Hospital Worthington, MN

Sanford Worthington Medical Center

Sanford Worthington Medical Center in Worthington, MN publishes cash prices for 229 common procedures listed here, from its own machine-readable price file updated Mar 4, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Minnesota median for 205 of 225 procedures and below it for 19. By typical cash price it ranks #74 of 85 Minnesota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1018 6th Ave, Worthington, MN 56187-2202 Collected Sep 23, 2026 Source price file Check a bill from this hospital (507) 372-3110

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 240022 · CMS hospital register NPI 1396712618

Financial assistance

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

Sanford Worthington Medical Center 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.

State law

This state limits hospital bills for lower-income patients

Minnesota law (Minn. Stat. §144.589): a hospital may not charge an uninsured patient whose household income is under $125,000 more than the lowest amount it would be paid for the same service by a private insurer, counting the insured patient's share. If the cash price below is higher, ask the billing office to apply this limit. Each hospital's page here shows the range of insurer rates in its own file (the "Insurers pay" column), a starting point when you ask. Other states' laws.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Sanford Worthington Medical Center in Worthington, MN:

Dec 7, 2023 Warning notice
Mar 25, 2024 Corrective action plan requested
Apr 24, 2024 Case closed
Jul 9, 2025 Met requirements

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems. Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN WO THEN W CONT	$3,484.80	$4,356.00	$135.41–$4,159.98	100% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WO THEN W CONT	$3,484.80	$4,356.00	$1,688.82–$4,159.98	—	20%
Abdominal X-ray, 2 views CPT 74019 RAD EXAM ABDOMEN 2 VWS	$335.20	$419.00	$81.04–$400.15	22% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 RAD EXAM ABDOMEN 2 VWS	$335.20	$419.00	$162.45–$400.15	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$353.60	$442.00	$66.97–$422.11	53% above	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$353.60	$442.00	$171.36–$422.11	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$527.20	$659.00	$94.15–$629.35	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS 52 MOD	$1,043.20	$1,304.00	$94.15–$1,245.32	201% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$527.20	$659.00	$255.49–$629.35	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS 52 MOD	$1,043.20	$1,304.00	$505.56–$1,245.32	—	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT EXT UPPER WO CONT	$1,750.40	$2,188.00	$81.04–$2,089.54	38% above	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT EXT UPPER WO CONT	$1,750.40	$2,188.00	$848.29–$2,089.54	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RAD EXAM ESOPHAGUS	$618.40	$773.00	$135.41–$738.22	100% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RAD EXAM ESOPHAGUS	$618.40	$773.00	$299.69–$738.22	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$2,059.20	$2,574.00	$303.98–$2,458.17	68% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$2,059.20	$2,574.00	$997.94–$2,458.17	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US UNILATERAL BREAST COMPLETE	$704.80	$881.00	$81.04–$841.36	77% above	20%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US UNILATERAL BREAST COMPLETE	$704.80	$881.00	$341.56–$841.36	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US UNILATERAL BREAST LIMITED	$516.00	$645.00	$66.97–$615.98	64% above	20%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US UNILATERAL BREAST LIMITED	$516.00	$645.00	$250.07–$615.98	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$4,371.20	$5,464.00	$283.44–$5,218.12	72% above	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$4,371.20	$5,464.00	$2,118.39–$5,218.12	—	20%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W CONT WO IF PERF	$3,183.20	$3,979.00	$135.41–$3,799.95	76% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W CONT WO IF PERF	$3,183.20	$3,979.00	$1,542.66–$3,799.95	—	20%
CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W CON+WO IF PERF	$3,183.20	$3,979.00	$135.41–$3,799.95	81% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W CON+WO IF PERF	$3,183.20	$3,979.00	$1,542.66–$3,799.95	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,789.71	$3,487.13	$135.41–$3,330.21	52% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,789.71	$3,487.13	$1,351.96–$3,330.21	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART SCORE	$231.20	$289.00	$66.97–$276.00	107% above	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART SCORE	$231.20	$289.00	$112.05–$276.00	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST	$3,623.76	$4,529.70	$180.60–$4,325.86	75% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST	$3,623.76	$4,529.70	$1,756.16–$4,325.86	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W CONTRAST	$4,127.64	$5,159.54	$283.44–$4,927.36	64% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W CONTRAST	$4,127.64	$5,159.54	$2,000.35–$4,927.36	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS WO THEN W CONT	$4,371.20	$5,464.00	$283.44–$5,218.12	62% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS WO THEN W CONT	$4,371.20	$5,464.00	$2,118.39–$5,218.12	—	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST	$2,987.20	$3,734.00	$135.41–$3,565.97	116% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST	$2,987.20	$3,734.00	$1,447.67–$3,565.97	—	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$2,472.80	$3,091.00	$81.04–$2,951.91	110% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$2,472.80	$3,091.00	$1,198.38–$2,951.91	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONT	$2,285.60	$2,857.00	$81.04–$2,728.44	82% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONT	$2,285.60	$2,857.00	$1,107.66–$2,728.44	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$1,795.20	$2,244.00	$81.04–$2,143.02	43% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$1,795.20	$2,244.00	$870.00–$2,143.02	—	20%
CT scan of the head with contrast CPT 70460 CT HEAD W CONTRAST	$1,870.40	$2,338.00	$135.41–$2,232.79	44% above	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONTRAST	$1,870.40	$2,338.00	$906.44–$2,232.79	—	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO THEN W CONTRAST	$2,056.80	$2,571.00	$135.41–$2,455.31	29% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO THEN W CONTRAST	$2,056.80	$2,571.00	$996.78–$2,455.31	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONT	$1,854.40	$2,318.00	$81.04–$2,213.69	36% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONT	$1,854.40	$2,318.00	$898.69–$2,213.69	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,072.40	$2,590.50	$81.04–$2,473.93	44% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,072.40	$2,590.50	$1,004.34–$2,473.93	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$2,348.80	$2,936.00	$135.41–$2,803.88	65% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$2,348.80	$2,936.00	$1,138.29–$2,803.88	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUP CAROTID BILAT	$1,120.80	$1,401.00	$180.60–$1,337.96	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUP CAROTID BILAT	$1,120.80	$1,401.00	$543.17–$1,337.96	—	20%
Chest CT scan without and with contrast CPT 71270 CT THORAX DIAGNOSTIC WO THEN W CONTRAST	$3,056.00	$3,820.00	$135.41–$3,648.10	92% above	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX DIAGNOSTIC WO THEN W CONTRAST	$3,056.00	$3,820.00	$1,481.01–$3,648.10	—	20%
Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS	$300.08	$375.10	$66.97–$358.22	33% above	20%
Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VWS	$300.08	$375.10	$145.43–$358.22	—	20%
Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW	$265.60	$332.00	$66.97–$317.06	32% above	20%
Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VW	$265.60	$332.00	$128.72–$317.06	—	20%
