Hospital

Grant Memorial Hospital

Grant Memorial Hospital in Petersburg, WV publishes cash prices for 433 common procedures listed here, from its own machine-readable price file updated Jul 12, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the West Virginia median for 233 of 432 procedures and above it for 194. By typical cash price it ranks #11 of 36 West Virginia hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

117 Hospital Dr,Petersburg,WV,26847 Collected Sep 23, 2026 Source price file Check a bill from this hospital (304) 257-1026

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 511316 · CMS hospital register NPI 1013603919

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Grant Memorial Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Abdominal CT scan without and with contrast CPT 74170 CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST	$729.60	$912.00	—	41% below	20%
Abdominal CT scan without and with contrast CPT 74170 CT ABD WO CNTRST FLWD CNTRST	$766.40	$958.00	—	38% below	20%
Abdominal X-ray, 2 views CPT 74019 X-RAY OF ABDOMEN; 2 VIEWS	$236.00	$295.00	—	8% above	20%
Abdominal X-ray, 2 views CPT 74019 RADEX ABDOMEN 2 VIEWS	$248.00	$310.00	—	13% above	20%
Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE	$201.60	$252.00	—	12% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 X-RAY OF ANKLE; MINIMUM OF 3 VIEWS	$192.00	$240.00	—	6% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 X-RAY OF ANKLE; MINIMUM OF 3 VIEWS	$201.60	$252.00	—	12% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$204.00	$255.00	—	30% below	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O DYE	$472.00	$590.00	—	33% below	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT SCAN OF ARM WITHOUT CONTRAST	$448.80	$561.00	—	36% below	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 SINGLE CONTRAST X-RAY OF ESOPHAGUS	$280.80	$351.00	—	24% below	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY	$810.40	$1,013.00	—	7% below	20%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$260.00	$325.00	—	11% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 COMPLETE ULTRASOUND SCAN OF 1 BREAST	$247.20	$309.00	—	15% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 COMPLETE ULTRASOUND SCAN OF 1 BREAST	$247.20	$309.00	—	15% below	20%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED	$134.40	$168.00	—	49% below	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 LIMITED ULTRASOUND SCAN OF 1 BREAST	$452.00	$565.00	—	72% above	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST	$1,528.00	$1,910.00	—	11% below	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD&PLVS W/CONTRAST	$1,604.80	$2,006.00	—	6% below	20%
CT angiography (CTA) of the head CPT 70496 CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST	$778.40	$973.00	—	36% below	20%
CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD	$817.60	$1,022.00	—	32% below	20%
CT angiography (CTA) of the neck CPT 70498 CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST	$778.40	$973.00	—	32% below	20%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK	$817.60	$1,022.00	—	29% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST	$1,864.00	$2,330.00	—	48% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST	$1,957.60	$2,447.00	—	55% above	20%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT SCAN OF BLOOD VESSELS AND GRAFTS OF HEART WITH CONTRAST	$402.40	$503.00	—	64% below	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST	$158.40	$198.00	—	60% above	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT SCAN OF HEART WITH EVALUATION OF BLOOD VESSEL CALCIUM	$172.80	$216.00	—	75% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST	$932.80	$1,166.00	—	31% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST	$980.00	$1,225.00	—	28% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST	$1,935.20	$2,419.00	—	20% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST	$2,032.00	$2,540.00	—	26% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST	$1,528.00	$1,910.00	—	10% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$1,604.80	$2,006.00	—	6% below	20%
CT scan of the abdomen with contrast CPT 74160 CT SCAN OF ABDOMEN WITH CONTRAST	$729.60	$912.00	—	31% below	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$766.40	$958.00	—	28% below	20%
CT scan of the abdomen without contrast CPT 74150 CT SCAN OF ABDOMEN WITHOUT CONTRAST	$448.80	$561.00	—	39% below	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$472.00	$590.00	—	36% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SCAN OF FACE WITHOUT CONTRAST	$478.40	$598.00	—	31% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE	$502.40	$628.00	—	27% below	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD OR BRAIN WITHOUT CONTRAST	$1,243.20	$1,554.00	—	75% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE	$1,305.60	$1,632.00	—	84% above	20%
CT scan of the head with contrast CPT 70460 CT SCAN HEAD OR BRAIN WITH CONTRAST	$778.40	$973.00	—	24% below	20%
CT scan of the head without and with contrast CPT 70470 CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST	$778.40	$973.00	—	33% below	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE	$817.60	$1,022.00	—	30% below	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SCAN OF LOWER SPINE WITHOUT CONTRAST	$1,165.60	$1,457.00	—	39% above	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE	$1,224.00	$1,530.00	—	46% above	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN OF UPPER SPINE WITHOUT CONTRAST	$1,431.20	$1,789.00	—	74% above	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE	$1,503.20	$1,879.00	—	83% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT SCAN OF PELVIS WITH CONTRAST	$729.60	$912.00	—	23% below	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE	$766.40	$958.00	—	19% below	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$490.40	$613.00	—	—	20%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 ULTRASOUND OF BOTH SIDES OF HEAD AND NECK BLOOD FLOW	$466.40	$583.00	—	19% below	20%
Chest CT scan without and with contrast CPT 71270 CT SCAN OF CHEST BEFORE AND AFTER CONTRAST	$729.60	$912.00	—	42% below	20%
Chest CT scan without and with contrast CPT 71270 CT THORAX DX C-/C+	$766.40	$958.00	—	39% below	20%
Chest X-ray, 2 views CPT 71046 X-RAY OF CHEST; 2 VIEWS	$192.00	$240.00	—	2% above	20%
Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$201.60	$252.00	—	7% above	20%
Chest X-ray, single view CPT 71045 X-RAY OF CHEST; 1 VIEW	$192.00	$240.00	—	9% above	20%
Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW	$201.60	$252.00	—	15% above	20%
Collarbone (clavicle) X-ray, complete CPT 73000 X-RAY EXAM OF COLLAR BONE	$201.60	$252.00	—	15% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY	$247.20	$309.00	—	44% below	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP	$260.00	$325.00	—	41% below	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY MEASUREMENT OF HIP; PELVIS; SPINE	$247.20	$309.00	—	22% below	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL	$260.00	$325.00	—	18% below	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY APPENDICULR	$132.00	$165.00	—	40% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN OF CHEST WITHOUT CONTRAST	$1,340.80	$1,676.00	—	70% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C-	$1,408.00	$1,760.00	—	79% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN OF CHEST WITH CONTRAST	$1,592.80	$1,991.00	—	45% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+	$1,672.80	$2,091.00	—	52% above	20%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$240.00	$300.00	—	—	20%
Diagnostic mammogram, both breasts CPT 77066 DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS	$228.00	$285.00	—	25% below	20%
Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST	$178.40	$223.00	—	18% below	20%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$188.00	$235.00	—	14% below	20%
Diagnostic mammogram, one breast one side CPT 77065 DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST	$178.40	$223.00	—	18% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 ULTRASOUND STUDY OF ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS	$512.80	$641.00	—	14% below	20%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$539.20	$674.00	—	9% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ULTRASOUND OF HEART WITH COLOR-DEPICTED BLOOD FLOW; RATE; DIRECTION AND VALVE FUNCTION	$963.20	$1,204.00	—	17% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE	$1,012.00	$1,265.00	—	12% below	20%
Elbow X-ray, 2 views CPT 73070 X-RAY EXAM OF ELBOW	$201.60	$252.00	—	6% above	20%
Elbow X-ray, complete, 3 or more views CPT 73080 X-RAY EXAM OF ELBOW	$201.60	$252.00	—	12% above	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 X-RAY OF ELBOW; MINIMUM OF 3 VIEWS	$192.00	$240.00	—	7% above	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST	$478.40	$598.00	—	31% below	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/EAR/FOSSA W/O DYE	$502.40	$628.00	—	28% below	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 X-RAY EXAM OF FACIAL BONES	$248.00	$310.00	—	5% above	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 X-RAY EXAM OF FOREARM	$201.60	$252.00	—	13% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 X-RAY OF FOREARM; 2 VIEWS	$192.00	$240.00	—	7% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM	$648.80	$811.00	—	24% below	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYSTEM IMAGING	$681.60	$852.00	—	20% below	20%
