Boone County Health Center
Boone County Health Center publishes cash prices for 391 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Click a procedure to compare it with other hospitals nearby.
Collected Sep 27, 2026 Source price file
The price file shows no self-pay discount
For 736 of the 736 prices listed here, the cash price in Boone County Health Center's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | Off list |
|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 Ct Abdomen W/ + W/o Contrast | $3,204.00 | $3,204.00 | $164.00–$4,037.00 | — |
| Abdominal X-ray, 2 views CPT 74019 Xr Abdomen 2 View | $379.00 | $379.00 | $24.00–$478.00 | — |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete Min 3v Right | $324.00 | $324.00 | $26.00–$408.00 | — |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Xr Ankle Complete Min 3v Left | $324.00 | $324.00 | $26.00–$408.00 | — |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Us Abi's | $500.00 | $500.00 | $65.00–$630.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Humerus W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Elbow W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Elbow W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Forearm W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Forearm W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Hand W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Wrist W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Wrist W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Upper Extremity W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Upper Extremity W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Shoulder W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Shoulder W/o Contrast Left | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Humerus W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Ct Hand W/o Contrast Right | $2,170.00 | $2,170.00 | $98.00–$2,734.00 | — |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Xr Esophagus | $439.00 | $439.00 | $66.00–$553.00 | — |
| Bone scan, whole body (nuclear medicine) CPT 78306 Nm Bone Imaging Whole Body | $1,978.00 | $1,978.00 | $82.00–$2,492.00 | — |
| Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Left Complete. | $592.00 | $592.00 | $64.00–$746.00 | — |
| Breast ultrasound, complete, one breast one side CPT 76641 Us Breast Right Complete. | $592.00 | $592.00 | $64.00–$746.00 | — |
| Breast ultrasound, limited (one breast or one area) both sides CPT 76642 Us Breast Bilateral Limited | $800.00 | $800.00 | $49.00–$1,008.00 | — |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Right Limited. | $400.00 | $400.00 | $49.00–$504.00 | — |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Us Breast Left Limited. | $400.00 | $400.00 | $49.00–$504.00 | — |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 Ct Angiography Abdomen/pelvis | $5,581.00 | $5,581.00 | $270.00–$7,032.00 | — |
| CT angiography (CTA) of the head CPT 70496 Ct Angiography Head W/ + W/o Contrast | $3,100.00 | $3,100.00 | $164.00–$3,906.00 | — |
| CT angiography (CTA) of the neck CPT 70498 Bchc Ct Angiography Neck W/ W/o | $3,100.00 | $3,100.00 | $164.00–$3,906.00 | — |
| CT angiography (CTA) of the neck CPT 70498 Ct Angiography Neck W/wo Contrast | $3,100.00 | $3,100.00 | $164.00–$3,906.00 | — |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Ct Angiography Chest W/wo Contrast | $3,410.00 | $3,410.00 | $164.00–$4,297.00 | — |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 Cta Heart And Coronary Arteries | $1,240.00 | $1,240.00 | $164.00–$1,562.00 | — |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 Ct Cardiac Calcium Score | $103.00 | $103.00 | $56.00–$130.00 | — |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abdomen/pelvis W/o Contrast | $4,030.00 | $4,030.00 | $99.00–$5,078.00 | — |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abd/pel W/o Contrast | $4,030.00 | $4,030.00 | $99.00–$5,078.00 | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast | $4,754.00 | $4,754.00 | $177.00–$5,990.00 | — |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen/pelvis W + W/o Contrast | $5,581.00 | $5,581.00 | $242.00–$7,032.00 | — |
| CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/ Contrast | $2,687.00 | $2,687.00 | $124.00–$3,386.00 | — |
| CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/o Contrast | $2,377.00 | $2,377.00 | $79.00–$2,995.00 | — |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Maxillofacial W/o Contrast | $1,963.00 | $1,963.00 | $85.00–$2,473.00 | — |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinus W/o Contrast | $1,963.00 | $1,963.00 | $85.00–$2,473.00 | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT scan | $2,170.00 | $2,170.00 | $64.00–$2,734.00 | — |
| CT scan of the head with contrast CPT 70460 Ct Head Or Brain W/ Contrast | $2,377.00 | $2,377.00 | $92.00–$2,995.00 | — |
| CT scan of the head without and with contrast CPT 70470 Ct Head Or Brain W/ + W/o Contrast | $2,687.00 | $2,687.00 | $111.00–$3,386.00 | — |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Spine Lumbar W/o Contrast | $2,480.00 | $2,480.00 | $80.00–$3,125.00 | — |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Spine Cervical W/o Contrast | $2,506.00 | $2,506.00 | $81.00–$3,158.00 | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast | $2,687.00 | $2,687.00 | $164.00–$3,386.00 | — |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Us Carotid Doppler Bilateral | $1,499.00 | $1,499.00 | $72.00–$1,889.00 | — |
| Chest CT scan without and with contrast CPT 71270 Ct Chest W/wo Contrast | $2,997.00 | $2,997.00 | $122.00–$3,776.00 | — |
| Chest X-ray, 2 views CPT 71046 Xr Chest 2 Views | $338.00 | $338.00 | $21.00–$426.00 | — |
| Chest X-ray, single view CPT 71045 Xr Chest 1 View | $256.00 | $256.00 | $16.00–$323.00 | — |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr Clavicle Right | $283.00 | $283.00 | $22.00–$357.00 | — |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Xr Clavicle Left | $283.00 | $283.00 | $22.00–$357.00 | — |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Retroperitoneal Complete | $782.00 | $782.00 | $69.00–$985.00 | — |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bd Bone Density Dexa Axial Skeleton | $466.00 | $466.00 | $26.00–$587.00 | — |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Bd Bone Density Dexa App Skeleton | $158.00 | $158.00 | $20.00–$199.00 | — |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Us Ob Detailed Single | $475.00 | $475.00 | $79.00–$599.00 | — |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest W/o Contrast | $2,377.00 | $2,377.00 | $80.00–$2,995.00 | — |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W/contrast | $2,678.00 | $2,678.00 | $109.00–$3,374.00 | — |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W/ Contrast | $2,678.00 | $2,678.00 | $109.00–$3,374.00 | — |
| Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts | $464.00 | $464.00 | $103.00–$585.00 | — |
| Diagnostic mammogram, one breast CPT 77065 Mammography of one breast | $402.00 | $402.00 | $79.00–$507.00 | — |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Us Le Arterial Duplex Bilateral | $1,240.00 | $1,240.00 | $188.00–$1,562.00 | — |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Us Venous Doppler Complete Bilateral | $1,447.00 | $1,447.00 | $63.00–$1,823.00 | — |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 93306 Cc Echocardiogram Transthoracis 2d, W/ Doppler | $2,310.00 | $2,310.00 | $118.00–$2,911.00 | — |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 93306 Cc Echocardiogram Transthoracic 2d, W/ Doppler | $2,310.00 | $2,310.00 | $118.00–$2,911.00 | — |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 93306 Cc Cardiac Echocardiogram. 2d W/ Doppler | $2,310.00 | $2,310.00 | $118.00–$2,911.00 | — |
| Elbow X-ray, 2 views one side CPT 73070 Xr Elbow 2 Views Left | $202.00 | $202.00 | $20.00–$255.00 | — |
| Elbow X-ray, 2 views one side CPT 73070 Xr Elbow 2 Views Right | $202.00 | $202.00 | $20.00–$255.00 | — |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Xr Elbow Complete Right | $248.00 | $248.00 | $22.00–$312.00 | — |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Xr Elbow Complete Left | $248.00 | $248.00 | $22.00–$312.00 | — |
| Eye socket (orbit) CT scan without contrast CPT 70480 Ct Orbit Sella Etc. W/o Contrast | $2,377.00 | $2,377.00 | $96.00–$2,995.00 | — |
| Facial bones X-ray, complete, 3 or more views CPT 70150 Xr Facial Bones Minimum 3 Views | $337.00 | $337.00 | $32.00–$425.00 | — |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr Forearm 2 Views Right | $215.00 | $215.00 | $16.00–$271.00 | — |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Xr Forearm 2 Views Left | $215.00 | $215.00 | $16.00–$271.00 | — |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nm Hepatobiliary Duct System Imaging | $1,860.00 | $1,860.00 | $248.00–$2,344.00 | — |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Xr Calcaneous Min 2v Right | $180.00 | $180.00 | $19.00–$227.00 | — |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Xr Calcaneous Min 2v Left | $180.00 | $180.00 | $19.00–$227.00 | — |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older one side CPT 95811 95811 Rt Polysomnography Sleep Study W/ Cpap | $4,700.00 | $4,700.00 | $239.00–$5,922.00 | — |
| Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Left | $343.00 | $343.00 | $29.00–$432.00 | — |
| Knee X-ray, 3 views one side CPT 73562 Xr Knee 3 Views Right | $343.00 | $343.00 | $29.00–$432.00 | — |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Xr Knee Complete Min 4v Right | $387.00 | $387.00 | $23.00–$488.00 | — |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Xr Knee Complete Min 4v Left | $387.00 | $387.00 | $23.00–$488.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Knee W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Lower Extremity W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Lower Extremity W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Hip W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Foot W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Foot W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Femur W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Femur W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Ankle W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Ankle W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Tibia/fibula W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Tibia/fibula W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Knee W/o Contrast Left | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Ct Hip W/o Contrast Right | $2,273.00 | $2,273.00 | $81.00–$2,864.00 | — |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Us Abdomen Limited | $723.00 | $723.00 | $56.00–$911.00 | — |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Us Extremity Non-vasc Real-time Limited | $486.00 | $486.00 | $8.00–$612.00 | — |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Low Dose Lung Screening | $1,757.00 | $1,757.00 | $85.00–$2,214.00 | — |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Tibia/fibula 2 Views Left | $336.00 | $336.00 | $22.00–$423.00 | — |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Xr Tibia/fibula 2 Views Right | $336.00 | $336.00 | $22.00–$423.00 | — |
