Hospital

Madison Hospital

Madison Hospital in Madison, MN publishes cash prices for 308 common procedures listed here, from its own machine-readable price file updated Jun 23, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Minnesota median for 198 of 306 procedures and below it for 105. By typical cash price it ranks #58 of 79 Minnesota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

820 3rd Ave, Madison, MN 56256 Collected Sep 27, 2026 Source price file (320) 598-7536

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 241372 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US DOP ANKLE BRACHIAL INDEX	$481.10	$566.00	$243.38–$566.00	30% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US DOP ANKLE BRACHIAL INDEX	$481.10	$566.00	$283.00–$2,713.07	—	15%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGRAM BARIUM	$399.50	$470.00	$202.10–$470.00	37% above	15%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPHAGRAM BARIUM	$399.50	$470.00	$235.00–$2,713.07	—	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY	$1,451.80	$1,708.00	$734.44–$1,708.00	19% above	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY	$1,451.80	$1,708.00	$854.00–$2,713.07	—	15%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST SAGE UNILATERAL COMPLETE	$524.45	$617.00	$265.31–$617.00	39% above	15%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL COMPLETE	$524.45	$617.00	$265.31–$617.00	39% above	15%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL COMPLETE	$524.45	$617.00	$308.50–$2,713.07	—	15%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST SAGE UNILATERAL COMPLETE	$524.45	$617.00	$308.50–$2,713.07	—	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNILATERAL LIMITED	$436.05	$513.00	$220.59–$513.00	38% above	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST SAGE UNILATERAL LIMITED	$447.10	$526.00	$226.18–$526.00	42% above	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNILATERAL LIMITED	$436.05	$513.00	$256.50–$2,713.07	—	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST SAGE UNILATERAL LIMITED	$447.10	$526.00	$263.00–$2,713.07	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST	$2,062.95	$2,427.00	$491.00–$2,427.00	25% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA PULMONARY EMBOLISM STUDY	$2,299.25	$2,705.00	$491.00–$2,705.00	39% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST	$2,062.95	$2,427.00	$1,213.50–$2,713.07	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA PULMONARY EMBOLISM STUDY	$2,299.25	$2,705.00	$1,352.50–$2,713.07	—	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD AND PELVIS WITHOUT IV CONTRAST	$2,992.00	$3,520.00	$491.00–$3,520.00	57% above	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD AND PELVIS WITHOUT IV CONTRAST	$2,992.00	$3,520.00	$1,760.00–$3,520.00	—	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD AND PELVIS WITH IV CONTRAST	$3,218.10	$3,786.00	$491.00–$3,786.00	31% above	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD AND PELVIS WITH IV CONTRAST	$3,218.10	$3,786.00	$1,893.00–$3,786.00	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD AND PELVIS WO W IV CONTRAST	$3,989.05	$4,693.00	$491.00–$4,693.00	55% above	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD AND PELVIS WO W IV CONTRAST	$3,989.05	$4,693.00	$2,346.50–$4,693.00	—	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W IV CONTRAST	$1,572.50	$1,850.00	$491.00–$1,850.00	8% above	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W IV CONTRAST	$1,572.50	$1,850.00	$925.00–$2,713.07	—	15%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN ROUTINE WO IV CONTRAST	$1,640.50	$1,930.00	$491.00–$1,930.00	39% above	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN ROUTINE WO IV CONTRAST	$1,640.50	$1,930.00	$965.00–$2,713.07	—	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS WO IV CONTRAST	$1,504.50	$1,770.00	$491.00–$1,770.00	20% above	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES WO IV CONTRAST	$1,504.50	$1,770.00	$491.00–$1,770.00	20% above	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL BONES WO IV CONTRAST	$1,504.50	$1,770.00	$885.00–$2,713.07	—	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS WO IV CONTRAST	$1,504.50	$1,770.00	$885.00–$2,713.07	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD ROUTINE WO IV CONTRAST	$1,513.00	$1,780.00	$491.00–$1,780.00	20% above	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD ROUTINE WO IV CONTRAST	$1,513.00	$1,780.00	$890.00–$2,713.07	—	15%
CT scan of the head with contrast CPT 70460 CT HEAD W IV CONTRAST	$1,921.00	$2,260.00	$491.00–$2,260.00	48% above	15%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W IV CONTRAST	$1,921.00	$2,260.00	$1,130.00–$2,713.07	—	15%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO W IV CONTRAST	$1,865.75	$2,195.00	$491.00–$2,195.00	17% above	15%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO W IV CONTRAST	$1,865.75	$2,195.00	$1,097.50–$2,713.07	—	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE ROUTINE WITHOUT CONTRAST	$1,611.60	$1,896.00	$491.00–$1,896.00	18% above	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE ROUTINE WITHOUT CONTRAST	$1,611.60	$1,896.00	$948.00–$2,713.07	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE ROUTINE WITHOUT CONTRAST	$1,653.25	$1,945.00	$491.00–$1,945.00	22% above	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE ROUTINE WITHOUT CONTRAST	$1,653.25	$1,945.00	$972.50–$2,713.07	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W IV CONTRAST	$1,548.70	$1,822.00	$491.00–$1,822.00	5% above	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W IV CONTRAST	$1,548.70	$1,822.00	$911.00–$2,713.07	—	15%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID BILATERAL ROUTINE	$1,092.25	$1,285.00	$552.55–$1,285.00	—	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILATERAL ROUTINE	$1,092.25	$1,285.00	$642.50–$2,713.07	—	15%
Chest X-ray, 2 views CPT 71046 XR CHEST PA AND LAT	$310.25	$365.00	$156.95–$365.00	34% above	15%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST PA AND LAT	$310.25	$365.00	$182.50–$2,713.07	—	15%
Chest X-ray, single view CPT 71045 XR CHEST ONE VIEW	$264.35	$311.00	$133.73–$311.00	49% above	15%
Chest X-ray, single view CPT 71045 XR CHEST DECUBITUS	$264.35	$311.00	$133.73–$311.00	49% above	15%
Chest X-ray, single view inpatient CPT 71045 XR CHEST DECUBITUS	$264.35	$311.00	$155.50–$2,713.07	—	15%
Chest X-ray, single view inpatient CPT 71045 XR CHEST ONE VIEW	$264.35	$311.00	$155.50–$2,713.07	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RETROPERITONEAL, COMPLETE	$724.20	$852.00	$366.36–$852.00	39% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL BIL	$781.15	$919.00	$395.17–$919.00	50% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 RETROPERITONEAL, COMPLETE	$724.20	$852.00	$426.00–$2,713.07	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL BIL	$781.15	$919.00	$459.50–$2,713.07	—	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA HIP	$510.85	$601.00	$258.43–$601.00	63% above	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA SPINE	$510.85	$601.00	$258.43–$601.00	63% above	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA HIP AND SPINE	$524.45	$617.00	$265.31–$617.00	67% above	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA HIP	$510.85	$601.00	$300.50–$2,713.07	—	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA SPINE	$510.85	$601.00	$300.50–$2,713.07	—	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA HIP AND SPINE	$524.45	$617.00	$308.50–$2,713.07	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA FOREARM	$534.65	$629.00	$270.47–$629.00	177% above	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA FOREARM	$534.65	$629.00	$314.50–$2,713.07	—	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO IV CONTRAST	$1,525.75	$1,795.00	$491.00–$1,795.00	22% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HIGH RESOL WO IV CONTRAST	$1,525.75	$1,795.00	$491.00–$1,795.00	22% above	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST PULMONARY NODULE FOLLOWUP WO CONTR	$1,525.75	$1,795.00	$491.00–$1,795.00	22% above	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HIGH RESOL WO IV CONTRAST	$1,525.75	$1,795.00	$897.50–$2,713.07	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO IV CONTRAST	$1,525.75	$1,795.00	$897.50–$2,713.07	—	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST PULMONARY NODULE FOLLOWUP WO CONTR	$1,525.75	$1,795.00	$897.50–$2,713.07	—	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W IV CONTRAST	$1,725.50	$2,030.00	$491.00–$2,030.00	15% above	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W IV CONTRAST	$1,725.50	$2,030.00	$1,015.00–$2,713.07	—	15%
Diagnostic mammogram, both breasts CPT 77066 MAMMO SAGE DIAG BSL BIL	$481.10	$566.00	$243.38–$566.00	50% above	15%
Diagnostic mammogram, both breasts CPT 77066 MAMMO BASELINE DIAG BIL	$481.10	$566.00	$243.38–$566.00	50% above	15%
Diagnostic mammogram, both breasts CPT 77066 MAMMO SAGE DIAG W IMPLANTS BIL	$481.10	$566.00	$243.38–$566.00	50% above	15%
Diagnostic mammogram, both breasts CPT 77066 MAMMO DIAG BIL	$515.10	$606.00	$260.58–$606.00	61% above	15%
Diagnostic mammogram, both breasts CPT 77066 MAMMO DIAG W IMPLANTS BIL	$521.05	$613.00	$263.59–$613.00	63% above	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO SAGE DIAG W IMPLANTS BIL	$481.10	$566.00	$283.00–$2,713.07	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO BASELINE DIAG BIL	$481.10	$566.00	$283.00–$2,713.07	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO SAGE DIAG BSL BIL	$481.10	$566.00	$283.00–$2,713.07	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO DIAG BIL	$515.10	$606.00	$303.00–$2,713.07	—	15%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO DIAG W IMPLANTS BIL	$521.05	$613.00	$306.50–$2,713.07	—	15%
Diagnostic mammogram, one breast CPT 77065 MAMMO DIAG POST CLIP OR WIRE PLACEMENT	$394.40	$464.00	$199.52–$464.00	27% above	15%
Diagnostic mammogram, one breast CPT 77065 MAMMO SAGE DIAG UNI	$394.40	$464.00	$199.52–$464.00	27% above	15%
Diagnostic mammogram, one breast CPT 77065 MAMMO DIAG UNI	$398.65	$469.00	$201.67–$469.00	28% above	15%
Diagnostic mammogram, one breast CPT 77065 MAMMO DIAG W IMPLANTS UNI	$436.90	$514.00	$221.02–$514.00	41% above	15%
Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIAG POST CLIP OR WIRE PLACEMENT	$394.40	$464.00	$232.00–$2,713.07	—	15%
Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO SAGE DIAG UNI	$394.40	$464.00	$232.00–$2,713.07	—	15%
Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIAG UNI	$398.65	$469.00	$234.50–$2,713.07	—	15%
Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIAG W IMPLANTS UNI	$436.90	$514.00	$257.00–$2,713.07	—	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US DOP ARTERY LEG BIL	$1,062.50	$1,250.00	$537.50–$1,250.00	32% above	15%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US DOP ARTERY LEG BIL	$1,062.50	$1,250.00	$625.00–$2,713.07	—	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US DOP VEIN ARM BIL	$792.20	$932.00	$400.76–$932.00	11% below	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US DOP VEIN COMPETENCE STUDY BIL	$1,133.90	$1,334.00	$573.62–$1,334.00	28% above	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VEIN MEAS AND OR MAP ARM BIL	$1,133.90	$1,334.00	$573.62–$1,334.00	28% above	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US DOP VEIN LEG BIL	$1,133.90	$1,334.00	$573.62–$1,334.00	28% above	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VEIN MEAS AND OR MAP LEG BIL	$1,133.90	$1,334.00	$573.62–$1,334.00	28% above	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DOP VEIN ARM BIL	$792.20	$932.00	$466.00–$2,713.07	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VEIN MEAS AND OR MAP LEG BIL	$1,133.90	$1,334.00	$667.00–$2,713.07	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DOP VEIN COMPETENCE STUDY BIL	$1,133.90	$1,334.00	$667.00–$2,713.07	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DOP VEIN LEG BIL	$1,133.90	$1,334.00	$667.00–$2,713.07	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VEIN MEAS AND OR MAP ARM BIL	$1,133.90	$1,334.00	$667.00–$2,713.07	—	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIOGRAM, PEDIATRIC	$1,822.40	$2,144.00	$921.92–$2,144.00	44% above	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 COMPLETE ECHO (2D/C/D)	$1,822.40	$2,144.00	$921.92–$2,144.00	44% above	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 COMPLETE ECHO (2D/C/D)	$1,822.40	$2,144.00	$1,072.00–$2,713.07	—	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAM, PEDIATRIC	$1,822.40	$2,144.00	$1,072.00–$2,713.07	—	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SCAN	$1,432.25	$1,685.00	$724.55–$1,685.00	6% above	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SCAN	$1,432.25	$1,685.00	$842.50–$2,713.07	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLY/SPLIT	$4,360.50	$5,130.00	$2,205.90–$5,130.00	26% above	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLY/SPLIT	$4,360.50	$5,130.00	$2,565.00–$5,130.00	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LTD	$632.40	$744.00	$319.92–$744.00	51% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD RUQ	$632.40	$744.00	$319.92–$744.00	51% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LTD	$632.40	$744.00	$372.00–$2,713.07	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD RUQ	$632.40	$744.00	$372.00–$2,713.07	—	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CANCER SCREENING	$1,293.70	$1,522.00	$491.00–$1,522.00	124% above	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG CANCER SCREENING	$1,293.70	$1,522.00	$761.00–$2,713.07	—	15%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN ROUTINE WO CONTRAST	$2,210.00	$2,600.00	$735.00–$2,600.00	2% above	15%
MRI of the abdomen without contrast CPT 74181 MRI MRCP WITHOUT CONTRAST	$2,258.45	$2,657.00	$735.00–$2,657.00	4% above	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN ROUTINE WO CONTRAST	$2,210.00	$2,600.00	$1,300.00–$2,713.07	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP WITHOUT CONTRAST	$2,258.45	$2,657.00	$1,328.50–$2,713.07	—	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI LIVER WITHOUT AND WITH CONTRAST	$3,031.95	$3,567.00	$735.00–$3,567.00	3% above	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO W CONTRAST	$3,031.95	$3,567.00	$735.00–$3,567.00	3% above	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI LIVER WITHOUT AND WITH CONTRAST	$3,031.95	$3,567.00	$1,783.50–$3,567.00	—	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO W CONTRAST	$3,031.95	$3,567.00	$1,783.50–$3,567.00	—	15%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD ROUTINE WO CONTRAST	$2,435.25	$2,865.00	$735.00–$2,865.00	20% above	15%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD ROUTINE WO CONTRAST	$2,435.25	$2,865.00	$1,432.50–$2,865.00	—	15%
MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD WO W CONTRAST	$3,208.75	$3,775.00	$735.00–$3,775.00	19% above	15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI HEAD WO W CONTRAST	$3,208.75	$3,775.00	$1,887.50–$3,775.00	—	15%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE ROUTINE WO CONTRAST	$2,358.75	$2,775.00	$735.00–$2,775.00	13% above	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE ROUTINE WO CONTRAST	$2,358.75	$2,775.00	$1,387.50–$2,775.00	—	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE WO W CONTRAST	$3,238.50	$3,810.00	$735.00–$3,810.00	26% above	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE WO W CONTRAST	$3,238.50	$3,810.00	$1,905.00–$3,810.00	—	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPINE ROUTINE WO CONTRAST	$2,358.75	$2,775.00	$735.00–$2,775.00	11% above	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THORACIC SPINE ROUTINE WO CONTRAST	$2,358.75	$2,775.00	$1,387.50–$2,775.00	—	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVICAL SPINE WO W CONTRAST	$3,057.45	$3,597.00	$735.00–$3,597.00	22% above	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVICAL SPINE WO W CONTRAST	$3,057.45	$3,597.00	$1,798.50–$3,597.00	—	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPINE ROUTINE WO CONTRAST	$2,358.75	$2,775.00	$735.00–$2,775.00	11% above	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERVICAL SPINE ROUTINE WO CONTRAST	$2,358.75	$2,775.00	$1,387.50–$2,775.00	—	15%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO W CONTRAST	$2,786.30	$3,278.00	$735.00–$3,278.00	5% above	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO W CONTRAST	$2,786.30	$3,278.00	$1,639.00–$3,278.00	—	15%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS ROUTINE WO CONTRAST	$2,223.60	$2,616.00	$735.00–$2,616.00	5% above	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS ROUTINE WO CONTRAST	$2,223.60	$2,616.00	$1,308.00–$2,713.07	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL PERFUSION SCAN SPECT MULTIPLE	$3,672.00	$4,320.00	$1,857.60–$4,320.00	29% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL PERFUSION SCAN SPECT MULTIPLE	$3,672.00	$4,320.00	$2,160.00–$4,320.00	—	15%
