Uintah Basin Medical Center
Uintah Basin Medical Center in Roosevelt, UT publishes cash prices for 226 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Utah median for 73 of 190 procedures and above it for 72. By typical cash price it ranks #2 of 5 Utah hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
250 W 300 N,Roosevelt,UT,84066 Collected Sep 27, 2026 Source price file (435) 722-4691
Acute care hospital Emergency department CMS star rating 2 of 5 CCN 460019 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Utah | Off list |
|---|---|---|---|---|---|
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS | $413.55 | $459.50 | $143.57–$502.50 | 18% above | 10% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED | $168.75 | $187.50 | $93.91–$328.68 | 62% below | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST | $2,203.65 | $2,448.50 | $189.27–$662.44 | at median | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST | $3,698.78 | $4,109.75 | $257.48–$901.18 | 27% above | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST | $3,962.25 | $4,402.50 | $376.48–$1,317.68 | 31% above | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD OR BRAIN WITHOUT CONTRAST | $1,890.00 | $2,100.00 | $112.81–$394.84 | 6% above | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SCAN OF UPPER SPINE WITHOUT CONTRAST | $2,250.45 | $2,500.50 | $112.81–$394.83 | 11% above | 10% |
| Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $364.50 | $405.00 | $93.91–$328.68 | 3% below | 10% |
| Chest X-ray, 2 views CPT 71046 X-RAY OF CHEST; 2 VIEWS | $405.00 | $450.00 | $93.91–$328.68 | 7% above | 10% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $294.30 | $327.00 | $93.91–$328.68 | 11% above | 10% |
| Chest X-ray, single view CPT 71045 X-RAY OF CHEST; 1 VIEW | $324.23 | $360.25 | $93.91–$328.68 | 22% above | 10% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY MEASUREMENT OF HIP; PELVIS; SPINE | $513.90 | $571.00 | $112.81–$394.84 | 2% below | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT SCAN OF CHEST WITHOUT CONTRAST | $1,534.50 | $1,705.00 | $112.81–$394.84 | at median | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT SCAN OF CHEST WITH CONTRAST | $2,040.30 | $2,267.00 | $189.27–$662.44 | at median | 10% |
| Diagnostic mammogram, both breasts CPT 77066 DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS | $546.98 | $607.75 | $45.52–$159.32 | — | 10% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ULTRASOUND OF HEART WITH COLOR-DEPICTED BLOOD FLOW; RATE; DIRECTION AND VALVE FUNCTION | $1,322.33 | $1,469.25 | $589.64–$2,063.74 | 14% below | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY INCLUDING HEART RATE; BREATHING; AIRFLOW; AND EFFORT | $393.30 | $437.00 | $233.00–$815.50 | — | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT | $437.63 | $486.25 | $233.00–$815.50 | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 LIMITED ULTRASOUND SCAN OF ABDOMEN | $763.20 | $848.00 | $112.81–$394.84 | at median | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING | $868.50 | $965.00 | $112.81–$394.83 | 5% above | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST | $3,982.50 | $4,425.00 | $376.48–$1,317.68 | 2% above | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI SCAN OF PELVIS WITHOUT CONTRAST | $2,719.13 | $3,021.25 | $257.48–$901.18 | 10% above | 10% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NUCLEAR MEDICINE STUDIES OF HEART MUSCLE AT REST AND WITH STRESS AND SPECT | $3,425.85 | $3,806.50 | $1,397.06–$4,889.71 | at median | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 COMPLETE ULTRASOUND SCAN OF PELVIS | $813.60 | $904.00 | $112.81–$394.84 | 21% above | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 LIMITED ULTRASOUND OF PREGNANT UTERUS | $416.70 | $463.00 | $112.81–$394.83 | at median | 10% |
| Screening mammogram, both breasts CPT 77067 SCREENING MAMMOGRAPHY | $496.13 | $551.25 | $34.39–$120.36 | — | 10% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ULTRASOUND OF HEART WITH CONTINUOUS ELECTROCARDIOGRAM (ECG) DURING REST; EXERCISE AND/OR DRUG INDUCED STRESS WITH REVIEW AND REPORT | $1,190.70 | $1,323.00 | $589.64–$2,063.74 | 15% below | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE | $160.65 | $178.50 | $112.81–$394.84 | 72% below | 10% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 SINGLE CONTRAST X-RAY OF UPPER DIGESTIVE TRACT | $639.90 | $711.00 | $189.27–$662.45 | at median | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY OF LOWER AND SACRAL SPINE; 2-3 VIEWS | $456.75 | $507.50 | $112.81–$394.84 | 5% above | 10% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY OF MIDDLE SPINE; 2 VIEWS | $381.38 | $423.75 | $112.81–$394.84 | 3% above | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY OF SACRUM AND TAILBONE; MINIMUM OF 2 VIEWS | $449.78 | $499.75 | $93.91–$328.68 | 28% above | 10% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Utah | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 LIVER ENZYME (SGPT); LEVEL | $59.18 | $65.75 | $5.30–$8.84 | 17% above | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 LIVER ENZYME (SGOT); LEVEL | $52.88 | $58.75 | $5.18–$8.63 | 1% above | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $55.58 | $61.75 | $5.18–$8.63 | 6% above | 10% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $148.50 | $165.00 | $47.63–$79.40 | 26% below | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $16.88 | $18.75 | $5.22–$8.70 | 30% below | 10% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE; CRUDE ALLERGEN EXTRACT; EACH | $141.53 | $157.25 | $5.22–$8.70 | 490% above | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT | $24.53 | $27.25 | $12.95–$21.59 | 45% below | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $25.65 | $28.50 | $12.95–$21.59 | 43% below | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 SCREENING TEST FOR AUTOIMMUNE DISORDER | $93.15 | $103.50 | $12.09–$20.15 | at median | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $173.70 | $193.00 | $12.09–$20.15 | 86% above | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL | $220.28 | $244.75 | $39.26–$58.89 | 18% below | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $231.30 | $257.00 | $39.26–$58.89 | 14% below | 10% |
| Basic metabolic panel (blood test) CPT 80048 BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) | $116.10 | $129.00 | $8.46–$14.10 | 22% above | 10% |
| Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA | $121.95 | $135.50 | $8.46–$14.10 | 28% above | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; INTERMEDIATE COMPLEXITY | $70.20 | $78.00 | $56.23–$196.80 | 42% below | 10% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST | $173.70 | $193.00 | $56.23–$196.80 | 45% above | 10% |
| Blood culture for bacteria CPT 87040 BACTERIAL BLOOD CULTURE | $176.85 | $196.50 | $10.32–$17.21 | at median | 10% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $185.63 | $206.25 | $10.32–$17.21 | 5% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $40.73 | $45.25 | $3.00–$9.34 | 33% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE | $81.45 | $90.50 | $3.00–$9.34 | 165% above | 10% |
| Blood glucose (sugar) test CPT 82947 BLOOD GLUCOSE (SUGAR) LEVEL | $56.70 | $63.00 | $3.93–$6.56 | at median | 10% |
| Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $59.63 | $66.25 | $3.93–$6.56 | 5% above | 10% |
| Blood lead test CPT 83655 LEAD LEVEL | $45.00 | $50.00 | $12.11–$20.18 | 44% below | 10% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS | $77.40 | $86.00 | $7.52–$12.54 | at median | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $56.93 | $63.25 | $2.99–$143.57 | at median | 10% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD GROUP TYPING (ABO) | $183.15 | $203.50 | $2.99–$143.57 | 222% above | 10% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION | $97.65 | $108.50 | $5.18–$8.63 | 4% above | 10% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $146.34 | $162.60 | $37.27–$58.49 | at median | 10% |
| C. difficile toxin gene test (stool PCR) CPT 87493 DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE; AMPLIFIED PROBE TECHNIQUE | $204.30 | $227.00 | $37.27–$58.49 | 40% above | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 19-9 | $81.00 | $90.00 | $20.81–$34.70 | 14% below | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $85.05 | $94.50 | $20.81–$34.70 | 10% below | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 125 | $123.75 | $137.50 | $20.81–$34.70 | 15% above | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $130.05 | $144.50 | $20.81–$34.70 | 21% above | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN | $85.05 | $94.50 | $51.31–$76.97 | 21% below | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $89.33 | $99.25 | $51.31–$76.97 | 17% below | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $55.35 | $61.50 | $35.09–$58.49 | 36% below | 10% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS; AMPLIFIED PROBE TECHNIQUE | $135.00 | $150.00 | $35.09–$58.49 | 57% above | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) | $96.98 | $107.75 | $13.39–$22.32 | 33% below | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $101.93 | $113.25 | $13.39–$22.32 | 29% below | 10% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT | $20.70 | $23.00 | $7.77–$12.95 | 73% below | 10% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $78.30 | $87.00 | $7.77–$12.95 | 3% above | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS | $135.45 | $150.50 | $10.56–$17.61 | 2% above | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $142.20 | $158.00 | $10.56–$17.61 | 8% above | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL | $149.18 | $165.75 | $22.23–$37.07 | at median | 10% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $113.40 | $126.00 | $27.94–$46.56 | at median | 10% |
| Estradiol blood test CPT 82670 MEASUREMENT OF TOTAL ESTRADIOL (HORMONE) | $213.30 | $237.00 | $27.94–$46.56 | 88% above | 10% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN; FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL | $152.78 | $169.75 | $18.58–$30.98 | at median | 10% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $203.63 | $226.25 | $19.63–$32.72 | 134% above | 10% |
