SelfPayRates
Hospital Phoenix-Mesa-Chandler, AZ

Dignity Health Arizona General Hospital

Listed in its price file as “Agh Mesa LLC”.

Dignity Health Arizona General Hospital in Mesa, AZ publishes cash prices for 200 common procedures listed here, from its own machine-readable price file updated Feb 28, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Arizona median for 139 of 200 procedures and above it for 54. By typical cash price it ranks #27 of 53 Arizona hospitals and #18 of 32 hospitals in the Phoenix, AZ area, cheapest first. Click a procedure to compare it with other hospitals nearby.

9130 E Elliot Rd, Mesa, AZ 85212 Collected Sep 27, 2026 Source price file (480) 410-4500

Acute care hospital Emergency department CMS star rating 5 of 5 CCN 030139 · CMS hospital register

Scans and imaging

ProcedureCash price List priceInsurers payvs ArizonaOff list
Ankle X-ray, complete, 3 or more views CPT 73610 XR ANKLE 3+ VIEWS BIL $483.38 $1,957.00 $38.27–$1,598.87 54% above 75%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3+ VIEWS RT $241.82 $979.00 $38.27–$799.85 23% below 75%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XR ANKLE 3+ VIEWS BIL $483.38 $1,957.00 $1,037.21–$1,598.87 — 75%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3+ VIEWS RT $241.82 $979.00 $518.87–$799.85 — 75%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS SCOUT CHEST W CON $276.89 $1,121.00 $102.28–$915.86 23% below 75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPHAGUS SCOUT CHEST W CON $276.89 $1,121.00 $594.13–$915.86 — 75%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST COMPLETE BILATERAL $388.29 $1,572.00 $108.00–$1,284.33 — 75%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RT $194.89 $789.00 $108.00–$672.41 43% below 75%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US BREAST COMPLETE BILATERAL $388.29 $1,572.00 $833.16–$1,284.33 — 75%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE RT $194.89 $789.00 $418.17–$644.62 — 75%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST LIMITED BILATERAL $155.12 $628.00 $89.40–$513.25 — 75%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RT $106.96 $433.00 $89.40–$513.25 55% below 75%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST LIMITED BILATERAL $155.12 $628.00 $332.84–$513.08 — 75%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED RT $106.96 $433.00 $229.49–$353.77 — 75%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W CON $1,206.85 $4,886.00 $189.74–$3,991.87 13% below 75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W CON $1,206.85 $4,886.00 $2,589.58–$3,991.87 — 75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT/COR ART 3D W CON $1,101.62 $4,460.00 $346.53–$3,643.82 65% above 75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT/COR ART 3D W CON $1,101.62 $4,460.00 $2,363.80–$3,643.82 — 75%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT EVAL COR CA WO CON $802.01 $3,247.00 $93.85–$2,652.80 48% above 75%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT EVAL COR CA WO CON $802.01 $3,247.00 $1,720.91–$2,652.80 — 75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN PELVIS WO CON $1,295.03 $5,243.00 $197.40–$4,283.54 2% below 75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN PELVIS WO CON $1,295.03 $5,243.00 $2,778.79–$4,283.54 — 75%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN PELVIS W CON $1,876.96 $7,599.00 $326.86–$6,208.39 1% above 75%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN PELVIS W CON $1,876.96 $7,599.00 $4,027.47–$6,208.39 — 75%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN PELVIS W WO CON $2,177.31 $8,815.00 $366.56–$7,201.86 6% below 75%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN PELVIS W WO CON $2,177.31 $8,815.00 $4,671.95–$7,201.86 — 75%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CON $1,198.20 $4,851.00 $189.74–$3,963.27 8% below 75%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CON $1,198.20 $4,851.00 $2,571.03–$3,963.27 — 75%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CON $742.98 $3,008.00 $113.34–$2,457.54 18% below 75%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CON $742.98 $3,008.00 $1,594.24–$2,457.54 — 75%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CON $742.24 $3,005.00 $113.34–$2,455.09 9% below 75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CON $742.24 $3,005.00 $1,592.65–$2,455.09 — 75%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CON $898.59 $3,638.00 $113.34–$2,972.25 2% above 75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CON $898.59 $3,638.00 $1,928.14–$2,972.25 — 75%
CT scan of the head with contrast CPT 70460 CT HEAD W CON $1,204.13 $4,875.00 $159.85–$3,982.88 6% above 75%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CON $1,204.13 $4,875.00 $2,583.75–$3,982.88 — 75%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO AND W CON $1,455.82 $5,894.00 $187.03–$4,815.40 2% above 75%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO AND W CON $1,455.82 $5,894.00 $3,123.82–$4,815.40 — 75%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CON $1,116.44 $4,520.00 $113.34–$3,692.84 5% below 75%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CON $1,116.44 $4,520.00 $2,395.60–$3,692.84 — 75%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CON $1,116.44 $4,520.00 $113.34–$3,692.84 at median 75%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CON $1,116.44 $4,520.00 $2,395.60–$3,692.84 — 75%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CON $1,340.72 $5,428.00 $189.74–$4,434.68 14% above 75%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CON $1,340.72 $5,428.00 $2,876.84–$4,434.68 — 75%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US DUPLEX EXTRACRANIAL CMP BIL $836.59 $3,387.00 $199.19–$2,767.18 1% below 75%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US DUPLEX EXTRACRANIAL CMP BIL $836.59 $3,387.00 $1,795.11–$2,767.18 — 75%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS $196.86 $797.00 $35.40–$651.15 2% above 75%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS $196.86 $797.00 $422.41–$651.15 — 75%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW $151.42 $613.00 $26.82–$500.83 42% above 75%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW $151.42 $613.00 $324.89–$500.83 — 75%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE $400.14 $1,620.00 $113.34–$1,323.54 at median 75%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE $400.14 $1,620.00 $858.60–$1,323.54 — 75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CON $736.31 $2,981.00 $113.34–$2,435.48 10% below 75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CON $736.31 $2,981.00 $1,579.93–$2,435.48 — 75%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W CON $1,185.36 $4,799.00 $179.88–$3,920.79 6% below 75%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W CON $1,185.36 $4,799.00 $2,543.47–$3,920.79 — 75%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US DUPLEX ART LOW EXT CMP BIL $544.15 $2,203.00 $251.76–$1,799.86 26% below 75%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US DUPLEX ART LOW EXT CMP BIL $544.15 $2,203.00 $1,167.59–$1,799.86 — 75%
