Hospital

Van Diest Medical Center

Listed in its price file as “Hamilton County Public Hospital DBA Van Diest Medical Center”.

Van Diest Medical Center in Webster City, IA publishes cash prices for 218 common procedures listed here, from its own machine-readable price file updated Feb 5, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Iowa median for 119 of 216 procedures and above it for 96. By typical cash price it ranks #36 of 78 Iowa hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

2350 Hospital Drive, Webster City, IA 50595 Collected Sep 27, 2026 Source price file (515) 832-9400

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 5 of 5 CCN 161361 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ankle Brachial Index Art Study 1-2 LVLS	$191.20	$239.00	$107.55–$215.10	40% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 TCOM/SPP - LIMITED 1-2 LEVELS	$304.00	$380.00	$171.00–$342.00	5% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Ankle Brachial Index Art Study 1-2 LVLS	$191.20	$239.00	$167.30–$215.10	—	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 TCOM/SPP - LIMITED 1-2 LEVELS	$304.00	$380.00	$266.00–$342.00	—	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$223.20	$279.00	$125.55–$251.10	39% below	20%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$223.20	$279.00	$195.30–$251.10	—	20%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body	$1,151.20	$1,439.00	$647.55–$1,295.10	6% below	20%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body	$1,151.20	$1,439.00	$1,007.30–$1,295.10	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 VDMC CT Anigo Chest w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	54% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 VDMC CT Angio Chest w/ Cont	$968.00	$1,210.00	$544.50–$1,089.00	54% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angiography Chest w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	54% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 VDMC CT Angiography Chest w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	54% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 VDMC CT Angiography Chest w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angiography Chest w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 VDMC CT Anigo Chest w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 VDMC CT Angio Chest w/ Cont	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Calcium Scoring	$80.00	$100.00	$45.00–$90.00	9% below	20%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT Cardiac Calcium Scoring	$80.00	$100.00	$70.00–$90.00	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 VDMC CT Abdomen + Pelvis w/o Contrast	$1,488.00	$1,860.00	$837.00–$1,674.00	47% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen + Pelvis w/o Contrast	$1,488.00	$1,860.00	$837.00–$1,674.00	47% below	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen + Pelvis w/o Contrast	$1,488.00	$1,860.00	$1,302.00–$1,674.00	—	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 VDMC CT Abdomen + Pelvis w/o Contrast	$1,488.00	$1,860.00	$1,302.00–$1,674.00	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 VDMC CT Abdomen + Pelvis w/ Contrast	$1,936.00	$2,420.00	$1,089.00–$2,178.00	40% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen + Pelvis w/ Contrast	$1,936.00	$2,420.00	$1,089.00–$2,178.00	40% below	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 VDMC CT Abdomen + Pelvis w/ Contrast	$1,936.00	$2,420.00	$1,694.00–$2,178.00	—	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen + Pelvis w/ Contrast	$1,936.00	$2,420.00	$1,694.00–$2,178.00	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 VDMC CT Abdomen + Pelvis w/ + w/o Contrast	$2,540.80	$3,176.00	$1,429.20–$2,858.40	29% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen + Pelvis w/ + w/o Contrast	$2,540.80	$3,176.00	$1,429.20–$2,858.40	29% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen + Pelvis w/ + w/o Contrast	$2,540.80	$3,176.00	$2,223.20–$2,858.40	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 VDMC CT Abdomen + Pelvis w/ + w/o Contrast	$2,540.80	$3,176.00	$2,223.20–$2,858.40	—	20%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	43% below	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$916.80	$1,146.00	$515.70–$1,031.40	32% below	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$916.80	$1,146.00	$802.20–$1,031.40	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$944.00	$1,180.00	$531.00–$1,062.00	27% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast	$944.00	$1,180.00	$531.00–$1,062.00	27% below	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$944.00	$1,180.00	$826.00–$1,062.00	—	20%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Sinus w/o Contrast	$944.00	$1,180.00	$826.00–$1,062.00	—	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast	$727.20	$909.00	$409.05–$818.10	47% below	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast	$727.20	$909.00	$636.30–$818.10	—	20%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Contrast	$932.00	$1,165.00	$524.25–$1,048.50	39% below	20%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Contrast	$932.00	$1,165.00	$815.50–$1,048.50	—	20%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Contrast	$1,303.20	$1,629.00	$733.05–$1,466.10	28% below	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Contrast	$1,303.20	$1,629.00	$1,140.30–$1,466.10	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$1,152.00	$1,440.00	$648.00–$1,296.00	24% below	20%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$1,152.00	$1,440.00	$1,008.00–$1,296.00	—	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$1,150.40	$1,438.00	$647.10–$1,294.20	24% below	20%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$1,150.40	$1,438.00	$1,006.60–$1,294.20	—	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	44% below	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$134.40	$168.00	$75.60–$151.20	35% below	20%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$134.40	$168.00	$117.60–$151.20	—	20%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$92.00	$115.00	$51.75–$103.50	45% below	20%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$92.00	$115.00	$80.50–$103.50	—	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$284.00	$355.00	$159.75–$319.50	27% below	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL 1+ SITES	$284.00	$355.00	$159.75–$319.50	27% below	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton Charge	$284.00	$355.00	$159.75–$319.50	27% below	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL 1+ SITES	$284.00	$355.00	$248.50–$319.50	—	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$284.00	$355.00	$248.50–$319.50	—	20%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton Charge	$284.00	$355.00	$248.50–$319.50	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton Charge	$284.00	$355.00	$159.75–$319.50	14% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton	$284.00	$355.00	$159.75–$319.50	14% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY/PERIPHERAL 1+ SITES	$284.00	$355.00	$159.75–$319.50	14% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY/PERIPHERAL 1+ SITES	$284.00	$355.00	$248.50–$319.50	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton	$284.00	$355.00	$248.50–$319.50	—	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD Bone Density DEXA App Skeleton Charge	$284.00	$355.00	$248.50–$319.50	—	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$909.60	$1,137.00	$511.65–$1,023.30	35% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 VDMC CT Chest w/o Cont	$909.60	$1,137.00	$511.65–$1,023.30	35% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 VDMC CT Chest w/o Contrast	$909.60	$1,137.00	$511.65–$1,023.30	35% below	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 VDMC CT Chest w/o