Hospital Wahpeton, ND-MN

St. Francis Medical Center

St. Francis Medical Center in Breckenridge, MN publishes cash prices for 269 common procedures listed here, from its own machine-readable price file updated Feb 28, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Minnesota median for 194 of 263 procedures and above it for 67. By typical cash price it ranks #13 of 79 Minnesota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

2400 ST. FRANCIS DR, Breckenridge, MN 56520 Collected Sep 27, 2026 Source price file (218) 643-3000

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 241377 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGUS	$467.40	$779.00	$327.18–$740.05	60% above	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGUS	$467.40	$779.00	$179.17–$740.05	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN WHOLE BODY	$1,336.20	$2,227.00	$935.34–$2,115.65	9% above	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE SCAN WHOLE BODY	$1,336.20	$2,227.00	$512.21–$2,115.65	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 ANG CHEST	$2,076.00	$3,460.00	$454.64–$3,287.00	25% above	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 ANG CHEST	$2,076.00	$3,460.00	$795.80–$3,287.00	—	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 ABDOMEN PELVIS WO CONT	$1,762.20	$2,937.00	$588.45–$2,790.15	8% below	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 ABDOMEN PELVIS WO CONT	$1,762.20	$2,937.00	$675.51–$2,790.15	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 ABDOMEN PELVIS W CONT	$2,553.60	$4,256.00	$618.69–$4,043.20	4% above	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 ABDOMEN PELVIS W CONT	$2,553.60	$4,256.00	$978.88–$4,043.20	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 ABDOMEN PELVIS W WO CONT	$2,860.20	$4,767.00	$618.69–$4,528.65	11% above	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 ABDOMEN PELVIS W WO CONT	$2,860.20	$4,767.00	$1,096.41–$4,528.65	—	40%
CT scan of the abdomen with contrast CPT 74160 ABDOMEN W CONT	$1,515.60	$2,526.00	$454.64–$2,399.70	4% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 ABDOMEN W CONT	$1,515.60	$2,526.00	$580.98–$2,399.70	—	40%
CT scan of the abdomen without contrast CPT 74150 ABDOMEN WO CONT	$988.80	$1,648.00	$358.90–$1,565.60	16% below	40%
CT scan of the abdomen without contrast inpatient CPT 74150 ABDOMEN WO CONT	$988.80	$1,648.00	$379.04–$1,565.60	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 MAX FACIAL SINUS WO CONT	$1,186.80	$1,978.00	$358.90–$1,879.10	5% below	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 MAX FACIAL SINUS WO CONT	$1,186.80	$1,978.00	$454.94–$1,879.10	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 HEAD WO CONT	$823.80	$1,373.00	$478.71–$1,304.35	35% below	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HEAD WO CONT	$823.80	$1,373.00	$315.79–$1,304.35	—	40%
CT scan of the head with contrast CPT 70460 HEAD W CONT	$1,203.00	$2,005.00	$454.64–$1,904.75	7% below	40%
CT scan of the head with contrast inpatient CPT 70460 HEAD W CONT	$1,203.00	$2,005.00	$461.15–$1,904.75	—	40%
CT scan of the head without and with contrast CPT 70470 HEAD W WO CONT	$1,441.80	$2,403.00	$454.64–$2,282.85	9% below	40%
CT scan of the head without and with contrast inpatient CPT 70470 HEAD W WO CONT	$1,441.80	$2,403.00	$552.69–$2,282.85	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 LUMBAR SPINE WO CONT	$1,449.60	$2,416.00	$358.90–$2,295.20	6% above	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 LUMBAR SPINE WO CONT	$1,449.60	$2,416.00	$555.68–$2,295.20	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CERVICAL SPINE WO CONT	$1,449.60	$2,416.00	$358.90–$2,295.20	7% above	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CERVICAL SPINE WO CONT	$1,449.60	$2,416.00	$555.68–$2,295.20	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 PELVIS W CONT	$1,636.80	$2,728.00	$454.64–$2,591.60	11% above	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 PELVIS W CONT	$1,636.80	$2,728.00	$627.44–$2,591.60	—	40%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID ARTERY W/DOP	$969.60	$1,616.00	$678.72–$1,535.20	17% above	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 CAROTID ARTERY W/DOP	$969.60	$1,616.00	$371.68–$1,535.20	—	40%
Chest X-ray, 2 views CPT 71046 CHEST 2V	$282.60	$471.00	$120.38–$447.45	22% above	40%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2V	$282.60	$471.00	$108.33–$447.45	—	40%
Chest X-ray, single view CPT 71045 CHEST SPECIAL 1V PF	$44.86	$74.76	$31.40–$71.03	75% below	40%
Chest X-ray, single view CPT 71045 CHEST 1V FRONTAL	$212.40	$354.00	$148.68–$336.30	20% above	40%
Chest X-ray, single view inpatient CPT 71045 CHEST SPECIAL 1V PF	$44.86	$74.76	$17.20–$71.03	—	40%
Chest X-ray, single view inpatient CPT 71045 CHEST 1V FRONTAL	$212.40	$354.00	$81.42–$336.30	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 AORTA COMP DUPLEX	$527.40	$879.00	$369.18–$835.05	1% above	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 AORTA COMP DUPLEX	$527.40	$879.00	$202.17–$835.05	—	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY BODY	$337.80	$563.00	$236.46–$534.85	8% above	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITY BODY	$337.80	$563.00	$129.49–$534.85	—	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA BONE DENSITY PERIPHERAL**	$131.40	$219.00	$91.98–$208.05	32% below	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA BONE DENSITY PERIPHERAL**	$131.40	$219.00	$50.37–$208.05	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CHEST WO CONT	$1,393.80	$2,323.00	$358.90–$2,206.85	11% above	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CHEST WO CONT	$1,393.80	$2,323.00	$534.29–$2,206.85	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CHEST W CONT	$1,533.60	$2,556.00	$454.64–$2,428.20	3% above	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CHEST W CONT	$1,533.60	$2,556.00	$587.88–$2,428.20	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMO DIGITAL BI	$375.60	$626.00	$262.92–$594.70	—	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMO DIGITAL BI	$375.60	$626.00	$143.98–$594.70	—	40%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DPLX SCAN LWR EXT ART COMP BI	$758.40	$1,264.00	$530.88–$1,200.80	—	40%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DPLX SCAN LWR EXT ART COMP BI	$758.40	$1,264.00	$290.72–$1,200.80	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 EXT DOP VEIN BILAT	$1,264.20	$2,107.00	$884.94–$2,001.65	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 EXT DOP VEIN BILAT	$1,264.20	$2,107.00	$484.61–$2,001.65	—	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO COMP WO CONT	$1,055.40	$1,759.00	$738.78–$1,730.09	16% below	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO COMP WO CONT	$1,055.40	$1,759.00	$404.57–$1,671.05	—	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 CHOLESCINTIGRAPHY	$2,314.20	$3,857.00	$1,619.94–$3,664.15	72% above	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 CHOLESCINTIGRAPHY	$2,314.20	$3,857.00	$887.11–$3,664.15	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSMG SLEEP 4+ PARAM SLEEP PROF	$1,573.20	$2,622.00	$1,101.24–$2,490.90	55% below	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY W CPAP LTD	$1,732.80	$2,888.00	$1,212.96–$2,743.60	50% below	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY	$1,839.00	$3,065.00	$1,287.30–$2,911.75	47% below	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 FULL POLYSOMNOGRAPHY W/CP	$2,043.60	$3,406.00	$1,430.52–$3,235.70	41% below	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSMG SLEEP 4+ PARAM SLEEP PROF	$1,573.20	$2,622.00	$603.06–$2,490.90	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY W CPAP LTD	$1,732.80	$2,888.00	$664.24–$2,743.60	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY	$1,839.00	$3,065.00	$704.95–$2,911.75	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 FULL POLYSOMNOGRAPHY W/CP	$2,043.60	$3,406.00	$783.38–$3,235.70	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 SOFT TISSUE LOWER BACK	$269.40	$449.00	$188.58–$426.55	36% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN LTD	$379.80	$633.00	$265.86–$601.35	9% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 SOFT TISSUE LOWER BACK	$269.40	$449.00	$103.27–$426.55	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ABDOMEN LTD	$379.80	$633.00	$145.59–$601.35	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LUNG SCREEN PROTOCOL	$669.00	$1,115.00	$468.30–$1,059.25	16% above	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LUNG SCREEN PROTOCOL	$669.00	$1,115.00	$256.45–$1,059.25	—	40%
MRI of the abdomen without contrast CPT 74181 ABDOMEN WO CONT	$1,809.60	$3,016.00	$588.45–$2,865.20	17% below	40%
MRI of the abdomen without contrast inpatient CPT 74181 ABDOMEN WO CONT	$1,809.60	$3,016.00	$693.68–$2,865.20	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 ABDOMEN W WO CONT	$2,827.20	$4,712.00	$618.69–$4,476.40	4% below	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 ABDOMEN W WO CONT	$2,827.20	$4,712.00	$1,083.76–$4,476.40	—	40%
MRI of the brain, no contrast dye CPT 70551 BRAIN WO CONT	$2,080.20	$3,467.00	$588.45–$3,293.65	2% above	40%
MRI of the brain, no contrast dye inpatient CPT 70551 BRAIN WO CONT	$2,080.20	$3,467.00	$797.41–$3,293.65	—	40%
MRI of the brain, with and without contrast dye CPT 70553 BRAIN W WO CONT	$3,466.20	$5,777.00	$618.69–$5,488.15	28% above	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 BRAIN W WO CONT	$3,466.20	$5,777.00	$1,328.71–$5,488.15	—	40%
MRI of the lower back, no contrast dye CPT 72148 LUMBAR SPINE COMP WO CONT	$2,253.60	$3,756.00	$588.45–$3,568.20	8% above	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 LUMBAR SPINE COMP WO CONT	$2,253.60	$3,756.00	$863.88–$3,568.20	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 LUMBAR SPINE COMP W WO CONT	$3,515.40	$5,859.00	$618.69–$5,566.05	37% above	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 LUMBAR SPINE COMP W WO CONT	$3,515.40	$5,859.00	$1,347.57–$5,566.05	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 THORACIC SPINE COMP WO CONT	$2,076.00	$3,460.00	$588.45–$3,287.00	2% below	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 THORACIC SPINE COMP WO CONT	$2,076.00	$3,460.00	$795.80–$3,287.00	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 CERVICAL SPINE COMP W WO CONT	$3,532.80	$5,888.00	$618.69–$5,593.60	41% above	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 CERVICAL SPINE COMP W WO CONT	$3,532.80	$5,888.00	$1,354.24–$5,593.60	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 CERVICAL SPINE COMP WO CONT	$2,180.40	$3,634.00	$588.45–$3,452.30	3% above	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 CERVICAL SPINE COMP WO CONT	$2,180.40	$3,634.00	$835.82–$3,452.30	—	40%
MRI of the pelvis without and with contrast CPT 72197 PELVIS W WO CONT	$3,501.60	$5,836.00	$618.69–$5,544.20	32% above	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 PELVIS W WO CONT	$3,501.60	$5,836.00	$1,342.28–$5,544.20	—	40%
MRI of the pelvis, no contrast dye CPT 72195 PELVIS WO CONT	$2,101.20	$3,502.00	$588.45–$3,326.90	1% below	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 PELVIS WO CONT	$2,101.20	$3,502.00	$805.46–$3,326.90	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PELVIS NON OB LTD	$165.60	$276.00	$115.92–$262.20	46% below	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 PELVIS NON OB LTD	$165.60	$276.00	$63.48–$262.20	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS NON OB COMP	$517.20	$862.00	$362.04–$818.90	10% above	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 PELVIS NON OB COMP	$517.20	$862.00	$198.26–$818.90	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB 2 OR 3 TRI SGL 1ST GEST	$504.60	$841.00	$353.22–$798.95	6% above	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB 2 OR 3 TRI SGL 1ST GEST	$504.60	$841.00	$193.43–$798.95	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB 1ST TRI SGL 1ST GEST	$399.60	$666.00	$279.72–$632.70	4% below	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB 1ST TRI SGL 1ST GEST	$399.60	$666.00	$153.18–$632.70	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 AMNIO FLUID INDEX	$256.20	$427.00	$179.34–$405.65	20% below	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 AMNIO FLUID INDEX	$256.20	$427.00	$98.21–$405.65	—	40%
Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMO DIGITAL BI	$316.20	$527.00	$91.61–$500.65	—	40%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMO DIGITAL BI	$316.20	$527.00	$121.21–$500.65	—	40%
Sleep study in a lab (polysomnography) CPT 95810 PSMG SLP STAGE 4+ PARAM W/T PR	$1,521.60	$2,536.00	$1,065.12–$2,409.20	51% below	40%
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY W MIN 4 PARAMETERS	$1,664.40	$2,774.00	$1,165.08–$2,635.30	46% below	40%
Sleep study in a lab (polysomnography) CPT 95810 FULL POLYSOMNOGRAPHY	$1,907.40	$3,179.00	$1,335.18–$3,020.05	38% below	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSMG SLP STAGE 4+ PARAM W/T PR	$1,521.60	$2,536.00	$583.28–$2,409.20	—	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STUDY W MIN 4 PARAMETERS	$1,664.40	$2,774.00	$638.02–$2,635.30	—	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 FULL POLYSOMNOGRAPHY	$1,907.40	$3,179.00	$731.17–$3,020.05	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 SWALLOWING FUNCTION W VIDEO	$712.20	$1,187.00	$498.54–$1,127.65	140% above	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 SWALLOWING FUNCTION W VIDEO	$712.20	$1,187.00	$273.01–$1,127.65	—	40%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL NON OB	$439.80	$733.00	$307.86–$696.35	13% above	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL NON OB	$439.80	$733.00	$168.59–$696.35	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 OB TRANSVAGINAL	$334.20	$557.00	$233.94–$529.15	at median	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB TRANSVAGINAL	$334.20	$557.00	$128.11–$529.15	—	40%
Ultrasound of the abdomen, complete CPT 76700 ABDOMEN COMP	$535.20	$892.00	$374.64–$847.40	9% below	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMEN COMP	$535.20	$892.00	$205.16–$847.40	—	40%