Duplex ultrasound of the leg veins, both legs CPT 93970 US DUPLEX VENOUS EXTREMITY BIL $567.86 $2,299.00 $195.97–$1,878.29 23% below 75%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DUPLEX VENOUS EXTREMITY BIL $567.86 $2,299.00 $1,218.47–$1,878.29 — 75%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W DOPPLER COMPLETE $1,016.16 $4,114.00 $206.35–$3,361.14 1% above 75%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W DOPPLER COMPLETE $1,016.16 $4,114.00 $2,180.42–$3,361.14 — 75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SYSTEM $569.34 $2,305.00 $310.77–$2,657.03 40% below 75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SYSTEM $569.34 $2,305.00 $1,221.65–$1,883.19 — 75%
Knee X-ray, 3 views CPT 73562 XR KNEE 3 VIEWS BIL $402.86 $1,631.00 $42.91–$1,332.53 26% above 75%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS RT $209.71 $849.00 $42.91–$693.64 35% below 75%
Knee X-ray, 3 views inpatient CPT 73562 XR KNEE 3 VIEWS BIL $402.86 $1,631.00 $864.43–$1,332.53 — 75%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEWS RT $209.71 $849.00 $449.97–$693.64 — 75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN WO CON LIMITED $448.06 $1,814.00 $91.19–$1,482.04 1% above 75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN WO CON LIMITED $448.06 $1,814.00 $961.42–$1,482.04 — 75%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING LOW DOSE $44.22 $179.00 $94.87–$1,482.00 66% below 75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREENING LOW DOSE $44.22 $179.00 $94.87–$146.25 — 75%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MR LOWER EXTREMITY JOINT WO BI $1,030.74 $4,173.00 $218.86–$3,409.35 — 75%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR LOWER EXTREMITY JOINT WO LT $710.87 $2,878.00 $218.86–$2,351.33 68% below 75%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR LOWER EXTREMITY JOINT WO BI $1,030.74 $4,173.00 $2,211.69–$3,409.35 — 75%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR LOWER EXTREMITY JOINT WO LT $710.87 $2,878.00 $1,525.34–$2,351.33 — 75%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR LOWER EXTREMITY JNT WO W RT $1,848.06 $7,482.00 $380.64–$6,112.80 38% below 75%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR LOWER EXTREMITY JNT WO W RT $1,848.06 $7,482.00 $3,965.46–$6,112.80 — 75%
MRI of the abdomen without contrast CPT 74181 MR ABDOMEN WO CON $1,026.04 $4,154.00 $211.35–$3,393.82 8% below 75%
MRI of the abdomen without contrast inpatient CPT 74181 MR ABDOMEN WO CON $1,026.04 $4,154.00 $2,201.62–$3,393.82 — 75%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR ABDOMEN WO AND W CON $2,093.08 $8,474.00 $365.13–$6,923.26 at median 75%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR ABDOMEN WO AND W CON $2,093.08 $8,474.00 $4,491.22–$6,923.26 — 75%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN WO CON $867.47 $3,512.00 $211.71–$2,869.31 31% below 75%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN WO CON $867.47 $3,512.00 $1,861.36–$2,869.31 — 75%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN WO AND W CON $1,548.94 $6,271.00 $343.67–$5,123.41 18% below 75%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN WO AND W CON $1,548.94 $6,271.00 $3,323.63–$5,123.41 — 75%
MRI of the lower back, no contrast dye CPT 72148 MR LUMBAR SPINE WO CON LTD $826.22 $3,345.00 $206.70–$2,732.87 47% below 75%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR LUMBAR SPINE WO CON LTD $826.22 $3,345.00 $1,772.85–$2,732.87 — 75%
MRI of the lower back, without and then with contrast dye CPT 72158 MR LUMBAR SPINE WO AND W CON $2,503.60 $10,136.00 $344.74–$8,281.12 5% above 75%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR LUMBAR SPINE WO AND W CON $2,503.60 $10,136.00 $5,372.08–$8,281.12 — 75%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR THORACIC SPINE WO CON $926.25 $3,750.00 $205.63–$3,063.75 39% below 75%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR THORACIC SPINE WO CON $926.25 $3,750.00 $1,987.50–$3,063.75 — 75%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR CERVICAL SPINE WO AND W CON $2,750.60 $11,136.00 $345.46–$9,098.12 15% above 75%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR CERVICAL SPINE WO AND W CON $2,750.60 $11,136.00 $5,902.08–$9,098.12 — 75%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR CERVICAL SPINE WO CON LTD $797.81 $3,230.00 $205.99–$2,638.91 41% below 75%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR CERVICAL SPINE WO CON LTD $797.81 $3,230.00 $1,711.90–$2,638.91 — 75%
MRI of the pelvis without and with contrast CPT 72197 MR PELVIS WO AND W CON $2,032.07 $8,227.00 $363.70–$6,721.46 at median 75%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS WO AND W CON $2,032.07 $8,227.00 $4,360.31–$6,721.46 — 75%
MRI of the pelvis, no contrast dye CPT 72195 MR PELVIS WO CON $995.66 $4,031.00 $247.47–$3,293.33 20% below 75%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR PELVIS WO CON $995.66 $4,031.00 $2,136.43–$3,293.33 — 75%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR UPP EXTREM JOINT WO CON LT $807.45 $3,269.00 $219.22–$2,670.78 66% below 75%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR UPP EXTREM JOINT WO CON LT $807.45 $3,269.00 $1,732.57–$2,670.78 — 75%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS NON OB LTD OR F/U $322.83 $1,307.00 $51.85–$1,067.82 10% above 75%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS NON OB LTD OR F/U $322.83 $1,307.00 $692.71–$1,067.82 — 75%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS NON OBSTETRIC COMP $474.74 $1,922.00 $110.50–$1,570.28 11% above 75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS NON OBSTETRIC COMP $474.74 $1,922.00 $1,018.66–$1,570.28 — 75%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG=>14WK SNG 1ST GES $260.10 $1,053.00 $113.34–$861.00 33% below 75%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG=>14WK SNG 1ST GES $260.10 $1,053.00 $558.09–$860.31 — 75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG<14WK SNGL OR 1ST GEST $388.29 $1,572.00 $113.34–$1,284.33 36% above 75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG<14WK SNGL OR 1ST GEST $388.29 $1,572.00 $833.16–$1,284.33 — 75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREG 1 OR >FETUSES LTD $186.74 $756.00 $85.11–$617.66 39% below 75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREG 1 OR >FETUSES LTD $186.74 $756.00 $400.68–$617.66 — 75%