Contrast	$909.60	$1,137.00	$795.90–$1,023.30	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 VDMC CT Chest w/o Cont	$909.60	$1,137.00	$795.90–$1,023.30	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$909.60	$1,137.00	$795.90–$1,023.30	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 VDMC CT Chest w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	47% below	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 VDMC CT Chest w/ Cont	$968.00	$1,210.00	$544.50–$1,089.00	47% below	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$968.00	$1,210.00	$544.50–$1,089.00	47% below	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 VDMC CT Chest w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 VDMC CT Chest w/ Cont	$968.00	$1,210.00	$847.00–$1,089.00	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Duplex Bilateral	$660.80	$826.00	$371.70–$743.40	—	20%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE Venous Duplex Bilateral	$660.80	$826.00	$578.20–$743.40	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 CARDIOLOGY	$1,070.40	$1,338.00	$602.10–$1,204.20	30% below	20%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 CARDIOLOGY	$1,070.40	$1,338.00	$936.60–$1,204.20	—	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary System w/o Pharm	$1,151.20	$1,439.00	$647.55–$1,295.10	3% below	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary System w/o Pharm	$1,151.20	$1,439.00	$1,007.30–$1,295.10	—	20%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 95806 SLEEP STUDY UNATT AND RESP EFFT	$525.60	$657.00	$295.65–$591.30	6% below	20%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 95806 SLEEP STUDY UNATT AND RESP EFFT	$525.60	$657.00	$459.90–$591.30	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY/CPAP TRIAL	$2,700.80	$3,376.00	$1,519.20–$3,038.40	14% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY/CPAP TRIAL	$2,700.80	$3,376.00	$2,363.20–$3,038.40	—	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG LOW CA SCREENING	$316.00	$395.00	$177.75–$355.50	31% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG LOW CA SCREENING	$316.00	$395.00	$276.50–$355.50	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$820.00	$1,025.00	$461.25–$922.50	74% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$820.00	$1,025.00	$717.50–$922.50	—	20%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$1,275.20	$1,594.00	$717.30–$1,434.60	39% below	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$1,275.20	$1,594.00	$1,115.80–$1,434.60	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Pancreas w+w/o Contrast	$1,366.40	$1,708.00	$768.60–$1,537.20	60% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,366.40	$1,708.00	$768.60–$1,537.20	60% below	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Pancreas w+w/o Contrast	$1,366.40	$1,708.00	$1,195.60–$1,537.20	—	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,366.40	$1,708.00	$1,195.60–$1,537.20	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$951.20	$1,189.00	$535.05–$1,070.10	58% below	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$951.20	$1,189.00	$832.30–$1,070.10	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$1,019.20	$1,274.00	$573.30–$1,146.60	72% below	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$1,019.20	$1,274.00	$891.80–$1,146.60	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$713.60	$892.00	$401.40–$802.80	70% below	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$713.60	$892.00	$624.40–$802.80	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$764.80	$956.00	$430.20–$860.40	78% below	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$764.80	$956.00	$669.20–$860.40	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$713.60	$892.00	$401.40–$802.80	70% below	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$713.60	$892.00	$624.40–$802.80	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$764.80	$956.00	$430.20–$860.40	77% below	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$764.80	$956.00	$669.20–$860.40	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$715.20	$894.00	$402.30–$804.60	69% below	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$715.20	$894.00	$625.80–$804.60	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,312.00	$1,640.00	$738.00–$1,476.00	59% below	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,312.00	$1,640.00	$1,148.00–$1,476.00	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$1,224.00	$1,530.00	$688.50–$1,377.00	41% below	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$1,224.00	$1,530.00	$1,071.00–$1,377.00	—	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Spect Multi Rest/Stress	$2,000.00	$2,500.00	$1,125.00–$2,250.00	29% below	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Spect Multi Rest/Stress	$2,000.00	$2,500.00	$1,750.00–$2,250.00	—	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET w/ CT Scan Skull Base to Midthigh	$3,688.80	$4,611.00	$2,074.95–$4,149.90	13% below	20%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET w/ CT Scan Skull Base to Midthigh	$3,688.80	$4,611.00	$3,227.70–$4,149.90	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG Mammogram Digital Screening Bilat.	$241.60	$302.00	$135.90–$271.80	—	20%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammogram Digital Screening Bilat.	$241.60	$302.00	$211.40–$271.80	—	20%
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY ATTENDED	$2,500.80	$3,126.00	$1,406.70–$2,813.40	13% below	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STUDY ATTENDED	$2,500.80	$3,126.00	$2,188.20–$2,813.40	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Speech Language Pathology Video Swallow	$311.20	$389.00	$175.05–$350.10	23% below	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Speech Evaluation Dyname Pharyngeal	$311.20	$389.00	$175.05–$350.10	23% below	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Video	$311.20	$389.00	$175.05–$350.10	23% below	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Swallowing Function w/ Video	$311.20	$389.00	$272.30–$350.10	—	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Speech Language Pathology Video Swallow	$311.20	$389.00	$272.30–$350.10	—	20%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Speech Evaluation Dyname Pharyngeal	$311.20	$389.00	$272.30–$350.10	—	20%
Transvaginal ultrasound during pregnancy CPT 76817 US	$315.20	$394.00	$177.30–$354.60	31% below	20%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US	$315.20	$394.00	$275.80–$354.60	—	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$315.20	$394.00	$177.30–$354.60	32% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Head/Neck Soft Tissue	$315.20	$394.00	$275.80–$354.60	—	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$363.20	$454.00	$204.30–$408.60	15% below	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$363.20	$454.00	$317.80–$408.60	—	20%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN AP	$120.00	$150.00	$67.50–$135.00	33% below	20%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN AP	$120.00	$150.00	$105.00–$135.00	—	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$140.80	$176.00	$79.20–$158.40	51% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$140.80	$176.00	$123.20–$158.40	—	20%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral Minimum 4 Views	$189.60	$237.00	$106.65–$213.30	46% below	20%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral Minimum 4 Views	$189.60	$237.00	$165.90–$213.30	—	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$140.80	$176.00	$79.20–$158.40	44% below	20%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$140.80	$176.00	$123.20–$158.40	—	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Minimum 3 Views	$144.00	$180.00	$81.00–$162.00	30% below	20%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Minimum 3 Views	$144.00	