Hand X-ray, 2 views CPT 73120 X-RAY EXAM OF HAND	$248.00	$310.00	—	27% above	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-RAY EXAM OF HEEL	$201.60	$252.00	—	17% above	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 X-RAY OF HEEL; MINIMUM OF 2 VIEWS	$192.00	$240.00	—	11% above	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY INCLUDING HEART RATE; BREATHING; AIRFLOW; AND EFFORT	$222.40	$278.00	—	37% below	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$267.20	$334.00	—	24% below	20%
Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3	$201.60	$252.00	—	1% above	20%
Knee X-ray, 3 views one side CPT 73562 X-RAY OF KNEE; 3 VIEWS	$192.00	$240.00	—	4% below	20%
Knee X-ray, 3 views one side CPT 73562 X-RAY OF KNEE; 3 VIEWS	$192.00	$240.00	—	4% below	20%
Knee X-ray, complete, 4 or more views CPT 73564 X-RAY EXAM KNEE 4 OR MORE	$248.00	$310.00	—	8% below	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 X-RAY OF KNEE; 4 OR MORE VIEWS	$236.00	$295.00	—	12% below	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 X-RAY OF KNEE; 4 OR MORE VIEWS	$248.00	$310.00	—	8% below	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O DYE	$472.00	$590.00	—	35% below	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT SCAN OF LEG WITHOUT CONTRAST	$448.80	$561.00	—	38% below	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT SCAN OF LEG WITHOUT CONTRAST	$472.00	$590.00	—	35% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 LIMITED ULTRASOUND SCAN OF ABDOMEN	$244.80	$306.00	—	39% below	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN	$257.60	$322.00	—	36% below	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 LIMITED ULTRASOUND SCAN OF JOINT OR OTHER EXTREMITY STRUCTURE LACKING BLOOD VESSELS	$247.20	$309.00	—	16% below	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JT/FCL EVL NVASC XTR	$260.00	$325.00	—	12% below	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 LIMITED ULTRASOUND SCAN OF JOINT OR OTHER EXTREMITY STRUCTURE LACKING BLOOD VESSELS	$247.20	$309.00	—	16% below	20%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 LIMITED ULTRASOUND SCAN OF JOINT OR OTHER EXTREMITY STRUCTURE LACKING BLOOD VESSELS	$247.20	$309.00	—	16% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING	$192.00	$240.00	—	23% above	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-RAY EXAM OF LOWER LEG	$201.60	$252.00	—	5% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 X-RAY OF LOWER LEG; 2 VIEWS	$192.00	$240.00	—	at median	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 X-RAY OF LOWER LEG; 2 VIEWS	$192.00	$240.00	—	at median	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST	$923.20	$1,154.00	—	34% below	20%
MR angiography (MRA) of the head without contrast CPT 70544 MR ANGIOGRAPHY HEAD W/O DYE	$969.60	$1,212.00	—	31% below	20%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI SCAN OF BOTH BREASTS	$3,055.20	$3,819.00	—	54% above	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE	$969.60	$1,212.00	—	26% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI SCAN OF LEG JOINT WITHOUT CONTRAST	$923.20	$1,154.00	—	29% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI SCAN OF LEG JOINT WITHOUT CONTRAST	$923.20	$1,154.00	—	29% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LWR EXTR W/O&W/DYE	$1,588.80	$1,986.00	—	14% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	18% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	18% below	20%
MRI of the abdomen without contrast CPT 74181 MRI SCAN OF ABDOMEN WITHOUT CONTRAST	$923.20	$1,154.00	—	27% below	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$969.60	$1,212.00	—	23% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	22% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/O CNTR FLWD CNTR	$1,588.80	$1,986.00	—	19% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI SCAN OF BRAIN WITHOUT CONTRAST	$923.20	$1,154.00	—	33% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE	$969.60	$1,212.00	—	29% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	22% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE	$1,588.80	$1,986.00	—	19% below	20%
MRI of the lower back, no contrast dye CPT 72148 MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST	$923.20	$1,154.00	—	32% below	20%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE	$969.60	$1,212.00	—	28% below	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	21% below	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O & W/DYE	$1,588.80	$1,986.00	—	17% below	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST	$923.20	$1,154.00	—	32% below	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI CHEST SPINE W/O DYE	$969.60	$1,212.00	—	28% below	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	20% below	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI NECK SPINE W/O & W/DYE	$1,588.80	$1,986.00	—	16% below	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST	$923.20	$1,154.00	—	37% below	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI NECK SPINE W/O DYE	$969.60	$1,212.00	—	33% below	20%
MRI of the pelvis without and with contrast CPT 72197 MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST	$1,512.80	$1,891.00	—	22% below	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE	$1,588.80	$1,986.00	—	18% below	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI SCAN OF PELVIS WITHOUT CONTRAST	$923.20	$1,154.00	—	32% below	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O DYE	$969.60	$1,212.00	—	28% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXTREM W/O DYE	$969.60	$1,212.00	—	28% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SCAN OF ARM JOINT WITHOUT CONTRAST	$923.20	$1,154.00	—	31% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SCAN OF ARM JOINT WITHOUT CONTRAST	$923.20	$1,154.00	—	31% below	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-RAY OF UPPER SPINE; 4-5 VIEWS	$236.00	$295.00	—	15% below	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-RAY EXAM NECK SPINE 4/5VWS	$248.00	$310.00	—	11% below	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST	$778.40	$973.00	—	28% below	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/DYE	$817.60	$1,022.00	—	25% below	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST	$478.40	$598.00	—	31% below	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O DYE	$502.40	$628.00	—	27% below	20%
Neck soft tissue X-ray CPT 70360 X-RAY EXAM OF NECK	$201.60	$252.00	—	10% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NUCLEAR MEDICINE STUDIES OF HEART MUSCLE AT REST AND WITH STRESS AND SPECT	$2,799.20	$3,499.00	—	at median	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HT MUSCLE IMAGE SPECT MULT	$2,939.20	$3,674.00	—	5% above	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET IMAGE W/CT SKULL-THIGH	$3,172.80	$3,966.00	—	6% below	20%
Pelvic CT scan without contrast CPT 72192 CT SCAN OF PELVIS WITHOUT CONTRAST	$448.80	$561.00	—	44% below	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O DYE	$472.00	$590.00	—	41% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 LIMITED ULTRASOUND SCAN OF PELVIS	$247.20	$309.00	—	20% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED	$260.00	$325.00	—	16% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 COMPLETE ULTRASOUND SCAN OF PELVIS	$247.20	$309.00	—	40% below	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE	$260.00	$325.00	—	37% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 WKS SNGL FETUS	$398.40	$498.00	—	6% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$160.00	$200.00	—	47% below	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED ULTRASOUND OF PREGNANT UTERUS	$448.00	$560.00	—	48% above	20%
Rib X-ray, one side, 2 views CPT 71100 X-RAY EXAM RIBS UNI 2 VIEWS	$201.60	$252.00	—	4% above	20%
Rib X-ray, one side, 2 views one side CPT 71100 X-RAY OF RIBS ON SIDE OF BODY; 2 VIEWS	$192.00	$240.00	—	1% below	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-RAY OF RIBS ON SIDE OF BODY; MINIMUM OF 3 VIEWS	$236.00	$295.00	—	2% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-RAY EXAM UNILAT RIBS/CHEST	$248.00	$310.00	—	7% above	20%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$398.40	$498.00	—	—	20%
Screening mammogram, both breasts CPT 77067 SCREENING MAMMOGRAPHY	$379.20	$474.00	—	32% above	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER	$201.60	$252.00	—	13% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 X-RAY OF SHOULDER; MINIMUM OF 2 VIEWS	$192.00	$240.00	—	7% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 X-RAY OF SHOULDER; MINIMUM OF 2 VIEWS	$192.00	$240.00	—	7% above	20%
Sinus X-ray, complete, 3 or more views CPT 70220 X-RAY EXAM OF SINUSES	$201.60	$252.00	—	8% below	20%