| Fecal calprotectin (stool inflammation test) CPT 83993 STOOL CALPROTECTIN (PROTEIN) LEVEL | $206.55 | $229.50 | $19.63–$32.72 | 137% above | 10% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN (BLOOD PROTEIN) LEVEL | $121.05 | $134.50 | $13.63–$22.73 | at median | 10% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $127.13 | $141.25 | $13.63–$22.73 | 5% above | 10% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID LEVEL; SERUM | $123.98 | $137.75 | $14.70–$24.51 | at median | 10% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $130.28 | $144.75 | $14.70–$24.51 | 5% above | 10% |
| Free T3 thyroid hormone test CPT 84481 THYROID HORMONE; T3 MEASUREMENT; FREE | $132.75 | $147.50 | $16.94–$28.23 | at median | 10% |
| Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) | $139.50 | $155.00 | $16.94–$28.23 | 5% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE (THYROID CHEMICAL); FREE | $124.43 | $138.25 | $9.02–$15.03 | 5% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $130.73 | $145.25 | $9.02–$15.03 | 11% above | 10% |
| Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE | $64.67 | $71.85 | $25.47–$42.45 | 52% below | 10% |
| Free testosterone test CPT 84402 TESTOSTERONE (HORMONE) LEVEL; FREE | $164.93 | $183.25 | $25.47–$42.45 | 22% above | 10% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $329.63 | $366.25 | $70.82 | 13% above | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE | $78.30 | $87.00 | $4.75–$7.91 | at median | 10% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $82.13 | $91.25 | $4.75–$7.91 | 5% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 BLOOD GLUCOSE (SUGAR) TOLERANCE TEST; 3 SPECIMENS | $139.95 | $155.50 | $12.87–$21.45 | at median | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $146.93 | $163.25 | $12.87–$21.45 | 5% above | 10% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA); AMPLIFIED PROBE TECHNIQUE | $126.68 | $140.75 | $35.09–$58.49 | at median | 10% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $164.25 | $182.50 | $16.85–$25.28 | 14% above | 10% |
| H. pylori stool antigen test CPT 87338 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI (GI TRACT BACTERIA) IN STOOL | $141.75 | $157.50 | $14.38–$23.97 | 83% above | 10% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $148.95 | $165.50 | $14.38–$23.97 | 92% above | 10% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS; QUANTIFICATION | $197.10 | $219.00 | $85.10–$141.83 | 23% below | 10% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ | $207.00 | $230.00 | $85.10–$141.83 | 19% below | 10% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $108.68 | $120.75 | $13.71–$22.85 | 1% below | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES | $36.05 | $40.05 | $24.08–$40.13 | at median | 10% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $43.88 | $48.75 | $24.08–$40.13 | 21% above | 10% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV); HIGH-RISK TYPES | $315.90 | $351.00 | $35.09–$58.49 | 126% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C LEVEL | $32.40 | $36.00 | $9.71–$16.19 | 55% below | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $99.00 | $110.00 | $9.71–$16.19 | 38% above | 10% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY MEASUREMENT | $105.98 | $117.75 | $10.74–$17.90 | at median | 10% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN | $83.48 | $92.75 | $10.33–$17.22 | 6% above | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY MEASUREMENT | $145.80 | $162.00 | $14.27–$23.78 | 37% above | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS; QUANTIFICATION | $130.95 | $145.50 | $42.84–$71.40 | at median | 10% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $360.90 | $401.00 | $42.84–$71.40 | 176% above | 10% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $38.48 | $42.75 | $13.19–$21.98 | 52% below | 10% |
| Herpes blood test, HSV-1 antibody CPT 86695 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS; TYPE 1 | $71.10 | $79.00 | $13.19–$21.98 | 11% below | 10% |
| Herpes blood test, HSV-2 antibody CPT 86696 ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS; TYPE 2 | $30.38 | $33.75 | $19.35–$32.27 | 69% below | 10% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $45.00 | $50.00 | $19.35–$32.27 | 54% below | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION; HIGH SENSITIVITY | $119.70 | $133.00 | $12.95–$21.59 | at median | 10% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE (AMINO ACID) LEVEL | $134.33 | $149.25 | $17.92–$28.11 | at median | 10% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $134.78 | $149.75 | $17.92–$28.11 | at median | 10% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN | $18.00 | $20.00 | $11.43–$19.05 | 75% below | 10% |
| Insulin blood test CPT 83525 INSULIN MEASUREMENT; TOTAL | $95.18 | $105.75 | $11.43–$19.05 | 33% above | 10% |