$180.00	$126.00–$162.00	—	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$124.00	$155.00	$69.75–$139.50	51% below	20%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$124.00	$155.00	$108.50–$139.50	—	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$120.00	$150.00	$67.50–$135.00	39% below	20%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$120.00	$150.00	$105.00–$135.00	—	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx Minimum 2 Views	$160.80	$201.00	$90.45–$180.90	27% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx Minimum 2 Views	$160.80	$201.00	$140.70–$180.90	—	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT)	$40.80	$51.00	$22.95–$45.90	3% below	20%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT)	$40.80	$51.00	$35.70–$45.90	—	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT)	$39.20	$49.00	$22.05–$44.10	1% below	20%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT)	$39.20	$49.00	$34.30–$44.10	—	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PROFILE	$242.40	$303.00	$136.35–$272.70	6% above	20%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PROFILE	$242.40	$303.00	$212.10–$272.70	—	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Ab DMCL	$98.40	$123.00	$55.35–$110.70	41% above	20%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide Ab DMCL	$98.40	$123.00	$86.10–$110.70	—	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab Scrn w Rflx ENA and IFA DMCL	$79.20	$99.00	$44.55–$89.10	9% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibody Screen, rflx Confirmation DMCL	$79.20	$99.00	$44.55–$89.10	9% above	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab Scrn w Rflx ENA and IFA DMCL	$79.20	$99.00	$69.30–$89.10	—	20%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibody Screen, rflx Confirmation DMCL	$79.20	$99.00	$69.30–$89.10	—	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B NATURIURETIC PEPTIDE	$184.80	$231.00	$103.95–$207.90	18% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 N-Terminal pro Brain Natriuretic Peptide	$184.80	$231.00	$103.95–$207.90	18% above	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B NATURIURETIC PEPTIDE	$184.80	$231.00	$161.70–$207.90	—	20%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 N-Terminal pro Brain Natriuretic Peptide	$184.80	$231.00	$161.70–$207.90	—	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PROFILE	$112.80	$141.00	$63.45–$126.90	36% above	20%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PROFILE	$112.80	$141.00	$98.70–$126.90	—	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Path Level 4	$127.20	$159.00	$71.55–$143.10	29% below	20%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Path Level 4	$127.20	$159.00	$111.30–$143.10	—	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD	$85.60	$107.00	$48.15–$96.30	1% below	20%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD	$85.60	$107.00	$74.90–$96.30	—	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$16.80	$21.00	$9.45–$18.90	15% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Venipuncture	$16.80	$21.00	$9.45–$18.90	15% below	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$16.80	$21.00	$14.70–$18.90	—	20%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Venipuncture	$16.80	$21.00	$14.70–$18.90	—	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$32.80	$41.00	$18.45–$36.90	2% below	20%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$32.80	$41.00	$28.70–$36.90	—	20%
Blood lead test CPT 83655 Lead Level Screen	$65.60	$82.00	$36.90–$73.80	25% above	20%
Blood lead test CPT 83655 Lead Level Screen DMCL	$65.60	$82.00	$36.90–$73.80	25% above	20%
Blood lead test CPT 83655 LEAD	$65.60	$82.00	$36.90–$73.80	25% above	20%
Blood lead test inpatient CPT 83655 LEAD	$65.60	$82.00	$57.40–$73.80	—	20%
Blood lead test inpatient CPT 83655 Lead Level Screen DMCL	$65.60	$82.00	$57.40–$73.80	—	20%
Blood lead test inpatient CPT 83655 Lead Level Screen	$65.60	$82.00	$57.40–$73.80	—	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY-SERUM	$73.60	$92.00	$41.40–$82.80	19% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY-SERUM	$73.60	$92.00	$64.40–$82.80	—	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CORD ABO/RH	$41.60	$52.00	$23.40–$46.80	27% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPE ABO/RH TYPING	$41.60	$52.00	$23.40–$46.80	27% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BILL ABO	$41.60	$52.00	$23.40–$46.80	27% below	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BILL ABO	$41.60	$52.00	$36.40–$46.80	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPE ABO/RH TYPING	$41.60	$52.00	$36.40–$46.80	—	20%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CORD ABO/RH	$41.60	$52.00	$36.40–$46.80	—	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN-HIGH SENS	$66.40	$83.00	$37.35–$74.70	15% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN-HIGH SENS	$66.40	$83.00	$58.10–$74.70	—	20%
C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICILE	$121.60	$152.00	$68.40–$136.80	13% above	20%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CLOSTRIDIUM DIFFICILE	$121.60	$152.00	$106.40–$136.80	—	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19 9 DMCL	$136.00	$170.00	$76.50–$153.00	42% above	20%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19 9 DMCL	$136.00	$170.00	$119.00–$153.00	—	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 DMCL	$136.00	$170.00	$76.50–$153.00	19% above	20%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 DMCL	$136.00	$170.00	$119.00–$153.00	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 ID Now COVID-19 Test	$102.40	$128.00	$57.60–$115.20	11% below	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus 2019 Novel Screening PCR	$270.40	$338.00	$152.10–$304.20	136% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus 2019 Novel (SARS-CoV-2) DMCL	$270.40	$338.00	$152.10–$304.20	136% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 ID Now COVID-19 Test	$102.40	$128.00	$89.60–$115.20	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Coronavirus 2019 Novel Screening PCR	$270.40	$338.00	$236.60–$304.20	—	20%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Coronavirus 2019 Novel (SARS-CoV-2) DMCL	$270.40	$338.00	$236.60–$304.20	—	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C. trach N. gonorrhea DNA DMCL	$113.60	$142.00	$63.90–$127.80	14% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C. trach N. gonorrhea DNA DMCL	$113.60	$142.00	$99.40–$127.80	—	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$87.20	$109.00	$49.05–$98.10	2% above	20%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$87.20	$109.00	$76.30–$98.10	—	20%
Complete blood count (CBC) with differential CPT 85025 CBC WITH DIFF	$64.00	$80.00	$36.00–$72.00	4% above	20%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH DIFF	$64.00	$80.00	$56.00–$72.00	—	20%
Complete blood count (CBC), no differential CPT 85027 Complete Blood Count w Man Diff DMCL	$52.80	$66.00	$29.70–$59.40	18% above	20%
Complete blood count (CBC), no differential CPT 85027 CBC NO DIFF	$52.80	$66.00	$29.70–$59.40	18% above	20%
Complete blood count (CBC), no differential inpatient CPT 85027 Complete Blood Count w Man Diff DMCL	$52.80	$66.00	$46.20–$59.40	—	20%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC NO DIFF	$52.80	$66.00	$46.20–$59.40	—	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$158.40	$198.00	$89.10–$178.20	33% above	20%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$158.40	$198.00	$138.60–$178.20	—	20%
D-dimer blood test (blood clot marker) CPT 85379 DDIMER	$61.60	$77.00	$34.65–$69.30	27% below	20%
D-dimer blood test (blood clot marker) inpatient CPT 85379 DDIMER	$61.60	$77.00	$53.90–$69.30	—	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate DMCL	$108.00	$135.00	$60.75–$121.50	3% below	20%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone Sulfate DMCL	$108.00	$135.00	$94.50–$121.50	—	20%