Skull X-ray, fewer than 4 views CPT 70250 X-RAY EXAM OF SKULL	$248.00	$310.00	—	23% above	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 IMAGING FOR EVALUATION OF SWALLOWING FUNCTION	$396.80	$496.00	—	at median	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY XM SWLNG FUNCJ C+	$416.80	$521.00	—	5% above	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-RAY EXAM OF FEMUR 2/>	$201.60	$252.00	—	7% above	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SCAN OF MIDDLE SPINE WITHOUT CONTRAST	$448.80	$561.00	—	46% below	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT CHEST SPINE W/O DYE	$472.00	$590.00	—	43% below	20%
Toe X-ray, 2 or more views CPT 73660 X-RAY EXAM OF TOE(S)	$201.60	$252.00	—	17% above	20%
Transvaginal pelvic ultrasound CPT 76830 ULTRASOUND SCAN OF UTERUS; OVARIES; TUBES; CERVIX AND PELVIC AREA THROUGH VAGINA	$247.20	$309.00	—	39% below	20%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB	$260.00	$325.00	—	35% below	20%
Ultrasound of the abdomen, complete CPT 76700 COMPLETE ULTRASOUND SCAN OF ABDOMEN	$247.20	$309.00	—	44% below	20%
Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE	$260.00	$325.00	—	41% below	20%
Ultrasound of the scrotum and testicles CPT 76870 ULTRASOUND SCAN OF SCROTUM	$247.20	$309.00	—	34% below	20%
Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM	$260.00	$325.00	—	31% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE	$247.20	$309.00	—	33% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK	$260.00	$325.00	—	30% below	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 SINGLE CONTRAST X-RAY OF UPPER DIGESTIVE TRACT	$280.80	$351.00	—	25% below	20%
Upper arm X-ray (humerus), 2 views CPT 73060 X-RAY EXAM OF HUMERUS	$201.60	$252.00	—	12% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ULTRASOUND STUDY OF ONE ARM OR LEG VEINS WITH COMPRESSION AND MANEUVERS	$247.20	$309.00	—	36% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$260.00	$325.00	—	32% below	20%
Wrist X-ray, 2 views CPT 73100 X-RAY EXAM OF WRIST	$201.60	$252.00	—	26% above	20%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST	$201.60	$252.00	—	14% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 X-RAY OF WRIST; MINIMUM OF 3 VIEWS	$192.00	$240.00	—	8% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS	$201.60	$252.00	—	7% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-RAY OF HIP; 2-3 VIEWS	$192.00	$240.00	—	2% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-RAY OF HIP; 2-3 VIEWS	$192.00	$240.00	—	2% above	20%
X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW	$201.60	$252.00	—	9% above	20%
X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE	$201.60	$252.00	—	14% above	20%
X-ray of the ankle, 2 views one side CPT 73600 X-RAY OF ANKLE; 2 VIEWS	$192.00	$240.00	—	8% above	20%
X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S)	$201.60	$252.00	—	14% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 X-RAY OF FINGER; MINIMUM OF 2 VIEWS	$192.00	$240.00	—	8% above	20%
X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT	$201.60	$252.00	—	26% above	20%
X-ray of the foot, 2 views one side CPT 73620 X-RAY OF FOOT; 2 VIEWS	$192.00	$240.00	—	20% above	20%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT	$201.60	$252.00	—	14% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 X-RAY OF FOOT; MINIMUM OF 3 VIEWS	$192.00	$240.00	—	8% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 X-RAY OF FOOT; MINIMUM OF 3 VIEWS	$201.60	$252.00	—	14% above	20%
X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND	$201.60	$252.00	—	11% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 X-RAY OF HAND; MINIMUM OF 3 VIEWS	$192.00	$240.00	—	5% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 X-RAY OF HAND; MINIMUM OF 3 VIEWS	$192.00	$240.00	—	5% above	20%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2	$201.60	$252.00	—	12% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY OF LOWER AND SACRAL SPINE; 2-3 VIEWS	$164.80	$206.00	—	24% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$173.60	$217.00	—	20% below	20%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY OF LOWER AND SACRAL SPINE; MINIMUM OF 4 VIEWS	$164.80	$206.00	—	42% below	20%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS	$173.60	$217.00	—	39% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS	$248.00	$310.00	—	8% above	20%
X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES	$201.60	$252.00	—	9% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$201.60	$252.00	—	4% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS	$248.00	$310.00	—	26% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE	$201.60	$252.00	—	13% above	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL	$48.00	$60.00	—	74% below	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 LIVER ENZYME (SGPT); LEVEL	$9.60	$12.00	—	67% below	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 LIVER ENZYME (SGOT); LEVEL	$9.60	$12.00	—	69% below	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$60.00	$75.00	—	73% below	20%
Albumin blood test CPT 82040 ALBUMIN (PROTEIN) LEVEL	$9.60	$12.00	—	47% below	20%
Albumin blood test CPT 82040 ASSAY OF SERUM ALBUMIN	$11.20	$14.00	—	38% below	20%
Aldosterone blood test CPT 82088 ALDOSTERONE HORMONE LEVEL	$32.80	$41.00	—	11% below	20%
Aldosterone blood test CPT 82088 ASSAY OF ALDOSTERONE	$52.80	$66.00	—	44% above	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ASSAY ALKALINE PHOSPHATASE	$9.60	$12.00	—	54% below	20%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE (ENZYME) LEVEL; ALKALINE	$28.80	$36.00	—	39% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$8.80	$11.00	—	49% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE; CRUDE ALLERGEN EXTRACT; EACH	$118.40	$148.00	—	591% above	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM	$14.40	$18.00	—	81% below	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN (AFP) LEVEL; SERUM	$19.20	$24.00	—	75% below	20%
Ammonia blood test CPT 82140 ASSAY OF AMMONIA	$45.60	$57.00	—	1% below	20%
Ammonia blood test CPT 82140 AMMONIA LEVEL	$120.00	$150.00	—	161% above	20%
Amylase blood test CPT 82150 AMYLASE (ENZYME) LEVEL	$18.40	$23.00	—	52% below	20%
Amylase blood test CPT 82150 ASSAY OF AMYLASE	$379.20	$474.00	—	885% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$40.00	$50.00	—	5% below	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT	$43.20	$54.00	—	2% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 SCREENING TEST FOR AUTOIMMUNE DISORDER	$19.20	$24.00	—	68% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL	$33.60	$42.00	—	72% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$72.00	$90.00	—	40% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 BACTERIAL CULTURE; ANY OTHER SOURCE EXCEPT URINE; BLOOD OR STOOL; AEROBIC	$17.60	$22.00	—	66% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE OTHR SPECIMN AEROBIC	$23.20	$29.00	—	55% below	20%
Basic metabolic panel (blood test) CPT 80048 BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL)	$62.40	$78.00	—	16% above	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN LEVEL; TOTAL	$9.60	$12.00	—	61% below	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$45.60	$57.00	—	86% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$72.00	$90.00	—	34% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; INTERMEDIATE COMPLEXITY	$432.00	$540.00	—	298% above	20%
Blood culture for bacteria CPT 87040 BACTERIAL BLOOD CULTURE	$24.00	$30.00	—	68% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE	$9.60	$12.00	—	9% below	20%
Blood glucose (sugar) test CPT 82947 BLOOD GLUCOSE (SUGAR) LEVEL	$9.60	$12.00	—	58% below	20%
Blood lead test CPT 83655 ASSAY OF LEAD	$11.20	$14.00	—	69% below	20%
Blood lead test CPT 83655 LEAD LEVEL	$48.00	$60.00	—	34% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS	$16.00	$20.00	—	61% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD GROUP TYPING (ABO)	$23.20	$29.00	—	43% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$40.00	$50.00	—	2% below	20%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION; QUANTITATIVE	$9.60	$12.00	—	65% below	20%
C-peptide blood test CPT 84681 C-PEPTIDE (PROTEIN) LEVEL	$16.80	$21.00	—	77% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION	$16.00	$20.00	—	48% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$64.00	$80.00	—	110% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE; AMPLIFIED PROBE TECHNIQUE	$64.00	$80.00	—	44% below	20%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$32.00	$40.00	—	61% below	20%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 19-9	$35.20	$44.00	—	58% below	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 125	$28.80	$36.00	—	73% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN	$108.00	$135.00	—	at median	20%
Calcium blood test, total CPT 82310 CALCIUM LEVEL; TOTAL	$9.60	$12.00	—	62% below	20%
