Hospital

Sanford Canby Medical Center

Sanford Canby Medical Center in Canby, MN publishes cash prices for 344 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 295 of 339 procedures and below it for 35. By typical cash price it ranks #78 of 85 Minnesota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

112 St Olaf Ave S, Canby, MN 56220-1433 Collected Sep 23, 2026 Source price file Check a bill from this hospital (507) 223-7277

Critical access hospital (rural, 25 beds or fewer) Government-owned hospital Emergency department CCN 241347 · CMS hospital register NPI 1780781054

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

Sanford Canby Medical Center is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

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 1 action for a hospital named Sanford Canby Medical Center in Canby, MN:

Jun 12, 2025 Met requirements

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	$2,701.60	$3,377.00	$186.92–$3,174.38	55% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WO THEN W CONT	$2,701.60	$3,377.00	$1,857.35–$3,194.64	—	20%
Abdominal X-ray, 2 views CPT 74019 RAD EXAM ABDOMEN 2 VWS	$404.80	$506.00	$111.66–$475.64	47% above	20%
Abdominal X-ray, 2 views inpatient CPT 74019 RAD EXAM ABDOMEN 2 VWS	$404.80	$506.00	$278.30–$478.68	—	20%
Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$368.80	$461.00	$92.45–$433.34	59% above	20%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$368.80	$461.00	$253.55–$436.11	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$540.80	$676.00	$135.35–$635.44	—	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	$441.60	$552.00	$133.64–$518.88	27% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 3+ LVLS	$460.00	$575.00	$135.35–$540.50	33% 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	$540.80	$676.00	$371.80–$639.50	—	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	$441.60	$552.00	$303.60–$522.19	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 3+ LVLS	$460.00	$575.00	$316.25–$543.95	—	20%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT EXT UPPER WO CONT	$1,944.80	$2,431.00	$111.66–$2,285.14	54% above	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT EXT UPPER WO CONT	$1,944.80	$2,431.00	$1,337.05–$2,299.73	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RAD EXAM ESOPHAGUS	$652.00	$815.00	$186.92–$766.10	110% above	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RAD EXAM ESOPHAGUS	$652.00	$815.00	$448.25–$770.99	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,943.20	$2,429.00	$421.92–$2,283.26	59% above	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,943.20	$2,429.00	$1,335.95–$2,297.83	—	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$4,181.60	$5,227.00	$374.99–$4,913.38	64% above	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD PELVIS W CONTRAST+WO IF PERFORM	$4,181.60	$5,227.00	$2,874.85–$4,944.74	—	20%
CT angiography (CTA) of the head CPT 70496 CTA HEAD W CONT WO IF PERF	$2,860.00	$3,575.00	$186.92–$3,360.50	58% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W CONT WO IF PERF	$2,860.00	$3,575.00	$1,966.25–$3,381.95	—	20%
CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W CON+WO IF PERF	$2,920.00	$3,650.00	$186.92–$3,431.00	66% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W CON+WO IF PERF	$2,920.00	$3,650.00	$2,007.50–$3,452.90	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,885.60	$3,607.00	$186.92–$3,390.58	58% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,885.60	$3,607.00	$1,983.85–$3,412.22	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST	$3,645.60	$4,557.00	$253.81–$4,283.58	76% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST	$3,645.60	$4,557.00	$2,506.35–$4,310.92	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W CONTRAST	$4,086.40	$5,108.00	$374.99–$4,801.52	63% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W CONTRAST	$4,086.40	$5,108.00	$2,809.40–$4,832.17	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS WO THEN W CONT	$4,394.40	$5,493.00	$374.99–$5,163.42	63% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS WO THEN W CONT	$4,394.40	$5,493.00	$3,021.15–$5,196.38	—	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST	$2,637.60	$3,297.00	$186.92–$3,099.18	90% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST	$2,637.60	$3,297.00	$1,813.35–$3,118.96	—	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$2,130.40	$2,663.00	$111.66–$2,503.22	81% above	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$2,130.40	$2,663.00	$1,464.65–$2,519.20	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONT	$2,045.60	$2,557.00	$111.66–$2,403.58	63% above	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONT	$2,045.60	$2,557.00	$1,406.35–$2,418.92	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$1,952.80	$2,441.00	$111.66–$2,294.54	55% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$1,952.80	$2,441.00	$1,342.55–$2,309.19	—	20%
CT scan of the head with contrast CPT 70460 CT HEAD W CONTRAST	$2,384.80	$2,981.00	$186.92–$2,802.14	84% above	20%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONTRAST	$2,384.80	$2,981.00	$1,639.55–$2,820.03	—	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO THEN W CONTRAST	$2,569.60	$3,212.00	$186.92–$3,019.28	62% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO THEN W CONTRAST	$2,569.60	$3,212.00	$1,766.60–$3,038.55	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONT	$2,447.20	$3,059.00	$111.66–$2,875.46	80% above	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONT	$2,447.20	$3,059.00	$1,682.45–$2,893.81	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,447.20	$3,059.00	$111.66–$2,875.46	71% above	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,447.20	$3,059.00	$1,682.45–$2,893.81	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$2,271.20	$2,839.00	$186.92–$2,668.66	60% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$2,271.20	$2,839.00	$1,561.45–$2,685.69	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUP CAROTID BILAT	$1,212.00	$1,515.00	$253.81–$1,424.10	—	20%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUP CAROTID BILAT	$1,212.00	$1,515.00	$833.25–$1,433.19	—	20%
Chest CT scan without and with contrast CPT 71270 CT THORAX DIAGNOSTIC WO THEN W CONTRAST	$2,726.40	$3,408.00	$186.92–$3,203.52	71% above	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX DIAGNOSTIC WO THEN W CONTRAST	$2,726.40	$3,408.00	$1,874.40–$3,223.97	—	20%
Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS	$374.40	$468.00	$92.45–$439.92	66% above	20%
Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VWS	$374.40	$468.00	$257.40–$442.73	—	20%
Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW	$313.60	$392.00	$92.45–$368.48	55% above	20%
Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VW	$313.60	$392.00	$215.60–$370.83	—	20%
Collarbone (clavicle) X-ray, complete CPT 73000 RAD EXAM CLAVICLE COMPL	$329.60	$412.00	$92.45–$387.28	65% above	20%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RAD EXAM CLAVICLE COMPL	$329.60	$412.00	$226.60–$389.75	—	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM	$1,017.60	$1,272.00	$111.66–$1,195.68	97% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM	$1,017.60	$1,272.00	$699.60–$1,203.31	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$580.80	$726.00	$111.66–$682.44	56% above	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$580.80	$726.00	$399.30–$686.80	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$2,071.20	$2,589.00	$111.66–$2,433.66	63% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$2,071.20	$2,589.00	$1,423.95–$2,449.19	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$2,637.60	$3,297.00	$186.92–$3,099.18	80% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$2,637.60	$3,297.00	$1,813.35–$3,118.96	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DX BILAT INCL CAD	$424.00	$530.00	$128.31–$498.20	—	20%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DX BILAT INCL CAD	$424.00	$530.00	$291.50–$501.38	—	20%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILAT INCL CAD	$272.80	$341.00	$82.56–$320.54	12% below	20%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILAT INCL CAD	$272.80	$341.00	$187.55–$322.59	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,441.60	$1,802.00	$253.81–$1,693.88	—	20%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,441.60	$1,802.00	$991.10–$1,704.69	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,372.80	$1,716.00	$253.81–$1,613.04	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,372.80	$1,716.00	$943.80–$1,623.34	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,481.60	$3,102.00	$575.70–$2,915.88	72% above	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,481.60	$3,102.00	$1,706.10–$2,934.49	—	20%
Elbow X-ray, 2 views CPT 73070 RAD EXAM ELBOW 2 VWS	$329.60	$412.00	$92.45–$387.28	62% above	20%
Elbow X-ray, 2 views inpatient CPT 73070 RAD EXAM ELBOW 2 VWS	$329.60	$412.00	$226.60–$389.75	—	20%
Elbow X-ray, complete, 3 or more views CPT 73080 RAD EXAM ELBOW COMPL MIN 3 VWS	$368.80	$461.00	$92.45–$433.34	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	$253.55–$436.11	—	20%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT SELLA FOSSA EAR WO CONTRAST	$2,116.00	$2,645.00	$111.66–$2,486.30	77% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT SELLA FOSSA EAR WO CONTRAST	$2,116.00	$2,645.00	$1,454.75–$2,502.17	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 RAD EXAM FACIAL BONES COMPL MIN 3 VWS	$477.60	$597.00	$111.66–$561.18	87% above	20%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RAD EXAM FACIAL BONES COMPL MIN 3 VWS	$477.60	$597.00	$328.35–$564.76	—	20%
Forearm X-ray (radius and ulna), 2 views CPT 73090 RAD EXAM FOREARM 2 VWS	$329.60	$412.00	$92.45–$387.28	62% above	20%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RAD EXAM FOREARM 2 VWS	$329.60	$412.00	$226.60–$389.75	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,938.40	$2,423.00	$421.92–$2,277.62	59% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,938.40	$2,423.00	$1,332.65–$2,292.16	—	20%
Hand X-ray, 2 views CPT 73120 RAD EXAM HAND 2 VWS	$329.60	$412.00	$99.75–$387.28	72% above	20%
Hand X-ray, 2 views inpatient CPT 73120 RAD EXAM HAND 2 VWS	$329.60	$412.00	$226.60–$389.75	—	20%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RAD EXAM CALCANEUS MIN 2 VWS	$329.60	$412.00	$92.45–$387.28	84% above	20%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RAD EXAM CALCANEUS MIN 2 VWS	$329.60	$412.00	$226.60–$389.75	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,696.00	$5,870.00	$1,068.26–$5,517.80	36% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,696.00	$5,870.00	$3,228.50–$5,553.02	—	20%
Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS	$373.60	$467.00	$92.45–$438.98	58% above	20%
Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS	$373.60	$467.00	$256.85–$441.78	—	20%