OCT scan of the retina (optical coherence tomography) both sides CPT 92134 COMPUTERIZED OPHTH DX IMAGING, POSTERIOR SEGMENT, W INTERP/REPORT, UNILATERAL OR BILATERAL; RETINA	$90.95	$107.00	$46.01–$107.00	—	15%
OCT scan of the retina (optical coherence tomography) one side CPT 92134 COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, W INTERP/REPORT, UNILAT OR BIL;RETINA	$138.55	$163.00	$76.61–$163.00	16% above	15%
OCT scan of the retina (optical coherence tomography) inpatient both sides CPT 92134 COMPUTERIZED OPHTH DX IMAGING, POSTERIOR SEGMENT, W INTERP/REPORT, UNILATERAL OR BILATERAL; RETINA	$90.95	$107.00	$53.50–$2,713.07	—	15%
OCT scan of the retina (optical coherence tomography) inpatient one side CPT 92134 COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, W INTERP/REPORT, UNILAT OR BIL;RETINA	$138.55	$163.00	$81.50–$2,713.07	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER	$382.50	$450.00	$193.50–$450.00	25% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LTD NON OB	$382.50	$450.00	$193.50–$450.00	25% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER	$382.50	$450.00	$225.00–$2,713.07	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LTD NON OB	$382.50	$450.00	$225.00–$2,713.07	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NON OB	$600.10	$706.00	$303.58–$706.00	28% above	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC NON OB	$600.10	$706.00	$353.00–$2,713.07	—	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB OVER 14 WKS COMP	$659.60	$776.00	$333.68–$776.00	38% above	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB OVER 14 WKS COMP	$659.60	$776.00	$388.00–$2,713.07	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB UNDER 14 WKS COMP	$579.70	$682.00	$293.26–$682.00	39% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB UNDER 14 WKS COMP	$579.70	$682.00	$341.00–$2,713.07	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ULTRASOUND, PREG UTERUS, REAL TIME W/IMAGE, LIMITED, FETAL POSIT/QUALIT AMNIOTIC FLUID, 1/MORE FETUS	$358.70	$422.00	$198.34–$422.00	12% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LTD	$476.00	$560.00	$240.80–$560.00	48% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ULTRASOUND, PREG UTERUS, REAL TIME W/IMAGE, LIMITED, FETAL POSIT/QUALIT AMNIOTIC FLUID, 1/MORE FETUS	$358.70	$422.00	$211.00–$2,713.07	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LTD	$476.00	$560.00	$280.00–$2,713.07	—	15%
Screening mammogram, both breasts CPT 77067 MAMMO SAGE SCREEN BIL	$416.50	$490.00	$127.98–$490.00	23% above	15%
Screening mammogram, both breasts CPT 77067 MAMMO BASELINE SCREEN BIL	$416.50	$490.00	$127.98–$490.00	23% above	15%
Screening mammogram, both breasts CPT 77067 MAMMO SAGE SCREEN W IMPLANTS BIL	$416.50	$490.00	$127.98–$490.00	23% above	15%
Screening mammogram, both breasts CPT 77067 MAMMO SAGE SCREEN BSL BIL	$416.50	$490.00	$127.98–$490.00	23% above	15%
Screening mammogram, both breasts CPT 77067 MAMMO SCREEN BIL	$448.80	$528.00	$127.98–$528.00	33% above	15%
Screening mammogram, both breasts CPT 77067 MAMMO SCREEN W IMPLANTS BIL	$453.90	$534.00	$127.98–$534.00	34% above	15%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SAGE SCREEN W IMPLANTS BIL	$416.50	$490.00	$245.00–$2,713.07	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SAGE SCREEN BSL BIL	$416.50	$490.00	$245.00–$2,713.07	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SAGE SCREEN BIL	$416.50	$490.00	$245.00–$2,713.07	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO BASELINE SCREEN BIL	$416.50	$490.00	$245.00–$2,713.07	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SCREEN BIL	$448.80	$528.00	$264.00–$2,713.07	—	15%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SCREEN W IMPLANTS BIL	$453.90	$534.00	$267.00–$2,713.07	—	15%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY	$3,933.80	$4,628.00	$1,990.04–$4,628.00	27% above	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY	$3,933.80	$4,628.00	$2,314.00–$4,628.00	—	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOWING FUNCTION W/CINERADIOGRAPHY/VIDEORADIOGRAPHY, INC RADIOGRAPH(S)/DELAYED IMAGE(S), CONTRAST	$111.35	$131.00	$61.57–$131.00	63% below	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR VIDEO SWALLOW EVAL	$483.65	$569.00	$244.67–$569.00	63% above	15%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOWING FUNCTION W/CINERADIOGRAPHY/VIDEORADIOGRAPHY, INC RADIOGRAPH(S)/DELAYED IMAGE(S), CONTRAST	$111.35	$131.00	$65.50–$2,713.07	—	15%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR VIDEO SWALLOW EVAL	$483.65	$569.00	$284.50–$2,713.07	—	15%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON OB	$555.90	$654.00	$281.22–$654.00	43% above	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON OB	$555.90	$654.00	$327.00–$2,713.07	—	15%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$524.45	$617.00	$265.31–$617.00	57% above	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL	$524.45	$617.00	$308.50–$2,713.07	—	15%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$844.05	$993.00	$426.99–$993.00	44% above	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$844.05	$993.00	$496.50–$2,713.07	—	15%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$589.05	$693.00	$297.99–$693.00	29% above	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$589.05	$693.00	$346.50–$2,713.07	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD NECK SOFT TISSUE	$616.25	$725.00	$311.75–$725.00	35% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID	$616.25	$725.00	$311.75–$725.00	35% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID	$616.25	$725.00	$362.50–$2,713.07	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD NECK SOFT TISSUE	$616.25	$725.00	$362.50–$2,713.07	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US DOP VEIN LTD UPPER EXTREMITY	$827.05	$973.00	$418.39–$973.00	51% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US DOP VEIN LTD UPPER EXTREMITY	$827.05	$973.00	$486.50–$2,713.07	—	15%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN ONE VIEW	$255.00	$300.00	$129.00–$300.00	21% above	15%
X-ray of the abdomen, 1 view CPT 74018 XR KIDNEYS URETERS AND BLADDER	$255.00	$300.00	$129.00–$300.00	21% above	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN ONE VIEW	$255.00	$300.00	$150.00–$2,713.07	—	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR KIDNEYS URETERS AND BLADDER	$255.00	$300.00	$150.00–$2,713.07	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEWS	$374.00	$440.00	$189.20–$440.00	42% above	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEWS	$374.00	$440.00	$220.00–$2,713.07	—	15%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4 VIEWS	$373.15	$439.00	$188.77–$439.00	9% above	15%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE W OBLIQ 4 OR MORE VIEWS	$373.15	$439.00	$188.77–$439.00	9% above	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4 VIEWS	$373.15	$439.00	$219.50–$2,713.07	—	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE W OBLIQ 4 OR MORE VIEWS	$373.15	$439.00	$219.50–$2,713.07	—	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE AP AND LAT	$288.15	$339.00	$145.77–$339.00	17% above	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE AP AND LAT	$288.15	$339.00	$169.50–$2,713.07	—	15%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES	$289.00	$340.00	$146.20–$340.00	32% above	15%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES	$289.00	$340.00	$170.00–$2,713.07	—	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR CERVICAL SPINE 2 OR 3 VIEWS	$323.00	$380.00	$163.40–$380.00	30% above	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL SPINE 2 OR 3 VIEWS	$323.00	$380.00	$190.00–$2,713.07	—	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS ROUTINE 1 OR 2 VIEWS	$272.00	$320.00	$137.60–$320.00	36% above	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS ROUTINE 1 OR 2 VIEWS	$272.00	$320.00	$160.00–$2,713.07	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM AND OR COCCYX	$272.00	$320.00	$137.60–$320.00	20% above	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM AND OR COCCYX	$272.00	$320.00	$160.00–$2,713.07	—	15%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINOTRANSFERASE (ALT)	$73.95	$87.00	$37.41–$87.00	64% above	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINOTRANSFERASE (ALT)	$73.95	$87.00	$43.50–$2,713.07	—	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 ASPARTIMINE AMINOTRANSFERASE (AST)	$73.95	$87.00	$37.41–$87.00	65% above	15%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 ASPARTIMINE AMINOTRANSFERASE (AST)	$73.95	$87.00	$43.50–$2,713.07	—	15%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL, ACUTE	$164.05	$193.00	$82.99–$193.00	30% below	15%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL, ACUTE	$164.05	$193.00	$96.50–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS, IGE	$39.10	$46.00	$19.78–$46.00	157% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT EPITHELIUM, IGE	$39.10	$46.00	$19.78–$46.00	157% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH, IGE	$39.10	$46.00	$19.78–$46.00	157% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG EPITHELIUM, IGE	$39.10	$46.00	$19.78–$46.00	157% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 OAK, IGE	$39.10	$46.00	$19.78–$46.00	157% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 SHORT RAGWEED, IGE	$39.10	$46.00	$19.78–$46.00	157% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD, IGE	$41.65	$49.00	$21.07–$49.00	174% above	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS, IGE	$39.10	$46.00	$23.00–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT EPITHELIUM, IGE	$39.10	$46.00	$23.00–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COCKROACH, IGE	$39.10	$46.00	$23.00–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG EPITHELIUM, IGE	$39.10	$46.00	$23.00–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK, IGE	$39.10	$46.00	$23.00–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 SHORT RAGWEED, IGE	$39.10	$46.00	$23.00–$2,713.07	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COTTONWOOD, IGE	$41.65	$49.00	$24.50–$2,713.07	—	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE	$108.80	$128.00	$55.04–$128.00	160% above	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE	$108.80	$128.00	$64.00–$2,713.07	—	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ABS CASCADE	$109.65	$129.00	$55.47–$129.00	144% above	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB SCREEN	$109.65	$129.00	$55.47–$129.00	144% above	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB SCREEN	$109.65	$129.00	$64.50–$2,713.07	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ABS CASCADE	$109.65	$129.00	$64.50–$2,713.07	—	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE B	$51.00	$60.00	$25.80–$60.00	62% below	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT PRO B-TYPE NATRIURETIC PEPTIDE	$156.40	$184.00	$79.12–$184.00	16% above	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE B	$51.00	$60.00	$30.00–$2,713.07	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT PRO B-TYPE NATRIURETIC PEPTIDE	$156.40	$184.00	$92.00–$2,713.07	—	15%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$17.00	$20.00	$8.60–$20.00	81% below	15%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$17.00	$20.00	$10.00–$2,713.07	—	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION (PATH)	$207.40	$244.00	$104.92–$244.00	98% above	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION (PATH)	$207.40	$244.00	$122.00–$2,713.07	—	15%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$147.90	$174.00	$74.82–$174.00	34% above	15%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE	$147.90	$174.00	$87.00–$2,713.07	—	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$34.00	$40.00	$17.20–$40.00	63% above	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD ALCOHOL COLLECTION-ER (BILL ONLY)	$51.85	$61.00	$26.23–$61.00	149% above	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$34.00	$40.00	$20.00–$2,713.07	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD ALCOHOL COLLECTION-ER (BILL ONLY)	$51.85	$61.00	$30.50–$2,713.07	—	15%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$56.10	$66.00	$28.38–$66.00	26% above	15%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$56.10	$66.00	$33.00–$2,713.07	—	15%
Blood lead test CPT 83655 LEAD	$76.50	$90.00	$38.70–$90.00	145% above	15%
Blood lead test inpatient CPT 83655 LEAD	$76.50	$90.00	$45.00–$2,713.07	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG, QUALITATIVE, SERUM	$87.55	$103.00	$44.29–$103.00	26% above	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG, QUALITATIVE, SERUM	$87.55	$103.00	$51.50–$2,713.07	—	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING, SEROLOGIC; ABO (BB)	$81.60	$96.00	$41.28–$96.00	55% above	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING, SEROLOGIC; ABO (BB)	$81.60	$96.00	$48.00–$2,713.07	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN, INFLAMMATORY	$88.40	$104.00	$44.72–$104.00	62% above	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN, INFLAMMATORY	$88.40	$104.00	$52.00–$2,713.07	—	15%
C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICILE, PCR	$161.50	$190.00	$81.70–$190.00	22% above	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFFICILE, PCR	$161.50	$190.00	$95.00–$2,713.07	—	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER AG 125	$102.85	$121.00	$52.03–$121.00	1% above	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER AG 125	$102.85	$121.00	$60.50–$2,713.07	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19/SARS-COV2, NAAT	$153.85	$181.00	$77.83–$181.00	28% above	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19/SARS-COV2, NAAT	$153.85	$181.00	$90.50–$2,713.07	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS, GENITAL AND URINE SOURCES, NAAT	$115.60	$136.00	$58.48–$136.00	23% above	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS AND NEISSERIA GONORRHOEAE, GENITAL AND URINE SOURCES, NAAT	$141.10	$166.00	$71.38–$166.00	50% above	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS, GENITAL AND URINE SOURCES, NAAT	$115.60	$136.00	$68.00–$2,713.07	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS AND NEISSERIA GONORRHOEAE, GENITAL AND URINE SOURCES, NAAT	$141.10	$166.00	$83.00–$2,713.07	—	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$123.25	$145.00	$62.35–$145.00	34% above	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL WITH DIRECT LDL	$140.25	$165.00	$70.95–$165.00	52% above	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$123.25	$145.00	$72.50–$2,713.07	—	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL WITH DIRECT LDL	$140.25	$165.00	$82.50–$2,713.07	—	15%
Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFFERENTIAL AND PLATELET COUNT	$12.75	$15.00	$6.45–$15.00	85% below	15%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFFERENTIAL AND PLATELET COUNT	$12.75	$15.00	$7.50–$2,713.07	—	15%
Complete blood count (CBC), no differential CPT 85027 HEMOGRAM WITH PLATELET COUNT	$12.75	$15.00	$6.45–$15.00	81% below	15%
Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM WITH PLATELET COUNT	$12.75	$15.00	$7.50–$2,713.07	—	15%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$21.25	$25.00	$10.75–$25.00	78% below	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$21.25	$25.00	$12.50–$2,713.07	—	15%
D-dimer blood test (blood clot marker) CPT 85379 D DIMER	$149.60	$176.00	$75.68–$176.00	51% above	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D DIMER	$149.60	$176.00	$88.00–$2,713.07	—	15%
Estradiol blood test CPT 82670 ESTRADIOL; TOTAL	$137.70	$162.00	$69.66–$162.00	108% above	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL; TOTAL	$137.70	$162.00	$81.00–$2,713.07	—	15%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING	$109.65	$129.00	$55.47–$129.00	55% above	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING	$109.65	$129.00	$64.50–$2,713.07	—	15%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$119.00	$140.00	$60.20–$140.00	33% above	15%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$119.00	$140.00	$70.00–$2,713.07	—	15%