Shoulder X-ray, complete, 2 or more views CPT 73030 XR SHOULDER 2+ VIEWS BIL $403.11 $1,632.00 $36.83–$1,333.35 87% above 75%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ VIEWS RT $200.57 $812.00 $36.83–$663.41 7% below 75%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR SHOULDER 2+ VIEWS BIL $403.11 $1,632.00 $864.96–$1,333.35 — 75%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ VIEWS RT $200.57 $812.00 $430.36–$663.41 — 75%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO STR TEST COMP W ECG $516.23 $2,090.00 $243.89–$1,707.53 43% below 75%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO STR TEST COMP W ECG $516.23 $2,090.00 $1,107.70–$1,707.53 — 75%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR SWL FUNCT/CINE/VID/SCT WCON $176.36 $714.00 $130.53–$1,020.26 57% below 75%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR SWL FUNCT/CINE/VID/SCT WCON $176.36 $714.00 $378.42–$583.34 — 75%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL $342.35 $1,386.00 $113.34–$1,132.37 5% below 75%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL $342.35 $1,386.00 $734.58–$1,132.37 — 75%
Transvaginal ultrasound during pregnancy CPT 76817 US PREG TRANSVAGINAL $342.35 $1,386.00 $97.27–$1,132.37 4% above 75%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREG TRANSVAGINAL $342.35 $1,386.00 $734.58–$1,132.37 — 75%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE WO CON $515.25 $2,086.00 $113.34–$1,704.27 at median 75%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE WO CON $515.25 $2,086.00 $1,105.58–$1,704.27 — 75%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM $417.43 $1,690.00 $105.14–$1,380.73 5% above 75%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM $417.43 $1,690.00 $895.70–$1,380.73 — 75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD AND NECK $277.14 $1,122.00 $113.34–$916.68 17% below 75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD AND NECK $277.14 $1,122.00 $594.66–$916.68 — 75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI/SCOUT ABD W SINGLE CON $268.99 $1,089.00 $128.74–$889.72 23% below 75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI/SCOUT ABD W SINGLE CON $268.99 $1,089.00 $577.17–$889.72 — 75%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US DUPLEX VENOUS EXTREMITY LT $423.86 $1,716.00 $113.34–$1,401.98 4% below 75%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US DUPLEX VENOUS EXTREMITY LT $423.86 $1,716.00 $909.48–$1,401.98 — 75%
Wrist X-ray, complete, 3 or more views CPT 73110 XR WRIST 3+ VIEWS BIL $329.01 $1,332.00 $43.27–$1,088.25 2% above 75%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3+ VIEWS RT $171.42 $694.00 $43.27–$567.00 47% below 75%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XR WRIST 3+ VIEWS BIL $329.01 $1,332.00 $705.96–$1,088.25 — 75%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3+ VIEWS RT $171.42 $694.00 $367.82–$567.00 — 75%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP UNIL W WO PELV 2-3VW LT $141.54 $573.00 $50.07–$468.15 61% below 75%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNIL W WO PELV 2-3VW LT $141.54 $573.00 $303.69–$468.15 — 75%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW $186.74 $756.00 $31.83–$617.66 8% above 75%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW $186.74 $756.00 $400.68–$617.66 — 75%
X-ray of the ankle, 2 views CPT 73600 XR ANKLE 2 VIEWS BIL $246.76 $999.00 $33.97–$816.19 11% above 75%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RT $164.51 $666.00 $33.97–$544.13 26% below 75%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 1 VIEW LTD LT $171.67 $695.00 $33.97–$567.82 23% below 75%
X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE 2 VIEWS BIL $246.76 $999.00 $529.47–$816.19 — 75%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS RT $164.51 $666.00 $352.98–$544.13 — 75%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 1 VIEW LTD LT $171.67 $695.00 $368.35–$567.82 — 75%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER(S) 2+ VIEWS RT $135.85 $550.00 $40.05–$449.35 at median 75%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER(S) 2+ VIEWS RT $135.85 $550.00 $291.50–$449.35 — 75%
X-ray of the foot, 2 views CPT 73620 XR FOOT 2 VIEWS BIL $210.20 $851.00 $30.04–$695.27 106% above 75%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 1 VIEW LTD LT $93.37 $378.00 $30.04–$311.33 9% below 75%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RT $140.05 $567.00 $30.04–$463.24 37% above 75%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 2 VIEWS BIL $210.20 $851.00 $451.03–$695.27 — 75%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 1 VIEW LTD LT $93.37 $378.00 $200.34–$308.83 — 75%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RT $140.05 $567.00 $300.51–$463.24 — 75%
X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT 3+ VIEWS BIL $271.46 $1,099.00 $36.12–$897.89 76% above 75%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3+ VIEWS RT $165.99 $672.00 $36.12–$549.03 8% above 75%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT 3+ VIEWS BIL $271.46 $1,099.00 $582.47–$897.89 — 75%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3+ VIEWS RT $165.99 $672.00 $356.16–$549.03 — 75%
X-ray of the hand, 3 or more views CPT 73130 XR HAND 3+ VIEWS BIL $345.80 $1,400.00 $38.98–$1,143.80 5% below 75%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3+ VIEWS RT $180.07 $729.00 $38.98–$595.60 51% below 75%
X-ray of the hand, 3 or more views inpatient CPT 73130 XR HAND 3+ VIEWS BIL $345.80 $1,400.00 $742.00–$1,143.80 — 75%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3+ VIEWS RT $180.07 $729.00 $386.37–$595.60 — 75%
X-ray of the knee, 1 or 2 views CPT 73560 XR KNEE 1 OR 2 VIEWS BIL $258.12 $1,045.00 $36.12–$853.77 11% below 75%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS RT $171.92 $696.00 $36.12–$568.64 41% below 75%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE 1 OR 2 VIEWS BIL $258.12 $1,045.00 $553.85–$853.77 — 75%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1 OR 2 VIEWS RT $171.92 $696.00 $368.88–$568.64 — 75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEWS $352.47 $1,427.00 $41.84–$1,165.86 105% above 75%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR SPINE 2 OR 3 VIEWS $352.47 $1,427.00 $756.31–$1,165.86 — 75%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4+ VIEWS $359.39 $1,455.00 $54.72–$1,188.74 4% above 75%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4+ VIEWS $359.39 $1,455.00 $771.15–$1,188.74 — 75%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES 3+ VIEWS $100.53 $407.00 $39.34–$332.52 6% below 75%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES 3+ VIEWS $100.53 $407.00 $215.71–$332.52 — 75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR CERVICAL SPINE 2-3 VIEWS $247.75 $1,003.00 $41.48–$819.46 11% above 75%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL SPINE 2-3 VIEWS $247.75 $1,003.00 $531.59–$819.46 — 75%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEWS $153.89 $623.00 $29.32–$509.00 17% below 75%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1 OR 2 VIEWS $153.89 $623.00 $330.19–$509.00 — 75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM AND COCCYX 2+ VIEWS $148.45 $601.00 $34.33–$491.02 38% above 75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM AND COCCYX 2+ VIEWS $148.45 $601.00 $318.53–$491.02 — 75%