| Iron blood test (serum iron) CPT 83540 IRON LEVEL | $58.05 | $64.50 | $6.47–$10.79 | 4% below | 10% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $60.98 | $67.75 | $6.47–$10.79 | 1% above | 10% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $103.28 | $114.75 | $8.74–$14.57 | 18% above | 10% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $108.45 | $120.50 | $8.74–$14.57 | 24% above | 10% |
| Kidney function blood test panel CPT 80069 KIDNEY FUNCTION BLOOD TEST PANEL | $123.30 | $137.00 | $8.68–$14.48 | 4% above | 10% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN; LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL | $142.20 | $158.00 | $18.52–$30.86 | at median | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $101.03 | $112.25 | $6.89–$11.48 | 72% above | 10% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE (FAT ENZYME) LEVEL | $102.38 | $113.75 | $6.89–$11.48 | 74% above | 10% |
| Liver function blood test panel CPT 80076 LIVER FUNCTION BLOOD TEST PANEL | $121.95 | $135.50 | $8.17–$13.62 | 49% above | 10% |
| Lyme disease antibody test CPT 86618 ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA) | $43.49 | $48.32 | $17.03–$28.38 | 68% below | 10% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $83.03 | $92.25 | $17.03–$28.38 | 38% below | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM LEVEL | $60.30 | $67.00 | $6.70–$11.16 | at median | 10% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $78.75 | $87.50 | $6.70–$11.16 | 31% above | 10% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $22.50 | $25.00 | $12.88–$21.47 | 76% below | 10% |
| Measles (rubeola) antibody test CPT 86765 ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS) | $93.60 | $104.00 | $12.88–$21.47 | 1% above | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 SCREENING TEST FOR MONONUCLEOSIS (MONO) | $52.20 | $58.00 | $5.18–$8.63 | 16% below | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $54.90 | $61.00 | $5.18–$8.63 | 12% below | 10% |
| Obstetric blood test panel CPT 80055 OBSTETRIC BLOOD TEST PANEL | $416.70 | $463.00 | $47.81–$79.68 | 142% above | 10% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $437.63 | $486.25 | $47.81–$79.68 | 154% above | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; FREE | $112.28 | $124.75 | $18.39–$30.66 | 2% below | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL | $127.13 | $141.25 | $18.39–$30.66 | 4% above | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $133.43 | $148.25 | $18.39–$30.66 | 9% above | 10% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP TEST; MANUAL SCREENING | $128.93 | $143.25 | $20.26–$33.77 | 16% above | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) LEVEL | $187.65 | $208.50 | $41.28–$68.79 | at median | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $197.10 | $219.00 | $41.28–$68.79 | 5% above | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $56.70 | $63.00 | $6.01–$10.01 | 32% below | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD | $85.28 | $94.75 | $6.01–$10.01 | 3% above | 10% |
| Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 FETAL CHRMOML ANEUPLOIDY | $1,525.95 | $1,695.50 | $759.05–$1,138.58 | 42% above | 10% |
| Progesterone blood test CPT 84144 PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL | $145.80 | $162.00 | $20.86–$34.77 | 25% above | 10% |
| Prolactin blood test CPT 84146 PROLACTIN (MILK PRODUCING HORMONE) LEVEL | $143.78 | $159.75 | $19.38–$32.30 | 2% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 BLOOD TEST; CLOTTING TIME | $6.30 | $7.00 | $4.29–$6.56 | 84% below | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $24.75 | $27.50 | $4.29–$6.56 | 37% below | 10% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC | $67.05 | $74.50 | $16.53–$24.80 | 9% below | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR LEVEL | $45.00 | $50.00 | $5.67–$9.45 | at median | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $54.45 | $60.50 | $5.67–$9.45 | 21% above | 10% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $27.68 | $30.75 | $14.39–$23.99 | 72% below | 10% |
| Rubella antibody test (immunity check) CPT 86762 ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS) | $59.63 | $66.25 | $14.39–$23.99 | 39% below | 10% |
| Stool ova and parasites exam CPT 87177 SMEAR FOR PARASITES | $163.80 | $182.00 | $8.90–$14.84 | 88% above | 10% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS | $62.55 | $69.50 | $4.38–$6.57 | 62% above | 10% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $65.70 | $73.00 | $4.38–$6.57 | 70% above | 10% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS DETECTION TEST | $52.20 | $58.00 | $4.27–$7.13 | 9% below | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST; GAMMA INTERFERON | $97.65 | $108.50 | $61.98–$103.31 | 45% below | 10% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $102.60 | $114.00 | $61.98–$103.31 | 42% below | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE (HORMONE) LEVEL; TOTAL | $170.78 | $189.75 | $25.81–$43.02 | 26% above | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH | $108.23 | $120.25 | $14.55–$24.26 | 9% above | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT | $136.58 | $151.75 | $14.55–$24.26 | 37% above | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 BLOOD TEST; THYROID STIMULATING HORMONE (TSH) | $103.95 | $115.50 | $16.80–$28.01 | 24% below | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $109.13 | $121.25 | $16.80–$28.01 | 21% below | 10% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $64.13 | $71.25 | $35.09–$58.49 | at median | 10% |