Estradiol blood test CPT 82670 Estradiol Level DMCL	$152.00	$190.00	$85.50–$171.00	17% above	20%
Estradiol blood test inpatient CPT 82670 Estradiol Level DMCL	$152.00	$190.00	$133.00–$171.00	—	20%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone DMCL	$108.00	$135.00	$60.75–$121.50	7% above	20%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone DMCL	$108.00	$135.00	$94.50–$121.50	—	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$88.00	$110.00	$49.50–$99.00	1% below	20%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$88.00	$110.00	$77.00–$99.00	—	20%
Folate (folic acid) blood test CPT 82746 FOLATE (FOLIC ACID)	$80.00	$100.00	$45.00–$90.00	10% below	20%
Folate (folic acid) blood test CPT 82746 Folate Level DMCL	$80.00	$100.00	$45.00–$90.00	10% below	20%
Folate (folic acid) blood test CPT 82746 Folate Level	$80.00	$100.00	$45.00–$90.00	10% below	20%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$80.00	$100.00	$70.00–$90.00	—	20%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level DMCL	$80.00	$100.00	$70.00–$90.00	—	20%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE (FOLIC ACID)	$80.00	$100.00	$70.00–$90.00	—	20%
Free T3 thyroid hormone test CPT 84481 T3 Free DMCL	$128.80	$161.00	$72.45–$144.90	20% above	20%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free DMCL	$128.80	$161.00	$112.70–$144.90	—	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$65.60	$82.00	$36.90–$73.80	1% above	20%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$65.60	$82.00	$57.40–$73.80	—	20%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$114.40	$143.00	$64.35–$128.70	8% above	20%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$114.40	$143.00	$100.10–$128.70	—	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$275.20	$344.00	$154.80–$309.60	45% above	20%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$275.20	$344.00	$240.80–$309.60	—	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE	$36.00	$45.00	$20.25–$40.50	at median	20%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE	$36.00	$45.00	$31.50–$40.50	—	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC PROBE	$102.40	$128.00	$57.60–$115.20	13% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC PROBE	$102.40	$128.00	$89.60–$115.20	—	20%
H. pylori antibody blood test CPT 86677 HELICOBACTER SERUM ANTIBODY	$94.40	$118.00	$53.10–$106.20	18% above	20%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER SERUM ANTIBODY	$94.40	$118.00	$82.60–$106.20	—	20%
H. pylori stool antigen test CPT 87338 Helicobacter pylori Antigen Stool	$94.40	$118.00	$53.10–$106.20	16% below	20%
H. pylori stool antigen test CPT 87338 Helicobacter pylori Antigen Stool DMCL	$117.60	$147.00	$66.15–$132.30	5% above	20%
H. pylori stool antigen test inpatient CPT 87338 Helicobacter pylori Antigen Stool	$94.40	$118.00	$82.60–$106.20	—	20%
H. pylori stool antigen test inpatient CPT 87338 Helicobacter pylori Antigen Stool DMCL	$117.60	$147.00	$102.90–$132.30	—	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1 2 DMCL	$72.80	$91.00	$40.95–$81.90	3% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1 2 DMCL	$72.80	$91.00	$63.70–$81.90	—	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Human Papilloma Virus PCR DMCL	$119.20	$149.00	$67.05–$134.10	26% above	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV mRNA E6/E7 with RFLX DMCL	$119.20	$149.00	$67.05–$134.10	26% above	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Human Papilloma Virus PCR DMCL	$119.20	$149.00	$104.30–$134.10	—	20%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV mRNA E6/E7 with RFLX DMCL	$119.20	$149.00	$104.30–$134.10	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hgb A1C	$61.60	$77.00	$34.65–$69.30	1% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c DMCL	$61.60	$77.00	$34.65–$69.30	1% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hgb A1C	$61.60	$77.00	$53.90–$69.30	—	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c DMCL	$61.60	$77.00	$53.90–$69.30	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Sur Ab Quant DMCL	$70.40	$88.00	$39.60–$79.20	4% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody DMCL	$70.40	$88.00	$39.60–$79.20	4% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Antibody DMCL	$70.40	$88.00	$61.60–$79.20	—	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Sur Ab Quant DMCL	$70.40	$88.00	$61.60–$79.20	—	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen DMCL	$73.60	$92.00	$41.40–$82.80	12% above	20%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Antigen DMCL	$73.60	$92.00	$64.40–$82.80	—	20%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody Screen DMCL	$93.60	$117.00	$52.65–$105.30	20% above	20%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody Screen DMCL	$93.60	$117.00	$81.90–$105.30	—	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA and Quant (R-PCR) DMCL	$326.40	$408.00	$183.60–$367.20	26% above	20%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA and Quant (R-PCR) DMCL	$326.40	$408.00	$285.60–$367.20	—	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 2 IgG Ab DMCL	$91.20	$114.00	$51.30–$102.60	36% above	20%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 2 IgG Ab DMCL	$91.20	$114.00	$79.80–$102.60	—	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 2	$52.00	$65.00	$29.25–$58.50	10% below	20%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 2	$52.00	$65.00	$45.50–$58.50	—	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein HS	$48.80	$61.00	$27.45–$54.90	37% below	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN-HIGH SENS	$98.40	$123.00	$55.35–$110.70	26% above	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein HS	$48.80	$61.00	$42.70–$54.90	—	20%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN-HIGH SENS	$98.40	$123.00	$86.10–$110.70	—	20%
Homocysteine blood test CPT 83090 Homocysteine DMCL	$128.80	$161.00	$72.45–$144.90	36% above	20%
Homocysteine blood test inpatient CPT 83090 Homocysteine DMCL	$128.80	$161.00	$112.70–$144.90	—	20%
Insulin blood test CPT 83525 Insulin Level DMCL	$87.20	$109.00	$49.05–$98.10	14% above	20%
Insulin blood test inpatient CPT 83525 Insulin Level DMCL	$87.20	$109.00	$76.30–$98.10	—	20%
Iron blood test (serum iron) CPT 83540 IRON	$56.80	$71.00	$31.95–$63.90	39% above	20%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$56.80	$71.00	$49.70–$63.90	—	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON IRON BINDING	$57.60	$72.00	$32.40–$64.80	18% above	20%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON IRON BINDING	$57.60	$72.00	$50.40–$64.80	—	20%
Kidney function blood test panel CPT 80069 RENAL PROFILE	$129.60	$162.00	$72.90–$145.80	48% above	20%
Kidney function blood test panel inpatient CPT 80069 RENAL PROFILE	$129.60	$162.00	$113.40–$145.80	—	20%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone DMCL	$108.00	$135.00	$60.75–$121.50	17% above	20%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone DMCL	$108.00	$135.00	$94.50–$121.50	—	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$57.60	$72.00	$32.40–$64.80	11% below	20%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$57.60	$72.00	$50.40–$64.80	—	20%
Liver function blood test panel CPT 80076 LIVER PROFILE	$88.80	$111.00	$49.95–$99.90	5% above	20%
Liver function blood test panel inpatient CPT 80076 LIVER PROFILE	$88.80	$111.00	$77.70–$99.90	—	20%
Lyme disease antibody test CPT 86618 Lyme Antibody Screen DMCL	$111.20	$139.00	$62.55–$125.10	26% above	20%
Lyme disease antibody test CPT 86618 Lyme IgG Antibody DMCL	$111.20	$139.00	$62.55–$125.10	26% above	20%
Lyme disease antibody test CPT 86618 Lyme IgM Antibody DMCL	$111.20	$139.00	$62.55–$125.10	26% above	20%
Lyme disease antibody test inpatient CPT 86618 Lyme Antibody Screen DMCL	$111.20	$139.00	$97.30–$125.10	—	20%