Calcium blood test, total CPT 82310 ASSAY OF CALCIUM	$16.80	$21.00	—	33% below	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL	$20.00	$25.00	—	81% below	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN	$230.40	$288.00	—	122% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX)	$20.80	$26.00	—	46% below	20%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA-ZOSTER ANTIBODY	$28.00	$35.00	—	27% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS; AMPLIFIED PROBE TECHNIQUE	$89.60	$112.00	—	58% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE	$121.60	$152.00	—	114% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$18.40	$23.00	—	71% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)	$100.00	$125.00	—	60% above	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$21.60	$27.00	—	48% below	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT	$65.60	$82.00	—	58% above	20%
Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST	$15.20	$19.00	—	57% below	20%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED	$16.00	$20.00	—	54% below	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$48.00	$60.00	—	2% below	20%
Comprehensive metabolic panel (blood test) CPT 80053 BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS	$78.40	$98.00	—	60% above	20%
Cortisol blood test, total CPT 82533 TOTAL CORTISOL	$32.00	$40.00	—	46% below	20%
Cortisol blood test, total CPT 82533 CORTISOL (HORMONE) MEASUREMENT; TOTAL	$40.00	$50.00	—	33% below	20%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE (CARDIAC ENZYME) LEVEL; TOTAL	$10.40	$13.00	—	76% below	20%
Creatine kinase (CK) blood test, total CPT 82550 ASSAY OF CK (CPK)	$20.00	$25.00	—	54% below	20%
Creatinine blood test CPT 82565 BLOOD CREATININE LEVEL	$9.60	$12.00	—	67% below	20%
Creatinine blood test CPT 82565 ASSAY OF CREATININE	$153.60	$192.00	—	421% above	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY	$13.60	$17.00	—	73% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV)	$49.60	$62.00	—	2% below	20%
D-dimer blood test (blood clot marker) CPT 85379 COAGULATION FUNCTION MEASUREMENT; D-DIMER; QUANTITATIVE	$26.40	$33.00	—	59% below	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL	$68.00	$85.00	—	27% below	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$44.80	$56.00	—	47% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 TESTING FOR PRESENCE OF DRUG; BY CHEMISTRY ANALYZERS	$316.80	$396.00	—	943% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM; CHLORIDE; CARBON DIOXIDE)	$18.40	$23.00	—	43% below	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR CAPSID VCA	$25.60	$32.00	—	58% below	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS); VIRAL CAPSID	$40.00	$50.00	—	34% below	20%
Estradiol blood test CPT 82670 MEASUREMENT OF TOTAL ESTRADIOL (HORMONE)	$22.40	$28.00	—	74% below	20%
Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL	$56.00	$70.00	—	35% below	20%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN; FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL	$20.00	$25.00	—	76% below	20%
Fecal calprotectin (stool inflammation test) CPT 83993 STOOL CALPROTECTIN (PROTEIN) LEVEL	$340.00	$425.00	—	277% above	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN (BLOOD PROTEIN) LEVEL	$17.60	$22.00	—	75% below	20%
Fibrinogen blood test CPT 85384 FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT	$18.40	$23.00	—	64% below	20%
Folate (folic acid) blood test CPT 82746 FOLIC ACID LEVEL; SERUM	$12.00	$15.00	—	83% below	20%
Free T3 thyroid hormone test CPT 84481 THYROID HORMONE; T3 MEASUREMENT; FREE	$47.20	$59.00	—	48% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE (THYROID CHEMICAL); FREE	$10.40	$13.00	—	82% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$103.20	$129.00	—	78% above	20%
Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE	$46.40	$58.00	—	34% below	20%
Free testosterone test CPT 84402 TESTOSTERONE (HORMONE) LEVEL; FREE	$117.60	$147.00	—	67% above	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL	$18.40	$23.00	—	47% below	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GGT	$45.60	$57.00	—	32% above	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$283.20	$354.00	—	24% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE	$9.60	$12.00	—	71% below	20%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$28.00	$35.00	—	57% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA); AMPLIFIED PROBE TECHNIQUE	$38.40	$48.00	—	37% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB	$90.40	$113.00	—	49% above	20%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY	$34.40	$43.00	—	35% below	20%
H. pylori stool antigen test CPT 87338 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI (GI TRACT BACTERIA) IN STOOL	$60.00	$75.00	—	1% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS; QUANTIFICATION	$174.40	$218.00	—	31% below	20%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY	$10.40	$13.00	—	84% below	20%
HIV-1 and HIV-2 antibody test CPT 86703 ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS	$53.60	$67.00	—	16% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES	$48.00	$60.00	—	25% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HI-RISK TYP POOLED RSLT	$40.00	$50.00	—	38% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV); HIGH-RISK TYPES	$59.20	$74.00	—	8% below	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C LEVEL	$20.00	$25.00	—	60% below	20%
Hemoglobin blood test CPT 85018 HEMOGLOBIN	$18.40	$23.00	—	31% above	20%
Hemoglobin blood test CPT 85018 BLOOD COUNT; HEMOGLOBIN	$20.00	$25.00	—	43% above	20%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY MEASUREMENT	$16.80	$21.00	—	66% below	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY MEASUREMENT	$18.40	$23.00	—	61% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$13.60	$17.00	—	61% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN	$14.40	$18.00	—	59% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST	$12.00	$15.00	—	79% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY MEASUREMENT	$12.80	$16.00	—	78% below	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$251.20	$314.00	—	26% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS; QUANTIFICATION	$280.80	$351.00	—	41% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS; TYPE 1	$32.80	$41.00	—	25% below	20%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$40.00	$50.00	—	9% below	20%
Herpes blood test, HSV-2 antibody CPT 86696 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS; TYPE 2	$32.80	$41.00	—	32% below	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$52.80	$66.00	—	10% above	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION; HIGH SENSITIVITY	$12.80	$16.00	—	79% below	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE (AMINO ACID) LEVEL	$54.40	$68.00	—	38% below	20%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$17.60	$22.00	—	68% below	20%
Insulin blood test CPT 83525 INSULIN MEASUREMENT; TOTAL	$27.20	$34.00	—	51% below	20%
Iron blood test (serum iron) CPT 83540 IRON LEVEL	$18.40	$23.00	—	57% below	20%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$27.20	$34.00	—	36% below	20%
Kidney function blood test panel CPT 80069 KIDNEY FUNCTION BLOOD TEST PANEL	$23.20	$29.00	—	46% below	20%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN; LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL	$32.00	$40.00	—	62% below	20%
Lactate (lactic acid) blood test CPT 83605 ASSAY OF LACTIC ACID	$18.40	$23.00	—	68% below	20%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID LEVEL	$73.60	$92.00	—	30% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE (ENZYME) LEVEL	$10.40	$13.00	—	45% below	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE (FAT ENZYME) LEVEL	$14.40	$18.00	—	64% below	20%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$43.20	$54.00	—	7% above	20%
Liver function blood test panel CPT 80076 LIVER FUNCTION BLOOD TEST PANEL	$24.00	$30.00	—	49% below	20%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$145.60	$182.00	—	362% above	20%
Lyme disease antibody test CPT 86618 ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA)	$226.40	$283.00	—	619% above	20%
Magnesium blood test CPT 83735 MAGNESIUM LEVEL	$10.40	$13.00	—	47% below	20%
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$21.60	$27.00	—	11% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$14.40	$18.00	—	63% below	20%
Measles (rubeola) antibody test CPT 86765 ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS)	$36.00	$45.00	—	8% below	20%
Mono test (heterophile antibody, Monospot) CPT 86308 SCREENING TEST FOR MONONUCLEOSIS (MONO)	$21.60	$27.00	—	38% below	20%
Mumps immunity blood test CPT 86735 MUMPS ANTIBODY	$30.40	$38.00	—	32% below	20%
Mumps immunity blood test CPT 86735 ANALYSIS FOR ANTIBODY TO MUMPS VIRUS	$32.80	$41.00	—	26% below	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; FREE	$24.80	$31.00	—	59% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL	$18.40	$23.00	—	71% below	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL	$48.80	$61.00	—	23% below	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP TEST; AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING	$62.40	$78.00	—	24% below	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER	$80.00	$100.00	—	60% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) LEVEL	$33.60	$42.00	—	78% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD	$20.80	$26.00	—	50% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$22.40	$28.00	—	46% below	20%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHATE LEVEL	$10.40	$13.00	—	67% below	20%
