Hospital

North Country Hospital & Health Center

North Country Hospital & Health Center in Newport, VT publishes cash prices for 325 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Vermont median for 216 of 319 procedures and below it for 89. By typical cash price it ranks #10 of 11 Vermont hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

189 Prouty Dr, Newport VT 05855 Collected Sep 22, 2026 Source price file Check a bill from this hospital (802) 334-7331

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 1 of 5 CCN 471304 · CMS hospital register NPI 1144251059

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

North Country Hospital & Health Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Abdominal CT scan without and with contrast CPT 74170 74170 CT Abdomen w/ + w/o Contrast	$2,962.00	$3,702.50	$888.60–$3,332.25	at median	20%
Abdominal X-ray, 2 views CPT 74019 74019 XR ABDOMEN 2V AP/UPR OR DECUB	$1,043.40	$1,304.25	$313.02–$1,173.83	65% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 73610 XR ANKLE COMPLETE MIN 3V LT	$877.80	$1,097.25	$263.34–$987.53	62% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 73610 XR ANKLE COMPLETE MIN 3V RT	$877.80	$1,097.25	$263.34–$987.53	62% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 US ABI W/DOPPLER	$788.40	$985.50	$236.52–$886.95	180% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 73200 CT Upper Extremity w/o Contrast Right	$2,723.00	$3,403.75	$816.90–$3,063.38	29% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 73200 CT Upper Extremity w/o Contrast Left	$2,723.00	$3,403.75	$816.90–$3,063.38	29% above	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 MISC	$1,017.40	$1,271.75	$305.22–$1,144.58	18% above	20%
Bone scan, whole body (nuclear medicine) CPT 78306 78306 NM BONE SCAN, WHOLE BODY	$4,161.40	$5,201.75	$1,248.42–$4,681.58	107% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 76641 US BREAST RT ABUS	$422.20	$527.75	$126.66–$474.98	27% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 76641 US BREAST LT ABUS	$422.20	$527.75	$126.66–$474.98	27% below	20%
Breast ultrasound, complete, one breast one side CPT 76641 76641 US BREAST LT: COMPLETE DX	$2,020.60	$2,525.75	$606.18–$2,273.18	252% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 76641 US BREAST RT: COMPLETE DX	$2,020.60	$2,525.75	$606.18–$2,273.18	252% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 76642 POCUS US BREAST RT LIMITED	$1,301.20	$1,626.50	$390.36–$1,463.85	126% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 76642 US BREAST LT: LIMITED	$1,301.20	$1,626.50	$390.36–$1,463.85	126% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 76642 US BREAST RT: LIMITED	$1,301.20	$1,626.50	$390.36–$1,463.85	126% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 76642 POCUS US BREAST LIMITED	$1,301.20	$1,626.50	$390.36–$1,463.85	126% above	20%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 74174 CT Angio Abdomen and Pelvis	$4,150.20	$5,187.75	$1,245.06–$4,668.98	6% above	20%
CT angiography (CTA) of the head CPT 70496 70496 CT Angio Brain/Head	$6,569.40	$8,211.75	$1,970.82–$7,390.58	90% above	20%
CT angiography (CTA) of the neck CPT 70498 70498 CT Angio Neck	$6,803.40	$8,504.25	$2,041.02–$7,653.83	114% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 71275 CT Angio Chest	$5,202.00	$6,502.50	$1,560.60–$5,852.25	82% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Enterography w/o Contrast	$2,893.00	$3,616.25	$867.90–$3,254.63	7% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 74176 CT Abdomen and Pelvis w/o Contrast	$2,893.20	$3,616.50	$867.96–$3,254.85	7% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 74177 CT ABD & PELVIS WO ORAL/W IV	$4,578.60	$5,723.25	$1,373.58–$5,150.93	8% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 74177 CT Abdomen and Pelvis w/ Contrast	$4,581.20	$5,726.50	$1,374.36–$5,153.85	8% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$5,819.40	$7,274.25	$1,745.82–$6,546.83	24% above	20%
CT scan of the abdomen with contrast CPT 74160 74160 CT Abdomen w/ Contrast	$2,415.40	$3,019.25	$724.62–$2,717.33	11% below	20%
CT scan of the abdomen without contrast CPT 74150 74150 CT Abdomen w/o Contrast	$2,025.20	$2,531.50	$607.56–$2,278.35	12% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 70486 CT Maxillofacial w/o Contrast	$2,097.20	$2,621.50	$629.16–$2,359.35	at median	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 70486 CT Sinus w/o Contrast	$2,980.60	$3,725.75	$894.18–$3,353.18	42% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 70450 CT Brain/Head w/o Contrast	$1,823.80	$2,279.75	$547.14–$2,051.78	3% below	20%
CT scan of the head with contrast CPT 70460 70460 CT Brain/Head w/ Contrast	$1,961.20	$2,451.50	$588.36–$2,206.35	14% below	20%
CT scan of the head without and with contrast CPT 70470 70470 CT Brain/Head w/ + w/o Contrast	$2,704.00	$3,380.00	$811.20–$3,042.00	2% below	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 72131 CT Spine Lumbar w/o Contrast	$2,137.40	$2,671.75	$641.22–$2,404.58	2% below	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 72125 CT Spine Cervical w/o Contrast	$2,103.00	$2,628.75	$630.90–$2,365.88	2% below	20%
CT scan of the pelvis, with contrast dye CPT 72193 72193 CT Pelvis w/ Contrast	$2,401.40	$3,001.75	$720.42–$2,701.58	7% below	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 93880 US CAROTID BILAT	$3,232.60	$4,040.75	$969.78–$3,636.68	—	20%
Chest CT scan without and with contrast CPT 71270 71270 CT Chest w/ + w/o Contrast	$2,754.60	$3,443.25	$826.38–$3,098.93	23% above	20%
Chest X-ray, 2 views CPT 71046 71046 XR CHEST 2VW	$556.20	$695.25	$166.86–$625.73	20% above	20%
Chest X-ray, single view CPT 71045 71045 XR CHEST 1 VW	$362.20	$452.75	$108.66–$407.48	at median	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 73000 XR CLAVICLE LT	$764.20	$955.25	$229.26–$859.73	51% above	20%
Collarbone (clavicle) X-ray, complete one side CPT 73000 73000 XR CLAVICLE RT	$764.20	$955.25	$229.26–$859.73	51% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 76770 US RETROPERITONEAL CMPL	$1,794.60	$2,243.25	$538.38–$2,018.93	148% above	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 77080 BM BMD -DXA AXIAL W/HIP,SPINE	$760.80	$951.00	$228.24–$855.90	16% above	20%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 77081 BM BMD -DXA PERIPHERAL:FOREARM	$718.00	$897.50	$215.40–$807.75	101% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 76811 US OB FETAL DETAIL SCAN >14 W	$1,898.60	$2,373.25	$569.58–$2,135.93	73% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 71250 CT Chest w/o	$1,973.20	$2,466.50	$591.96–$2,219.85	11% below	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 71260 CT Chest w/ Contrast	$2,464.80	$3,081.00	$739.44–$2,772.90	9% below	20%
Diagnostic mammogram, both breasts both sides CPT 77066 77066 MG MAMMO DX DIGITAL W/CAD BILAT	$512.60	$640.75	$153.78–$576.68	—	20%
Diagnostic mammogram, one breast one side CPT 77065 77065 MG MAMMO DX DIGITAL W/CAD UNILAT	$407.20	$509.00	$122.16–$458.10	23% below	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 93925 US EXTREM LOWER ARTERIAL-BILAT	$2,474.00	$3,092.50	$742.20–$2,783.25	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 93970 VEINS EXTREMITY US BILATERAL	$561.60	$702.00	$168.48–$631.80	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 93970 US EXTREMITY-VENOUS- BILAT	$2,532.40	$3,165.50	$759.72–$2,848.95	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 93306 UE Echo Complete	$3,860.40	$4,825.50	$1,158.12–$4,342.95	51% above	20%
Elbow X-ray, 2 views one side CPT 73070 73070 XR ELBOW 2V RT	$705.40	$881.75	$211.62–$793.58	74% above	20%
Elbow X-ray, 2 views one side CPT 73070 73070 XR ELBOW 2V LT	$705.40	$881.75	$211.62–$793.58	74% above	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 73080 XR ELBOW CMPLT MIN 3V RT	$887.00	$1,108.75	$266.10–$997.88	55% above	20%
Elbow X-ray, complete, 3 or more views one side CPT 73080 73080 XR ELBOW CMPLT MIN 3V LT	$887.00	$1,108.75	$266.10–$997.88	55% above	20%
Eye socket (orbit) CT scan without contrast CPT 70480 70480 CT Orbit Sella etc. or IAC w/o Cont	$3,619.40	$4,524.25	$1,085.82–$4,071.83	63% above	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 70150 XR FACIAL BONES MIN 3VWS	$1,104.60	$1,380.75	$331.38–$1,242.68	78% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 73090 XR FOREARM 2V RT	$727.40	$909.25	$218.22–$818.33	57% above	20%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 73090 XR FOREARM 2V LT	$727.40	$909.25	$218.22–$818.33	57% above	20%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 78226 NM HEPATOBILIARY W/O EF	$2,717.40	$3,396.75	$815.22–$3,057.08	57% above	20%
Hand X-ray, 2 views one side CPT 73120 73120 XR HAND 2V RT	$727.40	$909.25	$218.22–$818.33	52% above	20%
Hand X-ray, 2 views one side CPT 73120 73120 XR HAND 2V LT	$727.40	$909.25	$218.22–$818.33	52% above	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 73650 XR CALCANEUS 2V LT	$754.60	$943.25	$226.38–$848.93	93% above	20%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 73650 XR CALCANEUS 2V RT	$754.60	$943.25	$226.38–$848.93	93% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 Polysomnography; 6 yrs or older, w/ C-Pap therapy or bilev	$6,065.20	$7,581.50	$1,819.56–$6,823.35	6% below	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL Split Night - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL Adaptive Servo Ventiliation - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL Oral Appliance with CPAP - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL CPAP Pedi - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL BIPAP - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL CPAP - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SL Split Night Pedi - TECH PORTION	$9,085.00	$11,356.25	$2,725.50–$10,220.63	41% above	20%
Knee X-ray, 3 views one side CPT 73562 73562 XR KNEE 3V RT	$1,000.80	$1,251.00	$300.24–$1,125.90	69% above	20%
Knee X-ray, 3 views one side CPT 73562 73562 XR KNEE 3V LT	$1,000.80	$1,251.00	$300.24–$1,125.90	69% above	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 73564 XR KNEE COMPLETE MIN 4V LT	$1,156.80	$1,446.00	$347.04–$1,301.40	70% above	20%
