Hospital Phoenix-Mesa-Chandler, AZ

Dignity Health

Dignity Health in Gilbert, AZ publishes cash prices for 226 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 179 of 223 procedures and above it for 39. By typical cash price it ranks #21 of 53 Arizona hospitals and #15 of 32 hospitals in the Phoenix, AZ area, cheapest first. Click a procedure to compare it with other hospitals nearby.

3555 S Val Vista Dr, Gilbert, AZ 85297 Collected Sep 27, 2026 Source price file (480) 728-8000

Acute care hospital Emergency department CMS star rating 5 of 5 CCN 030119 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Arizona	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 TRANS O2 MEAS 1-2 LVL BI	$191.88	$780.00	$86.19–$780.00	—	75%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 TRANS O2 MEAS 1-2 LVL BI	$191.88	$780.00	$421.20–$600.60	—	75%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPH SCOUT CHST W CON	$410.82	$1,670.00	$102.28–$1,285.90	14% above	75%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPH SCOUT CHST W CON	$410.82	$1,670.00	$901.80–$1,285.90	—	75%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE/JOINT WHOLE BODY	$725.46	$2,949.00	$282.16–$2,408.75	50% below	75%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE/JOINT WHOLE BODY	$725.46	$2,949.00	$1,592.46–$2,270.73	—	75%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W CON	$924.23	$3,757.00	$189.74–$2,892.89	34% below	75%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W CON	$924.23	$3,757.00	$2,028.78–$2,892.89	—	75%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT/COR ART 3D W	$842.06	$3,423.00	$346.53–$2,635.71	26% 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	$842.06	$3,423.00	$1,848.42–$2,635.71	—	75%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT EVAL COR CA WO CON	$614.76	$2,499.00	$93.85–$1,924.23	13% above	75%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT EVAL COR CA WO CON	$614.76	$2,499.00	$1,349.46–$1,924.23	—	75%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN PELVIS WO CON	$992.37	$4,034.00	$197.40–$3,106.18	25% below	75%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN PELVIS WO CON	$992.37	$4,034.00	$2,178.36–$3,106.18	—	75%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN PELVIS W CON	$1,682.15	$6,838.00	$326.86–$5,265.26	9% below	75%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN PELVIS W CON	$1,682.15	$6,838.00	$3,692.52–$5,265.26	—	75%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN PELVIS WWO CON	$1,917.57	$7,795.00	$366.56–$6,002.15	17% below	75%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN PELVIS WWO CON	$1,917.57	$7,795.00	$4,209.30–$6,002.15	—	75%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CON	$966.05	$3,927.00	$189.74–$3,023.79	25% below	75%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CON	$966.05	$3,927.00	$2,120.58–$3,023.79	—	75%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CON	$878.96	$3,573.00	$113.34–$2,751.21	3% below	75%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CON	$878.96	$3,573.00	$1,929.42–$2,751.21	—	75%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CON	$732.10	$2,976.00	$113.34–$2,291.52	11% below	75%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CON	$732.10	$2,976.00	$1,607.04–$2,291.52	—	75%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CON	$828.04	$3,366.00	$113.34–$2,591.82	6% below	75%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CON	$828.04	$3,366.00	$1,817.64–$2,591.82	—	75%
CT scan of the head with contrast CPT 70460 CT HEAD W CON	$1,109.71	$4,511.00	$159.85–$3,473.47	2% below	75%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CON	$1,109.71	$4,511.00	$2,435.94–$3,473.47	—	75%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO AND W CON	$1,308.48	$5,319.00	$187.03–$4,095.63	8% below	75%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO AND W CON	$1,308.48	$5,319.00	$2,872.26–$4,095.63	—	75%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CON	$1,147.59	$4,665.00	$113.34–$3,592.05	2% below	75%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CON	$1,147.59	$4,665.00	$2,519.10–$3,592.05	—	75%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CON	$1,108.48	$4,506.00	$113.34–$3,469.62	1% below	75%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CON	$1,108.48	$4,506.00	$2,433.24–$3,469.62	—	75%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CON	$1,001.96	$4,073.00	$189.74–$3,136.21	15% below	75%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CON	$1,001.96	$4,073.00	$2,199.42–$3,136.21	—	75%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US DPLX EXTRACRAN CMP BIL	$624.60	$2,539.00	$199.19–$1,955.03	26% below	75%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US DPLX EXTRACRAN CMP BIL	$624.60	$2,539.00	$1,371.06–$1,955.03	—	75%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$56.09	$228.00	$31.92–$228.00	71% below	75%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$56.09	$228.00	$123.12–$175.56	—	75%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$53.39	$217.00	$26.82–$217.00	50% below	75%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$53.39	$217.00	$117.18–$167.09	—	75%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPL	$340.71	$1,385.00	$113.34–$1,066.45	15% below	75%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPL	$340.71	$1,385.00	$747.90–$1,066.45	—	75%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 XR BONE DENSITY(DXA)AXAL	$191.88	$780.00	$40.77–$600.60	37% below	75%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 XR BONE DENSITY(DXA)AXAL	$191.88	$780.00	$421.20–$600.60	—	75%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 XR BONE DENSITY(DXA)APEND	$97.91	$398.00	$33.26–$306.46	52% below	75%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR BONE DENSITY(DXA)APEND	$97.91	$398.00	$214.92–$306.46	—	75%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PREG+DETL SNGL1ST GEST	$258.55	$1,051.00	$147.14–$834.34	36% below	75%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PREG+DETL SNGL1ST GEST	$258.55	$1,051.00	$567.54–$809.27	—	75%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CON	$534.56	$2,173.00	$113.34–$1,673.21	35% below	75%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO CON	$534.56	$2,173.00	$1,173.42–$1,673.21	—	75%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W CON	$1,047.96	$4,260.00	$179.88–$3,280.20	17% below	75%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W CON	$1,047.96	$4,260.00	$2,300.40–$3,280.20	—	75%
Diagnostic mammogram, both breasts CPT 77066 MA MAMMO DIAG W CAD BIL	$151.29	$615.00	$86.10–$615.00	41% below	75%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA MAMMO DIAG W CAD BIL	$151.29	$615.00	$332.10–$473.55	—	75%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US DUPLEX ART LOW EXT BIL	$705.29	$2,867.00	$251.76–$2,207.59	4% below	75%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US DUPLEX ART LOW EXT BIL	$705.29	$2,867.00	$1,548.18–$2,207.59	—	75%
Duplex ultrasound of the leg veins, both legs CPT 93970 US DUPLEX VENOUS EXT BIL	$707.99	$2,878.00	$195.97–$2,216.06	4% below	75%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DUPLEX VENOUS EXT BIL	$707.99	$2,878.00	$1,554.12–$2,216.06	—	75%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE	$1,008.36	$4,099.00	$206.35–$3,156.23	at median	75%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE	$1,008.36	$4,099.00	$2,213.46–$3,156.23	—	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SYSTEM	$747.35	$3,038.00	$310.77–$2,732.68	21% below	75%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SYSTEM	$747.35	$3,038.00	$1,640.52–$2,339.26	—	75%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP UNATTEN W RESP EFFT	$375.15	$1,525.00	$99.42–$1,525.00	17% below	75%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP UNATTEN W RESP EFFT	$375.15	$1,525.00	$823.50–$1,174.25	—	75%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSS W 4/>P W CPAP >=6YRS	$1,341.69	$5,454.00	$683.41–$5,454.00	50% below	75%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSS W 4/>P W CPAP >=6YRS	$1,341.69	$5,454.00	$2,945.16–$4,199.58	—	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN WO CON LTD	$471.83	$1,918.00	$91.19–$1,476.86	6% above	75%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN WO CON LTD	$471.83	$1,918.00	$1,035.72–$1,476.86	—	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREEN LOW DOSE	$136.29	$554.00	$77.56–$554.00	4% above	75%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LUNG SCREEN LOW DOSE	$136.29	$554.00	$299.16–$426.58	—	75%
MRI of the abdomen without contrast CPT 74181 MR ABDOMEN WO CON	$1,023.61	$4,161.00	$211.35–$3,203.97	8% below	75%
MRI of the abdomen without contrast inpatient CPT 74181 MR ABDOMEN WO CON	$1,023.61	$4,161.00	$2,246.94–$3,203.97	—	75%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR ABDOMEN WO AND W CON	$1,740.21	$7,074.00	$365.13–$5,446.98	17% below	75%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR ABDOMEN WO AND W CON	$1,740.21	$7,074.00	$3,819.96–$5,446.98	—	75%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN WO CON	$878.96	$3,573.00	$211.71–$2,751.21	30% below	75%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN WO CON	$878.96	$3,573.00	$1,929.42–$2,751.21	—	75%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN WO AND W CON	$1,489.78	$6,056.00	$343.67–$4,663.12	21% below	75%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN WO AND W CON	$1,489.78	$6,056.00	$3,270.24–$4,663.12	—	75%
MRI of the lower back, no contrast dye CPT 72148 MR L SPINE WO CON	$833.45	$3,388.00	$206.70–$2,608.76	47% below	75%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR L SPINE WO CON	$833.45	$3,388.00	$1,829.52–$2,608.76	—	75%