Lyme disease antibody test inpatient CPT 86618 Lyme IgM Antibody DMCL	$111.20	$139.00	$97.30–$125.10	—	20%
Lyme disease antibody test inpatient CPT 86618 Lyme IgG Antibody DMCL	$111.20	$139.00	$97.30–$125.10	—	20%
Magnesium blood test CPT 83735 MAGNESIUM	$51.20	$64.00	$28.80–$57.60	6% above	20%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$51.20	$64.00	$44.80–$57.60	—	20%
Measles (rubeola) antibody test CPT 86765 Rubeola IgG Antibody DMCL	$98.40	$123.00	$55.35–$110.70	80% above	20%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola IgG Antibody DMCL	$98.40	$123.00	$86.10–$110.70	—	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO-SPOT	$46.40	$58.00	$26.10–$52.20	4% below	20%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO-SPOT	$46.40	$58.00	$40.60–$52.20	—	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$120.00	$150.00	$67.50–$135.00	23% above	20%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$120.00	$150.00	$105.00–$135.00	—	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAG	$118.40	$148.00	$66.60–$133.20	23% above	20%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAG	$118.40	$148.00	$103.60–$133.20	—	20%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intact DMCL	$224.80	$281.00	$126.45–$252.90	27% above	20%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone Intact DMCL	$224.80	$281.00	$196.70–$252.90	—	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time DMCL	$51.20	$64.00	$28.80–$57.60	14% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$51.20	$64.00	$28.80–$57.60	14% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Antiphospholipid Antibody Profile DMCL	$51.20	$64.00	$28.80–$57.60	14% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Lupus Anticoagulant DMCL	$51.20	$64.00	$28.80–$57.60	14% above	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time DMCL	$51.20	$64.00	$44.80–$57.60	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$51.20	$64.00	$44.80–$57.60	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Antiphospholipid Antibody Profile DMCL	$51.20	$64.00	$44.80–$57.60	—	20%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lupus Anticoagulant DMCL	$51.20	$64.00	$44.80–$57.60	—	20%
Progesterone blood test CPT 84144 Progesterone Level DMCL	$136.00	$170.00	$76.50–$153.00	40% above	20%
Progesterone blood test CPT 84144 NBS PROGESTERONE	$136.00	$170.00	$76.50–$153.00	40% above	20%
Progesterone blood test inpatient CPT 84144 NBS PROGESTERONE	$136.00	$170.00	$119.00–$153.00	—	20%
Progesterone blood test inpatient CPT 84144 Progesterone Level DMCL	$136.00	$170.00	$119.00–$153.00	—	20%
Prolactin blood test CPT 84146 Prolactin DMCL	$126.40	$158.00	$71.10–$142.20	26% above	20%
Prolactin blood test inpatient CPT 84146 Prolactin DMCL	$126.40	$158.00	$110.60–$142.20	—	20%
Prothrombin time (PT/INR) clotting test CPT 85610 INR PROTIME PROTHROMBIN TIME	$34.40	$43.00	$19.35–$38.70	5% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR	$34.40	$43.00	$19.35–$38.70	5% above	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 INR PROTIME PROTHROMBIN TIME	$34.40	$43.00	$30.10–$38.70	—	20%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR	$34.40	$43.00	$30.10–$38.70	—	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN-TRIAGE	$118.40	$148.00	$66.60–$133.20	64% above	20%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN-TRIAGE	$118.40	$148.00	$103.60–$133.20	—	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA AB	$65.60	$82.00	$36.90–$73.80	41% above	20%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA AB	$65.60	$82.00	$57.40–$73.80	—	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A TEST, THROAT	$39.20	$49.00	$22.05–$44.10	22% below	20%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A TEST, THROAT	$39.20	$49.00	$34.30–$44.10	—	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor DMCL	$46.40	$58.00	$26.10–$52.20	4% below	20%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor DMCL	$46.40	$58.00	$40.60–$52.20	—	20%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG Antibody DMCL	$94.40	$118.00	$53.10–$106.20	61% above	20%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG Antibody DMCL	$94.40	$118.00	$82.60–$106.20	—	20%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$28.80	$36.00	$16.20–$32.40	14% below	20%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE	$28.80	$36.00	$25.20–$32.40	—	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin DMCL	$46.40	$58.00	$26.10–$52.20	4% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin DMCL	$46.40	$58.00	$40.60–$52.20	—	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon TB Gold Plus DMCL	$112.00	$140.00	$63.00–$126.00	29% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Quantiferon TB Gold Plus DMCL	$112.00	$140.00	$98.00–$126.00	—	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total and Free DMCL	$125.60	$157.00	$70.65–$141.30	22% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total DMCL	$168.80	$211.00	$94.95–$189.90	64% above	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total and Free DMCL	$125.60	$157.00	$109.90–$141.30	—	20%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total DMCL	$168.80	$211.00	$147.70–$189.90	—	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody DMCL	$111.20	$139.00	$62.55–$125.10	47% above	20%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibody DMCL	$111.20	$139.00	$97.30–$125.10	—	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone DMCL	$109.60	$137.00	$61.65–$123.30	13% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$109.60	$137.00	$61.65–$123.30	13% above	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone DMCL	$109.60	$137.00	$95.90–$123.30	—	20%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$109.60	$137.00	$95.90–$123.30	—	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis RNA (Female Only) DMCL	$80.00	$100.00	$45.00–$90.00	14% below	20%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis RNA (Female Only) DMCL	$80.00	$100.00	$70.00–$90.00	—	20%
Uric acid blood test CPT 84550 URIC ACID	$36.80	$46.00	$20.70–$41.40	2% above	20%
Uric acid blood test inpatient CPT 84550 URIC ACID	$36.80	$46.00	$32.20–$41.40	—	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS BY DIPSTICK, AUTO W/O MICRO	$24.80	$31.00	$13.95–$27.90	4% below	20%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS BY DIPSTICK, AUTO W/O MICRO	$24.80	$31.00	$21.70–$27.90	—	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE WITH COLONY COUNT	$70.40	$88.00	$39.60–$79.20	20% above	20%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE WITH COLONY COUNT	$70.40	$88.00	$61.60–$79.20	—	20%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST-URINE	$48.00	$60.00	$27.00–$54.00	14% above	20%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST-URINE	$48.00	$60.00	$42.00–$54.00	—	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level DMCL	$82.40	$103.00	$46.35–$92.70	1% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B-12	$82.40	$103.00	$46.35–$92.70	1% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Lvl TMCL	$82.40	$103.00	$46.35–$92.70	1% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 and Folate DMCL	$82.40	$103.00	$46.35–$92.70	1% below	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B-12	$82.40	$103.00	$72.10–$92.70	—	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Lvl TMCL	$82.40	$103.00	$72.10–$92.70	—	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 and Folate DMCL	$82.40	$103.00	$72.10–$92.70	—	20%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level DMCL	$82.40	$103.00	$72.10–$92.70	—	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy DMCL	$111.20	$139.00	$62.55–$125.10	11% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy DMCL	$111.20	$139.00	$97.30–$125.10	—	20%
Zinc blood test CPT 84630 Zinc Level DMCL	$49.60	$62.00	$27.90–$55.80	6% below	20%