Knee X-ray, complete, 4 or more views CPT 73564 RAD EXAM KNEE COMPL 4 + VWS	$468.80	$586.00	$111.66–$550.84	67% above	20%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 RAD EXAM KNEE COMPL 4 + VWS	$468.80	$586.00	$322.30–$554.36	—	20%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT EXT LOWER WO CONT	$2,060.80	$2,576.00	$111.66–$2,421.44	57% above	20%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT EXT LOWER WO CONT	$2,060.80	$2,576.00	$1,416.80–$2,436.90	—	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$772.00	$965.00	$111.66–$907.10	74% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$772.00	$965.00	$530.75–$912.89	—	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC	$586.40	$733.00	$111.66–$689.02	69% above	20%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC	$586.40	$733.00	$403.15–$693.42	—	20%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RAD EXAM TIBIA FIBULA 2 VWS	$338.40	$423.00	$92.45–$397.62	59% above	20%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RAD EXAM TIBIA FIBULA 2 VWS	$338.40	$423.00	$232.65–$400.16	—	20%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD WO CONTRAST	$2,936.00	$3,670.00	$253.81–$3,449.80	38% above	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WO CONTRAST	$2,936.00	$3,670.00	$2,018.50–$3,471.82	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JT WO CONTRAST	$3,237.60	$4,047.00	$253.81–$3,804.18	64% above	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JT WO CONTRAST	$3,237.60	$4,047.00	$2,225.85–$3,828.46	—	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	$3,895.20	$4,869.00	$374.99–$4,576.86	52% 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	$3,895.20	$4,869.00	$2,677.95–$4,606.07	—	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$3,083.20	$3,854.00	$253.81–$3,622.76	44% above	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$3,083.20	$3,854.00	$2,119.70–$3,645.88	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO THEN W CONT	$4,098.40	$5,123.00	$374.99–$4,815.62	39% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO THEN W CONT	$4,098.40	$5,123.00	$2,817.65–$4,846.36	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$3,083.20	$3,854.00	$253.81–$3,622.76	48% above	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$3,083.20	$3,854.00	$2,119.70–$3,645.88	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO THEN W CONT	$4,214.40	$5,268.00	$374.99–$4,951.92	45% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO THEN W CONT	$4,214.40	$5,268.00	$2,897.40–$4,983.53	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST	$3,237.60	$4,047.00	$253.81–$3,804.18	59% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST	$3,237.60	$4,047.00	$2,225.85–$3,828.46	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE WO THEN W CONT	$4,217.60	$5,272.00	$374.99–$4,955.68	59% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE WO THEN W CONT	$4,217.60	$5,272.00	$2,899.60–$4,987.31	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST	$3,237.60	$4,047.00	$253.81–$3,804.18	57% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST	$3,237.60	$4,047.00	$2,225.85–$3,828.46	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE WO THEN W CONT	$4,304.00	$5,380.00	$374.99–$5,057.20	72% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE WO THEN W CONT	$4,304.00	$5,380.00	$2,959.00–$5,089.48	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE WO CONTRAST	$3,237.60	$4,047.00	$253.81–$3,804.18	61% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE WO CONTRAST	$3,237.60	$4,047.00	$2,225.85–$3,828.46	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO THEN W CONT	$4,303.20	$5,379.00	$374.99–$5,056.26	62% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO THEN W CONT	$4,303.20	$5,379.00	$2,958.45–$5,088.53	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$3,237.60	$4,047.00	$253.81–$3,804.18	53% above	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$3,237.60	$4,047.00	$2,225.85–$3,828.46	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT WO CONTRAST	$3,237.60	$4,047.00	$253.81–$3,804.18	53% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT WO CONTRAST	$3,237.60	$4,047.00	$2,225.85–$3,828.46	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RAD EXAM SPINE CERV 4 OR 5 VWS	$536.00	$670.00	$111.66–$629.80	72% above	20%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RAD EXAM SPINE CERV 4 OR 5 VWS	$536.00	$670.00	$368.50–$633.82	—	20%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W CONTRAST	$2,384.80	$2,981.00	$186.92–$2,802.14	75% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W CONTRAST	$2,384.80	$2,981.00	$1,639.55–$2,820.03	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK WO CON	$2,055.20	$2,569.00	$111.66–$2,414.86	80% above	20%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK WO CON	$2,055.20	$2,569.00	$1,412.95–$2,430.27	—	20%
Neck soft tissue X-ray CPT 70360 RAD EXAM NECK SOFT TISSUE	$329.60	$412.00	$92.45–$387.28	87% above	20%
Neck soft tissue X-ray inpatient CPT 70360 RAD EXAM NECK SOFT TISSUE	$329.60	$412.00	$226.60–$389.75	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$4,744.80	$5,931.00	$1,370.75–$5,575.14	74% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$4,744.80	$5,931.00	$3,262.05–$5,610.73	—	20%
Pelvic CT scan without contrast CPT 72192 CT PELVIS WO CONTRAST	$1,952.80	$2,441.00	$111.66–$2,294.54	48% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CONTRAST	$1,952.80	$2,441.00	$1,342.55–$2,309.19	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$586.40	$733.00	$111.66–$689.02	74% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$586.40	$733.00	$403.15–$693.42	—	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$819.20	$1,024.00	$111.66–$962.56	67% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$819.20	$1,024.00	$563.20–$968.70	—	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG UTR 2-3TRI SGL 1ST	$920.80	$1,151.00	$111.66–$1,081.94	83% above	20%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG UTR 2-3TRI SGL 1ST	$920.80	$1,151.00	$633.05–$1,088.85	—	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTER 1ST TRI SGL	$792.80	$991.00	$111.66–$931.54	84% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTER 1ST TRI SGL	$792.80	$991.00	$545.05–$937.49	—	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB REAL TIME LTD	$587.20	$734.00	$111.66–$689.96	75% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB REAL TIME LTD	$587.20	$734.00	$403.70–$694.36	—	20%
Rib X-ray, one side, 2 views one side CPT 71100 RAD EXAM RIBS UNILAT 2 VWS	$368.80	$461.00	$92.45–$433.34	81% above	20%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RAD EXAM RIBS UNILAT 2 VWS	$368.80	$461.00	$253.55–$436.11	—	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	$511.20	$639.00	$111.66–$600.66	76% 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	$511.20	$639.00	$351.45–$604.49	—	20%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$428.80	$536.00	$165.00–$503.84	—	20%
Screening mammogram, both breasts one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$480.80	$601.00	$165.00–$564.94	46% above	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$428.80	$536.00	$294.80–$507.06	—	20%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$480.80	$601.00	$330.55–$568.55	—	20%
Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$384.00	$480.00	$92.45–$451.20	63% above	20%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$384.00	$480.00	$264.00–$454.08	—	20%
Sinus X-ray, complete, 3 or more views CPT 70220 RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS	$433.60	$542.00	$92.45–$509.48	86% above	20%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS	$433.60	$542.00	$298.10–$512.73	—	20%
Skull X-ray, fewer than 4 views CPT 70250 RAD EXAM SKULL < 4 VWS	$410.40	$513.00	$111.66–$482.22	83% above	20%
Skull X-ray, fewer than 4 views inpatient CPT 70250 RAD EXAM SKULL < 4 VWS	$410.40	$513.00	$282.15–$485.30	—	20%
Sleep study in a lab (polysomnography) CPT 95810 PSG 4+ PARAMETERS	$4,175.20	$5,219.00	$1,068.26–$4,905.86	36% above	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4+ PARAMETERS	$4,175.20	$5,219.00	$2,870.45–$4,937.17	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$698.40	$873.00	$186.92–$820.62	91% above	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$698.40	$873.00	$480.15–$825.86	—	20%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 RAD EXAM FEMUR MIN 2 VWS	$329.60	$412.00	$92.45–$387.28	45% above	20%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RAD EXAM FEMUR MIN 2 VWS	$329.60	$412.00	$226.60–$389.75	—	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE WO CONT	$2,437.60	$3,047.00	$111.66–$2,864.18	82% above	20%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE WO CONT	$2,437.60	$3,047.00	$1,675.85–$2,882.46	—	20%
Toe X-ray, 2 or more views CPT 73660 RAD EXAM TOES MIN 2 VWS	$305.60	$382.00	$92.45–$359.08	65% above	20%
Toe X-ray, 2 or more views inpatient CPT 73660 RAD EXAM TOES MIN 2 VWS	$305.60	$382.00	$210.10–$361.37	—	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$742.40	$928.00	$111.66–$872.32	86% above	20%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$742.40	$928.00	$510.40–$877.89	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG	$656.80	$821.00	$111.66–$771.74	85% above	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PG UTR TRANSVAG	$656.80	$821.00	$451.55–$776.67	—	20%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$1,004.00	$1,255.00	$111.66–$1,179.70	66% above	20%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$1,004.00	$1,255.00	$690.25–$1,187.23	—	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$779.20	$974.00	$111.66–$915.56	73% above	20%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$779.20	$974.00	$535.70–$921.40	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$772.00	$965.00	$111.66–$907.10	77% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$772.00	$965.00	$530.75–$912.89	—	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	$910.40	$1,138.00	$186.92–$1,069.72	132% 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	$910.40	$1,138.00	$625.90–$1,076.55	—	20%
Upper arm X-ray (humerus), 2 views CPT 73060 RAD EXAM HUMERUS MIN 2 VWS	$338.40	$423.00	$92.45–$397.62	59% above	20%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RAD EXAM HUMERUS MIN 2 VWS	$338.40	$423.00	$232.65–$400.16	—	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$920.80	$1,151.00	$111.66–$1,081.94	70% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$920.80	$1,151.00	$633.05–$1,088.85	—	20%
Wrist X-ray, 2 views CPT 73100 RAD EXAM WRIST 2 VWS	$294.40	$368.00	$89.09–$345.92	49% above	20%
Wrist X-ray, 2 views inpatient CPT 73100 RAD EXAM WRIST 2 VWS	$294.40	$368.00	$202.40–$348.13	—	20%
Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$368.80	$461.00	$92.45–$433.34	59% above	20%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$368.80	$461.00	$253.55–$436.11	—	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	$362.40	$453.00	$92.45–$425.82	31% 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	$362.40	$453.00	$249.15–$428.54	—	20%
X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW	$329.60	$412.00	$92.45–$387.28	56% above	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN 1 VW	$329.60	$412.00	$226.60–$389.75	—	20%
X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VWS	$313.60	$392.00	$92.45–$368.48	53% above	20%
X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VWS	$313.60	$392.00	$215.60–$370.83	—	20%
X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$315.20	$394.00	$92.45–$370.36	62% above	20%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$315.20	$394.00	$216.70–$372.72	—	20%