MRI of the lower back, without and then with contrast dye CPT 72158 MR L SPINE WO AND W CON	$2,193.34	$8,916.00	$344.74–$6,865.32	8% below	75%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR L SPINE WO AND W CON	$2,193.34	$8,916.00	$4,814.64–$6,865.32	—	75%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR T SPINE WO CON	$833.45	$3,388.00	$205.63–$2,608.76	45% below	75%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR T SPINE WO CON	$833.45	$3,388.00	$1,829.52–$2,608.76	—	75%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR C SPINE WO AND W CON	$2,193.34	$8,916.00	$345.46–$6,865.32	8% below	75%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR C SPINE WO AND W CON	$2,193.34	$8,916.00	$4,814.64–$6,865.32	—	75%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR C SPINE WO CON	$833.45	$3,388.00	$205.99–$2,608.76	39% below	75%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR C SPINE WO CON	$833.45	$3,388.00	$1,829.52–$2,608.76	—	75%
MRI of the pelvis without and with contrast CPT 72197 MR PELVIS WO AND W CON	$1,740.21	$7,074.00	$363.70–$5,446.98	14% below	75%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS WO AND W CON	$1,740.21	$7,074.00	$3,819.96–$5,446.98	—	75%
MRI of the pelvis, no contrast dye CPT 72195 MR PELVIS WO CON	$1,026.81	$4,174.00	$247.47–$3,213.98	17% below	75%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR PELVIS WO CON	$1,026.81	$4,174.00	$2,253.96–$3,213.98	—	75%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCAR SPECT WALL MULT	$1,999.00	$8,126.00	$453.82–$6,257.02	25% below	75%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCAR SPECT WALL MULT	$1,999.00	$8,126.00	$4,388.04–$6,257.02	—	75%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS NON OB LTD F/U	$248.22	$1,009.00	$51.85–$776.93	15% below	75%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS NON OB LTD F/U	$248.22	$1,009.00	$544.86–$776.93	—	75%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS NON OB COMP	$349.57	$1,421.00	$110.50–$1,094.17	18% below	75%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS NON OB COMP	$349.57	$1,421.00	$767.34–$1,094.17	—	75%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG=>14WK SNG 1ST GES	$266.67	$1,084.00	$113.34–$885.52	32% below	75%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG=>14WK SNG 1ST GES	$266.67	$1,084.00	$585.36–$834.68	—	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG<14WK SNGL1ST GEST	$246.99	$1,004.00	$113.34–$773.08	13% below	75%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG<14WK SNGL1ST GEST	$246.99	$1,004.00	$542.16–$773.08	—	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREG 1 OR >FETUSES LTD	$282.41	$1,148.00	$85.11–$883.96	8% below	75%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREG 1 OR >FETUSES LTD	$282.41	$1,148.00	$619.92–$883.96	—	75%
Screening mammogram, both breasts CPT 77067 MA MAMMO SCREEN W CAD BIL	$167.28	$680.00	$95.20–$680.00	26% above	75%
Screening mammogram, both breasts inpatient CPT 77067 MA MAMMO SCREEN W CAD BIL	$167.28	$680.00	$367.20–$523.60	—	75%
Sleep study in a lab (polysomnography) CPT 95810 PSS W 4/> PAR W TECH>=6YR	$1,220.90	$4,963.00	$654.08–$4,963.00	48% below	75%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSS W 4/> PAR W TECH>=6YR	$1,220.90	$4,963.00	$2,680.02–$3,821.51	—	75%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO STR TEST COMP W ECG	$826.32	$3,359.00	$243.89–$2,586.43	8% below	75%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO STR TEST COMP W ECG	$826.32	$3,359.00	$1,813.86–$2,586.43	—	75%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR SWL FNC/CN/VD/SCT WCON	$372.69	$1,515.00	$130.53–$1,166.55	8% below	75%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR SWL FNC/CN/VD/SCT WCON	$372.69	$1,515.00	$818.10–$1,166.55	—	75%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$328.17	$1,334.00	$113.34–$1,027.18	9% below	75%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$328.17	$1,334.00	$720.36–$1,027.18	—	75%
Transvaginal ultrasound during pregnancy CPT 76817 US PREG TRANSVAGINAL	$328.17	$1,334.00	$97.27–$1,027.18	at median	75%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREG TRANSVAGINAL	$328.17	$1,334.00	$720.36–$1,027.18	—	75%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE WO CON	$575.64	$2,340.00	$113.34–$1,801.80	12% above	75%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE WO CON	$575.64	$2,340.00	$1,263.60–$1,801.80	—	75%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$348.34	$1,416.00	$105.14–$1,090.32	12% below	75%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$348.34	$1,416.00	$764.64–$1,090.32	—	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISS HEAD NECK	$264.21	$1,074.00	$113.34–$855.34	21% below	75%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISS HEAD NECK	$264.21	$1,074.00	$579.96–$826.98	—	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI/SCOUT ABD W CON	$261.50	$1,063.00	$128.74–$882.17	25% below	75%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI/SCOUT ABD W CON	$261.50	$1,063.00	$574.02–$818.51	—	75%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$69.13	$281.00	$31.83–$266.85	60% below	75%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$69.13	$281.00	$151.74–$216.37	—	75%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBAR SPINE 2 OR 3 VW	$92.01	$374.00	$41.84–$328.29	46% below	75%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBAR SPINE 2 OR 3 VW	$92.01	$374.00	$201.96–$287.98	—	75%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4+ VIEWS	$128.91	$524.00	$54.72–$403.48	63% below	75%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4+ VIEWS	$128.91	$524.00	$282.96–$403.48	—	75%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE 2 VIEWS	$212.30	$863.00	$34.69–$664.51	10% below	75%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE 2 VIEWS	$212.30	$863.00	$466.02–$664.51	—	75%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES 3+ VIEWS	$116.36	$473.00	$39.34–$364.21	9% above	75%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES 3+ VIEWS	$116.36	$473.00	$255.42–$364.21	—	75%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR CERVICAL SPINE 2-3 VW	$83.15	$338.00	$41.48–$287.15	63% below	75%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR CERVICAL SPINE 2-3 VW	$83.15	$338.00	$182.52–$260.26	—	75%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEWS	$76.76	$312.00	$29.32–$312.00	58% below	75%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1 OR 2 VIEWS	$76.76	$312.00	$168.48–$240.24	—	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM COCCYX 2+ VWS	$100.37	$408.00	$34.33–$314.16	7% below	75%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM COCCYX 2+ VWS	$100.37	$408.00	$220.32–$314.16	—	75%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Arizona	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT	$60.52	$246.00	$5.30–$189.42	65% above	75%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 RL-A-FIBRO V 2005661B	$83.64	$340.00	$5.30–$261.80	128% above	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT	$60.52	$246.00	$132.84–$189.42	—	75%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 RL-A-FIBRO V 2005661B	$83.64	$340.00	$183.60–$261.80	—	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST/SGOT	$69.87	$284.00	$5.18–$218.68	96% above	75%
AST (aspartate aminotransferase) enzyme test CPT 84450 RL-A-FIBRO V 2005661A	$83.64	$340.00	$5.18–$261.80	135% above	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST/SGOT	$69.87	$284.00	$153.36–$218.68	—	75%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 RL-A-FIBRO V 2005661A	$83.64	$340.00	$183.60–$261.80	—	75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 RL-A-HEPACUTEQR 3002989	$46.87	$190.52	$26.68–$190.52	66% below	75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$432.96	$1,760.00	$47.63–$1,355.20	214% above	75%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 UC ACUTE HEPATIT PANEL ER	$454.61	$1,848.00	$47.63–$1,422.96	230% above	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 RL-A-HEPACUTEQR 3002989	$46.87	$190.52	$102.89–$146.71	—	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$432.96	$1,760.00	$950.40–$1,355.20	—	75%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 UC ACUTE HEPATIT PANEL ER	$454.61	$1,848.00	$997.92–$1,422.96	—	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-CHICK 55008	$5.14	$20.88	$2.93–$20.88	59% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-BEEF 55096	$5.91	$24.00	$3.36–$24.00	53% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-BAKE YEAST 55079	$7.88	$32.00	$4.48–$26.49	38% below	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-STRAWBERRY 99639	$16.84	$68.44	$5.22–$52.70	33% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-CORN 55078	$20.67	$84.00	$5.22–$64.68	63% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ETHYLENE 98421	$23.65	$96.12	$5.22–$74.02	87% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-PED PAN 2 55300	$47.63	$193.60	$5.22–$149.08	277% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-PORK 99780	$47.97	$195.00	$5.22–$150.15	279% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-CARROT 55005	$55.60	$226.00	$5.22–$174.02	340% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-STACHPAN 3004553B	$57.33	$233.04	$5.22–$179.45	353% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-CHOCOLATE 99642	$209.60	$852.00	$5.22–$656.04	1557% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-COD 55036	$211.07	$858.00	$5.22–$660.66	1569% above	75%