Zinc blood test inpatient CPT 84630 Zinc Level DMCL	$49.60	$62.00	$43.40–$55.80	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG FREE ALPHA SUBUNIT	$98.40	$123.00	$55.35–$110.70	11% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG	$114.40	$143.00	$64.35–$128.70	29% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG FREE ALPHA SUBUNIT	$98.40	$123.00	$86.10–$110.70	—	20%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG	$114.40	$143.00	$100.10–$128.70	—	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$401.60	$502.00	$225.90–$451.80	7% below	20%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT OF ANKLE FRACTURE	$401.60	$502.00	$351.40–$451.80	—	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$761.60	$952.00	$428.40–$856.80	8% below	20%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT	$761.60	$952.00	$666.40–$856.80	—	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER	$1,194.40	$1,493.00	$671.85–$1,343.70	33% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUM 28 DAYS OR OLDER	$1,194.40	$1,493.00	$1,045.10–$1,343.70	—	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION	$143.20	$179.00	$80.55–$161.10	89% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION	$143.20	$179.00	$125.30–$161.10	—	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA	$502.40	$628.00	$282.60–$565.20	18% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FRACTURE RADIUS/ULNA	$502.40	$628.00	$439.60–$565.20	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$1,131.20	$1,414.00	$636.30–$1,272.60	31% above	20%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY	$1,131.20	$1,414.00	$989.80–$1,272.60	—	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$220.00	$275.00	$123.75–$247.50	48% above	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$220.00	$275.00	$192.50–$247.50	—	20%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$55.20	$69.00	$31.05–$62.10	47% below	20%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI	$55.20	$69.00	$48.30–$62.10	—	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$320.80	$401.00	$180.45–$360.90	26% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING	$320.80	$401.00	$280.70–$360.90	—	20%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S)	$652.00	$815.00	$366.75–$733.50	at median	20%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID(S)	$652.00	$815.00	$570.50–$733.50	—	20%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP	$2,234.40	$2,793.00	$1,256.85–$2,513.70	93% above	20%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REMOVE INT/EXT HEM 1 GROUP	$2,234.40	$2,793.00	$1,955.10–$2,513.70	—	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 VDMC Hsg-Contrast Injection	$101.60	$127.00	$57.15–$114.30	70% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 VDMC Hsg-Contrast Injection	$101.60	$127.00	$88.90–$114.30	—	20%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$316.80	$396.00	$178.20–$356.40	28% above	20%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$316.80	$396.00	$277.20–$356.40	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 VDMC Pc Injection Major Joint	$321.60	$402.00	$180.90–$361.80	9% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$321.60	$402.00	$180.90–$361.80	9% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 VDMC Pc Injection Major Joint	$321.60	$402.00	$281.40–$361.80	—	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$321.60	$402.00	$281.40–$361.80	—	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$300.80	$376.00	$169.20–$338.40	2% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$300.80	$376.00	$263.20–$338.40	—	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$280.00	$350.00	$157.50–$315.00	1% above	20%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$280.00	$350.00	$245.00–$315.00	—	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$304.00	$380.00	$171.00–$342.00	15% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$304.00	$380.00	$266.00–$342.00	—	20%
Lower-back epidural injection, without imaging guidance CPT 62322 ITM	$424.80	$531.00	$238.95–$477.90	45% below	20%
Lower-back epidural injection, without imaging guidance CPT 62322 INJECT SPINE LUMBAR/SACRAL	$1,087.20	$1,359.00	$611.55–$1,223.10	41% above	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 ITM	$424.80	$531.00	$371.70–$477.90	—	20%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECT SPINE LUMBAR/SACRAL	$1,087.20	$1,359.00	$951.30–$1,223.10	—	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$521.60	$652.00	$293.40–$586.80	88% above	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$521.60	$652.00	$456.40–$586.80	—	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$652.00	$815.00	$366.75–$733.50	47% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$652.00	$815.00	$570.50–$733.50	—	20%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$219.20	$274.00	$123.30–$246.60	3% above	20%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$219.20	$274.00	$191.80–$246.60	—	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$652.00	$815.00	$366.75–$733.50	51% above	20%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$652.00	$815.00	$570.50–$733.50	—	20%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$1,299.20	$1,624.00	$730.80–$1,461.60	8% below	20%
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION	$1,299.20	$1,624.00	$1,136.80–$1,461.60	—	20%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$503.20	$629.00	$283.05–$566.10	63% above	20%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY	$503.20	$629.00	$440.30–$566.10	—	20%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$183.20	$229.00	$103.05–$206.10	19% below	20%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST	$183.20	$229.00	$160.30–$206.10	—	20%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$192.80	$241.00	$108.45–$216.90	8% above	20%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$192.80	$241.00	$168.70–$216.90	—	20%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$183.20	$229.00	$103.05–$206.10	24% below	20%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST	$183.20	$229.00	$160.30–$206.10	—	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$243.20	$304.00	$136.80–$273.60	6% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$243.20	$304.00	$212.80–$273.60	—	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$521.60	$652.00	$293.40–$586.80	30% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$521.60	$652.00	$456.40–$586.80	—	20%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15	$220.00	$275.00	$123.75–$247.50	28% above	20%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS <W/15	$220.00	$275.00	$192.50–$247.50	—	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR	$324.80	$406.00	$182.70–$365.40	33% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$407.20	$509.00	$229.05–$458.10	16% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Tap Procedure	$481.60	$602.00	$270.90–$541.80	1% below	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR	$324.80	$406.00	$284.20–$365.40	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$407.20	$509.00	$356.30–$458.10	—	20%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Tap Procedure	$481.60	$602.00	$421.40–$541.80	—	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$284.00	$355.00	$159.75–$319.50	16% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$284.00	$355.00	$248.50–$319.50	—	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/<	$274.40	$343.00	$154.35–$308.70	9% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR F/E/E/N/L/M 2.5 CM/<	$274.40	$343.00	$240.10–$308.70	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$339.20	$424.00	$190.80–$381.60	13% above	20%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$339.20	$424.00	$296.80–$381.60	—	20%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$220.00	$275.00	$123.75–$247.50	