of the ribs | $179 | $219 | $42 |
| X-ray of the ribs (2 views) | $140 | $157 | $36 |
| X-ray of the ribs (3 views) | $223 | $219 | $42 |
| X-ray of the shoulder | $146 | $186 | $36 |
| X-ray of the skull | $159 | $191 | $40 |
| X-ray of the upper arm | $125 | $155 | $32 |
| X-ray of the wrist | $146 | $144 | $43 |
| Zinc blood test | $53 | $49 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