Lab tests

ProcedureCash price List priceInsurers payvs ArizonaOff list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE ALT SGPT $23.22 $94.00 $3.18–$76.80 37% below 75%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 RL-A-TRANSFERASE ALAN 2005661B $28.66 $116.00 $3.18–$94.78 22% below 75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE ALT SGPT $23.22 $94.00 $49.82–$76.80 — 75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 RL-A-TRANSFERASE ALAN 2005661B $28.66 $116.00 $61.48–$94.78 — 75%
AST (aspartate aminotransferase) enzyme test CPT 84450 RL-A-TRANSFERASE ASPAR2005661A $28.66 $116.00 $3.10–$94.78 20% below 75%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE ASPARTATE AST SGOT $28.90 $117.00 $3.10–$95.59 19% below 75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 RL-A-TRANSFERASE ASPAR2005661A $28.66 $116.00 $61.48–$94.78 — 75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE ASPARTATE AST SGOT $28.90 $117.00 $62.01–$95.59 — 75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL $281.09 $1,138.00 $28.57–$929.75 104% above 75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL $281.09 $1,138.00 $603.14–$929.75 — 75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ALLERG FOOD PAN 8 55133 $4.45 $18.00 $3.13–$25.41 65% below 75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ALL IGE QN/SEMIQN3001721A $5.19 $21.00 $3.13–$25.41 59% below 75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ALL IGE QN/SEMIQN3001561A $7.41 $30.00 $3.13–$25.41 41% below 75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ALLER IGE QN/SEMIQN50486B $61.51 $249.00 $3.13–$203.44 386% above 75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ALLERGEN PED FOOD 1 55121 $144.50 $585.00 $3.13–$477.95 1042% above 75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ALLERG FOOD PAN 8 55133 $4.45 $18.00 $9.54–$14.71 — 75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ALL IGE QN/SEMIQN3001721A $5.19 $21.00 $11.13–$17.16 — 75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ALL IGE QN/SEMIQN3001561A $7.41 $30.00 $15.90–$24.51 — 75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ALLER IGE QN/SEMIQN50486B $61.51 $249.00 $131.97–$203.44 — 75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ALLERGEN PED FOOD 1 55121 $144.50 $585.00 $310.05–$477.95 — 75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 RL-A-ANA IGG ELISA WRFLX 50080 $25.94 $105.00 $7.25–$85.79 16% below 75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 RL-A-ANA IGG ELISA WRFLX 50317 $62.99 $255.00 $7.25–$208.34 103% above 75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB SCR $64.97 $263.00 $7.25–$214.88 109% above 75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 RL-A-ANA IGG ELISA WRFLX 50080 $25.94 $105.00 $55.65–$85.79 — 75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 RL-A-ANA IGG ELISA WRFLX 50317 $62.99 $255.00 $135.15–$208.34 — 75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB SCR $64.97 $263.00 $139.39–$214.88 — 75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 RL-A-PROBRAIN NATRIU PEP 50083 $50.15 $203.00 $23.55–$191.09 42% below 75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE $135.11 $547.00 $23.55–$446.90 57% above 75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 RL-A-PROBRAIN NATRIU PEP 50083 $50.15 $203.00 $107.59–$165.86 — 75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE $135.11 $547.00 $289.91–$446.90 — 75%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL $56.57 $229.00 $5.07–$187.10 45% below 75%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL $56.57 $229.00 $121.37–$187.10 — 75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 GROSS MICRO LEVEL IV $312.21 $1,264.00 $30.97–$1,032.69 127% above 75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 S/O GROSS/MICRO LEVEL 4 $1,037.16 $4,199.00 $30.97–$3,430.59 655% above 75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 GROSS MICRO LEVEL IV $312.21 $1,264.00 $669.92–$1,032.69 — 75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 S/O GROSS/MICRO LEVEL 4 $1,037.16 $4,199.00 $2,225.47–$3,430.59 — 75%
Blood culture for bacteria CPT 87040 CULTURE BLOOD $145.49 $589.00 $6.19–$481.22 at median 75%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD $145.49 $589.00 $312.17–$481.22 — 75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE $14.58 $59.00 $3.08–$48.21 26% below 75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE $14.58 $59.00 $31.27–$48.21 — 75%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD QW $3.96 $16.00 $2.35–$19.11 91% below 75%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD $14.82 $60.00 $2.35–$49.02 68% below 75%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD QW $3.96 $16.00 $8.48–$13.08 — 75%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD $14.82 $60.00 $31.80–$49.02 — 75%
Blood lead test CPT 83655 RL-A-LEAD 99470B $18.53 $75.00 $7.26–$61.28 22% below 75%
Blood lead test CPT 83655 RL-A-LEAD URINE 25060 $48.91 $198.00 $7.26–$161.77 106% above 75%
Blood lead test CPT 83655 RL-A-LEAD 20584C $162.28 $657.00 $7.26–$536.77 583% above 75%
Blood lead test inpatient CPT 83655 RL-A-LEAD 99470B $18.53 $75.00 $39.75–$61.28 — 75%
Blood lead test inpatient CPT 83655 RL-A-LEAD URINE 25060 $48.91 $198.00 $104.94–$161.77 — 75%
Blood lead test inpatient CPT 83655 RL-A-LEAD 20584C $162.28 $657.00 $348.21–$536.77 — 75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QL (PREG TEST) $68.67 $278.00 $4.51–$227.13 9% below 75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QL (PREG TEST) $68.67 $278.00 $147.34–$227.13 — 75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO $20.26 $82.00 $1.79–$84.46 76% below 75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO $20.26 $82.00 $43.46–$67.00 — 75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN $41.99 $170.00 $3.10–$138.89 15% above 75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN $41.99 $170.00 $90.10–$138.89 — 75%
C. difficile toxin gene test (stool PCR) CPT 87493 IA CLOSTRID DIFF TOXIN AMP PRB $96.58 $391.00 $22.36–$319.45 31% above 75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 IA CLOSTRID DIFF TOXIN AMP PRB $96.58 $391.00 $207.23–$319.45 — 75%
CA 19-9 blood test (tumor marker) CPT 86301 RL-A-CANCER AG-GI 19-9 80461 $31.87 $129.00 $12.48–$105.40 9% below 75%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 RL-A-CANCER AG-GI 19-9 80461 $31.87 $129.00 $68.37–$105.40 — 75%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNO TUMOR AG CA 125 $106.21 $430.00 $12.48–$351.31 26% above 75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNO TUMOR AG CA 125 $106.21 $430.00 $227.90–$351.31 — 75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 PROB TECH $52.12 $211.00 $30.78–$367.23 9% below 75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 PROB TECH $52.12 $211.00 $111.83–$172.39 — 75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 RL-A-IA CHLAMYD AMP PRB 60241A $54.69 $221.40 $21.05–$180.89 8% below 75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 IA CHLAMYDIA TRACH AMP PROBE $71.14 $288.00 $21.05–$235.30 20% above 75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 RL-A-IA CHLAMYD AMP PRB 60241A $54.69 $221.40 $117.35–$180.89 — 75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 IA CHLAMYDIA TRACH AMP PROBE $71.14 $288.00 $152.64–$235.30 — 75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 RL-A-LIPID PANEL 80503B $30.14 $122.00 $8.03–$99.68 40% below 75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL $131.16 $531.00 $8.03–$433.83 160% above 75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 RL-A-LIPID PANEL 80503B $30.14 $122.00 $64.66–$99.68 — 75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL $131.16 $531.00 $281.43–$433.83 — 75%
Complete blood count (CBC) with differential CPT 85025 CBC AUTO W AUTO DIF $61.51 $249.00 $4.66–$203.44 22% below 75%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTO W AUTO DIF $61.51 $249.00 $131.97–$203.44 — 75%