8% above	20%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$220.00	$275.00	$192.50–$247.50	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$275.20	$344.00	$154.80–$309.60	35% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$275.20	$344.00	$240.80–$309.60	—	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-OB	$547.20	$684.00	$307.80–$615.60	4% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION, SCHEDULED	$547.20	$684.00	$307.80–$615.60	4% below	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION-ED	$632.80	$791.00	$355.95–$711.90	11% above	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION, SCHEDULED	$547.20	$684.00	$478.80–$615.60	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-OB	$547.20	$684.00	$478.80–$615.60	—	20%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION-ED	$632.80	$791.00	$553.70–$711.90	—	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB TRT/MDI - SPUTUM INDUCTION	$179.20	$224.00	$100.80–$201.60	56% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB TRT/MDI - SPUTUM INDUCTION	$179.20	$224.00	$156.80–$201.60	—	20%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION	$463.20	$579.00	$260.55–$521.10	15% below	20%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION	$463.20	$579.00	$405.30–$521.10	—	20%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE 1ST 74 MINS	$1,173.60	$1,467.00	$660.15–$1,320.30	33% above	20%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE 1ST 74 MINS	$1,173.60	$1,467.00	$1,026.90–$1,320.30	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG SUBSQ DIFF DR	$128.80	$161.00	$72.45–$144.90	19% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD	$128.80	$161.00	$72.45–$144.90	19% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 Lead	$128.80	$161.00	$72.45–$144.90	19% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG ROUTINE	$128.80	$161.00	$72.45–$144.90	19% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG SUBQU SAME DR	$128.80	$161.00	$72.45–$144.90	19% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 Lead	$128.80	$161.00	$112.70–$144.90	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG SUBSQ DIFF DR	$128.80	$161.00	$112.70–$144.90	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG SUBQU SAME DR	$128.80	$161.00	$112.70–$144.90	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG ROUTINE	$128.80	$161.00	$112.70–$144.90	—	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD	$128.80	$161.00	$112.70–$144.90	—	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 93017 Cardiovascular Stress Test - Tracing	$340.00	$425.00	$191.25–$382.50	49% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$450.40	$563.00	$253.35–$506.70	33% below	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$590.40	$738.00	$332.10–$664.20	12% below	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 93017 Cardiovascular Stress Test - Tracing	$340.00	$425.00	$297.50–$382.50	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST	$450.40	$563.00	$394.10–$506.70	—	20%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST	$590.40	$738.00	$516.60–$664.20	—	20%
Family therapy with the patient, 50 minutes CPT 90847 OHPS Psychotherapy - Family w/ Patient	$141.60	$177.00	$79.65–$159.30	39% below	20%
Family therapy with the patient, 50 minutes CPT 90847 IOP Psychotherapy - Family w/ Patient	$141.60	$177.00	$79.65–$159.30	39% below	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 OHPS Psychotherapy - Family w/ Patient	$141.60	$177.00	$123.90–$159.30	—	20%
Family therapy with the patient, 50 minutes inpatient CPT 90847 IOP Psychotherapy - Family w/ Patient	$141.60	$177.00	$123.90–$159.30	—	20%
Family therapy without the patient, 50 minutes CPT 90846 OHPS Psychotherapy - Family w/o Patient	$141.60	$177.00	$79.65–$159.30	37% below	20%
Family therapy without the patient, 50 minutes CPT 90846 IOP Psychotherapy - Family w/o Patient	$141.60	$177.00	$79.65–$159.30	37% below	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 OHPS Psychotherapy - Family w/o Patient	$141.60	$177.00	$123.90–$159.30	—	20%
Family therapy without the patient, 50 minutes inpatient CPT 90846 IOP Psychotherapy - Family w/o Patient	$141.60	$177.00	$123.90–$159.30	—	20%
Group psychotherapy session CPT 90853 OHPS Group Psychotherapy	$176.80	$221.00	$99.45–$198.90	21% below	20%
Group psychotherapy session inpatient CPT 90853 OHPS Group Psychotherapy	$176.80	$221.00	$154.70–$198.90	—	20%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 ECG Monitor/Record <= 48 hrs Charge	$300.00	$375.00	$168.75–$337.50	26% below	20%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 ECG Monitor w/ Report <= 48 hrs Charge	$300.00	$375.00	$168.75–$337.50	26% below	20%
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 93224 HOLTER MONITOR UP TO 48 HOURS	$304.00	$380.00	$171.00–$342.00	25% below	20%
Holter monitor, heart rhythm recording up to 48 hours, with report one side CPT 93224 Holter Monitor 48 Hour RT	$304.00	$380.00	$171.00–$342.00	25% below	20%
Holter monitor, heart rhythm recording up to 48 hours, with report one side CPT 93224 Holter Monitor 24 Hour RT	$304.00	$380.00	$171.00–$342.00	25% below	20%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 ECG Monitor/Record <= 48 hrs Charge	$300.00	$375.00	$262.50–$337.50	—	20%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 ECG Monitor w/ Report <= 48 hrs Charge	$300.00	$375.00	$262.50–$337.50	—	20%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 93224 HOLTER MONITOR UP TO 48 HOURS	$304.00	$380.00	$266.00–$342.00	—	20%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient one side CPT 93224 Holter Monitor 24 Hour RT	$304.00	$380.00	$266.00–$342.00	—	20%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient one side CPT 93224 Holter Monitor 48 Hour RT	$304.00	$380.00	$266.00–$342.00	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF TX HYDRATION-SCHED 1ST HR	$275.20	$344.00	$154.80–$309.60	2% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF TX HYDRATION 1ST HR	$275.20	$344.00	$154.80–$309.60	2% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION TX HYDRATION 1ST HR	$275.20	$344.00	$154.80–$309.60	2% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INFUSION TX HYDRATION 1ST HR	$275.20	$344.00	$240.80–$309.60	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF TX HYDRATION-SCHED 1ST HR	$275.20	$344.00	$240.80–$309.60	—	20%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF TX HYDRATION 1ST HR	$275.20	$344.00	$240.80–$309.60	—	20%
IV infusion of a medicine, first hour CPT 96365 INF TX MED 1ST HR	$305.60	$382.00	$171.90–$343.80	3% below	20%
IV infusion of a medicine, first hour CPT 96365 INFUSION TX MED ADMIN 1ST HR	$305.60	$382.00	$171.90–$343.80	3% below	20%
IV infusion of a medicine, first hour CPT 96365 INF TX MED SCHED 1ST HR	$305.60	$382.00	$171.90–$343.80	3% below	20%
IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION TX MED ADMIN 1ST HR	$305.60	$382.00	$267.40–$343.80	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 INF TX MED SCHED 1ST HR	$305.60	$382.00	$267.40–$343.80	—	20%
IV infusion of a medicine, first hour inpatient CPT 96365 INF TX MED 1ST HR	$305.60	$382.00	$267.40–$343.80	—	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADM IM	$51.20	$64.00	$28.80–$57.60	43% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SQ/IM INJECTIONS ADMIN	$52.80	$66.00	$29.70–$59.40	41% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADM IM SCHEDULED	$52.80	$66.00	$29.70–$59.40	41% below	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADM IM	$51.20	$64.00	$44.80–$57.60	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SQ/IM INJECTIONS ADMIN	$52.80	$66.00	$46.20–$59.40	—	20%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADM IM SCHEDULED	$52.80	$66.00	$46.20–$59.40	—	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL ASSESS EA 15 MIN	$71.20	$89.00	$40.05–$80.10	67% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL ASSESS EA 15 MIN	$71.20	$89.00	$62.30–$80.10	—	20%