Ultrasound of the scrotum and testicles CPT 76870 SCROTUM AND CONTENTS	$436.80	$728.00	$305.76–$691.60	5% below	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 SCROTUM AND CONTENTS	$436.80	$728.00	$167.44–$691.60	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HEAD NECK SOFT TISSUE	$421.20	$702.00	$294.84–$666.90	8% below	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HEAD NECK SOFT TISSUE	$421.20	$702.00	$161.46–$666.90	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI	$655.20	$1,092.00	$458.64–$1,037.40	104% above	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI	$655.20	$1,092.00	$251.16–$1,037.40	—	40%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1V DECUBITIS	$194.40	$324.00	$136.08–$307.80	8% below	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1V DECUBITIS	$194.40	$324.00	$74.52–$307.80	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2 OR 3V	$250.20	$417.00	$175.14–$396.15	5% below	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2 OR 3V	$250.20	$417.00	$95.91–$396.15	—	40%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE MIN 4V	$347.40	$579.00	$243.18–$550.05	1% above	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE MIN 4V	$347.40	$579.00	$133.17–$550.05	—	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC SPINE 2V	$222.60	$371.00	$155.82–$352.45	10% below	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC SPINE 2V	$222.60	$371.00	$85.33–$352.45	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE MIN 3V	$330.00	$550.00	$231.00–$522.50	51% above	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE MIN 3V	$330.00	$550.00	$126.50–$522.50	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2V OR 3V	$250.20	$417.00	$175.14–$396.15	1% above	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2V OR 3V	$250.20	$417.00	$95.91–$396.15	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1V OR 2V	$168.00	$280.00	$117.60–$266.00	16% below	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1V OR 2V	$168.00	$280.00	$64.40–$266.00	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM COCCYX MIN 2V	$211.20	$352.00	$147.84–$334.40	7% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM COCCYX MIN 2V	$211.20	$352.00	$80.96–$334.40	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT	$45.60	$76.00	$5.30–$72.20	1% above	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT	$45.60	$76.00	$17.48–$72.20	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$34.80	$58.00	$5.18–$55.10	22% below	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$34.80	$58.00	$13.34–$55.10	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS ACUTE W HCV NAA RFL	$85.74	$142.89	$47.63–$135.75	63% below	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE REFLEX	$303.00	$505.00	$47.63–$479.75	30% above	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS ACUTE W HCV NAA RFL	$85.74	$142.89	$32.87–$135.75	—	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL ACUTE REFLEX	$303.00	$505.00	$116.15–$479.75	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN HORMODENDRUM	$9.40	$15.66	$5.22–$14.88	38% below	40%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGENS GRASS PROFILE 9	$34.80	$58.00	$5.22–$55.10	129% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN D. PTERONYSSINUS	$40.20	$67.00	$5.22–$63.65	164% above	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN HORMODENDRUM	$9.40	$15.66	$3.61–$14.88	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGENS GRASS PROFILE 9	$34.80	$58.00	$13.34–$55.10	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN D. PTERONYSSINUS	$40.20	$67.00	$15.41–$63.65	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINAT PEPTIDEIGG	$23.31	$38.85	$12.95–$36.91	44% below	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CTD CCP	$82.20	$137.00	$12.95–$130.15	97% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINAT PEPTIDEIGG	$23.31	$38.85	$8.94–$36.91	—	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CTD CCP	$82.20	$137.00	$31.51–$130.15	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANAIGG ELISA RFLX ANAIGG IFA	$21.77	$36.27	$12.09–$34.46	52% below	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN & TITER END (REF)	$75.60	$126.00	$12.09–$119.70	68% above	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANAIGG ELISA RFLX ANAIGG IFA	$21.77	$36.27	$8.35–$34.46	—	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA SCREEN & TITER END (REF)	$75.60	$126.00	$28.98–$119.70	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$241.80	$403.00	$39.26–$382.85	80% above	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP	$241.80	$403.00	$92.69–$382.85	—	40%
Basic metabolic panel (blood test) CPT 80048 BMP	$65.40	$109.00	$8.46–$117.58	27% below	40%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP	$65.40	$109.00	$25.07–$103.55	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$92.94	$154.89	$65.06–$162.37	11% below	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 BONE MARROW EVALUATION	$123.00	$205.00	$81.19–$194.75	18% above	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH GROSS/MICRO L4	$205.20	$342.00	$81.19–$324.90	96% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST	$92.94	$154.89	$35.63–$147.15	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 BONE MARROW EVALUATION	$123.00	$205.00	$47.15–$194.75	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURG PATH GROSS/MICRO L4	$205.20	$342.00	$78.66–$324.90	—	40%
Blood culture for bacteria CPT 87040 CULT BLOOD AEROBIC	$100.20	$167.00	$10.32–$158.65	9% below	40%
Blood culture for bacteria inpatient CPT 87040 CULT BLOOD AEROBIC	$100.20	$167.00	$38.41–$158.65	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$32.40	$54.00	$8.83–$51.30	56% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$32.40	$54.00	$12.42–$51.30	—	40%
Blood glucose (sugar) test CPT 82947 GLUCOMETER NOVA	$49.20	$82.00	$3.93–$77.90	11% above	40%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$65.40	$109.00	$3.93–$103.55	47% above	40%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOMETER NOVA	$49.20	$82.00	$18.86–$77.90	—	40%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$65.40	$109.00	$25.07–$103.55	—	40%
Blood lead test CPT 83655 LEAD BLOOD (VENOUS)	$21.80	$36.33	$12.11–$34.52	30% below	40%
Blood lead test CPT 83655 LEAD URINE	$75.60	$126.00	$12.11–$119.70	142% above	40%
Blood lead test inpatient CPT 83655 LEAD BLOOD (VENOUS)	$21.80	$36.33	$8.36–$34.52	—	40%
Blood lead test inpatient CPT 83655 LEAD URINE	$75.60	$126.00	$28.98–$119.70	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL. SERUM	$48.60	$81.00	$7.52–$76.95	30% below	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL. SERUM	$48.60	$81.00	$18.63–$76.95	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO	$31.20	$52.00	$2.99–$49.40	41% below	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO	$31.20	$52.00	$11.96–$49.40	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$9.33	$15.54	$5.18–$14.77	83% below	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP	$79.20	$132.00	$5.18–$125.40	45% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$9.33	$15.54	$3.58–$14.77	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP	$79.20	$132.00	$30.36–$125.40	—	40%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOXIN B GENE TCDBRTPCR	$67.09	$111.81	$37.27–$106.22	49% below	40%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED	$218.40	$364.00	$37.27–$345.80	64% above	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOXIN B GENE TCDBRTPCR	$67.09	$111.81	$25.72–$106.22	—	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLIFIED	$218.40	$364.00	$83.72–$345.80	—	40%
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN-GI (CA 19-9)	$37.46	$62.43	$20.81–$59.31	63% below	40%
CA 19-9 blood test (tumor marker) CPT 86301 CA-19-9	$129.60	$216.00	$20.81–$205.20	28% above	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN-GI (CA 19-9)	$37.46	$62.43	$14.36–$59.31	—	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA-19-9	$129.60	$216.00	$49.68–$205.20	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125	$37.46	$62.43	$20.81–$59.31	63% below	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$129.60	$216.00	$20.81–$205.20	28% above	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125	$37.46	$62.43	$14.36–$59.31	—	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$129.60	$216.00	$49.68–$205.20	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2/2019-NCOV MN HLTH	$13.20	$22.00	$9.24–$134.38	89% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2/2019-NCOV CSH NRL	$33.00	$55.00	$23.10–$134.38	73% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2/2019-NCOV INHOUSE C	$51.00	$85.00	$35.70–$134.38	58% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2/2019-NCOV MN HLTH	$13.20	$22.00	$5.06–$20.90	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2/2019-NCOV CSH NRL	$33.00	$55.00	$12.65–$52.25	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2/2019-NCOV INHOUSE C	$51.00	$85.00	$19.55–$80.75	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C TRACHOMATIS BY TMA	$63.00	$105.00	$35.09–$99.75	33% below	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C. TRACHOMATIS BY TMA	$63.17	$105.27	$35.09–$100.01	33% below	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 VIPCG CHL TRACH DNA AMP PROBE	$225.00	$375.00	$35.09–$356.25	139% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C TRACHOMATIS BY TMA	$63.00	$105.00	$24.15–$99.75	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C. TRACHOMATIS BY TMA	$63.17	$105.27	$24.22–$100.01	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 VIPCG CHL TRACH DNA AMP PROBE	$225.00	$375.00	$86.25–$356.25	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PNL	$36.60	$61.00	$13.39–$95.18	60% below	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE	$111.00	$185.00	$13.39–$175.75	20% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PNL	$36.60	$61.00	$14.03–$57.95	—	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE	$111.00	$185.00	$42.55–$175.75	—	40%
Complete blood count (CBC) with differential CPT 85025 CBC W/MANUAL DIFF	$98.40	$164.00	$7.77–$155.80	18% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/MANUAL DIFF	$98.40	$164.00	$37.72–$155.80	—	40%
Complete blood count (CBC), no differential CPT 85027 CBC W/O DIFF	$84.00	$140.00	$6.47–$133.00	28% above	40%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC W/O DIFF	$84.00	$140.00	$32.20–$133.00	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$81.60	$136.00	$10.56–$151.17	14% below	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP	$81.60	$136.00	$31.28–$129.20	—	40%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT	$100.80	$168.00	$10.18–$159.60	2% above	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QUANT	$100.80	$168.00	$38.64–$159.60	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATESERUM	$40.02	$66.69	$22.23–$63.36	31% below	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-SO4	$136.80	$228.00	$22.23–$216.60	137% above	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATESERUM	$40.02	$66.69	$15.34–$63.36	—	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-SO4	$136.80	$228.00	$52.44–$216.60	—	40%
Estradiol blood test CPT 82670 ESTRADIOL BY IMMUNOASSAY	$50.30	$83.82	$27.94–$79.63	24% below	40%
Estradiol blood test CPT 82670 ESTRADIOL	$171.00	$285.00	$27.94–$270.75	159% above	40%
Estradiol blood test inpatient CPT 82670 ESTRADIOL BY IMMUNOASSAY	$50.30	$83.82	$19.28–$79.63	—	40%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$171.00	$285.00	$65.55–$270.75	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING HORMONE	$33.45	$55.74	$18.58–$52.96	53% below	40%
FSH (follicle-stimulating hormone) test CPT 83001 FSH PITUITARY	$117.00	$195.00	$18.58–$185.25	65% above	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING HORMONE	$33.45	$55.74	$12.83–$52.96	—	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH PITUITARY	$117.00	$195.00	$44.85–$185.25	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTINFECAL IMMUNOASSAY	$35.34	$58.89	$19.63–$55.95	58% below	40%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL ARUP	$123.00	$205.00	$19.63–$194.75	46% above	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTINFECAL IMMUNOASSAY	$35.34	$58.89	$13.55–$55.95	—	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL ARUP	$123.00	$205.00	$47.15–$194.75	—	40%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$24.54	$40.89	$13.63–$38.85	73% below	40%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$24.54	$40.89	$9.41–$38.85	—	40%
Folate (folic acid) blood test CPT 82746 FOLATESERUM	$26.46	$44.10	$14.70–$41.90	67% below	40%
Folate (folic acid) blood test CPT 82746 FOLIC ACID	$107.40	$179.00	$14.70–$170.05	34% above	40%
Folate (folic acid) blood test inpatient CPT 82746 FOLATESERUM	$26.46	$44.10	$10.15–$41.90	—	40%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID	$107.40	$179.00	$41.17–$170.05	—	40%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINEFREE FREE T3	$30.50	$50.82	$16.94–$48.28	70% below	40%
Free T3 thyroid hormone test CPT 84481 T3 FREE	$100.80	$168.00	$16.94–$159.60	2% below	40%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINEFREE FREE T3	$30.50	$50.82	$11.69–$48.28	—	40%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE	$100.80	$168.00	$38.64–$159.60	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$16.24	$27.06	$9.02–$25.71	76% below	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$62.40	$104.00	$9.02–$98.80	9% below	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$16.24	$27.06	$6.23–$25.71	—	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$62.40	$104.00	$23.92–$98.80	—	40%
Free testosterone test CPT 84402 TESTOSTERONEFREE	$45.85	$76.41	$25.47–$72.59	27% below	40%
Free testosterone test CPT 84402 TESTOSTERONE FREE ADULT MALES	$157.20	$262.00	$25.47–$248.90	152% above	40%
