Hospital

Ortonville Area Health Services

Ortonville Area Health Services in Ortonville, MN publishes cash prices for 269 common procedures listed here, from its own machine-readable price file updated Jun 18, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Minnesota median for 179 of 265 procedures and below it for 84. By typical cash price it ranks #49 of 79 Minnesota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

450 Eastvold Avenue, Ortonville, MN 56278 Collected Sep 27, 2026 Source price file (320) 839-2502

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 241342 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$237.15	$279.00	$114.64–$270.63	8% above	15%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$237.15	$279.00	$139.50–$270.63	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$432.65	$509.00	$209.15–$493.73	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS 52 MOD	$432.65	$509.00	$209.15–$493.73	17% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 3+ LVLS	$668.10	$786.00	$322.97–$762.42	80% above	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$432.65	$509.00	$254.50–$493.73	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS 52 MOD	$432.65	$509.00	$254.50–$493.73	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 3+ LVLS	$668.10	$786.00	$393.00–$762.42	—	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,358.30	$1,598.00	$656.62–$1,550.06	11% above	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,358.30	$1,598.00	$799.00–$1,550.06	—	15%
Breast ultrasound, complete, one breast one side CPT 76641 US UNILATERAL BREAST COMPLETE	$556.75	$655.00	$269.14–$635.35	48% above	15%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US UNILATERAL BREAST COMPLETE	$556.75	$655.00	$327.50–$635.35	—	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US UNILATERAL BREAST LIMITED	$357.85	$421.00	$172.99–$408.37	14% above	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ED 76642 US UNILATERAL BREAST LIMITED	$357.85	$421.00	$172.99–$408.37	14% above	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ED 76642 US UNILATERAL BREAST LIMITED	$357.85	$421.00	$210.50–$408.37	—	15%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US UNILATERAL BREAST LIMITED	$357.85	$421.00	$210.50–$408.37	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,346.85	$2,761.00	$358.40–$2,678.17	42% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,346.85	$2,761.00	$1,380.50–$2,678.17	—	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART CORONARY ART BYPASS GRAFTS CONTRAST 3D POST	$796.45	$937.00	$468.50–$1,996.01	25% below	15%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART CORONARY ART BYPASS GRAFTS CONTRAST 3D POST	$796.45	$937.00	$468.50–$908.89	—	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST	$1,609.05	$1,893.00	$487.54–$1,836.21	16% below	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST	$1,609.05	$1,893.00	$946.50–$1,836.21	—	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W CONTRAST	$3,026.00	$3,560.00	$491.00–$3,453.20	23% above	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W CONTRAST	$3,026.00	$3,560.00	$1,780.00–$3,453.20	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS WO THEN W CONT	$3,347.30	$3,938.00	$491.00–$3,819.86	30% above	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS WO THEN W CONT	$3,347.30	$3,938.00	$1,969.00–$3,819.86	—	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST	$1,542.75	$1,815.00	$358.40–$1,760.55	6% above	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST	$1,542.75	$1,815.00	$907.50–$1,760.55	—	15%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$1,375.30	$1,618.00	$213.62–$1,569.46	17% above	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$1,375.30	$1,618.00	$809.00–$1,569.46	—	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONT	$1,348.95	$1,587.00	$213.62–$1,539.39	8% above	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONT	$1,348.95	$1,587.00	$793.50–$1,539.39	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$1,348.95	$1,587.00	$213.62–$1,539.39	7% above	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$1,348.95	$1,587.00	$793.50–$1,539.39	—	15%
CT scan of the head with contrast CPT 70460 CT HEAD W CONTRAST	$1,511.30	$1,778.00	$358.40–$1,724.66	16% above	15%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONTRAST	$1,511.30	$1,778.00	$889.00–$1,724.66	—	15%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO THEN W CONTRAST	$1,707.65	$2,009.00	$358.40–$1,948.73	7% above	15%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO THEN W CONTRAST	$1,707.65	$2,009.00	$1,004.50–$1,948.73	—	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONT	$1,348.10	$1,586.00	$213.62–$1,538.42	1% below	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONT	$1,348.10	$1,586.00	$793.00–$1,538.42	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$1,375.30	$1,618.00	$213.62–$1,569.46	2% above	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$1,375.30	$1,618.00	$809.00–$1,569.46	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$1,542.75	$1,815.00	$358.40–$1,760.55	5% above	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$1,542.75	$1,815.00	$907.50–$1,760.55	—	15%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUP CAROTID BILAT	$1,021.70	$1,202.00	$493.90–$1,165.94	—	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUP CAROTID BILAT	$1,021.70	$1,202.00	$601.00–$1,165.94	—	15%
Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS	$306.00	$360.00	$177.82–$497.90	32% above	15%
Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VWS	$306.00	$360.00	$180.00–$349.20	—	15%
Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW	$243.10	$286.00	$117.52–$277.42	37% above	15%
Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VW	$243.10	$286.00	$143.00–$277.42	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM	$790.50	$930.00	$382.14–$902.10	52% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ED 76770 US RETROPERITONEUM	$790.50	$930.00	$382.14–$902.10	52% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ED 76770 US RETROPERITONEUM	$790.50	$930.00	$465.00–$902.10	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM	$790.50	$930.00	$465.00–$902.10	—	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$425.00	$500.00	$205.45–$485.00	36% above	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$425.00	$500.00	$250.00–$485.00	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PG UTR TRNSABD SG	$714.00	$840.00	$345.16–$814.80	57% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US PG UTR TRNSABD SG	$714.00	$840.00	$420.00–$814.80	—	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$1,375.30	$1,618.00	$213.62–$1,569.46	10% above	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$1,375.30	$1,618.00	$809.00–$1,569.46	—	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$1,542.75	$1,815.00	$358.40–$1,760.55	3% above	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$1,542.75	$1,815.00	$907.50–$1,760.55	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DX BILAT INCL CAD	$406.30	$478.00	$196.41–$463.66	—	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DX BILAT INCL CAD	$406.30	$478.00	$239.00–$463.66	—	15%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILAT INCL CAD	$397.80	$468.00	$192.30–$453.96	28% above	15%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILAT INCL CAD	$397.80	$468.00	$234.00–$453.96	—	15%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,030.20	$1,212.00	$498.01–$1,175.64	—	15%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,030.20	$1,212.00	$606.00–$1,175.64	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,060.80	$1,248.00	$512.80–$1,210.56	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,060.80	$1,248.00	$624.00–$1,210.56	—	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$1,715.30	$2,018.00	$1,009.00–$3,126.20	36% above	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$1,715.30	$2,018.00	$1,009.00–$1,957.46	—	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,380.40	$1,624.00	$667.30–$1,575.28	3% above	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,380.40	$1,624.00	$812.00–$1,575.28	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$2,970.75	$3,495.00	$1,436.10–$3,390.15	14% below	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY SPLT NGHT 95811	$3,119.50	$3,670.00	$1,508.00–$3,559.90	10% below	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$2,970.75	$3,495.00	$1,747.50–$3,390.15	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY SPLT NGHT 95811	$3,119.50	$3,670.00	$1,835.00–$3,559.90	—	15%
Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS	$255.00	$300.00	$123.27–$291.00	10% above	15%
Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS	$255.00	$300.00	$150.00–$291.00	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED 76705 US ABD LIMITED	$646.00	$760.00	$312.28–$737.20	55% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$646.00	$760.00	$312.28–$737.20	55% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$646.00	$760.00	$380.00–$737.20	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ED 76705 US ABD LIMITED	$646.00	$760.00	$380.00–$737.20	—	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$590.75	$695.00	$285.58–$674.15	2% above	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$590.75	$695.00	$347.50–$674.15	—	15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JT WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	20% above	15%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JT WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$2,463.30	$2,898.00	$712.86–$2,811.06	4% below	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$2,463.30	$2,898.00	$1,449.00–$2,811.06	—	15%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	2% below	15%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO THEN W CONT	$2,510.05	$2,953.00	$712.86–$2,864.41	15% below	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO THEN W CONT	$2,510.05	$2,953.00	$1,476.50–$2,864.41	—	15%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	5% above	15%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO THEN W CONT	$2,619.70	$3,082.00	$712.86–$2,989.54	3% below	15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO THEN W CONT	$2,619.70	$3,082.00	$1,541.00–$2,989.54	—	15%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	2% above	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE WO THEN W CONT	$2,521.95	$2,967.00	$712.86–$2,877.99	2% below	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE WO THEN W CONT	$2,521.95	$2,967.00	$1,483.50–$2,877.99	—	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	1% above	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE WO THEN W CONT	$2,521.95	$2,967.00	$712.86–$2,877.99	1% above	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE WO THEN W CONT	$2,521.95	$2,967.00	$1,483.50–$2,877.99	—	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	1% above	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO THEN W CONT	$2,657.95	$3,127.00	$712.86–$3,033.19	at median	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO THEN W CONT	$2,657.95	$3,127.00	$1,563.50–$3,033.19	—	15%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$2,142.00	$2,520.00	$487.54–$2,444.40	1% above	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$2,142.00	$2,520.00	$1,260.00–$2,444.40	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT WO CONTRAST	$2,101.20	$2,472.00	$487.54–$2,397.84	1% below	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT WO CONTRAST	$2,101.20	$2,472.00	$1,236.00–$2,397.84	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$4,137.80	$4,868.00	$2,434.00–$7,407.06	46% above	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$4,137.80	$4,868.00	$2,434.00–$4,721.96	—	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT SKULL BASE TO MID THIGH	$5,398.35	$6,351.00	$2,609.63–$6,160.47	111% above	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT SKULL BASE TO MID THIGH	$5,398.35	$6,351.00	$3,175.50–$6,160.47	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ED 76857 US PELVIC LIMITED	$344.25	$405.00	$166.41–$392.85	13% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$437.75	$515.00	$211.61–$499.55	43% above	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ED 76857 US PELVIC LIMITED	$344.25	$405.00	$202.50–$392.85	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$437.75	$515.00	$257.50–$499.55	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$440.30	$518.00	$212.85–$502.46	6% below	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ED 76856 US PELVIC COMPLETE	$440.30	$518.00	$212.85–$502.46	6% below	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$440.30	$518.00	$259.00–$502.46	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ED 76856 US PELVIC COMPLETE	$440.30	$518.00	$259.00–$502.46	—	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG UTR 2-3TRI SGL 1ST	$565.25	$665.00	$273.25–$645.05	18% above	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG UTR 2-3TRI SGL 1ST	$565.25	$665.00	$332.50–$645.05	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTER 1ST TRI SGL	$432.65	$509.00	$209.15–$493.73	3% above	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTER 1ST TRI SGL	$432.65	$509.00	$254.50–$493.73	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB REAL TIME LTD	$379.10	$446.00	$183.26–$432.62	18% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ED 76815 US OB REAL TIME LTD	$379.10	$446.00	$183.26–$432.62	18% above	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB REAL TIME LTD	$379.10	$446.00	$223.00–$432.62	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ED 76815 US OB REAL TIME LTD	$379.10	$446.00	$223.00–$432.62	—	15%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$397.80	$468.00	$127.98–$1,455.33	—	15%
Screening mammogram, both breasts one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$397.80	$468.00	$127.98–$1,455.33	18% above	15%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$397.80	$468.00	$234.00–$453.96	—	15%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$397.80	$468.00	$234.00–$453.96	—	15%
Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$284.75	$335.00	$137.65–$324.95	26% above	15%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$284.75	$335.00	$167.50–$324.95	—	15%
Sleep study in a lab (polysomnography) CPT 95810 PSG 4+ PARAMETERS	$3,119.50	$3,670.00	$1,508.00–$3,559.90	1% above	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4+ PARAMETERS	$3,119.50	$3,670.00	$1,835.00–$3,559.90	—	15%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$653.65	$769.00	$315.98–$745.93	120% above	15%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$653.65	$769.00	$384.50–$745.93	—	15%
Transvaginal pelvic ultrasound CPT 76830 ED 76830 US TRANSVAGINAL	$387.60	$456.00	$187.37–$442.32	at median	15%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$387.60	$456.00	$187.37–$442.32	at median	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 ED 76830 US TRANSVAGINAL	$387.60	$456.00	$228.00–$442.32	—	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$387.60	$456.00	$228.00–$442.32	—	15%
Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG	$175.10	$206.00	$84.65–$199.82	48% below	15%
Transvaginal ultrasound during pregnancy CPT 76817 ED 76817 US PG UTR TRANSVAG	$421.60	$496.00	$203.81–$481.12	26% above	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ED 76817 US PG UTR TRANSVAG	$421.60	$496.00	$248.00–$481.12	—	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PG UTR TRANSVAG	$437.75	$515.00	$257.50–$499.55	—	15%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$870.40	$1,024.00	$420.76–$993.28	48% above	15%
Ultrasound of the abdomen, complete CPT 76700 ED 76700 US ABD COMPLETE	$870.40	$1,024.00	$420.76–$993.28	48% above	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$870.40	$1,024.00	$512.00–$993.28	—	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 ED 76700 US ABD COMPLETE	$870.40	$1,024.00	$512.00–$993.28	—	15%
Ultrasound of the scrotum and testicles CPT 76870 ED 76870 US SCROTUM	$546.55	$643.00	$264.21–$623.71	19% above	15%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$546.55	$643.00	$264.21–$623.71	19% above	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 ED 76870 US SCROTUM	$546.55	$643.00	$321.50–$623.71	—	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$546.55	$643.00	$321.50–$623.71	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ED 76536 US EXAM OF HEAD AND NECK	$492.15	$579.00	$237.91–$561.63	8% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$492.15	$579.00	$237.91–$561.63	8% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ED 76536 US EXAM OF HEAD AND NECK	$492.15	$579.00	$289.50–$561.63	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$492.15	$579.00	$289.50–$561.63	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$914.60	$1,076.00	$442.13–$1,043.72	67% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$914.60	$1,076.00	$538.00–$1,043.72	—	15%
Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$248.20	$292.00	$119.98–$283.24	13% above	15%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$248.20	$292.00	$146.00–$283.24	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS	$266.05	$313.00	$128.61–$303.61	4% below	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS	$266.05	$313.00	$156.50–$303.61	—	15%
X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW	$247.35	$291.00	$119.57–$282.27	17% above	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN 1 VW	$247.35	$291.00	$145.50–$282.27	—	15%
X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VWS	$217.60	$256.00	$105.19–$248.32	34% above	15%
X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VWS	$217.60	$256.00	$128.00–$248.32	—	15%
X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$245.65	$289.00	$118.75–$280.33	27% above	15%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$245.65	$289.00	$144.50–$280.33	—	15%
X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS	$217.60	$256.00	$105.19–$248.32	30% above	15%
X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VWS	$217.60	$256.00	$128.00–$248.32	—	15%