Complete blood count (CBC), no differential CPT 85027 CBC AUTO WO DIFF $46.93 $190.00 $3.88–$155.23 15% below 75%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO WO DIFF $46.93 $190.00 $100.70–$155.23 — 75%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL $144.50 $585.00 $6.33–$477.95 7% below 75%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL $144.50 $585.00 $310.05–$477.95 — 75%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION D DIMER QN $108.19 $438.00 $6.10–$357.85 3% above 75%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION D DIMER QN $108.19 $438.00 $232.14–$357.85 — 75%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S $47.68 $193.00 $13.33–$157.69 24% below 75%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S $47.68 $193.00 $102.29–$157.69 — 75%
Estradiol blood test CPT 82670 ESTRADIOL TOTAL $84.48 $342.00 $16.76–$279.42 8% above 75%
Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL $84.48 $342.00 $181.26–$279.42 — 75%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FSH $82.50 $334.00 $11.14–$272.88 43% below 75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FSH $82.50 $334.00 $177.02–$272.88 — 75%
Fecal calprotectin (stool inflammation test) CPT 83993 RL-A-CALPROTECTN FECAL 3002859 $27.42 $111.00 $11.77–$95.55 43% below 75%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 RL-A-CALPROTECTN FECAL 3002859 $27.42 $111.00 $58.83–$90.69 — 75%
Ferritin blood test (iron stores) CPT 82728 FERRITIN $73.86 $299.00 $8.17–$244.29 20% below 75%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN $73.86 $299.00 $158.47–$244.29 — 75%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM $59.28 $240.00 $8.82–$196.08 44% below 75%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM $59.28 $240.00 $127.20–$196.08 — 75%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE FREE $58.54 $237.00 $10.16–$193.63 26% above 75%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE FREE $58.54 $237.00 $125.61–$193.63 — 75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE $66.69 $270.00 $5.41–$220.59 8% above 75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE $66.69 $270.00 $143.10–$220.59 — 75%
Free testosterone test CPT 84402 RL-A-TESTOSTER FREE MALE 70111 $12.11 $49.00 $15.28–$123.96 84% below 75%
Free testosterone test CPT 84402 RL-A-TESTOSTERONE FREE 81056C $25.20 $102.00 $15.28–$123.96 67% below 75%
Free testosterone test CPT 84402 TESTOSTERONE FREE $66.45 $269.00 $15.28–$219.78 12% below 75%
Free testosterone test inpatient CPT 84402 RL-A-TESTOSTER FREE MALE 70111 $12.11 $49.00 $25.97–$40.04 — 75%
Free testosterone test inpatient CPT 84402 RL-A-TESTOSTERONE FREE 81056C $25.20 $102.00 $54.06–$83.34 — 75%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE $66.45 $269.00 $142.57–$219.78 — 75%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST DOSE $32.61 $132.00 $2.85–$107.85 64% below 75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST DOSE $32.61 $132.00 $69.96–$107.85 — 75%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE 1ST 3 SPEC $80.03 $324.00 $7.72–$264.71 38% below 75%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE 1ST 3 SPEC $80.03 $324.00 $171.72–$264.71 — 75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 RL-A-IA NEISSERIA G AMP 60241B $57.56 $233.00 $21.05–$190.37 11% above 75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 IA NEISSERIA GONORR AMP PROBE $71.39 $289.00 $21.05–$236.12 38% above 75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 RL-A-IA NEISSERIA G AMP 60241B $57.56 $233.00 $123.49–$190.37 — 75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 IA NEISSERIA GONORR AMP PROBE $71.39 $289.00 $153.17–$236.12 — 75%
H. pylori stool antigen test CPT 87338 RL-A-H PYLORI AG FEC EIA 65147 $28.66 $116.00 $8.62–$94.78 35% below 75%
H. pylori stool antigen test inpatient CPT 87338 RL-A-H PYLORI AG FEC EIA 65147 $28.66 $116.00 $61.48–$94.78 — 75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 RL-A-RFL HIV1 QN NATT P3000867 $72.87 $295.00 $51.06–$414.18 40% below 75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 RL-A-HIV 1 QN NATT RFLX3000870 $84.23 $341.00 $51.06–$414.18 31% below 75%
HIV viral load test (HIV-1 RNA, quantitative) one side CPT 87536 IA HIV1 QN RT $90.90 $368.00 $51.06–$414.18 25% below 75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 RL-A-RFL HIV1 QN NATT P3000867 $72.87 $295.00 $156.35–$241.02 — 75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 RL-A-HIV 1 QN NATT RFLX3000870 $84.23 $341.00 $180.73–$278.60 — 75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient one side CPT 87536 IA HIV1 QN RT $90.90 $368.00 $195.04–$300.66 — 75%
HIV-1 and HIV-2 antibody test CPT 86703 AB HIV 1 HIV 2 SINGLE RESULT $68.18 $276.00 $8.22–$225.50 38% above 75%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 AB HIV 1 HIV 2 SINGLE RESULT $68.18 $276.00 $146.28–$225.50 — 75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 IA HIV1 AG W HIV1 HIV2 AB $46.93 $190.00 $14.44–$155.23 11% above 75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 IA HIV1 AG W HIV1 HIV2 AB $46.93 $190.00 $100.70–$155.23 — 75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYOSYLATED A1C $50.39 $204.00 $5.82–$166.67 6% below 75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYOSYLATED A1C $50.39 $204.00 $108.12–$166.67 — 75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB $54.84 $222.00 $6.44–$181.38 5% above 75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB $54.84 $222.00 $117.66–$181.38 — 75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 IA HEPATITIS B SURFACE AG QL $52.62 $213.00 $6.19–$174.03 1% below 75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 IA HEPATITIS B SURFACE AG QL $52.62 $213.00 $112.89–$174.03 — 75%
Hepatitis C antibody blood test (screening) CPT 86803 RL-A-HCV AB CIA RFLX 2010784 $14.08 $57.00 $8.56–$69.42 72% below 75%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY $76.33 $309.00 $8.56–$252.46 52% above 75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 RL-A-HCV AB CIA RFLX 2010784 $14.08 $57.00 $30.21–$46.57 — 75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY $76.33 $309.00 $163.77–$252.46 — 75%
Hepatitis C viral load (HCV RNA) test CPT 87522 RL-A-HCV QUANT NAAT 3000572 $130.42 $528.00 $25.70–$431.38 67% above 75%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 IA HEPATITIS C QUANT RT $48.42 $196.00 $25.70–$208.48 38% below 75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 RL-A-HCV QUANT NAAT 3000572 $130.42 $528.00 $279.84–$431.38 — 75%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 IA HEPATITIS C QUANT RT $48.42 $196.00 $103.88–$160.14 — 75%
Herpes blood test, HSV-1 antibody CPT 86695 RL-A-HSV 1 GLYCO G IGG 50292 $39.28 $159.00 $7.91–$129.91 24% above 75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 RL-A-HSV 1 GLYCO G IGG 50292 $39.28 $159.00 $84.27–$129.91 — 75%
Herpes blood test, HSV-2 antibody CPT 86696 RL-A-HSV 2 GLYCO G IGG 50294 $20.51 $83.00 $11.61–$94.19 38% below 75%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 RL-A-HSV 2 GLYCO G IGG 50294 $20.51 $83.00 $43.99–$67.82 — 75%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENS $73.86 $299.00 $7.77–$244.29 9% above 75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENS $73.86 $299.00 $158.47–$244.29 — 75%
Homocysteine blood test CPT 83090 RL-A-HOMOCYSTEINE TOTAL 99869 $44.46 $180.00 $10.75–$147.06 65% below 75%
Homocysteine blood test CPT 83090 HOMOCYSTEINE $82.50 $334.00 $10.75–$272.88 35% below 75%
Homocysteine blood test inpatient CPT 83090 RL-A-HOMOCYSTEINE TOTAL 99869 $44.46 $180.00 $95.40–$147.06 — 75%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE $82.50 $334.00 $177.02–$272.88 — 75%
Insulin blood test CPT 83525 RL-A-INSULIN TOTAL 70155A $12.60 $51.00 $6.85–$55.61 58% below 75%
Insulin blood test CPT 83525 INSULIN TOTAL $32.61 $132.00 $6.85–$107.85 9% above 75%
Insulin blood test inpatient CPT 83525 RL-A-INSULIN TOTAL 70155A $12.60 $51.00 $27.03–$41.67 — 75%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL $32.61 $132.00 $69.96–$107.85 — 75%
Iron blood test (serum iron) CPT 83540 RL-A-IRON LIVER 28250 $12.11 $49.00 $3.88–$40.04 71% below 75%