| MR angiography (MRA) of the head without contrast CPT 70544 Mra Head W/o Contrast | $3,517.00 | $3,517.00 | $117.00–$4,431.00 | — |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 Mri Breast W/ + W/o Contrast Bilateral. | $4,032.00 | $4,032.00 | $224.00–$5,080.00 | — |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| 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 | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Le Joint W/ + W/o Contrast Right | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Knee W/ + W/o Contrast Right | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Knee W/ + W/o Contrast Left | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Hip W/ + W/o Contrast Left | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Ankle W/ + W/o Contrast Right | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Ankle W/ + W/o Contrast Left | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Le Joint W/ + W/o Contrast Left | $3,723.00 | $3,723.00 | $280.00–$4,691.00 | — |
| MRI of the abdomen without contrast CPT 74181 Mri Abdomen W/o Contrast | $3,306.00 | $3,306.00 | $125.00–$4,166.00 | — |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/ + W/o Contrast | $4,238.00 | $4,238.00 | $231.00–$5,340.00 | — |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain W/o Contrast | $3,620.00 | $3,620.00 | $124.00–$4,561.00 | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Scan | $4,238.00 | $4,238.00 | $207.00–$5,340.00 | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal | $3,409.00 | $3,409.00 | $119.00–$4,295.00 | — |
| MRI of the lower back, without and then with contrast dye CPT 72158 Mri Spine Lumbar W/ + W/o Contrast | $4,341.00 | $4,341.00 | $208.00–$5,470.00 | — |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine Thoracic W/o Contrast | $3,564.00 | $3,564.00 | $118.00–$4,491.00 | — |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Spine Cervical W/ + W/o Contrast | $4,444.00 | $4,444.00 | $209.00–$5,599.00 | — |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Spine Cervical W/o Contrast | $3,517.00 | $3,517.00 | $118.00–$4,431.00 | — |
| MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/ + W/o Contrast | $4,238.00 | $4,238.00 | $230.00–$5,340.00 | — |
| MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis W/o Contrast | $3,203.00 | $3,203.00 | $157.00–$4,036.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Wrist W/o Contrast Right | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Elbow W/o Contrast Right | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Contrast Left | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Elbow W/o Contrast Left | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Shoulder W/o Contrast Right | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Shoulder W/o Contrast Left | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Ue Joint W/o Contrast Right | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Wrist W/o Contrast Left | $2,688.00 | $2,688.00 | $133.00–$3,387.00 | — |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Xr Spine Cervical Minimum 4 Views | $499.00 | $499.00 | $27.00–$629.00 | — |
| Neck soft tissue CT scan with contrast CPT 70491 Ct Soft Tissue Neck W/ Contrast | $2,480.00 | $2,480.00 | $117.00–$3,125.00 | — |
| Neck soft tissue CT scan without contrast CPT 70490 Ct Soft Tissue Neck W/o Contrast | $2,170.00 | $2,170.00 | $88.00–$2,734.00 | — |
| Neck soft tissue X-ray CPT 70360 Xr Neck Soft Tissue | $225.00 | $225.00 | $18.00–$284.00 | — |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nm Myocardial Spect Multi Rest/stress | $4,340.00 | $4,340.00 | $335.00–$5,468.00 | — |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet Skullmid Thigh | $6,450.00 | $6,450.00 | $1,360.00–$8,127.00 | — |
| Pelvic CT scan without contrast CPT 72192 Ct Pelvis W/o Contrast | $2,377.00 | $2,377.00 | $80.00–$2,995.00 | — |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Us Pelvic Limited | $517.00 | $517.00 | $23.00–$651.00 | — |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Us Pelvic Complete | $827.00 | $827.00 | $67.00–$1,042.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus | $773.00 | $773.00 | $82.00–$974.00 | — |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Us Pregnancy 1st Trimester | $721.00 | $721.00 | $66.00–$908.00 | — |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Us Ob Limited (Afi) | $438.00 | $438.00 | $47.00–$552.00 | — |
| Rib X-ray, one side, 2 views one side CPT 71100 Xr Ribs 2 Views Left | $234.00 | $234.00 | $24.00–$295.00 | — |
| Rib X-ray, one side, 2 views one side CPT 71100 Xr Ribs 2 Views Right | $234.00 | $234.00 | $24.00–$295.00 | — |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xr Ribs Min 3 Views Right W/ Pa Chest | $413.00 | $413.00 | $27.00–$520.00 | — |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Xr Ribs Min 3 Views Left W/ Pa Chest | $413.00 | $413.00 | $27.00–$520.00 | — |
| Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral | $402.00 | $402.00 | $74.00–$507.00 | — |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder 2 Views Right | $338.00 | $338.00 | $24.00–$426.00 | — |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Xr Shoulder 2 Views Left | $338.00 | $338.00 | $24.00–$426.00 | — |
| Sinus X-ray, complete, 3 or more views CPT 70220 Xr Sinuses Paranasal Complete | $281.00 | $281.00 | $25.00–$354.00 | — |
| Skull X-ray, fewer than 4 views CPT 70250 Xr Skull < 4 Views | $209.00 | $209.00 | $18.00–$263.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep study | $4,100.00 | $4,100.00 | $451.00–$5,166.00 | — |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Xr Swallowing Function W/ Video | $434.00 | $434.00 | $52.00–$547.00 | — |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Xr Femur 2 Views Right | $338.00 | $338.00 | $25.00–$426.00 | — |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Xr Femur 2 Views Left | $338.00 | $338.00 | $25.00–$426.00 | — |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Ct Spine Thoracic W/o Contrast | $2,480.00 | $2,480.00 | $81.00–$3,125.00 | — |
| Toe X-ray, 2 or more views one side CPT 73660 Xr Toes Min 2v Left | $170.00 | $170.00 | $21.00–$214.00 | — |
| Toe X-ray, 2 or more views one side CPT 73660 Xr Toes Min 2v Right | $170.00 | $170.00 | $21.00–$214.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina | $569.00 | $569.00 | $81.00–$717.00 | — |
| Transvaginal ultrasound during pregnancy CPT 76817 Us Pregnancy Transvaginal | $594.00 | $594.00 | $53.00–$748.00 | — |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen | $901.00 | $901.00 | $73.00–$1,135.00 | — |
| Ultrasound of the scrotum and testicles CPT 76870 Us Scrotum (Contents) | $723.00 | $723.00 | $66.00–$911.00 | — |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Thyroid | $569.00 | $569.00 | $78.00–$717.00 | — |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Xr Upper Gi | $672.00 | $672.00 | $80.00–$847.00 | — |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr Humerus Right Min 2v | $237.00 | $237.00 | $22.00–$299.00 | — |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Xr Humerus Left Min 2v | $237.00 | $237.00 | $22.00–$299.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study both sides CPT 93971 Us Venous Insufficiency Bilat | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Insufficiency Rt | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Le Venous Duplex Left | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Ue Venous Duplex Left | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Le Venous Duplex Right | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Ue Venous Duplex Right | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Us Venous Insufficiency Lt | $1,137.00 | $1,137.00 | $91.00–$1,433.00 | — |
| Wrist X-ray, 2 views one side CPT 73100 Xr Wrist 2 Views Left | $183.00 | $183.00 | $24.00–$231.00 | — |
| Wrist X-ray, 2 views one side CPT 73100 Xr Wrist 2 Views Right | $183.00 | $183.00 | $24.00–$231.00 | — |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete Left | $237.00 | $237.00 | $30.00–$299.00 | — |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Xr Wrist Complete Right | $237.00 | $237.00 | $30.00–$299.00 | — |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip Complete Right | $315.00 | $315.00 | $22.00–$397.00 | — |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip 2-3 Views Lt W/ Pelvis | $315.00 | $315.00 | $22.00–$397.00 | — |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip 2-3 Views Rt W/ Pelvis | $315.00 | $315.00 | $22.00–$397.00 | — |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Xr Hip Complete Left | $315.00 | $315.00 | $22.00–$397.00 | — |
| X-ray of the abdomen, 1 view CPT 74018 Xr Abdomen 1 View | $286.00 | $286.00 | $20.00–$360.00 | — |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger Right Min 3v | $220.00 | $220.00 | $29.00–$277.00 | — |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Xr Finger Left Min 3v | $220.00 | $220.00 | $29.00–$277.00 | — |
| X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Left | $306.00 | $306.00 | $19.00–$386.00 | — |
| X-ray of the foot, 2 views one side CPT 73620 Xr Foot 2 Views Right | $308.00 | $308.00 | $19.00–$388.00 | — |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete Min 3v Left | $312.00 | $312.00 | $24.00–$393.00 | — |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Xr Foot Complete Min 3v Right | $312.00 | $312.00 | $24.00–$393.00 | — |
| X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Complete Left Min 3v | $242.00 | $242.00 | $26.00–$305.00 | — |