Knee X-ray, complete, 4 or more views one side CPT 73564 73564 XR KNEE COMPLETE MIN 4V RT	$1,156.80	$1,446.00	$347.04–$1,301.40	70% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 73700 CT Lower Extremity w/o Contrast Right	$2,728.80	$3,411.00	$818.64–$3,069.90	31% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 73700 CT Lower Extremity w/o Contrast Left	$2,728.80	$3,411.00	$818.64–$3,069.90	31% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 76705 POCUS Abdomen Limited TechFee	$1,466.80	$1,833.50	$440.04–$1,650.15	124% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 76705 US ABD: LTD - ONE ORGAN/QUAD	$1,466.80	$1,833.50	$440.04–$1,650.15	124% above	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 76882 POCUS US EXTREM NON-VASC LIMITED	$466.40	$583.00	$139.92–$524.70	18% below	20%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 76882 US EXTREM NON-VASC: LIMITED	$466.40	$583.00	$139.92–$524.70	18% below	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 71271 CT Low Dose Lung Screening	$1,845.20	$2,306.50	$553.56–$2,075.85	22% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 73590 XR TIB/FIB 2V LT	$718.00	$897.50	$215.40–$807.75	52% above	20%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 73590 XR TIB/FIB 2V RT	$718.00	$897.50	$215.40–$807.75	52% above	20%
MR angiography (MRA) of the head without contrast CPT 70544 70544 MRA Brain/Head w/o Contrast	$3,194.80	$3,993.50	$958.44–$3,594.15	8% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Knee Replacement Left	$1,482.60	$1,853.25	$444.78–$1,667.93	56% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Knee Replacement Right	$1,482.60	$1,853.25	$444.78–$1,667.93	56% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Ankle w/o Contrast Left	$2,985.40	$3,731.75	$895.62–$3,358.58	11% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Ankle w/o Contrast Right	$2,985.40	$3,731.75	$895.62–$3,358.58	11% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Knee w/o Contrast Right	$2,999.80	$3,749.75	$899.94–$3,374.78	11% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Knee w/o Contrast Left	$2,999.80	$3,749.75	$899.94–$3,374.78	11% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Hip w/o Contrast Left	$2,999.80	$3,749.75	$899.94–$3,374.78	11% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 73721 MRI Hip w/o Contrast Right	$2,999.80	$3,749.75	$899.94–$3,374.78	11% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 73723 MRI Ankle w/ + w/o Contrast Left	$5,389.80	$6,737.25	$1,616.94–$6,063.53	14% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 73723 MRI Ankle w/ + w/o Contrast Right	$5,389.80	$6,737.25	$1,616.94–$6,063.53	14% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 73723 MRI Hip w/ + w/o Contrast Right	$5,713.40	$7,141.75	$1,714.02–$6,427.58	20% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 73723 MRI Hip w/ + w/o Contrast Left	$5,713.40	$7,141.75	$1,714.02–$6,427.58	20% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 73723 MRI Knee w/ + w/o Contrast Left	$5,941.60	$7,427.00	$1,782.48–$6,684.30	25% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 73723 MRI Knee w/ + w/o Contrast Right	$5,941.60	$7,427.00	$1,782.48–$6,684.30	25% above	20%
MRI of the abdomen without contrast CPT 74181 74181 MRI MRCP w/o Contrast	$2,617.60	$3,272.00	$785.28–$2,944.80	9% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 74183 MRI Abdomen w/ + w/o Contrast	$4,014.60	$5,018.25	$1,204.38–$4,516.43	1% above	20%
MRI of the brain, no contrast dye CPT 70551 70551 MRI Brain w/o Contrast	$3,941.40	$4,926.75	$1,182.42–$4,434.08	21% above	20%
MRI of the brain, with and without contrast dye CPT 70553 70553 MRI Brain w/ + w/o Contrast	$5,358.40	$6,698.00	$1,607.52–$6,028.20	11% above	20%
MRI of the lower back, no contrast dye CPT 72148 72148 MRI Spine Lumbar w/o Contrast	$3,951.60	$4,939.50	$1,185.48–$4,445.55	10% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 72158 MRI Spine Lumbar w/ + w/o Contrast	$5,452.80	$6,816.00	$1,635.84–$6,134.40	16% above	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 72146 MRI Spine Thoracic w/o Contrast	$3,907.80	$4,884.75	$1,172.34–$4,396.28	10% above	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 72156 MRI Spine Cervical w/ + w/o Contrast	$5,183.00	$6,478.75	$1,554.90–$5,830.88	8% above	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 72141 MRI Spine Cervical w/o Contrast	$3,855.00	$4,818.75	$1,156.50–$4,336.88	13% above	20%
MRI of the pelvis without and with contrast CPT 72197 72197 MRI Pelvis w/ + w/o Contrast	$5,101.80	$6,377.25	$1,530.54–$5,739.53	18% above	20%
MRI of the pelvis, no contrast dye CPT 72195 72195 MRI Pelvis w/o Contrast	$2,956.20	$3,695.25	$886.86–$3,325.73	25% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Elbow w/o Contrast Left	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Shoulder w/o Contrast Right	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Elbow w/o Contrast Right	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Shoulder w/o Contrast Left	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Wrist w/o Contrast Right	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Wrist w/o Contrast Left	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Finger(s) w/o Contrast Left	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 73221 MRI Finger(s) w/o Contrast Right	$3,005.60	$3,757.00	$901.68–$3,381.30	7% below	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 72050 XR C SPINE MIN 4-5 VIEWS	$1,385.40	$1,731.75	$415.62–$1,558.58	98% above	20%
Neck soft tissue CT scan with contrast CPT 70491 70491 CT Neck Soft Tissue w/ Contrast	$2,394.40	$2,993.00	$718.32–$2,693.70	at median	20%
Neck soft tissue CT scan without contrast CPT 70490 70490 CT Neck Soft Tissue w/o Contrast	$2,854.40	$3,568.00	$856.32–$3,211.20	38% above	20%
Neck soft tissue X-ray CPT 70360 70360 XR NECK, SOFT TISSUE	$700.40	$875.50	$210.12–$787.95	87% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial Viability	$2,527.80	$3,159.75	$758.34–$2,843.78	17% below	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 78815 NM PET SCAN:EYES TO THIGHS- SUBSEQUENT	$6,576.60	$8,220.75	$1,972.98–$7,398.68	2% below	20%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 78815 NM PET SCAN:EYES TO THIGHS-INITIAL	$6,590.40	$8,238.00	$1,977.12–$7,414.20	2% below	20%
Pelvic CT scan without contrast CPT 72192 72192 CT Pelvis w/o Contrast	$2,022.60	$2,528.25	$606.78–$2,275.43	6% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 76857 POCUS Pelvic Limited TechFee	$1,216.80	$1,521.00	$365.04–$1,368.90	93% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 76857 US PELVIC LTD/FOLLOW-UP	$1,216.80	$1,521.00	$365.04–$1,368.90	93% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 76856 US PELVIC NON-OB	$615.20	$769.00	$184.56–$692.10	9% below	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 76805 US OB FETAL BASIC ANAT >14 WKS	$810.20	$1,012.75	$243.06–$911.48	18% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 76801 US OB, 1ST TRIMESTER, <14 WKS	$1,707.80	$2,134.75	$512.34–$1,921.28	119% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES	$1,215.00	$1,518.75	$364.50–$1,366.88	94% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 76815 POCUS OB Limited TechFee	$1,215.00	$1,518.75	$364.50–$1,366.88	94% above	20%
Rib X-ray, one side, 2 views one side CPT 71100 71100 XR RIBS ONLY RT M2V	$850.60	$1,063.25	$255.18–$956.93	61% above	20%
Rib X-ray, one side, 2 views one side CPT 71100 71100 XR RIBS ONLY LT M2V	$850.60	$1,063.25	$255.18–$956.93	61% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 71101 XR RIBS W/PA CHEST RT M3V	$1,025.80	$1,282.25	$307.74–$1,154.03	58% above	20%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 71101 XR RIBS W/PA CHEST LT M3V	$1,025.80	$1,282.25	$307.74–$1,154.03	58% above	20%
Screening mammogram, both breasts both sides CPT 77067 77067 MG MAMMO SCREEN W/CAD BILAT	$504.00	$630.00	$151.20–$567.00	—	20%
Screening mammogram, both breasts one side CPT 77067 77067 MG MAMMO SCREEN DIG W/CAD UNILAT	$252.20	$315.25	$75.66–$283.73	22% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 73030 XR SHOULDER MIN 2V RT	$806.80	$1,008.50	$242.04–$907.65	58% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 73030 XR SHOULDER MIN 2V LT	$806.80	$1,008.50	$242.04–$907.65	58% above	20%
Sinus X-ray, complete, 3 or more views CPT 70220 70220 XR SINUSES CMPLT: MIN 3V	$967.00	$1,208.75	$290.10–$1,087.88	108% above	20%
Skull X-ray, fewer than 4 views CPT 70250 70250 XR Skull < 4 Views	$849.80	$1,062.25	$254.94–$956.03	60% above	20%
Sleep study in a lab (polysomnography) CPT 95810 95810 Polysomnography; age 6 years or older, attended by a techn	$5,483.20	$6,854.00	$1,644.96–$6,168.60	7% below	20%
Sleep study in a lab (polysomnography) CPT 95810 95810 SL Oral Appliance with out CPAP -TECH PORTION	$7,348.00	$9,185.00	$2,204.40–$8,266.50	25% above	20%
Sleep study in a lab (polysomnography) CPT 95810 95810 SL Polysomogram Pedi -TECH PORTION	$7,348.00	$9,185.00	$2,204.40–$8,266.50	25% above	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 74230 XR SWALLOWING FUNCTIONS W/VID	$1,464.40	$1,830.50	$439.32–$1,647.45	94% above	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 73552 XR FEMUR MIN 2V RT	$746.60	$933.25	$223.98–$839.93	77% above	20%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 73552 XR FEMUR MIN 2V LT	$746.60	$933.25	$223.98–$839.93	77% above	20%
Thoracic spine (mid back) CT scan without contrast CPT 72128 72128 CT Spine Thoracic w/o Contrast	$2,741.80	$3,427.25	$822.54–$3,084.53	54% above	20%
Toe X-ray, 2 or more views one side CPT 73660 73660 XR TOE(S) MIN 2V	$806.80	$1,008.50	$242.04–$907.65	107% above	20%
Transvaginal pelvic ultrasound CPT 76830 76830 US Transvaginal Non-OB	$1,016.00	$1,270.00	$304.80–$1,143.00	23% above	20%
Transvaginal pelvic ultrasound CPT 76830 76830 POCUS Transvaginal Non-OB Limited TechFee	$1,016.00	$1,270.00	$304.80–$1,143.00	23% above	20%
Transvaginal ultrasound during pregnancy CPT 76817 76817 US Preg Uterus Real Time W/Image Dcmtn Transvag	$1,378.00	$1,722.50	$413.40–$1,550.25	91% above	20%