X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT MIN 3 VWS	$245.65	$289.00	$118.75–$280.33	18% above	15%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT MIN 3 VWS	$245.65	$289.00	$144.50–$280.33	—	15%
X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND MIN 3 VWS	$265.20	$312.00	$128.20–$302.64	23% above	15%
X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND MIN 3 VWS	$265.20	$312.00	$156.00–$302.64	—	15%
X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$251.60	$296.00	$121.63–$287.12	34% above	15%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$251.60	$296.00	$148.00–$287.12	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$332.35	$391.00	$160.66–$379.27	26% above	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$332.35	$391.00	$195.50–$379.27	—	15%
X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$363.80	$428.00	$175.87–$415.16	6% above	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$363.80	$428.00	$214.00–$415.16	—	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS	$286.45	$337.00	$138.47–$326.89	16% above	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THOR 2 VWS	$286.45	$337.00	$168.50–$326.89	—	15%
X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$257.55	$303.00	$124.50–$293.91	18% above	15%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$257.55	$303.00	$151.50–$293.91	—	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$351.05	$413.00	$169.70–$400.61	41% above	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$351.05	$413.00	$206.50–$400.61	—	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$243.95	$287.00	$117.93–$278.39	22% above	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$243.95	$287.00	$143.50–$278.39	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$282.20	$332.00	$136.42–$322.04	24% above	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$282.20	$332.00	$166.00–$322.04	—	15%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$59.50	$70.00	$28.76–$67.90	32% above	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$59.50	$70.00	$35.00–$67.90	—	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450	$59.50	$70.00	$28.76–$67.90	33% above	15%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST 84450	$59.50	$70.00	$35.00–$67.90	—	15%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL 80074	$338.30	$398.00	$163.54–$386.06	45% above	15%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL 80074	$338.30	$398.00	$199.00–$386.06	—	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ON PANEL 86003	$40.80	$48.00	$19.72–$46.56	168% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALERGEN SPEC IGE QNT SO 86003	$41.65	$49.00	$20.13–$47.53	174% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$41.65	$49.00	$20.13–$47.53	174% above	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ON PANEL 86003	$40.80	$48.00	$24.00–$46.56	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$41.65	$49.00	$24.50–$47.53	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALERGEN SPEC IGE QNT SO 86003	$41.65	$49.00	$24.50–$47.53	—	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$113.05	$133.00	$54.65–$129.01	170% above	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$113.05	$133.00	$66.50–$129.01	—	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$35.70	$42.00	$17.26–$40.74	21% below	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$35.70	$42.00	$21.00–$40.74	—	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE 83880	$184.45	$217.00	$89.17–$210.49	37% above	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE 83880	$184.45	$217.00	$108.50–$210.49	—	15%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL 80048	$115.60	$136.00	$16.92–$131.92	30% above	15%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL 80048	$115.60	$136.00	$68.00–$131.92	—	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV 88305	$136.00	$160.00	$71.68–$372.68	30% above	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV 88305	$136.00	$160.00	$80.00–$155.20	—	15%
Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$127.50	$150.00	$61.64–$145.50	16% above	15%
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$127.50	$150.00	$75.00–$145.50	—	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE 36415	$29.75	$35.00	$17.50–$65.38	43% above	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE 36415	$29.75	$35.00	$17.50–$33.95	—	15%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$50.15	$59.00	$24.24–$57.23	13% above	15%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$50.15	$59.00	$29.50–$57.23	—	15%
Blood lead test CPT 83655 LEAD 83655	$68.00	$80.00	$32.87–$77.60	118% above	15%
Blood lead test inpatient CPT 83655 LEAD 83655	$68.00	$80.00	$40.00–$77.60	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL 84703	$81.60	$96.00	$39.45–$93.12	18% above	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL 84703	$81.60	$96.00	$48.00–$93.12	—	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$177.65	$209.00	$85.88–$202.73	236% above	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$177.65	$209.00	$104.50–$202.73	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN QUANT 86140	$98.60	$116.00	$47.66–$112.52	81% above	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN QUANT 86140	$98.60	$116.00	$58.00–$112.52	—	15%
C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$164.90	$194.00	$79.71–$188.18	24% above	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$164.90	$194.00	$97.00–$188.18	—	15%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9PANCREATIC CANCER86301	$136.85	$161.00	$66.15–$156.17	35% above	15%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9PANCREATIC CANCER86301	$136.85	$161.00	$80.50–$156.17	—	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 86304	$158.95	$187.00	$76.84–$181.39	56% above	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 86304	$158.95	$187.00	$93.50–$181.39	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$87.55	$103.00	$51.50–$359.17	27% below	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$87.55	$103.00	$51.50–$99.91	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$85.00	$100.00	$41.09–$97.00	10% below	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$85.00	$100.00	$50.00–$97.00	—	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 80061	$129.20	$152.00	$26.78–$147.44	40% above	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 80061	$129.20	$152.00	$76.00–$147.44	—	15%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$107.10	$126.00	$15.54–$122.22	29% above	15%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$107.10	$126.00	$63.00–$122.22	—	15%
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$93.50	$110.00	$45.20–$106.70	43% above	15%
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$93.50	$110.00	$55.00–$106.70	—	15%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$158.95	$187.00	$21.12–$181.39	68% above	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$158.95	$187.00	$93.50–$181.39	—	15%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$163.20	$192.00	$78.89–$186.24	65% above	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$163.20	$192.00	$96.00–$186.24	—	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE 82627	$136.85	$161.00	$66.15–$156.17	137% above	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE 82627	$136.85	$161.00	$80.50–$156.17	—	15%
Estradiol blood test CPT 82670 ESTRADIOL TOTAL 82670	$158.95	$187.00	$76.84–$181.39	141% above	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL 82670	$158.95	$187.00	$93.50–$181.39	—	15%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$113.05	$133.00	$54.65–$129.01	60% above	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$113.05	$133.00	$66.50–$129.01	—	15%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN 82728	$117.30	$138.00	$56.70–$133.86	31% above	15%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN 82728	$117.30	$138.00	$69.00–$133.86	—	15%
Folate (folic acid) blood test CPT 82746 FOLATE 82746	$113.05	$133.00	$54.65–$129.01	41% above	15%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE 82746	$113.05	$133.00	$66.50–$129.01	—	15%
Free T3 thyroid hormone test CPT 84481 T3 FREE 84481	$136.85	$161.00	$66.15–$156.17	34% above	15%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE 84481	$136.85	$161.00	$80.50–$156.17	—	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE 84439	$102.85	$121.00	$49.72–$117.37	51% above	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE 84439	$102.85	$121.00	$60.50–$117.37	—	15%
Free testosterone test CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$121.55	$143.00	$58.76–$138.71	95% above	15%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$121.55	$143.00	$71.50–$138.71	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE & DOSE-QW 82950	$20.40	$24.00	$9.86–$23.28	52% below	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$76.50	$90.00	$36.98–$87.30	82% above	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE & DOSE-QW 82950	$20.40	$24.00	$12.00–$23.28	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$76.50	$90.00	$45.00–$87.30	—	15%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$139.40	$164.00	$67.39–$159.08	45% above	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$139.40	$164.00	$82.00–$159.08	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$85.85	$101.00	$41.50–$97.97	2% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$87.55	$103.00	$42.32–$99.91	4% above	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$85.85	$101.00	$50.50–$97.97	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$87.55	$103.00	$51.50–$99.91	—	15%