| X-ray of the hand, 3 or more views one side CPT 73130 Xr Hand Complete Right Min 3v | $242.00 | $242.00 | $26.00–$305.00 | — |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Bchc Xr Knee One Or Two Views Right | $229.00 | $229.00 | $24.00–$289.00 | — |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee One Or Two Views Left | $229.00 | $229.00 | $24.00–$289.00 | — |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Xr Knee One Or Two Views Right | $229.00 | $229.00 | $24.00–$289.00 | — |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Bchc Xr Knee One Or Two Views Left | $229.00 | $229.00 | $24.00–$289.00 | — |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Xr Spine Lumbosacral 2 Or 3 Views | $420.00 | $420.00 | $22.00–$529.00 | — |
| X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back | $383.00 | $383.00 | $36.00–$483.00 | — |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Xr Spine Thoracic 2 Views | $387.00 | $387.00 | $21.00–$488.00 | — |
| X-ray of the nasal bones, 3 or more views CPT 70160 Xr Nasal Bones Minimum 3 Views | $224.00 | $224.00 | $28.00–$282.00 | — |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Xr Spine Cervical 2 Or 3 Views | $362.00 | $362.00 | $22.00–$456.00 | — |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Xr Pelvis 1 Or 2 Views | $336.00 | $336.00 | $17.00–$423.00 | — |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Xr Sacrum/coccyx Minimum 2 Views | $229.00 | $229.00 | $22.00–$289.00 | — |
Lab tests
| Procedure | Cash price | List price | Insurers pay | Off list |
|---|---|---|---|---|
| ACTH blood test CPT 82024 82024 Adrenocorticotropic Hormone (Acth) Rps | $200.00 | $200.00 | $23.00–$252.00 | — |
| ACTH blood test CPT 82024 Adrenocorticotropic (Acth) Hormone Level Rps | $218.00 | $218.00 | $23.00–$275.00 | — |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 84460 Lab Alt 1 | $60.00 | $60.00 | $3.00–$76.00 | — |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 84460 Alt 1 Add On | $60.00 | $60.00 | $3.00–$76.00 | — |
| AST (aspartate aminotransferase) enzyme test CPT 84450 84450 Ast 1 Add On | $65.00 | $65.00 | $3.00–$82.00 | — |
| AST (aspartate aminotransferase) enzyme test CPT 84450 84450 Lab Ast 1 | $65.00 | $65.00 | $3.00–$82.00 | — |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 80074 Lab Hepatitis Acute Panel | $331.00 | $331.00 | $29.00–$417.00 | — |
| Albumin blood test CPT 82040 82040 Lab Albumin Lvl | $58.00 | $58.00 | $3.00–$73.00 | — |
| Albumin blood test CPT 82040 Multiple Sclerosis(ms) Profile Rps | $58.00 | $58.00 | $3.00–$73.00 | — |
| Aldosterone blood test CPT 82088 Aldosterone Rps | $241.00 | $241.00 | $24.00–$304.00 | — |
| Aldosterone blood test CPT 82088 82088 Lab Aldosterone Rps | $241.00 | $241.00 | $24.00–$304.00 | — |
| Alkaline phosphatase (ALP) blood test CPT 84075 84075 Lab Alkaline Phosphatase | $38.00 | $38.00 | $3.00–$48.00 | — |
| Alkaline phosphatase (ALP) blood test CPT 84075 Alk Phos Isoenzyme Rps | $38.00 | $38.00 | $3.00–$48.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rye Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Rast Antibody Single Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio Nut Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Pecan Nut Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Peanut Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Peanut Component Profile Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Oat Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Milk Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergens, Mites, D Pteronyssinus Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergens, Mites, D Farinae, Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen,phoma Betae Unmc | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Pork Unmc | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Beef Unmc | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Food, Wheat Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 86003 Allergen, Region 9 Respiratory Panel Add-on Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 86003 Allergen Specific Ige Quant Or Semiquant Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Soy Allergen Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Food Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Whey Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Russian Thistle Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Latex Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut (Filbert) Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 F036-ige Coconut | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 F020-ige Almond Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 F018-ige Brazil Nut Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg White Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg Components Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Egg (Yolk) Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Fl Allergen-beef/phoma Betae/pork Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Dog Hair/dander Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium/dander Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Cashew Ige Rps | $49.00 | $49.00 | $3.00–$62.00 | — |
| Alpha-fetoprotein (AFP) blood test CPT 82105 82105 Lab Afp, Maternal Scrn Rps | $88.00 | $88.00 | $10.00–$111.00 | — |
| Alpha-fetoprotein (AFP) blood test CPT 82105 A Fetoprotein/ca Rps | $88.00 | $88.00 | $10.00–$111.00 | — |
| Ammonia blood test CPT 82140 82140 Lab Ammonia Lvl | $130.00 | $130.00 | $9.00–$164.00 | — |
| Amylase blood test CPT 82150 82150 Lab Amylase/fluid Rps | $85.00 | $85.00 | $4.00–$107.00 | — |
| Amylase blood test CPT 82150 82150 Lab Amylase Lvl | $85.00 | $85.00 | $4.00–$107.00 | — |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp Antibody, Igg Rps | $140.00 | $140.00 | $8.00–$176.00 | — |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Screen Rflx To Anasrx Rps | $110.00 | $110.00 | $7.00–$139.00 | — |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Connective Tissue Cascade Rps | $110.00 | $110.00 | $7.00–$139.00 | — |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 83880 Lab Brain Natriuretic Peptide (Bnp) | $253.00 | $253.00 | $24.00–$319.00 | — |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 83880 Probnp Rps | $253.00 | $253.00 | $24.00–$319.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Eye Culture 1 | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Genital Culture 1 | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Group B Strep Culture | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Sputum Culture | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Strep Confirmation | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Tissue Culture | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Tissue/wound Culture | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Body Fluid Culture. | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Synovial Fl Mb Rps | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Ear Culture 1 | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Cath Tip Mb Rps | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 C Sinus Mb Rps | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 C Sputum Mb Rps | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Tissue Mb Rps | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 Lab Csf Culture | $108.00 | $108.00 | $5.00–$136.00 | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Aerobic Mb Rps | $108.00 | $108.00 | $5.00–$136.00 | — |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel | $150.00 | $150.00 | $5.00–$189.00 | — |
| Bilirubin blood test, total CPT 82247 82247 Lab Bilirubin Total | $65.00 | $65.00 | $3.00–$82.00 | — |
| Bilirubin blood test, total CPT 82247 82247 Bilirubin, Total Add-on | $65.00 | $65.00 | $3.00–$82.00 | — |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Level Ivsurgical Pathology, Gross And Microscopic Examina | $164.00 | $164.00 | $21.00–$207.00 | — |
| Blood culture for bacteria CPT 87040 Culture Aerobic Blood Mb Rps | $228.00 | $228.00 | $6.00–$287.00 | — |
| Blood culture for bacteria CPT 87040 87040 Lab Blood Culture | $228.00 | $228.00 | $6.00–$287.00 | — |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Lab Vp Only (Send Out Testing) | $35.00 | $35.00 | $3.00–$44.00 | — |
| Blood glucose (sugar) test CPT 82947 82947 Lab Glucose, Poc | $58.00 | $58.00 | $3.00–$73.00 | — |
| Blood glucose (sugar) test CPT 82947 82947 Lab Glucose Level | $58.00 | $58.00 | $3.00–$73.00 | — |
| Blood glucose (sugar) test CPT 82947 Insulin Resistant 2 Hr Test Rps | $58.00 | $58.00 | $3.00–$73.00 | — |
| Blood glucose (sugar) test CPT 82947 82947 Glucose Level Add On | $58.00 | $58.00 | $3.00–$73.00 | — |
| Blood lead test CPT 83655 Lead Level (83655) Poc | $83.00 | $83.00 | $7.00–$105.00 | — |
| Blood lead test CPT 83655 Lead, Blood (Pediatric) Rps | $85.00 | $85.00 | $7.00–$107.00 | — |
| Blood lead test CPT 83655 Lead, Capillary Rps | $85.00 | $85.00 | $7.00–$107.00 | — |
| Blood lead test CPT 83655 Lead Rps | $85.00 | $85.00 | $7.00–$107.00 | — |
| Blood lead test CPT 83655 Lead, Venous Rps | $85.00 | $85.00 | $7.00–$107.00 | — |
| Blood lead test CPT 83655 Lead, 24 Hr, U Rps | $85.00 | $85.00 | $7.00–$107.00 | — |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 84703 Lab Hcg Qualitative, Serum 2 | $103.00 | $103.00 | $5.00–$130.00 | — |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 86900 Bld Aborh | $73.00 | $73.00 | $2.00–$92.00 | — |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 86900 Bld Pre Tr Aborh | $73.00 | $73.00 | $2.00–$92.00 | — |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 86900 Bld Aborh Newborn Interp Abo | $73.00 | $73.00 | $2.00–$92.00 | — |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 86900 Bld Post Tr Aborh | $73.00 | $73.00 | $2.00–$92.00 | — |
| Blood urea nitrogen (BUN) test CPT 84520 84520 Lab Blood Urea Nitrogen | $52.00 | $52.00 | $2.00–$66.00 | — |
| C-peptide blood test CPT 84681 C-peptide Rps | $150.00 | $150.00 | $12.00–$189.00 | — |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 86140 Lab C-reactive Protein | $97.00 | $97.00 | $3.00–$122.00 | — |
| C. difficile toxin gene test (stool PCR) CPT 87493 87493 Lab C Diff 2 | $153.00 | $153.00 | $22.00–$193.00 | — |
| CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9 Rps | $183.00 | $183.00 | $12.00–$231.00 | — |
| CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen 19-9 | $183.00 | $183.00 | $12.00–$231.00 | — |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Ca-125 Rps | $153.00 | $153.00 | $12.00–$193.00 | — |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 87635/u0002 Lab Sars-cov-2 (Covid-19) Pcr (Genexpert) | $125.00 | $125.00 | $51.00–$158.00 | — |
