Hospital

Douglas County Memorial Hospital

Douglas County Memorial Hospital in Armour, SD publishes cash prices for 294 common procedures listed here, from its own machine-readable price file updated Jan 9, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the South Dakota median for 165 of 287 procedures and below it for 119. By typical cash price it ranks #16 of 20 South Dakota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

708 8th St Armour, SD 57313 Collected Sep 27, 2026 Source price file (605) 724-2159

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 431305 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named Douglas County Memorial Hospital in Armour, SD:

Feb 11, 2025 Warning notice
Mar 27, 2025 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$514.80	$572.00	$280.28–$572.00	78% above	10%
Ankle X-ray, complete, 3 or more views CPT 73610 RADIOLOGIC EXAM ANKLE COMP 3+ VIEWS	$604.80	$672.00	$329.28–$672.00	110% above	10%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$486.20	$572.00	$486.20–$572.00	—	15%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RADIOLOGIC EXAM ANKLE COMP 3+ VIEWS	$571.20	$672.00	$571.20–$672.00	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 NON-INVASIVE STUDY EXTREMITY ARTERY BILAT SNGL LEVEL	$474.30	$527.00	$258.23–$527.00	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$701.10	$779.00	$381.71–$779.00	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 UNILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS 52 MOD	$473.40	$526.00	$257.74–$526.00	8% below	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 NON-INVASIVE STUDY EXTREMITY ARTERY BILAT SNGL LEVEL	$447.95	$527.00	$447.95–$527.00	—	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	$662.15	$779.00	$662.15–$779.00	—	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	$447.10	$526.00	$447.10–$526.00	—	15%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ULTRASOUND BREAST UNILAT REAL TIME WIMAGE DOCUMENTATION LIMITED	$397.80	$442.00	$216.58–$442.00	29% below	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ULTRASOUND BREAST UNILAT REAL TIME WIMAGE DOCUMENTATION LIMITED	$375.70	$442.00	$375.70–$442.00	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WCONT +WO IF PERF	$3,714.30	$4,127.00	$2,022.23–$4,127.00	36% above	10%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WCONT +WO IF PERF	$3,507.95	$4,127.00	$3,507.95–$4,127.00	—	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST	$5,580.00	$6,200.00	$3,038.00–$6,200.00	46% above	10%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST	$5,270.00	$6,200.00	$5,270.00–$6,200.00	—	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W CONTRAST	$6,163.20	$6,848.00	$3,355.52–$6,848.00	31% above	10%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W CONTRAST	$5,820.80	$6,848.00	$5,820.80–$6,848.00	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS WO THEN W CONT	$6,220.80	$6,912.00	$3,386.88–$6,912.00	25% above	10%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS WO THEN W CONT	$5,875.20	$6,912.00	$5,875.20–$6,912.00	—	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST	$2,943.00	$3,270.00	$1,602.30–$3,270.00	3% below	10%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST	$2,779.50	$3,270.00	$2,779.50–$3,270.00	—	15%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$2,208.60	$2,454.00	$1,202.46–$2,454.00	12% above	10%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$2,085.90	$2,454.00	$2,085.90–$2,454.00	—	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONT	$2,670.30	$2,967.00	$1,453.83–$2,967.00	37% above	10%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONT	$2,521.95	$2,967.00	$2,521.95–$2,967.00	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$2,700.00	$3,000.00	$1,470.00–$3,000.00	37% above	10%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$2,550.00	$3,000.00	$2,550.00–$3,000.00	—	15%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO THEN W CONTRAST	$2,772.90	$3,081.00	$1,509.69–$3,081.00	1% below	10%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO THEN W CONTRAST	$2,618.85	$3,081.00	$2,618.85–$3,081.00	—	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONT	$3,372.30	$3,747.00	$1,836.03–$3,747.00	42% above	10%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONT	$3,184.95	$3,747.00	$3,184.95–$3,747.00	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$3,147.30	$3,497.00	$1,713.53–$3,497.00	40% above	10%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$2,972.45	$3,497.00	$2,972.45–$3,497.00	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$3,263.40	$3,626.00	$1,776.74–$3,626.00	46% above	10%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$3,082.10	$3,626.00	$3,082.10–$3,626.00	—	15%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX SCAN EXTRACRANIAL ARTERIES COMP BILAT STUDY	$1,513.80	$1,682.00	$824.18–$1,682.00	—	10%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUP CAROTID BILAT	$2,115.90	$2,351.00	$1,151.99–$2,351.00	—	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX SCAN EXTRACRANIAL ARTERIES COMP BILAT STUDY	$1,429.70	$1,682.00	$1,429.70–$1,682.00	—	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUP CAROTID BILAT	$1,998.35	$2,351.00	$1,998.35–$2,351.00	—	15%
Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAMINIATION, CHEST; 2 VIEWS	$450.00	$500.00	$245.00–$500.00	20% above	10%
Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS	$600.30	$667.00	$326.83–$667.00	60% above	10%
Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VWS	$164.47	$193.49	$164.47–$193.49	—	15%
Chest X-ray, 2 views inpatient CPT 71046 RADIOLOGIC EXAMINIATION, CHEST; 2 VIEWS	$425.00	$500.00	$425.00–$500.00	—	15%
Chest X-ray, single view CPT 71045 RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW	$294.30	$327.00	$160.23–$327.00	4% below	10%
Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW	$335.70	$373.00	$182.77–$373.00	9% above	10%
Chest X-ray, single view inpatient CPT 71045 RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW	$277.95	$327.00	$277.95–$327.00	—	15%
Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VW	$317.05	$373.00	$317.05–$373.00	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 ULTRASOUND RETROPERITONEUM B-SCAN REAL TIME COMP	$1,975.50	$2,195.00	$1,075.55–$2,195.00	119% above	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM	$1,975.50	$2,195.00	$1,075.55–$2,195.00	119% above	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 ULTRASOUND RETROPERITONEUM B-SCAN REAL TIME COMP	$1,865.75	$2,195.00	$1,865.75–$2,195.00	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM	$1,865.75	$2,195.00	$1,865.75–$2,195.00	—	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$642.60	$714.00	$349.86–$714.00	17% above	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$606.90	$714.00	$606.90–$714.00	—	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$2,925.00	$3,250.00	$1,592.50–$3,250.00	41% above	10%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$2,762.50	$3,250.00	$2,762.50–$3,250.00	—	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$3,323.70	$3,693.00	$1,809.57–$3,693.00	25% above	10%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$3,139.05	$3,693.00	$3,139.05–$3,693.00	—	15%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,324.80	$1,472.00	$721.28–$1,472.00	—	10%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX SCAN LWR EXTREMITY ARTERIES ARTERIAL BYPASS GRFTS COMP BILAT	$1,378.80	$1,532.00	$750.68–$1,532.00	—	10%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,251.20	$1,472.00	$1,251.20–$1,472.00	—	15%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX SCAN LWR EXTREMITY ARTERIES ARTERIAL BYPASS GRFTS COMP BILAT	$1,302.20	$1,532.00	$1,302.20–$1,532.00	—	15%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX SCAN VEINS EXTREMITY COMP BILAT STUDY	$1,462.50	$1,625.00	$796.25–$1,625.00	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$2,145.60	$2,384.00	$1,168.16–$2,384.00	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX SCAN VEINS EXTREMITY COMP BILAT STUDY	$1,381.25	$1,625.00	$1,381.25–$1,625.00	—	15%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$2,026.40	$2,384.00	$2,026.40–$2,384.00	—	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,474.10	$2,749.00	$1,347.01–$2,749.00	3% above	10%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,336.65	$2,749.00	$2,336.65–$2,749.00	—	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY SPLT NGHT 95811	$5,107.50	$5,675.00	$2,780.75–$5,675.00	8% above	10%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,823.75	$5,675.00	$4,823.75–$5,675.00	—	15%