Potassium blood test CPT 84132 BLOOD POTASSIUM LEVEL	$9.60	$12.00	—	64% below	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHRMOML ANEUPLOIDY	$1,390.40	$1,738.00	—	74% above	20%
Progesterone blood test CPT 84144 PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL	$20.80	$26.00	—	79% below	20%
Prolactin blood test CPT 84146 PROLACTIN (MILK PRODUCING HORMONE) LEVEL	$17.60	$22.00	—	73% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 BLOOD TEST; CLOTTING TIME	$17.60	$22.00	—	39% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$19.20	$24.00	—	33% below	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$62.40	$78.00	—	34% above	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$40.00	$50.00	—	2% below	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 DETECTION TEST BY IMMUNOASSAY WITH DIRECT VISUAL OBSERVATION FOR STREPTOCOCCUS; GROUP A (STREP)	$42.40	$53.00	—	4% above	20%
Renin blood test CPT 84244 RENIN (KIDNEY ENZYME) LEVEL	$54.40	$68.00	—	6% below	20%
Rh blood typing CPT 86901 BLOOD TYPING FOR RH (D) ANTIGEN	$23.20	$29.00	—	19% below	20%
Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH(D)	$40.00	$50.00	—	40% above	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$16.00	$20.00	—	55% below	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR LEVEL	$169.60	$212.00	—	374% above	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$11.20	$14.00	—	77% below	20%
Rubella antibody test (immunity check) CPT 86762 ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS)	$12.80	$16.00	—	74% below	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RED BLOOD CELL SEDIMENTATION RATE; TO DETECT INFLAMMATION; AUTOMATED	$8.00	$10.00	—	52% below	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANAL VOL/COUNT/MOT	$25.60	$32.00	—	68% below	20%
Sodium blood test CPT 84295 ASSAY OF SERUM SODIUM	$9.60	$12.00	—	63% below	20%
Sodium blood test CPT 84295 BLOOD SODIUM LEVEL	$19.20	$24.00	—	26% below	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$38.40	$48.00	—	20% below	20%
Stool ova and parasites exam CPT 87177 SMEAR FOR PARASITES	$80.00	$100.00	—	67% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 STOOL ANALYSIS FOR BLOOD; BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY	$70.40	$88.00	—	93% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 ANALYSIS FOR ANTIBODY; TREPONEMA PALLIDUM	$37.60	$47.00	—	21% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM	$74.40	$93.00	—	140% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS DETECTION TEST	$18.40	$23.00	—	32% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST; GAMMA INTERFERON	$120.00	$150.00	—	37% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE (HORMONE) LEVEL; TOTAL	$13.60	$17.00	—	84% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$46.40	$58.00	—	47% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT	$22.40	$28.00	—	69% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH	$31.20	$39.00	—	57% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 BLOOD TEST; THYROID STIMULATING HORMONE (TSH)	$13.60	$17.00	—	79% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$24.80	$31.00	—	62% below	20%
Total IgE blood test CPT 82785 ASSAY OF IGE	$53.60	$67.00	—	2% below	20%
Total IgE blood test CPT 82785 IGE (IMMUNE SYSTEM PROTEIN) LEVEL	$76.00	$95.00	—	40% above	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL LEVEL	$10.40	$13.00	—	56% below	20%
Total thyroxine (T4) blood test CPT 84436 THYROXINE (THYROID CHEMICAL); TOTAL	$12.00	$15.00	—	74% below	20%
Total triiodothyronine (T3) blood test CPT 84480 THYROID HORMONE; T3 MEASUREMENT; TOTAL	$24.80	$31.00	—	68% below	20%
Transferrin blood test CPT 84466 TRANSFERRIN (IRON BINDING PROTEIN) LEVEL	$27.20	$34.00	—	51% below	20%
Trichomonas test (NAAT) CPT 87661 DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE); AMPLIFIED PROBE TECHNIQUE	$90.40	$113.00	—	17% above	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$96.00	$120.00	—	24% above	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES LEVEL	$10.40	$13.00	—	64% below	20%
Triglycerides blood test CPT 84478 ASSAY OF TRIGLYCERIDES	$81.60	$102.00	—	179% above	20%
Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANT	$14.40	$18.00	—	81% below	20%
Troponin test, quantitative CPT 84484 TROPONIN (PROTEIN) ANALYSIS; QUANTITATIVE	$43.20	$54.00	—	42% below	20%
Uric acid blood test CPT 84550 URIC ACID LEVEL; BLOOD	$10.40	$13.00	—	68% below	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$10.40	$13.00	—	65% below	20%
Urinalysis with microscope exam, automated CPT 81001 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED	$19.20	$24.00	—	36% below	20%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE	$8.80	$11.00	—	45% below	20%
Urinalysis without microscope exam, automated CPT 81003 AUTOMATED URINALYSIS TEST	$9.60	$12.00	—	38% below	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$10.40	$13.00	—	33% below	20%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$4.00	$5.00	—	68% below	20%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS; MANUAL TEST	$8.00	$10.00	—	36% below	20%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$20.00	$25.00	—	66% below	20%
Urine culture for bacteria, with colony count CPT 87086 BACTERIAL COLONY COUNT; URINE	$40.00	$50.00	—	32% below	20%
Urine microalbumin (albumin) test CPT 82043 UR ALBUMIN QUANTITATIVE	$10.40	$13.00	—	68% below	20%
Urine microalbumin (albumin) test CPT 82043 URINE MICROALBUMIN (PROTEIN) LEVEL	$13.60	$17.00	—	59% below	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$16.00	$20.00	—	28% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B-12) LEVEL	$24.00	$30.00	—	70% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D-3 LEVEL	$16.00	$20.00	—	81% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$114.40	$143.00	—	34% above	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 DIHYDROXYVITAMIN D; 1; 25 LEVEL	$35.20	$44.00	—	54% below	20%
Zinc blood test CPT 84630 ZINC LEVEL	$36.00	$45.00	—	8% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL	$12.80	$16.00	—	83% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST	$19.20	$24.00	—	74% below	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 REPAIR OF ANTERIOR CRUCIATE LIGAMENT OF KNEE USING AN ENDOSCOPE	$7,527.20	$9,409.00	—	3% below	20%
Arthroscopic ACL reconstruction or repair of the knee one side CPT 29888 REPAIR OF ANTERIOR CRUCIATE LIGAMENT OF KNEE USING AN ENDOSCOPE	$8,979.74	$11,224.67	—	16% above	20%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE	$5,391.83	$6,739.79	—	9% above	20%
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE	$470.40	$588.00	—	33% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$378.40	$473.00	—	24% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting one side CPT 27786 CLOSED TREATMENT OF BROKEN OUTSIDE LOWER LEG BONE AT ANKLE	$305.60	$382.00	—	at median	20%
Broken ankle (outer ankle bone) treatment without surgery or setting one side CPT 27786 CLOSED TREATMENT OF BROKEN OUTSIDE LOWER LEG BONE AT ANKLE	$305.60	$382.00	—	at median	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE	$378.40	$473.00	—	60% above	20%
Broken foot (metatarsal) treatment without surgery or setting one side CPT 28470 CLOSED TREATMENT OF BROKEN BONE IN FOREFOOT OR MIDFOOT	$213.60	$267.00	—	10% below	20%
Broken foot (metatarsal) treatment without surgery or setting one side CPT 28470 CLOSED TREATMENT OF BROKEN BONE IN FOREFOOT OR MIDFOOT	$378.40	$473.00	—	60% above	20%
Bunion correction with removal of part of the big toe joint one side CPT 28292 CORRECTION OF BUNION	$4,409.60	$5,512.00	—	17% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$1,013.60	$1,267.00	—	5% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT	$1,176.80	$1,471.00	—	11% above	20%
Carpal tunnel release, open surgery one side CPT 64721 RELEASE AND/OR RELOCATION OF HAND NERVE	$2,218.67	$2,773.34	—	18% below	20%
Carpal tunnel release, open surgery one side CPT 64721 RELEASE AND/OR RELOCATION OF HAND NERVE	$2,995.20	$3,744.00	—	10% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 REMOVAL OF FORESKIN USING CLAMP OR DEVICE	$1,202.40	$1,503.00	—	50% below	20%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION NEONATE	$1,068.80	$1,336.00	—	33% above	20%
Circumcision, surgical, older than a newborn CPT 54160 REMOVAL OF FORESKIN (28 DAYS OR YOUNGER)	$1,202.40	$1,503.00	—	50% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DST RDL FX/EPHYS SEP WO	$378.40	$473.00	—	19% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting one side CPT 25600 CLOSED TREATMENT OF BROKEN FOREARM (RADIUS) BONE AT THE WRIST AREA ON THE THUMB SIDE OF THE WRIST WITHOUT MANIPULATION	$336.00	$420.00	—	6% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting one side CPT 25600 CLOSED TREATMENT OF BROKEN FOREARM (RADIUS) BONE AT THE WRIST AREA ON THE THUMB SIDE OF THE WRIST WITHOUT MANIPULATION	$336.00	$420.00	—	6% above	20%
Colonoscopy with polyp removal CPT 45385 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE	$1,276.80	$1,596.00	—	12% below	20%