Collarbone (clavicle) X-ray, complete CPT 73000 RAD EXAM CLAVICLE COMPL	$328.80	$411.00	$66.97–$392.51	65% above	20%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RAD EXAM CLAVICLE COMPL	$328.80	$411.00	$159.34–$392.51	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM	$905.60	$1,132.00	$81.04–$1,081.06	75% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM	$905.60	$1,132.00	$438.88–$1,081.06	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$481.60	$602.00	$81.04–$574.91	30% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$481.60	$602.00	$233.40–$574.91	—	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PG UTR TRNSABD SG	$916.00	$1,145.00	$180.60–$1,093.48	101% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PG UTR TRNSABD SG	$916.00	$1,145.00	$443.92–$1,093.48	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$2,372.80	$2,966.00	$81.04–$2,832.53	86% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$2,372.80	$2,966.00	$1,149.92–$2,832.53	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$2,778.40	$3,473.00	$135.41–$3,316.72	90% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$2,778.40	$3,473.00	$1,346.48–$3,316.72	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DX BILAT INCL CAD	$424.00	$530.00	$147.51–$506.15	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DX BILAT INCL CAD	$424.00	$530.00	$205.48–$506.15	—	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILAT INCL CAD	$382.40	$478.00	$116.79–$456.49	23% above	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILAT INCL CAD	$382.40	$478.00	$185.32–$456.49	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,392.80	$1,741.00	$180.60–$1,662.66	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,392.80	$1,741.00	$674.99–$1,662.66	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,261.60	$1,577.00	$180.60–$1,506.04	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,261.60	$1,577.00	$611.40–$1,506.04	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,164.80	$2,706.00	$406.59–$2,584.23	50% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,164.80	$2,706.00	$1,049.12–$2,584.23	—	20%
Elbow X-ray, 2 views CPT 73070 RAD EXAM ELBOW 2 VWS	$251.20	$314.00	$66.97–$299.87	23% above	20%
Elbow X-ray, 2 views inpatient CPT 73070 RAD EXAM ELBOW 2 VWS	$251.20	$314.00	$121.74–$299.87	—	20%
Elbow X-ray, complete, 3 or more views CPT 73080 RAD EXAM ELBOW COMPL MIN 3 VWS	$368.80	$461.00	$66.97–$440.26	59% above	20%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RAD EXAM ELBOW COMPL MIN 3 VWS	$368.80	$461.00	$178.73–$440.26	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT SELLA FOSSA EAR WO CONTRAST	$2,448.80	$3,061.00	$81.04–$2,923.26	105% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT SELLA FOSSA EAR WO CONTRAST	$2,448.80	$3,061.00	$1,186.75–$2,923.26	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 RAD EXAM FACIAL BONES COMPL MIN 3 VWS	$412.80	$516.00	$81.04–$492.78	62% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RAD EXAM FACIAL BONES COMPL MIN 3 VWS	$412.80	$516.00	$200.05–$492.78	—	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 RAD EXAM FOREARM 2 VWS	$323.20	$404.00	$66.97–$385.82	59% above	20%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RAD EXAM FOREARM 2 VWS	$323.20	$404.00	$156.63–$385.82	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,646.40	$2,058.00	$303.98–$1,965.39	35% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,646.40	$2,058.00	$797.89–$1,965.39	—	20%
Hand X-ray, 2 views CPT 73120 RAD EXAM HAND 2 VWS	$283.20	$354.00	$81.04–$338.07	48% above	20%
Hand X-ray, 2 views inpatient CPT 73120 RAD EXAM HAND 2 VWS	$283.20	$354.00	$137.25–$338.07	—	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RAD EXAM CALCANEUS MIN 2 VWS	$235.20	$294.00	$66.97–$280.77	31% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RAD EXAM CALCANEUS MIN 2 VWS	$235.20	$294.00	$113.98–$280.77	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$4,212.00	$5,265.00	$770.59–$5,028.08	22% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,364.80	$5,456.00	$770.59–$5,210.48	26% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$4,212.00	$5,265.00	$2,041.24–$5,028.08	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,364.80	$5,456.00	$2,115.29–$5,210.48	—	20%
Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS	$310.40	$388.00	$66.97–$370.54	32% above	20%
Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS	$310.40	$388.00	$150.43–$370.54	—	20%
Knee X-ray, complete, 4 or more views CPT 73564 RAD EXAM KNEE COMPL 4 + VWS	$387.20	$484.00	$81.04–$462.22	38% above	20%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 RAD EXAM KNEE COMPL 4 + VWS	$387.20	$484.00	$187.65–$462.22	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT EXT LOWER WO CONT	$1,972.80	$2,466.00	$81.04–$2,355.03	50% above	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT EXT LOWER WO CONT	$1,972.80	$2,466.00	$956.07–$2,355.03	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$753.28	$941.60	$81.04–$899.23	70% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED 76705 US ABD LIMITED	$824.80	$1,031.00	$81.04–$984.61	86% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$753.28	$941.60	$365.06–$899.23	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ED 76705 US ABD LIMITED	$824.80	$1,031.00	$399.72–$984.61	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC	$577.60	$722.00	$81.04–$689.51	67% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC	$577.60	$722.00	$279.92–$689.51	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$2,896.36	$3,620.45	$81.04–$3,457.53	264% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$2,896.36	$3,620.45	$1,403.65–$3,457.53	—	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RAD EXAM TIBIA FIBULA 2 VWS	$349.60	$437.00	$66.97–$417.34	64% above	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RAD EXAM TIBIA FIBULA 2 VWS	$349.60	$437.00	$169.42–$417.34	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD WO CONTRAST	$2,796.80	$3,496.00	$180.60–$3,338.68	31% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WO CONTRAST	$2,796.80	$3,496.00	$1,355.40–$3,338.68	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JT WO CONTRAST	$2,912.28	$3,640.35	$180.60–$3,476.53	48% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JT WO CONTRAST	$2,912.28	$3,640.35	$1,411.36–$3,476.53	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$3,600.80	$4,501.00	$283.44–$4,298.46	40% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$3,600.80	$4,501.00	$1,745.04–$4,298.46	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$2,619.20	$3,274.00	$180.60–$3,126.67	22% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$2,619.20	$3,274.00	$1,269.33–$3,126.67	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO THEN W CONT	$3,967.92	$4,959.90	$283.44–$4,736.70	35% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO THEN W CONT	$3,967.92	$4,959.90	$1,922.95–$4,736.70	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$3,092.80	$3,866.00	$180.60–$3,692.03	49% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$3,092.80	$3,866.00	$1,498.85–$3,692.03	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO THEN W CONT	$3,875.12	$4,843.89	$283.44–$4,625.91	34% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO THEN W CONT	$3,875.12	$4,843.89	$1,877.98–$4,625.91	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST	$3,168.80	$3,961.00	$180.60–$3,782.76	56% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST	$3,168.80	$3,961.00	$1,535.68–$3,782.76	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE WO THEN W CONT	$4,224.80	$5,281.00	$283.44–$5,043.36	59% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE WO THEN W CONT	$4,224.80	$5,281.00	$2,047.44–$5,043.36	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST	$3,441.60	$4,302.00	$180.60–$4,108.41	67% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST	$3,441.60	$4,302.00	$1,667.89–$4,108.41	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE WO THEN W CONT	$4,632.80	$5,791.00	$283.44–$5,530.41	85% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE WO THEN W CONT	$4,632.80	$5,791.00	$2,245.17–$5,530.41	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE WO CONTRAST	$3,444.00	$4,305.00	$180.60–$4,111.28	71% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE WO CONTRAST	$3,444.00	$4,305.00	