| Calcium blood test, total CPT 82310 82310 Lab Calcium Level Total | $50.00 | $50.00 | $3.00–$63.00 | — |
| Carcinoembryonic antigen (CEA) test CPT 82378 Cea Rps | $145.00 | $145.00 | $11.00–$183.00 | — |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster, Igm Rps | $116.00 | $116.00 | $8.00–$146.00 | — |
| Chickenpox (varicella) immunity blood test CPT 86787 Varicella Ab Screen Rps | $116.00 | $116.00 | $8.00–$146.00 | — |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Ct/ng Probe Dna (Throat) Unmc | $34.00 | $34.00 | $21.00–$43.00 | — |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 Lab Chlamydia Trachomatis By Pcr | $116.00 | $116.00 | $21.00–$146.00 | — |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 87491 Lab Bill Chlamydia Pcr | $116.00 | $116.00 | $21.00–$146.00 | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids | $140.00 | $140.00 | $8.00–$176.00 | — |
| Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated | $98.00 | $98.00 | $5.00–$123.00 | — |
| Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated | $79.00 | $79.00 | $4.00–$100.00 | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals | $176.00 | $176.00 | $6.00–$222.00 | — |
| Cortisol blood test, total CPT 82533 82533 Cortisol Total Rps | $115.00 | $115.00 | $10.00–$145.00 | — |
| Cortisol blood test, total CPT 82533 Cortisol/4 Pm Rps | $119.00 | $119.00 | $10.00–$150.00 | — |
| Cortisol blood test, total CPT 82533 Cortisol/random Rps | $119.00 | $119.00 | $10.00–$150.00 | — |
| Cortisol blood test, total CPT 82533 Cortisol/8 Am Rps | $119.00 | $119.00 | $10.00–$150.00 | — |
| Creatine kinase (CK) blood test, total CPT 82550 82550 Lab Creatine Kinase | $85.00 | $85.00 | $4.00–$107.00 | — |
| Creatinine blood test CPT 82565 82565 Creatinine Charge | $55.00 | $55.00 | $3.00–$69.00 | — |
| Creatinine blood test CPT 82565 82565 Lab Creatinine | $55.00 | $55.00 | $3.00–$69.00 | — |
| Cytomegalovirus (CMV) antibody test CPT 86644 Cmv Igg Ab Rps | $121.00 | $121.00 | $9.00–$152.00 | — |
| D-dimer blood test (blood clot marker) CPT 85379 D-dimer Rps | $132.00 | $132.00 | $6.00–$166.00 | — |
| D-dimer blood test (blood clot marker) CPT 85379 85379 Lab D-dimer | $132.00 | $132.00 | $6.00–$166.00 | — |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dhea Sulfate Rps | $28.00 | $28.00 | $13.00–$35.00 | — |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconiem Drug Screen (Medtox) | $247.00 | $247.00 | $37.00–$311.00 | — |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 80051 Lab Electrolyte Panel | $135.00 | $135.00 | $4.00–$170.00 | — |
| Epstein-Barr virus (EBV) antibody test CPT 86665 86665 Ab Epstein Barr Viral Capsid Rps Add-on Charge | $106.00 | $106.00 | $11.00–$134.00 | — |
| Estradiol blood test CPT 82670 Estradiol Rps | $170.00 | $170.00 | $17.00–$214.00 | — |
| FSH (follicle-stimulating hormone) test CPT 83001 Fsh Rps | $110.00 | $110.00 | $11.00–$139.00 | — |
| FSH (follicle-stimulating hormone) test CPT 83001 Fsh And Lh Rps | $110.00 | $110.00 | $11.00–$139.00 | — |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool Rps | $367.00 | $367.00 | $12.00–$462.00 | — |
| Ferritin blood test (iron stores) CPT 82728 82728 Lab Ferritin | $121.00 | $121.00 | $8.00–$152.00 | — |
| Fibrinogen blood test CPT 85384 85384 Lab Fibrinogen | $87.00 | $87.00 | $6.00–$110.00 | — |
| Fibrinogen blood test CPT 85384 Fibrinogen Rps | $87.00 | $87.00 | $6.00–$110.00 | — |
| Folate (folic acid) blood test CPT 82746 82746 Lab Folate Level | $134.00 | $134.00 | $9.00–$169.00 | — |
| Free T3 thyroid hormone test CPT 84481 84481 Lab Triiodothyronine Free | $185.00 | $185.00 | $10.00–$233.00 | — |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free Direct Dialy Rps | $93.00 | $93.00 | $5.00–$117.00 | — |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Reflex? | $93.00 | $93.00 | $5.00–$117.00 | — |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 84439 Lab Free T4 | $93.00 | $93.00 | $5.00–$117.00 | — |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free Direct By Equilibrium Unmc | $93.00 | $93.00 | $5.00–$117.00 | — |
| Free testosterone test CPT 84402 Testosterone Free Rps | $180.00 | $180.00 | $15.00–$227.00 | — |
| Free testosterone test CPT 84402 84402 Lab Testosterone Free | $180.00 | $180.00 | $15.00–$227.00 | — |
| Free testosterone test CPT 84402 Testosterone, Free Rps | $180.00 | $180.00 | $15.00–$227.00 | — |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 82977 Gamma Glutamyl Transferase Charge | $63.00 | $63.00 | $4.00–$79.00 | — |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase Add On | $63.00 | $63.00 | $4.00–$79.00 | — |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 82977 Lab Ggt | $63.00 | $63.00 | $4.00–$79.00 | — |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 80050 Lab General Health Panel | $382.00 | $382.00 | $22.00–$481.00 | — |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 82950 Lab Glucose, Post Glucose Dose | $69.00 | $69.00 | $3.00–$87.00 | — |
| Glucose tolerance test, 3 samples CPT 82951 82951 Lab .Gtt-2 Hr | $130.00 | $130.00 | $8.00–$164.00 | — |
| Glucose tolerance test, 3 samples CPT 82951 82951 Lab .Ltt-1 Hr | $130.00 | $130.00 | $8.00–$164.00 | — |
| Glucose tolerance test, 3 samples CPT 82951 82951 Lab Gtt2 | $130.00 | $130.00 | $8.00–$164.00 | — |
| Glucose tolerance test, 3 samples CPT 82951 82951 Lab Bill Gtt First 3 Specimens | $130.00 | $130.00 | $8.00–$164.00 | — |
| Glucose tolerance test, 3 samples CPT 82951 82951 Lab .Gtt-1/2 Hr | $130.00 | $130.00 | $8.00–$164.00 | — |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 Lab Bill N. Gonorrhoeae Pcr | $119.00 | $119.00 | $21.00–$150.00 | — |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 Lab Neisseria Gonorrhoeae By Pcr | $119.00 | $119.00 | $21.00–$150.00 | — |
| H. pylori stool antigen test CPT 87338 H. Pylori Stool Anti Rps | $130.00 | $130.00 | $9.00–$164.00 | — |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv Rna Quant Ultra Rps | $264.00 | $264.00 | $51.00–$333.00 | — |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 87389 Lab Hiv 1 Ag Hiv 1/2 Ab | $140.00 | $140.00 | $14.00–$176.00 | — |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 87389 Hiv Ag/ab Panel Rps | $140.00 | $140.00 | $14.00–$176.00 | — |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv Dna Surepath Rps | $179.00 | $179.00 | $21.00–$226.00 | — |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 87624 Infectious Agent Detection By Dna Or Rna Hpv High Risk | $179.00 | $179.00 | $21.00–$226.00 | — |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 83036 Lab Hemoglobin A1c | $85.00 | $85.00 | $6.00–$107.00 | — |
| Hemoglobin blood test CPT 85018 85018 Cl Hemoglobin Poc | $31.00 | $31.00 | $2.00–$39.00 | — |
| Hemoglobin blood test CPT 85018 85018 Cl Hemoglobinpoct | $31.00 | $31.00 | $2.00–$39.00 | — |
| Hemoglobin blood test CPT 85018 85018 Lab Hemoglobin | $31.00 | $31.00 | $2.00–$39.00 | — |
| Hemoglobin blood test CPT 85018 85018 Cl Hemoglobinpoc | $31.00 | $31.00 | $2.00–$39.00 | — |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B/c Ab Rps | $107.00 | $107.00 | $7.00–$135.00 | — |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 86706 Lab Hepatitis B Surface Ab | $98.00 | $98.00 | $6.00–$123.00 | — |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 86287 Lab Hepatitis B Surface Antigen | $89.00 | $89.00 | $6.00–$112.00 | — |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 87340 Lab Hepatitis B Surface Ag | $89.00 | $89.00 | $6.00–$112.00 | — |
| Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab W/rflx Hep C Rna Quant Rps | $53.00 | $53.00 | $9.00–$67.00 | — |
| Hepatitis C antibody blood test (screening) CPT 86803 86803 Lab Hepatitis C Antibody | $118.00 | $118.00 | $9.00–$149.00 | — |
| Hepatitis C antibody blood test (screening) CPT 86803 86284 Lab Hepatitis C Antibody | $118.00 | $118.00 | $9.00–$149.00 | — |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Hcv Rna Detect/quant Rps | $286.00 | $286.00 | $26.00–$360.00 | — |
| Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1 And 2 Panel Rps | $32.00 | $32.00 | $8.00–$40.00 | — |
| High-sensitivity CRP (hs-CRP) test CPT 86141 81592 Lab C-reactive Protein Cardio | $97.00 | $97.00 | $8.00–$122.00 | — |
| Homocysteine blood test CPT 83090 Homocysteine/blood Rps | $163.00 | $163.00 | $11.00–$205.00 | — |
| Insulin blood test CPT 83525 Insulin | $114.00 | $114.00 | $7.00–$144.00 | — |
| Iron blood test (serum iron) CPT 83540 83540 Lab Iron Level | $58.00 | $58.00 | $4.00–$73.00 | — |
| Iron-binding capacity (TIBC) test CPT 83550 83550 Lab Total Iron Binding Capacity | $67.00 | $67.00 | $5.00–$84.00 | — |
| Kidney function blood test panel CPT 80069 Kidney function panel test | $161.00 | $161.00 | $5.00–$203.00 | — |
| LH (luteinizing hormone) test CPT 83002 83002 Fsh And Lh Rps Add-on Charge | $33.00 | $33.00 | $11.00–$42.00 | — |
| LH (luteinizing hormone) test CPT 83002 Lh Rps | $100.00 | $100.00 | $11.00–$126.00 | — |
| Lactate (lactic acid) blood test CPT 83605 83605 Lab Lactic Acid | $126.00 | $126.00 | $7.00–$159.00 | — |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Ld/fluid Rps | $65.00 | $65.00 | $4.00–$82.00 | — |
| Lactate dehydrogenase (LDH) blood test CPT 83615 83615 Lab Lactate Dehydrogenase | $65.00 | $65.00 | $4.00–$82.00 | — |
| Lipase blood test (pancreas enzyme) CPT 83690 83690 Lab Lipase Level | $102.00 | $102.00 | $4.00–$129.00 | — |
| Liver function blood test panel CPT 80076 Liver function blood test | $150.00 | $150.00 | $5.00–$189.00 | — |
| Lyme disease antibody test CPT 86618 .Lyme Igg Western Blot Rps | $65.00 | $65.00 | $10.00–$82.00 | — |
| Lyme disease antibody test CPT 86618 Lyme Rflx To Immunoblot Rps | $65.00 | $65.00 | $10.00–$82.00 | — |
| Lyme disease antibody test CPT 86618 Lyme Antibody Rps | $65.00 | $65.00 | $10.00–$82.00 | — |
| Lyme disease antibody test CPT 86618 Lyme Ab Total Igg, Igm Rps | $65.00 | $65.00 | $10.00–$82.00 | — |
| Magnesium blood test CPT 83735 83735 Lab Magnesium Level | $79.00 | $79.00 | $4.00–$100.00 | — |
| Magnesium blood test CPT 83735 83735 Lab Magnesium Level Urine Timed | $79.00 | $79.00 | $4.00–$100.00 | — |
| Magnesium blood test CPT 83735 83735 Lab Magnesium Level Urine | $79.00 | $79.00 | $4.00–$100.00 | — |
| Measles (rubeola) antibody test CPT 86765 Measles(rubeola) Igg Rps | $137.00 | $137.00 | $8.00–$173.00 | — |