H. pylori antibody blood test CPT 86677 H PYLORI IGG 86677	$173.40	$204.00	$83.82–$197.88	47% above	15%
H. pylori antibody blood test CPT 86677 H PYLORI IGM	$307.70	$362.00	$148.75–$351.14	162% above	15%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGG 86677	$173.40	$204.00	$102.00–$197.88	—	15%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGM	$307.70	$362.00	$181.00–$351.14	—	15%
H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL 87338	$136.85	$161.00	$66.15–$156.17	26% above	15%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG STOOL 87338	$136.85	$161.00	$80.50–$156.17	—	15%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 HIV-2 ANTIBODY 86703	$67.15	$79.00	$32.46–$76.63	1% above	15%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 & 2 RAPID 86703	$67.15	$79.00	$32.46–$76.63	1% above	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 & 2 RAPID 86703	$67.15	$79.00	$39.50–$76.63	—	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 HIV-2 ANTIBODY 86703	$67.15	$79.00	$39.50–$76.63	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$81.60	$96.00	$39.45–$93.12	29% above	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$81.60	$96.00	$48.00–$93.12	—	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$91.80	$108.00	$44.38–$104.76	29% below	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$91.80	$108.00	$54.00–$104.76	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$107.10	$126.00	$19.42–$122.22	86% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$107.10	$126.00	$63.00–$122.22	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$91.80	$108.00	$44.38–$104.76	39% above	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$91.80	$108.00	$54.00–$104.76	—	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$81.60	$96.00	$39.45–$93.12	53% above	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$81.60	$96.00	$48.00–$93.12	—	15%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY 86803	$117.30	$138.00	$56.70–$133.86	47% above	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY 86803	$117.30	$138.00	$69.00–$133.86	—	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$227.80	$268.00	$110.12–$259.96	84% above	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$227.80	$268.00	$134.00–$259.96	—	15%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$96.90	$114.00	$46.84–$110.58	109% above	15%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$96.90	$114.00	$57.00–$110.58	—	15%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$96.90	$114.00	$46.84–$110.58	68% above	15%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$96.90	$114.00	$57.00–$110.58	—	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$122.40	$144.00	$59.17–$139.68	73% above	15%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$122.40	$144.00	$72.00–$139.68	—	15%
Homocysteine blood test CPT 83090 HOMOCYSTINE 83090	$180.20	$212.00	$87.11–$205.64	101% above	15%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTINE 83090	$180.20	$212.00	$106.00–$205.64	—	15%
Insulin blood test CPT 83525 INSULIN LEVEL 83525	$91.80	$108.00	$44.38–$104.76	68% above	15%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL 83525	$91.80	$108.00	$54.00–$104.76	—	15%
Iron blood test (serum iron) CPT 83540 IRON 83540	$68.00	$80.00	$32.87–$77.60	32% above	15%
Iron blood test (serum iron) inpatient CPT 83540 IRON 83540	$68.00	$80.00	$40.00–$77.60	—	15%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY 83550	$68.00	$80.00	$32.87–$77.60	5% above	15%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY 83550	$68.00	$80.00	$40.00–$77.60	—	15%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL 80069	$152.15	$179.00	$73.55–$173.63	44% above	15%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL 80069	$152.15	$179.00	$89.50–$173.63	—	15%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$113.05	$133.00	$54.65–$129.01	39% above	15%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$113.05	$133.00	$66.50–$129.01	—	15%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE 83690	$78.20	$92.00	$37.80–$89.24	32% above	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE 83690	$78.20	$92.00	$46.00–$89.24	—	15%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL 80076	$126.65	$149.00	$61.22–$144.53	24% above	15%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL 80076	$126.65	$149.00	$74.50–$144.53	—	15%
Lyme disease antibody test CPT 86618 LYMES TOTAL 86618	$113.05	$133.00	$54.65–$129.01	75% above	15%
Lyme disease antibody test inpatient CPT 86618 LYMES TOTAL 86618	$113.05	$133.00	$66.50–$129.01	—	15%
Magnesium blood test CPT 83735 MAGNESIUM 83735	$69.70	$82.00	$33.69–$79.54	123% above	15%
Magnesium blood test inpatient CPT 83735 MAGNESIUM 83735	$69.70	$82.00	$41.00–$79.54	—	15%
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA 86765	$91.80	$108.00	$44.38–$104.76	152% above	15%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA 86765	$91.80	$108.00	$54.00–$104.76	—	15%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN WHOLE BLD-QW 86308	$20.40	$24.00	$9.86–$23.28	60% below	15%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN 86308	$75.65	$89.00	$36.57–$86.33	48% above	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN WHOLE BLD-QW 86308	$20.40	$24.00	$12.00–$23.28	—	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN 86308	$75.65	$89.00	$44.50–$86.33	—	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE 84154	$112.20	$132.00	$54.24–$128.04	212% above	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE 84154	$112.20	$132.00	$66.00–$128.04	—	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL 84153	$163.20	$192.00	$78.89–$186.24	102% above	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL 84153	$163.20	$192.00	$96.00–$186.24	—	15%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO CERV THN AUTO 88175	$111.35	$131.00	$53.83–$127.07	31% above	15%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO CERV THN AUTO 88175	$111.35	$131.00	$65.50–$127.07	—	15%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTO CERV THN MAN 88142	$85.85	$101.00	$41.50–$97.97	11% above	15%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTO CERV THN MAN 88142	$85.85	$101.00	$50.50–$97.97	—	15%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT 83970	$117.30	$138.00	$56.70–$133.86	at median	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT 83970	$117.30	$138.00	$69.00–$133.86	—	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$78.20	$92.00	$37.80–$89.24	33% above	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$78.20	$92.00	$46.00–$89.24	—	15%
Progesterone blood test CPT 84144 PROGESTERONE 84144	$91.80	$108.00	$44.38–$104.76	14% above	15%
Progesterone blood test inpatient CPT 84144 PROGESTERONE 84144	$91.80	$108.00	$54.00–$104.76	—	15%
Prolactin blood test CPT 84146 PROLACTIN 84146	$91.80	$108.00	$44.38–$104.76	41% above	15%
Prolactin blood test inpatient CPT 84146 PROLACTIN 84146	$91.80	$108.00	$54.00–$104.76	—	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME - PROTIME CLINIC 85610	$9.35	$11.00	$4.52–$10.67	69% below	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PT INR FINGERSTICK-QW 85610	$10.20	$12.00	$4.93–$11.64	66% below	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME 85610	$64.60	$76.00	$31.23–$73.72	113% above	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME - PROTIME CLINIC 85610	$9.35	$11.00	$5.50–$10.67	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT INR FINGERSTICK-QW 85610	$10.20	$12.00	$6.00–$11.64	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME 85610	$64.60	$76.00	$38.00–$73.72	—	15%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A B DIRECT 87804	$72.25	$85.00	$34.93–$82.45	29% above	15%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A B DIRECT-QW 87804	$73.10	$86.00	$35.34–$83.42	31% above	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A B DIRECT 87804	$72.25	$85.00	$42.50–$82.45	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A B DIRECT-QW 87804	$73.10	$86.00	$43.00–$83.42	—	15%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RPD GROUP A STREP SCREEN 87880	$68.85	$81.00	$33.28–$78.57	29% above	15%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RPD GROUP A STREP SCREEN 87880	$68.85	$81.00	$40.50–$78.57	—	15%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT 86431	$38.25	$45.00	$18.49–$43.65	21% below	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT 86431	$38.25	$45.00	$22.50–$43.65	—	15%