Iron blood test (serum iron) CPT 83540 IRON $37.80 $153.00 $3.88–$125.01 10% below 75%
Iron blood test (serum iron) inpatient CPT 83540 RL-A-IRON LIVER 28250 $12.11 $49.00 $25.97–$40.04 — 75%
Iron blood test (serum iron) inpatient CPT 83540 IRON $37.80 $153.00 $81.09–$125.01 — 75%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL $95.84 $388.00 $5.20–$317.00 18% below 75%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL $95.84 $388.00 $205.64–$317.00 — 75%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTENIZING HORM $83.24 $337.00 $11.11–$275.33 11% below 75%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTENIZING HORM $83.24 $337.00 $178.61–$275.33 — 75%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE BODY FLUID $25.69 $104.00 $4.13–$84.97 72% below 75%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE $28.16 $114.00 $4.13–$93.14 69% below 75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE BODY FLUID $25.69 $104.00 $55.12–$84.97 — 75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE $28.16 $114.00 $60.42–$93.14 — 75%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL $92.63 $375.00 $4.90–$306.38 10% below 75%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL $92.63 $375.00 $198.75–$306.38 — 75%
Lyme disease antibody test CPT 86618 RL-A-BORRELIA BURG TOTAL 50267 $16.80 $68.00 $10.21–$82.88 45% below 75%
Lyme disease antibody test CPT 86618 RL-A-BORR BUR CSF TOT 3016760 $17.29 $70.00 $10.21–$82.88 43% below 75%
Lyme disease antibody test CPT 86618 RL-A-B BURG E1/C10 ABS 3006053 $47.92 $194.00 $10.21–$158.50 57% above 75%
Lyme disease antibody test CPT 86618 RL-A-RFXLYMEMOD2TR2NDTR3006188 $50.89 $206.00 $10.21–$168.31 67% above 75%
Lyme disease antibody test CPT 86618 RL-A-BORRELI BURG TTL CSF99483 $155.12 $628.00 $10.21–$513.08 409% above 75%
Lyme disease antibody test inpatient CPT 86618 RL-A-BORRELIA BURG TOTAL 50267 $16.80 $68.00 $36.04–$55.56 — 75%
Lyme disease antibody test inpatient CPT 86618 RL-A-BORR BUR CSF TOT 3016760 $17.29 $70.00 $37.10–$57.19 — 75%
Lyme disease antibody test inpatient CPT 86618 RL-A-B BURG E1/C10 ABS 3006053 $47.92 $194.00 $102.82–$158.50 — 75%
Lyme disease antibody test inpatient CPT 86618 RL-A-RFXLYMEMOD2TR2NDTR3006188 $50.89 $206.00 $109.18–$168.31 — 75%
Lyme disease antibody test inpatient CPT 86618 RL-A-BORRELI BURG TTL CSF99483 $155.12 $628.00 $332.84–$513.08 — 75%
Magnesium blood test CPT 83735 MAGNESIUM $55.33 $224.00 $4.02–$183.01 178% above 75%
Magnesium blood test inpatient CPT 83735 MAGNESIUM $55.33 $224.00 $118.72–$183.01 — 75%
Measles (rubeola) antibody test CPT 86765 RL-A-ANTIBODY RUBEOLA 3017752C $15.57 $63.00 $7.72–$62.70 7% below 75%
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA $30.39 $123.00 $7.72–$100.50 82% above 75%
Measles (rubeola) antibody test CPT 86765 RL-A-MEASLES RUBEOLA IGM 99597 $43.72 $177.00 $7.72–$144.61 162% above 75%
Measles (rubeola) antibody test inpatient CPT 86765 RL-A-ANTIBODY RUBEOLA 3017752C $15.57 $63.00 $33.39–$51.48 — 75%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA $30.39 $123.00 $65.19–$100.50 — 75%
Measles (rubeola) antibody test inpatient CPT 86765 RL-A-MEASLES RUBEOLA IGM 99597 $43.72 $177.00 $93.81–$144.61 — 75%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST SCRN $57.80 $234.00 $3.10–$191.18 19% below 75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST SCRN $57.80 $234.00 $124.02–$191.18 — 75%
PSA (prostate-specific antigen) blood test, free CPT 84154 RL-A-PSA FREE 80206B $65.95 $267.00 $11.03–$218.14 4% above 75%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 RL-A-PSA FREE 80206B $65.95 $267.00 $141.51–$218.14 — 75%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSATE SPECIFIC AG TOTAL $67.93 $275.00 $11.03–$224.68 12% below 75%
PSA (prostate-specific antigen) blood test, total CPT 84153 RL-A-PSA TOTAL 80206A $68.18 $276.00 $11.03–$225.50 12% below 75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSATE SPECIFIC AG TOTAL $67.93 $275.00 $145.75–$224.68 — 75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 RL-A-PSA TOTAL 80206A $68.18 $276.00 $146.28–$225.50 — 75%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO THIN PREP AUTO MAN RESCRN $45.45 $184.00 $15.96–$150.33 6% above 75%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO THIN PREP AUTO MAN RESCRN $45.45 $184.00 $97.52–$150.33 — 75%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 RL-A-CYTOPATH THIN 2000137 $28.90 $117.00 $12.15–$98.62 8% below 75%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH CER/VAG AUTO MAN SCRN $56.57 $229.00 $12.15–$187.10 81% above 75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 RL-A-CYTOPATH THIN 2000137 $28.90 $117.00 $62.01–$95.59 — 75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH CER/VAG AUTO MAN SCRN $56.57 $229.00 $121.37–$187.10 — 75%
Parathyroid hormone (PTH) blood test CPT 83970 RL-A-PARATHORMONE 70172B $40.76 $165.00 $24.76–$200.90 66% below 75%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH) INTACT $41.50 $168.00 $24.76–$200.90 65% below 75%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH) INTRAOP $153.39 $621.00 $24.76–$507.36 28% above 75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 RL-A-PARATHORMONE 70172B $40.76 $165.00 $87.45–$134.81 — 75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH) INTACT $41.50 $168.00 $89.04–$137.26 — 75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PTH) INTRAOP $153.39 $621.00 $329.13–$507.36 — 75%
Partial thromboplastin time (PTT) clotting test CPT 85730 RL-A-INHIBIT ASSAY PTT 2003266 $5.69 $23.00 $3.60–$29.27 83% below 75%
Partial thromboplastin time (PTT) clotting test CPT 85730 RL-A-PART THROM TIME 3017009C $5.93 $24.00 $3.60–$29.27 83% below 75%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBO TIME $70.65 $286.00 $3.60–$233.67 107% above 75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 RL-A-INHIBIT ASSAY PTT 2003266 $5.69 $23.00 $12.19–$18.80 — 75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 RL-A-PART THROM TIME 3017009C $5.93 $24.00 $12.72–$19.61 — 75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBO TIME $70.65 $286.00 $151.58–$233.67 — 75%
Progesterone blood test CPT 84144 PROGESTERONE $89.17 $361.00 $12.51–$294.94 1% below 75%
Progesterone blood test inpatient CPT 84144 PROGESTERONE $89.17 $361.00 $191.33–$294.94 — 75%
Prolactin blood test CPT 84146 RL-A-MACROPROLACTIN 20765 $68.92 $279.00 $11.62–$227.95 13% below 75%
Prolactin blood test CPT 84146 PROLACTIN $74.60 $302.00 $11.62–$246.74 6% below 75%
Prolactin blood test inpatient CPT 84146 RL-A-MACROPROLACTIN 20765 $68.92 $279.00 $147.87–$227.95 — 75%
Prolactin blood test inpatient CPT 84146 PROLACTIN $74.60 $302.00 $160.06–$246.74 — 75%
Prothrombin time (PT/INR) clotting test CPT 85610 RL-A-PROTHROMBIN TIME 3017009A $4.20 $17.00 $2.57–$20.90 85% below 75%
Prothrombin time (PT/INR) clotting test CPT 85610 RL-A-INHIBITOR ASSAY PT2003260 $5.93 $24.00 $2.57–$20.90 79% below 75%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME $48.42 $196.00 $2.57–$160.14 72% above 75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 RL-A-PROTHROMBIN TIME 3017009A $4.20 $17.00 $9.01–$13.89 — 75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 RL-A-INHIBITOR ASSAY PT2003260 $5.93 $24.00 $12.72–$19.61 — 75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME $48.42 $196.00 $103.88–$160.14 — 75%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA AG OPTIC $28.90 $117.00 $9.93–$95.59 8% above 75%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA AG OPTIC $28.90 $117.00 $62.01–$95.59 — 75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOCCUS A IA AG OPTIC $43.72 $177.00 $9.91–$144.61 25% above 75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREPTOCOCCUS A IA AG OPTIC $43.72 $177.00 $93.81–$144.61 — 75%
Rubella antibody test (immunity check) CPT 86762 RL-A-RUBELLA AB IGG 50771 $14.33 $58.00 $8.63–$70.07 48% below 75%
Rubella antibody test (immunity check) CPT 86762 RL-A-ANTIBODY RUBELLA 50772B $17.54 $71.00 $8.63–$70.07 36% below 75%