Free testosterone test inpatient CPT 84402 TESTOSTERONEFREE	$45.85	$76.41	$17.58–$72.59	—	40%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE ADULT MALES	$157.20	$262.00	$60.26–$248.90	—	40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$211.80	$353.00	$148.26–$335.35	14% below	40%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$211.80	$353.00	$81.19–$335.35	—	40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2 HR	$55.20	$92.00	$4.75–$87.40	31% above	40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 2 HR	$55.20	$92.00	$21.16–$87.40	—	40%
Glucose tolerance test, 3 samples CPT 82951 GTT2	$82.20	$137.00	$12.87–$130.15	14% below	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT2	$82.20	$137.00	$31.51–$130.15	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N. GONORRHOEAE BY TMA	$63.17	$105.27	$35.09–$100.01	25% below	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 CULT GONORRHEA	$225.00	$375.00	$35.09–$356.25	166% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N. GONORRHOEAE BY TMA	$63.17	$105.27	$24.22–$100.01	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 CULT GONORRHEA	$225.00	$375.00	$86.25–$356.25	—	40%
H. pylori antibody blood test CPT 86677 HELICOBACTER AB IGG	$96.60	$161.00	$16.85–$152.95	18% below	40%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER AB IGG	$96.60	$161.00	$37.03–$152.95	—	40%
H. pylori stool antigen test CPT 87338 HELICOBACT PYLORI AGFECAL EIA	$25.89	$43.14	$14.38–$40.99	76% below	40%
H. pylori stool antigen test CPT 87338 HELI PYLORI ANTIGEN STOOL	$89.40	$149.00	$14.38–$141.55	17% below	40%
H. pylori stool antigen test inpatient CPT 87338 HELICOBACT PYLORI AGFECAL EIA	$25.89	$43.14	$9.93–$40.99	—	40%
H. pylori stool antigen test inpatient CPT 87338 HELI PYLORI ANTIGEN STOOL	$89.40	$149.00	$34.27–$141.55	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANTITATIVE NAATPLASMA	$153.18	$255.30	$85.10–$242.54	33% above	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT PCR RFLX GENOTYPE	$525.00	$875.00	$85.10–$831.25	357% above	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANTITATIVE NAATPLASMA	$153.18	$255.30	$58.72–$242.54	—	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT PCR RFLX GENOTYPE	$525.00	$875.00	$201.25–$831.25	—	40%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1&2 ANTIBODY (REFLEXIVE)	$82.20	$137.00	$13.71–$130.15	24% above	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1&2 ANTIBODY (REFLEXIVE)	$82.20	$137.00	$31.51–$130.15	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-12 COMBO AG/ABRFLX PNL	$43.35	$72.24	$24.08–$68.63	31% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 SHPANF HIV 1&2	$147.60	$246.00	$24.08–$233.70	133% above	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-12 COMBO AG/ABRFLX PNL	$43.35	$72.24	$16.62–$68.63	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 SHPANF HIV 1&2	$147.60	$246.00	$56.58–$233.70	—	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV NUCLEIC ACID AMPLIFICATION	$63.17	$105.27	$35.09–$100.01	51% below	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HIGH RISK HPV	$208.20	$347.00	$35.09–$329.65	61% above	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 BILL ONLY HPV HIGH RISK REFLEX	$214.20	$357.00	$35.09–$339.15	66% above	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV NUCLEIC ACID AMPLIFICATION	$63.17	$105.27	$24.22–$100.01	—	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HIGH RISK HPV	$208.20	$347.00	$79.81–$329.65	—	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 BILL ONLY HPV HIGH RISK REFLEX	$214.20	$357.00	$82.11–$339.15	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCO HGB	$63.60	$106.00	$9.71–$100.70	10% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCO HGB	$63.60	$106.00	$24.38–$100.70	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B VIRUS SURFACE AB	$19.34	$32.22	$10.74–$30.61	71% below	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HB SURFACE AB	$68.40	$114.00	$10.74–$108.30	4% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B VIRUS SURFACE AB	$19.34	$32.22	$7.42–$30.61	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HB SURFACE AB	$68.40	$114.00	$26.22–$108.30	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBV SURFACE AG W/RFLX TO CONF	$18.60	$30.99	$10.33–$29.45	65% below	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HB SURFACE ANTIGEN REFLEXIVE	$61.80	$103.00	$10.33–$97.85	16% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HBV SURFACE AG W/RFLX TO CONF	$18.60	$30.99	$7.13–$29.45	—	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HB SURFACE ANTIGEN REFLEXIVE	$61.80	$103.00	$23.69–$97.85	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS ANTIBODY CIA	$25.69	$42.81	$14.27–$40.67	68% below	40%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C	$101.40	$169.00	$14.27–$160.55	27% above	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS ANTIBODY CIA	$25.69	$42.81	$9.85–$40.67	—	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C	$101.40	$169.00	$38.87–$160.55	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV BY QUANTITATIVE NAAT	$77.12	$128.52	$42.84–$122.10	38% below	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV GENOTYPE BY PCR/LIPA REF	$266.40	$444.00	$42.84–$421.80	115% above	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV BY QUANTITATIVE NAAT	$77.12	$128.52	$29.56–$122.10	—	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV GENOTYPE BY PCR/LIPA REF	$266.40	$444.00	$102.12–$421.80	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 GLYCOPROTEIN G AB IGG	$23.75	$39.57	$13.19–$37.60	49% below	40%
Herpes blood test, HSV-1 antibody CPT 86695 HSV TYPE 1 G SPECIFIC IGG	$24.00	$40.00	$13.19–$38.00	48% below	40%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 TYPE-SPECIFIC IGG AB	$86.40	$144.00	$13.19–$136.80	86% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 GLYCOPROTEIN G AB IGG	$23.75	$39.57	$9.11–$37.60	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV TYPE 1 G SPECIFIC IGG	$24.00	$40.00	$9.20–$38.00	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1 TYPE-SPECIFIC IGG AB	$86.40	$144.00	$33.12–$136.80	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 2 G SPECIFIC IGG	$34.80	$58.00	$19.35–$55.10	40% below	40%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 GLYCOPROTEIN G AB IGG	$34.83	$58.05	$19.35–$55.15	40% below	40%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 TYPE-SPECIFIC IGG AB	$123.00	$205.00	$19.35–$194.75	113% above	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 2 G SPECIFIC IGG	$34.80	$58.00	$13.34–$55.10	—	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 GLYCOPROTEIN G AB IGG	$34.83	$58.05	$13.36–$55.15	—	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2 TYPE-SPECIFIC IGG AB	$123.00	$205.00	$47.15–$194.75	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRPHIGH SENSITIVITY	$23.31	$38.85	$12.95–$36.91	67% below	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP-HS	$82.20	$137.00	$12.95–$130.15	16% above	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRPHIGH SENSITIVITY	$23.31	$38.85	$8.94–$36.91	—	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP-HS	$82.20	$137.00	$31.51–$130.15	—	40%
Homocysteine blood test CPT 83090 HOMOCYSTEINETOTAL	$32.26	$53.76	$17.92–$51.08	64% below	40%
Homocysteine blood test CPT 83090 HOMOCYSTEINE CARDIAC RISK	$102.60	$171.00	$17.92–$162.45	14% above	40%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINETOTAL	$32.26	$53.76	$12.37–$51.08	—	40%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE CARDIAC RISK	$102.60	$171.00	$39.33–$162.45	—	40%
Insulin blood test CPT 83525 INSULINFASTING	$20.58	$34.29	$11.43–$32.58	62% below	40%
Insulin blood test CPT 83525 INSULIN ASSAY	$68.40	$114.00	$11.43–$108.30	25% above	40%
Insulin blood test inpatient CPT 83525 INSULINFASTING	$20.58	$34.29	$7.89–$32.58	—	40%
Insulin blood test inpatient CPT 83525 INSULIN ASSAY	$68.40	$114.00	$26.22–$108.30	—	40%
Iron blood test (serum iron) CPT 83540 IRONPLASMA OR SERUM	$11.65	$19.41	$6.47–$18.44	77% below	40%
Iron blood test (serum iron) CPT 83540 IRON	$53.40	$89.00	$6.47–$84.55	4% above	40%
Iron blood test (serum iron) inpatient CPT 83540 IRONPLASMA OR SERUM	$11.65	$19.41	$4.47–$18.44	—	40%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$53.40	$89.00	$20.47–$84.55	—	40%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY TOTAL	$15.74	$26.22	$8.74–$24.91	76% below	40%
Iron-binding capacity (TIBC) test CPT 83550 IRON PROFILE	$69.60	$116.00	$8.74–$110.20	8% above	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY TOTAL	$15.74	$26.22	$6.04–$24.91	—	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON PROFILE	$69.60	$116.00	$26.68–$110.20	—	40%
Kidney function blood test panel CPT 80069 RENAL PROFILE	$84.60	$141.00	$8.68–$133.95	20% below	40%
Kidney function blood test panel inpatient CPT 80069 RENAL PROFILE	$84.60	$141.00	$32.43–$133.95	—	40%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONESERUM	$33.34	$55.56	$18.52–$52.79	59% below	40%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE (LH)	$117.00	$195.00	$18.52–$185.25	44% above	40%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONESERUM	$33.34	$55.56	$12.78–$52.79	—	40%
LH (luteinizing hormone) test inpatient CPT 83002 LUTEINIZING HORMONE (LH)	$117.00	$195.00	$44.85–$185.25	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE SERUM OR PLASMA	$12.41	$20.67	$6.89–$19.64	79% below	40%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$51.00	$85.00	$6.89–$80.75	14% below	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE SERUM OR PLASMA	$12.41	$20.67	$4.76–$19.64	—	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$51.00	$85.00	$19.55–$80.75	—	40%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION	$105.00	$175.00	$8.17–$166.25	3% above	40%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION	$105.00	$175.00	$40.25–$166.25	—	40%
Lyme disease antibody test CPT 86618 LYME DISEASE ACUTE REFLEXIVE	$30.66	$51.09	$17.03–$48.54	53% below	40%
Lyme disease antibody test CPT 86618 LYME DISEASE TOTAL AB/REFLEX	$79.80	$133.00	$17.03–$126.35	24% above	40%
Lyme disease antibody test CPT 86618 LYME (B.BURGDORFERI) AB CSF	$102.60	$171.00	$17.03–$162.45	59% above	40%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ACUTE REFLEXIVE	$30.66	$51.09	$11.76–$48.54	—	40%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE TOTAL AB/REFLEX	$79.80	$133.00	$30.59–$126.35	—	40%
Lyme disease antibody test inpatient CPT 86618 LYME (B.BURGDORFERI) AB CSF	$102.60	$171.00	$39.33–$162.45	—	40%
Magnesium blood test CPT 83735 MAGNESIUM URINE	$8.40	$14.00	$5.88–$13.30	73% below	40%
Magnesium blood test CPT 83735 MAGNESIUM RBC	$12.06	$20.10	$6.70–$19.10	61% below	40%
Magnesium blood test CPT 83735 MAGNESIUM	$61.20	$102.00	$6.70–$96.90	96% above	40%
Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE	$8.40	$14.00	$3.22–$13.30	—	40%
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC	$12.06	$20.10	$4.63–$19.10	—	40%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$61.20	$102.00	$23.46–$96.90	—	40%
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA) ABIGG	$23.19	$38.64	$12.88–$36.71	36% below	40%
Measles (rubeola) antibody test CPT 86765 MECPAN RUBEOLA AB	$82.20	$137.00	$12.88–$130.15	125% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA) ABIGG	$23.19	$38.64	$8.89–$36.71	—	40%
Measles (rubeola) antibody test inpatient CPT 86765 MECPAN RUBEOLA AB	$82.20	$137.00	$31.51–$130.15	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST	$71.40	$119.00	$5.18–$113.05	39% above	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST	$71.40	$119.00	$27.37–$113.05	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 PROSTATE SPECIFIC AG FREE	$33.11	$55.17	$18.39–$52.42	8% below	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 RATPSA PSA FREE	$123.00	$205.00	$18.39–$194.75	242% above	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PROSTATE SPECIFIC AG FREE	$33.11	$55.17	$12.69–$52.42	—	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 RATPSA PSA FREE	$123.00	$205.00	$47.15–$194.75	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN	$33.11	$55.17	$18.39–$52.42	59% below	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSITC	$123.00	$205.00	$18.39–$194.75	52% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN	$33.11	$55.17	$12.69–$52.42	—	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSITC	$123.00	$205.00	$47.15–$194.75	—	40%
Pap test (liquid-based, automated screening with review) CPT 88175 LIQUID BASED PAP	$121.20	$202.00	$26.61–$191.90	42% above	40%
Pap test (liquid-based, automated screening with review) CPT 88175 LIQ PAP & HPV NEG & HPV POS	$161.40	$269.00	$26.61–$255.55	89% above	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 LIQUID BASED PAP	$121.20	$202.00	$46.46–$191.90	—	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 LIQ PAP & HPV NEG & HPV POS	$161.40	$269.00	$61.87–$255.55	—	40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOLOGYTHINPREP PAP W/ HPV	$36.47	$60.78	$20.26–$57.75	53% below	40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH CER/VAG	$123.00	$205.00	$20.26–$194.75	59% above	40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH CER/VAG IN OR B	$126.60	$211.00	$20.26–$200.45	64% above	40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOLOGYTHINPREP PAP W/ HPV	$36.47	$60.78	$13.98–$57.75	—	40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH CER/VAG	$123.00	$205.00	$47.15–$194.75	—	40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH CER/VAG IN OR B	$126.60	$211.00	$48.53–$200.45	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE INTACT	$74.31	$123.84	$41.28–$117.65	37% below	40%