Colonoscopy with tissue sample CPT 45380 BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$2,553.60	$3,192.00	—	59% above	20%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$1,478.40	$1,848.00	—	17% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$913.60	$1,142.00	—	11% above	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND SCRAPING OF UTERUS	$3,412.80	$4,266.00	—	10% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$308.00	$385.00	—	49% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL OF IMPACTED EAR WAX BY WASHING	$87.20	$109.00	—	4% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$91.20	$114.00	—	8% above	20%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL OF IMPACTED EAR WAX BY WASHING	$87.20	$109.00	—	4% above	20%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL OF IMPACTED EAR WAX BY WASHING	$87.20	$109.00	—	4% above	20%
Earwax removal with instruments, one ear CPT 69210 REMOVAL OF IMPACTED EAR WAX	$87.20	$109.00	—	23% above	20%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$91.20	$114.00	—	29% above	20%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL OF IMPACTED EAR WAX	$87.20	$109.00	—	23% above	20%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL OF IMPACTED EAR WAX	$87.20	$109.00	—	23% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION OF SUBSTANCE INTO MIDDLE OR UPPER SPINE CANAL USING IMAGING GUIDANCE	$1,449.60	$1,812.00	—	45% above	20%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC	$1,522.40	$1,903.00	—	52% above	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM; REDUCIBLE	$5,491.20	$6,864.00	—	6% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC EXAM OF LOWER PORTION OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE	$739.20	$924.00	—	14% below	20%
Gallbladder removal, laparoscopic CPT 47562 REMOVAL OF GALLBLADDER USING AN ENDOSCOPE	$6,913.60	$8,642.00	—	29% below	20%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE	$8,463.20	$10,579.00	—	5% above	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING	$915.20	$1,144.00	—	23% below	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S)	$1,425.60	$1,782.00	—	21% above	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVAL OF SINGLE EXTERNAL AND INTERNAL HEMORRHOID GROUP	$5,241.60	$6,552.00	—	1% above	20%
Hysterectomy through an abdominal incision (total) CPT 58150 REMOVAL OF UTERUS AND CERVIX THROUGH ABDOMEN	$7,155.20	$8,944.00	—	at median	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 INSERTION OF TUBE AND INTRODUCTION OF CONTRAST FOR X-RAY OF UTERUS AND FALLOPIAN TUBES	$112.00	$140.00	—	60% below	20%
Hysteroscopy with endometrial ablation CPT 58563 EXAM OF UTERUS WITH DESTRUCTION OF LINING OF UTERUS USING AN ENDOSCOPE	$2,579.20	$3,224.00	—	46% below	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE	$1,040.00	$1,300.00	—	75% below	20%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF IUD FOR PREGNANCY PREVENTION	$1,331.20	$1,664.00	—	709% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS	$314.40	$393.00	—	34% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$330.40	$413.00	—	41% above	20%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 REPAIR OF GROIN HERNIA (5 YEARS OR OLDER)	$7,654.40	$9,568.00	—	54% above	20%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 REPAIR OF GROIN HERNIA (5 YEARS OR OLDER)	$9,484.80	$11,856.00	—	90% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION INTO TENDON OR LIGAMENT	$470.40	$588.00	—	42% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 INJECTION INTO TENDON OR LIGAMENT	$423.20	$529.00	—	27% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 INJECTION INTO TENDON OR LIGAMENT	$423.20	$529.00	—	27% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT	$423.20	$529.00	—	23% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$470.40	$588.00	—	37% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT	$423.20	$529.00	—	23% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT	$423.20	$529.00	—	23% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION AND/OR INJECTION OF FLUID FROM MEDIUM JOINT	$465.60	$582.00	—	36% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$470.40	$588.00	—	37% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 ASPIRATION AND/OR INJECTION OF FLUID FROM MEDIUM JOINT	$998.40	$1,248.00	—	191% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 ASPIRATION AND/OR INJECTION OF FLUID FROM MEDIUM JOINT	$998.40	$1,248.00	—	191% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRATION AND/OR INJECTION OF FLUID FROM SMALL JOINT	$465.60	$582.00	—	33% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$470.40	$588.00	—	34% above	20%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 ASPIRATION AND/OR INJECTION OF FLUID FROM SMALL JOINT	$465.60	$582.00	—	33% above	20%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 ASPIRATION AND/OR INJECTION OF FLUID FROM SMALL JOINT	$465.60	$582.00	—	33% above	20%
Knee arthroscopy with meniscus repair (one side of the knee) one side CPT 29882 REPAIR OF INSIDE OR OUTSIDE KNEE JOINT CARTILAGE USING AN ENDOSCOPE	$7,654.40	$9,568.00	—	38% above	20%
Knee arthroscopy with meniscus trim one side CPT 29881 REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE	$1,885.87	$2,357.34	—	62% below	20%
Knee arthroscopy with meniscus trim one side CPT 29881 REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE	$4,370.67	$5,463.34	—	11% below	20%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE	$3,411.20	$4,264.00	—	26% below	20%
Knee arthroscopy with removal of both torn meniscus parts one side CPT 29880 REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE	$8,735.20	$10,919.00	—	90% above	20%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 REMOVAL OF APPENDIX USING AN ENDOSCOPE	$8,701.60	$10,877.00	—	19% above	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE	$4,688.54	$5,860.67	—	10% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS	$820.80	$1,026.00	—	93% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$903.20	$1,129.00	—	113% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE	$1,417.60	$1,772.00	—	28% above	20%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$1,488.80	$1,861.00	—	34% above	20%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$1,355.20	$1,694.00	—	17% above	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1	$1,436.80	$1,796.00	—	5% above	20%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE; SINGLE LEVEL	$1,368.00	$1,710.00	—	at median	20%
Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER	$2,256.00	$2,820.00	—	40% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS	$1,005.60	$1,257.00	—	52% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$1,085.60	$1,357.00	—	64% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm one side CPT 11400 REMOVAL OF NONCANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS	$1,085.60	$1,357.00	—	64% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$1,085.60	$1,357.00	—	58% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 REMOVAL OF NONCANCER SKIN GROWTH OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 0.5 CM OR LESS	$1,664.00	$2,080.00	—	143% above	20%
Nail removal (partial or complete), one nail CPT 11730 SIMPLE SEPARATION OF FINGERNAIL OR TOENAIL FROM NAIL BED; FIRST NAIL	$300.80	$376.00	—	12% above	20%
Nail removal (partial or complete), one nail one side CPT 11730 SIMPLE SEPARATION OF FINGERNAIL OR TOENAIL FROM NAIL BED; FIRST NAIL	$300.80	$376.00	—	12% above	20%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$487.20	$609.00	—	33% above	20%
Paracentesis with imaging guidance CPT 49083 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE	$1,572.00	$1,965.00	—	10% above	20%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$1,651.20	$2,064.00	—	16% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PERMANENT REMOVAL FINGERNAIL OR TOENAIL	$623.20	$779.00	—	34% above	20%
Permanent removal of a nail and nail root (partial or complete) one side CPT 11750 PERMANENT REMOVAL FINGERNAIL OR TOENAIL	$569.60	$712.00	—	22% above	20%
Removal of a breast lump, open surgery one side CPT 19120 REMOVAL OF GROWTH AND TISSUE OF BREAST; DUCT; OR NIPPLE	$2,662.40	$3,328.00	—	38% below	20%
Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL	$623.20	$779.00	—	60% above	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FOREIGN BODY FROM TISSUE; ACCESSED BENEATH THE SKIN; SIMPLE	$2,828.80	$3,536.00	—	626% above	20%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK	$694.40	$868.00	—	54% below	20%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK	$1,680.00	$2,100.00	—	21% above	20%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$428.80	$536.00	—	49% above	20%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF NONMOVEABLE FOREARM TO HAND SPLINT	$281.60	$352.00	—	53% above	20%
Short arm splint (forearm and hand) one side CPT 29125 APPLICATION OF NONMOVEABLE FOREARM TO HAND SPLINT	$256.00	$320.00	—	39% above	20%
Short arm splint (forearm and hand) one side CPT 29125 APPLICATION OF NONMOVEABLE FOREARM TO HAND SPLINT	$256.00	$320.00	—	39% above	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$428.80	$536.00	—	35% above	20%