Ultrasound of the abdomen, complete CPT 76700 76700 US Abdomen Complete	$1,896.20	$2,370.25	$568.86–$2,133.23	108% above	20%
Ultrasound of the scrotum and testicles CPT 76870 76870 US SCROTUM & CONTENTS	$1,682.20	$2,102.75	$504.66–$1,892.48	148% above	20%
Ultrasound of the scrotum and testicles CPT 76870 76870 POC US SCROTUM CONTENTS	$1,682.20	$2,102.75	$504.66–$1,892.48	148% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 76536 US SOFT TISSUE HEAD/NECK	$1,654.60	$2,068.25	$496.38–$1,861.43	90% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 76536 POCUS US SOFT TISSUE HEAD/NECK	$1,654.60	$2,068.25	$496.38–$1,861.43	90% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 74240 XR UGI SINGLE CONTRAST	$1,211.20	$1,514.00	$363.36–$1,362.60	4% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 73060 XR HUMERUS MIN 2V RT	$764.20	$955.25	$229.26–$859.73	51% above	20%
Upper arm X-ray (humerus), 2 views one side CPT 73060 73060 XR HUMERUS MIN 2V LT	$764.20	$955.25	$229.26–$859.73	51% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 93971 US EXTREMITY VENOUS - BIL-LTD	$2,051.20	$2,564.00	$615.36–$2,307.60	204% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 VEIN EXTREMITY US UNILATERAL	$369.60	$462.00	$110.88–$415.80	45% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 US EXTREMITY-VENOUS- RT	$1,550.80	$1,938.50	$465.24–$1,744.65	130% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 POCUS US EXTREMITY-VENOUS LT	$1,550.80	$1,938.50	$465.24–$1,744.65	130% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 POCUS US EXTREMITY-VENOUS RT	$1,550.80	$1,938.50	$465.24–$1,744.65	130% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 93971 US EXTREMITY-VENOUS- LT	$1,550.80	$1,938.50	$465.24–$1,744.65	130% above	20%
Wrist X-ray, 2 views one side CPT 73100 73100 XR WRIST 2V RT	$860.00	$1,075.00	$258.00–$967.50	77% above	20%
Wrist X-ray, 2 views one side CPT 73100 73100 XR WRIST 2V LT	$860.00	$1,075.00	$258.00–$967.50	77% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 73110 XR WRIST MIN 3 VIEWS RT	$991.40	$1,239.25	$297.42–$1,115.33	71% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 73110 XR WRIST MIN 3 VIEWS LT	$991.40	$1,239.25	$297.42–$1,115.33	71% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 73110 XR WRIST W/NAVICULAR RT M3V	$991.40	$1,239.25	$297.42–$1,115.33	71% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 73110 XR WRIST W/NAVICULAR LT M3V	$991.40	$1,239.25	$297.42–$1,115.33	71% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 73502 XR HIP MIN 2V LT	$1,034.00	$1,292.50	$310.20–$1,163.25	82% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 73502 XR HIP MIN 2V RT	$1,034.00	$1,292.50	$310.20–$1,163.25	82% above	20%
X-ray of the abdomen, 1 view CPT 74018 74018 XR ABDOMEN AP 1V	$643.80	$804.75	$193.14–$724.28	62% above	20%
X-ray of the ankle, 2 views one side CPT 73600 73600 XR ANKLE 2V RT	$764.20	$955.25	$229.26–$859.73	63% above	20%
X-ray of the ankle, 2 views one side CPT 73600 73600 XR ANKLE 2V LT	$764.20	$955.25	$229.26–$859.73	63% above	20%
X-ray of the finger(s), 2 or more views CPT 73140 73140 XR FINGER/S MIN 2V	$892.80	$1,116.00	$267.84–$1,004.40	129% above	20%
X-ray of the foot, 2 views one side CPT 73620 73620 XR FOOT 2V LT	$686.40	$858.00	$205.92–$772.20	44% above	20%
X-ray of the foot, 2 views one side CPT 73620 73620 XR FOOT 2V RT	$686.40	$858.00	$205.92–$772.20	44% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 73630 XR FOOT COMPLETE MIN 3V RT	$602.40	$753.00	$180.72–$677.70	18% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 73630 XR FOOT COMPLETE MIN 3V LT	$602.40	$753.00	$180.72–$677.70	18% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 73130 XR HAND MIN 3V RT	$849.40	$1,061.75	$254.82–$955.58	69% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 73130 XR HAND MIN 3V LT	$849.40	$1,061.75	$254.82–$955.58	69% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 73560 XR KNEE 1 OR 2V LT	$825.80	$1,032.25	$247.74–$929.03	65% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 73560 XR KNEE 1 OR 2V RT	$825.80	$1,032.25	$247.74–$929.03	65% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 72100 XR LS SPINE 2-3 VIEWS	$939.20	$1,174.00	$281.76–$1,056.60	41% above	20%
X-ray of the lower back, 4 or more views CPT 72110 72110 XR LS SPINE MIN 4VWS	$1,257.00	$1,571.25	$377.10–$1,414.13	49% above	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 72070 XR T SPINE AP&LAT	$877.80	$1,097.25	$263.34–$987.53	70% above	20%
X-ray of the nasal bones, 3 or more views CPT 70160 70160 XR NASAL BONES CMPLT MIN 3VWS	$868.40	$1,085.50	$260.52–$976.95	56% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 72040 XR C SPINE 3 VWS OR LESS	$1,049.20	$1,311.50	$314.76–$1,180.35	109% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 72170 XR PELVIS (1 OR 2 VIEWS)	$692.20	$865.25	$207.66–$778.73	58% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 72220 XR SACRUM/COCCYX MIN 2VIEWS	$754.60	$943.25	$226.38–$848.93	49% above	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone, P MAYO	$523.00	$653.75	$156.90–$588.38	36% above	20%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$164.60	$205.75	$49.38–$185.18	321% above	20%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$164.60	$205.75	$49.38–$185.18	161% above	20%
Albumin blood test CPT 82040 Albumin Level	$204.60	$255.75	$61.38–$230.18	377% above	20%
Aldosterone blood test CPT 82088 Aldosterone, S MAYO	$500.60	$625.75	$150.18–$563.18	15% above	20%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$176.00	$220.00	$52.80–$198.00	291% above	20%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase, S MAYO	$176.00	$220.00	$52.80–$198.00	291% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Oat, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander, IgE, S MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus Fumigatus, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria Tenuis, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Box Eld/Maple, S, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Silver Birch, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mulberry, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/D.P., IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mugwort, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/D.F., IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mountain Cedar, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut Tree, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Eastern Sycamore, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 White Ash, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Red Sorrel, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Milk, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Short Ragweed, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean, IgE MAYO	$12.40	$15.50	$3.72–$13.95	75% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Silver Birch, IgE, S MAYO	$52.80	$66.00	$15.84–$59.40	8% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Pistachio, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 White Hickory, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Nut Panel # 1, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Food Panel, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Pigweed, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Food-Nut Panel # 2, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Grass Panel # 2, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cocklebur, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Panel, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mold Panel, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Tree Panel #1, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium, IgE, S MAYO	$103.60	$129.50	$31.08–$116.55	111% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Coconut, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Apricot, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Banana, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Blueberry, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cranberry, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Grape, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Grapefruit, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lemon, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Orange, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Papaya, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Peach, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Pear, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Plum, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Raspberry, IgE, Serum MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Poplar White (Populus alba) IgE MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mint (Mentha Piperita) IgE MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Curvularia spicifera/Bipolaris IgE MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Gelatin Porcine IgE MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Sage (Artemisia spp.) IgE MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, IgE w/ Rflx to Components MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Grass Panel # 1, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Epithelia Panel # 1, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 1, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 2, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Weed Panel # 4, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Pine Nut, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cedar, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Green String Bean, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Sunflower, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillin G, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Short Ragweed, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Beech, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Grey Alder, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Elm, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mucor, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Strawberry, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Wormwood, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb's Quarter, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mugwort, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Giant Ragweed, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Stemphyllium, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lamb, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rough Marsh Elder, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 English Plantain, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Apple, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Eastern Sycamore, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Gelatin, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillium chrysogenum, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Aspergillus fumigatus, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria tenuis, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Rye Grass, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Orchard Grass, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Brazil Nut, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Walnut-Food, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 June Grass, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Meadow Fescue, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Sesame Seed, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 White Pine, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 White Ash, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Green Pea, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Lentil, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Almond, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cashew, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Pecan-Food, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Box Elder/Maple, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Mulberry, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Aureobasidium pullulans, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Epicoccum purpurascens, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Milk, Processed, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Latex, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg Yolk, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Fusarium moniliforme, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Cottonwood, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Willow, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Nettle, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Hazelnut-Food, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 Red Sorrel, IgE, S MAYO	$110.00	$137.50	$33.00–$123.75	124% above	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-Fetoprotein Tumor Marker, S MAYO	$30.00	$37.50	$9.00–$33.75	74% below	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-Fetoprotein (AFP), Single Marker Screen, Maternal, Serum M	$101.40	$126.75	$30.42–$114.08	13% below	20%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP Tumor Marker UVM	$252.20	$315.25	$75.66–$283.73	116% above	20%
Ammonia blood test CPT 82140 Ammonia Level	$157.60	$197.00	$47.28–$177.30	19% above	20%
Amylase blood test CPT 82150 Amylase, Fluid UVM	$43.00	$53.75	$12.90–$48.38	19% below	20%
Amylase blood test CPT 82150 Amylase Level Urine	$54.00	$67.50	$16.20–$60.75	2% above	20%
Amylase blood test CPT 82150 Amylase Level	$54.00	$67.50	$16.20–$60.75	2% above	20%
Amylase blood test CPT 82150 Amylase Level 24 Hour Urine	$54.00	$67.50	$16.20–$60.75	2% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Ab, S MAYO	$43.40	$54.25	$13.02–$48.83	62% below	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Abs, IgG, S MAYO	$241.00	$301.25	$72.30–$271.13	109% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Abs (ANA), S MAYO	$475.80	$594.75	$142.74–$535.28	361% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti Nuclear Ab (ANA), IFA UVM	$475.80	$594.75	$142.74–$535.28	361% above	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab, S MAYO	$475.80	$594.75	$142.74–$535.28	361% above	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-Pro BNP	$178.80	$223.50	$53.64–$201.15	29% below	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasal Culture	$122.00	$152.50	$36.60–$137.25	45% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture	$122.00	$152.50	$36.60–$137.25	45% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture	$356.20	$445.25	$106.86–$400.73	323% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture	$368.00	$460.00	$110.40–$414.00	337% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture	$382.40	$478.00	$114.72–$430.20	354% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture	$382.40	$478.00	$114.72–$430.20	354% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tissue Culture	$382.40	$478.00	$114.72–$430.20	354% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture	$382.40	$478.00	$114.72–$430.20	354% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Cerebrospinal Fluid Culture	$388.00	$485.00	$116.40–$436.50	360% above	20%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Wound Culture	$389.40	$486.75	$116.82–$438.08	362% above	20%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$118.20	$147.75	$35.46–$132.98	27% above	20%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$104.20	$130.25	$31.26–$117.23	104% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Only AP 88305 Pathology Tissue	$599.80	$749.75	$179.94–$674.78	129% above	20%
Blood culture for bacteria CPT 87040 Blood Culture	$355.00	$443.75	$106.50–$399.38	161% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Collection of venous blood by venipuncture	$12.00	$15.00	$3.60–$13.50	59% below	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture.	$50.80	$63.50	$15.24–$57.15	75% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$50.80	$63.50	$15.24–$57.15	75% above	20%
Blood glucose (sugar) test CPT 82947 .Glucose Fasting	$57.20	$71.50	$17.16–$64.35	40% above	20%
Blood glucose (sugar) test CPT 82947 Glucose Level	$65.60	$82.00	$19.68–$73.80	60% above	20%
Blood lead test CPT 83655 Lead, Venous, w/ Demographics, WB MAYO	$26.80	$33.50	$8.04–$30.15	58% below	20%
Blood lead test CPT 83655 Lead Level Clinic POC (RE)	$44.80	$56.00	$13.44–$50.40	30% below	20%
Blood lead test CPT 83655 Lead, 24 Hr Ur MAYO	$76.60	$95.75	$22.98–$86.18	19% above	20%
Blood lead test CPT 83655 Lead, Capillary UVM	$178.00	$222.50	$53.40–$200.25	177% above	20%
Blood lead test CPT 83655 Lead, Venous UVM	$178.00	$222.50	$53.40–$200.25	177% above	20%
Blood lead test CPT 83655 Lead Level UVM	$178.80	$223.50	$53.64–$201.15	178% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh 2	$90.20	$112.75	$27.06–$101.48	6% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh 3	$90.20	$112.75	$27.06–$101.48	6% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$90.20	$112.75	$27.06–$101.48	6% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO/Rh	$90.20	$112.75	$27.06–$101.48	6% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh	$90.20	$112.75	$27.06–$101.48	6% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh 2	$90.20	$112.75	$27.06–$101.48	6% above	20%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$114.00	$142.50	$34.20–$128.25	172% above	20%
C-peptide blood test CPT 84681 C-Peptide, S MAYO	$304.60	$380.75	$91.38–$342.68	63% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein UVM	$204.60	$255.75	$61.38–$230.18	235% above	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$204.60	$255.75	$61.38–$230.18	235% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Difficile (GeneXpert)	$416.40	$520.50	$124.92–$468.45	78% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Tox	$416.40	$520.50	$124.92–$468.45	78% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9, Pleural Fluid MAYO	$220.00	$275.00	$66.00–$247.50	at median	20%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9, S MAYO	$220.00	$275.00	$66.00–$247.50	at median	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 UVM	$318.40	$398.00	$95.52–$358.20	71% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now)	$112.60	$140.75	$33.78–$126.68	7% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Respiratory Panel 2.1 (BioFire)	$112.60	$140.75	$33.78–$126.68	7% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS (COVID-19) Testing UVM	$112.60	$140.75	$33.78–$126.68	7% above	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$112.60	$140.75	$33.78–$126.68	7% above	20%
Calcium blood test, total CPT 82310 Calcium Level Urine	$123.20	$154.00	$36.96–$138.60	255% above	20%
Calcium blood test, total CPT 82310 Calcium Level Total	$130.20	$162.75	$39.06–$146.48	275% above	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA, Pleural Fl MAYO	$316.00	$395.00	$94.80–$355.50	68% above	20%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA UVM	$316.00	$395.00	$94.80–$355.50	68% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Ab, IgG, S MAYO	$52.40	$65.50	$15.72–$58.95	45% below	20%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Ab, IgM, S MAYO	$57.60	$72.00	$17.28–$64.80	39% below	20%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella IgG Antibody UVM	$119.80	$149.75	$35.94–$134.78	26% above	20%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Ab, IgM & IgG, S MAYO	$153.00	$191.25	$45.90–$172.13	61% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Result UVM	$54.40	$68.00	$16.32–$61.20	55% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis NAA Misc Site MAYO	$58.80	$73.50	$17.64–$66.15	52% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Gonococcus Result UVM	$89.20	$111.50	$26.76–$100.35	27% below	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Pnl	$109.00	$136.25	$32.70–$122.63	11% above	20%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Diff	$116.20	$145.25	$34.86–$130.73	67% above	20%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Man Diff	$116.20	$145.25	$34.86–$130.73	67% above	20%
Complete blood count (CBC), no differential CPT 85027 CBC w/o Diff	$82.40	$103.00	$24.72–$92.70	40% above	20%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$195.40	$244.25	$58.62–$219.83	39% above	20%