Parathyroid hormone (PTH) blood test CPT 83970 PTH IO	$304.20	$507.00	$41.28–$481.65	159% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE INTACT	$74.31	$123.84	$28.49–$117.65	—	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH IO	$304.20	$507.00	$116.61–$481.65	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-LA SCREEN (PTT-D)	$10.82	$18.03	$6.01–$17.13	82% below	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$49.80	$83.00	$6.01–$78.85	15% below	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$56.40	$94.00	$6.01–$89.30	4% below	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT-LA SCREEN (PTT-D)	$10.82	$18.03	$4.15–$17.13	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$49.80	$83.00	$19.09–$78.85	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$56.40	$94.00	$21.62–$89.30	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 NON INV PRENATAL SCREENING	$1,366.29	$2,277.15	$759.05–$2,163.30	1% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 PRENATAL ANEUPLOIDY	$3,658.20	$6,097.00	$759.05–$5,792.15	166% above	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 NON INV PRENATAL SCREENING	$1,366.29	$2,277.15	$523.75–$2,163.30	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 PRENATAL ANEUPLOIDY	$3,658.20	$6,097.00	$1,402.31–$5,792.15	—	40%
Progesterone blood test CPT 84144 PROGESTERONE QUANTSER/PLAS	$37.55	$62.58	$20.86–$59.46	53% below	40%
Progesterone blood test CPT 84144 PROGESTERONE	$129.60	$216.00	$20.86–$205.20	61% above	40%
Progesterone blood test inpatient CPT 84144 PROGESTERONE QUANTSER/PLAS	$37.55	$62.58	$14.40–$59.46	—	40%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$129.60	$216.00	$49.68–$205.20	—	40%
Prolactin blood test CPT 84146 PROLACTIN	$34.89	$58.14	$19.38–$55.24	47% below	40%
Prolactin blood test CPT 84146 MONOMERIC PROLACTIN	$35.40	$59.00	$19.38–$56.05	46% below	40%
Prolactin blood test CPT 84146 MACROPROLACTIN	$117.00	$195.00	$19.38–$185.25	79% above	40%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$34.89	$58.14	$13.38–$55.24	—	40%
Prolactin blood test inpatient CPT 84146 MONOMERIC PROLACTIN	$35.40	$59.00	$13.57–$56.05	—	40%
Prolactin blood test inpatient CPT 84146 MACROPROLACTIN	$117.00	$195.00	$44.85–$185.25	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$7.73	$12.87	$4.29–$12.23	74% below	40%
Prothrombin time (PT/INR) clotting test CPT 85610 LACC - PT	$34.20	$57.00	$4.29–$54.15	13% above	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME/INR	$44.40	$74.00	$4.29–$70.30	47% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$7.73	$12.87	$2.97–$12.23	—	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LACC - PT	$34.20	$57.00	$13.11–$54.15	—	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME/INR	$44.40	$74.00	$17.02–$70.30	—	40%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A AG	$89.40	$149.00	$16.55–$141.55	60% above	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A AG	$89.40	$149.00	$34.27–$141.55	—	40%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$10.21	$17.01	$5.67–$16.16	79% below	40%
Rheumatoid factor (RF) test CPT 86431 ANALYZER RA	$34.80	$58.00	$5.67–$55.10	28% below	40%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$10.21	$17.01	$3.92–$16.16	—	40%
Rheumatoid factor (RF) test inpatient CPT 86431 ANALYZER RA	$34.80	$58.00	$13.34–$55.10	—	40%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODYIGG	$25.91	$43.17	$14.39–$41.02	45% below	40%
Rubella antibody test (immunity check) CPT 86762 OBPAN2 RUBELLA	$89.40	$149.00	$14.39–$141.55	89% above	40%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODYIGG	$25.91	$43.17	$9.93–$41.02	—	40%
Rubella antibody test (immunity check) inpatient CPT 86762 OBPAN2 RUBELLA	$89.40	$149.00	$34.27–$141.55	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$14.40	$24.00	$2.70–$22.80	62% below	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE	$14.40	$24.00	$5.52–$22.80	—	40%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN EXAMINATION	$75.60	$126.00	$12.31–$119.70	46% below	40%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN EXAMINATION	$75.60	$126.00	$28.98–$119.70	—	40%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$16.02	$26.70	$8.90–$25.37	55% below	40%
Stool ova and parasites exam CPT 87177 O/PCONCENTRATION	$55.20	$92.00	$8.90–$87.40	57% above	40%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS	$16.02	$26.70	$6.15–$25.37	—	40%
Stool ova and parasites exam inpatient CPT 87177 O/PCONCENTRATION	$55.20	$92.00	$21.16–$87.40	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD SCREEN	$51.60	$86.00	$4.38–$81.70	46% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD SCREEN	$51.60	$86.00	$19.78–$81.70	—	40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD BY IA	$28.66	$47.76	$15.92–$45.38	50% below	40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD IMMUNOASSAY-DIAG.	$96.60	$161.00	$15.92–$152.95	68% above	40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL OCCULT BLOOD BY IA	$28.66	$47.76	$10.99–$45.38	—	40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD IMMUNOASSAY-DIAG.	$96.60	$161.00	$37.03–$152.95	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR WITH REFLEX TO TITER	$7.69	$12.81	$4.27–$12.17	74% below	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF	$28.20	$47.00	$4.27–$44.65	5% below	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR WITH REFLEX TO TITER	$7.69	$12.81	$2.95–$12.17	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL CSF	$28.20	$47.00	$10.81–$44.65	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON-TB GOLD PLUS 4TUBE	$111.57	$185.94	$61.98–$176.65	10% below	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD IN-TUBE	$357.00	$595.00	$61.98–$565.25	189% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON-TB GOLD PLUS 4TUBE	$111.57	$185.94	$42.77–$176.65	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD IN-TUBE	$357.00	$595.00	$136.85–$565.25	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE BY IMMUNOASSAY	$46.46	$77.43	$25.81–$73.56	26% below	40%
Testosterone blood test, total (not free testosterone) CPT 84403 QDSCR ESTRIOL UNCONJUGATED	$157.20	$262.00	$25.81–$248.90	151% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE BY IMMUNOASSAY	$46.46	$77.43	$17.81–$73.56	—	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 QDSCR ESTRIOL UNCONJUGATED	$157.20	$262.00	$60.26–$248.90	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE (TPO) AB	$26.19	$43.65	$14.55–$41.47	50% below	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANALYZER MICROSOMAL	$89.40	$149.00	$14.55–$141.55	69% above	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE (TPO) AB	$26.19	$43.65	$10.04–$41.47	—	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANALYZER MICROSOMAL	$89.40	$149.00	$34.27–$141.55	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$30.24	$50.40	$16.80–$100.78	68% below	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 CONG HYPOTHYROIDISM	$104.40	$174.00	$16.80–$165.30	11% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE	$30.24	$50.40	$11.60–$47.88	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CONG HYPOTHYROIDISM	$104.40	$174.00	$40.02–$165.30	—	40%
Trichomonas test (NAAT) CPT 87661 T. VAGINALIS BY TMA	$63.17	$105.27	$35.09–$100.01	26% above	40%
Trichomonas test (NAAT) CPT 87661 APTCGT DET AGENT NOS DNA AMP	$218.40	$364.00	$35.09–$345.80	336% above	40%
Trichomonas test (NAAT) inpatient CPT 87661 T. VAGINALIS BY TMA	$63.17	$105.27	$24.22–$100.01	—	40%
Trichomonas test (NAAT) inpatient CPT 87661 APTCGT DET AGENT NOS DNA AMP	$218.40	$364.00	$83.72–$345.80	—	40%
Uric acid blood test CPT 84550 URIC ACID	$42.00	$70.00	$4.52–$66.50	4% below	40%
Uric acid blood test inpatient CPT 84550 URIC ACID	$42.00	$70.00	$16.10–$66.50	—	40%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS W/MICROSCOPIC	$37.20	$62.00	$3.17–$58.90	25% below	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS W/MICROSCOPIC	$37.20	$62.00	$14.26–$58.90	—	40%
Urinalysis without microscope exam, automated CPT 81003 UA W/O MICROSCOPIC	$18.00	$30.00	$2.25–$28.50	30% below	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA W/O MICROSCOPIC	$18.00	$30.00	$6.90–$28.50	—	40%
Urine culture for bacteria, with colony count CPT 87086 CULT URINE	$71.40	$119.00	$8.07–$113.05	30% above	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULT URINE	$71.40	$119.00	$27.37–$113.05	—	40%
Urine pregnancy test, read by color change CPT 81025 HCG QUAL URINE	$67.20	$112.00	$8.61–$106.40	73% above	40%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG QUAL URINE	$67.20	$112.00	$25.76–$106.40	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$27.15	$45.24	$15.08–$42.98	69% below	40%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 DEF CASCADE	$60.00	$100.00	$15.08–$95.00	32% below	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$27.15	$45.24	$10.41–$42.98	—	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12 DEF CASCADE	$60.00	$100.00	$23.00–$95.00	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D25-HYDROXY	$53.28	$88.80	$29.60–$84.36	45% below	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D25-HYDROXY	$53.28	$88.80	$20.43–$84.36	—	40%
Zinc blood test CPT 84630 ZINCSERUM OR PLASMA	$20.51	$34.17	$11.39–$32.47	32% below	40%
Zinc blood test CPT 84630 ZINC (SERUM)	$68.40	$114.00	$11.39–$108.30	127% above	40%
Zinc blood test inpatient CPT 84630 ZINCSERUM OR PLASMA	$20.51	$34.17	$7.86–$32.47	—	40%
Zinc blood test inpatient CPT 84630 ZINC (SERUM)	$68.40	$114.00	$26.22–$108.30	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG TUMOR MARKER	$27.09	$45.15	$15.05–$42.90	71% below	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANT SERUM	$99.60	$166.00	$15.05–$157.70	8% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG TUMOR MARKER	$27.09	$45.15	$10.39–$42.90	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANT SERUM	$99.60	$166.00	$38.18–$157.70	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TX FX FIB DIST WO MAN CLSD ER	$412.80	$688.00	$288.96–$653.60	12% below	40%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TX FX FIB DIS WO MAN CLS ER PF	$608.40	$1,014.00	$425.88–$963.30	30% above	40%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TX FX FIB DIST WO MAN CLSD ER	$412.80	$688.00	$158.24–$653.60	—	40%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TX FX FIB DIS WO MAN CLS ER PF	$608.40	$1,014.00	$233.22–$963.30	—	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL HOSP OP	$213.00	$355.00	$149.10–$337.25	79% below	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL CRNA	$232.80	$388.00	$162.96–$368.60	77% below	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL ER PF	$232.80	$388.00	$162.96–$368.60	77% below	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL ER	$630.60	$1,051.00	$441.42–$998.45	39% below	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE	$749.40	$1,249.00	$524.58–$1,186.55	27% below	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL HOSP OP	$213.00	$355.00	$81.65–$337.25	—	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL ER PF	$232.80	$388.00	$89.24–$368.60	—	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL CRNA	$232.80	$388.00	$89.24–$368.60	—	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION EXTERNAL ER	$630.60	$1,051.00	$241.73–$998.45	—	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE	$749.40	$1,249.00	$287.27–$1,186.55	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W CLAMP/OTH ER PF	$223.20	$372.00	$156.24–$353.40	8% below	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION WITH DEVICE	$681.00	$1,135.00	$476.70–$1,078.25	179% above	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W CLAMP/OTH ER PF	$223.20	$372.00	$85.56–$353.40	—	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION WITH DEVICE	$681.00	$1,135.00	$261.05–$1,078.25	—	40%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TX FX RADIAL DIST WO MANIP ER	$450.00	$750.00	$315.00–$712.50	9% below	40%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TX FX RADIAL DIST WO MAN ER PF	$660.00	$1,100.00	$462.00–$1,045.00	34% above	40%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TX FX RADIAL DIST WO MANIP ER	$450.00	$750.00	$172.50–$712.50	—	40%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TX FX RADIAL DIST WO MAN ER PF	$660.00	$1,100.00	$253.00–$1,045.00	—	40%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY LESN REM SUR PF	$762.60	$1,271.00	$533.82–$2,425.49	39% below	40%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY LESN REM SUR PF	$762.60	$1,271.00	$292.33–$1,207.45	—	40%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY & BIOPSY SUR PF	$729.00	$1,215.00	$510.30–$2,425.49	42% below	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY & BIOPSY SUR PF	$729.00	$1,215.00	$279.45–$1,154.25	—	40%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY DIAG SUR PF	$573.60	$956.00	$401.52–$2,791.66	53% below	40%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY DIAG SUR PF	$573.60	$956.00	$219.88–$908.20	—	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACT EAR WAX UNI CLI PF	$16.80	$28.00	$11.76–$26.60	78% below	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACT EAR WAX UNI CLI FAC	$32.40	$54.00	$22.68–$51.30	58% below	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX ER	$129.60	$216.00	$90.72–$205.20	67% above	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACT EAR WAX UNI CLI PF	$16.80	$28.00	$6.44–$26.60	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REM IMPACT EAR WAX UNI CLI FAC	$32.40	$54.00	$12.42–$51.30	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX ER	$129.60	$216.00	$49.68–$205.20	—	40%
Earwax removal with instruments, one ear CPT 69210 REM IMPACT EARWAX INSTR CLI PF	$27.00	$45.00	$18.90–$42.75	78% below	40%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTED EAR WAX UNI ER PF	$70.80	$118.00	$49.56–$112.10	43% below	40%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI ER	$129.60	$216.00	$90.72–$205.20	5% above	40%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACT EARWAX INSTR CLI PF	$27.00	$45.00	$10.35–$42.75	—	40%
Earwax removal with instruments, one ear inpatient CPT 69210 REM IMPACTED EAR WAX UNI ER PF	$70.80	$118.00	$27.14–$112.10	—	40%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI ER	$129.60	$216.00	$49.68–$205.20	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 LUMBAR FACET INJECTION PF	$154.46	$257.43	$108.13–$244.56	89% below	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 LUMBAR FACET INJECTION PF	$154.46	$257.43	$59.21–$244.56	—	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST<3CM SUR PF	$551.40	$919.00	$385.98–$873.05	64% below	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN 1ST<3CM SUR PF	$551.40	$919.00	$211.37–$873.05	—	40%