Allergy blood test, specific IgE, per allergen CPT 86003 RL-A-ORANGE 55023	$230.26	$936.00	$5.22–$720.72	1720% above	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-CHICK 55008	$5.14	$20.88	$11.28–$16.08	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-BEEF 55096	$5.91	$24.00	$12.96–$18.48	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-BAKE YEAST 55079	$7.88	$32.00	$17.28–$24.64	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-STRAWBERRY 99639	$16.84	$68.44	$36.96–$52.70	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-CORN 55078	$20.67	$84.00	$45.36–$64.68	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ETHYLENE 98421	$23.65	$96.12	$51.91–$74.02	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-PED PAN 2 55300	$47.63	$193.60	$104.55–$149.08	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-PORK 99780	$47.97	$195.00	$105.30–$150.15	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-CARROT 55005	$55.60	$226.00	$122.04–$174.02	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-STACHPAN 3004553B	$57.33	$233.04	$125.85–$179.45	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-CHOCOLATE 99642	$209.60	$852.00	$460.08–$656.04	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-COD 55036	$211.07	$858.00	$463.32–$660.66	—	75%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RL-A-ORANGE 55023	$230.26	$936.00	$505.44–$720.72	—	75%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 RL-A-CCP IGGIGA 3016632	$12.75	$51.80	$7.26–$51.80	62% below	75%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 S/O ANTI CCP IGG AB	$34.69	$141.00	$12.95–$108.57	4% above	75%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 RL-A-CCP IGGIGA 3016632	$12.75	$51.80	$27.98–$39.89	—	75%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 S/O ANTI CCP IGG AB	$34.69	$141.00	$76.14–$108.57	—	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 RL-A-ANA REF 50317	$11.90	$48.36	$6.78–$48.36	62% below	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 S/O ANA REFLEX (T)	$17.72	$72.00	$10.08–$61.35	43% below	75%
Antinuclear antibody (ANA) blood test, screen CPT 86038 S/O ANA ANTINUCLEAR BLD	$98.40	$400.00	$12.09–$308.00	217% above	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 RL-A-ANA REF 50317	$11.90	$48.36	$26.12–$37.24	—	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 S/O ANA REFLEX (T)	$17.72	$72.00	$38.88–$55.44	—	75%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 S/O ANA ANTINUCLEAR BLD	$98.40	$400.00	$216.00–$308.00	—	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 RL-A-PRO BNP 50083	$38.64	$157.04	$21.99–$157.04	55% below	75%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$146.62	$596.00	$39.26–$458.92	70% above	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 RL-A-PRO BNP 50083	$38.64	$157.04	$84.81–$120.93	—	75%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE	$146.62	$596.00	$321.84–$458.92	—	75%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$133.83	$544.00	$8.46–$418.88	30% above	75%
Basic metabolic panel (blood test) CPT 80048 UC BASIC METABOL PANEL ER	$140.47	$571.00	$8.46–$439.67	37% above	75%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$133.83	$544.00	$293.76–$418.88	—	75%
Basic metabolic panel (blood test) inpatient CPT 80048 UC BASIC METABOL PANEL ER	$140.47	$571.00	$308.34–$439.67	—	75%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 S/O GROSS/MICRO LEVEL 4	$56.09	$228.00	$31.92–$207.70	59% below	75%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 S/O GROSS/MICRO LEVEL 4	$56.09	$228.00	$123.12–$175.56	—	75%
Blood culture for bacteria CPT 87040 CULT BLOOD	$172.45	$701.00	$10.32–$539.77	19% above	75%
Blood culture for bacteria CPT 87040 S/O CULT BLOOD	$179.34	$729.00	$10.32–$561.33	23% above	75%
Blood culture for bacteria inpatient CPT 87040 CULT BLOOD	$172.45	$701.00	$378.54–$539.77	—	75%
Blood culture for bacteria inpatient CPT 87040 S/O CULT BLOOD	$179.34	$729.00	$393.66–$561.33	—	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE NON LAB	$3.69	$15.00	$2.10–$15.00	81% below	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE ER	$8.61	$35.00	$3.08–$26.95	56% below	75%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE IP/ER	$13.78	$56.00	$3.08–$43.12	30% below	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE NON LAB	$3.69	$15.00	$8.10–$11.55	—	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE ER	$8.61	$35.00	$18.90–$26.95	—	75%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE IP/ER	$13.78	$56.00	$30.24–$43.12	—	75%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD LAB	$3.94	$16.00	$2.24–$16.00	91% below	75%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD	$41.09	$167.00	$3.93–$128.59	11% below	75%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD LAB	$3.94	$16.00	$8.64–$12.32	—	75%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD	$41.09	$167.00	$90.18–$128.59	—	75%
Blood lead test CPT 83655 RL-A-LEAD U 25060	$11.92	$48.44	$6.79–$48.44	50% below	75%
Blood lead test inpatient CPT 83655 RL-A-LEAD U 25060	$11.92	$48.44	$26.16–$37.30	—	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG PREG QL	$122.51	$498.00	$7.52–$383.46	61% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 UC HCG PREG QL ER	$127.43	$518.00	$7.52–$398.86	68% above	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG PREG QL	$122.51	$498.00	$268.92–$383.46	—	75%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 UC HCG PREG QL ER	$127.43	$518.00	$279.72–$398.86	—	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO	$52.16	$212.00	$3.06–$163.24	39% below	75%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 UC ABO ER	$59.04	$240.00	$3.06–$184.80	31% below	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO	$52.16	$212.00	$114.48–$163.24	—	75%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 UC ABO ER	$59.04	$240.00	$129.60–$184.80	—	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 RL-A-CRP 50180	$5.10	$20.72	$2.91–$20.72	86% below	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$70.36	$286.00	$5.18–$220.22	92% above	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 RL-A-CRP 50180	$5.10	$20.72	$11.19–$15.96	—	75%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$70.36	$286.00	$154.44–$220.22	—	75%
C. difficile toxin gene test (stool PCR) CPT 87493 RL-A-CDIFF PCR 2002838	$36.68	$149.08	$20.88–$149.08	50% below	75%
C. difficile toxin gene test (stool PCR) CPT 87493 IA CLOS DIFF TOXN AMP PRB	$97.91	$398.00	$37.27–$306.46	33% above	75%
C. difficile toxin gene test (stool PCR) CPT 87493 UC C DIF TOX AMP PROBE ER	$106.52	$433.00	$37.27–$333.41	44% above	75%
C. difficile toxin gene test (stool PCR) CPT 87493 S/O CLOS DIF TOX AMP PROB	$109.97	$447.00	$37.27–$344.19	49% above	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 RL-A-CDIFF PCR 2002838	$36.68	$149.08	$80.51–$114.80	—	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 IA CLOS DIFF TOXN AMP PRB	$97.91	$398.00	$214.92–$306.46	—	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 UC C DIF TOX AMP PROBE ER	$106.52	$433.00	$233.82–$333.41	—	75%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 S/O CLOS DIF TOX AMP PROB	$109.97	$447.00	$241.38–$344.19	—	75%
CA 19-9 blood test (tumor marker) CPT 86301 RL-A-CA-GI FL 20746	$20.48	$83.24	$11.66–$83.24	42% below	75%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 RL-A-CA-GI FL 20746	$20.48	$83.24	$44.95–$64.10	—	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 RL-A-CA125 80462	$20.48	$83.24	$11.66–$83.24	76% below	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 RL-A-ROMA S 2012618A	$83.84	$340.80	$20.81–$262.42	at median	75%
CA-125 blood test (ovarian cancer marker) CPT 86304 SJP-CA 125	$115.13	$468.00	$20.81–$360.36	37% above	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 RL-A-CA125 80462	$20.48	$83.24	$44.95–$64.10	—	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 RL-A-ROMA S 2012618A	$83.84	$340.80	$184.04–$262.42	—	75%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 SJP-CA 125	$115.13	$468.00	$252.72–$360.36	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 UC SARS-CV2 CVD19 PRB TCH	$52.65	$214.00	$29.96–$214.00	8% below	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 CVD-19 PRB TCH	$58.06	$236.00	$33.04–$236.00	2% above	75%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 RL-A-COVID19NAA 3002638	$73.61	$299.20	$41.89–$299.20	29% above	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 UC SARS-CV2 CVD19 PRB TCH	$52.65	$214.00	$115.56–$164.78	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 CVD-19 PRB TCH	$58.06	$236.00	$127.44–$181.72	—	75%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 RL-A-COVID19NAA 3002638	$73.61	$299.20	$161.57–$230.39	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 S/O CHLAMYDIA AMP PROBE	$34.44	$140.00	$19.60–$140.00	42% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 UC RL-A-CGAMD 60241A ER	$34.53	$140.36	$19.66–$140.36	42% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 UC IA CHLYD TRCH AM PR ER	$45.51	$185.00	$25.90–$178.07	23% below	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 S/O CHLAMYDIA TRACHOMATIS	$62.98	$256.00	$35.09–$197.12	6% above	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 S/O CHLAMYDIA AMP PROBE	$34.44	$140.00	$75.60–$107.80	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 UC RL-A-CGAMD 60241A ER	$34.53	$140.36	$75.80–$108.08	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 UC IA CHLYD TRCH AM PR ER	$45.51	$185.00	$99.90–$142.45	—	75%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 S/O CHLAMYDIA TRACHOMATIS	$62.98	$256.00	$138.24–$197.12	—	75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 RL-A-NMRLIPFIT 2013716B	$13.18	$53.56	$7.50–$53.56	74% below	75%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$153.51	$624.00	$13.39–$480.48	205% above	75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 RL-A-NMRLIPFIT 2013716B	$13.18	$53.56	$28.93–$41.25	—	75%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$153.51	$624.00	$336.96–$480.48	—	75%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTO DIFF	$64.46	$262.00	$7.77–$201.74	18% below	75%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTO DIFF	$64.46	$262.00	$141.48–$201.74	—	75%
Complete blood count (CBC), no differential CPT 85027 CBC AUTO W/O DIFF	$53.14	$216.00	$6.47–$166.32	4% below	75%
Complete blood count (CBC), no differential CPT 85027 UC CBC AUTO W/O DIFF ER	$53.63	$218.00	$6.47–$167.86	3% below	75%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO W/O DIFF	$53.14	$216.00	$116.64–$166.32	—	75%