| Trichomonas test (NAAT) CPT 87661 DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE); AMPLIFIED PROBE TECHNIQUE | $105.98 | $117.75 | $35.09–$58.49 | 65% above | 10% |
| Uric acid blood test CPT 84550 URIC ACID LEVEL; BLOOD | $57.60 | $64.00 | $4.52–$7.53 | 20% above | 10% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $60.53 | $67.25 | $4.52–$7.53 | 26% above | 10% |
| Urinalysis with microscope exam, automated CPT 81001 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED | $73.58 | $81.75 | $3.17–$5.28 | 20% above | 10% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE | $41.63 | $46.25 | $2.25–$3.74 | at median | 10% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS; MANUAL TEST | $7.20 | $8.00 | $3.48–$5.22 | 73% below | 10% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $11.70 | $13.00 | $8.61–$12.92 | 84% below | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B-12) LEVEL | $132.08 | $146.75 | $15.08–$25.13 | at median | 10% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $138.60 | $154.00 | $15.08–$25.13 | 5% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D-3 LEVEL | $128.48 | $142.75 | $29.60–$49.34 | 5% above | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $135.00 | $150.00 | $29.60–$49.34 | 11% above | 10% |
| Zinc blood test CPT 84630 ZINC LEVEL | $54.90 | $61.00 | $11.39–$18.98 | 12% below | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL | $80.33 | $89.25 | $15.05–$25.10 | 36% below | 10% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $84.38 | $93.75 | $15.05–$25.10 | 33% below | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Utah | Off list |
|---|---|---|---|---|---|
| Appendectomy, open surgery CPT 44950 REMOVAL OF APPENDIX | $7,402.50 | $8,225.00 | $6,985.91–$24,450.68 | — | 10% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE | $482.85 | $536.50 | $266.18–$931.63 | — | 10% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE | $317.70 | $353.00 | $266.18–$931.63 | — | 10% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION OF BUNION WITH ALIGNMENT CORRECTION OF MIDFOOT BONE TOWARD TOE AREA | $8,370.00 | $9,300.00 | $3,530.81–$12,357.84 | — | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT | $1,302.53 | $1,447.25 | $713.22–$2,496.27 | 7% above | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,367.55 | $1,519.50 | $713.22–$2,496.27 | 12% above | 10% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 REMOVAL OF FORESKIN (OLDER THAN 28 DAYS) | $2,250.00 | $2,500.00 | $2,255.73–$7,895.06 | 20% below | 10% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $166.73 | $185.25 | — | — | 10% |
| Colonoscopy with polyp removal CPT 45385 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE | $1,113.75 | $1,237.50 | $1,291.29–$4,519.52 | 53% below | 10% |
| Colonoscopy with tissue sample CPT 45380 BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $2,227.50 | $2,475.00 | $1,291.29–$4,519.52 | at median | 10% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,980.00 | $2,200.00 | $1,003.52–$3,512.32 | 4% below | 10% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 DIAGNOSTIC EXAM OF BLADDER AND URETHRA USING AN ENDOSCOPE | $2,880.00 | $3,200.00 | $752.45–$2,633.58 | 42% above | 10% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND SCRAPING OF UTERUS | $5,467.50 | $6,075.00 | $3,493.18–$12,226.13 | — | 10% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 INCISION OF EARDRUM WITH PLACEMENT OF EARDRUM TUBE UNDER GENERAL ANESTHESIA | $2,880.00 | $3,200.00 | $1,674.32–$5,860.12 | — | 10% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI | $302.18 | $335.75 | $63.66–$222.81 | 87% above | 10% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI | $143.78 | $159.75 | $63.66–$222.81 | 14% above | 10% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF LINING OF UTERUS | $5,467.50 | $6,075.00 | $218.17–$763.60 | 2022% above | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION OF SUBSTANCE INTO MIDDLE OR UPPER SPINE CANAL USING IMAGING GUIDANCE | $1,170.00 | $1,300.00 | $761.72–$2,666.02 | 8% below | 10% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM; REDUCIBLE | $8,370.00 | $9,300.00 | $6,985.91–$24,450.68 | — | 10% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM; REDUCIBLE | $5,467.50 | $6,075.00 | $3,863.62–$13,522.67 | — | 10% |
| Gallbladder removal, laparoscopic CPT 47562 REMOVAL OF GALLBLADDER USING AN ENDOSCOPE | $10,305.00 | $11,450.00 | $6,523.74–$22,833.09 | — | 10% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE | $8,370.00 | $9,300.00 | $6,523.74–$22,833.09 | — | 10% |