| Measles (rubeola) antibody test CPT 86765 Rubeola Igm Rps | $138.00 | $138.00 | $8.00–$174.00 | — |
| Mono test (heterophile antibody, Monospot) CPT 86308 86308 Lab Mono Screen 3 | $72.00 | $72.00 | $3.00–$91.00 | — |
| Mumps immunity blood test CPT 86735 Mumps Antibody Igg Rps | $104.00 | $104.00 | $8.00–$131.00 | — |
| Obstetric blood test panel CPT 80055 Obstetric blood test panel | $261.00 | $261.00 | $29.00–$329.00 | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test | $150.00 | $150.00 | $11.00–$189.00 | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test | $140.00 | $140.00 | $11.00–$176.00 | — |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytology Genital Screen Rps | $47.00 | $47.00 | $13.00–$59.00 | — |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap With Hpvsp Rps | $143.00 | $143.00 | $13.00–$180.00 | — |
| Parathyroid hormone (PTH) blood test CPT 83970 Pth Intact Rps | $211.00 | $211.00 | $25.00–$266.00 | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test | $88.00 | $88.00 | $4.00–$111.00 | — |
| Phosphorus (phosphate) blood test CPT 84100 84100 Lab Phosphorus Level | $48.00 | $48.00 | $3.00–$60.00 | — |
| Potassium blood test CPT 84132 84132 Lab Potassium Level | $47.00 | $47.00 | $3.00–$59.00 | — |
| Progesterone blood test CPT 84144 84144 Lab Progesterone | $116.00 | $116.00 | $13.00–$146.00 | — |
| Prolactin blood test CPT 84146 Prolactin Rps | $136.00 | $136.00 | $12.00–$171.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $57.00 | $57.00 | $3.00–$72.00 | — |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 80305 Lab Uds 6 | $186.00 | $186.00 | $8.00–$234.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Cl Rapid Flu B Poc | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Lab Influenza Ab 2 | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Cl Influenza A And B Poct | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Lab Influenza A | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Cl Flu B Ag (Sofia) Poct | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Lab Influenza B | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Cl Flu A Ag (Sofia) Poct | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Cl Rapid Flu A Poc | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Cl Influenza B Poct | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid flu test (influenza antigen) CPT 87804 87804 Lab Influenza Ab | $104.00 | $104.00 | $11.00–$131.00 | — |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 87880 Cl Rapid Strep Poc | $82.00 | $82.00 | $11.00–$103.00 | — |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 87880 Cl Rapid Strep Poct | $82.00 | $82.00 | $11.00–$103.00 | — |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 87880 Lab Strep A Screen 1 | $82.00 | $82.00 | $11.00–$103.00 | — |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 87880 Lab Strep A Screen 3 | $82.00 | $82.00 | $11.00–$103.00 | — |
| Renin blood test CPT 84244 Renin Activity Rps | $34.00 | $34.00 | $13.00–$43.00 | — |
| Rh blood typing CPT 86901 86901 Lab Newborn Rh | $73.00 | $73.00 | $2.00–$92.00 | — |
| Rh blood typing CPT 86901 86901 Lab Rh (Including Du) | $73.00 | $73.00 | $2.00–$92.00 | — |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid Fact/ser Rps | $66.00 | $66.00 | $3.00–$83.00 | — |
| Rubella antibody test (immunity check) CPT 86762 86762 Lab Rubella Screen | $73.00 | $73.00 | $9.00–$92.00 | — |
| Rubella antibody test (immunity check) CPT 86762 86762 Lab Rubella Igg Eia Rps | $73.00 | $73.00 | $9.00–$92.00 | — |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 85652 Lab Sedimentation Rate | $50.00 | $50.00 | $2.00–$63.00 | — |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 89320 Lab Semen Analysis 1 | $177.00 | $177.00 | $8.00–$223.00 | — |
| Sodium blood test CPT 84295 84295 Lab Sodium Level | $45.00 | $45.00 | $3.00–$57.00 | — |
| Stool ova and parasites exam CPT 87177 Ova And Parasite Fecal Rps | $87.00 | $87.00 | $5.00–$110.00 | — |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 82270 Lab Occult Blood Stool I. | $32.00 | $32.00 | $3.00–$40.00 | — |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 82270 Lab Occult Blood Stool 1 | $32.00 | $32.00 | $3.00–$40.00 | — |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 82274 Cl Stool For Occult Blood Poc | $45.00 | $45.00 | $11.00–$57.00 | — |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 82274 Cl Hemosure Stool For Occult Blood | $45.00 | $45.00 | $11.00–$57.00 | — |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 82274 Cl Stool For Occult Blood Poct | $45.00 | $45.00 | $11.00–$57.00 | — |
| Syphilis antibody test (Treponema pallidum) CPT 86780 86780 Lab Syphilis Igg Rps | $72.00 | $72.00 | $8.00–$91.00 | — |
| Syphilis antibody test (Treponema pallidum) CPT 86780 86780 Lab Syphilis Ab. | $72.00 | $72.00 | $8.00–$91.00 | — |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 86592 Lab Rapid Plasma Reagin | $46.00 | $46.00 | $3.00–$58.00 | — |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr Rps | $46.00 | $46.00 | $3.00–$58.00 | — |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Csf Rps | $46.00 | $46.00 | $3.00–$58.00 | — |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tb Interferon Ag Rps | $216.00 | $216.00 | $37.00–$272.00 | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Rps | $20.00 | $20.00 | $13.00–$25.00 | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Rps | $20.00 | $20.00 | $13.00–$25.00 | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 84403 Testosterone Total Rps Add On | $34.00 | $34.00 | $15.00–$43.00 | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 84403 Lab Testosterone Panel Rps Add-on Charge | $48.00 | $48.00 | $15.00–$60.00 | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Female Or Children Rps | $66.00 | $66.00 | $15.00–$83.00 | — |
| Thyroid peroxidase (TPO) antibody test CPT 86376 86376 Lab Liver-kidney Microsomal Ab, Igg Rps | $125.00 | $125.00 | $9.00–$158.00 | — |
| Thyroid peroxidase (TPO) antibody test CPT 86376 86376 Lab Thyroid Ab Panel Rps | $125.00 | $125.00 | $9.00–$158.00 | — |
| Thyroid peroxidase (TPO) antibody test CPT 86376 86376 Lab Thyroid Peroxidase Ab Rps | $125.00 | $125.00 | $9.00–$158.00 | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $130.00 | $130.00 | $10.00–$164.00 | — |
| Total IgE blood test CPT 82785 Allergen, Region 9 Respiratory Panel Rps | $49.00 | $49.00 | $10.00–$62.00 | — |
| Total IgE blood test CPT 82785 Food Allergens,adult Rps | $49.00 | $49.00 | $10.00–$62.00 | — |
| Total IgE blood test CPT 82785 Ige Rps | $109.00 | $109.00 | $10.00–$137.00 | — |
| Total cholesterol blood test CPT 82465 82465 Lab Cholesterol, Serum Or Wb, Total | $65.00 | $65.00 | $3.00–$82.00 | — |
| Total cholesterol blood test CPT 82465 82465 Lab Cholesterol Total | $65.00 | $65.00 | $3.00–$82.00 | — |
| Total cholesterol blood test CPT 82465 82465 Cholesterol Total Add On | $65.00 | $65.00 | $3.00–$82.00 | — |
| Total thyroxine (T4) blood test CPT 84436 T4 Rps | $67.00 | $67.00 | $4.00–$84.00 | — |
| Total triiodothyronine (T3) blood test CPT 84480 T3 Total Rps | $99.00 | $99.00 | $9.00–$125.00 | — |
| Transferrin blood test CPT 84466 84466 Lab Transferrin | $111.00 | $111.00 | $8.00–$140.00 | — |
| Triglycerides blood test CPT 84478 84478 Triglycerides Add On | $65.00 | $65.00 | $3.00–$82.00 | — |
| Triglycerides blood test CPT 84478 84478 Lab Triglycerides | $65.00 | $65.00 | $3.00–$82.00 | — |
| Triglycerides blood test CPT 84478 84478 Lab Triglycerides Fluid Rps | $65.00 | $65.00 | $3.00–$82.00 | — |
| Troponin test, quantitative CPT 84484 84484 Lab Troponin I | $194.00 | $194.00 | $7.00–$244.00 | — |
| Uric acid blood test CPT 84550 84550 Lab Uric Acid | $48.00 | $48.00 | $3.00–$60.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope | $63.00 | $63.00 | $2.00–$79.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis test using microscope | $43.00 | $43.00 | $3.00–$54.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis test | $42.00 | $42.00 | $1.00–$53.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis test | $32.00 | $32.00 | $2.00–$40.00 | — |
| Urine culture for bacteria, with colony count CPT 87086 87086 Lab Urine Culture | $88.00 | $88.00 | $5.00–$111.00 | — |
| Urine microalbumin (albumin) test CPT 82043 82043 Lab Urine Micro Albumin | $114.00 | $114.00 | $3.00–$144.00 | — |
| Urine pregnancy test, read by color change CPT 81025 81025 Cl Urine Pregnancy Test Poc | $94.00 | $94.00 | $6.00–$118.00 | — |
| Urine pregnancy test, read by color change CPT 81025 81025 Cl Urine Pregnancy Test Poct | $94.00 | $94.00 | $6.00–$118.00 | — |
| Urine pregnancy test, read by color change CPT 81025 81025 Lab Hcg Qualitative, Urine 2 | $94.00 | $94.00 | $6.00–$118.00 | — |
| Vitamin B12 (cobalamin) blood test CPT 82607 82607 Lab Vitamin B12 Level | $134.00 | $134.00 | $9.00–$169.00 | — |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 82306 Lab Vitamin D 25 Hydroxy Level | $175.00 | $175.00 | $18.00–$221.00 | — |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vit D 1 25 Dihydroxy Rps | $162.00 | $162.00 | $23.00–$204.00 | — |
| Zinc blood test CPT 84630 Zinc Rps | $107.00 | $107.00 | $7.00–$135.00 | — |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 84702 Lab Hcg Quantitative | $126.00 | $126.00 | $10.00–$159.00 | — |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg, Tumor Mark Rps | $126.00 | $126.00 | $10.00–$159.00 | — |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | Off list |
|---|---|---|---|---|
| Appendectomy, open surgery CPT 44950 44950 Cl Appendectomy | $1,265.00 | $1,265.00 | $570.00–$1,594.00 | — |
| Botox injections for chronic migraine CPT 64615 64615 Spc Chemodenervation Musc Migraine | $180.00 | $180.00 | $113.00–$227.00 | — |
| Botox injections for chronic migraine CPT 64615 64615 Cl Chemodenerv Musc Migraine | $300.00 | $300.00 | $135.00–$378.00 | — |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Ma Stereotactic Localization Right | $3,991.00 | $3,991.00 | $316.00–$5,029.00 | — |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Ma Stereotactic Localization Left | $3,991.00 | $3,991.00 | $316.00–$5,029.00 | — |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 Cl Clsd Tx Ankle Fracture W/o Manip | $658.00 | $658.00 | $295.00–$829.00 | — |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 Cl Clsd Tx Metatarsal Fracture W/o Manip | $457.00 | $457.00 | $205.00–$576.00 | — |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 Ed Cardioversion Electv, Electrical Conv Of Arrhythmia | $405.00 | $405.00 | $145.00–$510.00 | — |