Complete blood count (CBC), no differential inpatient CPT 85027 UC CBC AUTO W/O DIFF ER	$53.63	$218.00	$117.72–$167.86	—	75%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL	$309.72	$1,259.00	$10.56–$969.43	100% above	75%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL	$309.72	$1,259.00	$679.86–$969.43	—	75%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QN	$189.42	$770.00	$10.18–$592.90	81% above	75%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER QN	$189.42	$770.00	$415.80–$592.90	—	75%
DHEA sulfate (DHEA-S) blood test CPT 82627 RL-A-DHEAS 70040	$21.88	$88.92	$12.45–$88.92	65% below	75%
DHEA sulfate (DHEA-S) blood test CPT 82627 S/O DHEA SULFATE	$21.90	$89.00	$12.46–$89.00	65% below	75%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 RL-A-DHEAS 70040	$21.88	$88.92	$48.02–$68.47	—	75%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 S/O DHEA SULFATE	$21.90	$89.00	$48.06–$68.53	—	75%
Estradiol blood test CPT 82670 RL-A-ESDIOL TMS 93247	$27.50	$111.76	$15.65–$111.76	65% below	75%
Estradiol blood test CPT 82670 SJP-ESTRADIOL	$393.36	$1,599.00	$27.94–$1,231.23	402% above	75%
Estradiol blood test CPT 82670 S/O ESTRADIOL	$409.10	$1,663.00	$27.94–$1,280.51	422% above	75%
Estradiol blood test inpatient CPT 82670 RL-A-ESDIOL TMS 93247	$27.50	$111.76	$60.36–$86.06	—	75%
Estradiol blood test inpatient CPT 82670 SJP-ESTRADIOL	$393.36	$1,599.00	$863.46–$1,231.23	—	75%
Estradiol blood test inpatient CPT 82670 S/O ESTRADIOL	$409.10	$1,663.00	$898.02–$1,280.51	—	75%
FSH (follicle-stimulating hormone) test CPT 83001 SJP-FSH	$308.73	$1,255.00	$18.58–$966.35	114% above	75%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 SJP-FSH	$308.73	$1,255.00	$677.70–$966.35	—	75%
Fecal calprotectin (stool inflammation test) CPT 83993 RL-A-CALPRO FEC 3002859	$19.32	$78.52	$11.00–$78.52	60% below	75%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 RL-A-CALPRO FEC 3002859	$19.32	$78.52	$42.41–$60.47	—	75%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$89.30	$363.00	$13.63–$279.51	3% below	75%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$89.30	$363.00	$196.02–$279.51	—	75%
Folate (folic acid) blood test CPT 82746 UC FOLIC ACID SERUM ER	$67.90	$276.00	$14.70–$212.52	36% below	75%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM	$68.39	$278.00	$14.70–$214.06	36% below	75%
Folate (folic acid) blood test inpatient CPT 82746 UC FOLIC ACID SERUM ER	$67.90	$276.00	$149.04–$212.52	—	75%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM	$68.39	$278.00	$150.12–$214.06	—	75%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE FREE	$39.86	$162.00	$16.94–$124.74	14% below	75%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE FREE	$39.86	$162.00	$87.48–$124.74	—	75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 RL-A-FT4 ED-TMS 93244	$8.88	$36.08	$5.06–$36.08	86% below	75%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE	$102.83	$418.00	$9.02–$321.86	66% above	75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 RL-A-FT4 ED-TMS 93244	$8.88	$36.08	$19.49–$27.79	—	75%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE	$102.83	$418.00	$225.72–$321.86	—	75%
Free testosterone test CPT 84402 RL-A-FREE T2 70111	$25.07	$101.88	$14.27–$101.88	67% below	75%
Free testosterone test CPT 84402 SJP-TESTOSTERONE FREE	$25.83	$105.00	$14.70–$105.00	66% below	75%
Free testosterone test inpatient CPT 84402 RL-A-FREE T2 70111	$25.07	$101.88	$55.02–$78.45	—	75%
Free testosterone test inpatient CPT 84402 SJP-TESTOSTERONE FREE	$25.83	$105.00	$56.70–$80.85	—	75%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1HR PP	$92.75	$377.00	$4.75–$290.29	2% above	75%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1HR PP	$92.75	$377.00	$203.58–$290.29	—	75%
Glucose tolerance test, 3 samples CPT 82951 GTT 1ST 3 SPEC	$75.53	$307.00	$12.87–$236.39	42% below	75%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 1ST 3 SPEC	$75.53	$307.00	$165.78–$236.39	—	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 S/O NEISSERIA AMP PROBE	$34.44	$140.00	$19.60–$140.00	33% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 UC RL-A-CGAMD 60241B ER	$34.53	$140.36	$19.66–$140.36	33% below	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 UC IA NEIS GONO AM PRB ER	$62.49	$254.00	$35.09–$195.58	21% above	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 S/O NEISSERIA AMP PROBE	$34.44	$140.00	$75.60–$107.80	—	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 UC RL-A-CGAMD 60241B ER	$34.53	$140.36	$75.80–$108.08	—	75%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 UC IA NEIS GONO AM PRB ER	$62.49	$254.00	$137.16–$195.58	—	75%
H. pylori antibody blood test CPT 86677 S/O H PYLORI AB IGG 8030	$28.05	$114.00	$15.96–$87.78	31% below	75%
H. pylori antibody blood test inpatient CPT 86677 S/O H PYLORI AB IGG 8030	$28.05	$114.00	$61.56–$87.78	—	75%
H. pylori stool antigen test CPT 87338 RL-A-PYLORI AG 65147	$14.15	$57.52	$8.06–$57.52	68% below	75%
H. pylori stool antigen test CPT 87338 S/O H PYLORI ANTIGEN	$33.46	$136.00	$14.38–$104.72	25% below	75%
H. pylori stool antigen test inpatient CPT 87338 RL-A-PYLORI AG 65147	$14.15	$57.52	$31.07–$44.30	—	75%
H. pylori stool antigen test inpatient CPT 87338 S/O H PYLORI ANTIGEN	$33.46	$136.00	$73.44–$104.72	—	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 S/O HIV1 QNT RNA PCR	$72.57	$295.00	$41.30–$295.00	40% below	75%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 RL-A-RFLX HIV QNT 3000867	$83.74	$340.40	$47.66–$340.40	31% below	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 S/O HIV1 QNT RNA PCR	$72.57	$295.00	$159.30–$227.15	—	75%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 RL-A-RFLX HIV QNT 3000867	$83.74	$340.40	$183.82–$262.11	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 RL-A-HIV PANEL 2012674	$23.70	$96.32	$13.49–$96.32	44% below	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 IA HIV1 AG W HIV1 HIV2 AB	$104.55	$425.00	$24.08–$327.25	147% above	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 RL-A-HIV PANEL 2012674	$23.70	$96.32	$52.02–$74.17	—	75%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 IA HIV1 AG W HIV1 HIV2 AB	$104.55	$425.00	$229.50–$327.25	—	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$74.30	$302.00	$9.71–$232.54	38% above	75%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN A1C	$74.30	$302.00	$163.08–$232.54	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 RL-A-HBSAB 20090	$10.57	$42.96	$6.02–$42.96	80% below	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB	$51.91	$211.00	$10.74–$162.47	at median	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 RL-A-HBSAB 20090	$10.57	$42.96	$23.20–$33.08	—	75%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE AB	$51.91	$211.00	$113.94–$162.47	—	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 RL-A-HBSAG 20089	$10.17	$41.32	$5.79–$41.32	81% below	75%
Hepatitis B surface antigen (HBsAg) test CPT 87340 IA HEP B SURFACE AG QL	$71.34	$290.00	$10.33–$223.30	34% above	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 RL-A-HBSAG 20089	$10.17	$41.32	$22.32–$31.82	—	75%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 IA HEP B SURFACE AG QL	$71.34	$290.00	$156.60–$223.30	—	75%
Hepatitis C antibody blood test (screening) CPT 86803 RL-A-HCV AB QR 2010784	$14.05	$57.08	$8.00–$57.08	72% below	75%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB	$92.99	$378.00	$14.27–$291.06	85% above	75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 RL-A-HCV AB QR 2010784	$14.05	$57.08	$30.83–$43.96	—	75%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB	$92.99	$378.00	$204.12–$291.06	—	75%
Hepatitis C viral load (HCV RNA) test CPT 87522 RL-A-HEPC QNT 3000572	$42.16	$171.36	$24.00–$171.36	46% below	75%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 RL-A-HEPC QNT 3000572	$42.16	$171.36	$92.54–$131.95	—	75%
Herpes blood test, HSV-1 antibody CPT 86695 RL-A-RFLX HERP I 50292	$12.98	$52.76	$7.39–$52.76	59% below	75%
Herpes blood test, HSV-1 antibody CPT 86695 S/O HERPESELECT TYPE1 IGG	$14.27	$58.00	$8.12–$58.00	55% below	75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 RL-A-RFLX HERP I 50292	$12.98	$52.76	$28.50–$40.63	—	75%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 S/O HERPESELECT TYPE1 IGG	$14.27	$58.00	$31.32–$44.66	—	75%
Herpes blood test, HSV-2 antibody CPT 86696 S/O HERPESELECT TYPE2 IGG	$16.49	$67.00	$9.38–$67.00	50% below	75%
Herpes blood test, HSV-2 antibody CPT 86696 RL-A-RFLX HERP II 50294	$19.05	$77.40	$10.84–$77.40	43% below	75%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 S/O HERPESELECT TYPE2 IGG	$16.49	$67.00	$36.18–$51.59	—	75%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 RL-A-RFLX HERP II 50294	$19.05	$77.40	$41.80–$59.60	—	75%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HIGH SENSITIVITY	$71.34	$290.00	$12.95–$223.30	6% above	75%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HIGH SENSITIVITY	$71.34	$290.00	$156.60–$223.30	—	75%
Homocysteine blood test CPT 83090 RL-A-THROMRISK 3017156B	$17.64	$71.68	$10.04–$71.68	81% below	75%
Homocysteine blood test CPT 83090 SJP-HOMOCYSTEINE TOTAL	$68.39	$278.00	$17.92–$214.06	27% below	75%
Homocysteine blood test inpatient CPT 83090 RL-A-THROMRISK 3017156B	$17.64	$71.68	$38.71–$55.20	—	75%
Homocysteine blood test inpatient CPT 83090 SJP-HOMOCYSTEINE TOTAL	$68.39	$278.00	$150.12–$214.06	—	75%
Insulin blood test CPT 83525 RL-A-INS F T 70155A	$11.25	$45.72	$6.41–$45.72	62% below	75%
Insulin blood test CPT 83525 S/O INSULIN TOTAL	$104.55	$425.00	$11.43–$327.25	250% above	75%
Insulin blood test inpatient CPT 83525 RL-A-INS F T 70155A	$11.25	$45.72	$24.69–$35.21	—	75%
Insulin blood test inpatient CPT 83525 S/O INSULIN TOTAL	$104.55	$425.00	$229.50–$327.25	—	75%
Iron blood test (serum iron) CPT 83540 IRON	$50.68	$206.00	$6.47–$158.62	21% above	75%