X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS	$313.60	$392.00	$92.45–$368.48	64% above	20%
X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VWS	$313.60	$392.00	$215.60–$370.83	—	20%
X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT MIN 3 VWS	$368.80	$461.00	$92.45–$433.34	67% above	20%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT MIN 3 VWS	$368.80	$461.00	$253.55–$436.11	—	20%
X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND MIN 3 VWS	$368.80	$461.00	$92.45–$433.34	67% above	20%
X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND MIN 3 VWS	$368.80	$461.00	$253.55–$436.11	—	20%
X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$329.60	$412.00	$92.45–$387.28	52% above	20%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$329.60	$412.00	$226.60–$389.75	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$425.60	$532.00	$111.66–$500.08	65% 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	$425.60	$532.00	$292.60–$503.27	—	20%
X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$551.20	$689.00	$111.66–$647.66	66% above	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$551.20	$689.00	$378.95–$651.79	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS	$382.40	$478.00	$111.66–$449.32	63% above	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THOR 2 VWS	$382.40	$478.00	$262.90–$452.19	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$368.80	$461.00	$92.45–$433.34	69% above	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$368.80	$461.00	$253.55–$436.11	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$382.40	$478.00	$92.45–$449.32	55% above	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$382.40	$478.00	$262.90–$452.19	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$376.80	$471.00	$111.66–$442.74	70% above	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$376.80	$471.00	$259.05–$445.57	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$359.20	$449.00	$92.45–$422.06	62% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$359.20	$449.00	$246.95–$424.75	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH SO 82024.900	$191.20	$239.00	$57.86–$224.66	80% above	20%
ACTH blood test inpatient CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH SO 82024.900	$191.20	$239.00	$131.45–$226.09	—	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$74.40	$93.00	$22.52–$87.42	52% above	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$74.40	$93.00	$51.15–$87.98	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450	$69.60	$87.00	$21.06–$81.78	40% above	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST 84450	$69.60	$87.00	$47.85–$82.30	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL 80074	$342.40	$428.00	$103.62–$402.32	47% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL 80074	$342.40	$428.00	$235.40–$404.89	—	20%
Albumin blood test CPT 82040 ALBUMIN SERUM 82040	$47.20	$59.00	$14.28–$55.46	66% above	20%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM 82040	$47.20	$59.00	$32.45–$55.81	—	20%
Aldosterone blood test CPT 82088 ALDOSTERONE ACT RATIO 82088.903	$104.80	$131.00	$31.72–$123.14	49% above	20%
Aldosterone blood test CPT 82088 ALDOSTERONE SO 82088.901	$195.20	$244.00	$59.07–$229.36	177% above	20%
Aldosterone blood test CPT 82088 ALDOSTERONE SERUM SO 82088.902	$293.60	$367.00	$88.85–$344.98	317% above	20%
Aldosterone blood test CPT 82088 ALDOSTERONE 24 HR URINE 82088.900	$293.60	$367.00	$88.85–$344.98	317% above	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE ACT RATIO 82088.903	$104.80	$131.00	$72.05–$123.93	—	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SO 82088.901	$195.20	$244.00	$134.20–$230.82	—	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE 24 HR URINE 82088.900	$293.60	$367.00	$201.85–$347.18	—	20%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SERUM SO 82088.902	$293.60	$367.00	$201.85–$347.18	—	20%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE FOR ISOENZYMES 84075.900	$32.00	$40.00	$9.68–$37.60	17% below	20%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE ALKALINE 84075	$50.40	$63.00	$15.25–$59.22	30% above	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE FOR ISOENZYMES 84075.900	$32.00	$40.00	$22.00–$37.84	—	20%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE ALKALINE 84075	$50.40	$63.00	$34.65–$59.60	—	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG MACADAMIA NUT SO 86003.926	$15.20	$19.00	$4.60–$17.86	27% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG BASIL SO 86003.948	$15.20	$19.00	$4.60–$17.86	27% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG GREEN BEAN SO 86003.913	$15.20	$19.00	$4.60–$17.86	27% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ON PANEL 86003	$25.60	$32.00	$7.75–$30.08	23% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$38.40	$48.00	$11.62–$45.12	85% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG WALLEYE SO 86003.944	$54.40	$68.00	$16.46–$63.92	162% above	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG GREEN BEAN SO 86003.913	$15.20	$19.00	$10.45–$17.97	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG MACADAMIA NUT SO 86003.926	$15.20	$19.00	$10.45–$17.97	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG BASIL SO 86003.948	$15.20	$19.00	$10.45–$17.97	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ON PANEL 86003	$25.60	$32.00	$17.60–$30.27	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$38.40	$48.00	$26.40–$45.41	—	20%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG WALLEYE SO 86003.944	$54.40	$68.00	$37.40–$64.33	—	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 MATERNAL AFP SO 82105.900	$124.80	$156.00	$37.77–$146.64	159% above	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM 82105	$155.20	$194.00	$46.97–$182.36	223% above	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 MATERNAL AFP SO 82105.900	$124.80	$156.00	$85.80–$147.58	—	20%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM 82105	$155.20	$194.00	$106.70–$183.52	—	20%
Ammonia blood test CPT 82140 AMMONIA 82140.901	$38.40	$48.00	$11.62–$45.12	58% below	20%
Ammonia blood test CPT 82140 AMMONIA 82140	$251.20	$314.00	$76.02–$295.16	178% above	20%
Ammonia blood test inpatient CPT 82140 AMMONIA 82140.901	$38.40	$48.00	$26.40–$45.41	—	20%
Ammonia blood test inpatient CPT 82140 AMMONIA 82140	$251.20	$314.00	$172.70–$297.04	—	20%
Amylase blood test CPT 82150 AMYLASE 82150	$67.20	$84.00	$20.34–$78.96	2% above	20%
Amylase blood test inpatient CPT 82150 AMYLASE 82150	$67.20	$84.00	$46.20–$79.46	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$133.60	$167.00	$40.43–$156.98	135% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$133.60	$167.00	$91.85–$157.98	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$121.60	$152.00	$36.80–$142.88	136% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$121.60	$152.00	$83.60–$143.79	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE 83880	$218.40	$273.00	$66.09–$256.62	36% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE 83880	$218.40	$273.00	$150.15–$258.26	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE: BACT RESPITOR 87070	$76.80	$96.00	$23.24–$90.24	10% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE: BACT OTHER 87070	$99.20	$124.00	$30.02–$116.56	42% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE: BACT RESPITOR 87070	$76.80	$96.00	$52.80–$90.82	—	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE: BACT OTHER 87070	$99.20	$124.00	$68.20–$117.30	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL 80048	$120.80	$151.00	$57.75–$141.94	21% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL 80048	$120.80	$151.00	$83.05–$142.85	—	20%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL 82247	$52.00	$65.00	$15.74–$61.10	6% above	20%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL 82247	$52.00	$65.00	$35.75–$61.49	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PROSTATE BIOPSY 88305.05	$115.20	$144.00	$65.66–$159.50	17% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV 88305	$115.20	$144.00	$65.66–$159.50	17% below	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV 88305	$115.20	$144.00	$79.20–$136.22	—	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PROSTATE BIOPSY 88305.05	$115.20	$144.00	$79.20–$136.22	—	20%
Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$133.60	$167.00	$40.43–$156.98	12% above	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$133.60	$167.00	$91.85–$157.98	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE 36415	$26.40	$33.00	$15.05–$38.50	23% above	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE 36415	$26.40	$33.00	$18.15–$31.22	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$47.20	$59.00	$14.28–$55.46	3% above	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$47.20	$59.00	$32.45–$55.81	—	20%
Blood lead test CPT 83655 HEAVY METAL SCREEN LEAD 83655.902	$30.40	$38.00	$9.20–$35.72	34% below	20%
Blood lead test CPT 83655 LEAD BLOOD VENOUS 83655.904	$31.20	$39.00	$9.44–$36.66	32% below	20%
Blood lead test CPT 83655 LEAD BLOOD CAPILLARY 83655.905	$31.20	$39.00	$9.44–$36.66	32% below	20%
Blood lead test CPT 83655 LEAD 83655	$122.40	$153.00	$37.04–$143.82	165% above	20%
Blood lead test inpatient CPT 83655 HEAVY METAL SCREEN LEAD 83655.902	$30.40	$38.00	$20.90–$35.95	—	20%
Blood lead test inpatient CPT 83655 LEAD BLOOD CAPILLARY 83655.905	$31.20	$39.00	$21.45–$36.89	—	20%
Blood lead test inpatient CPT 83655 LEAD BLOOD VENOUS 83655.904	$31.20	$39.00	$21.45–$36.89	—	20%
Blood lead test inpatient CPT 83655 LEAD 83655	$122.40	$153.00	$84.15–$144.74	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL 84703	$68.80	$86.00	$20.82–$80.84	4% below	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL 84703	$68.80	$86.00	$47.30–$81.36	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$72.00	$90.00	$21.79–$84.60	35% above	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$72.00	$90.00	$49.50–$85.14	—	20%
Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN QUANTITATIVE 84520	$47.20	$59.00	$14.28–$55.46	3% above	20%
Blood urea nitrogen (BUN) test CPT 84520 POST BUN	$52.00	$65.00	$15.74–$61.10	13% above	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN QUANTITATIVE 84520	$47.20	$59.00	$32.45–$55.81	—	20%
Blood urea nitrogen (BUN) test inpatient CPT 84520 POST BUN	$52.00	$65.00	$35.75–$61.49	—	20%
C-peptide blood test CPT 84681 ASSAY OF C PEPTIDE 84681	$178.40	$223.00	$53.99–$209.62	117% above	20%
C-peptide blood test inpatient CPT 84681 ASSAY OF C PEPTIDE 84681	$178.40	$223.00	$122.65–$210.96	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN QUANT 86140	$67.20	$84.00	$20.34–$78.96	9% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN QUANT 86140	$67.20	$84.00	$46.20–$79.46	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$202.40	$253.00	$61.25–$237.82	49% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$202.40	$253.00	$139.15–$239.34	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$101.60	$127.00	$30.75–$119.38	at median	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$101.60	$127.00	$69.85–$120.14	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR CA 125 86304	$101.60	$127.00	$30.75–$119.38	at median	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CDMR CA 125 86304	$101.60	$127.00	$69.85–$120.14	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$124.80	$156.00	$66.00–$146.64	4% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$124.80	$156.00	$85.80–$147.58	—	20%