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA 86762	$59.50	$70.00	$28.76–$67.90	26% above	15%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM AB 86762.903	$71.40	$84.00	$34.52–$81.48	51% above	15%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA 86762	$59.50	$70.00	$35.00–$67.90	—	15%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM AB 86762.903	$71.40	$84.00	$42.00–$81.48	—	15%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$27.20	$32.00	$13.15–$31.04	28% below	15%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$27.20	$32.00	$16.00–$31.04	—	15%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES 87177	$71.40	$84.00	$34.52–$81.48	103% above	15%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES 87177	$71.40	$84.00	$42.00–$81.48	—	15%
Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$27.20	$32.00	$13.15–$31.04	23% below	15%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$27.20	$32.00	$16.00–$31.04	—	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$34.00	$40.00	$16.44–$38.80	41% below	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 BLD OCLT FCL HGB DETRM-QW82274	$34.00	$40.00	$16.44–$38.80	41% below	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$34.00	$40.00	$20.00–$38.80	—	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 BLD OCLT FCL HGB DETRM-QW82274	$34.00	$40.00	$20.00–$38.80	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$68.00	$80.00	$32.87–$77.60	130% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$68.00	$80.00	$40.00–$77.60	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$124.10	$146.00	$59.99–$141.62	1% above	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$124.10	$146.00	$73.00–$141.62	—	15%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$136.85	$161.00	$66.15–$156.17	119% above	15%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$136.85	$161.00	$66.15–$156.17	119% above	15%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.900	$136.85	$161.00	$66.15–$156.17	119% above	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$136.85	$161.00	$80.50–$156.17	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$136.85	$161.00	$80.50–$156.17	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.900	$136.85	$161.00	$80.50–$156.17	—	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB ANTI TPO 86376	$112.20	$132.00	$54.24–$128.04	112% above	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID AB ANTI TPO 86376	$112.20	$132.00	$66.00–$128.04	—	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$124.10	$146.00	$33.60–$141.62	32% above	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$124.10	$146.00	$73.00–$141.62	—	15%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$59.50	$70.00	$28.76–$67.90	37% above	15%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$59.50	$70.00	$35.00–$67.90	—	15%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$68.85	$81.00	$33.28–$78.57	39% above	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$68.85	$81.00	$40.50–$78.57	—	15%
Urinalysis without microscope exam, automated CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$31.45	$37.00	$15.20–$35.89	23% above	15%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$51.85	$61.00	$25.06–$59.17	103% above	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$31.45	$37.00	$18.50–$35.89	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$51.85	$61.00	$30.50–$59.17	—	15%
Urinalysis without microscope exam, manual CPT 81002 CLINITEST DIPSTICK TABLET81002	$22.95	$27.00	$11.09–$26.19	4% above	15%
Urinalysis without microscope exam, manual CPT 81002 OB UA DIPSTK NONAU W/O MICRO 81002	$22.95	$27.00	$11.09–$26.19	4% above	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 OB UA DIPSTK NONAU W/O MICRO 81002	$22.95	$27.00	$13.50–$26.19	—	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 CLINITEST DIPSTICK TABLET81002	$22.95	$27.00	$13.50–$26.19	—	15%
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$35.70	$42.00	$17.26–$40.74	35% below	15%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$35.70	$42.00	$21.00–$40.74	—	15%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST 81025	$23.80	$28.00	$11.51–$27.16	39% below	15%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST 81025	$23.80	$28.00	$14.00–$27.16	—	15%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$97.75	$115.00	$47.25–$111.55	10% above	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$97.75	$115.00	$57.50–$111.55	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY 82306	$175.95	$207.00	$85.06–$200.79	81% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$175.95	$207.00	$85.06–$200.79	81% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY 82306	$175.95	$207.00	$103.50–$200.79	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$175.95	$207.00	$103.50–$200.79	—	15%
Zinc blood test CPT 84630 ZINC 84630.900	$85.85	$101.00	$41.50–$97.97	185% above	15%
Zinc blood test inpatient CPT 84630 ZINC 84630.900	$85.85	$101.00	$50.50–$97.97	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$151.30	$178.00	$73.14–$172.66	64% above	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$151.30	$178.00	$89.00–$172.66	—	15%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Botox injections for chronic migraine CPT 64615 TX RM 64615 CHEMODENERVATE MUSCLE MIGRAINE	$1,656.65	$1,949.00	$294.00–$1,890.53	173% above	15%
Botox injections for chronic migraine inpatient CPT 64615 TX RM 64615 CHEMODENERVATE MUSCLE MIGRAINE	$1,656.65	$1,949.00	$974.50–$1,890.53	—	15%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ED 27786 CLSD TX ANKLE FX WO MANIP	$581.40	$684.00	$281.06–$663.48	25% above	15%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 ED 27786 CLSD TX ANKLE FX WO MANIP	$581.40	$684.00	$342.00–$663.48	—	15%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ED 28470 CLSD TX METATARSAL FX WO MANIP	$446.25	$525.00	$215.72–$509.25	20% above	15%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 ED 28470 CLSD TX METATARSAL FX WO MANIP	$446.25	$525.00	$262.50–$509.25	—	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED 92960 CARDIOVERSION	$425.00	$500.00	$205.45–$485.00	59% below	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$519.35	$611.00	$251.06–$592.67	49% below	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED 92960 CARDIOVERSION	$425.00	$500.00	$250.00–$485.00	—	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$519.35	$611.00	$305.50–$592.67	—	15%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ED 25600 CLSD TX DISTAL RADIAL FX	$630.70	$742.00	$304.89–$719.74	28% above	15%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ED 25600 CLSD TX DISTAL RADIAL FX	$630.70	$742.00	$371.00–$719.74	—	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 PF 69209 RMVL IMPACTED CERUMEN IRR LAVAGE UNILATERAL	$28.90	$34.00	$13.97–$294.00	63% below	15%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 PF 69209 RMVL IMPACTED CERUMEN IRR LAVAGE UNILATERAL	$28.90	$34.00	$17.00–$32.98	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 SURG 62321 INJ IL NDL CATH CERV THOR W GUID	$901.85	$1,061.00	$435.96–$1,029.17	9% below	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 TX RM 62321 INJ IL NDL CATH CERV THOR W GUID	$1,954.15	$2,299.00	$441.00–$2,230.03	97% above	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 SURG 62321 INJ IL NDL CATH CERV THOR W GUID	$901.85	$1,061.00	$530.50–$1,029.17	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 TX RM 62321 INJ IL NDL CATH CERV THOR W GUID	$1,954.15	$2,299.00	$1,149.50–$2,230.03	—	15%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 TX RM 64493 INJ FACET JNT LUM SACRAL 1 LVL	$1,800.30	$2,118.00	$441.00–$2,054.46	30% above	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 TX RM 64493 INJ FACET JNT LUM SACRAL 1 LVL	$1,800.30	$2,118.00	$1,059.00–$2,054.46	—	15%
Incision and drainage of a simple or single skin abscess CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$226.95	$267.00	$109.71–$258.99	21% below	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$226.95	$267.00	$133.50–$258.99	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 TX RM 20550 INJ SINGLE TENDON LIGAMENT	$481.10	$566.00	$232.57–$549.02	30% above	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 TX RM 20550 INJ SINGLE TENDON LIGAMENT	$481.10	$566.00	$283.00–$549.02	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID	$116.45	$137.00	$56.29–$132.89	68% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 TX RM 20610 ARTHROCENT ASP INJ JOINT BURSA MAJOR WO US GUID	$558.45	$657.00	$269.96–$637.29	54% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 SURG 20610 ARTHROCENTESIS ASP INJ MJR JNT BURSA WO US GUID	$4,539.00	$5,340.00	$294.00–$5,179.80	1148% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID	$116.45	$137.00	$68.50–$132.89	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 TX RM 20610 ARTHROCENT ASP INJ JOINT BURSA MAJOR WO US GUID	$558.45	$657.00	$328.50–$637.29	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 SURG 20610 ARTHROCENTESIS ASP INJ MJR JNT BURSA WO US GUID	$4,539.00	$5,340.00	$2,670.00–$5,179.80	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 TX RM 20605 ARTHRO ASP INJ JOINT BURSA INTERMED WO US GUID	$620.50	$730.00	$294.00–$708.10	103% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 TX RM 20605 ARTHRO ASP INJ JOINT BURSA INTERMED WO US GUID	$620.50	$730.00	$365.00–$708.10	—	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 TX RM 20600 DRAIN INJ JOINT BURSA WO US	$424.15	$499.00	$205.04–$484.03	31% above	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 TX RM 20600 DRAIN INJ JOINT BURSA WO US	$424.15	$499.00	$249.50–$484.03	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR <	$469.20	$552.00	$226.82–$535.44	4% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR <	$469.20	$552.00	$276.00–$535.44	—	15%