Folate (folic acid) blood test CPT 82746 FOLATE	$115.60	$136.00	$58.48–$136.00	45% above	15%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$115.60	$136.00	$68.00–$2,713.07	—	15%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE (T3) FREE	$140.25	$165.00	$70.95–$165.00	37% above	15%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE (T3) FREE	$140.25	$165.00	$82.50–$2,713.07	—	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE (T4) FREE	$97.75	$115.00	$49.45–$115.00	43% above	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE (T4) FREE	$97.75	$115.00	$57.50–$2,713.07	—	15%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$382.50	$450.00	$193.50–$450.00	54% above	15%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$382.50	$450.00	$225.00–$2,713.07	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)	$63.75	$75.00	$32.25–$75.00	51% above	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)	$63.75	$75.00	$37.50–$2,713.07	—	15%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)	$162.35	$191.00	$82.13–$191.00	69% above	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)	$162.35	$191.00	$95.50–$2,713.07	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE, NAAT	$130.05	$153.00	$65.79–$153.00	54% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE, NAAT	$130.05	$153.00	$76.50–$2,713.07	—	15%
H. pylori stool antigen test CPT 87338 HELICOBACTER PYLORI AG, STOOL	$143.65	$169.00	$72.67–$169.00	33% above	15%
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLORI AG, STOOL	$143.65	$169.00	$84.50–$2,713.07	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 AB/HIV 1/2 AG	$152.15	$179.00	$76.97–$179.00	141% above	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 AB/HIV 1/2 AG	$152.15	$179.00	$89.50–$2,713.07	—	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK, POOLED RESULT	$147.05	$173.00	$74.39–$173.00	14% above	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH RISK, POOLED RESULT	$147.05	$173.00	$86.50–$2,713.07	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$89.25	$105.00	$45.15–$105.00	55% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$89.25	$105.00	$52.50–$2,713.07	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B VIRUS SURFACE AB	$76.50	$90.00	$38.70–$90.00	16% above	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B VIRUS SURFACE AB	$76.50	$90.00	$45.00–$2,713.07	—	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B VIRUS SURFACE AG	$81.60	$96.00	$41.28–$96.00	53% above	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B VIRUS SURFACE AG	$81.60	$96.00	$48.00–$2,713.07	—	15%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS AB	$79.05	$93.00	$39.99–$93.00	1% below	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS AB	$79.05	$93.00	$46.50–$2,713.07	—	15%
Herpes blood test, HSV-1 antibody CPT 86695 ANTIBODY; HERPES SIMPLEX TYPE 1	$59.50	$70.00	$30.10–$70.00	28% above	15%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 ANTIBODY; HERPES SIMPLEX TYPE 1	$59.50	$70.00	$35.00–$2,713.07	—	15%
Herpes blood test, HSV-2 antibody CPT 86696 ANTIBODY; HERPES SIMPLEX TYPE 2	$59.50	$70.00	$30.10–$70.00	3% above	15%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 ANTIBODY; HERPES SIMPLEX TYPE 2	$59.50	$70.00	$35.00–$2,713.07	—	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 C REACTIVE PROTEIN, CARDIAC HIGH SENSITIVITY	$117.30	$138.00	$59.34–$138.00	65% above	15%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C REACTIVE PROTEIN, CARDIAC HIGH SENSITIVITY	$117.30	$138.00	$69.00–$2,713.07	—	15%
Insulin blood test CPT 83525 INSULIN	$73.95	$87.00	$37.41–$87.00	35% above	15%
Insulin blood test inpatient CPT 83525 INSULIN	$73.95	$87.00	$43.50–$2,713.07	—	15%
Iron blood test (serum iron) CPT 83540 IRON	$64.60	$76.00	$32.68–$76.00	26% above	15%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$64.60	$76.00	$38.00–$2,713.07	—	15%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$69.70	$82.00	$35.26–$82.00	8% above	15%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$69.70	$82.00	$41.00–$2,713.07	—	15%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$137.70	$162.00	$69.66–$162.00	30% above	15%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$137.70	$162.00	$81.00–$2,713.07	—	15%
LH (luteinizing hormone) test CPT 83002 LUTROPIN (LH)	$109.65	$129.00	$55.47–$129.00	35% above	15%
LH (luteinizing hormone) test inpatient CPT 83002 LUTROPIN (LH)	$109.65	$129.00	$64.50–$2,713.07	—	15%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$17.00	$20.00	$8.60–$20.00	71% below	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$17.00	$20.00	$10.00–$2,713.07	—	15%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$17.00	$20.00	$8.60–$20.00	83% below	15%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$17.00	$20.00	$10.00–$2,713.07	—	15%
Lyme disease antibody test CPT 86618 BORRELIA BURGDORFERI SEROLOGY, EVALUATION WITH REFLEX	$104.55	$123.00	$52.89–$123.00	62% above	15%
Lyme disease antibody test inpatient CPT 86618 BORRELIA BURGDORFERI SEROLOGY, EVALUATION WITH REFLEX	$104.55	$123.00	$61.50–$2,713.07	—	15%
Magnesium blood test CPT 83735 MAGNESIUM	$12.75	$15.00	$6.45–$15.00	59% below	15%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$12.75	$15.00	$7.50–$2,713.07	—	15%
Measles (rubeola) antibody test CPT 86765 MEASLES VIRUS IGG AB	$43.35	$51.00	$21.93–$51.00	19% above	15%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES VIRUS IGG AB	$43.35	$51.00	$25.50–$2,713.07	—	15%
Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONONUCLEOSIS SCREEN	$64.60	$76.00	$32.68–$76.00	26% above	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 INFECTIOUS MONONUCLEOSIS SCREEN	$64.60	$76.00	$38.00–$2,713.07	—	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, SCREENING	$21.25	$25.00	$10.75–$25.00	74% below	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, DIAGNOSTIC	$131.75	$155.00	$66.65–$155.00	63% above	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, SCREENING	$21.25	$25.00	$12.50–$2,713.07	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, DIAGNOSTIC	$131.75	$155.00	$77.50–$2,713.07	—	15%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATHOLOGY, CERVICAL OR VAGINAL, PRESERVE FLD, THIN PREP; AUTO SYSTEM PHYS SUPERVISION (PATH)	$68.85	$81.00	$34.83–$81.00	19% below	15%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATHOLOGY, CERVICAL OR VAGINAL, PRESERVE FLD, THIN PREP; AUTO SYSTEM PHYS SUPERVISION (PATH)	$68.85	$81.00	$40.50–$2,713.07	—	15%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYRIN INTACT	$142.80	$168.00	$72.24–$168.00	22% above	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYRIN INTACT	$142.80	$168.00	$84.00–$2,713.07	—	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)	$102.00	$120.00	$51.60–$120.00	73% above	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)	$102.00	$120.00	$60.00–$2,713.07	—	15%
Progesterone blood test CPT 84144 PROGESTERONE	$90.95	$107.00	$46.01–$107.00	13% above	15%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$90.95	$107.00	$53.50–$2,713.07	—	15%
Prolactin blood test CPT 84146 PROLACTIN	$129.20	$152.00	$65.36–$152.00	98% above	15%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$129.20	$152.00	$76.00–$2,713.07	—	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$8.50	$10.00	$4.30–$10.00	72% below	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$8.50	$10.00	$5.00–$2,713.07	—	15%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 FENTANYL SCREEN, MANUAL	$249.05	$293.00	$125.99–$293.00	326% above	15%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 FENTANYL SCREEN, MANUAL	$249.05	$293.00	$146.50–$2,713.07	—	15%
Rheumatoid factor (RF) test CPT 86431 RA(RHEUMATOID FACTOR)	$51.85	$61.00	$26.23–$61.00	7% above	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RA(RHEUMATOID FACTOR)	$51.85	$61.00	$30.50–$2,713.07	—	15%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB, IGG	$37.40	$44.00	$18.92–$44.00	21% below	15%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB, IGG	$37.40	$44.00	$22.00–$2,713.07	—	15%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ERYTHROCYTE SEDIMENTATION RATE, AUTOMATED	$55.25	$65.00	$27.95–$65.00	46% above	15%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ERYTHROCYTE SEDIMENTATION RATE, AUTOMATED	$55.25	$65.00	$32.50–$2,713.07	—	15%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES	$83.30	$98.00	$42.14–$98.00	136% above	15%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES	$83.30	$98.00	$49.00–$2,713.07	—	15%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT,BLOOD, STOOL, CONSECUTIVE, FOR COLORECTAL NEOPLASM SCREEN	$22.10	$26.00	$11.18–$26.00	37% below	15%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT,BLOOD, STOOL, CONSECUTIVE, FOR COLORECTAL NEOPLASM SCREEN	$22.10	$26.00	$13.00–$2,713.07	—	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD, FIT	$92.65	$109.00	$46.87–$109.00	61% above	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD, FIT	$92.65	$109.00	$54.50–$2,713.07	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RAPID PLASMA REAGIN	$51.85	$61.00	$26.23–$61.00	75% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RAPID PLASMA REAGIN	$51.85	$61.00	$30.50–$2,713.07	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST, CELL MEDIATED IMMUNITY ANTIGEN RESP MEAS; QUANTIFERON	$153.00	$180.00	$77.40–$180.00	24% above	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST, CELL MEDIATED IMMUNITY ANTIGEN RESP MEAS; QUANTIFERON	$153.00	$180.00	$90.00–$2,713.07	—	15%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$76.50	$90.00	$38.70–$90.00	22% above	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE	$76.50	$90.00	$45.00–$2,713.07	—	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$119.00	$140.00	$60.20–$140.00	27% above	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE	$119.00	$140.00	$70.00–$2,713.07	—	15%
Uric acid blood test CPT 84550 URIC ACID	$64.60	$76.00	$32.68–$76.00	48% above	15%
Uric acid blood test inpatient CPT 84550 URIC ACID	$64.60	$76.00	$38.00–$2,713.07	—	15%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, AUTOMATED, WITH MICROSCOPY	$78.20	$92.00	$39.56–$92.00	58% above	15%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, MACROSCOPIC WITH MICROSCOPIC, REFLEX TO CULTURE	$78.20	$92.00	$39.56–$92.00	58% above	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, AUTOMATED, WITH MICROSCOPY	$78.20	$92.00	$46.00–$2,713.07	—	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, MACROSCOPIC WITH MICROSCOPIC, REFLEX TO CULTURE	$78.20	$92.00	$46.00–$2,713.07	—	15%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, MACROSCOPIC, AUTOMATED	$42.50	$50.00	$21.50–$50.00	66% above	15%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS WITH MACROSCOPIC, REFLEX TO MICROSCOPIC (MANUAL MICROSCOPIC)	$56.10	$66.00	$28.38–$66.00	119% above	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, MACROSCOPIC, AUTOMATED	$42.50	$50.00	$25.00–$2,713.07	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS WITH MACROSCOPIC, REFLEX TO MICROSCOPIC (MANUAL MICROSCOPIC)	$56.10	$66.00	$33.00–$2,713.07	—	15%
Urine culture for bacteria, with colony count CPT 87086 CULTURE, URINE	$78.20	$92.00	$39.56–$92.00	42% above	15%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, URINE	$78.20	$92.00	$46.00–$2,713.07	—	15%
Urine pregnancy test, read by color change CPT 81025 HCG, QUALITATIVE, URINE	$80.75	$95.00	$40.85–$95.00	108% above	15%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG, QUALITATIVE, URINE	$80.75	$95.00	$47.50–$2,713.07	—	15%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$109.65	$129.00	$55.47–$129.00	23% above	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$109.65	$129.00	$64.50–$2,713.07	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-HYDROXY, TOTAL	$158.10	$186.00	$79.98–$186.00	63% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25-HYDROXY, TOTAL	$158.10	$186.00	$93.00–$2,713.07	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA-HCG, QUANTITATIVE	$133.45	$157.00	$67.51–$157.00	45% above	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA-HCG, QUANTITATIVE	$133.45	$157.00	$78.50–$2,713.07	—	15%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12	$910.35	$1,071.00	$524.79–$1,480.50	47% above	15%
Adenoid removal (adenoidectomy), child under 12 inpatient CPT 42830 ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12	$910.35	$1,071.00	$535.50–$2,713.07	—	15%
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY; FOR RUPTURED APPENDX W/ABSCESS OR GENERALIZED PERITONITIS	$366.35	$431.00	$202.57–$431.00	78% below	15%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY; FOR RUPTURED APPENDX W/ABSCESS OR GENERALIZED PERITONITIS	$366.35	$431.00	$215.50–$2,713.07	—	15%
Botox injections for chronic migraine CPT 64615 BOTOX INJECTION; CHRONIC MIGRAINE	$259.25	$305.00	$76.53–$305.00	57% below	15%
Botox injections for chronic migraine inpatient CPT 64615 BOTOX INJECTION; CHRONIC MIGRAINE	$259.25	$305.00	$152.50–$2,713.07	—	15%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE; WITHOUT MANIPULATION	$987.70	$1,162.00	$135.54–$1,162.00	112% above	15%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION (RHC)	$987.70	$1,162.00	$135.54–$1,162.00	112% above	15%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION (RHC)	$987.70	$1,162.00	$581.00–$2,713.07	—	15%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE; WITHOUT MANIPULATION	$987.70	$1,162.00	$581.00–$2,713.07	—	15%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION	$702.95	$827.00	$135.54–$827.00	89% above	15%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH (RHC)	$702.95	$827.00	$135.54–$827.00	89% above	15%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH (RHC)	$702.95	$827.00	$413.50–$2,713.07	—	15%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION	$702.95	$827.00	$413.50–$2,713.07	—	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$728.45	$857.00	$363.56–$857.00	29% below	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$728.45	$857.00	$428.50–$2,713.07	—	15%
Carpal tunnel release, open surgery CPT 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL	$1,071.00	$1,260.00	$617.40–$1,260.00	27% below	15%
Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL	$1,071.00	$1,260.00	$630.00–$2,713.07	—	15%
Cervical biopsy CPT 57500 EXCISION OF LESION ON CERVIX	$221.00	$260.00	$106.07–$260.00	49% below	15%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (RHC)	$419.05	$493.00	$106.07–$941.00	3% below	15%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, W/W/O FULGURATION	$419.05	$493.00	$106.07–$493.00	3% below	15%
Cervical biopsy inpatient CPT 57500 EXCISION OF LESION ON CERVIX	$221.00	$260.00	$130.00–$2,713.07	—	15%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, W/W/O FULGURATION	$419.05	$493.00	$246.50–$2,713.07	—	15%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (RHC)	$419.05	$493.00	$246.50–$2,713.07	—	15%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS	$715.70	$842.00	$412.58–$1,001.95	48% below	15%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS	$715.70	$842.00	$421.00–$2,713.07	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK (RHC)	$566.95	$667.00	$286.81–$1,001.95	132% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION, USING CLAMP OR OTHER DEVICE W/REGIONAL DORSAL PENILE OR RING BLOCK	$566.95	$667.00	$326.83–$1,001.95	132% above	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION, USING CLAMP OR OTHER DEVICE W/REGIONAL DORSAL PENILE OR RING BLOCK	$566.95	$667.00	$333.50–$2,713.07	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK (RHC)	$566.95	$667.00	$333.50–$2,713.07	—	15%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; NEONATE (< 29 DAYS OF AGE)	$464.10	$546.00	$267.54–$546.00	11% below	15%
Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; NEONATE (< 29 DAYS OF AGE)	$464.10	$546.00	$273.00–$2,713.07	—	15%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED TREATMENT OF DISTAL RADIAL FX OR EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION	$953.70	$1,122.00	$135.54–$1,122.00	94% above	15%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION (RHC)	$953.70	$1,122.00	$135.54–$1,122.00	94% above	15%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TREATMENT OF DISTAL RADIAL FX OR EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION	$953.70	$1,122.00	$561.00–$2,713.07	—	15%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION; WITHOUT MANIPULATION (RHC)	$953.70	$1,122.00	$561.00–$2,713.07	—	15%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY, FLEXIBLE; W/REMOVAL OF TUMOR, POLYP, LESION BY SNARE TECH	$793.90	$934.00	$457.66–$934.00	36% below	15%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY, FLEXIBLE; W/REMOVAL OF TUMOR, POLYP, LESION BY SNARE TECH	$793.90	$934.00	$467.00–$2,713.07	—	15%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY, FLEXIBLE; W/BIOPSY, SINGLE OR MULTIPLE	$691.05	$813.00	$398.37–$813.00	45% below	15%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY, FLEXIBLE; W/BIOPSY, SINGLE OR MULTIPLE	$691.05	$813.00	$406.50–$2,713.07	—	15%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY, FLEXIBLE; DIAG, W/COLLECTION SPECIMEN BY BRUSHING OR WASHING	$652.80	$768.00	$376.32–$768.00	46% below	15%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY, FLEXIBLE; DIAG, W/COLLECTION SPECIMEN BY BRUSHING OR WASHING	$652.80	$768.00	$384.00–$2,713.07	—	15%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY (RHC)	$516.80	$608.00	$77.54–$608.00	6% below	15%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; W/BIOPSY OF CERVIX AND ENDOCERV CURETTAGE	$516.80	$608.00	$77.54–$608.00	6% below	15%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY (RHC)	$516.80	$608.00	$304.00–$2,713.07	—	15%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; W/BIOPSY OF CERVIX AND ENDOCERV CURETTAGE	$516.80	$608.00	$304.00–$2,713.07	—	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE)	$388.45	$457.00	$223.93–$457.00	48% below	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$1,984.75	$2,335.00	$310.63–$2,335.00	166% above	15%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE)	$388.45	$457.00	$228.50–$2,713.07	—	15%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$1,984.75	$2,335.00	$1,167.50–$2,713.07	—	15%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) (RHC)	$1,107.55	$1,303.00	$301.37–$3,307.24	23% below	15%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOB)	$1,107.55	$1,303.00	$638.47–$1,738.07	23% below	15%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOB)	$1,107.55	$1,303.00	$651.50–$2,713.07	—	15%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) (RHC)	$1,107.55	$1,303.00	$651.50–$2,713.07	—	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION, PREMALIGNANT LESION; FIRST LESION	$119.00	$140.00	$60.20–$140.00	34% below	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALIGNANT LESIONS 1ST LESION (RHC)	$200.60	$236.00	$101.48–$351.12	11% above	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION PREMALIGNANT LESIONS; 1ST LESION	$200.60	$236.00	$110.92–$236.00	11% above	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION, PREMALIGNANT LESION; FIRST LESION	$119.00	$140.00	$70.00–$2,713.07	—	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION PREMALIGNANT LESIONS; 1ST LESION	$200.60	$236.00	$118.00–$2,713.07	—	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALIGNANT LESIONS 1ST LESION (RHC)	$200.60	$236.00	$118.00–$2,713.07	—	15%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 TYMPANOSTOMY, GENERAL ANESTHESIA	$693.60	$816.00	$399.84–$816.00	20% below	15%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 TYMPANOSTOMY, GENERAL ANESTHESIA	$693.60	$816.00	$408.00–$2,713.07	—	15%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 TYMPANOSTOMY, LOCAL OR TOPICAL ANESTHESIA	$520.20	$612.00	$145.01–$612.00	22% above	15%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 TYMPANOSTOMY, LOCAL OR TOPICAL ANESTHESIA	$520.20	$612.00	$306.00–$2,713.07	—	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN BY IRRIGATION/LAVAGE, UNILATERAL	$34.00	$40.00	$17.20–$40.00	56% below	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL (RHC)	$45.05	$53.00	$22.79–$351.12	42% below	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL	$45.05	$53.00	$24.91–$53.00	42% below	15%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN BY IRRIGATION/LAVAGE, UNILATERAL	$34.00	$40.00	$20.00–$2,713.07	—	15%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL	$45.05	$53.00	$26.50–$2,713.07	—	15%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL (RHC)	$45.05	$53.00	$26.50–$2,713.07	—	15%
Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN	$69.70	$82.00	$35.26–$82.00	43% below	15%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL (RHC)	$118.15	$139.00	$59.77–$351.12	4% below	15%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL	$118.15	$139.00	$65.33–$139.00	4% below	15%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN	$69.70	$82.00	$41.00–$2,713.07	—	15%
Earwax removal with instruments, one ear inpatient one side CPT 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL	$118.15	$139.00	$69.50–$2,713.07	—	15%
Earwax removal with instruments, one ear inpatient one side CPT 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL (RHC)	$118.15	$139.00	$69.50–$2,713.07	—	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF ENDOMETRIAL W/O CERVICAL DILATION	$191.25	$225.00	$52.03–$225.00	23% below	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY; W/WO ENDOCERVICAL BIOPSY, W/O CERVICAL DILATION, ANY METHOD	$380.80	$448.00	$52.03–$448.00	54% above	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BIOPSY W OR W/O ENDOCERVICAL SAMPLING, WITHOUT CERVICAL DILATION, ANY METHOD (RHC)	$380.80	$448.00	$52.03–$448.00	54% above	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF ENDOMETRIAL W/O CERVICAL DILATION	$191.25	$225.00	$112.50–$2,713.07	—	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY W OR W/O ENDOCERVICAL SAMPLING, WITHOUT CERVICAL DILATION, ANY METHOD (RHC)	$380.80	$448.00	$224.00–$2,713.07	—	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BIOPSY; W/WO ENDOCERVICAL BIOPSY, W/O CERVICAL DILATION, ANY METHOD	$380.80	$448.00	$224.00–$2,713.07	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ(S) SBST(S), WO NEUROLYTIC SUB, W NEEDLE/CATH, INTERLAMINAR EPID/SUBARACHNOID, CRV/THRC; IMG GDN	$1,325.15	$1,559.00	$387.46–$1,559.00	34% above	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 XR EPIDURAL CERVICAL THORACIC INJ	$2,040.00	$2,400.00	$387.46–$2,400.00	106% above	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ(S) SBST(S), WO NEUROLYTIC SUB, W NEEDLE/CATH, INTERLAMINAR EPID/SUBARACHNOID, CRV/THRC; IMG GDN	$1,325.15	$1,559.00	$779.50–$2,713.07	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 XR EPIDURAL CERVICAL THORACIC INJ	$2,040.00	$2,400.00	$1,200.00–$2,713.07	—	15%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INTRAVITREAL INJECTION OF PHARMACOLOGIC AGENT	$559.30	$658.00	$64.11–$658.00	11% above	15%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)	$836.40	$984.00	$64.11–$984.00	66% above	15%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INTRAVITREAL INJECTION OF PHARMACOLOGIC AGENT	$559.30	$658.00	$329.00–$2,713.07	—	15%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)	$836.40	$984.00	$492.00–$2,713.07	—	15%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR ANTERIOR ABD HERNIA, ANY APPROACH, INITIAL, INCL IMPLANT OF MESH, 3 CM TO 10 CM, REDUCIBLE	$1,113.50	$1,310.00	$641.90–$3,365.12	28% below	15%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 REPAIR ANTERIOR ABD HERNIA, ANY APPROACH, INITIAL, INCL IMPLANT OF MESH, 3 CM TO 10 CM, REDUCIBLE	$1,113.50	$1,310.00	$655.00–$2,713.07	—	15%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 REPAIR ANT ABD HERNIA, ANY APPROACH, INITIAL, INCL IMPLANTATION MESH; GREATER THAN 10 CM, REDUCIBLE	$1,513.00	$1,780.00	$872.20–$3,365.12	12% below	15%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 REPAIR ANT ABD HERNIA, ANY APPROACH, INITIAL, INCL IMPLANTATION MESH; GREATER THAN 10 CM, REDUCIBLE	$1,513.00	$1,780.00	$890.00–$2,713.07	—	15%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR ANTERIOR ABD HERNIA, ANY APPROACH, INITIAL, INCL IMPLANT MESH, LESS THAN 3 CM, REDUCIBLE	$646.85	$761.00	$372.89–$1,744.22	58% below	15%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 REPAIR ANTERIOR ABD HERNIA, ANY APPROACH, INITIAL, INCL IMPLANT MESH, LESS THAN 3 CM, REDUCIBLE	$646.85	$761.00	$380.50–$2,713.07	—	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) (RHC)	$361.25	$425.00	$182.75–$425.00	58% below	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN BY BRUSHING OR WASHING	$361.25	$425.00	$184.96–$425.00	58% below	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN BY BRUSHING OR WASHING	$361.25	$425.00	$212.50–$2,713.07	—	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) (RHC)	$361.25	$425.00	$212.50–$2,713.07	—	15%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY	$1,517.25	$1,785.00	$874.65–$3,030.97	8% below	15%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY	$1,517.25	$1,785.00	$892.50–$2,713.07	—	15%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY	$1,729.75	$2,035.00	$997.15–$3,030.97	14% below	15%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY	$1,729.75	$2,035.00	$1,017.50–$2,713.07	—	15%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY;	$478.55	$563.00	$264.61–$563.00	72% below	15%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY;	$478.55	$563.00	$281.50–$2,713.07	—	15%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP (PBB)	$667.25	$785.00	$337.55–$1,432.51	64% below	15%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;	$1,908.25	$2,245.00	$1,100.05–$2,245.00	2% above	15%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP (RHC)	$1,908.25	$2,245.00	$301.37–$2,245.00	2% above	15%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP (PBB)	$667.25	$785.00	$392.50–$2,713.07	—	15%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;	$1,908.25	$2,245.00	$1,122.50–$2,713.07	—	15%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP (RHC)	$1,908.25	$2,245.00	$1,122.50–$2,713.07	—	15%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL ABD HYSTERECTOMY, W/WO REMOVAL OF TUBES, W/WO REMOVAL OF OVARIES;	$663.85	$781.00	$367.07–$781.00	70% below	15%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL ABD HYSTERECTOMY, W/WO REMOVAL OF TUBES, W/WO REMOVAL OF OVARIES;	$663.85	$781.00	$390.50–$2,713.07	—	15%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF INTRAUTERINE DEVICE (RHC)	$323.00	$380.00	$163.40–$380.00	27% above	15%
IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF INTRAUTERINE DEVICE	$323.00	$380.00	$178.60–$380.00	27% above	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION OF INTRAUTERINE DEVICE	$323.00	$380.00	$190.00–$2,713.07	—	15%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION OF INTRAUTERINE DEVICE (RHC)	$323.00	$380.00	$190.00–$2,713.07	—	15%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE OF ABSCESS; SIMPLE OR SINGLE	$280.50	$330.00	$84.93–$330.00	3% below	15%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE OF ABSCESS; SIMPLE OR SINGLE (RHC)	$280.50	$330.00	$84.93–$351.12	3% below	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION AND DRAINAGE OF ABSCESS; SIMPLE OR SINGLE (RHC)	$280.50	$330.00	$165.00–$2,713.07	—	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION AND DRAINAGE OF ABSCESS; SIMPLE OR SINGLE	$280.50	$330.00	$165.00–$2,713.07	—	15%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR INITIAL INGUINAL HERNIA, 5 YR OR OLDER; REDUCIBLE	$1,954.15	$2,299.00	$1,126.51–$2,299.00	12% above	15%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR INITIAL INGUINAL HERNIA, 5 YR OR OLDER; REDUCIBLE	$1,954.15	$2,299.00	$1,149.50–$2,713.07	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS	$173.40	$204.00	$33.23–$204.00	53% below	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION; SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA") (RHC)	$173.40	$204.00	$33.23–$351.12	53% below	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 SC INJ TENDON SHEATH OR LIGAMENT	$216.75	$255.00	$33.23–$255.00	41% below	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION TENDON SHEATH, SINGLE	$253.30	$298.00	$33.23–$298.00	31% below	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION; SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA") (RHC)	$173.40	$204.00	$102.00–$2,713.07	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS	$173.40	$204.00	$102.00–$2,713.07	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 SC INJ TENDON SHEATH OR LIGAMENT	$216.75	$255.00	$127.50–$2,713.07	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION TENDON SHEATH, SINGLE	$253.30	$298.00	$149.00–$2,713.07	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE	$204.00	$240.00	$38.94–$240.00	44% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE (RHC)	$204.00	$240.00	$38.94–$351.12	44% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA W/O US GUIDANCE	$335.75	$395.00	$38.94–$395.00	8% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE (RHC)	$204.00	$240.00	$120.00–$2,713.07	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE	$204.00	$240.00	$120.00–$2,713.07	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA W/O US GUIDANCE	$335.75	$395.00	$197.50–$2,713.07	—	15%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)	$170.64	$200.75	$94.35–$200.75	38% below	15%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE) (RHC)	$170.64	$200.75	$86.32–$351.12	38% below	15%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERTION,DRUG DELIVERY IMPLANT	$208.56	$245.36	$105.50–$245.36	24% below	15%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE) (RHC)	$170.64	$200.75	$100.38–$2,713.07	—	15%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)	$170.64	$200.75	$100.38–$2,713.07	—	15%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERTION,DRUG DELIVERY IMPLANT	$208.56	$245.36	$122.68–$2,713.07	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA; W/OUT ULTRASOUND GUIDANCE	$191.25	$225.00	$32.56–$225.00	37% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JT OR BURSA; W/O ULTRASOUND GUIDANCE (RHC)	$191.25	$225.00	$32.56–$351.12	37% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS MEDIUM JOINT W/O US GUIDANCE	$214.20	$252.00	$32.56–$252.00	30% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA; W/OUT ULTRASOUND GUIDANCE	$191.25	$225.00	$112.50–$2,713.07	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JT OR BURSA; W/O ULTRASOUND GUIDANCE (RHC)	$191.25	$225.00	$112.50–$2,713.07	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS MEDIUM JOINT W/O US GUIDANCE	$214.20	$252.00	$126.00–$2,713.07	—	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 SC INJ ASPIRATE SMALL JOINT	$158.95	$187.00	$32.22–$187.00	51% below	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE (RHC)	$170.00	$200.00	$32.22–$351.12	47% below	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE	$170.00	$200.00	$32.22–$200.00	47% below	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA; W/O ULTRASOUND GUIDANCE	$212.50	$250.00	$32.22–$250.00	34% below	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 SC INJ ASPIRATE SMALL JOINT	$158.95	$187.00	$93.50–$2,713.07	—	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE (RHC)	$170.00	$200.00	$100.00–$2,713.07	—	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA; WITHOUT ULTRASOUND GUIDANCE	$170.00	$200.00	$100.00–$2,713.07	—	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA; W/O ULTRASOUND GUIDANCE	$212.50	$250.00	$125.00–$2,713.07	—	15%
Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY, KNEE, SURGICAL; W/MENISCECTOMY (MEDIAL OR LATERAL) W/ DEBRIDEMENT/SHAVING OF ARTICULAR	$3,060.00	$3,600.00	$1,644.87–$3,600.00	58% above	15%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY, KNEE, SURGICAL; W/MENISCECTOMY (MEDIAL OR LATERAL) W/ DEBRIDEMENT/SHAVING OF ARTICULAR	$3,060.00	$3,600.00	$1,800.00–$3,600.00	—	15%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOPY, KNEE, SURGICAL; W/MENISCECTOMY (MEDIAL AND LATERAL) W/ DEBRIDEMENT/SHAVING OF ARTICULAR	$3,655.00	$4,300.00	$1,644.87–$4,300.00	54% above	15%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ARTHROSCOPY, KNEE, SURGICAL; W/MENISCECTOMY (MEDIAL AND LATERAL) W/ DEBRIDEMENT/SHAVING OF ARTICULAR	$3,655.00	$4,300.00	$2,150.00–$4,300.00	—	15%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA	$1,907.40	$2,244.00	$1,099.56–$3,030.97	60% above	15%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA	$1,907.40	$2,244.00	$1,122.00–$2,713.07	—	15%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY, SURGICAL; W/REMOVAL OF ADNEXAL STRUCTURES	$1,593.75	$1,875.00	$918.75–$3,030.97	7% below	15%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY, SURGICAL; W/REMOVAL OF ADNEXAL STRUCTURES	$1,593.75	$1,875.00	$937.50–$2,713.07	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERMEDIATE WOUND OF SCALP, AXILLAE, TRUNK OR EXTREMITIES, 2.5 CM OR LESS	$250.75	$295.00	$126.85–$295.00	45% below	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE WOUND SCALP,TRUNK,EXTREMITIES; 2.5 CM OR LESS (RHC)	$368.90	$434.00	$186.62–$434.00	19% below	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND SCALP,TRUNK,EXTREMITIES; 2.5 CM OR LESS	$368.90	$434.00	$187.98–$434.00	19% below	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE WOUND REPAIR SCALP/AX/TRUNK/EXTREM 2.5 CM OR LESS	$493.00	$580.00	$187.98–$580.00	9% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTERMEDIATE WOUND OF SCALP, AXILLAE, TRUNK OR EXTREMITIES, 2.5 CM OR LESS	$250.75	$295.00	$147.50–$2,713.07	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 WOUND SCALP,TRUNK,EXTREMITIES; 2.5 CM OR LESS	$368.90	$434.00	$217.00–$2,713.07	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE WOUND SCALP,TRUNK,EXTREMITIES; 2.5 CM OR LESS (RHC)	$368.90	$434.00	$217.00–$2,713.07	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTERMEDIATE WOUND REPAIR SCALP/AX/TRUNK/EXTREM 2.5 CM OR LESS	$493.00	$580.00	$290.00–$2,713.07	—	15%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ(S), SUBSTANCE(S), WO NEUROLYTIC SUB, W NEEDLE/CATH, INTRLMNR EPID/SUBARACHNOID, LMBR/SAC;IMG GDN	$1,713.60	$2,016.00	$387.46–$2,016.00	80% above	15%
Lower-back epidural injection, with imaging guidance CPT 62323 XR EPIDURAL LUMBAR OR SACRAL INJ	$2,040.00	$2,400.00	$387.46–$2,400.00	115% above	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ(S), SUBSTANCE(S), WO NEUROLYTIC SUB, W NEEDLE/CATH, INTRLMNR EPID/SUBARACHNOID, LMBR/SAC;IMG GDN	$1,713.60	$2,016.00	$1,008.00–$2,713.07	—	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR EPIDURAL LUMBAR OR SACRAL INJ	$2,040.00	$2,400.00	$1,200.00–$2,713.07	—	15%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ EPIDURAL SUBARACHNOID L S	$1,222.30	$1,438.00	$485.51–$1,438.00	27% above	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ EPIDURAL SUBARACHNOID L S	$1,222.30	$1,438.00	$719.00–$2,713.07	—	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, W IMG GD; LMBR/SAC, SINGLE LEVEL	$1,434.80	$1,688.00	$485.51–$1,688.00	12% above	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR CT FORAMIN INJ LUMB SACR SNGL LVL W GUID	$2,080.80	$2,448.00	$485.51–$2,448.00	62% above	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, W IMG GD; LMBR/SAC, SINGLE LEVEL	$1,434.80	$1,688.00	$844.00–$2,713.07	—	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR CT FORAMIN INJ LUMB SACR SNGL LVL W GUID	$2,080.80	$2,448.00	$1,224.00–$2,713.07	—	15%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY, PARTIAL;	$1,691.50	$1,990.00	$975.10–$1,990.00	15% above	15%
Lumpectomy (partial mastectomy) inpatient CPT 19301 MASTECTOMY, PARTIAL;	$1,691.50	$1,990.00	$995.00–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION, BENIGN LESION INCL MARGINS TRUNK/ARM/LEG 0.5CM OR LESS	$161.50	$190.00	$81.70–$190.00	60% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION,BENIGN,LESION TRUNK/ARM/LEG; .5 CM OR LESS (PBB)	$164.05	$193.00	$82.99–$193.00	60% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION, BENIGN LESION INCLUDING MARGINS, TRUNK, ARMS OR LEGS; 0.5 CM OR LESS	$290.70	$342.00	$95.33–$342.00	28% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN LESION TRUNK/ARM/LEG < = .5 CM (RHC)	$290.70	$342.00	$95.33–$723.47	28% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION, BENIGN LESION INCL MARGINS TRUNK/ARM/LEG 0.5CM OR LESS	$161.50	$190.00	$95.00–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION,BENIGN,LESION TRUNK/ARM/LEG; .5 CM OR LESS (PBB)	$164.05	$193.00	$96.50–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENIGN LESION TRUNK/ARM/LEG < = .5 CM (RHC)	$290.70	$342.00	$171.00–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION, BENIGN LESION INCLUDING MARGINS, TRUNK, ARMS OR LEGS; 0.5 CM OR LESS	$290.70	$342.00	$171.00–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION, OTHER BENIGN LESION, EXCEPT SKTAG,F,E,EYELID,N,L,MUC MEMB;EXC DIA 0.5 CM OR LESS	$221.00	$260.00	$104.73–$260.00	58% below	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION, BENIGN LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; .5 CM OR LESS (RHC)	$293.25	$345.00	$104.73–$723.47	44% below	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; 0.5 CM OR LESS	$293.25	$345.00	$104.73–$345.00	44% below	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION, OTHER BENIGN LESION, EXCEPT SKTAG,F,E,EYELID,N,L,MUC MEMB;EXC DIA 0.5 CM OR LESS	$221.00	$260.00	$130.00–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; 0.5 CM OR LESS	$293.25	$345.00	$172.50–$2,713.07	—	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION, BENIGN LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; .5 CM OR LESS (RHC)	$293.25	$345.00	$172.50–$2,713.07	—	15%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE	$153.00	$180.00	$77.40–$180.00	45% below	15%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE (RHC)	$236.30	$278.00	$119.54–$351.12	15% below	15%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE	$236.30	$278.00	$130.66–$278.00	15% below	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE	$153.00	$180.00	$90.00–$2,713.07	—	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE (RHC)	$236.30	$278.00	$139.00–$2,713.07	—	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE	$236.30	$278.00	$139.00–$2,713.07	—	15%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE (RHC)	$376.55	$443.00	$41.29–$443.00	38% below	15%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE	$376.55	$443.00	$41.29–$443.00	38% below	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE	$376.55	$443.00	$221.50–$2,713.07	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE (RHC)	$376.55	$443.00	$221.50–$2,713.07	—	15%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE (PBB)	$260.10	$306.00	$131.58–$497.85	70% below	15%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE	$693.60	$816.00	$399.84–$816.00	21% below	15%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE (524) (RHC)	$693.60	$816.00	$350.88–$816.00	21% below	15%
Paracentesis with imaging guidance CPT 49083 US GUIDE PARACENTESIS ABDOMEN	$1,432.25	$1,685.00	$497.85–$1,685.00	64% above	15%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE (PBB)	$260.10	$306.00	$153.00–$2,713.07	—	15%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE (524) (RHC)	$693.60	$816.00	$408.00–$2,713.07	—	15%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE	$693.60	$816.00	$408.00–$2,713.07	—	15%
Paracentesis with imaging guidance inpatient CPT 49083 US GUIDE PARACENTESIS ABDOMEN	$1,432.25	$1,685.00	$842.50–$2,713.07	—	15%
Partial knee replacement (one compartment) CPT 27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT	$4,373.25	$5,145.00	$2,521.05–$9,213.82	28% above	15%
Partial knee replacement (one compartment) inpatient CPT 27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT	$4,373.25	$5,145.00	$2,572.50–$5,145.00	—	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, FOR PERMANENT REMOVAL (RHC)	$429.25	$505.00	$102.05–$505.00	15% below	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL AND MATRIX, PARTIAL/COMPLETE, PERMANENT REMOVAL;	$429.25	$505.00	$102.05–$505.00	15% below	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, FOR PERMANENT REMOVAL (RHC)	$429.25	$505.00	$252.50–$2,713.07	—	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL AND MATRIX, PARTIAL/COMPLETE, PERMANENT REMOVAL;	$429.25	$505.00	$252.50–$2,713.07	—	15%
Removal of a breast lump, open surgery CPT 19120 EXCISION CYST, FIBROADENOMA, OTHER BENIGN OR MALIGNANT TUMOR, OPEN, MALE OR FEMALE, 1 OR MORE LESION	$1,470.50	$1,730.00	$847.70–$1,730.00	1% below	15%
Removal of a breast lump, open surgery inpatient CPT 19120 EXCISION CYST, FIBROADENOMA, OTHER BENIGN OR MALIGNANT TUMOR, OPEN, MALE OR FEMALE, 1 OR MORE LESION	$1,470.50	$1,730.00	$865.00–$2,713.07	—	15%
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMOVAL FB, SUBQ TISSUE; SIMPLE (PBB)	$194.65	$229.00	$98.47–$229.00	51% below	15%
Removal of a foreign object under the skin, simple CPT 10120 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE (RHC)	$344.25	$405.00	$113.46–$415.32	14% below	15%
Removal of a foreign object under the skin, simple CPT 10120 INCISION AND REMOVAL FOREIGN BODY, SUBQ TISSUE; SIMPLE	$344.25	$405.00	$113.46–$405.00	14% below	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMOVAL FB, SUBQ TISSUE; SIMPLE (PBB)	$194.65	$229.00	$114.50–$2,713.07	—	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION AND REMOVAL FOREIGN BODY, SUBQ TISSUE; SIMPLE	$344.25	$405.00	$202.50–$2,713.07	—	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE (RHC)	$344.25	$405.00	$202.50–$2,713.07	—	15%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON PT NOT MEETING CRITERIA FOR HIGH RISK	$374.00	$440.00	$215.60–$510.49	66% below	15%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON PT NOT MEETING CRITERIA FOR HIGH RISK	$374.00	$440.00	$220.00–$2,713.07	—	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK	$408.00	$480.00	$235.20–$510.49	65% below	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK	$408.00	$480.00	$240.00–$2,713.07	—	15%
Septoplasty to straighten the nasal septum CPT 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WIT	$2,319.65	$2,729.00	$1,337.21–$2,729.00	68% above	15%
Septoplasty to straighten the nasal septum inpatient CPT 30520 SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WIT	$2,319.65	$2,729.00	$1,364.50–$2,729.00	—	15%
Short arm cast (elbow to hand) CPT 29075 APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM)	$260.10	$306.00	$68.14–$306.00	10% above	15%
Short arm cast (elbow to hand) CPT 29075 APP CAST SHORT ARM (RHC)	$260.10	$306.00	$68.14–$351.12	10% above	15%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION, CAST; ELBOW TO FINGER (SHORT ARM)	$260.10	$306.00	$153.00–$2,713.07	—	15%
Short arm cast (elbow to hand) inpatient CPT 29075 APP CAST SHORT ARM (RHC)	$260.10	$306.00	$153.00–$2,713.07	—	15%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC	$178.50	$210.00	$98.70–$210.00	10% below	15%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC (RHC)	$178.50	$210.00	$90.30–$351.12	10% below	15%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SHORT ARM SPLINT	$221.00	$260.00	$111.80–$260.00	11% above	15%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC	$178.50	$210.00	$105.00–$2,713.07	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC (RHC)	$178.50	$210.00	$105.00–$2,713.07	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SHORT ARM SPLINT	$221.00	$260.00	$130.00–$2,713.07	—	15%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES)	$209.95	$247.00	$57.74–$247.00	23% below	15%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);	$282.20	$332.00	$57.74–$332.00	4% above	15%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) (RHC)	$282.20	$332.00	$57.74–$351.12	4% above	15%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES)	$209.95	$247.00	$123.50–$2,713.07	—	15%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);	$282.20	$332.00	$166.00–$2,713.07	—	15%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) (RHC)	$282.20	$332.00	$166.00–$2,713.07	—	15%
Short leg splint (calf to foot) CPT 29515 APP SHORT LEG SPLINT (CALF TO FOOT) (RHC)	$225.25	$265.00	$55.39–$351.12	1% above	15%
Short leg splint (calf to foot) CPT 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)	$225.25	$265.00	$55.39–$265.00	1% above	15%
Short leg splint (calf to foot) inpatient CPT 29515 APP SHORT LEG SPLINT (CALF TO FOOT) (RHC)	$225.25	$265.00	$132.50–$2,713.07	—	15%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)	$225.25	$265.00	$132.50–$2,713.07	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR WOUND (RHC)	$282.20	$332.00	$142.76–$351.12	4% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR WOUND SCALP, NECK, AXILLAE, EXT GENITALIA, TRUNK OR EXTREMITIES; 2.5 CM OR LESS	$282.20	$332.00	$156.04–$332.00	4% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE WOUND REPAIR SCALP/NECK/AX/GEN/TRUNK/EXT 2.5 CM OR LESS	$400.35	$471.00	$202.53–$471.00	48% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR WOUND (RHC)	$282.20	$332.00	$166.00–$2,713.07	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR WOUND SCALP, NECK, AXILLAE, EXT GENITALIA, TRUNK OR EXTREMITIES; 2.5 CM OR LESS	$282.20	$332.00	$166.00–$2,713.07	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE WOUND REPAIR SCALP/NECK/AX/GEN/TRUNK/EXT 2.5 CM OR LESS	$400.35	$471.00	$235.50–$2,713.07	—	15%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION (PBB)	$119.85	$141.00	$60.63–$141.00	58% below	15%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$199.75	$235.00	$91.64–$235.00	31% below	15%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION	$232.90	$274.00	$91.64–$274.00	19% below	15%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION (RHC)	$232.90	$274.00	$91.64–$415.32	19% below	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION (PBB)	$119.85	$141.00	$70.50–$2,713.07	—	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$199.75	$235.00	$117.50–$2,713.07	—	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION (RHC)	$232.90	$274.00	$137.00–$2,713.07	—	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION	$232.90	$274.00	$137.00–$2,713.07	—	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXC DIA 0.5 CM OR LESS	$255.00	$300.00	$129.00–$300.00	48% below	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS OR LEGS; 0.5CM OR LESS	$408.00	$480.00	$138.97–$480.00	17% below	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS (RHC)	$408.00	$480.00	$138.97–$723.47	17% below	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXC DIA 0.5 CM OR LESS	$255.00	$300.00	$150.00–$2,713.07	—	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS OR LEGS; 0.5CM OR LESS	$408.00	$480.00	$240.00–$2,713.07	—	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS (RHC)	$408.00	$480.00	$240.00–$2,713.07	—	15%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS; UP TO AND INCLUDING 15 LESIONS	$137.70	$162.00	$69.66–$162.00	30% below	15%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS; UP TO AND INCLIDING15 LESIONS	$188.70	$222.00	$104.34–$222.00	4% below	15%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS (RHC)	$188.70	$222.00	$95.46–$351.12	4% below	15%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS; UP TO AND INCLUDING 15 LESIONS	$137.70	$162.00	$81.00–$2,713.07	—	15%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS; UP TO AND INCLIDING15 LESIONS	$188.70	$222.00	$111.00–$2,713.07	—	15%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS (RHC)	$188.70	$222.00	$111.00–$2,713.07	—	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC	$456.45	$537.00	$263.13–$537.00	37% below	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC (RHC)	$456.45	$537.00	$230.91–$721.17	37% below	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$780.30	$918.00	$387.46–$918.00	7% above	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC (RHC)	$456.45	$537.00	$268.50–$2,713.07	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC	$456.45	$537.00	$268.50–$2,713.07	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$780.30	$918.00	$459.00–$2,713.07	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR WOUND SCALP, NECK, AXILLAE, EXT GENITALIA, TRUNK OR EXTREMITIES; 2.6 TO 7.5 CM	$396.10	$466.00	$219.02–$466.00	29% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR WOUND SCALP,NECK,TRUNK,EXTREMITIES; 2.6-7.5 CM (RHC)	$396.10	$466.00	$200.38–$466.00	29% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE WOUND REPAIR SCALP/NECK/AX/GEN/TRUNK/EXT 2.6 CM-7.5 CM	$412.25	$485.00	$208.55–$485.00	34% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR WOUND SCALP,NECK,TRUNK,EXTREMITIES; 2.6-7.5 CM (RHC)	$396.10	$466.00	$233.00–$2,713.07	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR WOUND SCALP, NECK, AXILLAE, EXT GENITALIA, TRUNK OR EXTREMITIES; 2.6 TO 7.5 CM	$396.10	$466.00	$233.00–$2,713.07	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE WOUND REPAIR SCALP/NECK/AX/GEN/TRUNK/EXT 2.6 CM-7.5 CM	$412.25	$485.00	$242.50–$2,713.07	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR WOUND FACE,EAR,EYELID,NOSE; 2.5 CM OR LESS (RHC)	$267.75	$315.00	$135.45–$351.12	2% below	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR WOUND FACE, EARS, EYELIDS, NOSE, LIPS; 2.5 CM OR LESS	$267.75	$315.00	$148.05–$315.00	2% below	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE WOUND REPAIR FACE/E/E/N/L/M 2.5 CM OR LESS	$399.50	$470.00	$202.10–$470.00	46% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR WOUND FACE,EAR,EYELID,NOSE; 2.5 CM OR LESS (RHC)	$267.75	$315.00	$157.50–$2,713.07	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR WOUND FACE, EARS, EYELIDS, NOSE, LIPS; 2.5 CM OR LESS	$267.75	$315.00	$157.50–$2,713.07	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE WOUND REPAIR FACE/E/E/N/L/M 2.5 CM OR LESS	$399.50	$470.00	$235.00–$2,713.07	—	15%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION (RHC)	$259.25	$305.00	$72.51–$415.32	6% above	15%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION	$259.25	$305.00	$72.51–$305.00	6% above	15%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION (RHC)	$259.25	$305.00	$152.50–$2,713.07	—	15%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION	$259.25	$305.00	$152.50–$2,713.07	—	15%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGE GUIDANCE (PBB)	$498.10	$586.00	$251.98–$586.00	44% below	15%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE (RHC)	$910.35	$1,071.00	$301.37–$1,071.00	2% above	15%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGE GUIDANCE	$910.35	$1,071.00	$344.58–$1,071.00	2% above	15%