Calcium blood test, total CPT 82310 CALCIUM TOTAL 82310	$52.00	$65.00	$15.74–$61.10	9% above	20%
Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL 82310	$52.00	$65.00	$35.75–$61.49	—	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CDMR CARCINOEMBRYONIC ANTIGEN (CEA) 82378	$100.00	$125.00	$30.26–$117.50	at median	20%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CDMR CARCINOEMBRYONIC ANTIGEN (CEA) 82378	$100.00	$125.00	$68.75–$118.25	—	20%
Chickenpox (varicella) immunity blood test CPT 86787 ANTIBODY VARICELLA-ZOSTER 86787	$60.00	$75.00	$18.16–$70.50	10% above	20%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 ANTIBODY VARICELLA-ZOSTER 86787	$60.00	$75.00	$41.25–$70.95	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$114.40	$143.00	$34.62–$134.42	20% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$171.20	$214.00	$51.81–$201.16	80% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$172.00	$215.00	$52.05–$202.10	81% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$114.40	$143.00	$78.65–$135.28	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$171.20	$214.00	$117.70–$202.44	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$172.00	$215.00	$118.25–$203.39	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 80061	$100.00	$125.00	$46.75–$117.50	6% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 80061	$100.00	$125.00	$68.75–$118.25	—	20%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$119.20	$149.00	$41.25–$140.06	40% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$119.20	$149.00	$81.95–$140.95	—	20%
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$84.00	$105.00	$25.42–$98.70	17% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$84.00	$105.00	$57.75–$99.33	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$180.80	$226.00	$74.25–$212.44	68% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$180.80	$226.00	$124.30–$213.80	—	20%
Cortisol blood test, total CPT 82533 CORTISOL SALIVA 82533.900	$47.20	$59.00	$14.28–$55.46	26% below	20%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL 82533	$69.60	$87.00	$21.06–$81.78	9% above	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL SALIVA 82533.900	$47.20	$59.00	$32.45–$55.81	—	20%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL 82533	$69.60	$87.00	$47.85–$82.30	—	20%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE (CK) (CPK) TOTAL 82550.900	$31.20	$39.00	$9.44–$36.66	47% below	20%
Creatine kinase (CK) blood test, total CPT 82550 CPK 82550	$72.80	$91.00	$22.03–$85.54	23% above	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE (CK) (CPK) TOTAL 82550.900	$31.20	$39.00	$21.45–$36.89	—	20%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK 82550	$72.80	$91.00	$50.05–$86.09	—	20%
Creatinine blood test CPT 82565 CREATININE BLOOD 82565	$52.00	$65.00	$15.74–$61.10	1% above	20%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD 82565	$52.00	$65.00	$35.75–$61.49	—	20%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG AB 86644	$71.20	$89.00	$21.55–$83.66	12% above	20%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG AB 86644	$71.20	$89.00	$48.95–$84.19	—	20%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$115.20	$144.00	$34.86–$135.36	11% above	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$115.20	$144.00	$79.20–$136.22	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE 82627	$197.60	$247.00	$59.80–$232.18	242% above	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE 82627	$197.60	$247.00	$135.85–$233.66	—	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 COMPLIANCE UR DRUG SCR 80307	$108.80	$136.00	$32.93–$127.84	52% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ACETAMINOPHEN 80307	$116.80	$146.00	$35.35–$137.24	63% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 COMPLIANCE DRUG SCREEN 80307.904	$150.40	$188.00	$45.51–$176.72	110% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUGS OF ABUSE SCREEN MECONIUM 80307.905	$175.20	$219.00	$53.02–$205.86	144% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRESUMPTIVE, ANY NUMBER INSTRUMENT CHEM ANALYZER, PER DOS 80307	$178.40	$223.00	$53.99–$209.62	149% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 SALICYLATE 80307	$179.20	$224.00	$54.23–$210.56	150% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PRESUMP CHEM ANALYZER 80307	$191.20	$239.00	$57.86–$224.66	167% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 PAIN CLINIC SURVEY WITH REFLEX 80307	$320.00	$400.00	$96.84–$376.00	346% above	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COMPLIANCE UR DRUG SCR 80307	$108.80	$136.00	$74.80–$128.66	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ACETAMINOPHEN 80307	$116.80	$146.00	$80.30–$138.12	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COMPLIANCE DRUG SCREEN 80307.904	$150.40	$188.00	$103.40–$177.85	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUGS OF ABUSE SCREEN MECONIUM 80307.905	$175.20	$219.00	$120.45–$207.17	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRESUMPTIVE, ANY NUMBER INSTRUMENT CHEM ANALYZER, PER DOS 80307	$178.40	$223.00	$122.65–$210.96	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 SALICYLATE 80307	$179.20	$224.00	$123.20–$211.90	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PRESUMP CHEM ANALYZER 80307	$191.20	$239.00	$131.45–$226.09	—	20%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 PAIN CLINIC SURVEY WITH REFLEX 80307	$320.00	$400.00	$220.00–$378.40	—	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL 80051	$109.60	$137.00	$33.17–$128.78	42% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL 80051	$109.60	$137.00	$75.35–$129.60	—	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 86665	$96.80	$121.00	$29.29–$113.74	87% above	20%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 86665	$96.80	$121.00	$66.55–$114.47	—	20%
Estradiol blood test CPT 82670 ESTRADIOL TOTAL 82670	$186.40	$233.00	$56.41–$219.02	181% above	20%
Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL 82670	$186.40	$233.00	$128.15–$220.42	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$132.80	$166.00	$40.19–$156.04	60% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$132.80	$166.00	$91.30–$157.04	—	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN 83993	$66.40	$83.00	$20.09–$78.02	24% below	20%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN 83993	$66.40	$83.00	$45.65–$78.52	—	20%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN 82728	$133.60	$167.00	$40.43–$156.98	40% above	20%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN 82728	$133.60	$167.00	$91.85–$157.98	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE 82746	$140.00	$175.00	$42.37–$164.50	64% above	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE 82746	$140.00	$175.00	$96.25–$165.55	—	20%
Free T3 thyroid hormone test CPT 84481 T3 FREE 84481	$358.40	$448.00	$108.46–$421.12	238% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE 84481	$358.40	$448.00	$246.40–$423.81	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE 84439	$87.20	$109.00	$26.39–$102.46	27% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE 84439	$87.20	$109.00	$59.95–$103.11	—	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$66.40	$83.00	$20.09–$78.02	5% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$66.40	$83.00	$45.65–$78.52	—	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA GGT 82977	$46.40	$58.00	$14.04–$54.52	at median	20%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA GGT 82977	$46.40	$58.00	$31.90–$54.87	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$404.80	$506.00	$122.50–$475.64	61% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$404.80	$506.00	$278.30–$478.68	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$50.40	$63.00	$15.25–$59.22	17% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$50.40	$63.00	$34.65–$59.60	—	20%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$166.40	$208.00	$50.36–$195.52	64% above	20%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$166.40	$208.00	$114.40–$196.77	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE OCULAR PERITONEAL NAA 87591.900	$86.40	$108.00	$26.15–$101.52	at median	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$91.20	$114.00	$27.60–$107.16	6% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$108.00	$135.00	$32.68–$126.90	25% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE OCULAR PERITONEAL NAA 87591.900	$86.40	$108.00	$59.40–$102.17	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$91.20	$114.00	$62.70–$107.84	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$108.00	$135.00	$74.25–$127.71	—	20%
H. pylori antibody blood test CPT 86677 H PYLORI IGG 86677	$184.00	$230.00	$55.68–$216.20	40% above	20%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGG 86677	$184.00	$230.00	$126.50–$217.58	—	20%
H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL 87338	$176.80	$221.00	$53.50–$207.74	62% above	20%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG STOOL 87338	$176.80	$221.00	$121.55–$209.07	—	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA PCR QNT 87536	$427.20	$534.00	$129.28–$501.96	272% above	20%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA PCR QNT 87536	$427.20	$534.00	$293.70–$505.16	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$106.40	$133.00	$32.20–$125.02	38% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$106.40	$133.00	$73.15–$125.82	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV MRNA E6E7 VAGINAL REFLEX HPV 16/18/45 87624.901	$106.40	$133.00	$32.20–$125.02	16% below	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$142.40	$178.00	$43.09–$167.32	13% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV MRNA E6E7 VAGINAL REFLEX HPV 16/18/45 87624.901	$106.40	$133.00	$73.15–$125.82	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$142.40	$178.00	$97.90–$168.39	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$87.20	$109.00	$38.50–$102.46	37% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$87.20	$109.00	$59.95–$103.11	—	20%
Hemoglobin blood test CPT 85018 BLOOD COUNT HEMOGLOBIN 85018	$40.00	$50.00	$12.11–$47.00	17% above	20%
Hemoglobin blood test inpatient CPT 85018 BLOOD COUNT HEMOGLOBIN 85018	$40.00	$50.00	$27.50–$47.30	—	20%
Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL 86704	$95.20	$119.00	$28.81–$111.86	35% above	20%
Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL 86704	$95.20	$119.00	$65.45–$112.57	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$95.20	$119.00	$28.81–$111.86	32% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$95.20	$119.00	$65.45–$112.57	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$92.00	$115.00	$27.84–$108.10	55% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$92.00	$115.00	$63.25–$108.79	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY 86803	$144.80	$181.00	$43.82–$170.14	51% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY 86803	$144.80	$181.00	$99.55–$171.23	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$455.20	$569.00	$137.75–$534.86	254% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$455.20	$569.00	$312.95–$538.27	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$88.00	$110.00	$26.63–$103.40	85% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$88.00	$110.00	$60.50–$104.06	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$88.00	$110.00	$26.63–$103.40	53% above	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$88.00	$110.00	$60.50–$104.06	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$130.40	$163.00	$39.46–$153.22	76% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$130.40	$163.00	$89.65–$154.20	—	20%
Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE 83090	$96.00	$120.00	$29.05–$112.80	2% above	20%
Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE 83090	$96.00	$120.00	$66.00–$113.52	—	20%
Insulin blood test CPT 83525 INSULIN LEVEL 83525	$95.20	$119.00	$28.81–$111.86	70% above	20%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL 83525	$95.20	$119.00	$65.45–$112.57	—	20%
Iron blood test (serum iron) CPT 83540 IRON 83540	$84.00	$105.00	$25.42–$98.70	62% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON 83540	$84.00	$105.00	$57.75–$99.33	—	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY 83550	$105.60	$132.00	$31.96–$124.08	59% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY 83550	$105.60	$132.00	$72.60–$124.87	—	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL 80069	$137.60	$172.00	$41.64–$161.68	30% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL 80069	$137.60	$172.00	$94.60–$162.71	—	20%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$131.20	$164.00	$39.70–$154.16	58% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$131.20	$164.00	$90.20–$155.14	—	20%
Lactate (lactic acid) blood test CPT 83605 LACTATE (LACTIC ACID) 83605	$57.60	$72.00	$17.43–$67.68	31% below	20%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE (LACTIC ACID) 83605	$57.60	$72.00	$39.60–$68.11	—	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE (LD) (LDH) 83615	$66.40	$83.00	$20.09–$78.02	38% above	20%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE (LD) (LDH) 83615	$66.40	$83.00	$45.65–$78.52	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE 83690	$107.20	$134.00	$32.44–$125.96	60% above	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE 83690	$107.20	$134.00	$73.70–$126.76	—	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL 80076	$114.40	$143.00	$34.62–$134.42	12% above	20%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL 80076	$114.40	$143.00	$78.65–$135.28	—	20%
Lyme disease antibody test CPT 86618 LYMES TOTAL 86618	$155.20	$194.00	$46.97–$182.36	123% above	20%
Lyme disease antibody test CPT 86618 LYMES IGG IGM 86618	$171.20	$214.00	$51.81–$201.16	146% above	20%
Lyme disease antibody test inpatient CPT 86618 LYMES TOTAL 86618	$155.20	$194.00	$106.70–$183.52	—	20%
Lyme disease antibody test inpatient CPT 86618 LYMES IGG IGM 86618	$171.20	$214.00	$117.70–$202.44	—	20%
Magnesium blood test CPT 83735 MAGNESIUM 83735.903	$20.80	$26.00	$6.29–$24.44	50% below	20%
Magnesium blood test CPT 83735 MAGNESIUM 83735	$80.00	$100.00	$24.21–$94.00	90% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM 83735.903	$20.80	$26.00	$14.30–$24.60	—	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM 83735	$80.00	$100.00	$55.00–$94.60	—	20%
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA 86765	$72.00	$90.00	$21.79–$84.60	79% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA 86765	$72.00	$90.00	$49.50–$85.14	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN 86308	$67.20	$84.00	$20.34–$78.96	24% above	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN 86308	$67.20	$84.00	$46.20–$79.46	—	20%
Mumps immunity blood test CPT 86735 ANTIBODY MUMPS 86735	$71.20	$89.00	$21.55–$83.66	42% above	20%
Mumps immunity blood test inpatient CPT 86735 ANTIBODY MUMPS 86735	$71.20	$89.00	$48.95–$84.19	—	20%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL 80055	$184.00	$230.00	$55.68–$216.20	34% below	20%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL 80055	$184.00	$230.00	$126.50–$217.58	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE 84154	$111.20	$139.00	$33.65–$130.66	93% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE 84154	$111.20	$139.00	$76.45–$131.49	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$89.60	$112.00	$27.12–$105.28	at median	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$89.60	$112.00	$61.60–$105.95	—	20%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO CERV THN AUTO 88175	$116.80	$146.00	$35.35–$137.24	37% above	20%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO CERV THN AUTO 88175	$116.80	$146.00	$80.30–$138.12	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT 83970	$276.00	$345.00	$83.52–$324.30	130% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT 83970	$276.00	$345.00	$189.75–$326.37	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$88.00	$110.00	$26.63–$103.40	36% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$88.00	$110.00	$60.50–$104.06	—	20%
Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS INORGANIC 84100	$56.80	$71.00	$17.19–$66.74	47% above	20%
Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS INORGANIC 84100	$56.80	$71.00	$39.05–$67.17	—	20%
Potassium blood test CPT 84132 POTASSIUM SERUM 84132	$48.80	$61.00	$14.77–$57.34	10% above	20%
Potassium blood test inpatient CPT 84132 POTASSIUM SERUM 84132	$48.80	$61.00	$33.55–$57.71	—	20%
Progesterone blood test CPT 84144 PROGESTERONE 84144	$124.00	$155.00	$37.53–$145.70	46% above	20%
Progesterone blood test inpatient CPT 84144 PROGESTERONE 84144	$124.00	$155.00	$85.25–$146.63	—	20%
Prolactin blood test CPT 84146 MACROPROLACTIN 84146.900	$48.80	$61.00	$14.77–$57.34	47% below	20%
Prolactin blood test CPT 84146 PROLACTIN 84146	$146.40	$183.00	$44.30–$172.02	59% above	20%
Prolactin blood test inpatient CPT 84146 MACROPROLACTIN 84146.900	$48.80	$61.00	$33.55–$57.71	—	20%
Prolactin blood test inpatient CPT 84146 PROLACTIN 84146	$146.40	$183.00	$100.65–$173.12	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME - PROTIME CLINIC 85610	$83.20	$104.00	$25.18–$97.76	151% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME 85610	$83.20	$104.00	$25.18–$97.76	151% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME 85610	$83.20	$104.00	$57.20–$98.38	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME - PROTIME CLINIC 85610	$83.20	$104.00	$57.20–$98.38	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$58.40	$73.00	$17.67–$68.62	at median	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$58.40	$73.00	$40.15–$69.06	—	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A B DIRECT 87804	$60.80	$76.00	$18.40–$71.44	at median	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A B DIRECT 87804	$60.80	$76.00	$41.80–$71.90	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RPD GROUP A STREP SCREEN 87880	$46.40	$58.00	$14.04–$54.52	15% below	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RPD GROUP A STREP SCREEN 87880	$46.40	$58.00	$31.90–$54.87	—	20%
Renin blood test CPT 84244 RENIN ACTIVITY 84244.901	$53.60	$67.00	$16.22–$62.98	15% above	20%
Renin blood test CPT 84244 RENIN ACT RATIO 84244.900	$56.00	$70.00	$16.95–$65.80	20% above	20%
Renin blood test CPT 84244 RENIN 84244	$107.20	$134.00	$32.44–$125.96	129% above	20%
Renin blood test inpatient CPT 84244 RENIN ACTIVITY 84244.901	$53.60	$67.00	$36.85–$63.38	—	20%
Renin blood test inpatient CPT 84244 RENIN ACT RATIO 84244.900	$56.00	$70.00	$38.50–$66.22	—	20%
Renin blood test inpatient CPT 84244 RENIN 84244	$107.20	$134.00	$73.70–$126.76	—	20%
Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH (D) 86901	$58.40	$73.00	$17.67–$68.62	35% above	20%
Rh blood typing inpatient CPT 86901 BLOOD TYPING SEROLOGIC RH (D) 86901	$58.40	$73.00	$40.15–$69.06	—	20%
Rheumatoid factor (RF) test CPT 86431 RA FACTOR QUANT 86431	$40.80	$51.00	$12.35–$47.94	17% below	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT 86431	$71.20	$89.00	$21.55–$83.66	45% above	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RA FACTOR QUANT 86431	$40.80	$51.00	$28.05–$48.25	—	20%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT 86431	$71.20	$89.00	$48.95–$84.19	—	20%
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA 86762	$50.40	$63.00	$15.25–$59.22	5% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA 86762	$50.40	$63.00	$34.65–$59.60	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$59.20	$74.00	$17.92–$69.56	54% above	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$59.20	$74.00	$40.70–$70.00	—	20%
Sodium blood test CPT 84295 SODIUM SERUM 84295	$50.40	$63.00	$15.25–$59.22	11% above	20%
Sodium blood test inpatient CPT 84295 SODIUM SERUM 84295	$50.40	$63.00	$34.65–$59.60	—	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES 87177	$60.80	$76.00	$18.40–$71.44	33% above	20%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES 87177	$60.80	$76.00	$41.80–$71.90	—	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$52.80	$66.00	$15.98–$62.04	50% above	20%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$52.80	$66.00	$36.30–$62.44	—	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$57.60	$72.00	$17.43–$67.68	at median	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR OCCULT BLOOD CRC SCREEN (FIT IMMUNOCHEMICAL) G0328 82274.006	$57.60	$72.00	$17.43–$67.68	at median	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$57.60	$72.00	$39.60–$68.11	—	20%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR OCCULT BLOOD CRC SCREEN (FIT IMMUNOCHEMICAL) G0328 82274.006	$57.60	$72.00	$39.60–$68.11	—	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM 86780	$72.80	$91.00	$22.03–$85.54	34% above	20%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM 86780	$72.80	$91.00	$50.05–$86.09	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$55.20	$69.00	$16.70–$64.86	68% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$55.20	$69.00	$37.95–$65.27	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$55.20	$69.00	$16.70–$64.86	54% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON GOLD TB TEST	$186.40	$233.00	$56.41–$219.02	56% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$55.20	$69.00	$37.95–$65.27	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON GOLD TB TEST	$186.40	$233.00	$128.15–$220.42	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.904	$63.20	$79.00	$19.13–$74.26	1% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.900	$67.20	$84.00	$20.34–$78.96	5% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$67.20	$84.00	$20.34–$78.96	5% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$172.80	$216.00	$52.29–$203.04	170% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.904	$63.20	$79.00	$43.45–$74.73	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.900	$67.20	$84.00	$46.20–$79.46	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$67.20	$84.00	$46.20–$79.46	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$172.80	$216.00	$118.80–$204.34	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME T1 AB SERUM 86376.900	$54.40	$68.00	$16.46–$63.92	at median	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB ANTI TPO 86376	$104.00	$130.00	$31.47–$122.20	91% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOME T1 AB SERUM 86376.900	$54.40	$68.00	$37.40–$64.33	—	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID AB ANTI TPO 86376	$104.00	$130.00	$71.50–$122.98	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$133.60	$167.00	$49.50–$156.98	42% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$133.60	$167.00	$91.85–$157.98	—	20%