$1,669.05–$4,111.28	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO THEN W CONT	$3,841.73	$4,802.16	$283.44–$4,586.06	44% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO THEN W CONT	$3,841.73	$4,802.16	$1,861.80–$4,586.06	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$2,604.80	$3,256.00	$180.60–$3,109.48	23% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$2,604.80	$3,256.00	$1,262.35–$3,109.48	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT WO CONTRAST	$3,016.44	$3,770.55	$180.60–$3,600.88	42% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT WO CONTRAST	$3,016.44	$3,770.55	$1,461.84–$3,600.88	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RAD EXAM SPINE CERV 4 OR 5 VWS	$437.60	$547.00	$81.04–$522.39	41% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RAD EXAM SPINE CERV 4 OR 5 VWS	$437.60	$547.00	$212.07–$522.39	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W CONTRAST	$2,282.40	$2,853.00	$135.41–$2,724.62	67% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W CONTRAST	$2,282.40	$2,853.00	$1,106.11–$2,724.62	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK WO CON	$2,047.20	$2,559.00	$81.04–$2,443.85	79% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK WO CON	$2,047.20	$2,559.00	$992.12–$2,443.85	—	20%
Neck soft tissue X-ray CPT 70360 RAD EXAM NECK SOFT TISSUE	$340.00	$425.00	$66.97–$405.88	93% above	20%
Neck soft tissue X-ray inpatient CPT 70360 RAD EXAM NECK SOFT TISSUE	$340.00	$425.00	$164.77–$405.88	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$3,340.48	$4,175.60	$1,046.54–$3,987.70	23% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$3,340.48	$4,175.60	$1,618.88–$3,987.70	—	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT SKULL BASE TO MID THIGH	$6,522.60	$8,153.25	$1,153.03–$7,786.35	137% above	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT SKULL BASE TO MID THIGH	$6,522.60	$8,153.25	$3,161.02–$7,786.35	—	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CONTRAST	$1,992.80	$2,491.00	$81.04–$2,378.91	51% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CONTRAST	$1,992.80	$2,491.00	$965.76–$2,378.91	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$574.40	$718.00	$81.04–$685.69	70% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$574.40	$718.00	$278.37–$685.69	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$767.20	$959.00	$81.04–$915.85	57% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$767.20	$959.00	$371.80–$915.85	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG UTR 2-3TRI SGL 1ST	$929.60	$1,162.00	$81.04–$1,109.71	85% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG UTR 2-3TRI SGL 1ST	$929.60	$1,162.00	$450.51–$1,109.71	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTER 1ST TRI SGL	$748.00	$935.00	$81.04–$892.93	74% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTER 1ST TRI SGL	$748.00	$935.00	$362.50–$892.93	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB REAL TIME LTD	$537.60	$672.00	$81.04–$641.76	60% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB REAL TIME LTD	$537.60	$672.00	$260.53–$641.76	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 RAD EXAM RIBS UNILAT 2 VWS	$333.60	$417.00	$66.97–$398.24	64% above	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RAD EXAM RIBS UNILAT 2 VWS	$333.60	$417.00	$161.67–$398.24	—	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS	$298.40	$373.00	$81.04–$356.22	3% above	20%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS	$298.40	$373.00	$144.61–$356.22	—	20%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$482.40	$603.00	$119.57–$575.87	—	20%
Screening mammogram, both breasts one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$482.40	$603.00	$119.57–$575.87	47% above	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$482.40	$603.00	$233.78–$575.87	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$482.40	$603.00	$233.78–$575.87	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$283.20	$354.00	$66.97–$338.07	20% above	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$283.20	$354.00	$137.25–$338.07	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS	$476.00	$595.00	$66.97–$568.23	104% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS	$476.00	$595.00	$230.68–$568.23	—	20%
Skull X-ray, fewer than 4 views CPT 70250 RAD EXAM SKULL < 4 VWS	$391.20	$489.00	$81.04–$467.00	74% above	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 RAD EXAM SKULL < 4 VWS	$391.20	$489.00	$189.59–$467.00	—	20%
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY PARTIAL 95810 M52	$3,066.40	$3,833.00	$770.59–$3,660.52	at median	20%
Sleep study in a lab (polysomnography) CPT 95810 PSG 4+ PARAMETERS	$4,378.40	$5,473.00	$770.59–$5,226.72	43% above	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STUDY PARTIAL 95810 M52	$3,066.40	$3,833.00	$1,486.05–$3,660.52	—	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4+ PARAMETERS	$4,378.40	$5,473.00	$2,121.88–$5,226.72	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$491.20	$614.00	$135.41–$586.37	34% above	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$491.20	$614.00	$238.05–$586.37	—	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 RAD EXAM FEMUR MIN 2 VWS	$321.60	$402.00	$66.97–$383.91	42% above	20%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RAD EXAM FEMUR MIN 2 VWS	$321.60	$402.00	$155.86–$383.91	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE WO CONT	$2,296.80	$2,871.00	$81.04–$2,741.81	71% above	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE WO CONT	$2,296.80	$2,871.00	$1,113.09–$2,741.81	—	20%
Toe X-ray, 2 or more views CPT 73660 RAD EXAM TOES MIN 2 VWS	$270.40	$338.00	$66.97–$322.79	46% above	20%
Toe X-ray, 2 or more views inpatient CPT 73660 RAD EXAM TOES MIN 2 VWS	$270.40	$338.00	$131.04–$322.79	—	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$718.40	$898.00	$81.04–$857.59	80% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$718.40	$898.00	$348.15–$857.59	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG	$763.20	$954.00	$81.04–$911.07	115% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PG UTR TRANSVAG	$763.20	$954.00	$369.87–$911.07	—	20%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$936.80	$1,171.00	$81.04–$1,118.31	55% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$936.80	$1,171.00	$454.00–$1,118.31	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$733.60	$917.00	$81.04–$875.74	63% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$733.60	$917.00	$355.52–$875.74	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$700.80	$876.00	$81.04–$836.58	61% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$700.80	$876.00	$339.63–$836.58	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RAD EXAM GI UPPER W WO DELAYED IMG WO KUB	$924.00	$1,155.00	$135.41–$1,103.03	135% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RAD EXAM GI UPPER W WO DELAYED IMG WO KUB	$924.00	$1,155.00	$447.79–$1,103.03	—	20%
Upper arm X-ray (humerus), 2 views CPT 73060 RAD EXAM HUMERUS MIN 2 VWS	$272.00	$340.00	$66.97–$324.70	28% above	20%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RAD EXAM HUMERUS MIN 2 VWS	$272.00	$340.00	$131.82–$324.70	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$928.00	$1,160.00	$81.04–$1,107.80	72% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$928.00	$1,160.00	$449.73–$1,107.80	—	20%
Wrist X-ray, 2 views CPT 73100 RAD EXAM WRIST 2 VWS	$296.80	$371.00	$66.97–$354.31	50% above	20%
Wrist X-ray, 2 views inpatient CPT 73100 RAD EXAM WRIST 2 VWS	$296.80	$371.00	$143.84–$354.31	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$350.40	$438.00	$66.97–$418.29	51% above	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$350.40	$438.00	$169.81–$418.29	—	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS	$290.40	$363.00	$66.97–$346.67	5% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS	$290.40	$363.00	$140.74–$346.67	—	20%
X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW	$272.80	$341.00	$66.97–$325.66	30% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN 1 VW	$272.80	$341.00	$132.21–$325.66	—	20%