Iron blood test (serum iron) CPT 83540 RL-A-FE LIVER 28250	$90.06	$366.08	$6.47–$281.89	115% above	75%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$50.68	$206.00	$111.24–$158.62	—	75%
Iron blood test (serum iron) inpatient CPT 83540 RL-A-FE LIVER 28250	$90.06	$366.08	$197.69–$281.89	—	75%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$57.81	$235.00	$8.74–$180.95	46% below	75%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$57.81	$235.00	$126.90–$180.95	—	75%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$155.48	$632.00	$8.68–$486.64	34% above	75%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$155.48	$632.00	$341.28–$486.64	—	75%
LH (luteinizing hormone) test CPT 83002 SJP-LH	$229.52	$933.00	$18.52–$718.41	145% above	75%
LH (luteinizing hormone) test inpatient CPT 83002 SJP-LH	$229.52	$933.00	$503.82–$718.41	—	75%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$179.58	$730.00	$6.89–$562.10	97% above	75%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$179.58	$730.00	$394.20–$562.10	—	75%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$110.21	$448.00	$8.17–$344.96	7% above	75%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$110.21	$448.00	$241.92–$344.96	—	75%
Lyme disease antibody test CPT 86618 RL-A-LYME MTTT 3006053	$16.76	$68.12	$9.54–$68.12	45% below	75%
Lyme disease antibody test inpatient CPT 86618 RL-A-LYME MTTT 3006053	$16.76	$68.12	$36.79–$52.46	—	75%
Magnesium blood test CPT 83735 RL-A-SUPERSAT 2008771E	$6.60	$26.80	$3.76–$26.80	67% below	75%
Magnesium blood test CPT 83735 MAGNESIUM	$60.27	$245.00	$6.70–$188.65	203% above	75%
Magnesium blood test CPT 83735 RL-A-UMG 20477	$72.57	$295.00	$6.70–$227.15	265% above	75%
Magnesium blood test inpatient CPT 83735 RL-A-SUPERSAT 2008771E	$6.60	$26.80	$14.48–$20.64	—	75%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$60.27	$245.00	$132.30–$188.65	—	75%
Magnesium blood test inpatient CPT 83735 RL-A-UMG 20477	$72.57	$295.00	$159.30–$227.15	—	75%
Measles (rubeola) antibody test CPT 86765 RL-A-MEASLES M 99597	$12.68	$51.52	$7.22–$51.52	24% below	75%
Measles (rubeola) antibody test CPT 86765 SJP-RUBEOLA AB IGG	$80.94	$329.00	$12.88–$253.33	385% above	75%
Measles (rubeola) antibody test inpatient CPT 86765 RL-A-MEASLES M 99597	$12.68	$51.52	$27.83–$39.68	—	75%
Measles (rubeola) antibody test inpatient CPT 86765 SJP-RUBEOLA AB IGG	$80.94	$329.00	$177.66–$253.33	—	75%
Mono test (heterophile antibody, Monospot) CPT 86308 UC HETEROPHILE AB SCR ER	$5.66	$23.00	$3.22–$23.00	92% below	75%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE AB SCR	$67.65	$275.00	$5.18–$211.75	6% below	75%
Mono test (heterophile antibody, Monospot) CPT 86308 UC MONO TEST SCRN QW ER	$88.07	$358.00	$5.18–$275.66	23% above	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 UC HETEROPHILE AB SCR ER	$5.66	$23.00	$12.42–$17.71	—	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE AB SCR	$67.65	$275.00	$148.50–$211.75	—	75%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 UC MONO TEST SCRN QW ER	$88.07	$358.00	$193.32–$275.66	—	75%
PSA (prostate-specific antigen) blood test, free CPT 84154 RL-A-PSA FP 80206B	$18.10	$73.56	$10.30–$73.56	72% below	75%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 RL-A-PSA FP 80206B	$18.10	$73.56	$39.73–$56.65	—	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 RL-A-TPSAR 80264	$18.10	$73.56	$10.30–$73.56	77% below	75%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$63.23	$257.00	$18.39–$197.89	18% below	75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 RL-A-TPSAR 80264	$18.10	$73.56	$39.73–$56.65	—	75%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$63.23	$257.00	$138.78–$197.89	—	75%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 RL-A-GT REQUEST 2000137	$39.61	$161.00	$20.26–$123.97	27% above	75%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 RL-A-GT REQUEST 2000137	$39.61	$161.00	$86.94–$123.97	—	75%
Parathyroid hormone (PTH) blood test CPT 83970 RL-A-PTHI 70172B	$40.62	$165.12	$23.12–$165.12	66% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 PTH-INTRAOP	$51.42	$209.00	$29.26–$209.00	57% below	75%
Parathyroid hormone (PTH) blood test CPT 83970 S/O PTH INTACT W/CA GRAPH	$144.90	$589.00	$41.28–$453.53	21% above	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 RL-A-PTHI 70172B	$40.62	$165.12	$89.17–$127.15	—	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH-INTRAOP	$51.42	$209.00	$112.86–$160.93	—	75%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 S/O PTH INTACT W/CA GRAPH	$144.90	$589.00	$318.06–$453.53	—	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 RL-A-PTT INHIB 2003266	$5.92	$24.04	$3.37–$24.04	83% below	75%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBO TIME	$52.40	$213.00	$6.01–$164.01	54% above	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 RL-A-PTT INHIB 2003266	$5.92	$24.04	$12.99–$18.52	—	75%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBO TIME	$52.40	$213.00	$115.02–$164.01	—	75%
Progesterone blood test CPT 84144 SJP-PROGESTERONE ASSAY	$183.52	$746.00	$20.86–$574.42	99% above	75%
Progesterone blood test inpatient CPT 84144 SJP-PROGESTERONE ASSAY	$183.52	$746.00	$402.84–$574.42	—	75%
Prolactin blood test CPT 84146 RL-A-MACROPRO 20765	$19.07	$77.52	$10.86–$77.52	76% below	75%
Prolactin blood test CPT 84146 SJP-PROLACTIN ASSAY	$218.45	$888.00	$19.38–$683.76	175% above	75%
Prolactin blood test inpatient CPT 84146 RL-A-MACROPRO 20765	$19.07	$77.52	$41.87–$59.70	—	75%
Prolactin blood test inpatient CPT 84146 SJP-PROLACTIN ASSAY	$218.45	$888.00	$479.52–$683.76	—	75%
Prothrombin time (PT/INR) clotting test CPT 85610 RL-A-PT INHIB 2003260	$4.23	$17.16	$2.41–$17.16	85% below	75%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$40.84	$166.00	$4.29–$127.82	45% above	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 RL-A-PT INHIB 2003260	$4.23	$17.16	$9.27–$13.22	—	75%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$40.84	$166.00	$89.64–$127.82	—	75%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRG SCRN PRESUMPT OPTICAL	$12.55	$51.00	$7.14–$51.00	13% below	75%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRG SCRN PRESUMPT OPTICAL	$12.55	$51.00	$27.54–$39.27	—	75%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA IA AG OPTIC	$77.25	$314.00	$16.55–$241.78	188% above	75%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA IA AG OPTIC	$77.25	$314.00	$169.56–$241.78	—	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 UC IMMUNOAS STREP A QW ER	$34.94	$142.00	$16.53–$109.34	at median	75%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A IA AG OPTIC	$292.01	$1,187.00	$16.53–$913.99	736% above	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 UC IMMUNOAS STREP A QW ER	$34.94	$142.00	$76.68–$109.34	—	75%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A IA AG OPTIC	$292.01	$1,187.00	$640.98–$913.99	—	75%
Rheumatoid factor (RF) test CPT 86431 RL-A-RA-FL 2003347	$5.58	$22.68	$3.18–$22.68	65% below	75%
Rheumatoid factor (RF) test CPT 86431 RL-A-LUPUS COMP 50119C	$24.60	$100.00	$5.67–$77.00	55% above	75%
Rheumatoid factor (RF) test inpatient CPT 86431 RL-A-RA-FL 2003347	$5.58	$22.68	$12.25–$17.47	—	75%
Rheumatoid factor (RF) test inpatient CPT 86431 RL-A-LUPUS COMP 50119C	$24.60	$100.00	$54.00–$77.00	—	75%
Rubella antibody test (immunity check) CPT 86762 RL-A-RUBEIGM 50551	$14.16	$57.56	$8.06–$57.56	48% below	75%
Rubella antibody test (immunity check) CPT 86762 RUBELLA AB	$67.65	$275.00	$14.39–$211.75	146% above	75%
Rubella antibody test (immunity check) inpatient CPT 86762 RL-A-RUBEIGM 50551	$14.16	$57.56	$31.09–$44.33	—	75%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA AB	$67.65	$275.00	$148.50–$211.75	—	75%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE RBC AUTO	$53.14	$216.00	$2.70–$166.32	8% below	75%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE RBC AUTO	$53.14	$216.00	$116.64–$166.32	—	75%
Stool ova and parasites exam CPT 87177 UC RL-A-PARAST 60046A ER	$8.76	$35.60	$4.99–$35.60	69% below	75%
Stool ova and parasites exam CPT 87177 S/O OVA PARASITES A	$8.86	$36.00	$5.04–$36.00	69% below	75%
Stool ova and parasites exam CPT 87177 S/O OVA PARASITES	$13.04	$53.00	$7.42–$45.15	54% below	75%
Stool ova and parasites exam CPT 87177 UC OVA & PARASITES	$48.47	$197.00	$8.90–$151.69	69% above	75%
Stool ova and parasites exam inpatient CPT 87177 UC RL-A-PARAST 60046A ER	$8.76	$35.60	$19.23–$27.42	—	75%
Stool ova and parasites exam inpatient CPT 87177 S/O OVA PARASITES A	$8.86	$36.00	$19.44–$27.72	—	75%
Stool ova and parasites exam inpatient CPT 87177 S/O OVA PARASITES	$13.04	$53.00	$28.62–$40.81	—	75%
Stool ova and parasites exam inpatient CPT 87177 UC OVA & PARASITES	$48.47	$197.00	$106.38–$151.69	—	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 UC OCC BLD FEC QL 3 SPEC	$23.87	$97.00	$4.38–$74.69	11% below	75%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLD FEC QL 3 SPEC	$24.85	$101.00	$4.38–$77.77	8% below	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 UC OCC BLD FEC QL 3 SPEC	$23.87	$97.00	$52.38–$74.69	—	75%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLD FEC QL 3 SPEC	$24.85	$101.00	$54.54–$77.77	—	75%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 RL-A-FOB IA 2007190	$15.67	$63.68	$8.92–$63.68	19% below	75%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 S/O FECAL BLOOD ASSAY	$15.75	$64.00	$8.96–$64.00	18% below	75%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 RL-A-FOB IA 2007190	$15.67	$63.68	$34.39–$49.04	—	75%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 S/O FECAL BLOOD ASSAY	$15.75	$64.00	$34.56–$49.28	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RL-A-VDRL CSF 50206	$4.21	$17.08	$2.40–$17.08	68% below	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 UC SYPHIL VDRL/RPR QL	$43.30	$176.00	$4.27–$135.52	233% above	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RL-A-VDRL CSF 50206	$4.21	$17.08	$9.23–$13.16	—	75%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 UC SYPHIL VDRL/RPR QL	$43.30	$176.00	$95.04–$135.52	—	75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 RL-A-QFT 4 3017562	$60.99	$247.92	$34.71–$247.92	17% below	75%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 S/O QUANTIFERON TB	$61.01	$248.00	$34.72–$248.00	17% below	75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 RL-A-QFT 4 3017562	$60.99	$247.92	$133.88–$190.90	—	75%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 S/O QUANTIFERON TB	$61.01	$248.00	$133.92–$190.96	—	75%