Total IgE blood test CPT 82785 ASSAY OF GAMMAGLOBULIN IGE 82785	$137.60	$172.00	$41.64–$161.68	167% above	20%
Total IgE blood test inpatient CPT 82785 ASSAY OF GAMMAGLOBULIN IGE 82785	$137.60	$172.00	$94.60–$162.71	—	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL CDC LIPOPROTEIN PANEL 82465.900	$31.20	$39.00	$9.44–$36.66	11% below	20%
Total cholesterol blood test CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL 82465	$47.20	$59.00	$14.28–$55.46	35% above	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL TOTAL CDC LIPOPROTEIN PANEL 82465.900	$31.20	$39.00	$21.45–$36.89	—	20%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL 82465	$47.20	$59.00	$32.45–$55.81	—	20%
Total thyroxine (T4) blood test CPT 84436 T4 84436	$68.80	$86.00	$20.82–$80.84	59% above	20%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 84436	$68.80	$86.00	$47.30–$81.36	—	20%
Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL (TRIIODOTHYRON) 84480	$156.80	$196.00	$47.45–$184.24	125% above	20%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL (TRIIODOTHYRON) 84480	$156.80	$196.00	$107.80–$185.42	—	20%
Transferrin blood test CPT 84466 TRANSFERRIN 84466	$62.40	$78.00	$18.88–$73.32	16% below	20%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN 84466	$62.40	$78.00	$42.90–$73.79	—	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES CDC LIPOPROTEIN PANEL 84478.900	$31.20	$39.00	$9.44–$36.66	27% below	20%
Triglycerides blood test CPT 84478 TRIGLYCERIDES 84478	$52.00	$65.00	$15.74–$61.10	21% above	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES CDC LIPOPROTEIN PANEL 84478.900	$31.20	$39.00	$21.45–$36.89	—	20%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES 84478	$52.00	$65.00	$35.75–$61.49	—	20%
Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANTITATIVE 84484	$194.40	$243.00	$58.83–$228.42	90% above	20%
Troponin test, quantitative inpatient CPT 84484 ASSAY OF TROPONIN QUANTITATIVE 84484	$194.40	$243.00	$133.65–$229.88	—	20%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$53.60	$67.00	$16.22–$62.98	17% above	20%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$53.60	$67.00	$36.85–$63.38	—	20%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$56.80	$71.00	$17.19–$66.74	10% above	20%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$56.80	$71.00	$39.05–$67.17	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$28.80	$36.00	$8.72–$33.84	11% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$36.80	$46.00	$11.14–$43.24	42% above	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$28.80	$36.00	$19.80–$34.06	—	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$36.80	$46.00	$25.30–$43.52	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$88.00	$110.00	$26.63–$103.40	48% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$88.00	$110.00	$60.50–$104.06	—	20%
Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE MICROALBUMIN QUANT 82043	$67.20	$84.00	$20.34–$78.96	15% above	20%
Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE MICROALBUMIN QUANT 82043	$67.20	$84.00	$46.20–$79.46	—	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST 81025	$68.80	$86.00	$20.82–$80.84	65% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST 81025	$68.80	$86.00	$47.30–$81.36	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$140.00	$175.00	$42.37–$164.50	58% above	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$140.00	$175.00	$96.25–$165.55	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$96.80	$121.00	$29.29–$113.74	9% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$132.00	$165.00	$39.95–$155.10	24% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$96.80	$121.00	$66.55–$114.47	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$132.00	$165.00	$90.75–$156.09	—	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 CDMR DIHYDROXYVITAMIN D, 1,25 82652.900	$122.40	$153.00	$37.04–$143.82	59% above	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIHYDROXY SER 82652	$312.80	$391.00	$94.66–$367.54	307% above	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 CDMR DIHYDROXYVITAMIN D, 1,25 82652.900	$122.40	$153.00	$84.15–$144.74	—	20%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25-DIHYDROXY SER 82652	$312.80	$391.00	$215.05–$369.89	—	20%
Zinc blood test CPT 84630 ZINC 84630.900	$55.20	$69.00	$16.70–$64.86	83% above	20%
Zinc blood test inpatient CPT 84630 ZINC 84630.900	$55.20	$69.00	$37.95–$65.27	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$162.40	$203.00	$49.15–$190.82	76% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$162.40	$203.00	$111.65–$192.04	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED 92960 CARDIOVERSION ELECTIVE EXTERNAL	$1,224.80	$1,531.00	$370.66–$1,439.14	17% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$1,224.80	$1,531.00	$370.66–$1,439.14	17% above	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED 92960 CARDIOVERSION ELECTIVE EXTERNAL	$1,224.80	$1,531.00	$842.05–$1,448.33	—	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$1,224.80	$1,531.00	$842.05–$1,448.33	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 SURG 52000 CYSTOURETHROSCOPY	$3,423.20	$4,279.00	$700.84–$4,022.26	312% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 SURG 52000 CYSTOURETHROSCOPY	$3,423.20	$4,279.00	$2,353.45–$4,047.93	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 SURG 17000 CRYOTHERAPY X 1 LESION	$219.20	$274.00	$66.34–$257.56	20% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 SURG 17000 CRYOTHERAPY X 1 LESION	$219.20	$274.00	$150.70–$259.20	—	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ED 69209 RMVL IMPACTED CERUMEN IRRIGATION LAVAGE UNI	$264.00	$330.00	$62.37–$310.20	241% above	20%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ED 69209 RMVL IMPACTED CERUMEN IRRIGATION LAVAGE UNI	$264.00	$330.00	$181.50–$312.18	—	20%
Earwax removal with instruments, one ear CPT 69210 ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI	$288.80	$361.00	$62.37–$339.34	134% above	20%
Earwax removal with instruments, one ear inpatient CPT 69210 ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI	$288.80	$361.00	$198.55–$341.51	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 TX RM 58100 BIOPSY ENDOMETRIAL SAMPLING W/O DILATATION	$385.60	$482.00	$116.69–$453.08	55% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 TX RM 58100 BIOPSY ENDOMETRIAL SAMPLING W/O DILATATION	$385.60	$482.00	$265.10–$455.97	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 SURG 46221 LIGATION OF HEMORRHOID(S)	$1,665.60	$2,082.00	$504.05–$1,957.08	104% above	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 SURG 46221 LIGATION OF HEMORRHOID(S)	$1,665.60	$2,082.00	$1,145.10–$1,969.57	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$585.60	$732.00	$177.22–$688.08	105% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 SURG 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$585.60	$732.00	$177.22–$688.08	105% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$585.60	$732.00	$402.60–$692.47	—	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 SURG 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$585.60	$732.00	$402.60–$692.47	—	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 SURG 20550 INJ SINGLE TENDON SHEATH/LIGAMENT APONEUROSIS	$552.00	$690.00	$167.05–$648.60	49% above	20%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 SURG 20550 INJ SINGLE TENDON SHEATH/LIGAMENT APONEUROSIS	$552.00	$690.00	$379.50–$652.74	—	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	$971.20	$1,214.00	$293.91–$1,141.16	169% above	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	$971.20	$1,214.00	$293.91–$1,141.16	169% above	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	$971.20	$1,214.00	$667.70–$1,148.44	—	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	$971.20	$1,214.00	$667.70–$1,148.44	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ED 20605 ASP INJ JOINT BURSA INTERMED WO US GUID	$726.40	$908.00	$219.83–$853.52	138% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 SURG 20605 ARTHROCENTESIS ASP INJ INTRM JNT BURSA WO US GUID	$726.40	$908.00	$219.83–$853.52	138% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ED 20605 ASP INJ JOINT BURSA INTERMED WO US GUID	$726.40	$908.00	$499.40–$858.97	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 SURG 20605 ARTHROCENTESIS ASP INJ INTRM JNT BURSA WO US GUID	$726.40	$908.00	$499.40–$858.97	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 SURG 20600 ARTHROCENTESIS ASP INJ SM JNT BURSA WO US GUID	$636.00	$795.00	$192.47–$747.30	97% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 SURG 20600 ARTHROCENTESIS ASP INJ SM JNT BURSA WO US GUID	$636.00	$795.00	$437.25–$752.07	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 SURG 12031 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM <	$994.40	$1,243.00	$300.93–$1,168.42	119% above	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 <	$994.40	$1,243.00	$300.93–$1,168.42	119% 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 <	$994.40	$1,243.00	$683.65–$1,175.88	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 SURG 12031 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM <	$994.40	$1,243.00	$683.65–$1,175.88	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 SURG 11440 EXC BENIGN SKIN LESN INCL MARGINS FACE EXC DIAM 0.5 CM <	$1,568.80	$1,961.00	$474.76–$1,843.34	164% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 SURG 11440 EXC BENIGN SKIN LESN INCL MARGINS FACE EXC DIAM 0.5 CM <	$1,568.80	$1,961.00	$1,078.55–$1,855.11	—	20%
Nail removal (partial or complete), one nail CPT 11730 SURG 11730 AVULSION NAIL PLATE PARTIAL COMP SMPL SNGL	$425.60	$532.00	$128.80–$500.08	59% above	20%
Nail removal (partial or complete), one nail CPT 11730 ED 11730 REMV OF NAIL PLATE	$425.60	$532.00	$128.80–$500.08	59% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 SURG 11730 AVULSION NAIL PLATE PARTIAL COMP SMPL SNGL	$425.60	$532.00	$292.60–$503.27	—	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 ED 11730 REMV OF NAIL PLATE	$425.60	$532.00	$292.60–$503.27	—	20%
Paracentesis with imaging guidance CPT 49083 SURG 49083 ABD PARACENTESIS W IMAGING	$1,934.40	$2,418.00	$585.40–$2,272.92	117% above	20%
Paracentesis with imaging guidance inpatient CPT 49083 SURG 49083 ABD PARACENTESIS W IMAGING	$1,934.40	$2,418.00	$1,329.90–$2,287.43	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 SURG 11750 EXC NAIL NAIL MATRIX PERM REMVL	$1,132.80	$1,416.00	$342.81–$1,331.04	122% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 SURG 11750 EXC NAIL NAIL MATRIX PERM REMVL	$1,132.80	$1,416.00	$778.80–$1,339.54	—	20%
Removal of a foreign object under the skin, simple CPT 10120 SURG 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$891.20	$1,114.00	$269.70–$1,047.16	120% above	20%
Removal of a foreign object under the skin, simple CPT 10120 ED 10120 INC&REMV FB SMPL	$891.20	$1,114.00	$269.70–$1,047.16	120% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED 10120 INC&REMV FB SMPL	$891.20	$1,114.00	$612.70–$1,053.84	—	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 SURG 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$891.20	$1,114.00	$612.70–$1,053.84	—	20%