X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VWS	$303.20	$379.00	$66.97–$361.95	48% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VWS	$303.20	$379.00	$146.94–$361.95	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$277.60	$347.00	$66.97–$331.39	43% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$277.60	$347.00	$134.53–$331.39	—	20%
X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS	$288.80	$361.00	$66.97–$344.76	51% above	20%
X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VWS	$288.80	$361.00	$139.96–$344.76	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT MIN 3 VWS	$345.60	$432.00	$66.97–$412.56	56% above	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT MIN 3 VWS	$345.60	$432.00	$167.49–$412.56	—	20%
X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND MIN 3 VWS	$330.40	$413.00	$66.97–$394.42	50% above	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND MIN 3 VWS	$330.40	$413.00	$160.12–$394.42	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$304.80	$381.00	$66.97–$363.86	41% above	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$304.80	$381.00	$147.71–$363.86	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$288.80	$361.00	$81.04–$344.76	12% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$288.80	$361.00	$139.96–$344.76	—	20%
X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$392.00	$490.00	$81.04–$467.95	18% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$392.00	$490.00	$189.97–$467.95	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS	$349.60	$437.00	$81.04–$417.34	49% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THOR 2 VWS	$349.60	$437.00	$169.42–$417.34	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$184.00	$230.00	$66.97–$247.43	16% below	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$184.00	$230.00	$89.17–$219.65	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$283.20	$354.00	$66.97–$338.07	15% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$283.20	$354.00	$137.25–$338.07	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$280.80	$351.00	$81.04–$335.21	27% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$280.80	$351.00	$136.08–$335.21	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$283.20	$354.00	$66.97–$338.07	28% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$283.20	$354.00	$137.25–$338.07	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV 88305	$323.20	$404.00	$39.93–$385.82	134% above	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV 88305	$323.20	$404.00	$156.63–$385.82	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO CERV THN AUTO 88175	$137.60	$172.00	$25.28–$164.26	62% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO CERV THN AUTO 88175	$137.60	$172.00	$66.68–$164.26	—	20%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO CERV THN MAN 88142	$133.60	$167.00	$19.25–$159.49	72% above	20%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO CERV THN MAN 88142	$133.60	$167.00	$64.75–$159.49	—	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS COMPLETE 89320	$140.00	$175.00	$11.69–$167.13	17% above	20%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANALYSIS COMPLETE 89320	$140.00	$175.00	$67.85–$167.13	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ED 27786 CLSD TX ANKLE FX WO MANIP	$442.40	$553.00	$173.80–$963.18	1% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 ED 27786 CLSD TX ANKLE FX WO MANIP	$442.40	$553.00	$214.40–$528.12	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$1,061.60	$1,327.00	$479.67–$1,772.14	2% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED 92960 CARDIOVERSION	$1,652.80	$2,066.00	$479.67–$1,973.03	58% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$1,061.60	$1,327.00	$514.48–$1,267.29	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED 92960 CARDIOVERSION	$1,652.80	$2,066.00	$800.99–$1,973.03	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ED 25600 CLSD TX DISTAL RADIAL FX	$411.20	$514.00	$173.80–$963.18	17% below	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ED 25600 CLSD TX DISTAL RADIAL FX	$411.20	$514.00	$199.28–$490.87	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ED 69209 RMVL IMPACTED CERUMEN IRRIGATION LAVAGE UNI	$171.20	$214.00	$45.08–$249.83	121% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ED 69209 RMVL IMPACTED CERUMEN IRRIGATION LAVAGE UNI	$171.20	$214.00	$82.97–$204.37	—	20%
Earwax removal with instruments, one ear CPT 69210 ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI	$134.40	$168.00	$45.08–$166.55	9% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI	$134.40	$168.00	$65.13–$160.44	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 ED 46221 HEMORRHOIDECTOMY SMPL LIG	$600.80	$751.00	$291.16–$2,488.63	26% below	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 ED 46221 HEMORRHOIDECTOMY SMPL LIG	$600.80	$751.00	$291.16–$717.21	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 SURG 58340 HYSTERO INJ CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$260.80	$326.00	$1.00–$311.33	17% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 SURG 58340 HYSTERO INJ CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI	$260.80	$326.00	$126.39–$311.33	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$435.20	$544.00	$147.55–$545.11	52% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 SURG 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$435.20	$544.00	$147.55–$545.11	52% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 TX RM 10060 I&D ABSCESS SIMPLE	$435.20	$544.00	$147.55–$545.11	52% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 SURG 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$435.20	$544.00	$210.91–$519.52	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$435.20	$544.00	$210.91–$519.52	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 TX RM 10060 I&D ABSCESS SIMPLE	$435.20	$544.00	$210.91–$519.52	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID	$733.60	$917.00	$218.29–$1,209.73	103% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 SURG 20610 ARTHROCENTESIS ASP INJ MJR JNT BURSA WO US GUID	$747.20	$934.00	$218.29–$1,209.73	107% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID	$733.60	$917.00	$355.52–$875.74	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 SURG 20610 ARTHROCENTESIS ASP INJ MJR JNT BURSA WO US GUID	$747.20	$934.00	$362.11–$891.97	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ED 20605 ASP INJ JOINT BURSA INTERMED WO US GUID	$488.80	$611.00	$218.29–$1,209.73	60% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 SURG 20605 ARTHROCENTESIS ASP INJ INTRM JNT BURSA WO US GUID	$488.80	$611.00	$218.29–$1,209.73	60% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 SURG 20605 ARTHROCENTESIS ASP INJ INTRM JNT BURSA WO US GUID	$488.80	$611.00	$236.88–$583.51	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ED 20605 ASP INJ JOINT BURSA INTERMED WO US GUID	$488.80	$611.00	$236.88–$583.51	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ED 20600 ASP INJ JOINT BURSA SMALL WO US GUID	$457.60	$572.00	$218.29–$1,209.73	41% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ED 20600 ASP INJ JOINT BURSA SMALL WO US GUID	$457.60	$572.00	$221.76–$546.26	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR <	$674.40	$843.00	$293.89–$1,085.77	49% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR <	$674.40	$843.00	$326.83–$805.07	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 ED 11400 EXC BNGN LSN .5 CM OR <TAL	$1,248.00	$1,560.00	$518.54–$1,915.77	208% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 ED 11400 EXC BNGN LSN .5 CM OR <TAL	$1,248.00	$1,560.00	$604.81–$1,489.80	—	20%
Nail removal (partial or complete), one nail CPT 11730 ED 11730 REMV OF NAIL PLATE	$418.40	$523.00	$147.55–$545.11	56% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 ED 11730 REMV OF NAIL PLATE	$418.40	$523.00	$202.77–$499.47	—	20%
Occipital nerve block (injection for headaches) CPT 64405 ED 64405 INJ NERVE BLOCK GR OCCPTAL	$590.40	$738.00	$218.29–$1,209.73	4% below	20%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ED 64405 INJ NERVE BLOCK GR OCCPTAL	$590.40	$738.00	$286.12–$704.79	—	20%
Paracentesis with imaging guidance CPT 49083 ED 49083 ABD PARACNTSIS WIMAG GUID	$1,364.00	$1,705.00	$661.03–$2,468.30	53% above	20%