Testosterone blood test, total (not free testosterone) CPT 84403 RL-A-TESTOS 70130	$25.40	$103.24	$14.46–$103.24	29% below	75%
Testosterone blood test, total (not free testosterone) CPT 84403 SJP-TESTOSTERONE TOTAL	$38.38	$156.00	$21.84–$130.98	8% above	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 RL-A-TESTOS 70130	$25.40	$103.24	$55.75–$79.50	—	75%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 SJP-TESTOSTERONE TOTAL	$38.38	$156.00	$84.24–$120.12	—	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 RL-A-LIVER-KID 99270	$14.32	$58.20	$8.15–$58.20	37% below	75%
Thyroid peroxidase (TPO) antibody test CPT 86376 S/O ANTI THYROID PEROXID	$64.95	$264.00	$14.55–$203.28	186% above	75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 RL-A-LIVER-KID 99270	$14.32	$58.20	$31.43–$44.82	—	75%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 S/O ANTI THYROID PEROXID	$64.95	$264.00	$142.56–$203.28	—	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 RL-A-TSH 3 70225	$16.54	$67.20	$9.41–$67.20	81% below	75%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIM HORMONE	$112.67	$458.00	$16.80–$352.66	27% above	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 RL-A-TSH 3 70225	$16.54	$67.20	$36.29–$51.75	—	75%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIM HORMONE	$112.67	$458.00	$247.32–$352.66	—	75%
Trichomonas test (NAAT) CPT 87661 UC AP IA NA AM PR TRIV ER	$32.72	$133.00	$18.62–$133.00	37% below	75%
Trichomonas test (NAAT) CPT 87661 RL-A-TVAG AMD 2005506	$34.53	$140.36	$19.66–$140.36	33% below	75%
Trichomonas test (NAAT) CPT 87661 SJP-TRICHOMON VAG APTIMA	$34.69	$141.00	$19.74–$141.00	33% below	75%
Trichomonas test (NAAT) CPT 87661 UC IA TRICHVAG AMP PRB ER	$45.51	$185.00	$25.90–$185.00	12% below	75%
Trichomonas test (NAAT) inpatient CPT 87661 UC AP IA NA AM PR TRIV ER	$32.72	$133.00	$71.82–$102.41	—	75%
Trichomonas test (NAAT) inpatient CPT 87661 RL-A-TVAG AMD 2005506	$34.53	$140.36	$75.80–$108.08	—	75%
Trichomonas test (NAAT) inpatient CPT 87661 SJP-TRICHOMON VAG APTIMA	$34.69	$141.00	$76.14–$108.57	—	75%
Trichomonas test (NAAT) inpatient CPT 87661 UC IA TRICHVAG AMP PRB ER	$45.51	$185.00	$99.90–$142.45	—	75%
Uric acid blood test CPT 84550 URIC ACID BLOOD	$67.65	$275.00	$4.52–$211.75	51% above	75%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD	$67.65	$275.00	$148.50–$211.75	—	75%
Urinalysis with microscope exam, automated CPT 81001 UA AUTO W MICRO	$78.48	$319.00	$3.17–$245.63	76% above	75%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA AUTO W MICRO	$78.48	$319.00	$172.26–$245.63	—	75%
Urinalysis without microscope exam, automated CPT 81003 UA AUTO WO MICRO	$23.87	$97.00	$2.25–$74.69	8% below	75%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA AUTO WO MICRO	$23.87	$97.00	$52.38–$74.69	—	75%
Urinalysis without microscope exam, manual CPT 81002 UA NONAUTO WO MICRO	$19.19	$78.00	$3.48–$60.06	198% above	75%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NONAUTO WO MICRO	$19.19	$78.00	$42.12–$60.06	—	75%
Urine culture for bacteria, with colony count CPT 87086 S/O CULT UR W/COLONY CNT	$7.88	$32.00	$4.48–$32.00	88% below	75%
Urine culture for bacteria, with colony count CPT 87086 UC CULT UR W/COLNY CNT ER	$245.51	$998.00	$8.07–$768.46	263% above	75%
Urine culture for bacteria, with colony count inpatient CPT 87086 S/O CULT UR W/COLONY CNT	$7.88	$32.00	$17.28–$24.64	—	75%
Urine culture for bacteria, with colony count inpatient CPT 87086 UC CULT UR W/COLNY CNT ER	$245.51	$998.00	$538.92–$768.46	—	75%
Urine pregnancy test, read by color change CPT 81025 UC PREG URINE VISUAL ER	$68.39	$278.00	$8.61–$214.06	42% above	75%
Urine pregnancy test, read by color change CPT 81025 PREG URINE VISUAL	$115.38	$469.00	$8.61–$361.13	140% above	75%
Urine pregnancy test, read by color change inpatient CPT 81025 UC PREG URINE VISUAL ER	$68.39	$278.00	$150.12–$214.06	—	75%
Urine pregnancy test, read by color change inpatient CPT 81025 PREG URINE VISUAL	$115.38	$469.00	$253.26–$361.13	—	75%
Vitamin B12 (cobalamin) blood test CPT 82607 RL-A-B12 MMA 55662	$14.84	$60.32	$8.45–$60.32	80% below	75%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$73.31	$298.00	$15.08–$229.46	3% below	75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 RL-A-B12 MMA 55662	$14.84	$60.32	$32.58–$46.45	—	75%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$73.31	$298.00	$160.92–$229.46	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$29.03	$118.00	$16.52–$118.00	59% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 RL-A-VIT D 25 80379	$29.13	$118.40	$16.58–$118.40	59% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 SJP-VITAMIN D (25HYDROXY)	$31.98	$130.00	$18.20–$130.00	54% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 S/O VITAMIN D(25 HYDROXY)	$38.38	$156.00	$21.84–$152.17	45% below	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$29.03	$118.00	$63.72–$90.86	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 RL-A-VIT D 25 80379	$29.13	$118.40	$63.94–$91.17	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 SJP-VITAMIN D (25HYDROXY)	$31.98	$130.00	$70.20–$100.10	—	75%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 S/O VITAMIN D(25 HYDROXY)	$38.38	$156.00	$84.24–$120.12	—	75%
Zinc blood test CPT 84630 RL-A-ZINC 20097	$11.21	$45.56	$6.38–$45.56	54% below	75%
Zinc blood test CPT 84630 RL-A-ZN RBC 3003758	$45.27	$184.00	$11.39–$141.68	86% above	75%
Zinc blood test CPT 84630 RL-A-UUT ZINC FL 4844FL	$233.21	$948.00	$11.39–$729.96	860% above	75%
Zinc blood test inpatient CPT 84630 RL-A-ZINC 20097	$11.21	$45.56	$24.61–$35.09	—	75%
Zinc blood test inpatient CPT 84630 RL-A-ZN RBC 3003758	$45.27	$184.00	$99.36–$141.68	—	75%
Zinc blood test inpatient CPT 84630 RL-A-UUT ZINC FL 4844FL	$233.21	$948.00	$511.92–$729.96	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 RL-A-BHCG TM 70029	$14.81	$60.20	$8.43–$60.20	62% below	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QN	$440.59	$1,791.00	$15.05–$1,379.07	1037% above	75%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 UC HCG QN ER	$458.30	$1,863.00	$15.05–$1,434.51	1083% above	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 RL-A-BHCG TM 70029	$14.81	$60.20	$32.51–$46.36	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QN	$440.59	$1,791.00	$967.14–$1,379.07	—	75%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 UC HCG QN ER	$458.30	$1,863.00	$1,006.02–$1,434.51	—	75%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Arizona	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BRST STERO PRC 1ST UNI	$1,079.21	$4,387.00	$168.44–$4,807.98	76% below	75%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BRST STERO PRC 1ST UNI	$1,079.21	$4,387.00	$2,368.98–$3,377.99	—	75%
Cardiac catheterization with coronary angiogram CPT 93458 LT HRT CTH COR ANG VNTRCU	$6,188.13	$25,155.00	$1,072.85–$19,369.35	30% below	75%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 LT HRT CTH COR ANG VNTRCU	$6,188.13	$25,155.00	$13,583.70–$19,369.35	—	75%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELCTIVE EXT	$650.43	$2,644.00	$111.93–$2,644.00	30% below	75%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELCTIVE EXT	$650.43	$2,644.00	$1,427.76–$2,035.88	—	75%
Catheter ablation for atrial fibrillation CPT 93656 EP AFIB ABL PV ISOL 3DMAP	$13,004.06	$52,862.00	$963.78–$42,667.71	61% below	75%
Catheter ablation for atrial fibrillation inpatient CPT 93656 EP AFIB ABL PV ISOL 3DMAP	$13,004.06	$52,862.00	$28,545.48–$40,703.74	—	75%
Cystoscopy with ureteral stent placement CPT 52332 CYSTO W STENT URETERL INS	$3,519.28	$14,306.00	$161.29–$11,015.62	19% below	75%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTO W STENT URETERL INS	$3,519.28	$14,306.00	$7,725.24–$11,015.62	—	75%
Earwax removal with instruments, one ear CPT 69210 PF REMOVE CERUMEN IMPACTD	$42.81	$174.00	$24.36–$133.98	63% below	75%
Earwax removal with instruments, one ear inpatient CPT 69210 PF REMOVE CERUMEN IMPACTD	$42.81	$174.00	$93.96–$133.98	—	75%
Incision and drainage of a simple or single skin abscess CPT 10060 PF I AND D ABSCESS SIMPLE	$41.33	$168.00	$23.52–$649.39	81% below	75%
Incision and drainage of a simple or single skin abscess CPT 10060 I AND D ABSCESS SIMPLE	$117.84	$479.00	$67.06–$649.39	46% below	75%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PF I AND D ABSCESS SIMPLE	$41.33	$168.00	$90.72–$129.36	—	75%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I AND D ABSCESS SIMPLE	$117.84	$479.00	$258.66–$368.83	—	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTH ASP MJR JT WO US UNI	$434.44	$1,766.00	$47.56–$3,590.33	52% below	75%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTH ASP MJR JT WO US UNI	$434.44	$1,766.00	$953.64–$1,359.82	—	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PF ARTHROC ASP INTE JT WO	$67.65	$275.00	$38.50–$3,590.33	88% below	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCEN ASP INTER JT WO	$447.48	$1,819.00	$38.62–$3,590.33	20% below	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 PF ARTHROC ASP INTE JT WO	$67.65	$275.00	$148.50–$211.75	—	75%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCEN ASP INTER JT WO	$447.48	$1,819.00	$982.26–$1,400.63	—	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 PF LR INT SCP/TRN <=2.5CM	$162.61	$661.00	$92.54–$3,590.33	63% below	75%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 PF LR INT SCP/TRN <=2.5CM	$162.61	$661.00	$356.94–$508.97	—	75%
Left heart catheterization, diagnostic CPT 93452 LT HRT CTH VENTRICULGRPHY	$3,043.52	$12,372.00	$924.80–$16,852.28	23% below	75%