Lower-back epidural injection, with imaging guidance CPT 62323 SURG 62323 INJ IL NDL CATH LUMB SACR W GUID	$518.50	$610.00	$250.65–$591.70	45% below	15%
Lower-back epidural injection, with imaging guidance CPT 62323 TX RM 62323 TR RM INJ INTERLAMINAR LUMBR SAC W IMAG GUID	$1,644.75	$1,935.00	$441.00–$1,876.95	73% above	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 SURG 62323 INJ IL NDL CATH LUMB SACR W GUID	$518.50	$610.00	$305.00–$591.70	—	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 TX RM 62323 TR RM INJ INTERLAMINAR LUMBR SAC W IMAG GUID	$1,644.75	$1,935.00	$967.50–$1,876.95	—	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TX RM 64483 INJ TRNFRM EPID LUM SNGL 1LVL	$2,410.60	$2,836.00	$441.00–$2,750.92	88% above	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TX RM 64483 INJ TRNFRM EPID LUM SNGL 1LVL	$2,410.60	$2,836.00	$1,418.00–$2,750.92	—	15%
Nail removal (partial or complete), one nail CPT 11730 ED 11730 REMV OF NAIL PLATE	$205.70	$242.00	$99.44–$234.74	26% below	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 ED 11730 REMV OF NAIL PLATE	$205.70	$242.00	$121.00–$234.74	—	15%
Occipital nerve block (injection for headaches) CPT 64405 ED 64405 INJ NERVE BLOCK GR OCCPTAL	$134.30	$158.00	$64.92–$153.26	78% below	15%
Occipital nerve block (injection for headaches) CPT 64405 TX RM 64405 INJ ANES NRV GREAT OCCIPITAL	$929.90	$1,094.00	$294.00–$1,061.18	54% above	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ED 64405 INJ NERVE BLOCK GR OCCPTAL	$134.30	$158.00	$79.00–$153.26	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 TX RM 64405 INJ ANES NRV GREAT OCCIPITAL	$929.90	$1,094.00	$547.00–$1,061.18	—	15%
Paracentesis with imaging guidance CPT 49083 ED 49083 ABD PARACNTSIS WIMAG GUID	$136.85	$161.00	$66.15–$156.17	84% below	15%
Paracentesis with imaging guidance inpatient CPT 49083 ED 49083 ABD PARACNTSIS WIMAG GUID	$136.85	$161.00	$80.50–$156.17	—	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ED 11750 REMV OF NAIL BED	$287.30	$338.00	$138.88–$327.86	43% below	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ED 11750 REMV OF NAIL BED	$287.30	$338.00	$169.00–$327.86	—	15%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 TX RM 64635 DESTROY LUMB SAC FACET JNT	$2,400.40	$2,824.00	$1,160.38–$2,739.28	14% above	15%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 TX RM 64635 DESTROY LUMB SAC FACET JNT	$2,400.40	$2,824.00	$1,412.00–$2,739.28	—	15%
Removal of a foreign object under the skin, simple CPT 10120 ED 10120 INC&REMV FB SMPL	$272.00	$320.00	$131.49–$310.40	32% below	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED 10120 INC&REMV FB SMPL	$272.00	$320.00	$160.00–$310.40	—	15%
Short arm splint (forearm and hand) CPT 29125 ED 29125 APPL SPLINT FOREARM	$121.55	$143.00	$58.76–$138.71	39% below	15%
Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM	$121.55	$143.00	$71.50–$138.71	—	15%
Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$121.55	$143.00	$58.76–$138.71	45% below	15%
Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$121.55	$143.00	$71.50–$138.71	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ED 12001 RPR SUPERFCL WND 2.5CM OR<	$168.30	$198.00	$81.36–$192.06	38% below	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ED 12001 RPR SUPERFCL WND 2.5CM OR<	$168.30	$198.00	$99.00–$192.06	—	15%
Skin biopsy, punch, one lesion CPT 11104 ED 11104 PUNCH BX SKIN SINGLE LESION	$233.75	$275.00	$113.00–$266.75	19% below	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 ED 11104 PUNCH BX SKIN SINGLE LESION	$233.75	$275.00	$137.50–$266.75	—	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$135.15	$159.00	$65.33–$154.23	81% below	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SURG 62270 SPINAL PUNCTURE LUMBAR DIAG	$1,076.95	$1,267.00	$441.00–$1,228.99	48% above	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 TX RM 62270 LUMBAR PUNCTURE DIAGNOSTIC	$1,076.95	$1,267.00	$441.00–$1,228.99	48% above	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$135.15	$159.00	$79.50–$154.23	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 TX RM 62270 LUMBAR PUNCTURE DIAGNOSTIC	$1,076.95	$1,267.00	$633.50–$1,228.99	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SURG 62270 SPINAL PUNCTURE LUMBAR DIAG	$1,076.95	$1,267.00	$633.50–$1,228.99	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ED 12002 RPR SUPERFCL WND 2.6-7.5CM	$204.00	$240.00	$98.62–$232.80	34% below	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ED 12002 RPR SUPERFCL WND 2.6-7.5CM	$204.00	$240.00	$120.00–$232.80	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ED 12011 RPR SUPERFCL WND 2.5CM OR<	$200.60	$236.00	$96.97–$228.92	27% below	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ED 12011 RPR SUPERFCL WND 2.5CM OR<	$200.60	$236.00	$118.00–$228.92	—	15%
Thoracentesis with imaging guidance CPT 32555 ED 32555 THORACENTESIS W IMAGING	$554.20	$652.00	$267.91–$632.44	38% below	15%
Thoracentesis with imaging guidance inpatient CPT 32555 ED 32555 THORACENTESIS W IMAGING	$554.20	$652.00	$326.00–$632.44	—	15%
Trigger point injections, 1 or 2 muscles CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$94.35	$111.00	$45.61–$107.67	70% below	15%
Trigger point injections, 1 or 2 muscles CPT 20552 TX RM 20552 INJ TRIGGER POINT 1 OR 2	$552.50	$650.00	$267.09–$630.50	79% above	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$94.35	$111.00	$55.50–$107.67	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TX RM 20552 INJ TRIGGER POINT 1 OR 2	$552.50	$650.00	$325.00–$630.50	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 SURG 19083 BX BREAST W DVC US GUIDE 1ST LSN	$2,608.65	$3,069.00	$711.00–$2,976.93	60% above	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 SURG 19083 BX BREAST W DVC US GUIDE 1ST LSN	$2,608.65	$3,069.00	$1,534.50–$2,976.93	—	15%
Vein ablation, radiofrequency, first vein CPT 36475 SURG 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$7,208.85	$8,481.00	$1,471.00–$8,226.57	90% above	15%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 SURG 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$7,208.85	$8,481.00	$4,240.50–$8,226.57	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ED 11042 DEBR SKN SUBQ TISS 20 CM <	$231.20	$272.00	$111.76–$263.84	48% below	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ED 11042 DEBR SKN SUBQ TISS 20 CM <	$231.20	$272.00	$136.00–$263.84	—	15%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 TRANSFUSION BLOOD	$446.25	$525.00	$215.72–$509.25	37% below	15%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD	$531.25	$625.00	$256.81–$606.25	26% below	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 TRANSFUSION BLOOD	$446.25	$525.00	$262.50–$509.25	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD	$531.25	$625.00	$312.50–$606.25	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PF 94640 NEBULIZER TREATMENT	$46.75	$55.00	$22.60–$53.35	60% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI SUBSEQ TX	$50.15	$59.00	$24.24–$57.23	57% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TENT HOURLY	$50.15	$59.00	$24.24–$57.23	57% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUBSEQ TX	$79.05	$93.00	$38.21–$90.21	33% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB INITIAL TX	$79.05	$93.00	$38.21–$90.21	33% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PF 94640 NEBULIZER TREATMENT	$46.75	$55.00	$27.50–$53.35	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TENT HOURLY	$50.15	$59.00	$29.50–$57.23	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI SUBSEQ TX	$50.15	$59.00	$29.50–$57.23	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB SUBSEQ TX	$79.05	$93.00	$46.50–$90.21	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB INITIAL TX	$79.05	$93.00	$46.50–$90.21	—	15%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR	$525.30	$618.00	$253.94–$599.46	3% above	15%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR	$525.30	$618.00	$309.00–$599.46	—	15%