| Hysteroscopy with endometrial ablation CPT 58563 EXAM OF UTERUS WITH DESTRUCTION OF LINING OF UTERUS USING AN ENDOSCOPE | $6,435.00 | $7,150.00 | $5,398.16–$18,893.56 | at median | 10% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE | $3,690.00 | $4,100.00 | $3,493.18–$12,226.13 | at median | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $415.80 | $462.00 | $216.50–$757.75 | 12% above | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS | $454.50 | $505.00 | $216.50–$757.75 | 22% above | 10% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) | $11,272.50 | $12,525.00 | $3,863.62–$13,522.67 | 29% above | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $482.40 | $536.00 | $331.24–$1,159.34 | 10% above | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT | $250.20 | $278.00 | $331.24–$1,159.34 | 50% below | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $437.63 | $486.25 | $331.24–$1,159.34 | 13% below | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION AND/OR INJECTION OF FLUID FROM MEDIUM JOINT | $445.73 | $495.25 | $331.24–$1,159.34 | at median | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $450.00 | $500.00 | $331.24–$1,159.34 | 1% above | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $629.10 | $699.00 | $331.24–$1,159.34 | 36% above | 10% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 REMOVAL OF APPENDIX USING AN ENDOSCOPE | $6,435.00 | $7,150.00 | $6,523.74–$22,833.09 | — | 10% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE | $8,370.00 | $9,300.00 | $6,523.74–$22,833.09 | 23% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $547.20 | $608.00 | $438.67–$1,535.34 | 37% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE REPAIR OF WOUND OF SCALP; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS | $562.73 | $625.25 | $438.67–$1,535.34 | 41% above | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE | $1,261.35 | $1,401.50 | $761.72–$2,666.02 | 5% below | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC | $1,390.50 | $1,545.00 | $761.72–$2,666.02 | 5% above | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE; SINGLE LEVEL | $766.02 | $851.13 | $954.44–$3,340.54 | 31% below | 10% |
| Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER | $2,880.00 | $3,200.00 | $3,493.18–$12,226.13 | at median | 10% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $186.30 | $207.00 | $216.50–$757.75 | 9% below | 10% |
| Occipital nerve block (injection for headaches) CPT 64405 INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO UPPER NECK AND BACK OF HEAD NERVE | $505.35 | $561.50 | $331.24–$1,159.34 | 7% below | 10% |
| Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV | $530.55 | $589.50 | $331.24–$1,159.34 | 3% below | 10% |
| Paracentesis with imaging guidance CPT 49083 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE | $1,443.83 | $1,604.25 | $978.73–$3,425.56 | 14% above | 10% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $1,516.05 | $1,684.50 | $978.73–$3,425.56 | 20% above | 10% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED | $418.50 | $465.00 | $438.67–$1,535.34 | 7% below | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE; SINGLE FACET JOINT | $2,925.90 | $3,251.00 | $2,107.19–$7,375.16 | — | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $423.68 | $470.75 | $438.67–$1,535.34 | 4% below | 10% |
| Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FOREIGN BODY FROM TISSUE; ACCESSED BENEATH THE SKIN; SIMPLE | $5,467.50 | $6,075.00 | $438.67–$1,535.35 | 1144% above | 10% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 REMOVAL OF THYROID LOBE ON SIDE OF NECK | $10,305.00 | $11,450.00 | $6,523.74–$22,833.09 | — | 10% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK | $1,980.00 | $2,200.00 | $1,003.52–$3,512.32 | at median | 10% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK | $1,980.00 | $2,200.00 | $1,003.52–$3,512.32 | 8% below | 10% |
| Septoplasty to straighten the nasal septum CPT 30520 RESHAPING OF NASAL CARTILAGE | $2,061.00 | $2,290.00 | $3,577.72–$12,522.02 | 47% below | 10% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST | $497.70 | $553.00 | $301.81–$1,056.34 | 24% above | 10% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT | $217.35 | $241.50 | $143.57–$502.50 | 20% below | 10% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST | $497.70 | $553.00 | $301.81–$1,056.34 | 24% above | 10% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT | $281.48 | $312.75 | $175.36–$613.76 | 4% below | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS | $252.00 | $280.00 | $216.50–$757.75 | 6% above | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $264.60 | $294.00 | $216.50–$757.75 | 11% above | 10% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $364.05 | $404.50 | $438.67–$1,535.34 | 1% below | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $720.00 | $800.00 | $761.72–$2,666.02 | 6% below | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 REMOVAL OF CEREBROSPINAL FLUID WITH LOWER BACK SPINAL TAP FOR DIAGNOSTIC TEST | $1,154.93 | $1,283.25 | $761.72–$2,666.02 | 50% above | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.6-7.5 CM | $326.93 | $363.25 | $216.50–$757.75 | 6% above | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $343.35 | $381.50 | $216.50–$757.75 | 11% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS | $328.50 | $365.00 | $216.50–$757.75 | 2% above | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $344.93 | $383.25 | $216.50–$757.75 | 7% above | 10% |