Paracentesis with imaging guidance CPT 49083 SURG 49083 ABD PARACENTESIS W IMAGING	$1,389.60	$1,737.00	$668.10–$2,468.30	56% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 ED 49083 ABD PARACNTSIS WIMAG GUID	$1,364.00	$1,705.00	$661.03–$1,628.28	—	20%
Paracentesis with imaging guidance inpatient CPT 49083 SURG 49083 ABD PARACENTESIS W IMAGING	$1,389.60	$1,737.00	$673.43–$1,658.84	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ED 11750 REMV OF NAIL BED	$835.20	$1,044.00	$293.89–$1,085.77	64% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ED 11750 REMV OF NAIL BED	$835.20	$1,044.00	$404.76–$997.02	—	20%
Removal of a foreign object under the skin, simple CPT 10120 ED 10120 INC&REMV FB SMPL	$619.20	$774.00	$293.89–$1,085.77	53% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED 10120 INC&REMV FB SMPL	$619.20	$774.00	$300.08–$739.17	—	20%
Short arm cast (elbow to hand) CPT 29075 ED 29075 APPL CAST FOREARM ARM	$212.80	$266.00	$103.13–$1,096.93	19% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 ED 29075 APPL CAST FOREARM ARM	$212.80	$266.00	$103.13–$254.03	—	20%
Short arm splint (forearm and hand) CPT 29125 ED 29125 APPL SPLINT FOREARM	$249.60	$312.00	$94.15–$521.76	26% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM	$249.60	$312.00	$120.96–$297.96	—	20%
Short leg cast (below the knee) CPT 29405 ED 29405 APPL CAST SHORT LEG	$258.40	$323.00	$125.23–$1,096.93	13% below	20%
Short leg cast (below the knee) inpatient CPT 29405 ED 29405 APPL CAST SHORT LEG	$258.40	$323.00	$125.23–$308.47	—	20%
Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$270.40	$338.00	$116.13–$643.60	21% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$270.40	$338.00	$131.04–$322.79	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ED 12001 RPR SUPERFCL WND 2.5CM OR<	$324.80	$406.00	$147.55–$545.11	17% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ED 12001 RPR SUPERFCL WND 2.5CM OR<	$324.80	$406.00	$157.41–$387.73	—	20%
Skin tag removal, up to 15 tags CPT 11200 ED 11200 SKIN TAG RMV <16	$277.60	$347.00	$134.53–$545.11	30% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 ED 11200 SKIN TAG RMV <16	$277.60	$347.00	$134.53–$331.39	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$896.80	$1,121.00	$434.61–$1,883.02	22% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SURG 62270 SPINAL PUNCTURE LUMBAR DIAG	$913.60	$1,142.00	$442.75–$1,883.02	24% above	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$896.80	$1,121.00	$434.61–$1,070.56	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SURG 62270 SPINAL PUNCTURE LUMBAR DIAG	$913.60	$1,142.00	$442.75–$1,090.61	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ED 12002 RPR SUPERFCL WND 2.6-7.5CM	$342.40	$428.00	$147.55–$545.11	6% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ED 12002 RPR SUPERFCL WND 2.6-7.5CM	$342.40	$428.00	$165.94–$408.74	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ED 12011 RPR SUPERFCL WND 2.5CM OR<	$338.40	$423.00	$147.55–$545.11	17% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ED 12011 RPR SUPERFCL WND 2.5CM OR<	$338.40	$423.00	$164.00–$403.97	—	20%
Thoracentesis with imaging guidance CPT 32555 ED 32555 THORACENTESIS W IMAGING	$933.60	$1,167.00	$452.45–$2,565.85	1% above	20%
Thoracentesis with imaging guidance CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$1,392.00	$1,740.00	$463.00–$2,565.85	51% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 ED 32555 THORACENTESIS W IMAGING	$933.60	$1,167.00	$452.45–$1,114.49	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$1,392.00	$1,740.00	$674.60–$1,661.70	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$488.00	$610.00	$218.29–$806.47	53% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$488.00	$610.00	$236.50–$582.55	—	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 SURG 19083 BX BREAST W DVC US GUIDE 1ST LSN	$2,232.80	$2,791.00	$1,082.07–$6,621.97	27% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 SURG 19083 BX BREAST W DVC US GUIDE 1ST LSN	$2,232.80	$2,791.00	$1,082.07–$2,665.41	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 TX RM 11042 DEBRIDE SKIN & SUBQ TISSUE	$463.20	$579.00	$224.48–$1,085.77	3% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 TX RM 11042 DEBRIDE SKIN & SUBQ TISSUE	$463.20	$579.00	$224.48–$552.95	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 TRANSFUSION BLOOD	$1,017.60	$1,272.00	$319.94–$1,214.76	44% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD	$1,017.60	$1,272.00	$319.94–$1,214.76	44% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 TRANSFUSION BLOOD	$1,017.60	$1,272.00	$493.15–$1,214.76	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD	$1,017.60	$1,272.00	$493.15–$1,214.76	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB INITIAL TX	$64.80	$81.00	$31.40–$398.54	44% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUBSEQ TX	$66.88	$83.60	$32.41–$398.54	43% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 DIAGNOSTIC SPUTUM	$103.20	$129.00	$50.01–$398.54	12% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI SUBSEQ TX	$129.60	$162.00	$62.81–$398.54	11% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 OLE SUBSEQUENT RX	$132.80	$166.00	$64.36–$398.54	14% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZ PAP SUBSEQUENT	$136.00	$170.00	$65.91–$398.54	17% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI INITIAL TX	$141.60	$177.00	$68.62–$398.54	21% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZ PAP INITIAL	$156.00	$195.00	$75.60–$398.54	34% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ED 94640 NEBULIZER TREATMENT	$192.80	$241.00	$93.44–$398.54	65% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 OLE INITIAL RX	$246.40	$308.00	$107.87–$398.54	111% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ED 94640 NON OR PRES'D INHALATION TX	$252.00	$315.00	$107.87–$398.54	116% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB INITIAL TX	$64.80	$81.00	$31.40–$77.36	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB SUBSEQ TX	$66.88	$83.60	$32.41–$79.84	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 DIAGNOSTIC SPUTUM	$103.20	$129.00	$50.01–$123.20	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI SUBSEQ TX	$129.60	$162.00	$62.81–$154.71	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 OLE SUBSEQUENT RX	$132.80	$166.00	$64.36–$158.53	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZ PAP SUBSEQUENT	$136.00	$170.00	$65.91–$162.35	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI INITIAL TX	$141.60	$177.00	$68.62–$169.04	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZ PAP INITIAL	$156.00	$195.00	$75.60–$186.23	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ED 94640 NEBULIZER TREATMENT	$192.80	$241.00	$93.44–$230.16	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 OLE INITIAL RX	$246.40	$308.00	$119.41–$294.14	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ED 94640 NON OR PRES'D INHALATION TX	$252.00	$315.00	$122.13–$300.83	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR	$473.80	$592.25	$229.62–$922.18	7% below	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR	$473.80	$592.25	$229.62–$565.60	—	20%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 AUDIOMETRY COMPREHENSIVE	$184.00	$230.00	$89.17–$425.32	19% above	20%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 AUDIOMETRY COMPREHENSIVE	$184.00	$230.00	$89.17–$219.65	—	20%