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA $53.36 $216.00 $8.63–$176.48 94% above 75%
Rubella antibody test (immunity check) CPT 86762 RL-A-RUBELLA AB IGM 50551 $56.32 $228.00 $8.63–$186.28 105% above 75%
Rubella antibody test (immunity check) inpatient CPT 86762 RL-A-RUBELLA AB IGG 50771 $14.33 $58.00 $30.74–$47.39 — 75%
Rubella antibody test (immunity check) inpatient CPT 86762 RL-A-ANTIBODY RUBELLA 50772B $17.54 $71.00 $37.63–$58.01 — 75%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA $53.36 $216.00 $114.48–$176.48 — 75%
Rubella antibody test (immunity check) inpatient CPT 86762 RL-A-RUBELLA AB IGM 50551 $56.32 $228.00 $120.84–$186.28 — 75%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE RBC AUTO $39.52 $160.00 $1.62–$130.72 32% below 75%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE RBC AUTO $39.52 $160.00 $84.80–$130.72 — 75%
Stool ova and parasites exam CPT 87177 RL-A-OVA PARA SMR CID 3001662A $19.27 $78.00 $5.34–$63.73 33% below 75%
Stool ova and parasites exam CPT 87177 OVA PARASITE SMEAR CONCENTR ID $45.70 $185.00 $5.34–$151.15 60% above 75%
Stool ova and parasites exam CPT 87177 RL-A-OVA PARA SMR CID 60046A $63.48 $257.00 $5.34–$209.97 122% above 75%
Stool ova and parasites exam inpatient CPT 87177 RL-A-OVA PARA SMR CID 3001662A $19.27 $78.00 $41.34–$63.73 — 75%
Stool ova and parasites exam inpatient CPT 87177 OVA PARASITE SMEAR CONCENTR ID $45.70 $185.00 $98.05–$151.15 — 75%
Stool ova and parasites exam inpatient CPT 87177 RL-A-OVA PARA SMR CID 60046A $63.48 $257.00 $136.21–$209.97 — 75%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL BLOOD IMMUNOASSAY QL $24.21 $98.00 $9.55–$80.07 25% above 75%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL BLOOD IMMUNOASSAY QL $24.21 $98.00 $51.94–$80.07 — 75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RL-A-VDRL CSF W REFLEX 50206 $25.20 $102.00 $2.56–$83.34 94% above 75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS VDRL RPR QL $31.37 $127.00 $2.56–$103.76 141% above 75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RL-A-VDRL CSF W REFLEX 50206 $25.20 $102.00 $54.06–$83.34 — 75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS VDRL RPR QL $31.37 $127.00 $67.31–$103.76 — 75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 RL-A-QFT GOLD PL 4TUBE 3000399 $30.63 $124.00 $37.18–$301.67 59% below 75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 RL-A-QFT GOLD PL 1TUBE 3017554 $62.99 $255.00 $37.18–$301.67 15% below 75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 RL-A-QFT GOLD PL 4TUBE 3000399 $30.63 $124.00 $65.72–$101.31 — 75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 RL-A-QFT GOLD PL 1TUBE 3017554 $62.99 $255.00 $135.15–$208.34 — 75%
Testosterone blood test, total (not free testosterone) CPT 84403 RL-A-TESTOSTERONE TOTAL 81056B $25.45 $103.00 $15.48–$125.61 29% below 75%
Testosterone blood test, total (not free testosterone) CPT 84403 RL-A-TESTOS FEMALE/CHILD 81058 $31.13 $126.00 $15.48–$125.61 13% below 75%
Testosterone blood test, total (not free testosterone) CPT 84403 RL-A-TESTOSTERONE TOTAL 70102B $35.08 $142.00 $15.48–$125.61 1% below 75%
Testosterone blood test, total (not free testosterone) CPT 84403 RL-A-TESTOS ADULT MALE 70130 $36.07 $146.00 $15.48–$125.61 1% above 75%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL $101.52 $411.00 $15.48–$335.79 185% above 75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 RL-A-TESTOSTERONE TOTAL 81056B $25.45 $103.00 $54.59–$84.16 — 75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 RL-A-TESTOS FEMALE/CHILD 81058 $31.13 $126.00 $66.78–$102.95 — 75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 RL-A-TESTOSTERONE TOTAL 70102B $35.08 $142.00 $75.26–$116.02 — 75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 RL-A-TESTOS ADULT MALE 70130 $36.07 $146.00 $77.38–$119.29 — 75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL $101.52 $411.00 $217.83–$335.79 — 75%
Thyroid peroxidase (TPO) antibody test CPT 86376 RL-A-MICROSOMAL AB 50645A $14.33 $58.00 $8.73–$70.78 37% below 75%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY $47.68 $193.00 $8.73–$157.69 110% above 75%
Thyroid peroxidase (TPO) antibody test CPT 86376 RL-A-LIVER-KIDNEY MIC IGG99270 $60.03 $243.00 $8.73–$198.54 164% above 75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 RL-A-MICROSOMAL AB 50645A $14.33 $58.00 $30.74–$47.39 — 75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY $47.68 $193.00 $102.29–$157.69 — 75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 RL-A-LIVER-KIDNEY MIC IGG99270 $60.03 $243.00 $128.79–$198.54 — 75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE $94.85 $384.00 $10.08–$313.73 7% above 75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE $94.85 $384.00 $203.52–$313.73 — 75%
Trichomonas test (NAAT) CPT 87661 RL-A-VAGINOS PNL TMA 3002581C $34.58 $140.00 $21.05–$170.77 33% below 75%
Trichomonas test (NAAT) CPT 87661 IA TRICHOMONAS VAG AMP PROBE $51.87 $210.00 $21.05–$171.57 at median 75%
Trichomonas test (NAAT) inpatient CPT 87661 RL-A-VAGINOS PNL TMA 3002581C $34.58 $140.00 $74.20–$114.38 — 75%
Trichomonas test (NAAT) inpatient CPT 87661 IA TRICHOMONAS VAG AMP PROBE $51.87 $210.00 $111.30–$171.57 — 75%
Uric acid blood test CPT 84550 URIC ACID BLOOD $36.81 $149.00 $2.71–$121.74 18% below 75%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD $36.81 $149.00 $78.97–$121.74 — 75%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W MICRO $24.21 $98.00 $1.90–$80.07 46% below 75%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W MICRO $24.21 $98.00 $51.94–$80.07 — 75%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO WO MICRO $22.48 $91.00 $1.35–$74.35 14% below 75%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO WO MICRO $22.48 $91.00 $48.23–$74.35 — 75%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO WO MICRO $6.43 $26.00 $2.08–$21.25 at median 75%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO WO MICRO $6.43 $26.00 $13.78–$21.25 — 75%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE W COLONY COUNT $45.21 $183.00 $4.84–$149.52 33% below 75%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE W COLONY COUNT $45.21 $183.00 $96.99–$149.52 — 75%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY VISUAL $89.91 $364.00 $5.16–$297.39 87% above 75%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY VISUAL $89.91 $364.00 $192.92–$297.39 — 75%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 $74.85 $303.00 $9.04–$247.56 1% below 75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 $74.85 $303.00 $160.59–$247.56 — 75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 RL-A-25HYDROXY D2D3 TMS2002348 $37.05 $150.00 $17.76–$144.07 47% below 75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY $81.02 $328.00 $17.76–$267.98 15% above 75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 RL-A-25HYDROXY D2D3 TMS2002348 $37.05 $150.00 $79.50–$122.55 — 75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY $81.02 $328.00 $173.84–$267.98 — 75%
Zinc blood test CPT 84630 RL-A-ZINC QN WHOLE BLD 2009373 $16.06 $65.00 $6.83–$55.47 34% below 75%
Zinc blood test CPT 84630 RL-A-ZINC SERUM/PLASMA 20097 $17.54 $71.00 $6.83–$58.01 28% below 75%
Zinc blood test inpatient CPT 84630 RL-A-ZINC QN WHOLE BLD 2009373 $16.06 $65.00 $34.45–$53.11 — 75%
Zinc blood test inpatient CPT 84630 RL-A-ZINC SERUM/PLASMA 20097 $17.54 $71.00 $37.63–$58.01 — 75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 RL-A-BETA-HCG QN 70029 $17.05 $69.00 $9.03–$73.22 56% below 75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 RL-A-BHCG QUANT CSF 20730 $23.72 $96.00 $9.03–$78.44 39% below 75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QN $83.24 $337.00 $9.03–$275.33 115% above 75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 RL-A-BETA-HCG QN 70029 $17.05 $69.00 $36.57–$56.38 — 75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 RL-A-BHCG QUANT CSF 20730 $23.72 $96.00 $50.88–$78.44 — 75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QN $83.24 $337.00 $178.61–$275.33 — 75%