Short leg splint (calf to foot) CPT 29515 APPLICATION OF SHORT LEG SPLINT FROM CALF TO FOOT	$248.80	$311.00	—	8% above	20%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$354.40	$443.00	—	53% above	20%
Short leg splint (calf to foot) one side CPT 29515 APPLICATION OF SHORT LEG SPLINT FROM CALF TO FOOT	$321.60	$402.00	—	39% above	20%
Short leg splint (calf to foot) one side CPT 29515 APPLICATION OF SHORT LEG SPLINT FROM CALF TO FOOT	$321.60	$402.00	—	39% above	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE	$1,700.40	$2,125.50	—	14% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS	$417.60	$522.00	—	48% above	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY; FIRST SKIN GROWTH	$531.20	$664.00	—	38% above	20%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$623.20	$779.00	—	62% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 REMOVAL OF CANCER SKIN GROWTH OF BODY; ARMS; OR LEGS; 0.5 CM OR LESS	$1,055.20	$1,319.00	—	30% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$1,085.60	$1,357.00	—	34% above	20%
Skin tag removal, up to 15 tags CPT 11200 RMVL SKIN TAGS UP TO&INC 15	$308.00	$385.00	—	57% above	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAG; 1-15 SKIN TAGS	$1,774.94	$2,218.67	—	806% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR	$1,089.60	$1,362.00	—	8% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.6-7.5 CM	$397.60	$497.00	—	54% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$437.60	$547.00	—	69% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS	$397.60	$497.00	—	38% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/<	$437.60	$547.00	—	52% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$623.20	$779.00	—	80% above	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BIOPSY OF RELATED SKIN GROWTH; FIRST GROWTH	$887.46	$1,109.33	—	156% above	20%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$961.60	$1,202.00	—	23% below	20%
Thoracentesis with imaging guidance CPT 32555 ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE	$1,388.00	$1,735.00	—	11% above	20%
Thoracentesis with imaging guidance one side CPT 32555 ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE	$1,388.00	$1,735.00	—	11% above	20%
Thoracentesis with imaging guidance one side CPT 32555 ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE	$1,388.00	$1,735.00	—	11% above	20%
Total hip replacement CPT 27130 REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS	$16,480.80	$20,601.00	—	62% above	20%
Total hip replacement one side CPT 27130 REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS	$5,354.40	$6,693.00	—	47% below	20%
Total hip replacement one side CPT 27130 REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS	$7,652.75	$9,565.94	—	25% below	20%
Total knee replacement CPT 27447 REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE	$12,493.60	$15,617.00	—	23% above	20%
Total knee replacement one side CPT 27447 REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE	$10,708.80	$13,386.00	—	5% above	20%
Total knee replacement one side CPT 27447 REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE	$11,562.40	$14,453.00	—	14% above	20%
Total shoulder replacement one side CPT 23472 PROSTHETIC REPAIR OF SHOULDER JOINT; TOTAL SHOULDER	$2,706.80	$3,383.50	—	73% below	20%
Total shoulder replacement one side CPT 23472 PROSTHETIC REPAIR OF SHOULDER JOINT; TOTAL SHOULDER	$10,612.80	$13,266.00	—	7% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION OF TRIGGER POINTS; 1-2 MUSCLES	$423.20	$529.00	—	44% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$470.40	$588.00	—	60% above	20%
Trigger point injections, 1 or 2 muscles one side CPT 20552 INJECTION OF TRIGGER POINTS; 1-2 MUSCLES	$423.20	$529.00	—	44% above	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 DESTRUCTION OF FALLOPIAN TUBES USING AN ENDOSCOPE	$5,840.80	$7,301.00	—	58% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$2,531.20	$3,164.00	—	7% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND; FIRST GROWTH	$2,883.20	$3,604.00	—	22% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND; FIRST GROWTH	$2,745.60	$3,432.00	—	16% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND; FIRST GROWTH	$2,745.60	$3,432.00	—	16% above	20%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 BALLOON DILATION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE; LESS THAN 3.0 CM	$985.60	$1,232.00	—	37% below	20%
Upper endoscopy (EGD) with biopsy CPT 43239 BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE	$2,284.80	$2,856.00	—	111% above	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE	$1,579.20	$1,974.00	—	9% above	20%
Upper endoscopy (EGD), diagnostic CPT 43235 DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE	$453.60	$567.00	—	45% below	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS	$300.80	$376.00	—	46% above	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$308.00	$385.00	—	49% above	20%
Wart removal, up to 14 warts one side CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS	$308.00	$385.00	—	49% above	20%
Wart removal, up to 14 warts one side CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS	$308.00	$385.00	—	49% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS	$598.40	$748.00	—	59% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/<	$623.20	$779.00	—	65% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm one side CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS	$598.40	$748.00	—	59% above	20%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST; ABOVE WRIST; WITH PLACEMENT OF STABILIZING DEVICE	$7,390.40	$9,238.00	—	3% above	20%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST; ABOVE WRIST; WITH PLACEMENT OF STABILIZING DEVICE	$11,681.60	$14,602.00	—	62% above	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS	$293.60	$367.00	—	54% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT	$360.80	$451.00	—	43% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$403.20	$504.00	$586.00–$12,172.00	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT FOR AIRWAY OBSTRUCTION OR SPUTUM PRODUCTION	$2,688.00	$3,360.00	$586.00–$12,172.00	—	20%
Chemotherapy IV infusion, first hour CPT 96413 ADMINISTRATION OF CHEMOTHERAPY INTO VEIN; 1 HOUR OR LESS	$621.60	$777.00	—	1% above	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR	$652.80	$816.00	—	6% above	20%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$1,859.20	$2,324.00	—	48% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING	$128.00	$160.00	—	6% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING	$243.20	$304.00	—	102% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD SEVERITY	$165.60	$207.00	—	4% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP	$182.40	$228.00	—	15% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY	$308.00	$385.00	—	22% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM	$339.20	$424.00	—	34% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY	$539.20	$674.00	—	34% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$593.60	$742.00	—	48% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY	$840.80	$1,051.00	—	23% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$925.60	$1,157.00	—	35% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY	$1,206.40	$1,508.00	—	27% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM	$1,327.20	$1,659.00	—	40% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 EXERCISE OR DRUG-INDUCED HEART STRESS TEST WITH ELECTROCARDIOGRAM (ECG)	$556.80	$696.00	—	13% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$584.80	$731.00	—	9% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES	$368.00	$460.00	$336.96	63% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$455.20	$569.00	$336.96	102% above	20%
IV infusion of a medicine, first hour CPT 96365 INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS	$368.00	$460.00	—	49% above	20%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$455.20	$569.00	—	84% above	20%
IV push of a medicine, first drug CPT 96374 INJECTION OF DRUG OR SUBSTANCE INTO VEIN	$413.60	$517.00	—	103% above	20%
IV push of a medicine, first drug CPT 96374 THER/PROPH/DIAG INJ IV PUSH	$455.20	$569.00	—	123% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION OF DRUG OR SUBSTANCE UNDER SKIN OR INTO MUSCLE	$104.80	$131.00	—	47% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$118.40	$148.00	—	66% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION	$73.60	$92.00	—	5% below	20%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-44 MINUTES	$84.00	$105.00	—	1% above	20%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 45-59 MINUTES	$133.60	$167.00	—	46% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 15-29 MINUTES	$84.00	$105.00	—	23% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN	$94.40	$118.00	—	38% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN	$50.40	$63.00	—	5% above	20%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEX 30 MIN	$204.80	$256.00	—	11% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEX 45 MIN	$211.20	$264.00	—	at median	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20 MIN	$211.20	$264.00	—	14% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN	$211.20	$264.00	—	1% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS	$60.00	$75.00	—	10% below	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES	$67.20	$84.00	—	5% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (18-39 YEARS)	$176.00	$220.00	—	113% above	20%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE 18-39	$184.80	$231.00	—	124% above	20%