Gallbladder removal, laparoscopic CPT 47562 LAP CHOLE ASSIST SUR PF	$1,081.20	$1,802.00	$756.84–$1,711.90	35% below	40%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAP CHOLE ASSIST SUR PF	$1,081.20	$1,802.00	$414.46–$1,711.90	—	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE SC FAC	$43.20	$72.00	$30.24–$68.40	85% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAIN SKIN ABSC SIMPLE CLI FAC	$70.20	$117.00	$49.14–$111.15	76% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE SC PF	$129.60	$216.00	$90.72–$205.20	55% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE ER PF	$210.60	$351.00	$147.42–$333.45	27% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAIN SKIN ABSC SIMPLE CLI PF	$210.60	$351.00	$147.42–$333.45	27% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D SIMPLE ABCESS - IP	$280.80	$468.00	$196.56–$444.60	3% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D SIMPLE ABSCESS - OP	$280.80	$468.00	$196.56–$444.60	3% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SIMPLE ABSCESS	$345.00	$575.00	$241.50–$546.25	20% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE ER	$345.00	$575.00	$241.50–$546.25	20% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE SC FAC	$43.20	$72.00	$16.56–$68.40	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAIN SKIN ABSC SIMPLE CLI FAC	$70.20	$117.00	$26.91–$111.15	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE SC PF	$129.60	$216.00	$49.68–$205.20	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAIN SKIN ABSC SIMPLE CLI PF	$210.60	$351.00	$80.73–$333.45	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE ER PF	$210.60	$351.00	$80.73–$333.45	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D SIMPLE ABCESS - IP	$280.80	$468.00	$107.64–$444.60	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D SIMPLE ABSCESS - OP	$280.80	$468.00	$107.64–$444.60	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE ER	$345.00	$575.00	$132.25–$546.25	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SIMPLE ABSCESS	$345.00	$575.00	$132.25–$546.25	—	40%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 RPR ING HRNA 5YRS+ RED SUR PF	$862.20	$1,437.00	$603.54–$1,365.15	50% below	40%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 RPR ING HRNA 5YRS+ RED SUR PF	$862.20	$1,437.00	$330.51–$1,365.15	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ SGL TENDN SHTH/LIGA ORTFAC	$39.60	$66.00	$27.72–$62.70	89% below	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ SGL TENDN SHTH/LIGA ORTFAC	$39.60	$66.00	$15.18–$62.70	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS MAJOR JOINT B	$75.53	$125.88	$52.87–$119.59	79% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJ JNT MAJOR WO US ER PF	$99.00	$165.00	$69.30–$156.75	73% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ MAJ JT BURSA CYST CLI PF	$105.60	$176.00	$73.92–$167.20	71% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ MAJOR JOINT/BURSA HOSP OP	$140.40	$234.00	$98.28–$222.30	61% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ MAJOR JOINT/BURSA HOSP IP	$140.40	$234.00	$98.28–$222.30	61% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHOCENTESISASP/INJ MJR JNT	$465.00	$775.00	$325.50–$736.25	28% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASP/INJ JOINT MAJOR WO US ER	$465.00	$775.00	$325.50–$736.25	28% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS MAJOR JOINT B	$75.53	$125.88	$28.96–$119.59	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP/INJ JNT MAJOR WO US ER PF	$99.00	$165.00	$37.95–$156.75	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ MAJ JT BURSA CYST CLI PF	$105.60	$176.00	$40.48–$167.20	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ MAJOR JOINT/BURSA HOSP OP	$140.40	$234.00	$53.82–$222.30	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ MAJOR JOINT/BURSA HOSP IP	$140.40	$234.00	$53.82–$222.30	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASP/INJ JOINT MAJOR WO US ER	$465.00	$775.00	$178.25–$736.25	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHOCENTESISASP/INJ MJR JNT	$465.00	$775.00	$178.25–$736.25	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJ INTR JNT/BUR WO US ERP	$76.80	$128.00	$53.76–$121.60	75% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCEN ASP/INJ JT IN CLI PF	$91.20	$152.00	$63.84–$144.40	70% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJ INTR JNT/BUR WO US HOS	$121.20	$202.00	$84.84–$191.90	60% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASP/INJ INTR JNT/BUR WO US ER	$465.00	$775.00	$325.50–$736.25	52% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP/INJ INTR JNT/BUR WO US ERP	$76.80	$128.00	$29.44–$121.60	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCEN ASP/INJ JT IN CLI PF	$91.20	$152.00	$34.96–$144.40	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP/INJ INTR JNT/BUR WO US HOS	$121.20	$202.00	$46.46–$191.90	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASP/INJ INTR JNT/BUR WO US ER	$465.00	$775.00	$178.25–$736.25	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP/INJ SMALL JOINT ER PF	$76.80	$128.00	$53.76–$121.60	76% below	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP/INJ SMALL JOINT	$465.00	$775.00	$325.50–$736.25	44% above	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASP/INJ SMALL JOINT ER	$465.00	$775.00	$325.50–$736.25	44% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP/INJ SMALL JOINT ER PF	$76.80	$128.00	$29.44–$121.60	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP/INJ SMALL JOINT ER	$465.00	$775.00	$178.25–$736.25	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASP/INJ SMALL JOINT	$465.00	$775.00	$178.25–$736.25	—	40%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAP APPENDECTOMY SUR PF	$988.20	$1,647.00	$691.74–$1,564.65	25% below	40%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAP APPENDECTOMY SUR PF	$988.20	$1,647.00	$378.81–$1,564.65	—	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 RPR LAP INIT ING HERNIA SUR PF	$717.00	$1,195.00	$501.90–$1,135.25	40% below	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 RPR LAP INIT ING HERNIA SUR PF	$717.00	$1,195.00	$274.85–$1,135.25	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR LAC INT SCLP AXIL<2.5ER PF	$347.40	$579.00	$243.18–$550.05	23% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR LAC INT SCLP AXIL <2.5C ER	$552.60	$921.00	$386.82–$874.95	22% above	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR LAC INT SCLP AXIL<2.5ER PF	$347.40	$579.00	$133.17–$550.05	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR LAC INT SCLP AXIL <2.5C ER	$552.60	$921.00	$211.83–$874.95	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 EPIDURAL STEROID INJ W GUIDE	$567.00	$945.00	$396.90–$897.75	40% below	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPIDURAL STEROID INJ W GUIDE	$567.00	$945.00	$217.35–$897.75	—	40%
Lower-back epidural injection, without imaging guidance CPT 62322 EPIDURAL STEROID INJ WO GUIDE	$567.00	$945.00	$396.90–$897.75	41% below	40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 EPIDURAL STEROID INJ WO GUIDE	$567.00	$945.00	$217.35–$897.75	—	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TRANSFORINJSGLLUMB/SAC	$1,498.20	$2,497.00	$1,048.74–$2,372.15	17% above	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TRANSFORINJSGLLUMB/SAC	$1,498.20	$2,497.00	$574.31–$2,372.15	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC LESN B9 FACE >0.5 CM ER PF	$217.20	$362.00	$152.04–$343.90	59% below	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC LESN B9 FACE >0.5 CM ER	$1,021.80	$1,703.00	$715.26–$1,617.85	94% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC LESN B9 FACE >0.5 CM ER PF	$217.20	$362.00	$83.26–$343.90	—	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC LESN B9 FACE >0.5 CM ER	$1,021.80	$1,703.00	$391.69–$1,617.85	—	40%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE CLI FAC	$63.60	$106.00	$44.52–$100.70	77% below	40%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SGL ER PF	$153.60	$256.00	$107.52–$243.20	45% below	40%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE CLI PF	$191.40	$319.00	$133.98–$303.05	32% below	40%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SINGLE ER	$303.60	$506.00	$212.52–$480.70	9% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE CLI FAC	$63.60	$106.00	$24.38–$100.70	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SGL ER PF	$153.60	$256.00	$58.88–$243.20	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE CLI PF	$191.40	$319.00	$73.37–$303.05	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SINGLE ER	$303.60	$506.00	$116.38–$480.70	—	40%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W GUIDE PF	$177.79	$296.31	$124.46–$281.50	80% below	40%
Paracentesis with imaging guidance CPT 49083 ABD PARA W GUIDE OP HOSP PF	$198.00	$330.00	$138.60–$313.50	77% below	40%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W GUIDE ER PF	$738.60	$1,231.00	$517.02–$1,169.45	15% below	40%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W GUIDE US	$1,535.40	$2,559.00	$1,074.78–$2,431.05	76% above	40%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W GUIDE ER	$1,535.40	$2,559.00	$1,074.78–$2,431.05	76% above	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W GUIDE PF	$177.79	$296.31	$68.16–$281.50	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARA W GUIDE OP HOSP PF	$198.00	$330.00	$75.90–$313.50	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W GUIDE ER PF	$738.60	$1,231.00	$283.13–$1,169.45	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W GUIDE ER	$1,535.40	$2,559.00	$588.57–$2,431.05	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W GUIDE US	$1,535.40	$2,559.00	$588.57–$2,431.05	—	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & MATRIX ER PF	$217.20	$362.00	$152.04–$343.90	57% below	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & MATRIX ER	$552.60	$921.00	$386.82–$874.95	10% above	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL & MATRIX ER PF	$217.20	$362.00	$83.26–$343.90	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL & MATRIX ER	$552.60	$921.00	$211.83–$874.95	—	40%
Prostate biopsy CPT 55700 BIOPSY PROSTATE	$216.60	$360.99	$151.62–$342.95	85% below	40%
Prostate biopsy inpatient CPT 55700 BIOPSY PROSTATE	$216.60	$360.99	$83.03–$342.95	—	40%
Removal of a foreign object under the skin, simple CPT 10120 INCISION/REM FB SIMPLE CLI FAC	$88.80	$148.00	$62.16–$140.60	78% below	40%
Removal of a foreign object under the skin, simple CPT 10120 INCISION/REM FB SIMPLE ER PF	$223.20	$372.00	$156.24–$353.40	44% below	40%
Removal of a foreign object under the skin, simple CPT 10120 INCISION/REM FB SIMPLE CLI PF	$268.20	$447.00	$187.74–$424.65	33% below	40%
Removal of a foreign object under the skin, simple CPT 10120 INCISION/REM FB SIMPLE ER	$586.20	$977.00	$410.34–$928.15	47% above	40%
Removal of a foreign object under the skin, simple CPT 10120 FB REMOVAL SUBQ TISSUE	$586.20	$977.00	$410.34–$928.15	47% above	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REM FB SIMPLE CLI FAC	$88.80	$148.00	$34.04–$140.60	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REM FB SIMPLE ER PF	$223.20	$372.00	$85.56–$353.40	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REM FB SIMPLE CLI PF	$268.20	$447.00	$102.81–$424.65	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REM FB SIMPLE ER	$586.20	$977.00	$224.71–$928.15	—	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 FB REMOVAL SUBQ TISSUE	$586.20	$977.00	$224.71–$928.15	—	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 SCREEN COLON-NONHI RISK SUR PF	$574.20	$957.00	$401.94–$2,326.94	48% below	40%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 SCREEN COLON-NONHI RISK SUR PF	$574.20	$957.00	$220.11–$909.15	—	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 SCREEN COLON-HI RISK SUR PF	$573.60	$956.00	$401.52–$2,326.94	51% below	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 SCREEN COLON-HI RISK SUR PF	$573.60	$956.00	$219.88–$908.20	—	40%
Short arm cast (elbow to hand) CPT 29075 APP FOREARM CAST ORT FAC	$51.00	$85.00	$35.70–$80.75	78% below	40%
Short arm cast (elbow to hand) CPT 29075 APPLICAT CAST SHORT ARM ER PF	$134.40	$224.00	$94.08–$212.80	43% below	40%
Short arm cast (elbow to hand) CPT 29075 APP FOREARM CAST ORT PF	$153.00	$255.00	$107.10–$242.25	35% below	40%
Short arm cast (elbow to hand) CPT 29075 APPLICATION CAST SHORT ARM ER	$453.00	$755.00	$317.10–$717.25	92% above	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APP FOREARM CAST ORT FAC	$51.00	$85.00	$19.55–$80.75	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICAT CAST SHORT ARM ER PF	$134.40	$224.00	$51.52–$212.80	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APP FOREARM CAST ORT PF	$153.00	$255.00	$58.65–$242.25	—	40%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION CAST SHORT ARM ER	$453.00	$755.00	$173.65–$717.25	—	40%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT CLI FAC	$38.40	$64.00	$26.88–$60.80	81% below	40%
Short arm splint (forearm and hand) CPT 29125 APPL SPLINT SHORT ARM ER PF	$93.00	$155.00	$65.10–$147.25	53% below	40%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT CLI PF	$115.20	$192.00	$80.64–$182.40	42% below	40%
Short arm splint (forearm and hand) CPT 29125 APPL SPLINT SHORT ARM ER	$215.40	$359.00	$150.78–$341.05	8% above	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT CLI FAC	$38.40	$64.00	$14.72–$60.80	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPL SPLINT SHORT ARM ER PF	$93.00	$155.00	$35.65–$147.25	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT CLI PF	$115.20	$192.00	$44.16–$182.40	—	40%
Short arm splint (forearm and hand) inpatient CPT 29125 APPL SPLINT SHORT ARM ER	$215.40	$359.00	$82.57–$341.05	—	40%
Short leg cast (below the knee) CPT 29405 APPL CAST SHORT LEG ER PF	$127.80	$213.00	$89.46–$202.35	53% below	40%
Short leg cast (below the knee) CPT 29405 APPL CAST SHORT LEG ER	$453.00	$755.00	$317.10–$717.25	66% above	40%