| Cervical biopsy CPT 57500 57500 Spc Biopsy Of Cervix | $271.00 | $271.00 | $143.00–$341.00 | — |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Obstetric care, planned cesarean delivery | $11,356.00 | $11,356.00 | $2,318.00–$14,309.00 | — |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 Pf Circumcision, Using Clamp, W/ Reg Block | $307.00 | $307.00 | $78.00–$301.00 | — |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150circumcision, Using Clamp Or Other Device | $307.00 | $307.00 | $138.00–$387.00 | — |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 L Andd Circumcision, Using Clamp, Outside Of Nb Encounter | $350.00 | $350.00 | $138.00–$441.00 | — |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Spc Closed Tx Distal Radial Fx; W/o Manip | $440.00 | $440.00 | $277.00–$655.00 | — |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Cl Clsd Tx Distal Rad Fx, W/o Manip | $712.00 | $712.00 | $320.00–$897.00 | — |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 Ed Clsd Tx Distal Radial Fx W/o Manip | $900.00 | $900.00 | $320.00–$1,134.00 | — |
| Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope | $3,362.00 | $3,362.00 | $423.00–$4,236.00 | — |
| Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope | $3,404.00 | $3,404.00 | $387.00–$4,289.00 | — |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope | $3,006.00 | $3,006.00 | $158.00–$3,788.00 | — |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 Cl Colposcopy Cervix | $348.00 | $348.00 | $156.00–$438.00 | — |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 52000 Spc Cystourethroscopy | $300.00 | $300.00 | $155.00–$378.00 | — |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Spc Destr Premalignant Lesion, 1st | $82.00 | $82.00 | $52.00–$109.00 | — |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Cl Destroy Pre Malignant Lesion, 1st | $140.00 | $140.00 | $63.00–$176.00 | — |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Spc Tympanostomy Tube Insertion, Local Anes | $380.00 | $380.00 | $189.00–$479.00 | — |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Cl Ear Lavage/irrigation W/ Water Unilat | $32.00 | $32.00 | $14.00–$40.00 | — |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Spc Removal Impacted Cerumen W/ Irrigation, Unilateral | $40.00 | $40.00 | $14.00–$50.00 | — |
| Earwax removal by irrigation (rinsing), one ear one side CPT 69209 69209 Ed Removal Impacted Cerumen W/ Irrigation, Unilateral | $55.00 | $55.00 | $14.00–$69.00 | — |
| Earwax removal with instruments, one ear CPT 69210 69210 Cl Ear Lavage | $98.00 | $98.00 | $44.00–$123.00 | — |
| Earwax removal with instruments, one ear one side CPT 69210 69210 Spc Remvl Impacted Cerumen Req Instrument, Unilat | $50.00 | $50.00 | $32.00–$63.00 | — |
| Earwax removal with instruments, one ear one side CPT 69210 69210 Ed Remvl Impacted Cerumen Req Instrument, Unilat | $124.00 | $124.00 | $44.00–$156.00 | — |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Spc Endometrial Biopsy W/o Cerv Dilation | $90.00 | $90.00 | $57.00–$121.00 | — |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 Cl Endometrial Biopsy W/o Cerv Dilation | $210.00 | $210.00 | $94.00–$265.00 | — |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Crna- Epid, Cerv Or Thoracic W/ Image | $545.00 | $545.00 | $90.00–$534.00 | — |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Ct Spine C-t Epidural Steroid Injection | $1,550.00 | $1,550.00 | $211.00–$1,953.00 | — |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Xr Spine C-t Epidural Steroid Injection | $1,550.00 | $1,550.00 | $211.00–$1,953.00 | — |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 64493crna Inj, Pvf Jnt, Lumb Or Sac, W/ Image, Sing Lvl | $365.00 | $365.00 | $76.00–$358.00 | — |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Ct Spine Lumb Or Sac Facet Sngl Lvl | $2,067.00 | $2,067.00 | $164.00–$2,604.00 | — |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Xr Spine Lumb Or Sac Facet Sngl Lvl | $2,067.00 | $2,067.00 | $164.00–$2,604.00 | — |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 Pf Diag Sigmoidoscopy, Flex, W/ Spec Collect | $386.00 | $386.00 | $50.00–$378.00 | — |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 Or Minor Diag Sigmoidoscopy, Flex, W/ Spec Collect | $1,090.00 | $1,090.00 | $110.00–$1,373.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope | $9,919.00 | $9,919.00 | $586.00–$12,498.00 | — |
| Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Cl Hemorrhoid Banding | $587.00 | $587.00 | $264.00–$740.00 | — |
| Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Pf Hemorrhoidectomy, Internal Rubber Band Ligation | $587.00 | $587.00 | $181.00–$575.00 | — |
| Hemorrhoid banding (rubber band ligation) CPT 46221 46221 Or Minor Hemorrhoid Banding | $989.00 | $989.00 | $264.00–$1,246.00 | — |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Bchc Hsg | $260.00 | $260.00 | $112.00–$328.00 | — |
| IUD insertion (the device itself billed separately) CPT 58300 58300 Cl Iud, Insert Charge | $231.00 | $231.00 | $99.00–$291.00 | — |
| Incision and drainage of a simple or single skin abscess CPT 10060 10060 Spc Drainage Skin Abscess Simple | $110.00 | $110.00 | $69.00–$211.00 | — |
| Incision and drainage of a simple or single skin abscess CPT 10060 10060 Cl Drain Skin Abscess, Simple | $262.00 | $262.00 | $117.00–$330.00 | — |
| Incision and drainage of a simple or single skin abscess CPT 10060 10060 Ed I And D Of Skin Abscess, Simple | $385.00 | $385.00 | $117.00–$485.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older | $13,809.00 | $13,809.00 | $467.00–$17,399.00 | — |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Spc Inj Single Tendon Sheath/ligament | $85.00 | $85.00 | $54.00–$107.00 | — |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Pf Inj Single Tendon Sheath/ligament | $120.00 | $120.00 | $31.00–$118.00 | — |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 Cl Injection, Single Tendon/ligament | $120.00 | $120.00 | $54.00–$151.00 | — |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Bchc Tendon/sheath Ligament Injection | $141.00 | $141.00 | $54.00–$178.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 20610-50 Cl Arthrocentesis Maj Jnt (Shld/hip/knee) Bilateral | $266.00 | $266.00 | $59.00–$335.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Spc/wnd Arthrocentesis Major Joint,shoulder, Hip,knee | $90.00 | $90.00 | $57.00–$113.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Cl Arthrocentesis Maj Jnt (Shld/hip/knee) | $133.00 | $133.00 | $59.00–$168.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Ed Asp/inj Mjr Jnt/bursa | $133.00 | $133.00 | $36.00–$130.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Bchc Xr Aspiration Mj Joint | $217.00 | $217.00 | $59.00–$273.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Bchc Aspiration Mj Joint | $217.00 | $217.00 | $59.00–$273.00 | — |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Or Minor Arthrocentesis Maj Jnt/shld/hip/knee | $1,320.00 | $1,320.00 | $59.00–$1,663.00 | — |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Cl Insertion, Non-biodegradable Drug Delivery Implant | $206.00 | $206.00 | $92.00–$260.00 | — |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Spc Arthrocentesis Intermediate Joint Or Bursa | $55.00 | $55.00 | $35.00–$72.00 | — |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Cl Arthrocentesis Intmd Joint (Wr/elb/ankle) | $114.00 | $114.00 | $51.00–$144.00 | — |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Ed Arthrocentesis Intmd Joint/bursa | $125.00 | $125.00 | $51.00–$158.00 | — |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Spc Arthrocent/asp/inj Small Joint/bursa(finger/toes) | $50.00 | $50.00 | $32.00–$70.00 | — |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Cl Arthrocent/asp/inj Small Joint/bursa(finger/toes) | $110.00 | $110.00 | $49.00–$139.00 | — |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Pf Arthrocentesis Inj Small Joint, W/o Us | $110.00 | $110.00 | $29.00–$108.00 | — |
| Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope | $10,165.00 | $10,165.00 | $496.00–$12,808.00 | — |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Removal of recurring cataract in lens capsule using laser | $972.00 | $972.00 | $311.00–$1,225.00 | — |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Spc Repr Intmd Wounds Sc/ax/trnk/extrem <= 2.5cm | $300.00 | $300.00 | $189.00–$378.00 | — |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Ed Rpr Intm Wound Sc/neck/gent/extr; 2.5cm< | $547.00 | $547.00 | $124.00–$536.00 | — |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 Cl Rep Intmd Wounds Sc/ax/trnk/extr; <= 2.5cm | $547.00 | $547.00 | $245.00–$689.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance | $1,396.00 | $1,396.00 | $195.00–$1,759.00 | — |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection(s) of therapeutic substance | $287.00 | $287.00 | $129.00–$362.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance | $1,803.00 | $1,803.00 | $219.00–$2,272.00 | — |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 Cl Excision Ben Lesion, Trunk/arm/leg; <= 0.5 Cm | $266.00 | $266.00 | $119.00–$335.00 | — |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Spc Exc B9 Lesion Fc/er/eye/ns/lip; 0.5cm Or < | $232.00 | $232.00 | $134.00–$292.00 | — |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Cl Excision Ben Lesion, F/e/n/l/mm; <=0.5 Cm | $299.00 | $299.00 | $134.00–$377.00 | — |
| Nail removal (partial or complete), one nail CPT 11730 11730 Cl Avulsion Of Nail Plate, Part/comp, Simple; Single | $240.00 | $240.00 | $106.00–$302.00 | — |
| Nail removal (partial or complete), one nail CPT 11730 11730 Spc Avulsion Nail Plate, Simple | $272.00 | $272.00 | $106.00–$343.00 | — |
| Nail removal (partial or complete), one nail CPT 11730 11730 Ed Avulsion Nail Plate, Simple | $272.00 | $272.00 | $106.00–$343.00 | — |
| Occipital nerve block (injection for headaches) CPT 64405 64405crna Inj, Occipital Nerve, Ea Branch | $150.00 | $150.00 | $41.00–$147.00 | — |
| Occipital nerve block (injection for headaches) CPT 64405 64405 Cl Injection, Occipital Nerve, Ea Branch | $150.00 | $150.00 | $67.00–$189.00 | — |
| Paracentesis with imaging guidance CPT 49083 49083 Pf Paracentesis With Imaging | $615.00 | $615.00 | $584.00–$603.00 | — |