Surgery and procedures

ProcedureCash price List priceInsurers payvs ArizonaOff list
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE EXTRNAL $637.26 $2,580.00 $111.93–$2,107.86 31% below 75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE EXTRNAL $637.26 $2,580.00 $1,367.40–$2,107.86 — 75%

Doctor visits and therapy

ProcedureCash price List priceInsurers payvs ArizonaOff list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD/BLOOD COMP $247.50 $1,002.00 $43.99–$2,053.00 54% below 75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD/BLOOD COMP $247.50 $1,002.00 $531.06–$818.64 — 75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BLAND AERO TX INIT EA DAY $91.64 $371.00 $8.23–$303.11 58% below 75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BLAND AERO TX INIT EA DAY $91.64 $371.00 $196.63–$303.11 — 75%
Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL CARE 30-74MINS $2,980.80 $12,068.00 $185.32–$9,859.56 42% above 75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER CRITICAL CARE 30-74MINS $2,980.80 $12,068.00 $6,396.04–$9,859.56 — 75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD TRACING ONLY $204.27 $827.00 $6.44–$675.66 75% above 75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD TRACING ONLY $204.27 $827.00 $438.31–$675.66 — 75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1 $151.42 $613.00 $9.85–$769.00 37% below 75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1 $151.42 $613.00 $324.89–$500.83 — 75%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2 $287.02 $1,162.00 $36.41–$949.36 21% below 75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2 $287.02 $1,162.00 $615.86–$949.36 — 75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3 $502.16 $2,033.00 $62.07–$1,831.00 19% below 75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3 $502.16 $2,033.00 $1,077.49–$1,660.97 — 75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4 $797.07 $3,227.00 $105.34–$2,927.00 27% below 75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4 $797.07 $3,227.00 $1,710.31–$2,636.46 — 75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5 $1,020.11 $4,130.00 $152.79–$3,374.21 32% below 75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5 $1,020.11 $4,130.00 $2,188.90–$3,374.21 — 75%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVAS STR TEST WO RX $261.58 $1,059.00 $39.34–$865.21 52% below 75%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVAS STR TEST WO RX $261.58 $1,059.00 $561.27–$865.21 — 75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF IV HYDRA INIT 31-60MN $84.73 $343.00 $33.97–$280.24 52% below 75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF IV HYDRA INIT 31-60MN $84.73 $343.00 $181.79–$280.24 — 75%
IV infusion of a medicine, first hour CPT 96365 INF TX/DX/PRO INIT 1ST HR $226.26 $916.00 $65.44–$748.38 3% below 75%
IV infusion of a medicine, first hour inpatient CPT 96365 INF TX/DX/PRO INIT 1ST HR $226.26 $916.00 $485.48–$748.38 — 75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ TX/DX/PROPH SUBQ/IM $124.25 $503.00 $15.02–$410.96 85% above 75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ TX/DX/PROPH SUBQ/IM $124.25 $503.00 $266.59–$410.96 — 75%
Neuromuscular re-education, 15 minutes CPT 97112 OT RE-ED NEUROMSCL EA 15 $53.85 $218.00 $35.76–$178.11 57% below 75%
Neuromuscular re-education, 15 minutes CPT 97112 PT RE-ED NEUROMSCL EA 15 $53.85 $218.00 $35.76–$178.11 57% below 75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT RE-ED NEUROMSCL EA 15 $53.85 $218.00 $115.54–$178.11 — 75%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT RE-ED NEUROMSCL EA 15 $53.85 $218.00 $115.54–$178.11 — 75%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY $131.90 $534.00 $107.29–$436.28 62% below 75%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY $131.90 $534.00 $283.02–$436.28 — 75%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY $131.16 $531.00 $106.21–$433.83 80% below 75%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY $131.16 $531.00 $281.43–$433.83 — 75%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY $131.16 $531.00 $106.21–$433.83 63% below 75%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY $131.16 $531.00 $281.43–$433.83 — 75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY $131.16 $531.00 $106.21–$433.83 75% below 75%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY $131.16 $531.00 $281.43–$433.83 — 75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT THERAPY MANUAL EA 15 $48.91 $198.00 $28.61–$161.77 61% below 75%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT THERAPY MANUAL EA 15 $48.91 $198.00 $28.61–$161.77 61% below 75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT THERAPY MANUAL EA 15 $48.91 $198.00 $104.94–$161.77 — 75%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT THERAPY MANUAL EA 15 $48.91 $198.00 $104.94–$161.77 — 75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT EXERCISE THR EA 15 $65.46 $265.00 $31.11–$216.51 62% below 75%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT EXERCISE THR EA 15 $65.46 $265.00 $31.11–$216.51 62% below 75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT EXERCISE THR EA 15 $65.46 $265.00 $140.45–$216.51 — 75%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT EXERCISE THR EA 15 $65.46 $265.00 $140.45–$216.51 — 75%
Speech and language evaluation CPT 92523 ST EVL PROD/COMPREHENSN SP $296.16 $1,199.00 $241.39–$979.59 60% below 75%
Speech and language evaluation inpatient CPT 92523 ST EVL PROD/COMPREHENSN SP $296.16 $1,199.00 $635.47–$979.59 — 75%
Speech therapy session, individual CPT 92507 ST TREATMENT SPEECH $99.79 $404.00 $40.69–$330.07 72% below 75%
Speech therapy session, individual inpatient CPT 92507 ST TREATMENT SPEECH $99.79 $404.00 $214.12–$330.07 — 75%
Spirometry (breathing test) CPT 94010 SPIROMETRY $109.92 $445.00 $28.61–$363.57 37% below 75%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY $109.92 $445.00 $235.85–$363.57 — 75%
Spirometry before and after a bronchodilator CPT 94060 BRNCHSPASM EVAL PRE/POST $165.00 $668.00 $40.77–$545.76 27% below 75%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRNCHSPASM EVAL PRE/POST $165.00 $668.00 $354.04–$545.76 — 75%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THR ACTIVITY EA 15 $55.33 $224.00 $38.62–$183.01 74% below 75%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THR ACTIVITY EA 15 $55.33 $224.00 $38.62–$183.01 74% below 75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THR ACTIVITY EA 15 $55.33 $224.00 $118.72–$183.01 — 75%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THR ACTIVITY EA 15 $55.33 $224.00 $118.72–$183.01 — 75%

Vaccines

ProcedureCash price List priceInsurers payvs ArizonaOff list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC PF TR SV 0.5ML PFS $49.40 $200.00 $20.05–$163.40 33% below 75%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACC PF TR SV 0.5ML PFS $49.40 $200.00 $58.00–$163.40 — 75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VACC 23 VAL 0.5ML $295.17 $1,195.00 $136.81–$976.32 294% above 75%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACC 23 VAL 0.5ML $295.17 $1,195.00 $346.55–$976.32 — 75%
Rabies vaccine, one dose CPT 90675 RABIES VACC 2.5IU/ML 1ML INJ $955.15 $3,867.00 $266.30–$3,159.34 160% above 75%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACC 2.5IU/ML 1ML INJ $955.15 $3,867.00 $2,049.51–$3,159.34 — 75%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TET/DIP VACC PF 0.5ML>=7YRS IM $95.10 $385.00 $34.32–$314.55 at median 75%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TET/DIP VACC PF 0.5ML>=7YRS IM $95.10 $385.00 $204.05–$314.55 — 75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACC 0.5ML >=7YR BOOSTER $112.14 $454.00 $39.60–$370.92 21% below 75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACC 0.5ML >=7YR BOOSTER $112.14 $454.00 $240.62–$370.92 — 75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN OTHER IMMUN VAC ONE $49.40 $200.00 $23.10–$163.40 1% below 75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN OTHER IMMUN VAC ONE $49.40 $200.00 $106.00–$163.40 — 75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN OTHER IMMUN VAC ADD $49.40 $200.00 $12.82–$163.40 22% above 75%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN OTHER IMMUN VAC ADD $49.40 $200.00 $106.00–$163.40 — 75%

Source file: https://www.commonspirit.org/content/dam/commonspiritorg/en/dharz/ceaz/finance/price-transparency/383990879-1689121188_agh-mesa-llc_standardcharges.json