Short leg cast (below the knee) inpatient CPT 29405 APPL CAST SHORT LEG ER PF	$127.80	$213.00	$48.99–$202.35	—	40%
Short leg cast (below the knee) inpatient CPT 29405 APPL CAST SHORT LEG ER	$453.00	$755.00	$173.65–$717.25	—	40%
Short leg splint (calf to foot) CPT 29515 APPL SPLINT SHORT LEG ER PF	$105.60	$176.00	$73.92–$167.20	53% below	40%
Short leg splint (calf to foot) CPT 29515 APPL SPLINT SHORT LEG ER	$269.40	$449.00	$188.58–$426.55	21% above	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPL SPLINT SHORT LEG ER PF	$105.60	$176.00	$40.48–$167.20	—	40%
Short leg splint (calf to foot) inpatient CPT 29515 APPL SPLINT SHORT LEG ER	$269.40	$449.00	$103.27–$426.55	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR LAC SMP SCLP<2.5CM CLI FAC	$52.20	$87.00	$36.54–$82.65	81% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR LAC SMP SCALP <2.5CM ER PF	$127.80	$213.00	$89.46–$202.35	53% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR LAC SMP SCLP <2.5CM CLI PF	$158.40	$264.00	$110.88–$250.80	41% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR LAC SMP SCALP<2.5CM HOSPIP	$210.60	$351.00	$147.42–$333.45	22% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR LAC SMP SCALP <2.5CM ER	$330.60	$551.00	$231.42–$523.45	22% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR LAC SMP SCLP<2.5CM CLI FAC	$52.20	$87.00	$20.01–$82.65	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR LAC SMP SCALP <2.5CM ER PF	$127.80	$213.00	$48.99–$202.35	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR LAC SMP SCLP <2.5CM CLI PF	$158.40	$264.00	$60.72–$250.80	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR LAC SMP SCALP<2.5CM HOSPIP	$210.60	$351.00	$80.73–$333.45	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR LAC SMP SCALP <2.5CM ER	$330.60	$551.00	$126.73–$523.45	—	40%
Skin biopsy, punch, one lesion CPT 11104 BX SKIN PUNCH SGL LES SC FAC	$52.80	$88.00	$36.96–$83.60	82% below	40%
Skin biopsy, punch, one lesion CPT 11104 BX SKIN PUNCH SGL LES SC PF	$158.40	$264.00	$110.88–$250.80	45% below	40%
Skin biopsy, punch, one lesion CPT 11104 BX SKIN PUNCH SINGLE LES OR	$544.80	$908.00	$381.36–$862.60	89% above	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 BX SKIN PUNCH SGL LES SC FAC	$52.80	$88.00	$20.24–$83.60	—	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 BX SKIN PUNCH SGL LES SC PF	$158.40	$264.00	$60.72–$250.80	—	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 BX SKIN PUNCH SINGLE LES OR	$544.80	$908.00	$208.84–$862.60	—	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS CLI FAC	$52.20	$87.00	$36.54–$82.65	73% below	40%
Skin tag removal, up to 15 tags CPT 11200 REM SKINTAG < OR =15 ER PF	$153.60	$256.00	$107.52–$243.20	22% below	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS CLI PF	$158.40	$264.00	$110.88–$250.80	19% below	40%
Skin tag removal, up to 15 tags CPT 11200 REM SKINTAG < OR =15 ER	$303.60	$506.00	$212.52–$480.70	55% above	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS CLI FAC	$52.20	$87.00	$20.01–$82.65	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKINTAG < OR =15 ER PF	$153.60	$256.00	$58.88–$243.20	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS CLI PF	$158.40	$264.00	$60.72–$250.80	—	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REM SKINTAG < OR =15 ER	$303.60	$506.00	$116.38–$480.70	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DIAG ER PF	$210.60	$351.00	$147.42–$333.45	71% below	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT LUMB DIAG PF	$445.80	$743.00	$312.06–$705.85	39% below	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT LUMB DIAG CRNA PF	$1,130.40	$1,884.00	$791.28–$1,789.80	56% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DIAG	$1,423.80	$2,373.00	$996.66–$2,254.35	96% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC ER	$1,423.80	$2,373.00	$996.66–$2,254.35	96% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAG ER PF	$210.60	$351.00	$80.73–$333.45	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT LUMB DIAG PF	$445.80	$743.00	$170.89–$705.85	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT LUMB DIAG CRNA PF	$1,130.40	$1,884.00	$433.32–$1,789.80	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAGNOSTIC ER	$1,423.80	$2,373.00	$545.79–$2,254.35	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE DIAG	$1,423.80	$2,373.00	$545.79–$2,254.35	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR LAC SMP SCLP2.6-7.5CLI FAC	$63.60	$106.00	$44.52–$100.70	79% below	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR LAC SMP SCLP 2.6-7.5 ER PF	$172.80	$288.00	$120.96–$273.60	44% below	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR LAC SMP SCLP 2.6-7.5CLI PF	$191.40	$319.00	$133.98–$303.05	38% below	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR LAC SMP SCALP 2.6-7.5CM ER	$321.00	$535.00	$224.70–$508.25	5% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR LAC SMP SCLP2.6-7.5CLI FAC	$63.60	$106.00	$24.38–$100.70	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR LAC SMP SCLP 2.6-7.5 ER PF	$172.80	$288.00	$66.24–$273.60	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR LAC SMP SCLP 2.6-7.5CLI PF	$191.40	$319.00	$73.37–$303.05	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR LAC SMP SCALP 2.6-7.5CM ER	$321.00	$535.00	$123.05–$508.25	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR LAC FAC <2.5CM CLI FAC	$63.60	$106.00	$44.52–$100.70	77% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR LAC SMP FACE <2.5CM ER PF	$153.60	$256.00	$107.52–$243.20	44% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR LAC FAC <2.5CM CLI PF	$191.40	$319.00	$133.98–$303.05	30% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR LAC SMP FACE <2.5CM ER	$330.60	$551.00	$231.42–$523.45	21% above	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR LAC FAC <2.5CM CLI FAC	$63.60	$106.00	$24.38–$100.70	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR LAC SMP FACE <2.5CM ER PF	$153.60	$256.00	$58.88–$243.20	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR LAC FAC <2.5CM CLI PF	$191.40	$319.00	$73.37–$303.05	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR LAC SMP FACE <2.5CM ER	$330.60	$551.00	$126.73–$523.45	—	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX SKIN TANGENT SINGLE LES OR	$544.80	$908.00	$381.36–$862.60	122% above	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BX SKIN TANGENT SINGLE LES OR	$544.80	$908.00	$208.84–$862.60	—	40%
Thoracentesis with imaging guidance both sides CPT 32555 THORACENTESIS WO TUBE INS BI	$361.98	$603.30	$253.39–$573.14	—	40%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W IMAGING PF	$180.99	$301.65	$126.70–$286.57	80% below	40%
Thoracentesis with imaging guidance CPT 32555 THORA W IMAG OP HOSP PF	$526.20	$877.00	$368.34–$833.15	41% below	40%
Thoracentesis with imaging guidance CPT 32555 THORA W IMAG IP HOSP PF	$526.20	$877.00	$368.34–$833.15	41% below	40%
Thoracentesis with imaging guidance inpatient both sides CPT 32555 THORACENTESIS WO TUBE INS BI	$361.98	$603.30	$138.76–$573.14	—	40%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W IMAGING PF	$180.99	$301.65	$69.38–$286.57	—	40%
Thoracentesis with imaging guidance inpatient CPT 32555 THORA W IMAG IP HOSP PF	$526.20	$877.00	$201.71–$833.15	—	40%
Thoracentesis with imaging guidance inpatient CPT 32555 THORA W IMAG OP HOSP PF	$526.20	$877.00	$201.71–$833.15	—	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUSC CRNA	$63.00	$105.00	$44.10–$99.75	80% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUSC ER PF	$63.00	$105.00	$44.10–$99.75	80% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUS HOSP OP	$88.80	$148.00	$62.16–$140.60	71% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUS HOSP IP	$88.80	$148.00	$62.16–$140.60	71% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUSC SUR	$241.80	$403.00	$169.26–$382.85	22% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1-2 MUSC ER	$467.40	$779.00	$327.18–$740.05	51% above	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUSC ER PF	$63.00	$105.00	$24.15–$99.75	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUSC CRNA	$63.00	$105.00	$24.15–$99.75	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUS HOSP OP	$88.80	$148.00	$34.04–$140.60	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUS HOSP IP	$88.80	$148.00	$34.04–$140.60	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUSC SUR	$241.80	$403.00	$92.69–$382.85	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER PT 1-2 MUSC ER	$467.40	$779.00	$179.17–$740.05	—	40%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SING/MULT SUR PF	$631.80	$1,053.00	$442.26–$2,311.27	40% below	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SING/MULT SUR PF	$631.80	$1,053.00	$242.19–$1,000.35	—	40%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD FLX DX BRSH/WASH SUR PF	$466.20	$777.00	$326.34–$2,311.27	51% below	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD FLX DX BRSH/WASH SUR PF	$466.20	$777.00	$178.71–$738.15	—	40%
Wart removal, up to 14 warts CPT 17110 DEST BENIGN LESION<15 CLI FAC	$65.40	$109.00	$45.78–$103.55	67% below	40%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESN <15 ER PF	$156.60	$261.00	$109.62–$247.95	20% below	40%
Wart removal, up to 14 warts CPT 17110 DEST BENIGN LESION <15 CLI PF	$196.20	$327.00	$137.34–$310.65	at median	40%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESN <15 ER	$334.20	$557.00	$233.94–$529.15	70% above	40%
Wart removal, up to 14 warts inpatient CPT 17110 DEST BENIGN LESION<15 CLI FAC	$65.40	$109.00	$25.07–$103.55	—	40%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT BENIGN LESN <15 ER PF	$156.60	$261.00	$60.03–$247.95	—	40%
Wart removal, up to 14 warts inpatient CPT 17110 DEST BENIGN LESION <15 CLI PF	$196.20	$327.00	$75.21–$310.65	—	40%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT BENIGN LESN <15 ER	$334.20	$557.00	$128.11–$529.15	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBR SKIN/SUBQ<20SQCM SC PF	$124.20	$207.00	$86.94–$196.65	72% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SKIN/SQ TISS<20SQCM SUR PF	$165.60	$276.00	$115.92–$262.20	63% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBR SKIN/SUBQ TISS<20SQ ER PF	$172.80	$288.00	$120.96–$273.60	61% below	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBR SKIN/SUBQ TISS<20SQCM ER	$552.60	$921.00	$386.82–$874.95	24% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBR SKIN/SUBQ<20SQCM SC PF	$124.20	$207.00	$47.61–$196.65	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SKIN/SQ TISS<20SQCM SUR PF	$165.60	$276.00	$63.48–$262.20	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBR SKIN/SUBQ TISS<20SQ ER PF	$172.80	$288.00	$66.24–$273.60	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBR SKIN/SUBQ TISS<20SQCM ER	$552.60	$921.00	$211.83–$874.95	—	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION	$562.20	$937.00	$393.54–$890.15	21% below	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION	$562.20	$937.00	$215.51–$890.15	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER SMALL VOL ER	$85.80	$143.00	$60.06–$135.85	27% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI/NEBULIZER SMALL VOL NUR	$85.80	$143.00	$60.06–$135.85	27% below	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER SMALL VOL ER	$85.80	$143.00	$32.89–$135.85	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI/NEBULIZER SMALL VOL NUR	$85.80	$143.00	$32.89–$135.85	—	40%
Chemotherapy IV infusion, first hour CPT 96413 IV INF CHEMO 16-90M MS	$675.00	$1,125.00	$472.50–$1,068.75	32% above	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV INF CHEMO 16-90M MS	$675.00	$1,125.00	$258.75–$1,068.75	—	40%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE 1ST 30-74 MIN ER PF	$478.20	$797.00	$334.74–$757.15	69% below	40%
Critical care, first 30 to 74 minutes CPT 99291 OBS CRIT CARE 30-74 MIN HOSP	$513.00	$855.00	$359.10–$812.25	67% below	40%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE 1ST 30-74 MIN ER	$1,932.00	$3,220.00	$1,352.40–$3,059.00	25% above	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE 1ST 30-74 MIN ER PF	$478.20	$797.00	$183.31–$757.15	—	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 OBS CRIT CARE 30-74 MIN HOSP	$513.00	$855.00	$196.65–$812.25	—	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE 1ST 30-74 MIN ER	$1,932.00	$3,220.00	$740.60–$3,059.00	—	40%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG ROUTINE GLOBAL CLI (P)	$24.00	$40.00	$16.80–$38.00	82% below	40%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG ROUTINE GLOBAL CLI (P)	$24.00	$40.00	$9.20–$38.00	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD TRACE	$170.40	$284.00	$81.19–$269.80	1% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD TRACE	$170.40	$284.00	$65.32–$269.80	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL 1 ER PF	$51.60	$86.00	$36.12–$81.70	73% below	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL 1 ER	$202.80	$338.00	$141.96–$321.10	5% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL 1 ER PF	$51.60	$86.00	$19.78–$81.70	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL 1 ER	$202.80	$338.00	$77.74–$321.10	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL 2 ER PF	$99.00	$165.00	$69.30–$156.75	60% below	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LEVEL 2 ER	$292.20	$487.00	$204.54–$462.65	18% above	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL 2 ER PF	$99.00	$165.00	$37.95–$156.75	—	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 LEVEL 2 ER	$292.20	$487.00	$112.01–$462.65	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL 3 ER PF	$147.00	$245.00	$102.90–$232.75	63% below	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LEVEL 3 ER	$527.40	$879.00	$369.18–$835.05	33% above	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 LEVEL 3 ER PF	$147.00	$245.00	$56.35–$232.75	—	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 LEVEL 3 ER	$527.40	$879.00	$202.17–$835.05	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL 4 ER PF	$286.80	$478.00	$200.76–$454.10	55% below	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LEVEL 4 ER	$907.80	$1,513.00	$635.46–$1,437.35	43% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL 4 ER PF	$286.80	$478.00	$109.94–$454.10	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 LEVEL 4 ER	$907.80	$1,513.00	$347.99–$1,437.35	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL 5 ER PF	$414.60	$691.00	$290.22–$656.45	56% below	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LEVEL 5 ER	$1,350.00	$2,250.00	$945.00–$2,137.50	43% above	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 LEVEL 5 ER PF	$414.60	$691.00	$158.93–$656.45	—	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 LEVEL 5 ER	$1,350.00	$2,250.00	$517.50–$2,137.50	—	40%