| Paracentesis with imaging guidance CPT 49083 49083 Us Guided Abd Paracentesis | $1,339.00 | $1,339.00 | $206.00–$1,687.00 | — |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Spc Exc Of Nail Bed, Part Or Compl | $205.00 | $205.00 | $129.00–$258.00 | — |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Cl Removal Of Nail Bed | $334.00 | $334.00 | $150.00–$421.00 | — |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Ed Exc Of Nail Bed, Part Or Compl | $380.00 | $380.00 | $150.00–$479.00 | — |
| Prostate biopsy CPT 55700 Biopsy of prostate gland | $835.00 | $835.00 | $224.00–$1,052.00 | — |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Xr Nerve Root Ablation Lumbar Or Sacral | $2,199.00 | $2,199.00 | $379.00–$2,771.00 | — |
| Removal of a breast lump, open surgery CPT 19120 Removal of one or more breast growth, open procedure | $1,044.00 | $1,044.00 | $469.00–$1,315.00 | — |
| Removal of a foreign object under the skin, simple CPT 10120 10120 Cl Remvl Fb, Subcutaneous Tissue, Simple | $313.00 | $313.00 | $140.00–$394.00 | — |
| Removal of a foreign object under the skin, simple CPT 10120 10120 Ed Remvl Fb, Subcutaneous Tiss, Simple | $375.00 | $375.00 | $140.00–$473.00 | — |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Pf Colonoscopy, Low Risk, Mdcr | $703.00 | $703.00 | $153.00–$689.00 | — |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 G0121 Or Minor Colonoscopy, Low Risk, Mdcr | $2,468.00 | $2,468.00 | $158.00–$3,110.00 | — |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Pf Colonoscopy, Hi Risk Screen, Mdcr | $703.00 | $703.00 | $153.00–$689.00 | — |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 G0105 Or Minor Colonoscopy, Hi Risk Screen, Mdcr | $2,303.00 | $2,303.00 | $158.00–$2,902.00 | — |
| Short arm cast (elbow to hand) CPT 29075 29075 Cl Appl Of Forearm Cast | $180.00 | $180.00 | $81.00–$227.00 | — |
| Short arm cast (elbow to hand) CPT 29075 29075 Ed Application Of Cast, Elbow To Finger (Short Arm) | $185.00 | $185.00 | $81.00–$233.00 | — |
| Short arm splint (forearm and hand) CPT 29125 29125 Cl Application Of Short Arm Splint; Static | $137.00 | $137.00 | $61.00–$173.00 | — |
| Short arm splint (forearm and hand) CPT 29125 29125 Ed Application Of Splint Short Arm; Static | $137.00 | $137.00 | $38.00–$134.00 | — |
| Short leg cast (below the knee) CPT 29405 29405 Cl Apply Short Leg Cast | $165.00 | $165.00 | $74.00–$208.00 | — |
| Short leg splint (calf to foot) CPT 29515 29515 Cl Applic Of Short Leg Splint (Calf To Foot) Charge | $148.00 | $148.00 | $66.00–$186.00 | — |
| Short leg splint (calf to foot) CPT 29515 29515 Ed Application Splint Calf To Foot (Short Leg) | $185.00 | $185.00 | $66.00–$233.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of shoulder bone using endoscope | $12,169.00 | $12,169.00 | $154.00–$15,333.00 | — |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Cl Repr Sf Wounds Sc/neck/gent/trnk/extr;<=2.5cm | $193.00 | $193.00 | $85.00–$243.00 | — |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 Ed Rpr Sf Wound Sc/neck/gent/etr; 2.5cm< | $232.00 | $232.00 | $85.00–$292.00 | — |
| Skin biopsy, punch, one lesion CPT 11104 11104 Spc/wnd Punch Bx Of Skin Sq, Single Lesion | $200.00 | $200.00 | $91.00–$252.00 | — |
| Skin biopsy, punch, one lesion CPT 11104 11104 Pf Punch Biopsy Skin W/ Simple Close, Single Lesion | $261.00 | $261.00 | $36.00–$256.00 | — |
| Skin biopsy, punch, one lesion CPT 11104 11104 Cl Punch Biopsy Skin Sq, Single Lesion | $261.00 | $261.00 | $91.00–$329.00 | — |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Spc Exc Malig Les Tr/arm/legs; 0.5cm Or < | $215.00 | $215.00 | $135.00–$271.00 | — |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 Cl Excision Mal Lesion, Trunk/arm/leg; <= 0.5 Cm | $410.00 | $410.00 | $184.00–$517.00 | — |
| Skin tag removal, up to 15 tags CPT 11200 11200 Spc Removal Skin Tags, Up To 15 | $103.00 | $103.00 | $65.00–$151.00 | — |
| Skin tag removal, up to 15 tags CPT 11200 11200 Cl Removal Of Skin Tags, <= 15 Lesions | $190.00 | $190.00 | $85.00–$239.00 | — |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 62270crna Spinal Punct Lumbar Diag | $280.00 | $280.00 | $52.00–$274.00 | — |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Bchc Xr Spinal Puncture | $530.00 | $530.00 | $119.00–$668.00 | — |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Cl Repr Sf Wounds Sc/neck/gent/trnk/extr; 2.6-7.5cm | $233.00 | $233.00 | $104.00–$294.00 | — |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Ed Rpr Sf Wound Sc/neck/gent/extr; 2.6-7.5cm | $283.00 | $283.00 | $104.00–$357.00 | — |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Cl Repr Sf Wounds Face/lid/ear/nose/lip/mmr; <=2.5cm | $231.00 | $231.00 | $103.00–$291.00 | — |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Ed Rpr Sf Wound Fac/lid/ear/nose/lip; 2.5cm< | $232.00 | $232.00 | $103.00–$292.00 | — |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Spc Tangenital Bx Skin, Single Lesion | $127.00 | $127.00 | $74.00–$160.00 | — |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Cl Tangential Bx Skin, Single Lesion | $211.00 | $211.00 | $74.00–$266.00 | — |
| Thoracentesis with imaging guidance CPT 32555 32555thoracentesis, W/ Imaging- Clinic | $659.00 | $659.00 | $212.00–$830.00 | — |
| Thoracentesis with imaging guidance CPT 32555 32555 Pf Thoracentesis, W/ Imaging | $659.00 | $659.00 | $88.00–$646.00 | — |
| Thoracentesis with imaging guidance CPT 32555 Us Guided Thoracentesis | $1,185.00 | $1,185.00 | $212.00–$1,493.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands, patient younger than age 12 | $4,065.00 | $4,065.00 | $271.00–$5,122.00 | — |
| Trigger point injections, 1 or 2 muscles CPT 20552 20552 Cl Inj Sing/multi Trigger Pt, 1 Or 2 Musc | $110.00 | $110.00 | $49.00–$139.00 | — |
| Trigger point injections, 1 or 2 muscles CPT 20552 20552 Ed Inj Trigger Pt 1-2 Musc | $110.00 | $110.00 | $33.00–$108.00 | — |
| Trigger point injections, 1 or 2 muscles CPT 20552 Bchc Ct Muscle Injection | $397.00 | $397.00 | $49.00–$500.00 | — |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Us Breast Biopsy Perc Ndl Core Lt | $2,487.00 | $2,487.00 | $298.00–$3,134.00 | — |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Us Breast Biopsy Perc Ndl Core Rt | $2,487.00 | $2,487.00 | $298.00–$3,134.00 | — |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 Or Minor Transoral Egd, Flex, W/ Balloon Dilation | $2,046.00 | $2,046.00 | $296.00–$2,578.00 | — |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 43249 Pf Transoral Egd, Flex, W/ Balloon Dilation | $2,254.00 | $2,254.00 | $127.00–$2,209.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope | $3,133.00 | $3,133.00 | $268.00–$3,948.00 | — |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 Pf Transoral Egd, Flex, W/ Snare Removal | $1,030.00 | $1,030.00 | $161.00–$1,009.00 | — |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 Or Minor Transoral Egd, Flex, W/ Snare Removal | $2,115.00 | $2,115.00 | $378.00–$2,665.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope | $2,127.00 | $2,127.00 | $237.00–$2,680.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Obstetric care, planned vaginal delivery | $4,714.00 | $4,714.00 | $2,117.00–$5,940.00 | — |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Spc Vasectomy, Unilateral Or Bilateral, W/ Postop Exam | $534.00 | $534.00 | $311.00–$673.00 | — |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Cl Vasectomy, Unilat Or Bilateral, W/ Post Op Exam | $693.00 | $693.00 | $311.00–$873.00 | — |
| Vein ablation, radiofrequency, first vein CPT 36475 Us Endovenous Ablation 1st Vein | $7,035.00 | $7,035.00 | $511.00–$8,864.00 | — |
| Wart removal, up to 14 warts CPT 17110 17110 Spc Destruct Benign Lesions 1-14 | $150.00 | $150.00 | $95.00–$189.00 | — |
| Wart removal, up to 14 warts CPT 17110 17110 Cl Destruct Benign Lesions 1-14 | $237.00 | $237.00 | $106.00–$299.00 | — |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Spc/wc Debridement Subq, 1st 20sq Cm Or < | $155.00 | $155.00 | $98.00–$195.00 | — |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Pf Debridement, Subq; 1st 20sq Cm Or < | $267.00 | $267.00 | $52.00–$262.00 | — |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Cl Debridement, Subq; 1st 20sq Cm Or < | $267.00 | $267.00 | $118.00–$336.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | Off list |
|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 36430 Blood Admin Hours 1-4 | $1,020.00 | $1,020.00 | $36.00–$1,285.00 | — |
| Blood transfusion (giving blood or blood components) CPT 36430 36430 Blood Administration Hours 5-8 | $1,180.00 | $1,180.00 | $36.00–$1,487.00 | — |
| Blood transfusion (giving blood or blood components) CPT 36430 36430 Blood Administration Hours >8 | $1,490.00 | $1,490.00 | $36.00–$1,877.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 Cl Press Or Non-pres Inhalation Tx (Nebulizer) | $33.00 | $33.00 | $8.00–$42.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Ezpap Subsequent | $201.00 | $201.00 | $8.00–$253.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Pep Therapy Subsequent | $201.00 | $201.00 | $8.00–$253.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Mini-neb Subsequent | $201.00 | $201.00 | $8.00–$253.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Meter Dose Inhaler (Mdi) Subsequent | $201.00 | $201.00 | $8.00–$253.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Ezpap Initial | $251.00 | $251.00 | $8.00–$316.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Meter Dose Inhaler (Mdi) Initial | $251.00 | $251.00 | $8.00–$316.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Mini-neb Initial | $251.00 | $251.00 | $8.00–$316.00 | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction one side CPT 94640 94640 Rt Pep Therapy Initial | $251.00 | $251.00 | $8.00–$316.00 | — |
| Chemotherapy IV infusion, first hour CPT 96413 96413 Tx Chemo Iv < 1 Hr, Single/1st Drug | $700.00 | $700.00 | $118.00–$882.00 | — |
| Critical care, first 30 to 74 minutes CPT 99291 99291 Pf Ed Critical Care, 1st Hour | $567.00 | $567.00 | $187.00–$556.00 | — |