Short arm splint (forearm and hand) CPT 29125 ED 29125 APPL SPLINT FOREARM	$352.00	$440.00	$106.52–$413.60	77% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM	$352.00	$440.00	$242.00–$416.24	—	20%
Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$365.60	$457.00	$110.64–$429.58	64% above	20%
Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$365.60	$457.00	$251.35–$432.32	—	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<	$458.40	$573.00	$138.72–$538.62	65% 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<	$458.40	$573.00	$315.15–$542.06	—	20%
Skin biopsy, punch, one lesion CPT 11104 SURG 11104 PUNCH BIOPSY SKIN SINGLE LESION	$564.80	$706.00	$170.92–$663.64	90% above	20%
Skin biopsy, punch, one lesion inpatient CPT 11104 SURG 11104 PUNCH BIOPSY SKIN SINGLE LESION	$564.80	$706.00	$388.30–$667.88	—	20%
Skin tag removal, up to 15 tags CPT 11200 SURG 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$424.80	$531.00	$128.56–$499.14	99% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 SURG 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$424.80	$531.00	$292.05–$502.33	—	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	$506.40	$633.00	$153.25–$595.02	57% 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	$506.40	$633.00	$348.15–$598.82	—	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<	$473.60	$592.00	$143.32–$556.48	64% 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<	$473.60	$592.00	$325.60–$560.03	—	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 SURG 11102 TANGENTIAL BX SKIN SINGLE LESION	$430.40	$538.00	$130.25–$505.72	70% above	20%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 SURG 11102 TANGENTIAL BX SKIN SINGLE LESION	$430.40	$538.00	$295.90–$508.95	—	20%
Thoracentesis with imaging guidance CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$1,907.20	$2,384.00	$577.17–$2,240.96	107% above	20%
Thoracentesis with imaging guidance inpatient CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$1,907.20	$2,384.00	$1,311.20–$2,255.26	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$668.00	$835.00	$202.15–$784.90	110% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 SURG 20552 INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$668.00	$835.00	$202.15–$784.90	110% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$668.00	$835.00	$459.25–$789.91	—	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 SURG 20552 INJ SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$668.00	$835.00	$459.25–$789.91	—	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 SURG 55250 VASECTOMY UNI/BILATERAL INCL POSTOP SEMEN EXAM	$3,408.00	$4,260.00	$1,031.35–$4,004.40	—	20%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 SURG 55250 VASECTOMY UNI/BILATERAL INCL POSTOP SEMEN EXAM	$3,408.00	$4,260.00	$2,343.00–$4,029.96	—	20%
Wart removal, up to 14 warts CPT 17110 SURG 17110 DESTRUCTION BENIGN LESIONS 1 TO 14	$243.20	$304.00	$73.60–$285.76	24% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 SURG 17110 DESTRUCTION BENIGN LESIONS 1 TO 14	$243.20	$304.00	$167.20–$287.58	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 SURG 11042 DEBRIDEMENT SKIN & SUBQ TISSUE	$1,383.20	$1,729.00	$418.59–$1,625.26	207% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 SURG 11042 DEBRIDEMENT SKIN & SUBQ TISSUE	$1,383.20	$1,729.00	$950.95–$1,635.63	—	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 TRANSFUSION BLOOD	$1,020.00	$1,275.00	$308.68–$1,198.50	45% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 TRANSFUSION BLOOD	$1,020.00	$1,275.00	$308.68–$1,198.50	45% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD	$1,020.00	$1,275.00	$701.25–$1,206.15	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 TRANSFUSION BLOOD	$1,020.00	$1,275.00	$701.25–$1,206.15	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI INITIAL TX	$66.40	$83.00	$20.09–$213.56	43% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI SUBSEQ TX	$66.40	$83.00	$20.09–$213.56	43% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUBSEQ TX	$72.80	$91.00	$22.03–$213.56	38% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB SUBSEQUENT TX	$105.60	$132.00	$31.96–$213.56	10% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 DIAGNOSTIC SPUTUM	$116.00	$145.00	$35.10–$213.56	1% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ED 94640 NON OR PRES'D INHALATION TX	$120.00	$150.00	$36.32–$213.56	3% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB INITIAL TX	$148.00	$185.00	$44.79–$213.56	27% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI INITIAL TX	$66.40	$83.00	$45.65–$78.52	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI SUBSEQ TX	$66.40	$83.00	$45.65–$78.52	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB SUBSEQ TX	$72.80	$91.00	$50.05–$86.09	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB SUBSEQUENT TX	$105.60	$132.00	$72.60–$124.87	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 DIAGNOSTIC SPUTUM	$116.00	$145.00	$79.75–$137.17	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ED 94640 NON OR PRES'D INHALATION TX	$120.00	$150.00	$82.50–$141.90	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB INITIAL TX	$148.00	$185.00	$101.75–$175.01	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR	$799.20	$999.00	$241.86–$939.06	56% above	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR	$799.20	$999.00	$549.45–$945.05	—	20%
Critical care, first 30 to 74 minutes CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$2,857.60	$3,572.00	$864.78–$3,357.68	79% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$2,857.60	$3,572.00	$1,964.60–$3,379.11	—	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE DROWSY	$1,134.40	$1,418.00	$326.96–$1,332.92	117% above	20%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE DROWSY	$1,134.40	$1,418.00	$779.90–$1,341.43	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING WO INTERP	$265.60	$332.00	$62.37–$312.08	54% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING WO INTERP	$265.60	$332.00	$182.60–$314.07	—	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED 99281 EMER CASE LEVEL I	$296.80	$371.00	$89.82–$348.74	46% 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	$296.80	$371.00	$204.05–$350.97	—	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED 99282 EMER CASE LEVEL II	$504.80	$631.00	$152.77–$593.14	68% above	20%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED 99282 EMER CASE LEVEL II	$504.80	$631.00	$347.05–$596.93	—	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED 99283 EMER CASE LEVEL III	$836.00	$1,045.00	$252.99–$982.30	73% above	20%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED 99283 EMER CASE LEVEL III	$836.00	$1,045.00	$574.75–$988.57	—	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED 99284 EMER CASE LEVEL IV	$1,224.00	$1,530.00	$370.41–$1,438.20	57% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED 99284 EMER CASE LEVEL IV	$1,224.00	$1,530.00	$841.50–$1,447.38	—	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED 99285 EMER CASE LEVEL V	$1,670.40	$2,088.00	$505.50–$1,962.72	44% above	20%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED 99285 EMER CASE LEVEL V	$1,670.40	$2,088.00	$1,148.40–$1,975.25	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST TRACING	$900.80	$1,126.00	$272.60–$1,058.44	25% above	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST TRACING	$900.80	$1,126.00	$619.30–$1,065.20	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INITIAL 31-60MINS	$632.80	$791.00	$191.50–$743.54	132% above	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	$632.80	$791.00	$191.50–$743.54	132% above	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	$632.80	$791.00	$435.05–$748.29	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRAT INITIAL 31-60MINS	$632.80	$791.00	$435.05–$748.29	—	20%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$600.00	$750.00	$151.20–$705.00	84% above	20%
IV infusion of a medicine, first hour CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$705.60	$882.00	$151.20–$829.08	116% above	20%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$600.00	$750.00	$412.50–$709.50	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$705.60	$882.00	$485.10–$834.37	—	20%
IV push of a medicine, first drug CPT 96374 ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL	$484.80	$606.00	$88.80–$569.64	163% above	20%
IV push of a medicine, first drug CPT 96374 IV PUSH INITIAL	$484.80	$606.00	$88.80–$569.64	163% above	20%
IV push of a medicine, first drug inpatient CPT 96374 ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL	$484.80	$606.00	$333.30–$573.28	—	20%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH INITIAL	$484.80	$606.00	$333.30–$573.28	—	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	$6.05–$74.73	74% below	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	$6.05–$74.73	74% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SC IM INJECTION	$149.60	$187.00	$34.40–$175.78	93% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$149.60	$187.00	$34.40–$175.78	93% 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	$13.75–$23.65	—	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	$13.75–$23.65	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SC IM INJECTION	$149.60	$187.00	$102.85–$176.90	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$149.60	$187.00	$102.85–$176.90	—	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CONDUCTION TEST 7-8 STUDIES	$938.40	$1,173.00	$283.98–$1,102.62	107% above	20%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CONDUCTION TEST 7-8 STUDIES	$938.40	$1,173.00	$645.15–$1,109.66	—	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$120.00	$150.00	$63.25–$141.00	48% above	20%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$120.00	$150.00	$82.50–$141.90	—	20%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LEVEL 3	$195.20	$244.00	$59.07–$229.36	67% above	20%
New patient office visit, about 30 minutes CPT 99203 NEW AMS OR CONSULT PATIENT LVL 3	$195.20	$244.00	$59.07–$229.36	67% above	20%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT LEVEL 3	$195.20	$244.00	$134.20–$230.82	—	20%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW AMS OR CONSULT PATIENT LVL 3	$195.20	$244.00	$134.20–$230.82	—	20%
New patient office visit, about 45 minutes CPT 99204 NEW AMS OR CONSULT PATIENT LVL 4	$244.00	$305.00	$73.84–$286.70	42% above	20%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LEVEL 4	$245.60	$307.00	$74.32–$288.58	43% above	20%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW AMS OR CONSULT PATIENT LVL 4	$244.00	$305.00	$167.75–$288.53	—	20%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT LEVEL 4	$245.60	$307.00	$168.85–$290.42	—	20%