Preventive checkup, new patient aged 40–64 CPT 99386 INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (40-64 YEARS)	$206.40	$258.00	—	129% above	20%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64	$216.80	$271.00	—	141% above	20%
Preventive checkup, new patient aged 65 or older CPT 99387 INIT PM E/M NEW PAT 65+ YRS	$138.40	$173.00	—	26% above	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (18-39 YEARS)	$153.60	$192.00	—	134% above	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39	$161.60	$202.00	—	146% above	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 ESTABLISHED PATIENT PERIODIC PREVENTIVE MEDICINE EXAMINATION (40-64 YEARS)	$168.00	$210.00	—	126% above	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64	$176.80	$221.00	—	137% above	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 PER PM REEVAL EST PAT 65+ YR	$177.60	$222.00	—	164% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING AND TOBACCO USE INTENSIVE COUNSELING; 4-10 MINUTES	$43.20	$54.00	—	18% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 40-54 MINUTES	$84.00	$105.00	—	1% below	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES	$84.00	$105.00	—	8% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-39 MINUTES	$97.60	$122.00	—	at median	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 10-19 MINUTES	$35.20	$44.00	—	45% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN	$94.40	$118.00	—	46% above	20%
Speech and language evaluation CPT 92523 SPEECH SOUND LANG COMPREHEN	$374.40	$468.00	—	34% above	20%
Speech therapy session, individual CPT 92507 TX SP LANG VOICE COMM INDIV	$154.40	$193.00	—	at median	20%
Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST	$320.80	$401.00	—	55% above	20%
Spirometry before and after a bronchodilator CPT 94060 TEST TO MEASURE EXPIRATORY AIRFLOW AND VOLUME CHANGES BEFORE AND AFTER MEDICATION ADMINISTRATION	$556.80	$696.00	—	43% above	20%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING	$572.00	$715.00	—	47% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES	$81.60	$102.00	—	7% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 DRAWING OF BLOOD FOR A MEDICAL PROBLEM	$192.00	$240.00	—	28% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$201.60	$252.00	—	34% above	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs West Virginia	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VACCINE; INACTIVATED	$138.67	$173.34	—	90% above	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Fluad 2025-2026 Formula	$139.20	$174.00	—	91% above	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 IIV ADJUVANT VACCINE IM	$175.20	$219.00	—	140% above	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARSCOV2 VAC 50 MCG/0.5ML IM	$297.60	$372.00	$240.77	92% above	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCV2 VAC 30MCG TRS-SUC IM	$240.80	$301.00	$216.32	60% above	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VAR VACCINE LIVE SUBQ	$438.40	$548.00	$344.92	121% above	20%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACCINE 4-6 YRS IM	$137.60	$172.00	$172.00	110% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP VACCINE < 7 YRS IM	$65.60	$82.00	$56.96	108% above	20%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEP B-IPV VACCINE IM	$151.20	$189.00	$187.79	65% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-IPV/HIB VACCINE IM	$254.40	$318.00	$217.26	140% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM	$31.20	$39.00	$21.07	60% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE; TRIVALENT; SPLIT VIRUS; PRESERVATIVE-FREE; 0.5 ML DOSAGE	$33.60	$42.00	$21.07	72% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluarix 2025-2026 Formula	$33.60	$42.00	$21.07	72% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM	$696.80	$871.00	$569.07	120% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VACC ADULT IM	$228.80	$286.00	$213.39	60% above	20%
Hepatitis A vaccine, adult dose CPT 90632 HEPA VACCINE ADULT IM	$156.00	$195.00	$115.93	60% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEPA VACC PED/ADOL 2 DOSE IM	$78.40	$98.00	$68.72	118% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPB VACCINE 3 DOSE ADULT IM	$111.20	$139.00	$116.13	67% above	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPB VACC 2/4 DOSE ADULT IM	$304.00	$380.00	$264.46	139% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPB VACC 3 DOSE PED/ADOL IM	$51.20	$64.00	$50.77	60% above	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 HIB PRP-OMP VACC 3 DOSE IM	$66.40	$83.00	$58.58	137% above	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HIB PRP-T VACCINE 4 DOSE IM	$29.60	$37.00	$25.21	74% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 IIV NO PRSV INCREASED AG IM	$190.40	$238.00	$121.11	138% above	20%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 INACTIVATED JE VACC IM	$850.40	$1,063.00	$504.42	140% above	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC	$186.40	$233.00	$182.39	59% above	20%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV VACCINE SC	$646.40	$808.00	$218.94	114% above	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM	$250.40	$313.00	$299.95	60% above	20%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENACWY-TT VACCINE IM	$352.80	$441.00	$330.38	104% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACCINE IM	$366.40	$458.00	$411.10	60% above	20%
Meningococcal B vaccine (Trumenba) CPT 90621 MENB-FHBP VACC 2/3 DOSE IM	$407.20	$509.00	$376.46	140% above	20%
Nasal spray flu vaccine, live (FluMist) CPT 90660 LAIV3 VACCINE INTRANASAL	$58.40	$73.00	$27.56	138% above	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 PCV15 VACCINE IM	$436.00	$545.00	$418.37	140% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM	$581.60	$727.00	$476.29	60% above	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PCV21 VACCINE IM	$533.60	$667.00	—	127% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM	$252.80	$316.00	$220.23	131% above	20%
Polio vaccine, inactivated (IPV) CPT 90713 POLIOVIRUS IPV SC/IM	$98.40	$123.00	$84.18	140% above	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 RSV MONOC ANTB SEASN 1 ML IM	$1,262.40	$1,578.00	$980.10	60% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV MONOC ANTB SEASN .5ML IM	$1,262.40	$1,578.00	$1,578.00	60% above	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV VACC PREF BIVALENT IM	$649.60	$812.00	$584.10	140% above	20%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSV VACC PREF RECOMB ADJT IM	$547.20	$684.00	$554.40	140% above	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE FOR INJECTION INTO MUSCLE	$783.17	$978.96	$535.82	60% above	20%
Rabies vaccine, one dose CPT 90675 RabAvert	$783.17	$978.96	$535.82	60% above	20%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$974.40	$1,218.00	$535.82	99% above	20%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 RV1 VACC 2 DOSE LIVE ORAL	$247.20	$309.00	$182.97	65% above	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 RV5 VACC 3 DOSE LIVE ORAL	$202.40	$253.00	$189.75	107% above	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM	$418.40	$523.00	—	98% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Boostrix PFS	$93.60	$117.00	$50.06	82% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM	$111.20	$139.00	$50.06	117% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix PFS	$82.14	$102.68	$63.21	60% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTHERIA; TETANUS; AND ACELLULAR PERTUSSIS VACCINE (7 YEARS OR OLDER)	$82.40	$103.00	$63.21	60% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM	$84.80	$106.00	$63.21	65% above	20%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE IM	$340.00	$425.00	$180.23	140% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF VACCINE	$57.60	$72.00	—	32% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$60.80	$76.00	—	40% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD	$39.20	$49.00	—	60% above	20%
Yellow fever vaccine, live CPT 90717 YELLOW FEVER VACCINE SUBQ	$493.60	$617.00	$263.36	140% above	20%

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

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

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

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

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

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

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

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

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

Source file: https://wvumedicine.org/wp-content/uploads/2026/08/881740605_Grant-Memorial-Hospital-Inc_standardcharges.csv