Thoracentesis with imaging guidance CPT 32555 US THORACENTESIS W IMAGING GUIDANCE	$1,432.25	$1,685.00	$344.58–$1,685.00	60% above	15%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGE GUIDANCE (PBB)	$498.10	$586.00	$293.00–$2,713.07	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGE GUIDANCE	$910.35	$1,071.00	$535.50–$2,713.07	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE (RHC)	$910.35	$1,071.00	$535.50–$2,713.07	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 US THORACENTESIS W IMAGING GUIDANCE	$1,432.25	$1,685.00	$842.50–$2,713.07	—	15%
Tonsil and adenoid removal, age 12 or older CPT 42821 TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER	$1,040.40	$1,224.00	$599.76–$1,480.50	20% above	15%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER	$1,040.40	$1,224.00	$612.00–$2,713.07	—	15%
Tonsil and adenoid removal, child under 12 CPT 42820 TONSILLECTOMY AND ADENOIDECTOMY; UNDER 12 YEARS	$910.35	$1,071.00	$524.79–$3,025.62	24% above	15%
Tonsil and adenoid removal, child under 12 inpatient CPT 42820 TONSILLECTOMY AND ADENOIDECTOMY; UNDER 12 YEARS	$910.35	$1,071.00	$535.50–$2,713.07	—	15%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 TONSILLECTOMY, PRIMARY OR SECONDARY; 12 YEARS OR OVER	$936.70	$1,102.00	$539.98–$1,480.50	29% above	15%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 TONSILLECTOMY, PRIMARY OR SECONDARY; 12 YEARS OR OVER	$936.70	$1,102.00	$551.00–$2,713.07	—	15%
Total knee replacement CPT 27447 ARTHROPLASTY, KNEE, CONDYLE & PLATEAU;MEDIAL & LATERAL COMPARTMENTS W/ OR W/OUT PATELLA RESURFACING	$3,009.00	$3,540.00	$1,734.60–$9,393.16	20% below	15%
Total knee replacement inpatient CPT 27447 ARTHROPLASTY, KNEE, CONDYLE & PLATEAU;MEDIAL & LATERAL COMPARTMENTS W/ OR W/OUT PATELLA RESURFACING	$3,009.00	$3,540.00	$1,770.00–$3,540.00	—	15%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINTS, 1 OR 2 MUSCLE(S)	$137.70	$162.00	$28.20–$162.00	55% below	15%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION; SINGLE OR MULTIPLE TRIGGER POINT, 1 OR 2 MUSCLE (RHC)	$137.70	$162.00	$28.20–$351.12	55% below	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION; SINGLE OR MULTIPLE TRIGGER POINT, 1 OR 2 MUSCLE (RHC)	$137.70	$162.00	$81.00–$2,713.07	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINTS, 1 OR 2 MUSCLE(S)	$137.70	$162.00	$81.00–$2,713.07	—	15%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY, SURGICAL; W/FULGURATION OF OVIDUCTS	$266.05	$313.00	$153.37–$3,030.97	66% below	15%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPAROSCOPY, SURGICAL; W/FULGURATION OF OVIDUCTS	$266.05	$313.00	$156.50–$2,713.07	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BIOPSY, BREAST, W/PLACEMENT OF BREAST LOCALIZATION DEVICE, WHEN PERFORMED, 1ST LESION, ULTRASOUND (PBB)	$1,014.05	$1,193.00	$512.99–$1,193.00	38% below	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BIOPSY, BREAST, W/PLACEMENT OF BREAST LOCALIZATION DEVICE, WHEN PERFORMED, 1ST LESION, ULTRASOUND	$1,967.75	$2,315.00	$742.04–$2,315.00	20% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BIOPSY, BREAST, W/PLACEMENT OF BREAST LOCALIZATION DEVICE, WHEN PERFORMED, 1ST LESION, ULTRASOUND (PBB)	$1,014.05	$1,193.00	$596.50–$2,713.07	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BIOPSY, BREAST, W/PLACEMENT OF BREAST LOCALIZATION DEVICE, WHEN PERFORMED, 1ST LESION, ULTRASOUND	$1,967.75	$2,315.00	$1,157.50–$2,713.07	—	15%
Upper endoscopy (EGD) with biopsy CPT 43239 UGI ENDOSCOPY; W/BIOPSY, SINGLE OR MULTIPLE	$612.00	$720.00	$352.80–$720.00	42% below	15%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UGI ENDOSCOPY; W/BIOPSY, SINGLE OR MULTIPLE	$612.00	$720.00	$360.00–$2,713.07	—	15%
Upper endoscopy (EGD), diagnostic CPT 43235 UGI ENDOSCOPY; DIAGNOSTIC W/W/O COLLECTION OF SPECIMEN BY BRUSHING OR WASHING	$413.10	$486.00	$238.14–$497.85	57% below	15%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UGI ENDOSCOPY; DIAGNOSTIC W/W/O COLLECTION OF SPECIMEN BY BRUSHING OR WASHING	$413.10	$486.00	$243.00–$2,713.07	—	15%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY, UNILATERAL OR BILATERAL, INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S) (PBB)	$241.40	$284.00	$122.12–$1,001.95	—	15%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY, UNILATERAL OR BILATERAL, INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S) (RHC)	$603.50	$710.00	$301.37–$1,001.95	—	15%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY, UNILATERAL OR BILATERAL, INCLUDING POSTOPERATIVE SEMEN EXAM	$603.50	$710.00	$347.90–$1,001.95	—	15%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$845.75	$995.00	$427.85–$1,001.95	45% below	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY, UNILATERAL OR BILATERAL, INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S) (PBB)	$241.40	$284.00	$142.00–$2,713.07	—	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY, UNILATERAL OR BILATERAL, INCLUDING POSTOPERATIVE SEMEN EXAM	$603.50	$710.00	$355.00–$2,713.07	—	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY, UNILATERAL OR BILATERAL, INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S) (RHC)	$603.50	$710.00	$355.00–$2,713.07	—	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$845.75	$995.00	$497.50–$2,713.07	—	15%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF BENIGN SKIN LESIONS, UP TO 14 LESIONS	$136.00	$160.00	$68.80–$160.00	31% below	15%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF BENIGN LESIONS (OTHER THAN SKIN TAGS); UP TO 14 LESIONS	$255.00	$300.00	$141.00–$300.00	30% above	15%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS; UP TO 14 LESIONS (RHC)	$255.00	$300.00	$129.00–$351.12	30% above	15%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION OF BENIGN SKIN LESIONS, UP TO 14 LESIONS	$136.00	$160.00	$80.00–$2,713.07	—	15%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESIONS; UP TO 14 LESIONS (RHC)	$255.00	$300.00	$150.00–$2,713.07	—	15%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION OF BENIGN LESIONS (OTHER THAN SKIN TAGS); UP TO 14 LESIONS	$255.00	$300.00	$150.00–$2,713.07	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBQ TISSUE 1ST 20CM2	$132.60	$156.00	$67.08–$223.01	70% below	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBQ TISSUE; 1ST 20CM OR LESS (PBB)	$320.45	$377.00	$162.11–$377.00	28% below	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT, SUBCUTANEOUS TISSUE; FIRST 20 SQ CM OR LESS (RHC)	$607.75	$715.00	$223.01–$715.00	36% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT, SUBQ TISSUE; FIRST 20 SQ CM OR LESS	$607.75	$715.00	$223.01–$715.00	36% above	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBQ TISSUE 1ST 20CM2	$132.60	$156.00	$78.00–$2,713.07	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBQ TISSUE; 1ST 20CM OR LESS (PBB)	$320.45	$377.00	$188.50–$2,713.07	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT, SUBQ TISSUE; FIRST 20 SQ CM OR LESS	$607.75	$715.00	$357.50–$2,713.07	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT, SUBCUTANEOUS TISSUE; FIRST 20 SQ CM OR LESS (RHC)	$607.75	$715.00	$357.50–$2,713.07	—	15%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD/BLOOD PRODUCT ADMINISTRATION	$816.00	$960.00	$46.66–$960.00	14% above	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD/BLOOD PRODUCT ADMINISTRATION	$816.00	$960.00	$480.00–$2,713.07	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PRESSUR/NONPRESSURIZED INHALATION TREATMENT ACUTE AIRWAY OBSTRUCTION OR SPUTUM INDUCT FOR DIAG PURP	$42.50	$50.00	$23.50–$50.00	64% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INHAL TRMT ACUTE AIRWAY OBSTRUCTION (RHC)	$42.50	$50.00	$21.50–$351.12	64% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PRESSUR/NONPRESSURIZED INHALATION TREATMENT ACUTE AIRWAY OBSTRUCTION OR SPUTUM INDUCT FOR DIAG PURP	$42.50	$50.00	$25.00–$2,713.07	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHAL TRMT ACUTE AIRWAY OBSTRUCTION (RHC)	$42.50	$50.00	$25.00–$2,713.07	—	15%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 EYE EXAM; COMPREHENSIVE NEW PATIENT 1+ VISITS	$130.05	$153.00	$65.79–$153.00	at median	15%
Comprehensive eye exam by an eye doctor, new patient CPT 92004 OPHTHALMOLOGICAL SERVICE: MED EXAM AND EVAL W/INITIATION DIAG AND TX PROGRAM; COMP, NEW PT, >=1 VST	$195.50	$230.00	$108.10–$230.00	50% above	15%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 EYE EXAM; COMPREHENSIVE NEW PATIENT 1+ VISITS	$130.05	$153.00	$76.50–$2,713.07	—	15%
Comprehensive eye exam by an eye doctor, new patient inpatient CPT 92004 OPHTHALMOLOGICAL SERVICE: MED EXAM AND EVAL W/INITIATION DIAG AND TX PROGRAM; COMP, NEW PT, >=1 VST	$195.50	$230.00	$115.00–$2,713.07	—	15%
Comprehensive eye exam, returning patient CPT 92014 EYE EXAM W CONTINUATION OF DX AND TX PLAN, COMPREHENSIVE ESTABLISH PATIENT 1+ VISITS	$113.05	$133.00	$57.19–$133.00	at median	15%
Comprehensive eye exam, returning patient CPT 92014 OPHTHALMOLOGICAL SERVICE: MED EXAM AND EVAL W/INITIATION DIAG AND TX PROGRAM; COMP, EST PT, >=1 VST	$169.15	$199.00	$93.53–$199.00	50% above	15%
Comprehensive eye exam, returning patient inpatient CPT 92014 EYE EXAM W CONTINUATION OF DX AND TX PLAN, COMPREHENSIVE ESTABLISH PATIENT 1+ VISITS	$113.05	$133.00	$66.50–$2,713.07	—	15%
Comprehensive eye exam, returning patient inpatient CPT 92014 OPHTHALMOLOGICAL SERVICE: MED EXAM AND EVAL W/INITIATION DIAG AND TX PROGRAM; COMP, EST PT, >=1 VST	$169.15	$199.00	$99.50–$2,713.07	—	15%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION	$133.45	$157.00	$73.79–$157.00	14% below	15%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION	$133.45	$157.00	$78.50–$2,713.07	—	15%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE, E&M, FIRST 30-74 MIN COVERED PART A (524) (RHC)	$658.75	$775.00	$333.25–$775.00	57% below	15%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR INJURED; FIRST HOUR	$658.75	$775.00	$364.25–$775.00	57% below	15%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30 - 74 MINUTES	$1,717.00	$2,020.00	$868.60–$2,020.00	11% above	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE, E&M, FIRST 30-74 MIN COVERED PART A (524) (RHC)	$658.75	$775.00	$387.50–$2,713.07	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR INJURED; FIRST HOUR	$658.75	$775.00	$387.50–$2,713.07	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 30 - 74 MINUTES	$1,717.00	$2,020.00	$1,010.00–$2,713.07	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING	$199.75	$235.00	$101.05–$235.00	16% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING	$199.75	$235.00	$117.50–$2,713.07	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENT LEVEL 1	$282.20	$332.00	$8.12–$332.00	46% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENT LEVEL 1	$282.20	$332.00	$166.00–$2,713.07	—	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT, STRAIGHTFORWARD MDM	$165.75	$195.00	$29.71–$195.00	33% below	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENT LEVEL 2	$413.10	$486.00	$29.71–$486.00	67% above	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPARTMENT VISIT, STRAIGHTFORWARD MDM	$165.75	$195.00	$97.50–$2,713.07	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENT LEVEL 2	$413.10	$486.00	$243.00–$2,713.07	—	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT, LIMITED MDM	$249.05	$293.00	$50.54–$293.00	37% below	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENT LEVEL 3	$627.30	$738.00	$50.54–$738.00	59% above	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPARTMENT VISIT, LIMITED MDM	$249.05	$293.00	$146.50–$2,713.07	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENT LEVEL 3	$627.30	$738.00	$369.00–$2,713.07	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT, MODERATE MDM	$362.95	$427.00	$86.36–$427.00	43% below	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENT LEVEL 4	$1,034.45	$1,217.00	$86.36–$1,217.00	63% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPARTMENT VISIT, MODERATE MDM	$362.95	$427.00	$213.50–$2,713.07	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENT LEVEL 4	$1,034.45	$1,217.00	$608.50–$2,713.07	—	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT, HIGH MDM	$561.00	$660.00	$124.96–$660.00	41% below	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENT LEVEL 5	$1,467.10	$1,726.00	$124.96–$1,726.00	55% above	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPARTMENT VISIT, HIGH MDM	$561.00	$660.00	$330.00–$2,713.07	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENT LEVEL 5	$1,467.10	$1,726.00	$863.00–$2,713.07	—	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$786.25	$925.00	$397.75–$925.00	9% above	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST	$786.25	$925.00	$462.50–$2,713.07	—	15%
Eye exam, returning patient, intermediate CPT 92012 EYE EXAM W CONTINUATION OF DX AND TX PLAN, INTERMEDIATE, ESTABLISH PATIENT	$82.45	$97.00	$41.71–$97.00	10% below	15%
Eye exam, returning patient, intermediate CPT 92012 OPHTHALMOLOGICAL SERVICE: MED EXAM AND EVAL W/INITIATION DIAG AND TX PROGRAM; INTERM, EST PT	$130.05	$153.00	$71.91–$153.00	42% above	15%
Eye exam, returning patient, intermediate inpatient CPT 92012 EYE EXAM W CONTINUATION OF DX AND TX PLAN, INTERMEDIATE, ESTABLISH PATIENT	$82.45	$97.00	$48.50–$2,713.07	—	15%
Eye exam, returning patient, intermediate inpatient CPT 92012 OPHTHALMOLOGICAL SERVICE: MED EXAM AND EVAL W/INITIATION DIAG AND TX PROGRAM; INTERM, EST PT	$130.05	$153.00	$76.50–$2,713.07	—	15%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MIN (RHC)	$212.50	$250.00	$107.50–$250.00	9% above	15%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MINUTES	$212.50	$250.00	$109.52–$250.00	9% above	15%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MIN (RHC)	$212.50	$250.00	$125.00–$2,713.07	—	15%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MINUTES	$212.50	$250.00	$125.00–$2,713.07	—	15%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MIN (RHC)	$173.40	$204.00	$87.72–$204.00	5% below	15%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MINUTES	$173.40	$204.00	$95.88–$204.00	5% below	15%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MINUTES	$173.40	$204.00	$102.00–$2,713.07	—	15%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MIN (RHC)	$173.40	$204.00	$102.00–$2,713.07	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRATION PRIMARY UP TO 1 HOUR	$316.20	$372.00	$159.96–$372.00	16% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRATION PRIMARY UP TO 1 HOUR	$316.20	$372.00	$186.00–$2,713.07	—	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION THERAPY PRIMARY UP TO 1 HOUR	$363.80	$428.00	$184.04–$428.00	11% above	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION THERAPY PRIMARY UP TO 1 HOUR	$363.80	$428.00	$214.00–$2,713.07	—	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION; SUBCUTANEOUS OR INTRAMUSCULAR (RHC)	$43.35	$51.00	$10.41–$351.12	44% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION; SUBCUTANEOUS OR INTRAMUSCULAR	$43.35	$51.00	$10.41–$51.00	44% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ MED INJECTION	$106.25	$125.00	$10.41–$125.00	38% above	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION; SUBCUTANEOUS OR INTRAMUSCULAR	$43.35	$51.00	$25.50–$2,713.07	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION; SUBCUTANEOUS OR INTRAMUSCULAR (RHC)	$43.35	$51.00	$25.50–$2,713.07	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ MED INJECTION	$106.25	$125.00	$62.50–$2,713.07	—	15%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION - NO MEDICAL (RHC)	$327.25	$385.00	$124.19–$387.39	28% above	15%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION	$327.25	$385.00	$124.19–$387.39	28% above	15%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION - NO MEDICAL (RHC)	$327.25	$385.00	$192.50–$2,713.07	—	15%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION	$327.25	$385.00	$192.50–$2,713.07	—	15%