Left heart catheterization, diagnostic inpatient CPT 93452 LT HRT CTH VENTRICULGRPHY	$3,043.52	$12,372.00	$6,680.88–$9,526.44	—	75%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 ANES/STE EPI L/S SNGL INJ	$896.67	$3,645.00	$116.58–$2,806.65	60% below	75%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 ANES/STE EPI L/S SNGL INJ	$896.67	$3,645.00	$1,968.30–$2,806.65	—	75%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLAT SINGLE	$171.47	$697.00	$56.50–$536.69	4% below	75%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLAT SINGLE	$171.47	$697.00	$376.38–$536.69	—	75%
Paracentesis with imaging guidance CPT 49083 PARACENTSIS ABD W IMAGING	$688.56	$2,799.00	$109.79–$4,807.98	53% below	75%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTSIS ABD W IMAGING	$688.56	$2,799.00	$1,511.46–$2,155.23	—	75%
Short arm splint (forearm and hand) both sides CPT 29125 PF APP SPLNT SHORT ARM BI	$43.55	$177.00	$24.78–$498.47	—	75%
Short arm splint (forearm and hand) inpatient both sides CPT 29125 PF APP SPLNT SHORT ARM BI	$43.55	$177.00	$95.58–$136.29	—	75%
Short leg splint (calf to foot) both sides CPT 29515 PF APP SPLINT SHRT LEG BI	$54.37	$221.00	$30.94–$498.47	—	75%
Short leg splint (calf to foot) inpatient both sides CPT 29515 PF APP SPLINT SHRT LEG BI	$54.37	$221.00	$119.34–$170.17	—	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 PF LR SMPL TRK/NK <=2.5CM	$148.59	$604.00	$46.85–$603.26	at median	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LR SMPL TRNK/NECK <=2.5CM	$195.82	$796.00	$46.85–$612.92	32% above	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 PF LR SMPL TRK/NK <=2.5CM	$148.59	$604.00	$326.16–$465.08	—	75%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 LR SMPL TRNK/NECK <=2.5CM	$195.82	$796.00	$429.84–$612.92	—	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 PUNCTURE SPINAL LUMBER DX	$408.12	$1,659.00	$66.16–$2,782.00	21% below	75%
Spinal tap (lumbar puncture), diagnostic CPT 62270 PUNCTURE SPINAL LUMBAR DX	$506.76	$2,060.00	$66.16–$2,782.00	2% below	75%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 PUNCTURE SPINAL LUMBER DX	$408.12	$1,659.00	$895.86–$1,277.43	—	75%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 PUNCTURE SPINAL LUMBAR DX	$506.76	$2,060.00	$1,112.40–$1,586.20	—	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 PF LR SMPL TRK/NK 2.6-7.5	$149.33	$607.00	$61.51–$603.26	25% below	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LR SMPL TRNK/NECK 2.6-7.5	$167.04	$679.00	$61.51–$603.26	16% below	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 PF LR SMPL TRK/NK 2.6-7.5	$149.33	$607.00	$327.78–$467.39	—	75%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 LR SMPL TRNK/NECK 2.6-7.5	$167.04	$679.00	$366.66–$522.83	—	75%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 PF LR SMPL FACE/EAR <=2.5	$155.72	$633.00	$57.93–$603.26	51% below	75%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 PF LR SMPL FACE/EAR <=2.5	$155.72	$633.00	$341.82–$487.41	—	75%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX SKN TANGENTIAL SNG LES	$194.34	$790.00	$39.34–$608.30	36% below	75%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BX SKN TANGENTIAL SNG LES	$194.34	$790.00	$426.60–$608.30	—	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST US PERC 1ST UNI	$990.15	$4,025.00	$159.14–$4,807.98	80% below	75%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST US PERC 1ST UNI	$990.15	$4,025.00	$2,173.50–$3,099.25	—	75%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBR SUBQ TISS 1ST 20SQCM	$416.73	$1,694.00	$63.30–$3,149.00	34% below	75%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBR SUBQ TISS 1ST 20SQCM	$416.73	$1,694.00	$914.76–$1,304.38	—	75%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Arizona	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLD/BLD COMP	$183.52	$746.00	$43.99–$2,782.00	66% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 1HR	$328.91	$1,337.00	$43.99–$2,782.00	39% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 2HR	$365.07	$1,484.00	$43.99–$2,782.00	33% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 3HR	$405.41	$1,648.00	$43.99–$2,782.00	25% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 4HR	$450.68	$1,832.00	$43.99–$2,782.00	17% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 5HR	$495.69	$2,015.00	$43.99–$2,782.00	8% below	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 6HR	$545.14	$2,216.00	$43.99–$2,782.00	1% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 7HR	$599.26	$2,436.00	$43.99–$2,782.00	11% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP 8HR	$657.81	$2,674.00	$43.99–$2,782.00	22% above	75%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUS BLOOD/COMP >8HR	$725.46	$2,949.00	$43.99–$2,782.00	34% above	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLD/BLD COMP	$183.52	$746.00	$402.84–$574.42	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 1HR	$328.91	$1,337.00	$721.98–$1,029.49	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 2HR	$365.07	$1,484.00	$801.36–$1,142.68	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 3HR	$405.41	$1,648.00	$889.92–$1,268.96	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 4HR	$450.68	$1,832.00	$989.28–$1,410.64	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 5HR	$495.69	$2,015.00	$1,088.10–$1,551.55	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 6HR	$545.14	$2,216.00	$1,196.64–$1,706.32	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 7HR	$599.26	$2,436.00	$1,315.44–$1,875.72	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP 8HR	$657.81	$2,674.00	$1,443.96–$2,058.98	—	75%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUS BLOOD/COMP >8HR	$725.46	$2,949.00	$1,592.46–$2,270.73	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INH TX INITIAL EA DAY ER	$93.24	$379.00	$8.23–$379.00	57% below	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INH TX INITIAL EA DAY	$233.21	$948.00	$8.23–$729.96	7% above	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INH TX INITIAL EA DAY ER	$93.24	$379.00	$204.66–$291.83	—	75%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INH TX INITIAL EA DAY	$233.21	$948.00	$511.92–$729.96	—	75%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INF INIT 1ST HR	$591.39	$2,404.00	$135.18–$1,851.08	35% above	75%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INF INIT 1ST HR	$591.39	$2,404.00	$1,298.16–$1,851.08	—	75%
Critical care, first 30 to 74 minutes CPT 99291 ER CRITICAL CARE 30-74MIN	$3,220.14	$13,090.00	$185.32–$10,079.30	53% above	75%
Critical care, first 30 to 74 minutes CPT 99291 TRAUMA COMPREHENSIVE	$4,476.22	$18,196.00	$185.32–$18,196.00	113% above	75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ER CRITICAL CARE 30-74MIN	$3,220.14	$13,090.00	$7,068.60–$10,079.30	—	75%
Critical care, first 30 to 74 minutes inpatient CPT 99291 TRAUMA COMPREHENSIVE	$4,476.22	$18,196.00	$4,380.00–$14,010.92	—	75%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$405.66	$1,649.00	$230.86–$1,400.51	30% below	75%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY	$405.66	$1,649.00	$890.46–$1,269.73	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD TRAC ONLY ER	$26.33	$107.00	$6.44–$107.00	77% below	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12 LEAD TRACING ONLY	$176.14	$716.00	$6.44–$551.32	51% above	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD TRAC ONLY ER	$26.33	$107.00	$57.78–$82.39	—	75%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12 LEAD TRACING ONLY	$176.14	$716.00	$386.64–$551.32	—	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER TYPE B LEVEL 1 ER	$51.17	$208.00	$9.85–$1,112.00	79% below	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1	$156.95	$638.00	$9.85–$1,112.00	34% below	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER TYPE B LEVEL 1 ER	$51.17	$208.00	$112.32–$160.16	—	75%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1	$156.95	$638.00	$344.52–$491.26	—	75%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER TYPE B LEVEL 2 ER	$78.97	$321.00	$36.41–$1,344.00	78% below	75%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2	$240.59	$978.00	$36.41–$1,344.00	34% below	75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER TYPE B LEVEL 2 ER	$78.97	$321.00	$173.34–$247.17	—	75%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2	$240.59	$978.00	$528.12–$753.06	—	75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER TYPE B LEVEL 3 ER	$108.24	$440.00	$61.60–$2,455.00	82% below	75%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3	$386.96	$1,573.00	$62.07–$2,455.00	37% below	75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER TYPE B LEVEL 3 ER	$108.24	$440.00	$237.60–$338.80	—	75%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3	$386.96	$1,573.00	$849.42–$1,211.21	—	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER TYPE B LEVEL 4 ER	$122.02	$496.00	$69.44–$3,061.00	89% below	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4	$669.12	$2,720.00	$105.34–$3,061.00	39% below	75%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 TRAUMA LIMITED	$2,122.49	$8,628.00	$105.34–$6,643.56	94% above	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER TYPE B LEVEL 4 ER	$122.02	$496.00	$267.84–$381.92	—	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4	$669.12	$2,720.00	$1,468.80–$2,094.40	—	75%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 TRAUMA LIMITED	$2,122.49	$8,628.00	$4,380.00–$6,643.56	—	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER TYPE B LEVEL 5 ER	$169.25	$688.00	$96.32–$3,273.00	89% below	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5	$1,045.50	$4,250.00	$152.79–$3,273.00	31% below	75%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 TRAUMA ESSENTIAL	$4,380.77	$17,808.00	$152.79–$13,712.16	190% above	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER TYPE B LEVEL 5 ER	$169.25	$688.00	$371.52–$529.76	—	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5	$1,045.50	$4,250.00	$2,295.00–$3,272.50	—	75%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 TRAUMA ESSENTIAL	$4,380.77	$17,808.00	$4,380.00–$13,712.16	—	75%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVAS STR TEST W RX	$463.47	$1,884.00	$39.34–$1,450.68	15% below	75%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVAS STR TEST W RX	$463.47	$1,884.00	$1,017.36–$1,450.68	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF IV HYDR INIT 31-60 ER	$108.49	$441.00	$33.97–$441.00	39% below	75%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF IV HYDRA INIT 31-60MN	$280.69	$1,141.00	$33.97–$878.57	58% above	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF IV HYDR INIT 31-60 ER	$108.49	$441.00	$238.14–$339.57	—	75%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF IV HYDRA INIT 31-60MN	$280.69	$1,141.00	$616.14–$878.57	—	75%