Psychotherapy session, 30 minutes CPT 90832 IOP Psychotherapy - Individual 16-37 min	$144.80	$181.00	$81.45–$162.90	15% below	20%
Psychotherapy session, 30 minutes CPT 90832 OHPS Psychotherapy - Individual 16-37 min	$144.80	$181.00	$81.45–$162.90	15% below	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 OHPS Psychotherapy - Individual 16-37 min	$144.80	$181.00	$126.70–$162.90	—	20%
Psychotherapy session, 30 minutes inpatient CPT 90832 IOP Psychotherapy - Individual 16-37 min	$144.80	$181.00	$126.70–$162.90	—	20%
Psychotherapy session, 45 minutes CPT 90834 IOP Psychotherapy - Individual 38-57 min	$290.40	$363.00	$163.35–$326.70	30% above	20%
Psychotherapy session, 45 minutes CPT 90834 OHPS Psychotherapy - Individual 38-57 min	$290.40	$363.00	$163.35–$326.70	30% above	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 IOP Psychotherapy - Individual 38-57 min	$290.40	$363.00	$254.10–$326.70	—	20%
Psychotherapy session, 45 minutes inpatient CPT 90834 OHPS Psychotherapy - Individual 38-57 min	$290.40	$363.00	$254.10–$326.70	—	20%
Psychotherapy session, 60 minutes CPT 90837 OHPS Psychotherapy - Individual 58 min or more	$290.40	$363.00	$163.35–$326.70	2% above	20%
Psychotherapy session, 60 minutes CPT 90837 IOP Psychotherapy - Individual 58 min or more	$290.40	$363.00	$163.35–$326.70	2% above	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 OHPS Psychotherapy - Individual 58 min or more	$290.40	$363.00	$254.10–$326.70	—	20%
Psychotherapy session, 60 minutes inpatient CPT 90837 IOP Psychotherapy - Individual 58 min or more	$290.40	$363.00	$254.10–$326.70	—	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 GENERAL PHYSICAL	$56.00	$70.00	$31.50–$63.00	29% below	20%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 GENERAL PHYSICAL	$56.00	$70.00	$49.00–$63.00	—	20%
Spirometry (breathing test) CPT 94010 94010 INCENTIVE SPIROMETRY CHARGE	$208.00	$260.00	$117.00–$234.00	4% above	20%
Spirometry (breathing test) CPT 94010 SIMPLE SPIROMETRY	$208.00	$260.00	$117.00–$234.00	4% above	20%
Spirometry (breathing test) inpatient CPT 94010 SIMPLE SPIROMETRY	$208.00	$260.00	$182.00–$234.00	—	20%
Spirometry (breathing test) inpatient CPT 94010 94010 INCENTIVE SPIROMETRY CHARGE	$208.00	$260.00	$182.00–$234.00	—	20%
Spirometry before and after a bronchodilator CPT 94060 BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA	$266.40	$333.00	$149.85–$299.70	33% below	20%
Spirometry before and after a bronchodilator CPT 94060 94060 PULMONARY FUNCTION CHARGE	$266.40	$333.00	$149.85–$299.70	33% below	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 94060 PULMONARY FUNCTION CHARGE	$266.40	$333.00	$233.10–$299.70	—	20%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRNCDILAT RSPSE SPMTRY PREPOST BRNCDILA	$266.40	$333.00	$233.10–$299.70	—	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$165.60	$207.00	$93.15–$186.30	16% below	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, SCHEDULED	$177.60	$222.00	$99.90–$199.80	10% below	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$165.60	$207.00	$144.90–$186.30	—	20%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, SCHEDULED	$177.60	$222.00	$155.40–$199.80	—	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza HD virus vaccine, inactivated adjuvanted preservative-free trivalent Sus UD[VDMC]	$97.34	$121.68	$54.76–$109.51	72% above	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 influenza HD virus vaccine, inactivated adjuvanted preservative-free trivalent Sus UD[VDMC]	$97.34	$121.68	$85.18–$109.51	—	20%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-CoV-2 (COVID-19) 12YR+ mRNA-LNP vaccine (cvx 312) preservative-free 50 mcg/0.5 mL Sus	$219.06	$273.82	$123.22–$246.44	18% below	20%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-CoV-2 (COVID-19) 12YR+ mRNA-LNP vaccine (cvx 312) preservative-free 50 mcg/0.5 mL Sus	$219.06	$273.82	$191.67–$246.44	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine - Pow[VDMC]	$259.25	$324.06	$145.83–$291.65	62% above	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine - Pow[VDMC]	$259.25	$324.06	$226.84–$291.65	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza TRI Syringe virus vaccine, inactivated preservative-free trivalent Sus[VDMC]	$24.80	$31.00	$13.95–$27.90	14% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza TRI Syringe virus vaccine, inactivated preservative-free trivalent Sus[VDMC]	$24.80	$31.00	$21.70–$27.90	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus vaccine 9-valent Sus[VDMC]	$483.62	$604.53	$272.04–$544.07	61% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus vaccine 9-valent Sus[VDMC]	$483.62	$604.53	$423.17–$544.07	—	20%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A adult vaccine 1440 units/mL preservative free Sus[VDMC]	$117.13	$146.41	$65.89–$131.77	9% below	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A adult vaccine 1440 units/mL preservative free Sus[VDMC]	$117.13	$146.41	$102.49–$131.77	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 10 mcg/mL Sus[VDMC]	$81.90	$102.38	$46.07–$92.14	26% below	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 10 mcg/mL Sus[VDMC]	$81.90	$102.38	$71.67–$92.14	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 mEAsles/mumps/rubella virus vaccine SubQ Inj [VDMC]	$156.76	$195.95	$88.18–$176.36	50% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 mEAsles/mumps/rubella virus vaccine SubQ Inj [VDMC]	$156.76	$195.95	$137.17–$176.36	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conjugate vaccine - Pow[VDMC]	$176.75	$220.93	$99.42–$198.84	24% below	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conjugate vaccine - Pow[VDMC]	$176.75	$220.93	$154.65–$198.84	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent vaccine inj Dip CR Syr 0.5ml [VDMC]	$365.81	$457.27	$205.77–$411.54	27% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent vaccine inj Dip CR Syr 0.5ml [VDMC]	$365.81	$457.27	$320.09–$411.54	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-valent vaccine Inj Sol 0.5ml [VDMC]	$182.30	$227.88	$102.54–$205.09	17% below	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-valent vaccine Inj Sol 0.5ml [VDMC]	$182.30	$227.88	$159.51–$205.09	—	20%
Rabies vaccine, one dose CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units SDV Pow[VDMC]	$1,234.30	$1,542.88	$694.30–$1,388.59	77% above	20%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, purified chick embryo cell 2.5 intl units SDV Pow[VDMC]	$1,234.30	$1,542.88	$1,080.02–$1,388.59	—	20%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 zoster vaccine recombinant IM Injection kit 50 and older [VDMC]	$292.68	$365.85	$164.63–$329.26	24% above	20%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 zoster vaccine recombinant IM Injection kit 50 and older [VDMC]	$292.68	$365.85	$256.10–$329.26	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphtheria toxoids adult IM Susp 0.5 mL [VDMC]	$70.67	$88.34	$39.75–$79.51	18% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphtheria toxoids adult IM Susp 0.5 mL [VDMC]	$70.67	$88.34	$61.84–$79.51	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus [VDMC]	$72.36	$90.45	$40.70–$81.40	14% below	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus [VDMC]	$72.36	$90.45	$63.31–$81.40	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM VACC 1ST	$24.00	$30.00	$13.50–$27.00	31% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM VACC 1ST	$24.00	$30.00	$21.00–$27.00	—	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADM VACC EA ADDL VACCINE	$32.80	$41.00	$18.45–$36.90	14% above	20%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADM VACC EA ADDL VACCINE	$32.80	$41.00	$28.70–$36.90	—	20%

Source file: https://pricetransparency.healthcare/van-diest-medical-center/charges/export