Cortisol blood test, total CPT 82533 Cortisol, Saliva MAYO	$132.40	$165.50	$39.72–$148.95	9% above	20%
Cortisol blood test, total CPT 82533 Cortisol UVM	$253.00	$316.25	$75.90–$284.63	107% above	20%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase Isoenzyme Rflx, S MAYO	$178.80	$223.50	$53.64–$201.15	142% above	20%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$178.80	$223.50	$53.64–$201.15	142% above	20%
Creatine kinase (CK) blood test, total CPT 82550 .CK Isoenzyme Electrophoresis, S MAYO	$398.20	$497.75	$119.46–$447.98	438% above	20%
Creatinine blood test CPT 82565 Creatinine	$69.80	$87.25	$20.94–$78.53	55% above	20%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus Ab, IgG, S MAYO	$78.40	$98.00	$23.52–$88.20	2% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus IgG UVM	$78.80	$98.50	$23.64–$88.65	2% below	20%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus (CMV) Abs, IgG, S MAYO	$78.80	$98.50	$23.64–$88.65	2% below	20%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer LC	$39.00	$48.75	$11.70–$43.88	59% below	20%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer	$106.80	$133.50	$32.04–$120.15	13% above	20%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer, P MAYO	$106.80	$133.50	$32.04–$120.15	13% above	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate, S MAYO	$332.20	$415.25	$99.66–$373.73	27% above	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA Sulfate UVM	$332.20	$415.25	$99.66–$373.73	27% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Abuse Survey w/ Cnfrm, Ur MAYO	$96.00	$120.00	$28.80–$108.00	42% below	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U Fentanyl Scr	$116.00	$145.00	$34.80–$130.50	30% below	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse Scr, Meconium 5 MAYO	$227.60	$284.50	$68.28–$256.05	37% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Buprenorphine Scr, Ur MAYO	$249.40	$311.75	$74.82–$280.58	50% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Scr, Prescription/OTC Ur MAYO	$249.40	$311.75	$74.82–$280.58	50% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Comprehensive Drug Scr, UC MAYO	$249.40	$311.75	$74.82–$280.58	50% above	20%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl Screen w/Reflex, U CTOX	$325.80	$407.25	$97.74–$366.53	96% above	20%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electolyte Panel	$150.60	$188.25	$45.18–$169.43	86% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)	$70.00	$87.50	$21.00–$78.75	38% below	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA IgM Ab, S MAYO	$200.40	$250.50	$60.12–$225.45	79% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA IgG Ab, S MAYO	$200.40	$250.50	$60.12–$225.45	79% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 86665-EBV Panel, S UVM	$201.20	$251.50	$60.36–$226.35	80% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 VCA IgM UVM	$201.20	$251.50	$60.36–$226.35	80% above	20%
Epstein-Barr virus (EBV) antibody test CPT 86665 VCA IgG UVM	$201.20	$251.50	$60.36–$226.35	80% above	20%
Estradiol blood test CPT 82670 Estradiol, MS, S MAYO	$174.80	$218.50	$52.44–$196.65	at median	20%
Estradiol blood test CPT 82670 Estradiol, Adults UVM	$181.40	$226.75	$54.42–$204.08	4% above	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH UVM	$543.40	$679.25	$163.02–$611.33	178% above	20%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Feces MAYO	$533.20	$666.50	$159.96–$599.85	63% above	20%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$252.20	$315.25	$75.66–$283.73	103% above	20%
Fibrinogen blood test CPT 85384 Fibrinogen, Clauss, P MAYO	$66.40	$83.00	$19.92–$74.70	at median	20%
Folate (folic acid) blood test CPT 82746 Folate Level	$368.00	$460.00	$110.40–$414.00	223% above	20%
Free T3 thyroid hormone test CPT 84481 T3, Free UVM	$152.60	$190.75	$45.78–$171.68	at median	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 (Thyroxine), Free, Dialysis, S MAYO	$214.20	$267.75	$64.26–$240.98	110% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$214.20	$267.75	$64.26–$240.98	110% above	20%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$181.40	$226.75	$54.42–$204.08	294% above	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel (Bill Only)	$545.40	$681.75	$163.62–$613.58	117% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1Hr 50 gm OB	$116.20	$145.25	$34.86–$130.73	114% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Screen	$116.20	$145.25	$34.86–$130.73	114% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Tolerance 1 Hr - 50gm	$116.20	$145.25	$34.86–$130.73	114% above	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 2 Hour Post Prandial	$246.00	$307.50	$73.80–$276.75	354% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 2 HR 75gm	$164.40	$205.50	$49.32–$184.95	9% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 1 HR OB 50gm	$164.40	$205.50	$49.32–$184.95	9% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 1 HR OB 100gm	$164.40	$205.50	$49.32–$184.95	9% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 2 HR OB 100gm	$164.40	$205.50	$49.32–$184.95	9% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 3 HR OB 100gm	$164.40	$205.50	$49.32–$184.95	9% above	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gonococcus Result UVM	$54.40	$68.00	$16.32–$61.20	66% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC	$54.40	$68.00	$16.32–$61.20	66% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Chlamydia Result UVM	$89.20	$111.50	$26.76–$100.35	43% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae, NAA MAYO	$141.20	$176.50	$42.36–$158.85	11% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae,Misc Site NAA MAYO	$141.20	$176.50	$42.36–$158.85	11% below	20%
H. pylori stool antigen test CPT 87338 H. pylori Antigen UVM	$402.40	$503.00	$120.72–$452.70	88% above	20%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA , P MAYO	$584.80	$731.00	$175.44–$657.90	58% above	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1 and 2 Ab/p24 Ag, 4th Gen UVM	$100.20	$125.25	$30.06–$112.73	9% above	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA w/ Geno, HR PCR, ThinPrep MAYO	$199.00	$248.75	$59.70–$223.88	30% above	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV Detection-High Risk Types UVM	$199.00	$248.75	$59.70–$223.88	30% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$201.20	$251.50	$60.36–$226.35	130% above	20%
Hemoglobin blood test CPT 85018 85018 Blood count; hemoglobin (Hgb) POCT	$17.60	$22.00	$5.28–$19.80	22% below	20%
Hemoglobin blood test CPT 85018 Hemoglobin	$32.20	$40.25	$9.66–$36.23	43% above	20%
Hemoglobin blood test CPT 85018 Hemoglobin Clinic POC (RE)	$73.20	$91.50	$21.96–$82.35	225% above	20%
Hepatitis B core antibody test (total) CPT 86704 HBs Ab, S MAYO	$39.40	$49.25	$11.82–$44.33	61% below	20%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Total Abs, S MAYO	$234.20	$292.75	$70.26–$263.48	134% above	20%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody (Total) UVM	$234.20	$292.75	$70.26–$263.48	134% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HBc Total Ab, S MAYO	$35.20	$44.00	$10.56–$39.60	63% below	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody UVM	$206.00	$257.50	$61.80–$231.75	114% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HBs Ag, S MAYO	$33.80	$42.25	$10.14–$38.03	64% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen UVM	$179.60	$224.50	$53.88–$202.05	94% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Ab, S MAYO	$46.60	$58.25	$13.98–$52.43	58% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab w/Rflx to HCV RNA PCR UVM	$145.60	$182.00	$43.68–$163.80	32% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Detect Quant UVM	$702.80	$878.50	$210.84–$790.65	51% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA w/ Rflx to HCV Genotype, S MAYO	$702.80	$878.50	$210.84–$790.65	51% above	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RNA RT-PCR, S MAYO	$702.80	$878.50	$210.84–$790.65	51% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV Type 1 Ab, IgG, S MAYO	$83.40	$104.25	$25.02–$93.83	24% below	20%
Herpes blood test, HSV-2 antibody CPT 86696 Antibody; herpes simplex, type 2	$67.60	$84.50	$20.28–$76.05	43% below	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV Type 2 Ab, IgG, S MAYO	$92.40	$115.50	$27.72–$103.95	23% below	20%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity	$85.40	$106.75	$25.62–$96.08	11% below	20%
Homocysteine blood test CPT 83090 Homocysteine, Total, P MAYO	$231.00	$288.75	$69.30–$259.88	14% above	20%
Insulin blood test CPT 83525 Insulin UVM	$98.40	$123.00	$29.52–$110.70	5% below	20%
Iron blood test (serum iron) CPT 83540 Iron Level	$169.60	$212.00	$50.88–$190.80	142% above	20%
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$169.60	$212.00	$50.88–$190.80	108% above	20%
Kidney function blood test panel CPT 80069 Renal Pnl	$185.80	$232.25	$55.74–$209.03	55% above	20%
LH (luteinizing hormone) test CPT 83002 LH UVM	$543.40	$679.25	$163.02–$611.33	239% above	20%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$125.40	$156.75	$37.62–$141.08	10% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, Fluid UVM	$185.80	$232.25	$55.74–$209.03	123% above	20%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$185.80	$232.25	$55.74–$209.03	123% above	20%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$340.80	$426.00	$102.24–$383.40	595% above	20%
Liver function blood test panel CPT 80076 Hep Fnct Pnl	$194.60	$243.25	$58.38–$218.93	77% above	20%
Lyme disease antibody test CPT 86618 Lyme Disease Serology, S MAYO	$87.80	$109.75	$26.34–$98.78	12% below	20%
Lyme disease antibody test CPT 86618 Lyme Antibody UVM	$129.00	$161.25	$38.70–$145.13	29% above	20%
Magnesium blood test CPT 83735 Magnesium Level Urine	$123.20	$154.00	$36.96–$138.60	119% above	20%
Magnesium blood test CPT 83735 Magnesium Level	$200.20	$250.25	$60.06–$225.23	255% above	20%
Magnesium blood test CPT 83735 Magnesium Level 24 Hour Urine	$202.40	$253.00	$60.72–$227.70	259% above	20%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Ab, IgG, S MAYO	$52.60	$65.75	$15.78–$59.18	34% below	20%