New patient office visit, about 30 minutes CPT 99203 NEW PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 30 MIN MET OR EXCEEDED (PBB)	$123.25	$145.00	$62.35–$145.00	6% above	15%
New patient office visit, about 30 minutes CPT 99203 NEW PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 30 MIN MET OR EXCEEDED	$195.50	$230.00	$83.05–$230.00	67% above	15%
New patient office visit, about 30 minutes CPT 99203 NEW PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 30 MIN MET OR EXCEEDED (RHC)	$263.50	$310.00	$83.05–$351.12	126% above	15%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 30 MIN MET OR EXCEEDED (PBB)	$123.25	$145.00	$72.50–$2,713.07	—	15%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 30 MIN MET OR EXCEEDED	$195.50	$230.00	$115.00–$2,713.07	—	15%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 30 MIN MET OR EXCEEDED (RHC)	$263.50	$310.00	$155.00–$2,713.07	—	15%
New patient office visit, about 45 minutes CPT 99204 NEW PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 45 MIN MET OR EXCEEDED (PBB)	$136.00	$160.00	$68.80–$198.75	21% below	15%
New patient office visit, about 45 minutes CPT 99204 NEW PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 45 MIN MET OR EXCEEDED	$221.00	$260.00	$111.80–$260.00	29% above	15%
New patient office visit, about 45 minutes CPT 99204 NEW PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 45 MIN MET OR EXCEEDED (RHC)	$368.05	$433.00	$124.46–$433.00	114% above	15%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 45 MIN MET OR EXCEEDED (PBB)	$136.00	$160.00	$80.00–$2,713.07	—	15%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 45 MIN MET OR EXCEEDED	$221.00	$260.00	$130.00–$2,713.07	—	15%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 45 MIN MET OR EXCEEDED (RHC)	$368.05	$433.00	$216.50–$2,713.07	—	15%
New patient office visit, about 60 minutes CPT 99205 NEW PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 60 MIN MET OR EXCEEDED	$479.40	$564.00	$163.83–$564.00	104% above	15%
New patient office visit, about 60 minutes CPT 99205 NEW PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 60 MIN MET OR EXCEEDED (RHC)	$479.40	$564.00	$163.83–$564.00	104% above	15%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 60 MIN MET OR EXCEEDED	$479.40	$564.00	$282.00–$2,713.07	—	15%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 60 MIN MET OR EXCEEDED (RHC)	$479.40	$564.00	$282.00–$2,713.07	—	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 15 MIN MET OR EXCEEDED (PBB)	$63.75	$75.00	$32.25–$83.75	16% below	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 15 MIN MET OR EXCEEDED (RHC)	$160.65	$189.00	$54.35–$351.12	111% above	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 15 MIN MET OR EXCEEDED	$165.75	$195.00	$54.35–$195.00	118% above	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 15 MIN MET OR EXCEEDED (PBB)	$63.75	$75.00	$37.50–$2,713.07	—	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 15 MIN MET OR EXCEEDED (RHC)	$160.65	$189.00	$94.50–$2,713.07	—	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 15 MIN MET OR EXCEEDED	$165.75	$195.00	$97.50–$2,713.07	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT, INDIVIDUAL, EACH 15 MINUTE (RHC)	$38.25	$45.00	$19.35–$45.00	39% below	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENT, INDIVIDUAL, FACE TO FACE, EACH 15 MINS	$38.25	$45.00	$21.15–$45.00	39% below	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT-NEW-FUP YR	$56.95	$67.00	$28.81–$67.00	9% below	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENT, INDIVIDUAL, FACE TO FACE, EACH 15 MINS	$38.25	$45.00	$22.50–$2,713.07	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT, INDIVIDUAL, EACH 15 MINUTE (RHC)	$38.25	$45.00	$22.50–$2,713.07	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT-NEW-FUP YR	$56.95	$67.00	$33.50–$2,713.07	—	15%
Preventive checkup, new patient aged 18–39 CPT 99385 INITIAL PREVENTIVE CARE 18 - 39 YRS (RHC)	$266.90	$314.00	$135.02–$351.12	64% above	15%
Preventive checkup, new patient aged 18–39 CPT 99385 NEW PT - 18-39 YRS INITIAL PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT	$266.90	$314.00	$147.58–$314.00	64% above	15%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 NEW PT - 18-39 YRS INITIAL PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT	$266.90	$314.00	$157.00–$2,713.07	—	15%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INITIAL PREVENTIVE CARE 18 - 39 YRS (RHC)	$266.90	$314.00	$157.00–$2,713.07	—	15%
Preventive checkup, new patient aged 40–64 CPT 99386 INITIAL PREVENTIVE CARE 40 - 64 YRS (RHC)	$300.05	$353.00	$151.79–$353.00	36% above	15%
Preventive checkup, new patient aged 40–64 CPT 99386 NEW PT - 40-64 YRS INITIAL PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT	$300.05	$353.00	$165.91–$353.00	36% above	15%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INITIAL PREVENTIVE CARE 40 - 64 YRS (RHC)	$300.05	$353.00	$176.50–$2,713.07	—	15%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 NEW PT - 40-64 YRS INITIAL PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT	$300.05	$353.00	$176.50–$2,713.07	—	15%
Preventive checkup, new patient aged 65 or older CPT 99387 NEW PT - 65+ YRS INITIAL PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT	$291.55	$343.00	$161.21–$343.00	11% above	15%
Preventive checkup, new patient aged 65 or older CPT 99387 INITIAL PREVENTIVE CARE 65+ YRS (RHC)	$291.55	$343.00	$147.49–$351.12	11% above	15%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 NEW PT - 65+ YRS INITIAL PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT	$291.55	$343.00	$171.50–$2,713.07	—	15%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 INITIAL PREVENTIVE CARE 65+ YRS (RHC)	$291.55	$343.00	$171.50–$2,713.07	—	15%
Preventive checkup, returning patient aged 18–39 CPT 99395 PERIODIC PREVENTIVE CARE 18 - 39 YRS (RHC)	$240.55	$283.00	$121.69–$351.12	85% above	15%
Preventive checkup, returning patient aged 18–39 CPT 99395 EST PT - 18-39 YRS PERIODIC PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT	$240.55	$283.00	$133.01–$283.00	85% above	15%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 EST PT - 18-39 YRS PERIODIC PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT	$240.55	$283.00	$141.50–$2,713.07	—	15%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PERIODIC PREVENTIVE CARE 18 - 39 YRS (RHC)	$240.55	$283.00	$141.50–$2,713.07	—	15%
Preventive checkup, returning patient aged 40–64 CPT 99396 PERIODIC PREVENTIVE CARE 40 - 64 YRS (RHC)	$261.80	$308.00	$132.44–$351.12	80% above	15%
Preventive checkup, returning patient aged 40–64 CPT 99396 EST PT - 40-64 YRS PERIODIC PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT	$261.80	$308.00	$144.76–$308.00	80% above	15%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 EST PT - 40-64 YRS PERIODIC PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT	$261.80	$308.00	$154.00–$2,713.07	—	15%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PERIODIC PREVENTIVE CARE 40 - 64 YRS (RHC)	$261.80	$308.00	$154.00–$2,713.07	—	15%
Preventive checkup, returning patient aged 65 or older CPT 99397 PERIODIC PREVENTIVE CARE 65 YRS & UP (RHC)	$275.40	$324.00	$139.32–$351.12	28% above	15%
Preventive checkup, returning patient aged 65 or older CPT 99397 EST PT - 65+ YRS PERIODIC PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT	$275.40	$324.00	$152.28–$324.00	28% above	15%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PERIODIC PREVENTIVE CARE 65 YRS & UP (RHC)	$275.40	$324.00	$162.00–$2,713.07	—	15%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 EST PT - 65+ YRS PERIODIC PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT	$275.40	$324.00	$162.00–$2,713.07	—	15%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYCHOTHERAPY FOR CRISIS; FIRST 60 MINUTES	$238.85	$281.00	$132.07–$281.00	1% above	15%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYCHOTHERAPY FOR CRISIS; FIRST 60 MINUTES (RHC)	$238.85	$281.00	$120.83–$281.00	1% above	15%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYCHOTHERAPY FOR CRISIS; FIRST 60 MINUTES (RHC)	$238.85	$281.00	$140.50–$2,713.07	—	15%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYCHOTHERAPY FOR CRISIS; FIRST 60 MINUTES	$238.85	$281.00	$140.50–$2,713.07	—	15%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT (RHC)	$173.40	$204.00	$69.95–$204.00	52% above	15%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT	$173.40	$204.00	$69.95–$204.00	52% above	15%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT (RHC)	$173.40	$204.00	$102.00–$2,713.07	—	15%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT	$173.40	$204.00	$102.00–$2,713.07	—	15%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT	$232.90	$274.00	$111.04–$274.00	56% above	15%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT (RHC)	$232.90	$274.00	$111.04–$274.00	56% above	15%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT (RHC)	$232.90	$274.00	$137.00–$2,713.07	—	15%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT	$232.90	$274.00	$137.00–$2,713.07	—	15%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT (RHC)	$330.65	$389.00	$163.53–$389.00	83% above	15%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT	$330.65	$389.00	$163.53–$389.00	83% above	15%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT (RHC)	$330.65	$389.00	$194.50–$2,713.07	—	15%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT	$330.65	$389.00	$194.50–$2,713.07	—	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MIN AND UP TO 10 MIN	$33.15	$39.00	$10.92–$39.00	at median	15%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING TOBACCO USE CESSATION COUNSELING VISIT INTERMEDIATE GREATER THAN 3 MIN AND UP TO 10 MIN (RHC)	$33.15	$39.00	$10.92–$351.12	at median	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING TOBACCO USE CESSATION COUNSELING VISIT INTERMEDIATE GREATER THAN 3 MIN AND UP TO 10 MIN (RHC)	$33.15	$39.00	$19.50–$2,713.07	—	15%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MIN AND UP TO 10 MIN	$33.15	$39.00	$19.50–$2,713.07	—	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 CLINICAL NURSING LEVEL 5 (EP)	$208.25	$245.00	$105.35–$245.00	23% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 40 MIN MET OR EXCEEDED	$375.70	$442.00	$135.12–$442.00	122% above	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 40 MIN MET OR EXCEEDED (RHC)	$375.70	$442.00	$135.12–$442.00	122% above	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 CLINICAL NURSING LEVEL 5 (EP)	$208.25	$245.00	$122.50–$2,713.07	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 40 MIN MET OR EXCEEDED	$375.70	$442.00	$221.00–$2,713.07	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PT LEVEL 5 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, HIGH LEVEL MDM OR 40 MIN MET OR EXCEEDED (RHC)	$375.70	$442.00	$221.00–$2,713.07	—	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 20 MIN MET OR EXCEEDED (PBB)	$80.75	$95.00	$40.85–$95.00	14% below	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINICAL NURSING LEVEL 3 (EP)	$144.50	$170.00	$68.32–$170.00	53% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 20 MIN MET OR EXCEEDED	$159.80	$188.00	$68.32–$188.00	70% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 20 MIN MET OR EXCEEDED (RHC)	$193.80	$228.00	$68.32–$351.12	106% above	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 20 MIN MET OR EXCEEDED (PBB)	$80.75	$95.00	$47.50–$2,713.07	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CLINICAL NURSING LEVEL 3 (EP)	$144.50	$170.00	$85.00–$2,713.07	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 20 MIN MET OR EXCEEDED	$159.80	$188.00	$94.00–$2,713.07	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PT LEVEL 3 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, LOW LEVEL MDM OR 20 MIN MET OR EXCEEDED (RHC)	$193.80	$228.00	$114.00–$2,713.07	—	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 30 MIN MET OR EXCEEDED (PBB)	$110.50	$130.00	$55.90–$130.00	8% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 CLINICAL NURSING LEVEL 4 (EP)	$174.25	$205.00	$88.15–$205.00	45% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 30 MIN MET OR EXCEEDED	$181.05	$213.00	$91.59–$213.00	51% above	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 30 MIN MET OR EXCEEDED(RHC)	$269.45	$317.00	$96.26–$351.12	124% above	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 30 MIN MET OR EXCEEDED (PBB)	$110.50	$130.00	$65.00–$2,713.07	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 CLINICAL NURSING LEVEL 4 (EP)	$174.25	$205.00	$102.50–$2,713.07	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 30 MIN MET OR EXCEEDED	$181.05	$213.00	$106.50–$2,713.07	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PT LEVEL 4 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, MODERATE LEVEL MDM OR 30 MIN MET OR EXCEEDED(RHC)	$269.45	$317.00	$158.50–$2,713.07	—	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CLINICAL NURSING LEVEL 2 (EP)	$110.50	$130.00	$42.67–$130.00	35% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 10 MIN MET OR EXCEEDED (RHC)	$135.15	$159.00	$42.67–$351.12	66% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 10 MIN MET OR EXCEEDED (PBB)	$136.00	$160.00	$42.67–$160.00	67% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 10 MIN MET OR EXCEEDED	$140.25	$165.00	$42.67–$165.00	72% above	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 CLINICAL NURSING LEVEL 2 (EP)	$110.50	$130.00	$65.00–$2,713.07	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 10 MIN MET OR EXCEEDED (RHC)	$135.15	$159.00	$79.50–$2,713.07	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 10 MIN MET OR EXCEEDED (PBB)	$136.00	$160.00	$80.00–$2,713.07	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PT LEVEL 2 OFFICE/OTHER OUTPT VISIT EVAL AND MGMT, STRAIGHTFORWARD MDM OR 10 MIN MET OR EXCEEDED	$140.25	$165.00	$82.50–$2,713.07	—	15%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE OR OUTPT CONSULT, NEW OR EST PT, LOW MDM OR 30-39 MINS (RHC)	$182.75	$215.00	$84.32–$351.12	at median	15%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE OR OUTPT CONSULT, NEW OR EST PT, LOW MDM OR 30-39 MINS	$182.75	$215.00	$84.32–$215.00	at median	15%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE OR OUTPT CONSULT, NEW OR EST PT, LOW MDM OR 30-39 MINS (RHC)	$182.75	$215.00	$107.50–$2,713.07	—	15%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE OR OUTPT CONSULT, NEW OR EST PT, LOW MDM OR 30-39 MINS	$182.75	$215.00	$107.50–$2,713.07	—	15%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE OR OUTPT CONSULT, NEW OR EST PT, MODERATE MDM OR 40-54 MINS (PBB)	$43.35	$51.00	$21.93–$252.18	79% below	15%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE OR OUTPT CONSULT, NEW OR EST PT, MODERATE MDM OR 40-54 MINS (RHC)	$407.15	$479.00	$120.39–$479.00	97% above	15%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE OR OUTPT CONSULT, NEW OR EST PT, MODERATE MDM OR 40-54 MINS	$407.15	$479.00	$120.39–$479.00	97% above	15%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE OR OUTPT CONSULT, NEW OR EST PT, MODERATE MDM OR 40-54 MINS (PBB)	$43.35	$51.00	$25.50–$2,713.07	—	15%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE OR OUTPT CONSULT, NEW OR EST PT, MODERATE MDM OR 40-54 MINS	$407.15	$479.00	$239.50–$2,713.07	—	15%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE OR OUTPT CONSULT, NEW OR EST PT, MODERATE MDM OR 40-54 MINS (RHC)	$407.15	$479.00	$239.50–$2,713.07	—	15%
Spirometry (breathing test) CPT 94010 SPIROMETRY, INCL GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASURE (RHC)	$142.80	$168.00	$72.24–$351.12	10% below	15%
Spirometry (breathing test) CPT 94010 SPIROMETRY, W/GRAPHIC REC, TOTAL/TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE, W/W/O MAX VOLUNT VENT	$142.80	$168.00	$78.96–$168.00	10% below	15%