| TURP (transurethral resection of the prostate) CPT 52601 REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE | $9,337.50 | $10,375.00 | $5,785.92–$20,250.72 | — | 10% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $316.58 | $351.75 | $438.67–$1,535.34 | at median | 10% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE | $859.50 | $955.00 | $676.92–$2,369.22 | 24% below | 10% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $902.48 | $1,002.75 | $676.92–$2,369.22 | 21% below | 10% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVAL OF TONSILS AND ADENOID GLANDS (12 YEARS OR OLDER) | $3,690.00 | $4,100.00 | $3,577.72–$12,522.02 | — | 10% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS) | $3,690.00 | $4,100.00 | $6,388.09–$22,358.31 | — | 10% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS (12 YEARS OR OLDER) | $6,435.00 | $7,150.00 | $3,577.72–$12,522.02 | — | 10% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REMOVAL OF TONSILS (YOUNGER THAN 12 YEARS) | $2,880.00 | $3,200.00 | $6,388.09–$22,358.32 | — | 10% |
| Total thyroid removal (thyroidectomy) CPT 60240 REMOVAL OF THYROID | $17,077.50 | $18,975.00 | $6,523.74–$22,833.09 | — | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION OF TRIGGER POINTS; 1-2 MUSCLES | $326.03 | $362.25 | $331.24–$1,159.34 | 4% below | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL | $342.23 | $380.25 | $331.24–$1,159.34 | 1% above | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 BALLOON DILATION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE; LESS THAN 3.0 CM | $969.75 | $1,077.50 | $2,070.69–$7,247.42 | 34% below | 10% |
| Upper endoscopy (EGD) with biopsy CPT 43239 BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $1,939.50 | $2,155.00 | $978.73–$3,425.55 | at median | 10% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE | $969.75 | $1,077.50 | $978.73–$3,425.55 | — | 10% |
| Upper endoscopy (EGD), diagnostic CPT 43235 DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $1,552.50 | $1,725.00 | $978.73–$3,425.56 | at median | 10% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT | $3,217.50 | $3,575.00 | $2,255.73–$7,895.06 | — | 10% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS | $300.02 | $333.35 | $216.50–$757.75 | 36% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $651.38 | $723.75 | $438.67–$1,535.34 | 7% above | 10% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS | $677.25 | $752.50 | $438.67–$1,535.34 | 11% above | 10% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Utah | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT | $1,332.00 | $1,480.00 | $476.07–$1,666.24 | 9% above | 10% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS | $1,422.00 | $1,580.00 | $476.07–$1,666.24 | 16% above | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT FOR AIRWAY OBSTRUCTION OR SPUTUM PRODUCTION | $126.00 | $140.00 | — | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $132.30 | $147.00 | — | — | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 ADMINISTRATION OF CHEMOTHERAPY INTO VEIN; 1 HOUR OR LESS | $637.88 | $708.75 | $356.43–$1,247.51 | at median | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $669.83 | $744.25 | $356.43–$1,247.51 | 5% above | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE; FIRST 30-74 MINUTES | $2,835.00 | $3,150.00 | $891.37–$3,119.80 | 24% below | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR | $2,976.75 | $3,307.50 | $891.37–$3,119.79 | 21% below | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $193.50 | $215.00 | $63.66–$222.81 | at median | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING | $609.53 | $677.25 | $63.66–$222.81 | 215% above | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD SEVERITY | $180.00 | $200.00 | $91.00–$318.50 | 43% below | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP | $189.00 | $210.00 | $91.00–$318.50 | 40% below | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY | $351.00 | $390.00 | $165.69–$579.92 | 35% below | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM | $368.55 | $409.50 | $165.69–$579.92 | 32% below | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY | $787.50 | $875.00 | $294.57–$1,030.99 | 10% below | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $826.88 | $918.75 | $294.57–$1,030.99 | 6% below | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY | $1,327.50 | $1,475.00 | $450.27–$1,575.94 | at median | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $1,393.88 | $1,548.75 | $450.27–$1,575.94 | 5% above | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY | $2,506.50 | $2,785.00 | $642.64–$2,249.24 | 7% above | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM | $2,631.83 | $2,924.25 | $642.64–$2,249.24 | 12% above | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 EXERCISE OR DRUG-INDUCED HEART STRESS TEST WITH ELECTROCARDIOGRAM (ECG) | $738.45 | $820.50 | $233.00–$815.50 | 20% below | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST | $775.35 | $861.50 | $233.00–$815.50 | 16% below | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES | $342.00 | $380.00 | $229.53–$803.36 | 22% below | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $359.10 | $399.00 | $229.53–$803.36 | 18% below | 10% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS | $459.00 | $510.00 | $229.53–$803.35 | 14% below | 10% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $481.95 | $535.50 | $229.53–$803.36 | 9% below | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $166.50 | $185.00 | $77.70–$271.95 | 16% above | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION OF DRUG OR SUBSTANCE UNDER SKIN OR INTO MUSCLE | $499.50 | $555.00 | $77.70–$271.95 | 248% above | 10% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN | $189.00 | $210.00 | $70.17–$245.60 | at median | 10% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-44 MINUTES | $239.63 | $266.25 | $70.17–$245.60 | 27% above | 10% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN | $272.70 | $303.00 | $114.76–$401.66 | — | 10% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN | $716.63 | $796.25 | $157.21–$550.24 | 5% above | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 15-29 MINUTES | $182.25 | $202.50 | $40.39–$141.36 | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN | $191.48 | $212.75 | $40.39–$141.36 | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN | $716.63 | $796.25 | $123.37–$431.80 | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES | $265.73 | $295.25 | $56.48–$197.68 | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN | $279.00 | $310.00 | $56.48–$197.68 | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN | $179.10 | $199.00 | $83.08–$290.78 | at median | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-39 MINUTES | $355.50 | $395.00 | $83.08–$290.78 | 98% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN | $89.10 | $99.00 | $30.52–$106.82 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 10-19 MINUTES | $238.28 | $264.75 | $30.52–$106.82 | — | 10% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $463.05 | $514.50 | $233.00–$815.50 | 52% above | 10% |
| Spirometry before and after a bronchodilator CPT 94060 TEST TO MEASURE EXPIRATORY AIRFLOW AND VOLUME CHANGES BEFORE AND AFTER MEDICATION ADMINISTRATION | $568.80 | $632.00 | $402.68–$1,409.38 | 3% below | 10% |
| Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING | $597.15 | $663.50 | $402.68–$1,409.38 | 2% above | 10% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 DRAWING OF BLOOD FOR A MEDICAL PROBLEM | $212.40 | $236.00 | $143.57–$502.50 | at median | 10% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $222.98 | $247.75 | $143.57–$502.50 | 5% above | 10% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Utah | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Spikevax 2024-2025 Formula Ages 12 and up | $698.36 | $775.95 | — | — | 10% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Spikevax 2023-2024 Formula | $169.93 | $188.81 | — | — | 10% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Spikevax 2024-2025 Formula Ages 12 and up | $349.16 | $387.96 | — | — | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FluLaval 2024-2025 Formula | $66.91 | $74.34 | — | — | 10% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High-Dose 2024-2025 Formula | $192.20 | $213.56 | — | — | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20 | $642.24 | $713.60 | — | 58% above | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20 | $642.22 | $713.58 | — | — | 10% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Arexvy | $613.17 | $681.30 | — | — | 10% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 Arexvy | $613.13 | $681.26 | — | — | 10% |
| Rabies vaccine, one dose inpatient CPT 90675 RabAvert | $933.35 | $1,037.06 | — | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix | $118.49 | $131.65 | — | at median | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tenivac | $98.87 | $109.85 | — | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix | $118.47 | $131.63 | — | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF VACCINE | $70.88 | $78.75 | $77.70–$271.95 | 8% below | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $78.08 | $86.75 | $77.70–$271.95 | 1% above | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD | $59.63 | $66.25 | — | 13% below | 10% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMINISTRATION OF VACCINE; EACH ADDITIONAL VACCINE | $340.20 | $378.00 | — | 398% above | 10% |
Source file: https://apim.services.craneware.com/api-pricing-transparency/api/public/6e8a5a2ffad6b97f31198aa99dbc26b1/charges/mrf