Critical care, first 30 to 74 minutes CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$1,572.50	$1,850.00	$147.00–$1,794.50	2% above	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$1,572.50	$1,850.00	$925.00–$1,794.50	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING WO INTERP	$56.10	$66.00	$33.00–$337.51	67% below	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING WO INTERP	$56.10	$66.00	$33.00–$64.02	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED 99281 EMER CASE LEVEL I	$221.85	$261.00	$107.24–$1,078.00	15% above	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED 99281 EMER CASE LEVEL I	$221.85	$261.00	$130.50–$253.17	—	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED 99282 EMER CASE LEVEL II	$327.25	$385.00	$158.20–$491.00	32% above	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED 99282 EMER CASE LEVEL II	$327.25	$385.00	$192.50–$373.45	—	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED 99283 EMER CASE LEVEL III	$525.30	$618.00	$253.94–$599.46	33% above	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED 99283 EMER CASE LEVEL III	$525.30	$618.00	$309.00–$599.46	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED 99284 EMER CASE LEVEL IV	$822.80	$968.00	$270.00–$938.96	29% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED 99284 EMER CASE LEVEL IV	$822.80	$968.00	$484.00–$938.96	—	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED 99285 EMER CASE LEVEL V	$1,208.70	$1,422.00	$147.00–$1,379.34	28% above	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED 99285 EMER CASE LEVEL V	$1,208.70	$1,422.00	$711.00–$1,379.34	—	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST TRACING	$725.05	$853.00	$350.50–$827.41	1% above	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST TRACING	$725.05	$853.00	$426.50–$827.41	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 PF 96360 IV HYDRAT INIT 31-60M	$144.50	$170.00	$69.85–$164.90	47% below	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$148.75	$175.00	$71.91–$169.75	45% below	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INITIAL 31-60MINS	$153.00	$180.00	$73.96–$174.60	44% below	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 PF 96360 IV HYDRAT INIT 31-60M	$144.50	$170.00	$85.00–$164.90	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$148.75	$175.00	$87.50–$169.75	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRAT INITIAL 31-60MINS	$153.00	$180.00	$90.00–$174.60	—	15%
IV infusion of a medicine, first hour CPT 96365 PF 96365 IV INF THPY PRO DX UP	$175.10	$206.00	$84.65–$199.82	47% below	15%
IV infusion of a medicine, first hour CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$178.50	$210.00	$86.29–$203.70	46% below	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$183.60	$216.00	$88.75–$209.52	44% below	15%
IV infusion of a medicine, first hour inpatient CPT 96365 PF 96365 IV INF THPY PRO DX UP	$175.10	$206.00	$103.00–$199.82	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$178.50	$210.00	$105.00–$203.70	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$183.60	$216.00	$108.00–$209.52	—	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PF 96372 THER PRO DX INJ SQ IM	$43.35	$51.00	$20.96–$49.47	44% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$76.50	$90.00	$36.98–$87.30	1% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SC IM INJECTION	$79.05	$93.00	$38.21–$90.21	2% above	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PF 96372 THER PRO DX INJ SQ IM	$43.35	$51.00	$25.50–$49.47	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$76.50	$90.00	$45.00–$87.30	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SC IM INJECTION	$79.05	$93.00	$46.50–$90.21	—	15%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$102.85	$121.00	$60.50–$256.26	42% above	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$102.85	$121.00	$60.50–$117.37	—	15%
New patient office visit, about 30 minutes CPT 99203 PF 99203 FAC OFFICE OP VISIT NEW PT LEVEL III	$29.75	$35.00	$14.38–$33.95	75% below	15%
New patient office visit, about 30 minutes inpatient CPT 99203 PF 99203 FAC OFFICE OP VISIT NEW PT LEVEL III	$29.75	$35.00	$17.50–$33.95	—	15%
New patient office visit, about 45 minutes CPT 99204 PF 99204 FAC OFFICE OP VISIT NEW PT LEVEL IV	$29.75	$35.00	$14.38–$33.95	83% below	15%
New patient office visit, about 45 minutes inpatient CPT 99204 PF 99204 FAC OFFICE OP VISIT NEW PT LEVEL IV	$29.75	$35.00	$17.50–$33.95	—	15%
New patient office visit, about 60 minutes CPT 99205 PF 99205 FAC OFFICE OP VISIT NEW PT LEVEL V	$29.75	$35.00	$14.38–$33.95	87% below	15%
New patient office visit, about 60 minutes inpatient CPT 99205 PF 99205 FAC OFFICE OP VISIT NEW PT LEVEL V	$29.75	$35.00	$17.50–$33.95	—	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PF 99202 FAC OFFICE OP VISIT NEW PT LEVEL II	$29.75	$35.00	$14.38–$33.95	61% below	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PF 99202 FAC OFFICE OP VISIT NEW PT LEVEL II	$29.75	$35.00	$17.50–$33.95	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 PF 97802 NUTRITION EVAL 15 MIN	$25.50	$30.00	$12.33–$29.10	59% below	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$25.50	$30.00	$12.33–$29.10	59% below	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$25.50	$30.00	$15.00–$29.10	—	15%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 PF 97802 NUTRITION EVAL 15 MIN	$25.50	$30.00	$15.00–$29.10	—	15%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY 97165	$192.10	$226.00	$92.86–$219.22	14% above	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY 97165	$192.10	$226.00	$113.00–$219.22	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$232.05	$273.00	$112.18–$264.81	16% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$232.05	$273.00	$136.50–$264.81	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY 97161	$192.10	$226.00	$113.00–$766.08	14% above	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY 97161	$192.10	$226.00	$113.00–$219.22	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$211.65	$249.00	$102.31–$241.53	15% above	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$211.65	$249.00	$124.50–$241.53	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN 97140	$102.85	$121.00	$60.50–$217.00	24% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN 97140	$102.85	$121.00	$60.50–$117.37	—	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN 97110	$102.85	$121.00	$60.50–$227.47	14% above	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN 97110	$102.85	$121.00	$60.50–$117.37	—	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF 99215 FAC OFFICE OP VISIT EST PT LEVEL V W PROC M25	$29.75	$35.00	$14.38–$33.95	82% below	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF 99215 FAC OFFICE OP VISIT EST PT LEVEL V	$29.75	$35.00	$14.38–$33.95	82% below	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF 99215 FAC OFFICE OP VISIT EST PT LEVEL V W PROC M25	$29.75	$35.00	$17.50–$33.95	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF 99215 FAC OFFICE OP VISIT EST PT LEVEL V	$29.75	$35.00	$17.50–$33.95	—	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PF 99213 FAC OFFICE OP VISIT EST PT LEVEL III W PROC M25	$29.75	$35.00	$14.38–$33.95	68% below	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PF 99213 FAC OFFICE OP VISIT EST PT LEVEL III	$29.75	$35.00	$14.38–$33.95	68% below	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PF 99213 FAC OFFICE OP VISIT EST PT LEVEL III W PROC M25	$29.75	$35.00	$17.50–$33.95	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PF 99213 FAC OFFICE OP VISIT EST PT LEVEL III	$29.75	$35.00	$17.50–$33.95	—	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF 99214 FAC OFFICE OP VISIT EST PT LEVEL IV	$29.75	$35.00	$14.38–$33.95	75% below	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF 99214 FAC OFFICE OP VISIT EST PT LEVEL IV W PROC M25	$29.75	$35.00	$14.38–$33.95	75% below	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF 99214 FAC OFFICE OP VISIT EST PT LEVEL IV	$29.75	$35.00	$17.50–$33.95	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF 99214 FAC OFFICE OP VISIT EST PT LEVEL IV W PROC M25	$29.75	$35.00	$17.50–$33.95	—	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PF 99212 FAC OFFICE OP VISIT EST PT LEVEL II	$29.75	$35.00	$14.38–$33.95	64% below	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PF 99212 FAC OFFICE OP VISIT EST PT LEVEL II	$29.75	$35.00	$17.50–$33.95	—	15%
Speech and language evaluation CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$357.00	$420.00	$172.58–$407.40	11% above	15%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$357.00	$420.00	$210.00–$407.40	—	15%
Speech therapy session, individual CPT 92507 SPEECH THERAPY TX 92507	$232.05	$273.00	$136.50–$736.18	10% above	15%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TX 92507	$232.05	$273.00	$136.50–$264.81	—	15%
Spirometry (breathing test) CPT 94010 PF 94010 BREATHING CAPACITY	$72.25	$85.00	$34.93–$82.45	55% below	15%
Spirometry (breathing test) CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$85.00	$100.00	$41.09–$97.00	46% below	15%
Spirometry (breathing test) inpatient CPT 94010 PF 94010 BREATHING CAPACITY	$72.25	$85.00	$42.50–$82.45	—	15%
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$85.00	$100.00	$50.00–$97.00	—	15%