Spirometry (breathing test) CPT 94010 SPIROMETRY SCREEN PULMONARY	$199.75	$235.00	$101.05–$235.00	26% above	15%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY, INCL GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASURE (RHC)	$142.80	$168.00	$84.00–$2,713.07	—	15%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY, W/GRAPHIC REC, TOTAL/TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE, W/W/O MAX VOLUNT VENT	$142.80	$168.00	$84.00–$2,713.07	—	15%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY SCREEN PULMONARY	$199.75	$235.00	$117.50–$2,713.07	—	15%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY PRE AND POST BRONCHODILATION	$229.50	$270.00	$116.10–$270.00	21% below	15%
Spirometry before and after a bronchodilator CPT 94060 BRONCHODILATION RESPONSIVENESS, PRE AND POST BRONCHODILATOR ADMINISTRATION	$229.50	$270.00	$126.90–$270.00	21% below	15%
Spirometry before and after a bronchodilator CPT 94060 BRONCHODILATION RESPONSIVENESS, SPIROMETRY AS IN 94010, PRE- AND POST-BRONCHODILATOR ADMIN (RHC)	$229.50	$270.00	$116.10–$381.24	21% below	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY PRE AND POST BRONCHODILATION	$229.50	$270.00	$135.00–$2,713.07	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHODILATION RESPONSIVENESS, PRE AND POST BRONCHODILATOR ADMINISTRATION	$229.50	$270.00	$135.00–$2,713.07	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHODILATION RESPONSIVENESS, SPIROMETRY AS IN 94010, PRE- AND POST-BRONCHODILATOR ADMIN (RHC)	$229.50	$270.00	$135.00–$2,713.07	—	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPUETIC	$257.55	$303.00	$130.29–$303.00	22% above	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPUETIC	$257.55	$303.00	$151.50–$2,713.07	—	15%
Visual field test, extended both sides CPT 92083 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, W/INTERPRETATION AND REPORT; EXTENDED EXAM	$160.65	$189.00	$88.83–$189.00	—	15%
Visual field test, extended inpatient both sides CPT 92083 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, W/INTERPRETATION AND REPORT; EXTENDED EXAM	$160.65	$189.00	$94.50–$2,713.07	—	15%

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 VACCINE, INACTIVATED, SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE	$83.44	$98.16	$46.14–$98.16	8% above	15%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 INFLUENZA VACCINE, INACTIVATED (IIV), SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE (RHC)	$83.44	$98.16	$42.21–$98.16	8% above	15%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VACCINE, INACTIVATED (IIV), SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE (RHC)	$83.44	$98.16	$49.08–$2,713.07	—	15%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 INFLUENZA VACCINE, INACTIVATED, SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE	$83.44	$98.16	$49.08–$2,713.07	—	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-COV-2, COVID-19 VACCINE, MRNA-LNP, 50 MCG/0.5 ML DOSAGE, IM USE (MODERNA 12+ YRS) (RHC)	$141.54	$166.51	$71.60–$166.51	23% below	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-COV-2, COVID-19 VACCINE, MRNA-LNP, 50 MCG/0.5 ML DOSAGE, IM USE (MODERNA 12+ YRS)	$141.54	$166.51	$78.26–$166.51	23% below	15%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-COV-2, COVID-19 VACCINE, MRNA-LNP, 50 MCG/0.5 ML DOSAGE, IM USE (MODERNA 12+ YRS) (RHC)	$141.54	$166.51	$83.26–$2,713.07	—	15%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-COV-2, COVID-19 VACCINE, MRNA-LNP, 50 MCG/0.5 ML DOSAGE, IM USE (MODERNA 12+ YRS)	$141.54	$166.51	$83.26–$2,713.07	—	15%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS SQ (RHC)	$196.35	$231.00	$99.33–$231.00	18% below	15%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE	$196.35	$231.00	$108.57–$231.00	18% below	15%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE, LIVE, FOR SUBCUTANEOUS USE	$196.35	$231.00	$115.50–$2,713.07	—	15%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS SQ (RHC)	$196.35	$231.00	$115.50–$2,713.07	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACCINE, TRIVALENT, SPLIT VIRUS, PRESERVATIVE FREE, 0.5ML DOSAGE, FOR IM USE	$21.25	$25.00	$11.75–$25.00	4% below	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE, TRIVALENT, SV, PF, 0.5ML FOR IM USE (RHC)	$21.25	$25.00	$10.75–$25.00	4% below	15%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE, TRIVALENT, SV, PF, 0.5ML FOR IM USE (RHC)	$21.25	$25.00	$12.50–$2,713.07	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACCINE, TRIVALENT, SPLIT VIRUS, PRESERVATIVE FREE, 0.5ML DOSAGE, FOR IM USE	$21.25	$25.00	$12.50–$2,713.07	—	15%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE (9VHPV),2 OR 3 DOSE SCHEDULE (PER DOSE) (RHC)	$378.25	$445.00	$191.35–$445.00	at median	15%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE TYPES 6, 11, 16, 18, 31, 33, 45, 52, 58, NONAVALENT (HPV), 3 DOSE SCHED	$378.25	$445.00	$209.15–$445.00	at median	15%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE (9VHPV),2 OR 3 DOSE SCHEDULE (PER DOSE) (RHC)	$378.25	$445.00	$222.50–$2,713.07	—	15%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE TYPES 6, 11, 16, 18, 31, 33, 45, 52, 58, NONAVALENT (HPV), 3 DOSE SCHED	$378.25	$445.00	$222.50–$2,713.07	—	15%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VAC ADULT DOSAGE IM (RHC)	$136.85	$161.00	$69.23–$161.00	31% above	15%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE, ADULT DOSAGE, FOR IM USE	$136.85	$161.00	$75.67–$161.00	31% above	15%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VAC ADULT DOSAGE IM (RHC)	$136.85	$161.00	$80.50–$2,713.07	—	15%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE, ADULT DOSAGE, FOR IM USE	$136.85	$161.00	$80.50–$2,713.07	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B ADULT DOSE IM (3 DOSE SCHEDULE) (RHC)	$106.25	$125.00	$53.75–$125.00	5% below	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE, ADULT DOSAGE (3 DOSE SCHEDULE), FOR IM USE	$106.25	$125.00	$58.75–$125.00	5% below	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE, ADULT DOSAGE (3 DOSE SCHEDULE), FOR IM USE	$106.25	$125.00	$62.50–$2,713.07	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B ADULT DOSE IM (3 DOSE SCHEDULE) (RHC)	$106.25	$125.00	$62.50–$2,713.07	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VACCINE SPLIT PRESERV FREE ENHANCED FOR IM USE (RHC)	$93.50	$110.00	$47.30–$110.00	25% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, INCREASED ANTIGEN CONTENT, FOR IM USE	$93.50	$110.00	$51.70–$110.00	25% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG	$273.70	$322.00	$138.46–$322.00	265% above	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VIRUS VACCINE, SPLIT VIRUS, PRESERVATIVE FREE, INCREASED ANTIGEN CONTENT, FOR IM USE	$93.50	$110.00	$55.00–$2,713.07	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VACCINE SPLIT PRESERV FREE ENHANCED FOR IM USE (RHC)	$93.50	$110.00	$55.00–$2,713.07	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG	$273.70	$322.00	$161.00–$2,713.07	—	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SUBQ OR JET (RHC)	$155.04	$182.40	$78.43–$182.40	24% above	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS, RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS USE	$155.04	$182.40	$85.73–$182.40	24% above	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR	$349.35	$411.00	$176.73–$411.00	180% above	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS, RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS USE	$155.04	$182.40	$91.20–$2,713.07	—	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE SUBQ OR JET (RHC)	$155.04	$182.40	$91.20–$2,713.07	—	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR	$349.35	$411.00	$205.50–$2,713.07	—	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING CONJ VACCINE,SEROGROUPS A,C,W Y,QUADRIVALENT,DIPHTHERIA TOX CARRIER,IM USE(MENACTRA)(RHC)	$216.75	$255.00	$109.65–$255.00	11% above	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS A, C, Y AND W-135, QUADRIVALENT, FOR IM USE (MENACTRA)	$216.75	$255.00	$119.85–$255.00	11% above	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN	$589.05	$693.00	$297.99–$693.00	202% above	15%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS A, C, Y AND W-135, QUADRIVALENT, FOR IM USE (MENACTRA)	$216.75	$255.00	$127.50–$2,713.07	—	15%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING CONJ VACCINE,SEROGROUPS A,C,W Y,QUADRIVALENT,DIPHTHERIA TOX CARRIER,IM USE(MENACTRA)(RHC)	$216.75	$255.00	$127.50–$2,713.07	—	15%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN	$589.05	$693.00	$346.50–$2,713.07	—	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL RECOMBINANT PROTEIN AND OUTER MEMBRANE VESICLE VACCINE, SEROGROUP B, 2 DOSE SCHED, IM	$190.40	$224.00	$105.28–$224.00	37% below	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL RECOMBINANT PROTEIN AND OUTER MEMBRANE VESICLE VACCINE, SEROGROUP B, 2 DOSE SCHED, IM	$190.40	$224.00	$112.00–$2,713.07	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL CONJUGATE VACCINE, 20 VALENT (PCV20), FOR INTRAMUSCULAR USE	$412.59	$485.39	$228.13–$485.39	3% above	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL CONJUGATE VACCINE, 20 VALENT (PCV20), FOR INTRAMUSCULAR USE (RHC)	$412.59	$485.39	$208.72–$485.39	3% above	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL CONJUGATE VACCINE, 20 VALENT (PCV20), FOR INTRAMUSCULAR USE (RHC)	$412.59	$485.39	$242.70–$2,713.07	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL CONJUGATE VACCINE, 20 VALENT (PCV20), FOR INTRAMUSCULAR USE	$412.59	$485.39	$242.70–$2,713.07	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACCINE SQ OR IM (RHC)	$167.06	$196.53	$84.51–$196.53	27% above	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT, ADULT/IMMUNOSUPPRESSED DOSE, 2YRS OR OLDER, SUBQ/IM	$167.06	$196.53	$92.37–$196.53	27% above	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG	$465.80	$548.00	$235.64–$548.00	253% above	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE SQ OR IM (RHC)	$167.06	$196.53	$98.27–$2,713.07	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT, ADULT/IMMUNOSUPPRESSED DOSE, 2YRS OR OLDER, SUBQ/IM	$167.06	$196.53	$98.27–$2,713.07	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG	$465.80	$548.00	$274.00–$2,713.07	—	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE; 0.5 ML DOSAGE, INTRAMUSCULAR USE (RHC)	$646.00	$760.00	$326.80–$760.00	23% above	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE; 0.5 ML DOSAGE, INTRAMUSCULAR USE	$646.00	$760.00	$357.20–$760.00	23% above	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE; 0.5 ML DOSAGE, INTRAMUSCULAR USE	$646.00	$760.00	$380.00–$2,713.07	—	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE; 0.5 ML DOSAGE, INTRAMUSCULAR USE (RHC)	$646.00	$760.00	$380.00–$2,713.07	—	15%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE FOR INTRAMUSCULAR USE (RHC)	$600.55	$706.52	$303.80–$706.52	9% above	15%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, FOR IM USE	$600.55	$706.52	$332.06–$706.52	9% above	15%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR	$1,461.15	$1,719.00	$739.17–$1,719.00	165% above	15%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, FOR IM USE	$600.55	$706.52	$353.26–$2,713.07	—	15%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE FOR INTRAMUSCULAR USE (RHC)	$600.55	$706.52	$353.26–$2,713.07	—	15%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR	$1,461.15	$1,719.00	$859.50–$2,713.07	—	15%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER (SHINGLES) VACCINE (HZV) FOR IM USE (RHC)	$250.75	$295.00	$126.85–$295.00	9% above	15%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER (SHINGLES) VACCINE (HZV), RECOMBINANT, SUB-UNIT, ADJUVANTED, FOR INTRAMUSCULAR INJECTION	$250.75	$295.00	$138.65–$295.00	9% above	15%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER (SHINGLES) VACCINE (HZV) FOR IM USE (RHC)	$250.75	$295.00	$147.50–$2,713.07	—	15%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER (SHINGLES) VACCINE (HZV), RECOMBINANT, SUB-UNIT, ADJUVANTED, FOR INTRAMUSCULAR INJECTION	$250.75	$295.00	$147.50–$2,713.07	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED, PRESERVATIVE FREE, ADMIN 7YRS AND OLDER, FOR IM USE	$74.80	$88.00	$41.36–$88.00	20% above	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS & DIPTHERIA TOXOIDS (RHC)	$74.80	$88.00	$37.84–$88.00	20% above	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG	$175.95	$207.00	$89.01–$207.00	182% above	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOXOIDS (TD) ADSORBED, PRESERVATIVE FREE, ADMIN 7YRS AND OLDER, FOR IM USE	$74.80	$88.00	$44.00–$2,713.07	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS & DIPTHERIA TOXOIDS (RHC)	$74.80	$88.00	$44.00–$2,713.07	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG	$175.95	$207.00	$103.50–$2,713.07	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS DIP TOX & ACE PERT TDAP > = 7 YRS (RHC)	$92.65	$109.00	$46.87–$109.00	18% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS, DIPTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), ADMIN 7YRS AND OLDER, FOR IM USE	$92.65	$109.00	$51.23–$109.00	18% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG	$215.05	$253.00	$108.79–$253.00	174% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS DIP TOX & ACE PERT TDAP > = 7 YRS (RHC)	$92.65	$109.00	$54.50–$2,713.07	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS, DIPTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), ADMIN 7YRS AND OLDER, FOR IM USE	$92.65	$109.00	$54.50–$2,713.07	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG	$215.05	$253.00	$126.50–$2,713.07	—	15%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE, VI CAPSULAR POLYSACCHARIDE (VICPS), FOR IM USE	$394.40	$464.00	$218.08–$464.00	170% above	15%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE, VI CAPSULAR POLYSACCHARIDE (VICPS), FOR IM USE	$394.40	$464.00	$232.00–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION PNEUMOCOCCAL VACCINE	$21.25	$25.00	$10.75–$25.00	48% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 FLU CLINIC-INJECTION FLU ADMINISTRATION	$29.75	$35.00	$16.45–$35.00	27% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 FLU CLINIC-INJECTION FLU ADMINISTRATION (RHC)	$29.75	$35.00	$15.05–$35.00	27% below	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN; 1 VACCINE (SINGLE OR COMBINATION VAC/TOXIOD)	$40.80	$48.00	$22.56–$48.00	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION; 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) (RHC)	$40.80	$48.00	$20.64–$351.12	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF HEPATITIS B VACCINE (RHC)	$40.80	$48.00	$20.64–$48.00	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION INFLUENZA VACCINE	$51.00	$60.00	$25.80–$60.00	25% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION VACCINE	$51.00	$60.00	$25.80–$60.00	25% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION PNEUMOCOCCAL VACCINE	$21.25	$25.00	$12.50–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 FLU CLINIC-INJECTION FLU ADMINISTRATION	$29.75	$35.00	$17.50–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 FLU CLINIC-INJECTION FLU ADMINISTRATION (RHC)	$29.75	$35.00	$17.50–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN; 1 VACCINE (SINGLE OR COMBINATION VAC/TOXIOD)	$40.80	$48.00	$24.00–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION; 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) (RHC)	$40.80	$48.00	$24.00–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION OF HEPATITIS B VACCINE (RHC)	$40.80	$48.00	$24.00–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION INFLUENZA VACCINE	$51.00	$60.00	$30.00–$2,713.07	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMINISTRATION VACCINE	$51.00	$60.00	$30.00–$2,713.07	—	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN; EACH ADDTL VACCINE (SINGLE OR COMBINATION VAC/TOXIOD)	$18.04	$21.22	$9.97–$21.22	28% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN; EACH ADDTL SINGLE OR COMBINATION VAC/TOXIOD (RHC)	$18.04	$21.22	$9.12–$351.12	28% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMINISTRATION VACCINE - EA ADDITIONAL VACCINE	$23.80	$28.00	$12.04–$28.00	6% below	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN; EACH ADDTL VACCINE (SINGLE OR COMBINATION VAC/TOXIOD)	$18.04	$21.22	$10.61–$2,713.07	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN; EACH ADDTL SINGLE OR COMBINATION VAC/TOXIOD (RHC)	$18.04	$21.22	$10.61–$2,713.07	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMINISTRATION VACCINE - EA ADDITIONAL VACCINE	$23.80	$28.00	$14.00–$2,713.07	—	15%

Source file: https://mhsmn.org/machine-readable-files/411653496_madison-healthcare-services_standardcharges.csv