Knee X-ray, 3 views CPT 73562 RADIOLOGIC EXAM KNEE 3 VIEWS	$566.10	$629.00	$308.21–$629.00	67% above	10%
Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS	$566.10	$629.00	$308.21–$629.00	67% above	10%
Knee X-ray, 3 views inpatient CPT 73562 RADIOLOGIC EXAM KNEE 3 VIEWS	$534.65	$629.00	$534.65–$629.00	—	15%
Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS	$534.65	$629.00	$534.65–$629.00	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$1,376.10	$1,529.00	$749.21–$1,529.00	61% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ULTRASOUND ABDOMINAL B-SCAN & OR REAL TIME WIMAGE DOCUMENTATION LTD	$1,376.10	$1,529.00	$749.21–$1,529.00	61% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$1,299.65	$1,529.00	$1,299.65–$1,529.00	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ULTRASOUND ABDOMINAL B-SCAN & OR REAL TIME WIMAGE DOCUMENTATION LTD	$1,299.65	$1,529.00	$1,299.65–$1,529.00	—	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	$698.40	$776.00	$380.24–$776.00	20% below	10%
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	$659.60	$776.00	$659.60–$776.00	—	15%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JT WO CONTRAST	$3,847.50	$4,275.00	$2,094.75–$4,275.00	21% above	10%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JT WO CONTRAST	$3,633.75	$4,275.00	$3,633.75–$4,275.00	—	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	$4,392.00	$4,880.00	$2,391.20–$4,880.00	5% above	10%
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	$4,148.00	$4,880.00	$4,148.00–$4,880.00	—	15%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$3,462.30	$3,847.00	$1,885.03–$3,847.00	10% above	10%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$3,269.95	$3,847.00	$3,269.95–$3,847.00	—	15%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO THEN W CONT	$4,599.00	$5,110.00	$2,503.90–$5,110.00	6% above	10%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO THEN W CONT	$4,343.50	$5,110.00	$4,343.50–$5,110.00	—	15%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST	$4,500.00	$5,000.00	$2,450.00–$5,000.00	38% above	10%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST	$4,250.00	$5,000.00	$4,250.00–$5,000.00	—	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE WO THEN W CONT	$4,738.50	$5,265.00	$2,579.85–$5,265.00	7% above	10%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE WO THEN W CONT	$4,475.25	$5,265.00	$4,475.25–$5,265.00	—	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST	$4,374.00	$4,860.00	$2,381.40–$4,860.00	34% above	10%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST	$4,131.00	$4,860.00	$4,131.00–$4,860.00	—	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE WO THEN W CONT	$4,540.50	$5,045.00	$2,472.05–$5,045.00	6% above	10%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE WO THEN W CONT	$4,288.25	$5,045.00	$4,288.25–$5,045.00	—	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE WO CONTRAST	$4,180.50	$4,645.00	$2,276.05–$4,645.00	28% above	10%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE WO CONTRAST	$3,948.25	$4,645.00	$3,948.25–$4,645.00	—	15%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$3,819.60	$4,244.00	$2,079.56–$4,244.00	6% above	10%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$3,607.40	$4,244.00	$3,607.40–$4,244.00	—	15%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT WO CONTRAST	$4,380.30	$4,867.00	$2,384.83–$4,867.00	34% above	10%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT WO CONTRAST	$4,136.95	$4,867.00	$4,136.95–$4,867.00	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$4,879.80	$5,422.00	$2,656.78–$5,422.00	14% above	10%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$4,608.70	$5,422.00	$4,608.70–$5,422.00	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ECHOGRAPHY PELVIS B-SCAN REAL TIME LIMITED FOLLOW-UP	$429.30	$477.00	$233.73–$477.00	13% below	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$429.30	$477.00	$233.73–$477.00	13% below	