Measles (rubeola) antibody test CPT 86765 Measles IgG Antibody UVM	$178.80	$223.50	$53.64–$201.15	124% above	20%
Mono test (heterophile antibody, Monospot) CPT 86308 Monospot Clinic POC (RE)	$26.40	$33.00	$7.92–$29.70	45% below	20%
Mono test (heterophile antibody, Monospot) CPT 86308 Mono Scrn	$97.00	$121.25	$29.10–$109.13	103% above	20%
Mumps immunity blood test CPT 86735 Mumps Ab, IgG, S MAYO	$52.00	$65.00	$15.60–$58.50	53% below	20%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgM, S MAYO	$211.80	$264.75	$63.54–$238.28	93% above	20%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgG, S MAYO	$211.80	$264.75	$63.54–$238.28	93% above	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 Free PSA MAYO	$199.00	$248.75	$59.70–$223.88	40% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 Total PSA MAYO	$134.40	$168.00	$40.32–$151.20	at median	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Ultrasensitive, S MAYO	$139.60	$174.50	$41.88–$157.05	4% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic, S MAYO	$139.60	$174.50	$41.88–$157.05	4% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Diagnostic	$139.60	$174.50	$41.88–$157.05	4% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 Bill Only AP 88175 Thin Prep Pap	$190.60	$238.25	$57.18–$214.43	96% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 PAP Test UVM	$190.80	$238.50	$57.24–$214.65	97% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact UVM	$399.80	$499.75	$119.94–$449.78	60% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Activated Partial Thrombopl Time, P MAYO	$15.60	$19.50	$4.68–$17.55	71% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT-Heparin Removed UVM	$36.40	$45.50	$10.92–$40.95	33% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT UVM	$150.60	$188.25	$45.18–$169.43	175% above	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$150.60	$188.25	$45.18–$169.43	175% above	20%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$128.00	$160.00	$38.40–$144.00	184% above	20%
Potassium blood test CPT 84132 Potassium Level	$75.80	$94.75	$22.74–$85.28	82% above	20%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MaterniT21 Plus MAYO	$2,556.40	$3,195.50	$766.92–$2,875.95	—	20%
Progesterone blood test CPT 84144 Progesterone UVM	$267.60	$334.50	$80.28–$301.05	52% above	20%
Progesterone blood test CPT 84144 Progesterone, S MAYO	$267.60	$334.50	$80.28–$301.05	52% above	20%
Prolactin blood test CPT 84146 Prolactin UVM	$332.20	$415.25	$99.66–$373.73	131% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time (PT), P MAYO	$11.20	$14.00	$3.36–$12.60	71% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR Clinic POC (RE)	$52.40	$65.50	$15.72–$58.95	38% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR POCT	$59.80	$74.75	$17.94–$67.28	57% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT(INR)	$60.00	$75.00	$18.00–$67.50	58% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR	$64.00	$80.00	$19.20–$72.00	68% above	20%
Rapid flu test (influenza antigen) CPT 87804 Influenza A/B Clinic POC (RE)	$113.40	$141.75	$34.02–$127.58	147% above	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A (Sofia)	$158.60	$198.25	$47.58–$178.43	137% above	20%
Renin blood test CPT 84244 Renin Activity, P MAYO	$207.00	$258.75	$62.10–$232.88	at median	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Titer	$23.80	$29.75	$7.14–$26.78	58% below	20%
Rheumatoid factor (RF) test CPT 86431 RF	$23.80	$29.75	$7.14–$26.78	58% below	20%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor UVM	$209.00	$261.25	$62.70–$235.13	270% above	20%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG Antibody UVM	$22.60	$28.25	$6.78–$25.43	77% below	20%
Rubella antibody test (immunity check) CPT 86762 Rubella Ab, IgG, S MAYO	$52.20	$65.25	$15.66–$58.73	47% below	20%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG Ab	$139.60	$174.50	$41.88–$157.05	42% above	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis	$555.00	$693.75	$166.50–$624.38	274% above	20%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Post Vas	$555.00	$693.75	$166.50–$624.38	274% above	20%
Sodium blood test CPT 84295 Sodium Level	$58.40	$73.00	$17.52–$65.70	30% above	20%
Stool ova and parasites exam CPT 87177 87177- Exam	$98.00	$122.50	$29.40–$110.25	3% below	20%
Stool ova and parasites exam CPT 87177 Exam-87177	$98.00	$122.50	$29.40–$110.25	3% below	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hemoccult Stool POC (RE)	$22.40	$28.00	$6.72–$25.20	23% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen, Feces	$104.00	$130.00	$31.20–$117.00	469% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool I	$118.20	$147.75	$35.46–$132.98	547% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood, Colorectal Cancer Screen, Qualitative, Immun	$103.00	$128.75	$30.90–$115.88	6% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Immunochemical Test (FIT)	$170.40	$213.00	$51.12–$191.70	75% above	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Total Ab w/ Rflx, S MAYO	$55.20	$69.00	$16.56–$62.10	5% below	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Serology UVM	$55.20	$69.00	$16.56–$62.10	5% below	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Total Ab, S MAYO	$55.20	$69.00	$16.56–$62.10	5% below	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Ab, (TP-PA), S MAYO	$55.20	$69.00	$16.56–$62.10	5% below	20%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Ab, TPA S MAYO	$55.20	$69.00	$16.56–$62.10	5% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF MAYO	$114.80	$143.50	$34.44–$129.15	59% above	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin	$138.40	$173.00	$41.52–$155.70	92% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus, WB MAYO	$258.20	$322.75	$77.46–$290.48	30% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone UVM	$346.80	$433.50	$104.04–$390.15	73% above	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase Abs, S MAYO	$35.80	$44.75	$10.74–$40.28	70% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase Ab, S MAYO	$52.00	$65.00	$15.60–$58.50	57% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase Ab UVM	$59.20	$74.00	$17.76–$66.60	51% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH w/ Rflx to Free T4	$234.20	$292.75	$70.26–$263.48	23% above	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$234.20	$292.75	$70.26–$263.48	23% above	20%
Total IgE blood test CPT 82785 Immunoglobulin E (IgE), S MAYO	$30.80	$38.50	$9.24–$34.65	63% below	20%
Total IgE blood test CPT 82785 IgE UVM	$156.40	$195.50	$46.92–$175.95	86% above	20%
Total cholesterol blood test CPT 82465 Cholesterol, Fluid UVM	$28.40	$35.50	$8.52–$31.95	30% below	20%
Total cholesterol blood test CPT 82465 Cholesterol Total	$87.60	$109.50	$26.28–$98.55	114% above	20%
Total thyroxine (T4) blood test CPT 84436 Thyroxine, Total, S MAYO	$24.60	$30.75	$7.38–$27.68	57% below	20%
Total thyroxine (T4) blood test CPT 84436 Total T4 Level	$144.60	$180.75	$43.38–$162.68	153% above	20%
Total triiodothyronine (T3) blood test CPT 84480 T3, Total UVM	$491.00	$613.75	$147.30–$552.38	297% above	20%
Transferrin blood test CPT 84466 UNSATURATED IRON BINDING CAPACITY	$47.40	$59.25	$14.22–$53.33	52% below	20%
Transferrin blood test CPT 84466 Transferrin UVM	$174.00	$217.50	$52.20–$195.75	76% above	20%
Transferrin blood test CPT 84466 Transferrin, S MAYO	$174.00	$217.50	$52.20–$195.75	76% above	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis	$32.80	$41.00	$9.84–$36.90	44% below	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis UVM	$54.40	$68.00	$16.32–$61.20	8% below	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis,Nucleic Acid Amplification,Varies MAYO	$133.20	$166.50	$39.96–$149.85	126% above	20%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis, Nucleic Acid Amplification, Varies MAYO	$133.20	$166.50	$39.96–$149.85	126% above	20%
Trichomonas test (NAAT) CPT 87661 87481-Vaginal CTGC and Molecular Vaginitis Detection, UVM	$325.80	$407.25	$97.74–$366.53	454% above	20%
Triglycerides blood test CPT 84478 Triglycerides, Fluid UVM	$29.80	$37.25	$8.94–$33.53	26% below	20%
Triglycerides blood test CPT 84478 Triglycerides, BF MAYO	$89.00	$111.25	$26.70–$100.13	121% above	20%
Triglycerides blood test CPT 84478 Triglyceride	$89.00	$111.25	$26.70–$100.13	121% above	20%
Troponin test, quantitative CPT 84484 Troponin I	$241.20	$301.50	$72.36–$271.35	46% above	20%
Uric acid blood test CPT 84550 Uric Acid	$216.40	$270.50	$64.92–$243.45	232% above	20%
Urinalysis with microscope exam, automated CPT 81001 UA w Micro	$128.00	$160.00	$38.40–$144.00	173% above	20%
Urinalysis with microscope exam, manual CPT 81000 Urine Dipstick and Microscopy Clinic POC (RE)	$22.40	$28.00	$6.72–$25.20	15% above	20%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis Complete with Culture if Indicated	$128.00	$160.00	$38.40–$144.00	558% above	20%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick Clinic POC (RE)	$40.80	$51.00	$12.24–$45.90	7% above	20%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick	$48.60	$60.75	$14.58–$54.68	28% above	20%
Urinalysis without microscope exam, automated CPT 81003 .Urinalysis POCT	$128.00	$160.00	$38.40–$144.00	237% above	20%
Urinalysis without microscope exam, manual CPT 81002 UA w Micro if Ind & Cult if Ind	$48.60	$60.75	$14.58–$54.68	111% above	20%
Urinalysis without microscope exam, manual CPT 81002 UA w Micro if Ind	$48.60	$60.75	$14.58–$54.68	111% above	20%
Urinalysis without microscope exam, manual CPT 81002 UA w Culture if Ind	$48.60	$60.75	$14.58–$54.68	111% above	20%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Level Urine	$81.60	$102.00	$24.48–$91.80	62% above	20%
Urine microalbumin (albumin) test CPT 82043 Urine Creatinine	$81.60	$102.00	$24.48–$91.80	62% above	20%
Urine microalbumin (albumin) test CPT 82043 Albumin, 24 Hour, Urine MAYO	$123.20	$154.00	$36.96–$138.60	145% above	20%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Clinic POC (RE)	$49.00	$61.25	$14.70–$55.13	24% above	20%
Urine pregnancy test, read by color change CPT 81025 Pregnancy Test Urine	$55.60	$69.50	$16.68–$62.55	41% above	20%