| Critical care, first 30 to 74 minutes CPT 99291 99291 Facil Ed Critical Care, 1st Hour | $1,940.00 | $1,940.00 | $240.00–$2,444.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine, with interpretation and report | $421.00 | $421.00 | $13.00–$530.00 | — |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 Cl Ekg 12 Lead W/o Interp/rpt | $19.00 | $19.00 | $6.00–$24.00 | — |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 Ekg 12 Lead W/o Interp/rpt | $315.00 | $315.00 | $6.00–$397.00 | — |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Facil Ed Visit, Lvl 1, No Phys Req | $220.00 | $220.00 | $10.00–$277.00 | — |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Facil Ed Visit, Lvl 2, Sf Dec Making | $400.00 | $400.00 | $37.00–$504.00 | — |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Facil Ed Visit, Lvl 3 Low Dec Making | $610.00 | $610.00 | $63.00–$769.00 | — |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Facil Ed Visit, Lvl 4 Moderate Dec Making | $940.00 | $940.00 | $106.00–$1,184.00 | — |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Facil Ed Visit, Lvl 5, High Dec Making | $1,480.00 | $1,480.00 | $154.00–$1,865.00 | — |
| Exercise stress test, tracing only, the hospital charge CPT 93017 93017 Cc Exercise Stress Test | $1,155.00 | $1,155.00 | $33.00–$1,455.00 | — |
| Family therapy with the patient, 50 minutes CPT 90847 Family psychotherapy, including patient, 50 min | $800.00 | $800.00 | $101.00–$1,008.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 Family psychotherapy, not including patient, 50 min | $755.00 | $755.00 | $97.00–$951.00 | — |
| Group psychotherapy session CPT 90853 Group psychotherapy | $845.00 | $845.00 | $27.00–$1,065.00 | — |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Tx Iv Hydrat Tr < 1 Hr | $430.00 | $430.00 | $30.00–$542.00 | — |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Ed/obs/op Hydration, First Hour | $430.00 | $430.00 | $30.00–$542.00 | — |
| IV infusion of a medicine, first hour CPT 96365 96365 Cl Infusion Therapy, 1st Hour | $137.00 | $137.00 | $59.00–$173.00 | — |
| IV infusion of a medicine, first hour CPT 96365 96365 Ed/obs/op Iv Infusion Therapy, 1st Hour | $460.00 | $460.00 | $59.00–$580.00 | — |
| IV infusion of a medicine, first hour CPT 96365 96365 Tx Iv Inf And Dx < 1hr | $460.00 | $460.00 | $59.00–$580.00 | — |
| IV push of a medicine, first drug CPT 96374 96374 Cl Iv Push, Single Or Initial | $79.00 | $79.00 | $34.00–$100.00 | — |
| IV push of a medicine, first drug CPT 96374 96374 Tx Iv Push Initia | $270.00 | $270.00 | $34.00–$340.00 | — |
| IV push of a medicine, first drug CPT 96374 96374 Ed/tx/obs Iv Push, Single Or Initial | $270.00 | $270.00 | $34.00–$340.00 | — |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Cl Injection Admin, Sq Or Im | $30.00 | $30.00 | $13.00–$38.00 | — |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Cl Pt Own Med, Admin Only | $30.00 | $30.00 | $13.00–$38.00 | — |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Ed/tx/obs/spc Injection Admin, Sq Or Im | $160.00 | $160.00 | $13.00–$202.00 | — |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Tx Thera/dx Inject | $160.00 | $160.00 | $13.00–$202.00 | — |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Psych Pf Diag Eval | $355.00 | $355.00 | $136.00–$348.00 | — |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 Bh Psychiatric Pre-tx Assessment | $355.00 | $355.00 | $176.00–$447.00 | — |
| Neuromuscular re-education, 15 minutes CPT 97112 97112 Ot Neuromuscular Reeducation Charges | $110.00 | $110.00 | $29.00–$139.00 | — |
| Neuromuscular re-education, 15 minutes CPT 97112 97112 Pt Neuromuscular Reeducation Charges | $110.00 | $110.00 | $29.00–$139.00 | — |
| Neuromuscular re-education, 15 minutes CPT 97112 97112 Pt Neuro Reeducation/15 Min | $110.00 | $110.00 | $29.00–$139.00 | — |
| Neuromuscular re-education, 15 minutes CPT 97112 97112 Ot- Neuromuscular Reeducation Charges | $110.00 | $110.00 | $29.00–$139.00 | — |
| Neuromuscular re-education, 15 minutes CPT 97112 97112 Pt- Neuromuscular Reeducation Charges | $110.00 | $110.00 | $29.00–$139.00 | — |
| Neuromuscular re-education, 15 minutes CPT 97112 97112 Ot Neuro Reeducation/15 Min | $110.00 | $110.00 | $29.00–$139.00 | — |
| New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min | $231.00 | $231.00 | $98.00–$291.00 | — |
| New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min | $345.00 | $345.00 | $146.00–$435.00 | — |
| New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min | $455.00 | $455.00 | $193.00–$573.00 | — |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Wnd New Patient Office Visit Level 2 | $81.00 | $81.00 | $51.00–$102.00 | — |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Pf New Patient Office Visit Level 2 | $150.00 | $150.00 | $39.00–$147.00 | — |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Cl New Patient Office Visit Level 2 | $150.00 | $150.00 | $63.00–$189.00 | — |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 De Med Nutrition Therapy / Int Charge Per 15m | $35.00 | $35.00 | $22.00–$63.00 | — |
| Occupational therapy evaluation, low complexity CPT 97165 97165 Ot Evaluation Low Complex Units | $180.00 | $180.00 | $87.00–$227.00 | — |
| Occupational therapy evaluation, low complexity CPT 97165 97165 Ot Evaluation Low Complexity | $180.00 | $180.00 | $87.00–$227.00 | — |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 97163 Pt Evaluation High Complex Units | $265.00 | $265.00 | $86.00–$334.00 | — |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 97163 Pt Evaluation High Complexity | $265.00 | $265.00 | $86.00–$334.00 | — |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 97161 Pt Evaluation Low Complexity | $170.00 | $170.00 | $86.00–$214.00 | — |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 97161 Pt Eval Low Complexity Units | $170.00 | $170.00 | $86.00–$214.00 | — |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 97162 Pt Evaluation Moderate Complexity | $201.00 | $201.00 | $86.00–$253.00 | — |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 97162 Pt Evaluation Moderate Complex Units | $201.00 | $201.00 | $86.00–$253.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Ot Manual Traction/ 15 Min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Pt Manual Therapy/ 15 Min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Pt Manual Therapy/15 Min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Pt Manual Traction/ 15 Min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Pt Myofacial Release/15 Min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Ot Manual Therapy/ 15 Min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 Ot Manual Therapy/15min | $110.00 | $110.00 | $23.00–$139.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise | $105.00 | $105.00 | $25.00–$132.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years) | $270.00 | $270.00 | $122.00–$340.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventative medicine evaluation (40-64 years) | $311.00 | $311.00 | $140.00–$392.00 | — |
| Preventive checkup, new patient aged 65 or older CPT 99387 99387 Cl Preventive Medicine 65+ Years New Pat | $338.00 | $338.00 | $152.00–$426.00 | — |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Self Pay Cl Class 3 Flight Physical Charge | $134.00 | $134.00 | $84.00–$171.00 | — |
| Preventive checkup, returning patient aged 18–39 CPT 99395 99395 Cl Preventive Medicine 18-39 Years Established Pat | $243.00 | $243.00 | $110.00–$306.00 | — |
| Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Cl Preventive Medicine 40-64 Years Established Pat | $258.00 | $258.00 | $116.00–$325.00 | — |
| Preventive checkup, returning patient aged 65 or older CPT 99397 99397 Cl Preventive Medicine 65+ Years Established Pat | $279.00 | $279.00 | $125.00–$352.00 | — |
| Psychotherapy for crisis, first 60 minutes CPT 90839 90839 Bh Crisis Psychotherapy (Ind Or Fam), 1st 60m | $285.00 | $285.00 | $142.00–$359.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 min | $535.00 | $535.00 | $76.00–$674.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 min | $700.00 | $700.00 | $100.00–$882.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 min | $855.00 | $855.00 | $148.00–$1,077.00 | — |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 Cr Smoking Cessation,10 Min Charge | $35.00 | $35.00 | $14.00–$44.00 | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Wnd E2 Wound Clinic Charge | $100.00 | $100.00 | $50.00–$126.00 | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Cc E2 Cardiology Clinic | $100.00 | $100.00 | $50.00–$126.00 | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Or E2 Surgical Clinic Charge | $100.00 | $100.00 | $50.00–$126.00 | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Spc E2 Specialty Clinic Visit | $100.00 | $100.00 | $50.00–$126.00 | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Pf Est Patient Office Visit Level 2 | $117.00 | $117.00 | $50.00–$147.00 | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Tx Nursing Level 2 Charge | $135.00 | $135.00 | $50.00–$170.00 | — |
| Speech and language evaluation CPT 92523 92523 St Speech Sound Prod W/ Language Charge | $386.00 | $386.00 | $221.00–$486.00 | — |
| Speech and language evaluation CPT 92523 92523 St Speech Sound Prod W/ Language | $386.00 | $386.00 | $221.00–$486.00 | — |
| Speech therapy session, individual CPT 92507 92507 St Tx Of Speech/lang/voice/comm/auditory Chg | $309.00 | $309.00 | $74.00–$389.00 | — |
| Speech therapy session, individual CPT 92507 92507 St Tx Spch/lang/voice/comm/auditory | $309.00 | $309.00 | $74.00–$389.00 | — |
| Spirometry (breathing test) one side CPT 94010 94010 Rt Spirometry Charge | $330.00 | $330.00 | $16.00–$416.00 | — |
| Spirometry before and after a bronchodilator one side CPT 94060 94060 Rt Pre And Post Spirometry | $700.00 | $700.00 | $26.00–$882.00 | — |
| Therapeutic activities (functional training), 15 minutes CPT 97530 97530 Pt- Ther Act/15 Min | $105.00 | $105.00 | $31.00–$132.00 | — |
| Therapeutic activities (functional training), 15 minutes CPT 97530 97530 Pt Therapeutic Activities/ 15 Min | $105.00 | $105.00 | $31.00–$132.00 | — |
| Therapeutic activities (functional training), 15 minutes CPT 97530 97530 Ot Therapeutic Activities/ 15 Min | $105.00 | $105.00 | $31.00–$132.00 | — |
| Therapeutic activities (functional training), 15 minutes CPT 97530 97530 Ot- Ther Act/15 Min | $105.00 | $105.00 | $31.00–$132.00 | — |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy | $200.00 | $200.00 | $88.00–$252.00 | — |
Vaccines
| Procedure | Cash price | List price | Insurers pay | Off list |
|---|---|---|---|---|
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Cl Immunization Admin, 1 Vaccine | $41.00 | $41.00 | $9.00–$52.00 | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 Tx Tetanus Administration | $80.00 | $80.00 | $9.00–$101.00 | — |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Cl Im Admin; Ea Addl Vaccine | $30.00 | $30.00 | $4.00–$38.00 | — |