Critical care, first 30 to 74 minutes CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$1,664.00	$2,080.00	$654.01–$2,416.25	4% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$1,664.00	$2,080.00	$806.42–$1,986.40	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG STANDARD	$696.80	$871.00	$231.33–$854.66	33% above	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE DROWSY	$768.00	$960.00	$231.33–$916.80	47% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG STANDARD	$696.80	$871.00	$337.69–$831.81	—	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE DROWSY	$768.00	$960.00	$372.19–$916.80	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING WO INTERP	$123.20	$154.00	$45.08–$166.55	29% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING WO INTERP	$123.20	$154.00	$59.71–$147.07	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED 99281 EMER CASE LEVEL I	$256.00	$320.00	$65.44–$305.60	26% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED 99281 EMER CASE LEVEL I	$256.00	$320.00	$124.06–$305.60	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED 99282 EMER CASE LEVEL II	$432.80	$541.00	$120.54–$516.66	44% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED 99282 EMER CASE LEVEL II	$432.80	$541.00	$209.75–$516.66	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED 99283 EMER CASE LEVEL III	$668.00	$835.00	$210.29–$797.43	38% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED 99283 EMER CASE LEVEL III	$668.00	$835.00	$323.73–$797.43	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED 99284 EMER CASE LEVEL IV	$880.00	$1,100.00	$326.43–$1,206.01	13% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED 99284 EMER CASE LEVEL IV	$880.00	$1,100.00	$426.47–$1,050.50	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED 99285 EMER CASE LEVEL V	$1,335.20	$1,669.00	$473.40–$1,748.98	15% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED 99285 EMER CASE LEVEL V	$1,335.20	$1,669.00	$647.07–$1,593.90	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST TRACING	$1,184.00	$1,480.00	$231.33–$1,413.40	64% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST TRACING	$1,184.00	$1,480.00	$573.80–$1,413.40	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INITIAL 31-60MINS	$265.60	$332.00	$128.72–$583.62	3% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$440.80	$551.00	$157.97–$583.62	62% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRAT INITIAL 31-60MINS	$265.60	$332.00	$128.72–$317.06	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$440.80	$551.00	$213.62–$526.21	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$501.60	$627.00	$151.20–$598.79	54% above	20%
IV infusion of a medicine, first hour CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$501.60	$627.00	$151.20–$598.79	54% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$501.60	$627.00	$243.09–$598.79	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$501.60	$627.00	$243.09–$598.79	—	20%
IV push of a medicine, first drug CPT 96374 IV PUSH INITIAL	$166.40	$208.00	$80.64–$583.62	10% below	20%
IV push of a medicine, first drug CPT 96374 ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL	$166.52	$208.15	$80.70–$583.62	10% below	20%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH INITIAL	$166.40	$208.00	$80.64–$198.64	—	20%
IV push of a medicine, first drug inpatient CPT 96374 ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL	$166.52	$208.15	$80.70–$198.78	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CDMR INJECT SQ IM SELF ADM MED GY	$20.00	$25.00	$9.69–$191.82	74% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CDMR ED 96372 INJECT SQ IM SELF ADM MED GY	$20.00	$25.00	$9.69–$191.82	74% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SC IM INJECTION	$126.40	$158.00	$34.40–$191.82	63% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$148.80	$186.00	$34.40–$191.82	92% above	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 CDMR INJECT SQ IM SELF ADM MED GY	$20.00	$25.00	$9.69–$23.88	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 CDMR ED 96372 INJECT SQ IM SELF ADM MED GY	$20.00	$25.00	$9.69–$23.88	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SC IM INJECTION	$126.40	$158.00	$61.26–$150.89	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$148.80	$186.00	$72.11–$177.63	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CONDUCTION TEST 7-8 STUDIES	$1,190.40	$1,488.00	$231.33–$1,421.04	163% above	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CONDUCTION TEST 7-8 STUDIES	$1,190.40	$1,488.00	$576.90–$1,421.04	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$113.60	$142.00	$30.58–$135.61	40% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$113.60	$142.00	$55.05–$135.61	—	20%
New patient office visit, about 30 minutes CPT 99203 NEW AMS OR CONSULT PATIENT LVL 3	$154.40	$193.00	$74.83–$184.32	32% above	20%
New patient office visit, about 30 minutes CPT 99203 NEW OB CHECK LVL3	$565.60	$707.00	$101.35–$675.19	384% above	20%
New patient office visit, about 30 minutes CPT 99203 NEW OB CHECK LVL 3 W MOD 25	$565.60	$707.00	$101.35–$675.19	384% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW AMS OR CONSULT PATIENT LVL 3	$154.40	$193.00	$74.83–$184.32	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW OB CHECK LVL3	$565.60	$707.00	$274.10–$675.19	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW OB CHECK LVL 3 W MOD 25	$565.60	$707.00	$274.10–$675.19	—	20%
New patient office visit, about 45 minutes CPT 99204 NEW AMS OR CONSULT PATIENT LVL 4	$180.80	$226.00	$87.62–$237.41	5% above	20%
New patient office visit, about 45 minutes CPT 99204 NEW OB CHECK LVL4	$792.80	$991.00	$151.72–$946.41	362% above	20%
New patient office visit, about 45 minutes CPT 99204 NEW OB CHECK LVL 4 W MOD 25	$792.80	$991.00	$151.72–$946.41	362% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW AMS OR CONSULT PATIENT LVL 4	$180.80	$226.00	$87.62–$215.83	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW OB CHECK LVL4	$792.80	$991.00	$384.21–$946.41	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW OB CHECK LVL 4 W MOD 25	$792.80	$991.00	$384.21–$946.41	—	20%
New patient office visit, about 60 minutes CPT 99205 NEW AMS OR CONSULT PATIENT LVL 5	$235.20	$294.00	$113.98–$322.92	2% below	20%
New patient office visit, about 60 minutes CPT 99205 NEW OB CHECK LVL5	$1,170.40	$1,463.00	$199.82–$1,397.17	390% above	20%
New patient office visit, about 60 minutes CPT 99205 NEW OB CHECK LVL 5 W MOD 25	$1,170.40	$1,463.00	$199.82–$1,397.17	390% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW AMS OR CONSULT PATIENT LVL 5	$235.20	$294.00	$113.98–$280.77	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW OB CHECK LVL 5 W MOD 25	$1,170.40	$1,463.00	$567.21–$1,397.17	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW OB CHECK LVL5	$1,170.40	$1,463.00	$567.21–$1,397.17	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW AMS OR CONSULT PATIENT LVL 2	$125.60	$157.00	$60.87–$149.94	65% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW OB CHECK LVL2	$337.60	$422.00	$65.76–$403.01	344% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW OB CHECK LVL 2 W MOD 25	$337.60	$422.00	$65.76–$403.01	344% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW AMS OR CONSULT PATIENT LVL 2	$125.60	$157.00	$60.87–$149.94	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW OB CHECK LVL 2 W MOD 25	$337.60	$422.00	$163.61–$403.01	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW OB CHECK LVL2	$337.60	$422.00	$163.61–$403.01	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$48.80	$61.00	$23.65–$58.26	21% below	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$48.80	$61.00	$23.65–$58.26	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY 97165	$240.80	$301.00	$95.88–$287.46	42% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY 97165	$240.80	$301.00	$116.70–$287.46	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$241.60	$302.00	$93.36–$288.41	21% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$241.60	$302.00	$117.09–$288.41	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY 97161	$219.20	$274.00	$93.36–$261.67	30% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY 97161	$219.20	$274.00	$106.23–$261.67	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$225.60	$282.00	$93.36–$269.31	18% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$225.60	$282.00	$109.33–$269.31	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN 97140	$120.96	$151.20	$25.90–$144.40	43% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN 97140	$120.96	$151.20	$58.62–$144.40	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN 97110	$124.32	$155.40	$27.46–$148.41	37% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN 97110	$124.32	$155.40	$60.25–$148.41	—	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO CONSULT 3-10 MIN	$50.40	$63.00	$21.16–$78.17	47% above	20%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 TOBACCO CONSULT 3-10 MIN	$50.40	$63.00	$24.43–$60.17	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST AMS OR CONSULT PATIENT LVL 5	$207.20	$259.00	$100.41–$256.54	19% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 LEVEL 5 EST W MOD 25	$299.20	$374.00	$145.00–$357.17	71% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB LEVEL 5	$299.20	$374.00	$145.00–$357.17	71% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST OB CHECK LVL 5 W MOD 25	$1,059.20	$1,324.00	$164.20–$1,264.42	506% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST OB CHECK LVL5	$1,059.20	$1,324.00	$164.20–$1,264.42	506% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST AMS OR CONSULT PATIENT LVL 5	$207.20	$259.00	$100.41–$247.35	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTAB LEVEL 5	$299.20	$374.00	$145.00–$357.17	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 LEVEL 5 EST W MOD 25	$299.20	$374.00	$145.00–$357.17	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST OB CHECK LVL 5 W MOD 25	$1,059.20	$1,324.00	$513.31–$1,264.42	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST OB CHECK LVL5	$1,059.20	$1,324.00	$513.31–$1,264.42	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST AMS OR CONSULT PATIENT LVL 3	$136.80	$171.00	$66.30–$163.31	2% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB LEVEL 3	$176.00	$220.00	$83.39–$210.10	32% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 LEVEL 3 EST W MOD 25	$176.00	$220.00	$83.39–$210.10	32% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 TX RM 99213 TREATMENT RM LEVEL III	$336.00	$420.00	$83.39–$401.10	151% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST OB CHECK LVL 3 W MOD 25	$453.60	$567.00	$83.39–$541.49	240% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST OB CHECK LVL3	$453.60	$567.00	$83.39–$541.49	240% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST AMS OR CONSULT PATIENT LVL 3	$136.80	$171.00	$66.30–$163.31	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 LEVEL 3 EST W MOD 25	$176.00	$220.00	$85.29–$210.10	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTAB LEVEL 3	$176.00	$220.00	$85.29–$210.10	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 TX RM 99213 TREATMENT RM LEVEL III	$336.00	$420.00	$162.83–$401.10	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST OB CHECK LVL 3 W MOD 25	$453.60	$567.00	$219.83–$541.49	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST OB CHECK LVL3	$453.60	$567.00	$219.83–$541.49	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST AMS OR CONSULT PATIENT LVL 4	$183.20	$229.00	$88.78–$218.70	64% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB LEVEL 4	$244.80	$306.00	$117.08–$292.23	119% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 LEVEL 4 EST W MOD 25	$244.80	$306.00	$117.08–$292.23	119% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST OB CHECK LVL4	$680.80	$851.00	$117.08–$812.71	510% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST OB CHECK LVL 4 W MOD 25	$680.80	$851.00	$117.08–$812.71	510% above	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST AMS OR CONSULT PATIENT LVL 4	$183.20	$229.00	$88.78–$218.70	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTAB LEVEL 4	$244.80	$306.00	$118.64–$292.23	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 LEVEL 4 EST W MOD 25	$244.80	$306.00	$118.64–$292.23	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST OB CHECK LVL4	$680.80	$851.00	$329.93–$812.71	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST OB CHECK LVL 4 W MOD 25	$680.80	$851.00	$329.93–$812.71	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB LEVEL 2	$105.60	$132.00	$51.18–$126.06	15% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 LEVEL 2 EST W MOD 25	$105.60	$132.00	$51.18–$126.06	15% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST AMS OR CONSULT PATIENT LVL 2	$128.00	$160.00	$51.89–$152.80	39% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST OB CHECK LVL2	$228.80	$286.00	$51.89–$273.13	149% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 TX RM 99212 TREATMENT RM LEVEL II	$232.00	$290.00	$51.89–$276.95	152% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST OB CHECK LVL 2 W MOD 25	$251.20	$314.00	$51.89–$299.87	173% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTAB LEVEL 2	$105.60	$132.00	$51.18–$126.06	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 LEVEL 2 EST W MOD 25	$105.60	$132.00	$51.18–$126.06	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST AMS OR CONSULT PATIENT LVL 2	$128.00	$160.00	$62.03–$152.80	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST OB CHECK LVL2	$228.80	$286.00	$110.88–$273.13	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 TX RM 99212 TREATMENT RM LEVEL II	$232.00	$290.00	$112.43–$276.95	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST OB CHECK LVL 2 W MOD 25	$251.20	$314.00	$121.74–$299.87	—	20%
Speech and language evaluation CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$477.60	$597.00	$115.12–$570.14	48% above	20%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$477.60	$597.00	$231.46–$570.14	—	20%
Speech therapy session, individual CPT 92507 SPEECH THERAPY TX 92507	$297.44	$371.80	$71.41–$425.32	40% above	20%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TX 92507	$297.44	$371.80	$144.15–$355.07	—	20%
Spirometry (breathing test) CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$188.80	$236.00	$91.50–$425.32	15% above	20%
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$188.80	$236.00	$91.50–$225.38	—	20%
Spirometry before and after a bronchodilator CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$347.20	$434.00	$168.26–$854.66	9% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$347.20	$434.00	$168.26–$414.47	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA15 MIN 97530	$117.04	$146.30	$33.14–$139.72	51% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA15 MIN 97530	$117.04	$146.30	$56.72–$139.72	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$216.00	$270.00	$94.15–$347.84	6% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$216.00	$270.00	$104.68–$257.85	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Influenza Vac Type A&B Surface Ant Adj Susp Pref Syr 0.5 ML	$51.71	$64.63	$25.06–$103.07	24% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 Influenza Vac Type A&B Surface Ant Adj Susp Pref Syr 0.5 ML	$51.71	$64.63	$25.06–$61.72	—	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML	$256.68	$320.84	$124.39–$306.40	40% above	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML	$256.68	$320.84	$124.39–$306.40	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vac Live For Inj 1350 PFU/0.5ML	$324.87	$406.08	$157.44–$387.81	65% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Virus Vac Live For Inj 1350 PFU/0.5ML	$324.87	$406.08	$157.44–$387.81	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diph, Acellular Pert & Tet Tox Inj 15 LF-23 MCG-5 LF/0.5ML	$75.08	$93.84	$1.00–$89.62	42% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diph, Acellular Pert & Tet Tox Inj 25 LF-58 MCG-10 LF/0.5ML	$78.13	$97.66	$1.00–$93.27	48% above	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Diph, Acellular Pert & Tet Tox Inj 15 LF-23 MCG-5 LF/0.5ML	$75.08	$93.84	$36.38–$89.62	—	20%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Diph, Acellular Pert & Tet Tox Inj 25 LF-58 MCG-10 LF/0.5ML	$78.13	$97.66	$37.86–$93.27	—	20%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Diph-Ac Per-Tet Tox Ad-PolioV-Haemoph B Poly Vac For IM Susp	$108.20	$135.25	$1.00–$129.16	8% above	20%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Diph-Ac Per-Tet Tox Ad-PolioV-Haemoph B Poly Vac For IM Susp	$108.20	$135.25	$52.44–$129.16	—	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Diph-Tet Tox-Ac Pert Ad-Polio IPV-Hib-Hep B Rec Susp Pre Syr	$214.68	$268.35	$104.04–$256.27	99% above	20%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Diph-Tet Tox-Ac Pert Ad-Polio IPV-Hib-Hep B Rec Susp Pre Syr	$214.68	$268.35	$104.04–$256.27	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac IM Susp	$385.31	$481.63	$186.73–$459.96	2% above	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac Susp Pref Syr	$469.81	$587.26	$227.68–$560.83	24% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac IM Susp	