Vitamin B12 (cobalamin) blood test CPT 82607 Vit B12 Lvl	$329.20	$411.50	$98.76–$370.35	195% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-Hydroxyvitamin D2 & D3, S MAYO	$288.60	$360.75	$86.58–$324.68	36% above	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-OH Total UVM	$288.60	$360.75	$86.58–$324.68	36% above	20%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 1,25-Dihydroxyvitamin D, S MAYO	$237.00	$296.25	$71.10–$266.63	32% below	20%
Zinc blood test CPT 84630 Zinc, S MAYO	$191.60	$239.50	$57.48–$215.55	24% above	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative	$122.00	$152.50	$36.60–$137.25	2% below	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786-Distal Fibular w/o Manipulation	$743.20	$929.00	$222.96–$836.10	59% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee	$743.20	$929.00	$222.96–$836.10	59% above	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee	$498.60	$623.25	$149.58–$560.93	28% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 Cardioversion PACU Charge	$1,826.40	$2,283.00	$547.92–$2,054.70	20% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 - Cardioversion; Elective	$1,826.40	$2,283.00	$547.92–$2,054.70	20% above	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$1,826.40	$2,283.00	$547.92–$2,054.70	20% above	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision Clamp Type	$4,596.80	$5,746.00	$1,379.04–$5,171.40	63% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600-Distal Radial w/o Manipulation	$772.00	$965.00	$231.60–$868.50	43% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee	$772.00	$965.00	$231.60–$868.50	43% above	20%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 69433 Tympanostomy (requiring insertion of ventilating tube), lo	$404.80	$506.00	$121.44–$455.40	15% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATER	$143.00	$178.75	$42.90–$160.88	44% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209-Cerumen Irrigation/Lavage	$143.00	$178.75	$42.90–$160.88	44% above	20%
Earwax removal with instruments, one ear CPT 69210 69210-Cerumen w/ Instrumentation	$123.20	$154.00	$36.96–$138.60	26% below	20%
Earwax removal with instruments, one ear one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee	$123.20	$154.00	$36.96–$138.60	26% below	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 58340 US SONOHYSTERO CATH INSERT	$505.40	$631.75	$151.62–$568.58	36% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$453.20	$566.50	$135.96–$509.85	2% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$453.20	$566.50	$135.96–$509.85	2% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS TechFee	$150.40	$188.00	$45.12–$169.20	47% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 US GUIDED TENDON SHEATH INJ	$553.60	$692.00	$166.08–$622.80	94% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$669.80	$837.25	$200.94–$753.53	2% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-L Drain/inj joint/bursa w/o us	$669.80	$837.25	$200.94–$753.53	2% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate	$124.80	$156.00	$37.44–$140.40	55% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$669.80	$837.25	$200.94–$753.53	141% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-L xyphoid joint injection	$669.80	$837.25	$200.94–$753.53	141% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600-Small Joint Aspirate/Inject w/o US	$669.80	$837.25	$200.94–$753.53	87% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600-Small Joint Aspirate/Inject w/o US TechFee	$669.80	$837.25	$200.94–$753.53	87% above	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee	$78.60	$98.25	$23.58–$88.43	83% below	20%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$239.40	$299.25	$71.82–$269.33	47% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440-Excise Lesion Benign Face Less Than/Equal to 0.5 cm	$1,594.80	$1,993.50	$478.44–$1,794.15	336% above	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< TechFee	$1,594.80	$1,993.50	$478.44–$1,794.15	336% above	20%
Nail removal (partial or complete), one nail CPT 11730 11730-Avulsion Nail Plate Single	$622.00	$777.50	$186.60–$699.75	52% above	20%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$622.00	$777.50	$186.60–$699.75	52% above	20%
Paracentesis with imaging guidance CPT 49083 49083-Abdominal Paracentesis w/ Imaging Guide	$590.80	$738.50	$177.24–$664.65	16% below	20%
Paracentesis with imaging guidance CPT 49083 49083 POCUS ABDOMINAL PARACENTESIS W GUIDE CHARGE	$590.80	$738.50	$177.24–$664.65	16% below	20%
Paracentesis with imaging guidance CPT 49083 49083 ED ABDOMINAL PARACENTESIS W GUIDE CHARGE	$590.80	$738.50	$177.24–$664.65	16% below	20%
Paracentesis with imaging guidance CPT 49083 49083 US PARACENTESIS W/GUIDANCE	$1,205.00	$1,506.25	$361.50–$1,355.63	71% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee	$771.60	$964.50	$231.48–$868.05	16% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750-Excision Nail & Matrix	$771.60	$964.50	$231.48–$868.05	16% below	20%
Prostate biopsy CPT 55700 55700 Biopsy, prostate; needle or punch, single or multiple, any	$327.20	$409.00	$98.16–$368.10	40% below	20%
Prostate biopsy CPT 55700 55700 US BX PROSTATE - NEEDLE	$4,596.80	$5,746.00	$1,379.04–$5,171.40	739% above	20%
Removal of a foreign object under the skin, simple CPT 10120 10120-Subcutaneous Tissue Simple	$365.40	$456.75	$109.62–$411.08	26% below	20%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$365.40	$456.75	$109.62–$411.08	26% below	20%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee	$618.60	$773.25	$185.58–$695.93	53% above	20%
Short arm splint (forearm and hand) CPT 29125 29125-Short Arm	$397.60	$497.00	$119.28–$447.30	79% above	20%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$397.60	$497.00	$119.28–$447.30	79% above	20%
Short leg cast (below the knee) CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TechFee	$526.00	$657.50	$157.80–$591.75	45% above	20%
Short leg splint (calf to foot) CPT 29515 29515-Short Leg	$563.20	$704.00	$168.96–$633.60	66% above	20%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$563.20	$704.00	$168.96–$633.60	66% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$508.20	$635.25	$152.46–$571.73	28% above	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$590.60	$738.25	$177.18–$664.43	49% above	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic	$837.40	$1,046.75	$251.22–$942.08	1% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic TechFee	$837.40	$1,046.75	$251.22–$942.08	1% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$1,137.80	$1,422.25	$341.34–$1,280.03	114% above	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$1,185.20	$1,481.50	$355.56–$1,333.35	123% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$1,181.60	$1,477.00	$354.48–$1,329.30	157% above	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee	$1,189.20	$1,486.50	$356.76–$1,337.85	159% above	20%
Thoracentesis with imaging guidance CPT 32555 32555 CT THORACENTESIS W/NEEDLE	$1,235.00	$1,543.75	$370.50–$1,389.38	2% below	20%
Thoracentesis with imaging guidance CPT 32555 32555 US THORACENTESIS W/NEEDLE	$1,286.00	$1,607.50	$385.80–$1,446.75	2% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 20552-Inject Trigger Point 1-2 Muscles	$669.80	$837.25	$200.94–$753.53	16% above	20%
Trigger point injections, 1 or 2 muscles CPT 20552 20552-Inject Trigger Point 1-2 Muscles TechFee	$669.80	$837.25	$200.94–$753.53	16% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 19083 US BX BREAST VAC CORE W/IMG	$3,193.60	$3,992.00	$958.08–$3,592.80	23% above	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 Vasectomy, unilateral or bilateral, including postoperativ	$680.00	$850.00	$204.00–$765.00	—	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042-SQ Tissue Less Than/Equal to 1st 20 sq cm	$341.60	$427.00	$102.48–$384.30	10% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee	$341.60	$427.00	$102.48–$384.30	10% below	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration < 2 Hour CHARGE	$945.20	$1,181.50	$283.56–$1,063.35	41% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration 2-4 Hour CHARGE	$1,835.00	$2,293.75	$550.50–$2,064.38	174% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration > 4 Hour CHARGE	$2,434.40	$3,043.00	$730.32–$2,738.70	263% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Mini-Neb Subsequent CHARGE	$200.20	$250.25	$60.06–$225.23	3% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Heliox Therapy/ Hr Supply Medical Gas CHARGE	$238.80	$298.50	$71.64–$268.65	23% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$482.00	$602.50	$144.60–$542.25	148% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 HHN INITIAL	$482.00	$602.50	$144.60–$542.25	148% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT EzPAP Initial CHARGE	$482.00	$602.50	$144.60–$542.25	148% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$482.00	$602.50	$144.60–$542.25	148% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Mini-Neb Initial CHARGE	$482.00	$602.50	$144.60–$542.25	148% above	20%
Chemotherapy IV infusion, first hour CPT 96413 96413 IN INFUSION CHEMOTHERAPY 16-60	$1,384.00	$1,730.00	$415.20–$1,557.00	97% above	20%
Chemotherapy IV infusion, first hour CPT 96413 IN INFUSION CHEMOTHERAPY 16-60 CHARGE	$1,384.00	$1,730.00	$415.20–$1,557.00	97% above	20%
Critical care, first 30 to 74 minutes CPT 99291 99291 Facility Level Critical Care Ill/Injured Patient Init 30	$3,851.20	$4,814.00	$1,155.36–$4,332.60	120% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV ECG Acquisition	$326.20	$407.75	$97.86–$366.98	98% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG w/ 12+ leads; Tracing Only	$347.20	$434.00	$104.16–$390.60	111% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF P	$253.00	$316.25	$75.90–$284.63	5% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM	$461.20	$576.50	$138.36–$518.85	10% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW	$868.40	$1,085.50	$260.52–$976.95	19% above	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MOD	$965.60	$1,207.00	$289.68–$1,086.30	at median	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIG	$1,351.00	$1,688.75	$405.30–$1,519.88	at median	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 93017 Cardiac Stress Test OPNCH	$2,773.00	$3,466.25	$831.90–$3,119.63	234% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION, INITIAL 31-60 MIN CHARGE	$674.40	$843.00	$202.32–$758.70	196% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360-IV Hydration Initial 31 min - 1 hr	$674.40	$843.00	$202.32–$758.70	196% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - ED Hydration, first hour	$674.40	$843.00	$202.32–$758.70	196% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 INTRAVENOUS INFUSION, HYDRATION TechFee	$674.40	$843.00	$202.32–$758.70	196% above	20%