Spirometry before and after a bronchodilator CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$136.00	$160.00	$65.74–$155.20	53% below	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$136.00	$160.00	$80.00–$155.20	—	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA15 MIN 97530	$102.85	$121.00	$60.50–$274.51	33% above	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA15 MIN 97530	$102.85	$121.00	$60.50–$117.37	—	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$184.45	$217.00	$89.17–$210.49	13% below	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$184.45	$217.00	$108.50–$210.49	—	15%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 CDMR PF 91322 SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$137.70	$162.00	$81.00–$452.62	25% below	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 CDMR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$137.70	$162.00	$81.00–$452.62	25% below	15%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 CDMR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$137.70	$162.00	$81.00–$157.14	—	15%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 CDMR PF 91322 SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$137.70	$162.00	$81.00–$157.14	—	15%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 PF 90716 VARICELLA VACC SQ	$100.30	$118.00	$59.00–$548.32	58% below	15%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 PF 90716 VARICELLA VACC SQ	$100.30	$118.00	$59.00–$114.46	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 CDMR PF 90656 FLU VACC TRIVALENT SPLT PF 0.5 ML DOSAGE IM	$24.65	$29.00	$14.50–$65.02	11% above	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$30.30	$35.64	$17.82–$65.02	37% above	15%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 CDMR PF 90656 FLU VACC TRIVALENT SPLT PF 0.5 ML DOSAGE IM	$24.65	$29.00	$14.50–$28.13	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$30.30	$35.64	$17.82–$34.57	—	15%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PF 90651 HPV VIRUS VACCINE 9 VAL IM	$208.25	$245.00	$122.50–$939.51	45% below	15%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 PF 90651 HPV VIRUS VACCINE 9 VAL IM	$208.25	$245.00	$122.50–$237.65	—	15%
Hepatitis A vaccine, adult dose CPT 90632 PF 90632 HEPAT A VACC ADULT	$68.00	$80.00	$40.00–$205.91	35% below	15%
Hepatitis A vaccine, adult dose inpatient CPT 90632 PF 90632 HEPAT A VACC ADULT	$68.00	$80.00	$40.00–$77.60	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PF 90746 HEPAT B VACC ADULT IM	$75.65	$89.00	$44.50–$210.42	33% below	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJ SUSP	$105.61	$124.24	$62.12–$210.42	6% below	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJ SUSY	$128.40	$151.05	$75.15–$210.42	14% above	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 PF 90746 HEPAT B VACC ADULT IM	$75.65	$89.00	$44.50–$86.33	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJ SUSP	$105.61	$124.24	$62.12–$120.51	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML INJ SUSY	$128.40	$151.05	$75.53–$146.52	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY	$64.90	$76.35	$38.18–$274.85	13% below	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CDMR PF 90662 INFLU VACC PF ANTIGEN	$72.25	$85.00	$42.50–$274.85	4% below	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY	$64.90	$76.35	$38.18–$74.06	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 CDMR PF 90662 INFLU VACC PF ANTIGEN	$72.25	$85.00	$42.50–$82.45	—	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PF 90707 MMR VIRUS VAC LIVE SQ	$72.25	$85.00	$42.50–$278.80	42% below	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC INJ SOLR	$139.01	$163.54	$81.77–$278.80	11% above	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 PF 90707 MMR VIRUS VAC LIVE SQ	$72.25	$85.00	$42.50–$82.45	—	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC INJ SOLR	$141.36	$166.30	$83.15–$161.31	—	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 PF 90734 MENING CONJ VACC-QUADRIVALENT IM	$121.55	$143.00	$71.50–$504.31	38% below	15%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 PF 90734 MENING CONJ VACC-QUADRIVALENT IM	$121.55	$143.00	$71.50–$138.71	—	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 PF 90620 MENINGOCOCCAL RECOMB PROTEIN OMV SEROGRP B 2 DOSE IM	$195.50	$230.00	$115.00–$717.39	35% below	15%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 PF 90620 MENINGOCOCCAL RECOMB PROTEIN OMV SEROGRP B 2 DOSE IM	$195.50	$230.00	$115.00–$223.10	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PF 90677 PNEUMO VACC 20 VAL IM	$178.50	$210.00	$105.00–$876.12	56% below	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PF 90677 PNEUMO VACC 20 VAL IM	$178.50	$210.00	$105.00–$203.70	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PF 90732 IMM PNEUMOCOCCAL VACC	$87.55	$103.00	$51.50–$373.72	34% below	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML INJ SOLN	$97.69	$114.92	$57.46–$373.72	26% below	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PF 90732 IMM PNEUMOCOCCAL VACC	$87.55	$103.00	$51.50–$99.91	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML INJ SOLN	$97.69	$114.92	$57.46–$111.47	—	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 PF 90380 RSV MONOC ANTB SEASN .5ML IM	$501.50	$590.00	$295.00–$1,699.49	4% below	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 PF 90380 RSV MONOC ANTB SEASN .5ML IM	$501.50	$590.00	$295.00–$572.30	—	15%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 PF 90678 RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$293.25	$345.00	$172.50–$911.26	33% above	15%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 PF 90678 RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$293.25	$345.00	$172.50–$334.65	—	15%
Rabies vaccine, one dose CPT 90675 PF 90675 RABIES VACC IM VL 1ML	$276.25	$325.00	$162.50–$878.30	50% below	15%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$1,052.43	$1,238.15	$313.68–$1,201.01	91% above	15%
Rabies vaccine, one dose CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR	$1,057.71	$1,244.36	$313.68–$1,207.03	92% above	15%
Rabies vaccine, one dose inpatient CPT 90675 PF 90675 RABIES VACC IM VL 1ML	$276.25	$325.00	$162.50–$315.25	—	15%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VIRUS VACCINE, HDC IM SUSR	$1,057.71	$1,244.36	$622.18–$1,207.03	—	15%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR	$1,092.82	$1,285.67	$642.84–$1,247.10	—	15%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 PF 90750 ZOSTER VAC HZV RECOMBINANT SUBUNIT ADJUVANTED IM	$229.50	$270.00	$135.00–$565.18	at median	15%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 PF 90750 ZOSTER VAC HZV RECOMBINANT SUBUNIT ADJUVANTED IM	$229.50	$270.00	$135.00–$261.90	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 PF 90714 DIP TET PF >7YR IM DO	$36.55	$43.00	$21.50–$109.12	41% below	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ	$72.08	$84.79	$38.97–$109.12	15% above	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 PF 90714 DIP TET PF >7YR IM DO	$36.55	$43.00	$21.50–$41.71	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ	$72.08	$84.79	$42.40–$82.25	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PF 90715 TDAP VACC >7 YR IM	$53.55	$63.00	$31.50–$111.13	32% below	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP	$69.04	$81.22	$39.69–$111.13	12% below	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 PF 90715 TDAP VACC >7 YR IM	$53.55	$63.00	$31.50–$61.11	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP	$69.04	$81.22	$40.61–$78.78	—	15%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 PF 90691 TYPHOID VACC VI CAP	$86.70	$102.00	$51.00–$461.52	41% below	15%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 PF 90691 TYPHOID VACC VI CAP	$86.70	$102.00	$51.00–$98.94	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VAC	$40.80	$48.00	$19.72–$46.56	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN 1 VACCINE	$40.80	$48.00	$19.72–$46.56	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIR VAC	$40.80	$48.00	$19.72–$46.56	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEPATITIS B VACCINE	$40.80	$48.00	$19.72–$46.56	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PF 90471 IMMUN ADM 1 VACC IM	$40.80	$48.00	$19.72–$46.56	at median	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$68.85	$81.00	$33.28–$78.57	68% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEPATITIS B VACCINE	$40.80	$48.00	$24.00–$46.56	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VAC	$40.80	$48.00	$24.00–$46.56	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PF 90471 IMMUN ADM 1 VACC IM	$40.80	$48.00	$24.00–$46.56	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN 1 VACCINE	$40.80	$48.00	$24.00–$46.56	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIR VAC	$40.80	$48.00	$24.00–$46.56	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$68.85	$81.00	$40.50–$78.57	—	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$21.25	$25.00	$10.27–$24.25	16% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PF 90472 IMMUN ADM ADD VAC IM	$21.25	$25.00	$10.27–$24.25	16% below	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$68.85	$81.00	$33.28–$78.57	173% above	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$21.25	$25.00	$12.50–$24.25	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PF 90472 IMMUN ADM ADD VAC IM	$21.25	$25.00	$12.50–$24.25	—	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$68.85	$81.00	$40.50–$78.57	—	15%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8030/411369442_ortonville-area-health-services_standardcharges.csv