Family therapy with the patient, 50 minutes CPT 90847 FAM PSY W PT 50MIN MHU FAC	$45.00	$75.00	$31.50–$71.25	77% below	40%
Family therapy with the patient, 50 minutes CPT 90847 FAM PSY W PT 50MIN MHU PF	$135.00	$225.00	$94.50–$213.75	30% below	40%
Family therapy with the patient, 50 minutes CPT 90847 FAM PSY W PT 50MIN MHU (P)	$180.00	$300.00	$126.00–$285.00	7% below	40%
Family therapy with the patient, 50 minutes CPT 90847 FAM PSYTX W PT 50 MIN SLS	$744.00	$1,240.00	$520.80–$1,178.00	283% above	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAM PSY W PT 50MIN MHU FAC	$45.00	$75.00	$17.25–$71.25	—	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAM PSY W PT 50MIN MHU PF	$135.00	$225.00	$51.75–$213.75	—	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAM PSY W PT 50MIN MHU (P)	$180.00	$300.00	$69.00–$285.00	—	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAM PSYTX W PT 50 MIN SLS	$744.00	$1,240.00	$285.20–$1,178.00	—	40%
Family therapy without the patient, 50 minutes CPT 90846 FAM PSY WO PT 50MIN MHU FAC	$43.20	$72.00	$30.24–$68.40	76% below	40%
Family therapy without the patient, 50 minutes CPT 90846 FAM PSY WO PT 50MIN MHU PF	$129.60	$216.00	$90.72–$205.20	29% below	40%
Family therapy without the patient, 50 minutes CPT 90846 FAM PSY WO PT 50MIN MHU (P)	$172.80	$288.00	$120.96–$273.60	6% below	40%
Family therapy without the patient, 50 minutes CPT 90846 FAM PSYTX W/O PT 50 MIN SLS	$702.00	$1,170.00	$491.40–$1,111.50	284% above	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAM PSY WO PT 50MIN MHU FAC	$43.20	$72.00	$16.56–$68.40	—	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAM PSY WO PT 50MIN MHU PF	$129.60	$216.00	$49.68–$205.20	—	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAM PSY WO PT 50MIN MHU (P)	$172.80	$288.00	$66.24–$273.60	—	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAM PSYTX W/O PT 50 MIN SLS	$702.00	$1,170.00	$269.10–$1,111.50	—	40%
Group psychotherapy session CPT 90853 GROUP PSYTX SLS	$798.00	$1,330.00	$558.60–$1,263.50	922% above	40%
Group psychotherapy session inpatient CPT 90853 GROUP PSYTX SLS	$798.00	$1,330.00	$305.90–$1,263.50	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT CLI	$53.40	$89.00	$37.38–$84.55	80% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYD 1ST HR (31-90M) MS	$414.60	$691.00	$290.22–$656.45	52% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYD 1ST HR (31-90M) ER	$435.60	$726.00	$304.92–$689.70	60% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT CLI	$53.40	$89.00	$20.47–$84.55	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYD 1ST HR (31-90M) MS	$414.60	$691.00	$158.93–$656.45	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYD 1ST HR (31-90M) ER	$435.60	$726.00	$166.98–$689.70	—	40%
IV infusion of a medicine, first hour CPT 96365 IV INF TX/DX 1ST 16-90M MS	$414.60	$691.00	$290.22–$656.45	26% above	40%
IV infusion of a medicine, first hour CPT 96365 IV INF TX/DX 1ST 16-90M ER	$435.60	$726.00	$304.92–$689.70	33% above	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF TX/DX 1ST 16-90M MS	$414.60	$691.00	$158.93–$656.45	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF TX/DX 1ST 16-90M ER	$435.60	$726.00	$166.98–$689.70	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQ/IM RHC	$24.60	$41.00	$17.22–$38.95	68% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQ/IM CLI	$24.60	$41.00	$17.22–$38.95	68% below	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQ/IM NON ER	$129.60	$216.00	$90.72–$205.20	68% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQIM-TX;PRO;DX	$129.60	$216.00	$90.72–$205.20	68% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQ/IM MS	$130.80	$218.00	$91.56–$207.10	69% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQ/IM ER	$130.80	$218.00	$91.56–$207.10	69% above	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SUBQ/IM LDR	$137.40	$229.00	$96.18–$217.55	78% above	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQ/IM CLI	$24.60	$41.00	$9.43–$38.95	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQ/IM RHC	$24.60	$41.00	$9.43–$38.95	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQIM-TX;PRO;DX	$129.60	$216.00	$49.68–$205.20	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQ/IM NON ER	$129.60	$216.00	$49.68–$205.20	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQ/IM ER	$130.80	$218.00	$50.14–$207.10	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQ/IM MS	$130.80	$218.00	$50.14–$207.10	—	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SUBQ/IM LDR	$137.40	$229.00	$52.67–$217.55	—	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL MHU FAC	$73.20	$122.00	$51.24–$115.90	71% below	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL MHU PF	$219.60	$366.00	$153.72–$347.70	14% below	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAG EVAL MHU (P)	$292.80	$488.00	$204.96–$463.60	14% above	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAG EVAL MHU FAC	$73.20	$122.00	$28.06–$115.90	—	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAG EVAL MHU PF	$219.60	$366.00	$84.18–$347.70	—	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAG EVAL MHU (P)	$292.80	$488.00	$112.24–$463.60	—	40%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LVL 3 CLI FAC	$47.40	$79.00	$33.18–$75.05	59% below	40%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LVL 3 ORT FAC	$90.00	$150.00	$63.00–$142.50	23% below	40%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT LVL 3 ORT PF	$142.20	$237.00	$99.54–$225.15	22% above	40%
New patient office visit, about 30 minutes CPT 99203 OFF/OP VISIT NEW LVL 3 HOSP PF	$189.60	$316.00	$132.72–$300.20	62% above	40%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT LVL 3 CLI FAC	$47.40	$79.00	$18.17–$75.05	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT LVL 3 ORT FAC	$90.00	$150.00	$34.50–$142.50	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT LVL 3 ORT PF	$142.20	$237.00	$54.51–$225.15	—	40%
New patient office visit, about 30 minutes inpatient CPT 99203 OFF/OP VISIT NEW LVL 3 HOSP PF	$189.60	$316.00	$72.68–$300.20	—	40%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LVL 4 CLI FAC	$70.80	$118.00	$49.56–$112.10	59% below	40%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LVL 4 ORT FAC	$133.80	$223.00	$93.66–$211.85	22% below	40%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT LVL 4 ORT PF	$213.00	$355.00	$149.10–$337.25	24% above	40%
New patient office visit, about 45 minutes CPT 99204 OFF/OP VISIT NEW LVL 4 HOSP PF	$283.80	$473.00	$198.66–$449.35	65% above	40%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT LVL 4 CLI FAC	$70.80	$118.00	$27.14–$112.10	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT LVL 4 ORT FAC	$133.80	$223.00	$51.29–$211.85	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT LVL 4 ORT PF	$213.00	$355.00	$81.65–$337.25	—	40%
New patient office visit, about 45 minutes inpatient CPT 99204 OFF/OP VISIT NEW LVL 4 HOSP PF	$283.80	$473.00	$108.79–$449.35	—	40%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LVL 5 CLI FAC	$93.60	$156.00	$65.52–$148.20	60% below	40%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT LVL 5 CLI PF	$280.80	$468.00	$196.56–$444.60	19% above	40%
New patient office visit, about 60 minutes CPT 99205 OFF/OP VISIT NEW LVL 5 HOSP PF	$374.40	$624.00	$262.08–$592.80	59% above	40%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT LVL 5 CLI FAC	$93.60	$156.00	$35.88–$148.20	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT LVL 5 CLI PF	$280.80	$468.00	$107.64–$444.60	—	40%
New patient office visit, about 60 minutes inpatient CPT 99205 OFF/OP VISIT NEW LVL 5 HOSP PF	$374.40	$624.00	$143.52–$592.80	—	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LVL 2 CLI FAC	$30.60	$51.00	$21.42–$48.45	60% below	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LVL 2 ORT FAC	$62.40	$104.00	$43.68–$98.80	18% below	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT LVL 2 ORT PF	$91.80	$153.00	$64.26–$145.35	21% above	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFF/OP VISIT NEW LVL 2 HOSP PF	$122.40	$204.00	$85.68–$193.80	61% above	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT LVL 2 CLI FAC	$30.60	$51.00	$11.73–$48.45	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT LVL 2 ORT FAC	$62.40	$104.00	$23.92–$98.80	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT LVL 2 ORT PF	$91.80	$153.00	$35.19–$145.35	—	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFF/OP VISIT NEW LVL 2 HOSP PF	$122.40	$204.00	$46.92–$193.80	—	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTR THERAPY-INT ASSMT 15	$150.00	$250.00	$26.78–$237.50	140% above	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTR THERAPY-INT ASSMT 15	$150.00	$250.00	$57.50–$237.50	—	40%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE18-39CLI FAC	$56.40	$94.00	$39.48–$89.30	65% below	40%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV VISIT NEW AGE18-39 CLI PF	$170.40	$284.00	$119.28–$269.80	5% above	40%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV VISIT NEW AGE18-39CLI FAC	$56.40	$94.00	$21.62–$89.30	—	40%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV VISIT NEW AGE18-39 CLI PF	$170.40	$284.00	$65.32–$269.80	—	40%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE40-64 CLIFAC	$65.40	$109.00	$45.78–$103.55	70% below	40%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE40-64 CLI PF	$196.20	$327.00	$137.34–$310.65	11% below	40%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE40-64 CLIFAC	$65.40	$109.00	$25.07–$103.55	—	40%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE40-64 CLI PF	$196.20	$327.00	$75.21–$310.65	—	40%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VST EST AGE 18-39 CLI FAC	$51.00	$85.00	$35.70–$80.75	61% below	40%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VST EST AGE 18-39 CLI PF	$154.20	$257.00	$107.94–$244.15	19% above	40%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VST EST AGE 18-39 CLI FAC	$51.00	$85.00	$19.55–$80.75	—	40%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VST EST AGE 18-39 CLI PF	$154.20	$257.00	$59.11–$244.15	—	40%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64CLIFAC	$54.00	$90.00	$37.80–$85.50	63% below	40%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64CLI PF	$163.80	$273.00	$114.66–$259.35	13% above	40%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV VISIT EST AGE 40-64CLIFAC	$54.00	$90.00	$20.70–$85.50	—	40%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV VISIT EST AGE 40-64CLI PF	$163.80	$273.00	$62.79–$259.35	—	40%
Preventive checkup, returning patient aged 65 or older CPT 99397 PM REEVAL EST PT 65+ CLIFAC	$58.20	$97.00	$40.74–$92.15	73% below	40%
Preventive checkup, returning patient aged 65 or older CPT 99397 PM REEVAL EST PT 65+ CLI PF	$176.40	$294.00	$123.48–$279.30	18% below	40%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PM REEVAL EST PT 65+ CLIFAC	$58.20	$97.00	$22.31–$92.15	—	40%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PM REEVAL EST PT 65+ CLI PF	$176.40	$294.00	$67.62–$279.30	—	40%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EV W MED MHU FAC	$82.20	$137.00	$57.54–$130.15	59% below	40%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EV W MED MHU PF	$246.60	$411.00	$172.62–$390.45	24% above	40%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EV W MED MHU (P)	$328.80	$548.00	$230.16–$520.60	65% above	40%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAG EV W MED MHU FAC	$82.20	$137.00	$31.51–$130.15	—	40%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAG EV W MED MHU PF	$246.60	$411.00	$94.53–$390.45	—	40%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAG EV W MED MHU (P)	$328.80	$548.00	$126.04–$520.60	—	40%
Psychotherapy session, 30 minutes CPT 90832 PSYTX 30 MIN MHU FAC	$34.20	$57.00	$23.94–$54.15	70% below	40%
Psychotherapy session, 30 minutes CPT 90832 PSYTX 30 MIN MHU PF	$104.40	$174.00	$73.08–$165.30	9% below	40%
Psychotherapy session, 30 minutes CPT 90832 PSYTX 30 MIN MHU (P)	$138.60	$231.00	$97.02–$219.45	21% above	40%
Psychotherapy session, 30 minutes CPT 90832 BH THERAPY 30 MIN SLS	$501.00	$835.00	$350.70–$793.25	339% above	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX 30 MIN MHU FAC	$34.20	$57.00	$13.11–$54.15	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX 30 MIN MHU PF	$104.40	$174.00	$40.02–$165.30	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX 30 MIN MHU (P)	$138.60	$231.00	$53.13–$219.45	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 BH THERAPY 30 MIN SLS	$501.00	$835.00	$192.05–$793.25	—	40%
Psychotherapy session, 45 minutes CPT 90834 PSYTX 45 MIN MHU FAC	$45.60	$76.00	$31.92–$72.20	69% below	40%
Psychotherapy session, 45 minutes CPT 90834 PSYTX 45 MIN MHU PF	$137.40	$229.00	$96.18–$217.55	8% below	40%
Psychotherapy session, 45 minutes CPT 90834 PSYTX 45 MIN MHU (P)	$183.00	$305.00	$128.10–$289.75	22% above	40%
Psychotherapy session, 45 minutes CPT 90834 BH THERAPY 45 MIN SLS	$660.00	$1,100.00	$462.00–$1,045.00	342% above	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX 45 MIN MHU FAC	$45.60	$76.00	$17.48–$72.20	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX 45 MIN MHU PF	$137.40	$229.00	$52.67–$217.55	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX 45 MIN MHU (P)	$183.00	$305.00	$70.15–$289.75	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 BH THERAPY 45 MIN SLS	$660.00	$1,100.00	$253.00–$1,045.00	—	40%