IV infusion of a medicine, first hour CPT 96365 INF, MEDICAL, EA ADDL 31-60 MIN CHARGE	$374.00	$467.50	$112.20–$420.75	19% above	20%
IV infusion of a medicine, first hour CPT 96365 INF, MEDICAL, INITIAL 16-60 CHARGE	$868.40	$1,085.50	$260.52–$976.95	177% above	20%
IV infusion of a medicine, first hour CPT 96365 96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins	$868.40	$1,085.50	$260.52–$976.95	177% above	20%
IV infusion of a medicine, first hour CPT 96365 96365- ED IV tx, first hour	$868.40	$1,085.50	$260.52–$976.95	177% above	20%
IV infusion of a medicine, first hour CPT 96365 96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOS	$868.40	$1,085.50	$260.52–$976.95	177% above	20%
IV push of a medicine, first drug CPT 96374 96374 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION TechFee	$384.60	$480.75	$115.38–$432.68	62% above	20%
IV push of a medicine, first drug CPT 96374 IVP, INITIAL < 15 MIN CHARGE	$384.60	$480.75	$115.38–$432.68	62% above	20%
IV push of a medicine, first drug CPT 96374 96374- ED Injection, single/initial	$384.60	$480.75	$115.38–$432.68	62% above	20%
IV push of a medicine, first drug CPT 96374 96374-IV Push Initial Drug	$384.60	$480.75	$115.38–$432.68	62% above	20%
IV push of a medicine, first drug CPT 96374 96374 Injection Code	$384.60	$480.75	$115.38–$432.68	62% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372-Injection/SQ/IM	$189.60	$237.00	$56.88–$213.30	233% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SQ/IM THERAPEUTIC, PROPHL, DIAG CHARGE	$189.60	$237.00	$56.88–$213.30	233% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 IM SC Injection Each TechFee	$189.60	$237.00	$56.88–$213.30	233% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 ED Subq/IM Injection	$189.60	$237.00	$56.88–$213.30	233% above	20%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$204.00	$255.00	$61.20–$229.50	at median	20%
Psychiatric evaluation with medical services CPT 90792 90792 Psychiatric diagnostic evaluation with medical services	$236.80	$296.00	$71.04–$266.40	1% below	20%
Psychotherapy session, 45 minutes CPT 90834 90834 Psychotherapy, 45 minutes with patient and/or family membe	$108.00	$135.00	$32.40–$121.50	23% below	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5	$1,294.40	$1,618.00	$388.32–$1,456.20	353% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3	$831.60	$1,039.50	$249.48–$935.55	413% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4	$872.40	$1,090.50	$261.72–$981.45	311% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PT LEVEL 2 MEDICAL CARE CHARGE	$435.80	$544.75	$130.74–$490.28	294% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2	$435.80	$544.75	$130.74–$490.28	294% above	20%
Spirometry (breathing test) CPT 94010 94010 SPIROMETRY PRE	$730.00	$912.50	$219.00–$821.25	134% above	20%
Spirometry (breathing test) CPT 94010 94010 SPIROMETRY - NO LOOP	$730.00	$912.50	$219.00–$821.25	134% above	20%
Spirometry before and after a bronchodilator CPT 94060 RT Pre & Post Spiro CHARGE	$1,690.60	$2,113.25	$507.18–$1,901.93	156% above	20%
Spirometry before and after a bronchodilator CPT 94060 94060 SPIROMETRY, PRE & POST Charge	$1,690.60	$2,113.25	$507.18–$1,901.93	156% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY CHARGE	$243.80	$304.75	$73.14–$274.28	10% above	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 influ triv adjuvant vacc im - AMB influenza vacc Charge	$44.00	$55.00	$13.20–$49.50	63% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 influ triv adjuvant vacc im - AMB influenza vacc Charge	$44.00	$55.00	$13.20–$49.50	63% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 Influenza vaccine, inactivated (IIV), fluad	$52.00	$65.00	$15.60–$58.50	57% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 Influenza vaccine, inactivated (IIV), fluad	$52.00	$65.00	$15.60–$58.50	57% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza virus vaccine inactivated adjuvanted preservative-free trivalent Sus UD FLUAD 24/25	$171.58	$214.48	$51.48–$193.03	43% above	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza virus vaccine inactivated adjuvanted preservative-free trivalent Sus UD FLUAD 24/25	$171.58	$214.48	$51.48–$193.03	43% above	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 90653 influ triv adjuvant vacc im - AMB influenza vacc Charge	$44.00	$55.00	$13.20–$49.50	—	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 90653 Influenza vaccine, inactivated (IIV), fluad	$52.00	$65.00	$15.60–$58.50	—	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 influenza virus vaccine inactivated adjuvanted preservative-free trivalent Sus UD FLUAD 24/25	$171.58	$214.48	$51.48–$193.03	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated preservative-free trivalent Sus AFLURIA 24/25	$42.90	$53.62	$12.87–$48.26	16% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated preservative-free trivalent Sus AFLURIA 24/25	$42.90	$53.62	$12.87–$48.26	16% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90657 3 yrs im - AMB influenza vacc Charge	$43.20	$54.00	$12.96–$48.60	17% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90657 3 yrs im - AMB influenza vacc Charge	$43.20	$54.00	$12.96–$48.60	17% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine inactivated preservative-free trivalent Sus AFLURIA 24/25	$42.90	$53.62	$12.87–$48.26	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90657 3 yrs im - AMB influenza vacc Charge	$43.20	$54.00	$12.96–$48.60	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus	$137.54	$171.93	$41.26–$154.74	45% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus	$137.54	$171.93	$41.26–$154.74	45% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus	$137.54	$171.93	$41.26–$154.74	—	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 vaccine pneumococcal 13-valent conjugate (Prevnar) - AMB pneumoc	$180.00	$225.00	$54.00–$202.50	28% below	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 vaccine pneumococcal 13-valent conjugate (Prevnar) - AMB pneumoc	$180.00	$225.00	$54.00–$202.50	28% below	20%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 vaccine pneumococcal 13-valent conjugate (Prevnar) - AMB pneumoc	$180.00	$225.00	$54.00–$202.50	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20-valent Conjugate Vaccine - AMB pneumococcal 20-v	$184.00	$230.00	$55.20–$207.00	62% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20-valent Conjugate Vaccine - AMB pneumococcal 20-v	$184.00	$230.00	$55.20–$207.00	62% below	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal 20-valent Conjugate Vaccine - AMB pneumococcal 20-v	$184.00	$230.00	$55.20–$207.00	—	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 AMB pneumococcal 21-valent conjugate vac charge	$621.54	$776.92	$186.46–$699.23	11% above	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 AMB pneumococcal 21-valent conjugate vac charge	$621.54	$776.92	$186.46–$699.23	11% above	20%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 AMB pneumococcal 21-valent conjugate vac charge	$621.54	$776.92	$186.46–$699.23	—	20%
Rabies vaccine, one dose CPT 90675 rabies vaccine purified chick embyro cell 2.5 intl units IM Inj	$365.47	$456.84	$109.64–$411.16	13% below	20%
Rabies vaccine, one dose CPT 90675 rabies vaccine purified chick embyro cell 2.5 intl units IM Inj	$365.47	$456.84	$109.64–$411.16	13% below	20%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine purified chick embyro cell 2.5 intl units IM Inj	$365.47	$456.84	$109.64–$411.16	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphth toxoids (Td) adult/adol 2 units-2 units/0.5 mL	$70.53	$88.16	$21.16–$79.34	64% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphth toxoids (Td) adult/adol 2 units-2 units/0.5 mL	$70.53	$88.16	$21.16–$79.34	64% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphth toxoids (Td) adult/adol 2 units-2 units/0.5 mL	$70.53	$88.16	$21.16–$79.34	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix - AMB Tdap Charge	$56.00	$70.00	$16.80–$63.00	at median	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix - AMB Tdap Charge	$56.00	$70.00	$16.80–$63.00	at median	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Boostrix) adult/adol	$108.83	$136.04	$32.65–$122.44	94% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Boostrix) adult/adol	$108.83	$136.04	$32.65–$122.44	94% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix - AMB Tdap Charge	$56.00	$70.00	$16.80–$63.00	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Boostrix) adult/adol	$108.83	$136.04	$32.65–$122.44	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN, INITIAL CHARGE	$159.00	$198.75	$47.70–$178.88	231% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 INITIAL VACCINE INJ CHARGE	$159.00	$198.75	$47.70–$178.88	231% above	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 OB INJ VACCINE CHARGE	$159.00	$198.75	$47.70–$178.88	231% above	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Addl Admin Charge 90472 - AMB Only Admin Charge	$19.20	$24.00	$5.76–$21.60	37% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 INJ/PO/IV VACCINE ADMIN SEQUE DRUG CHARGE	$19.20	$24.00	$5.76–$21.60	37% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 INJ/ADMIN VACC EA AD CHARGE	$30.00	$37.50	$9.00–$33.75	1% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 OB ADD'L VACCINE CHARGE	$35.40	$44.25	$10.62–$39.83	17% above	20%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://northcountryhospital.org/wp-content/uploads/030185556_north-country-hospital-and-health-center-inc_standardcharges.csv