$385.31	$481.63	$186.73–$459.96	—	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac Susp Pref Syr	$469.81	$587.26	$227.68–$560.83	—	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hep A-Hep B Vaccine Susp Pref Syr 720-20 ELU-MCG/ML	$245.62	$307.02	$1.00–$293.20	69% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Hep A-Hep B Vaccine Susp Pref Syr 720-20 ELU-MCG/ML	$245.62	$307.02	$119.03–$293.20	—	20%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine Inj Susp 50 Unit/ML	$105.10	$131.37	$1.00–$125.46	at median	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine Inj Susp 50 Unit/ML	$105.10	$131.37	$50.93–$125.46	—	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A Vaccine Inj Susp 25 Unit/0.5ML	$78.52	$98.15	$1.00–$93.73	38% above	20%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hepatitis A Vaccine Inj Susp 25 Unit/0.5ML	$78.52	$98.15	$38.05–$93.73	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 20 MCG/ML	$103.74	$129.67	$50.27–$123.83	8% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine (Recombinant) Susp 20 MCG/ML	$103.74	$129.67	$50.27–$123.83	8% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 20 MCG/ML	$103.74	$129.67	$50.27–$123.83	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine (Recombinant) Susp 20 MCG/ML	$103.74	$129.67	$50.27–$123.83	—	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Hepatitis B Vaccine Recomb Adjuvanted Pref Syr 20 MCG/0.5ML	$218.79	$273.48	$106.03–$261.17	36% above	20%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Hepatitis B Vaccine Recomb Adjuvanted Pref Syr 20 MCG/0.5ML	$218.79	$273.48	$106.03–$261.17	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 5 MCG/0.5ML	$75.87	$94.83	$30.09–$90.56	46% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 5 MCG/0.5ML	$75.87	$94.83	$36.77–$90.56	—	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Haemophilus B Polysaccharide Conj Vac IM Susp 7.5 MCG/0.5 ML	$78.60	$98.24	$1.00–$93.82	11% above	20%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Haemophilus B Polysaccharide Conj Vac IM Susp 7.5 MCG/0.5 ML	$78.60	$98.24	$38.09–$93.82	—	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Haemophilus B Polysaccharide Conjugate Vaccine For Inj	$68.21	$85.26	$1.00–$81.42	74% above	20%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Haemophilus B Polysaccharide Conjugate Vaccine For Inj	$68.21	$85.26	$33.06–$81.42	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$190.84	$238.55	$1.00–$227.82	62% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$190.84	$238.55	$92.49–$227.82	—	20%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Meningococcal (A, C, Y, and W-135) Tetanus Conjugate Vaccine	$220.52	$275.64	$106.87–$263.24	50% above	20%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Meningococcal (A, C, Y, and W-135) Tetanus Conjugate Vaccine	$220.52	$275.64	$106.87–$263.24	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe	$375.62	$469.52	$182.03–$448.39	25% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe	$375.62	$469.52	$182.03–$448.39	—	20%
Meningococcal B vaccine (Trumenba) CPT 90621 Meningococcal Group B Vac (Recomb) IM Susp Prefilled Syr	$289.03	$361.28	$140.07–$345.02	54% above	20%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 Meningococcal Group B Vac (Recomb) IM Susp Prefilled Syr	$289.03	$361.28	$140.07–$345.02	—	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Pneumococcal 15-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$367.34	$459.17	$178.02–$438.51	2% above	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Pneumococcal 15-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$367.34	$459.17	$178.02–$438.51	—	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 Pneumococcal 21-Valent Conjugate Vaccine Soln Pref Syr 0.5ML	$410.26	$512.82	$198.82–$489.74	17% above	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 Pneumococcal 21-Valent Conjugate Vaccine Soln Pref Syr 0.5ML	$410.26	$512.82	$198.82–$489.74	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$215.94	$269.92	$104.65–$257.77	70% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$215.94	$269.92	$104.65–$257.77	—	20%
Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus Vaccine, IPV Injection	$79.53	$99.41	$1.00–$94.94	5% above	20%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 Poliovirus Vaccine, IPV Injection	$79.53	$99.41	$38.54–$94.94	—	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Nirsevimab-alip IM Soln Prefilled Syringe 100 MG/ML	$723.40	$904.24	$350.57–$863.55	19% above	20%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Nirsevimab-alip IM Soln Prefilled Syringe 100 MG/ML	$723.40	$904.24	$350.57–$863.55	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Nirsevimab-alip IM Soln Prefilled Syringe 50 MG/0.5ML	$794.82	$993.52	$385.19–$948.81	47% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Nirsevimab-alip IM Soln Prefilled Syringe 50 MG/0.5ML	$794.82	$993.52	$385.19–$948.81	—	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV Pre-Fusion F A&B Vac Recomb For IM Soln 120 MCG/0.5ML	$449.67	$562.08	$217.92–$536.79	104% above	20%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV Pre-Fusion F A&B Vac Recomb For IM Soln 120 MCG/0.5ML	$449.67	$562.08	$217.92–$536.79	—	20%
Rabies vaccine, one dose CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$514.04	$642.54	$249.11–$937.97	at median	20%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine, PCEC For Inj	$663.38	$829.22	$253.88–$937.97	30% above	20%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$514.04	$642.54	$249.11–$613.63	—	20%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine, PCEC For Inj	$663.38	$829.22	$321.49–$791.91	—	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus Vaccine, Live Oral Pentavalent Soln	$111.48	$139.35	$54.03–$133.08	13% below	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotavirus Vaccine, Live Oral Pentavalent Soln	$111.48	$139.35	$54.03–$133.08	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$300.53	$375.66	$145.64–$358.76	35% above	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$300.53	$375.66	$145.64–$358.76	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LFU	$79.88	$99.84	$1.00–$95.35	28% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LFU	$79.88	$99.84	$38.71–$95.35	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML	$88.12	$110.15	$1.00–$105.19	12% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML	$88.12	$110.15	$42.71–$105.19	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEPATITIS B VACCINE	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIRUS VAC	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED G0008 ADMIN INFLUENZA VIRUS VACCINE	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED G0009 ADMIN PNEUMOCOCCAL VACCINE	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIR VAC	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED G0010 ADMIN HEPATITIS B VACCINE	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN 1 VACCINE	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VAC	$94.40	$118.00	$45.75–$191.82	128% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN 1 VACCINE	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEPATITIS B VACCINE	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIRUS VAC	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED G0008 ADMIN INFLUENZA VIRUS VACCINE	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED G0009 ADMIN PNEUMOCOCCAL VACCINE	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED G0010 ADMIN HEPATITIS B VACCINE	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIR VAC	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VAC	$94.40	$118.00	$45.75–$112.69	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$31.20	$39.00	$1.00–$37.25	23% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$59.20	$74.00	$1.00–$70.67	134% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$31.20	$39.00	$15.12–$37.25	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$59.20	$74.00	$28.69–$70.67	—	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://sthpiprd.blob.core.windows.net/machine-readable-files/8370/460388596_sanford-worthington-medical-center_standardcharges.csv