Psychotherapy session, 60 minutes CPT 90837 PSYTX 60 MIN MHU FAC	$67.80	$113.00	$47.46–$107.35	63% below	40%
Psychotherapy session, 60 minutes CPT 90837 PSYTX 60 MIN MHU PF	$203.40	$339.00	$142.38–$322.05	12% above	40%
Psychotherapy session, 60 minutes CPT 90837 PSYTX 60 MIN MHU (P)	$271.20	$452.00	$189.84–$429.40	50% above	40%
Psychotherapy session, 60 minutes CPT 90837 BH THERAPY 60 MIN SLS	$798.00	$1,330.00	$558.60–$1,263.50	341% above	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX 60 MIN MHU FAC	$67.80	$113.00	$25.99–$107.35	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX 60 MIN MHU PF	$203.40	$339.00	$77.97–$322.05	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYTX 60 MIN MHU (P)	$271.20	$452.00	$103.96–$429.40	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 BH THERAPY 60 MIN SLS	$798.00	$1,330.00	$305.90–$1,263.50	—	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFF/OP VISIT EST LVL 5 CLI FAC	$76.20	$127.00	$53.34–$120.65	55% below	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFF/OP VISIT EST LVL 5 CLI PF	$230.40	$384.00	$161.28–$364.80	36% above	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP VISIT LEVEL 5 NON-ER	$280.20	$467.00	$196.14–$443.65	66% above	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFF/OP VISIT EST LVL 5 HOSP PF	$306.60	$511.00	$214.62–$485.45	81% above	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFF/OP VISIT EST LVL 5 CLI FAC	$76.20	$127.00	$29.21–$120.65	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFF/OP VISIT EST LVL 5 CLI PF	$230.40	$384.00	$88.32–$364.80	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP VISIT LEVEL 5 NON-ER	$280.20	$467.00	$107.41–$443.65	—	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFF/OP VISIT EST LVL 5 HOSP PF	$306.60	$511.00	$117.53–$485.45	—	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFF/OP VISIT EST LVL 3 CLI FAC	$39.00	$65.00	$27.30–$61.75	59% below	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFF/OP VISIT EST LVL 3 ORT FAC	$61.20	$102.00	$42.84–$96.90	35% below	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFF/OP VISIT EST LVL 3 ORT PF	$117.00	$195.00	$81.90–$185.25	24% above	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP VISIT LEVEL 3 NON-ER	$145.20	$242.00	$101.64–$229.90	54% above	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFF/OP VISIT EST LVL 3 HOSP	$156.00	$260.00	$109.20–$247.00	66% above	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFF/OP VISIT EST LVL 3 CLI FAC	$39.00	$65.00	$14.95–$61.75	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFF/OP VISIT EST LVL 3 ORT FAC	$61.20	$102.00	$23.46–$96.90	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFF/OP VISIT EST LVL 3 ORT PF	$117.00	$195.00	$44.85–$185.25	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP VISIT LEVEL 3 NON-ER	$145.20	$242.00	$55.66–$229.90	—	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFF/OP VISIT EST LVL 3 HOSP	$156.00	$260.00	$59.80–$247.00	—	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFF/OP VISIT EST LVL 4 CLI FAC	$54.60	$91.00	$38.22–$86.45	55% below	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFF/OP VISIT EST LVL 4 ORT FAC	$90.00	$150.00	$63.00–$142.50	25% below	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFF/OP VISIT EST LVL 4 ORT PF	$164.40	$274.00	$115.08–$260.30	37% above	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP VISIT LEVEL 4 NON-ER	$181.20	$302.00	$126.84–$286.90	51% above	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFF/OP VISIT EST LVL 4 HOSP	$219.00	$365.00	$153.30–$346.75	82% above	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFF/OP VISIT EST LVL 4 CLI FAC	$54.60	$91.00	$20.93–$86.45	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFF/OP VISIT EST LVL 4 ORT FAC	$90.00	$150.00	$34.50–$142.50	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFF/OP VISIT EST LVL 4 ORT PF	$164.40	$274.00	$63.02–$260.30	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP VISIT LEVEL 4 NON-ER	$181.20	$302.00	$69.46–$286.90	—	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFF/OP VISIT EST LVL 4 HOSP	$219.00	$365.00	$83.95–$346.75	—	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFF/OP VISIT EST LVL 2 CLI FAC	$24.00	$40.00	$16.80–$38.00	71% below	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFF/OP VISIT EST LVL 2 ORT FAC	$42.00	$70.00	$29.40–$66.50	49% below	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFF/OP VISIT EST LVL 2 ORT PF	$72.60	$121.00	$50.82–$114.95	11% below	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFF/OP VISIT EST LVL 2 HOSP	$96.60	$161.00	$67.62–$152.95	18% above	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP VISIT LEVEL 2 NON-ER	$127.20	$212.00	$89.04–$201.40	56% above	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFF/OP VISIT EST LVL 2 CLI FAC	$24.00	$40.00	$9.20–$38.00	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFF/OP VISIT EST LVL 2 ORT FAC	$42.00	$70.00	$16.10–$66.50	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFF/OP VISIT EST LVL 2 ORT PF	$72.60	$121.00	$27.83–$114.95	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFF/OP VISIT EST LVL 2 HOSP	$96.60	$161.00	$37.03–$152.95	—	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP VISIT LEVEL 2 NON-ER	$127.20	$212.00	$48.76–$201.40	—	40%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT/OP VISIT LEVEL 4	$328.20	$547.00	$229.74–$519.65	59% above	40%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT/OP VISIT LEVEL 4	$328.20	$547.00	$125.81–$519.65	—	40%
Spirometry (breathing test) CPT 94010 SPIROMETRY TOTAL EXP FLOW PROF	$46.80	$78.00	$32.76–$74.10	71% below	40%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$99.60	$166.00	$69.72–$157.70	37% below	40%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY TOTAL EXP FLOW PROF	$46.80	$78.00	$17.94–$74.10	—	40%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$99.60	$166.00	$38.18–$157.70	—	40%
Spirometry before and after a bronchodilator CPT 94060 BRONCHOSPASM EVAL BEF/AF PROF	$67.20	$112.00	$47.04–$106.40	77% below	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHOSPASM EVAL BEF/AF PROF	$67.20	$112.00	$25.76–$106.40	—	40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPUTIC PHLEBOTOMY	$409.20	$682.00	$286.44–$647.90	94% above	40%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPUTIC PHLEBOTOMY	$409.20	$682.00	$156.86–$647.90	—	40%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 STRESS TEST	$301.20	$502.00	$210.84–$476.90	162% above	40%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 STRESS TEST	$301.20	$502.00	$115.46–$476.90	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 IV ADJUVANT VACCINE IM CLI	$74.13	$123.54	$51.89–$117.37	4% below	40%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 FL FLUAD TRI 24-25 (65UP) 0.5M	$184.56	$307.59	$78.86–$292.22	140% above	40%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 IV ADJUVANT VACCINE IM CLI	$74.13	$123.54	$28.42–$117.37	—	40%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 FL FLUAD TRI 24-25 (65UP) 0.5M	$184.56	$307.59	$70.75–$292.22	—	40%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VACLIVE1350 U/.5ML	$382.73	$637.88	$196.73–$605.99	60% above	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VACLIVE1350 U/.5ML	$382.73	$637.88	$146.72–$605.99	—	40%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML CLI	$25.86	$43.10	$18.11–$40.95	17% above	40%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX TRIV24-25 6M+ 0.5M SY	$49.41	$82.34	$21.21–$78.23	123% above	40%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 IIV3 VACC NO PRSV 0.5 ML CLI	$25.86	$43.10	$9.92–$40.95	—	40%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX TRIV24-25 6M+ 0.5M SY	$49.41	$82.34	$18.94–$78.23	—	40%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 3 DOSE IM CLI	$238.25	$397.08	$166.78–$377.23	37% below	40%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 9VHPV VACCINE 3 DOSE IM CLI	$238.25	$397.08	$91.33–$377.23	—	40%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VIRUS VAC PF 20 MCG/ML	$150.14	$250.22	$73.97–$237.71	34% above	40%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B VIRUS VAC PF 20 MCG/ML	$150.14	$250.22	$57.56–$237.71	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES MU & RUB VAC.5 ML	$195.20	$325.33	$102.34–$309.07	56% above	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES MU & RUB VAC.5 ML	$195.20	$325.33	$74.83–$309.07	—	40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MCV4 MENACWY VACCINE IM	$125.55	$209.25	$87.89–$198.79	36% below	40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VACC 4MCG/0.5ML	$310.80	$518.00	$179.26–$492.10	59% above	40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MCV4 MENACWY VACCINE IM	$125.55	$209.25	$48.13–$198.79	—	40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VACC 4MCG/0.5ML	$310.80	$518.00	$119.14–$492.10	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM CLI	$209.86	$349.76	$146.90–$332.28	48% below	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOL 20-VAL CONJUG 0.5 ML	$593.17	$988.61	$415.22–$939.18	47% above	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM CLI	$209.86	$349.76	$80.45–$332.28	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOL 20-VAL CONJUG 0.5 ML	$593.17	$988.61	$227.39–$939.18	—	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM	$95.91	$159.85	$67.14–$151.86	27% below	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEU 23-VAL P-SAC VAC 0.5ML	$245.87	$409.78	$125.86–$389.30	86% above	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEU 23-VAL P-SAC VAC 2.5ML	$759.99	$1,266.65	$125.86–$1,203.32	476% above	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM	$95.91	$159.85	$36.77–$151.86	—	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEU 23-VAL P-SAC VAC 0.5ML	$245.87	$409.78	$94.25–$389.30	—	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEU 23-VAL P-SAC VAC 2.5ML	$759.99	$1,266.65	$291.33–$1,203.32	—	40%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM CLI	$876.60	$1,461.00	$344.65–$1,387.95	59% above	40%
Rabies vaccine, one dose CPT 90675 RABIES VAC HUM DIPLOID PF2.5	$911.01	$1,518.34	$344.65–$1,442.43	65% above	40%
Rabies vaccine, one dose CPT 90675 RABIES VAC (AVIAN) 2.5 INJ KIT	$1,043.06	$1,738.42	$344.65–$1,651.50	89% above	40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM CLI	$876.60	$1,461.00	$336.03–$1,387.95	—	40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VAC HUM DIPLOID PF2.5	$911.01	$1,518.34	$349.22–$1,442.43	—	40%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VAC (AVIAN) 2.5 INJ KIT	$1,043.06	$1,738.42	$399.84–$1,651.50	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TET/DIP TOXOIDSADULT TD0.5ML	$92.87	$154.77	$36.84–$147.04	49% above	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TET/DIP TOXOIDSADULT TD0.5ML	$92.87	$154.77	$35.60–$147.04	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE >7 IM	$49.50	$82.50	$34.65–$78.38	37% below	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPPERT(ACELL)TET VAC .5 ML	$97.65	$162.75	$42.39–$154.62	25% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPPERT(ACELL)TET VAC. 5 ML	$98.60	$164.33	$42.39–$156.12	26% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 10+YRS 0.5ML SYRNG	$115.17	$191.94	$42.39–$182.35	47% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE >7 IM	$49.50	$82.50	$18.98–$78.38	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPPERT(ACELL)TET VAC .5 ML	$97.65	$162.75	$37.44–$154.62	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPPERT(ACELL)TET VAC. 5 ML	$98.60	$164.33	$37.80–$156.12	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 10+YRS 0.5ML SYRNG	$115.17	$191.94	$44.15–$182.35	—	40%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYP VI POLY VACC 25 MCG/0.5ML	$307.80	$513.00	$157.56–$487.35	111% above	40%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYP VI POLY VACC 25 MCG/0.5ML	$307.80	$513.00	$117.99–$487.35	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN OTHER FBC	$35.40	$59.00	$24.78–$56.05	14% below	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN OTHER MS	$48.00	$80.00	$33.60–$76.00	17% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN FLU SFO	$58.20	$97.00	$40.74–$92.15	42% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN FLU FBC	$59.40	$99.00	$41.58–$94.05	45% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN OTHER FBC	$35.40	$59.00	$13.57–$56.05	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN OTHER MS	$48.00	$80.00	$18.40–$76.00	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN FLU SFO	$58.20	$97.00	$22.31–$92.15	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN FLU FBC	$59.40	$99.00	$22.77–$94.05	—	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN ADDL EACH FBC	$25.20	$42.00	$17.64–$39.90	at median	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN ADDL EACH SWG	$34.20	$57.00	$23.94–$54.15	36% above	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADMIN ADDL EACH ER	$135.60	$226.00	$94.92–$214.70	438% above	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADMIN ADDL EACH FBC	$25.20	$42.00	$9.66–$39.90	—	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADMIN ADDL EACH SWG	$34.20	$57.00	$13.11–$54.15	—	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADMIN ADDL EACH ER	$135.60	$226.00	$51.98–$214.70	—	40%

Dental

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Removal of an impacted tooth fully covered by bone, often a wisdom tooth CDT D7240 EXT IMPACT TOOTH-COMP BON	$345.60	$576.00	$241.92–$547.20	—	40%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth inpatient CDT D7240 EXT IMPACT TOOTH-COMP BON	$345.60	$576.00	$132.48–$547.20	—	40%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 EXT ERUPT TOOTH/EXP ROOT	$93.60	$156.00	$65.52–$148.20	—	40%
Simple extraction of a tooth or exposed root that is above the gum inpatient CDT D7140 EXT ERUPT TOOTH/EXP ROOT	$93.60	$156.00	$35.88–$148.20	—	40%

Source file: https://www.chistfrancishealth.org/content/dam/sfcareorg/website/workfiles/410695598-1639162381_st-francis-medical-center_standardcharges.csv