IV infusion of a medicine, first hour CPT 96365 INF TX/DX/PR INT 1ST H ER	$108.49	$441.00	$61.74–$441.00	54% below	75%
IV infusion of a medicine, first hour CPT 96365 INF TX/DX/PRO INIT 1ST HR	$295.70	$1,202.00	$65.44–$925.54	26% above	75%
IV infusion of a medicine, first hour inpatient CPT 96365 INF TX/DX/PR INT 1ST H ER	$108.49	$441.00	$238.14–$339.57	—	75%
IV infusion of a medicine, first hour inpatient CPT 96365 INF TX/DX/PRO INIT 1ST HR	$295.70	$1,202.00	$649.08–$925.54	—	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ TX/DX/PRPH SUBQ/IM ER	$63.47	$258.00	$15.02–$397.00	6% below	75%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ TX/DX/PROPH SUBQ/IM	$195.57	$795.00	$15.02–$612.15	191% above	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ TX/DX/PRPH SUBQ/IM ER	$63.47	$258.00	$139.32–$198.66	—	75%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ TX/DX/PROPH SUBQ/IM	$195.57	$795.00	$429.30–$612.15	—	75%
New patient office visit, about 30 minutes CPT 99203 VISIT LOW 30MN NW PT	$179.58	$730.00	$57.49–$562.10	at median	75%
New patient office visit, about 30 minutes inpatient CPT 99203 VISIT LOW 30MN NW PT	$179.58	$730.00	$394.20–$562.10	—	75%
New patient office visit, about 45 minutes CPT 99204 VISIT MDT 45MN NW PT	$215.75	$877.00	$93.66–$675.29	7% below	75%
New patient office visit, about 45 minutes CPT 99204 FETAL DEMISE <23WK NEW PT	$269.87	$1,097.00	$93.66–$1,097.00	16% above	75%
New patient office visit, about 45 minutes inpatient CPT 99204 VISIT MDT 45MN NW PT	$215.75	$877.00	$473.58–$675.29	—	75%
New patient office visit, about 45 minutes inpatient CPT 99204 FETAL DEMISE <23WK NEW PT	$269.87	$1,097.00	$592.38–$844.69	—	75%
New patient office visit, about 60 minutes CPT 99205 VISIT HIGH 60MN NW PT	$288.56	$1,173.00	$127.20–$903.21	at median	75%
New patient office visit, about 60 minutes inpatient CPT 99205 VISIT HIGH 60MN NW PT	$288.56	$1,173.00	$633.42–$903.21	—	75%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 VISIT STFD 15MIN NW PT	$119.31	$485.00	$33.30–$373.45	1% below	75%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OB VISIT/FETAL MONITR NEW	$667.16	$2,712.00	$33.30–$2,712.00	453% above	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 VISIT STFD 15MIN NW PT	$119.31	$485.00	$261.90–$373.45	—	75%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OB VISIT/FETAL MONITR NEW	$667.16	$2,712.00	$1,464.48–$2,088.24	—	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT NUTRITION INITL EA15	$38.13	$155.00	$21.70–$155.00	80% below	75%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT NUTRITION INITL EA15	$38.13	$155.00	$83.70–$119.35	—	75%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO COUNSELING 3-10MN	$33.21	$135.00	$18.90–$135.00	7% above	75%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 TOBACCO COUNSELING 3-10MN	$33.21	$135.00	$72.90–$103.95	—	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF VISIT HIGH 40MN EST PT	$113.41	$461.00	$64.54–$354.97	56% below	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 UC VISIT HIGH 40MN EST ER	$169.25	$688.00	$96.32–$688.00	34% below	75%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 VISIT HIGH 40MN EST PT	$260.03	$1,057.00	$101.32–$813.89	1% above	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF VISIT HIGH 40MN EST PT	$113.41	$461.00	$248.94–$354.97	—	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 UC VISIT HIGH 40MN EST ER	$169.25	$688.00	$371.52–$529.76	—	75%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 VISIT HIGH 40MN EST PT	$260.03	$1,057.00	$570.78–$813.89	—	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PF VISIT LOW 20MN EST PT	$50.93	$207.00	$28.98–$159.39	66% below	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 UC VST LOW 20MN EST PT ER	$108.24	$440.00	$46.23–$440.00	27% below	75%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 VISIT LOW 20MN EST PT	$119.31	$485.00	$46.23–$373.45	20% below	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PF VISIT LOW 20MN EST PT	$50.93	$207.00	$111.78–$159.39	—	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 UC VST LOW 20MN EST PT ER	$108.24	$440.00	$237.60–$338.80	—	75%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 VISIT LOW 20MN EST PT	$119.31	$485.00	$261.90–$373.45	—	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF VISIT MDT 30MN EST PT	$67.65	$275.00	$38.50–$211.75	70% below	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 UC VISIT MDT 30MN EST ER	$122.02	$496.00	$68.27–$496.00	45% below	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 VISIT MDT 30MN EST PT	$184.26	$749.00	$68.27–$576.73	17% below	75%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 FETAL DEMISE <23WK EST PT	$269.87	$1,097.00	$68.27–$1,097.00	21% above	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF VISIT MDT 30MN EST PT	$67.65	$275.00	$148.50–$211.75	—	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 UC VISIT MDT 30MN EST ER	$122.02	$496.00	$267.84–$381.92	—	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 VISIT MDT 30MN EST PT	$184.26	$749.00	$404.46–$576.73	—	75%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 FETAL DEMISE <23WK EST PT	$269.87	$1,097.00	$592.38–$844.69	—	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PF VISIT STFD 10MN EST PT	$27.06	$110.00	$15.40–$84.70	72% below	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 VISIT STFD 10MN EST PT	$60.03	$244.00	$24.67–$187.88	38% below	75%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 UC VISIT STFD 10MN EST ER	$78.97	$321.00	$24.67–$397.00	19% below	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PF VISIT STFD 10MN EST PT	$27.06	$110.00	$59.40–$84.70	—	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 VISIT STFD 10MN EST PT	$60.03	$244.00	$131.76–$187.88	—	75%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 UC VISIT STFD 10MN EST ER	$78.97	$321.00	$173.34–$247.17	—	75%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$103.57	$421.00	$28.61–$421.00	41% below	75%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$103.57	$421.00	$227.34–$324.17	—	75%
Spirometry before and after a bronchodilator CPT 94060 BRNCHSPASM EVAL PRE/POST	$176.88	$719.00	$40.77–$719.00	22% below	75%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRNCHSPASM EVAL PRE/POST	$176.88	$719.00	$388.26–$553.63	—	75%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUT	$159.41	$648.00	$90.72–$609.31	33% below	75%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUT	$159.41	$648.00	$349.92–$498.96	—	75%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Arizona	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VAC PF TR SV 0.5MLPFS	$49.20	$200.00	$16.00–$154.00	33% below	75%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VAC PF TR SV 0.5MLPFS	$49.20	$200.00	$16.00–$154.00	—	75%
Hepatitis A vaccine, adult dose CPT 90632 HEPAT A VACC 1440U 1ML IN	$184.75	$751.00	$73.40–$578.27	111% above	75%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPAT A VACC 1440U 1ML IN	$184.75	$751.00	$292.89–$578.27	—	75%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUBELLA VAC	$206.15	$838.00	$94.80–$645.26	37% above	75%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELLA VAC	$206.15	$838.00	$326.82–$645.26	—	75%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENING VAC ACYW PF0.5MLIM	$351.05	$1,427.00	$161.28–$1,098.79	2% below	75%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENING VAC ACYW PF0.5MLIM	$351.05	$1,427.00	$556.53–$1,098.79	—	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOC VACC 20 VALENT	$624.60	$2,539.00	$355.46–$1,955.03	at median	75%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOC VACC 20 VALENT	$624.60	$2,539.00	$990.21–$1,955.03	—	75%
Rabies vaccine, one dose CPT 90675 RABIES VACC 2.5IU/ML 1ML	$951.29	$3,867.00	$266.30–$2,977.59	159% above	75%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACC 2.5IU/ML 1ML	$951.29	$3,867.00	$1,508.13–$2,977.59	—	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 0.5ML >=7YR IM	$111.69	$454.00	$39.60–$349.58	21% below	75%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 0.5ML >=7YR IM	$111.69	$454.00	$177.06–$349.58	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN OTH IMUN VAC ONE ER	$47.97	$195.00	$25.36–$150.15	4% below	75%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEP B VACCINE	$56.58	$230.00	$25.36–$177.10	14% above	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN OTH IMUN VAC ONE ER	$47.97	$195.00	$105.30–$150.15	—	75%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEP B VACCINE	$56.58	$230.00	$124.20–$177.10	—	75%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN OTHER IMMUN VAC ADD	$56.58	$230.00	$12.82–$177.10	40% above	75%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN OTHER IMMUN VAC ADD	$56.58	$230.00	$124.20–$177.10	—	75%

Source file: https://www.commonspirit.org/content/dam/commonspiritorg/en/dharz/ceaz/finance/price-transparency/941196203-1992735088_dignity-health_standardcharges.json