New patient office visit, about 60 minutes CPT 99205 NEW AMS OR CONSULT PATIENT LVL 5	$303.20	$379.00	$91.76–$356.26	27% above	20%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LEVEL 5	$320.80	$401.00	$97.08–$376.94	34% above	20%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW AMS OR CONSULT PATIENT LVL 5	$303.20	$379.00	$208.45–$358.53	—	20%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT LEVEL 5	$320.80	$401.00	$220.55–$379.35	—	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW AMS OR CONSULT PATIENT LVL 2	$153.60	$192.00	$46.48–$180.48	102% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LEVEL 2	$153.60	$192.00	$46.48–$180.48	102% above	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW AMS OR CONSULT PATIENT LVL 2	$153.60	$192.00	$105.60–$181.63	—	20%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT LEVEL 2	$153.60	$192.00	$105.60–$181.63	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$41.60	$52.00	$12.59–$48.88	32% below	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$41.60	$52.00	$28.60–$49.19	—	20%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY 97165	$280.00	$350.00	$84.74–$329.00	65% above	20%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY 97165	$280.00	$350.00	$192.50–$331.10	—	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$323.20	$404.00	$97.81–$379.76	61% above	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$323.20	$404.00	$222.20–$382.18	—	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY 97161	$256.80	$321.00	$115.50–$301.74	52% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY 97161	$256.80	$321.00	$176.55–$303.67	—	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$280.00	$350.00	$84.74–$329.00	46% above	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$280.00	$350.00	$192.50–$331.10	—	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN 97140	$120.80	$151.00	$63.25–$141.94	42% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN 97140	$120.80	$151.00	$83.05–$142.85	—	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN 97110	$126.40	$158.00	$63.25–$148.52	39% above	20%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN 97110	$126.40	$158.00	$86.90–$149.47	—	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST AMS OR CONSULT PATIENT LVL 5	$229.60	$287.00	$69.48–$269.78	31% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB LEVEL 5	$240.80	$301.00	$72.87–$282.94	38% above	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST AMS OR CONSULT PATIENT LVL 5	$229.60	$287.00	$157.85–$271.50	—	20%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTAB LEVEL 5	$240.80	$301.00	$165.55–$284.75	—	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST AMS OR CONSULT PATIENT LVL 3	$146.40	$183.00	$44.30–$172.02	10% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB LEVEL 3	$153.60	$192.00	$46.48–$180.48	15% above	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST AMS OR CONSULT PATIENT LVL 3	$146.40	$183.00	$100.65–$173.12	—	20%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTAB LEVEL 3	$153.60	$192.00	$105.60–$181.63	—	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST AMS OR CONSULT PATIENT LVL 4	$183.20	$229.00	$55.44–$215.26	64% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB LEVEL 4	$192.00	$240.00	$58.10–$225.60	72% 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	$125.95–$216.63	—	20%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTAB LEVEL 4	$192.00	$240.00	$132.00–$227.04	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST AMS OR CONSULT PATIENT LVL 2	$123.20	$154.00	$37.28–$144.76	34% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB LEVEL 2	$123.20	$154.00	$37.28–$144.76	34% above	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST AMS OR CONSULT PATIENT LVL 2	$123.20	$154.00	$84.70–$145.68	—	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTAB LEVEL 2	$123.20	$154.00	$84.70–$145.68	—	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE OP CONSULT EST LOW MDM 30 MIN	$178.40	$223.00	$53.99–$209.62	4% below	20%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE OP CONSULT EST LOW MDM 30 MIN	$178.40	$223.00	$122.65–$210.96	—	20%
Speech and language evaluation CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$467.20	$584.00	$141.39–$548.96	45% above	20%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$467.20	$584.00	$321.20–$552.46	—	20%
Speech therapy session, individual CPT 92507 SPEECH THERAPY TX 92507	$315.20	$394.00	$167.75–$370.36	49% above	20%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TX 92507	$315.20	$394.00	$216.70–$372.72	—	20%
Spirometry (breathing test) CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$358.40	$448.00	$108.46–$421.12	119% above	20%
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$358.40	$448.00	$246.40–$423.81	—	20%
Spirometry before and after a bronchodilator CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$688.80	$861.00	$208.45–$809.34	117% above	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$688.80	$861.00	$473.55–$814.51	—	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA15 MIN 97530	$125.60	$157.00	$60.50–$147.58	62% above	20%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA15 MIN 97530	$125.60	$157.00	$86.35–$148.52	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$247.20	$309.00	$74.81–$290.46	22% above	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$247.20	$309.00	$169.95–$292.31	—	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	$53.76	$67.19	$16.27–$63.16	21% 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	$53.76	$67.19	$36.95–$63.56	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COVID-19 mRNA Vac TriS-Pfizer IM Susp Pref Syr 30 MCG/0.3ML	$232.02	$290.02	$70.21–$272.62	34% above	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COVID-19 mRNA Vac TriS-Pfizer IM Susp Pref Syr 30 MCG/0.3ML	$232.02	$290.02	$159.51–$274.36	—	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	$76.58	$95.72	$23.17–$89.98	45% 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	$76.58	$95.72	$52.65–$90.55	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac IM Susp	$318.07	$397.58	$96.25–$373.73	16% below	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac Susp Pref Syr	$443.59	$554.48	$134.24–$521.21	17% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac IM Susp	$318.07	$397.58	$218.67–$376.11	—	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus (HPV) 9-Valent Recomb Vac Susp Pref Syr	$443.59	$554.48	$304.96–$524.54	—	20%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine Inj Susp 50 Unit/ML	$101.91	$127.38	$30.84–$119.74	3% below	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine Inj Susp 50 Unit/ML	$101.91	$127.38	$70.06–$120.50	—	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	$66.21–$257.07	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	$150.41–$258.71	—	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Vaccine (Recombinant) Susp 5 MCG/0.5ML	$76.32	$95.39	$23.09–$89.67	46% above	20%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Vaccine (Recombinant) Susp 5 MCG/0.5ML	$76.32	$95.39	$52.46–$90.24	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$104.84	$131.05	$31.73–$123.19	11% below	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$104.84	$131.05	$72.08–$123.97	—	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe	$394.26	$492.82	$119.31–$463.25	31% above	20%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal Vac B (Recomb OMV Adjuv) Inj Prefilled Syringe	$394.26	$492.82	$271.05–$466.21	—	20%
Meningococcal B vaccine (Trumenba) CPT 90621 Meningococcal Group B Vac (Recomb) IM Susp Prefilled Syr	$238.10	$297.62	$72.05–$279.76	27% above	20%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 Meningococcal Group B Vac (Recomb) IM Susp Prefilled Syr	$238.10	$297.62	$163.69–$281.55	—	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal 13-Valent Conjugate Vaccine Inj	$287.84	$359.80	$87.11–$338.21	7% above	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal 13-Valent Conjugate Vaccine Inj	$287.84	$359.80	$197.89–$340.37	—	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Pneumococcal 15-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$365.22	$456.52	$110.52–$429.13	1% above	20%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Pneumococcal 15-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$365.22	$456.52	$251.09–$431.87	—	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 Pneumococcal 21-Valent Conjugate Vaccine Soln Pref Syr 0.5ML	$418.77	$523.46	$126.73–$492.05	19% above	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 Pneumococcal 21-Valent Conjugate Vaccine Soln Pref Syr 0.5ML	$418.77	$523.46	$287.90–$495.19	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Inj Soln 25 MCG/0.5ML	$110.40	$138.00	$33.41–$129.72	13% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$192.88	$241.10	$58.37–$226.63	52% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Inj Soln 25 MCG/0.5ML	$110.40	$138.00	$75.90–$130.55	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$192.88	$241.10	$132.61–$228.08	—	20%
Rabies vaccine, one dose CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$496.92	$621.14	$150.38–$583.87	3% below	20%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine, PCEC For Inj	$510.29	$637.86	$154.43–$599.59	at median	20%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$496.92	$621.14	$341.63–$587.60	—	20%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine, PCEC For Inj	$510.29	$637.86	$350.82–$603.42	—	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus Vaccine, Live Oral Pentavalent Soln	$106.63	$133.28	$32.27–$125.28	17% below	20%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotavirus Vaccine, Live Oral Pentavalent Soln	$106.63	$133.28	$73.30–$126.08	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$267.33	$334.16	$80.90–$314.11	20% above	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$267.33	$334.16	$183.79–$316.12	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LFU	$74.75	$93.43	$22.62–$87.82	20% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LFU	$74.75	$93.43	$51.39–$88.38	—	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	$86.52	$108.15	$26.18–$101.66	10% 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	$86.52	$108.15	$59.48–$102.31	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEPATITIS B VACCINE	$40.00	$50.00	$12.11–$47.00	3% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN 1 VACCINE	$40.00	$50.00	$12.11–$47.00	3% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$40.00	$50.00	$12.11–$47.00	3% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VAC	$73.60	$92.00	$22.27–$86.48	78% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIR VAC	$73.60	$92.00	$22.27–$86.48	78% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$40.00	$50.00	$27.50–$47.30	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN 1 VACCINE	$40.00	$50.00	$27.50–$47.30	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEPATITIS B VACCINE	$40.00	$50.00	$27.50–$47.30	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VAC	$73.60	$92.00	$50.60–$87.03	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIR VAC	$73.60	$92.00	$50.60–$87.03	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$40.00	$50.00	$12.11–$47.00	58% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$40.00	$50.00	$12.11–$47.00	58% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$40.00	$50.00	$27.50–$47.30	—	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$40.00	$50.00	$27.50–$47.30	—	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/8375/460388596_sanford-canby-medical-center_standardcharges.csv