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 ECHOGRAPHY PELVIS B-SCAN REAL TIME LIMITED FOLLOW-UP	$405.45	$477.00	$405.45–$477.00	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$405.45	$477.00	$405.45–$477.00	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$1,084.50	$1,205.00	$590.45–$1,205.00	8% above	10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ECHOGRAPHY PELVIC(NONOBSTETRIC) B-SCAN & OR REAL TIME WIMAGE DOCATION	$1,084.50	$1,205.00	$590.45–$1,205.00	8% above	10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$1,024.25	$1,205.00	$1,024.25–$1,205.00	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ECHOGRAPHY PELVIC(NONOBSTETRIC) B-SCAN & OR REAL TIME WIMAGE DOCATION	$1,024.25	$1,205.00	$1,024.25–$1,205.00	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$747.00	$830.00	$406.70–$830.00	3% above	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTER 1ST TRI SGL	$747.00	$830.00	$406.70–$830.00	3% above	10%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$705.50	$830.00	$705.50–$830.00	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTER 1ST TRI SGL	$705.50	$830.00	$705.50–$830.00	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB REAL TIME LTD	$659.70	$733.00	$359.17–$733.00	22% above	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANT UTERUS REAL TIME WIMAGE DOCUMENT LIMITED 1 > FETUSES	$659.70	$733.00	$359.17–$733.00	22% above	10%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB REAL TIME LTD	$623.05	$733.00	$623.05–$733.00	—	15%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANT UTERUS REAL TIME WIMAGE DOCUMENT LIMITED 1 > FETUSES	$623.05	$733.00	$623.05–$733.00	—	15%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$465.30	$517.00	$253.33–$517.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD WHEN PERF	$465.30	$517.00	$253.33–$517.00	—	10%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOGRAPHY, BILATERAL, INCL CAD WHEN PERF	$439.45	$517.00	$439.45–$517.00	—	15%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$439.45	$517.00	$439.45–$517.00	—	15%
Shoulder X-ray, complete, 2 or more views CPT 73030 RADIOLOGIC EXAM SHLDR COMP 2+ VIEWS	$594.00	$660.00	$323.40–$660.00	73% above	10%
Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$594.00	$660.00	$323.40–$660.00	73% above	10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$561.00	$660.00	$561.00–$660.00	—	15%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RADIOLOGIC EXAM SHLDR COMP 2+ VIEWS	$561.00	$660.00	$561.00–$660.00	—	15%
Sleep study in a lab (polysomnography) CPT 95810 PSG 4+ PARAMETERS	$4,828.50	$5,365.00	$2,628.85–$5,365.00	11% above	10%
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4+ PARAMETERS	$4,560.25	$5,365.00	$4,560.25–$5,365.00	—	15%
Transvaginal pelvic ultrasound CPT 76830 ECHOGRAPHY TRANSVAGINAL	$661.50	$735.00	$360.15–$735.00	5% below	10%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$661.50	$735.00	$360.15–$735.00	5% below	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$624.75	$735.00	$624.75–$735.00	—	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 ECHOGRAPHY TRANSVAGINAL	$624.75	$735.00	$624.75–$735.00	—	15%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANT UTERUS REAL TIME WIMAGE DOCUMENT TRANSVAGINAL	$663.30	$737.00	$361.13–$737.00	8% above	10%
Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG	$1,324.80	$1,472.00	$721.28–$1,472.00	115% above	10%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANT UTERUS REAL TIME WIMAGE DOCUMENT TRANSVAGINAL	$626.45	$737.00	$626.45–$737.00	—	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PG UTR TRANSVAG	$1,251.20	$1,472.00	$1,251.20–$1,472.00	—	15%
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$1,359.00	$1,510.00	$739.90–$1,510.00	19% above	10%
Ultrasound of the abdomen, complete CPT 76700 ULTRASOUND ABDOMINAL B-SCAN & OR REAL TIME WIMAGE DOCUMENTATN COMP	$1,359.00	$1,510.00	$739.90–$1,510.00	19% above	10%
Ultrasound of the abdomen, complete inpatient CPT 76700 ULTRASOUND ABDOMINAL B-SCAN & OR REAL TIME WIMAGE DOCUMENTATN COMP	$1,283.50	$1,510.00	$1,283.50–$1,510.00	—	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$1,283.50	$1,510.00	$1,283.50–$1,510.00	—	15%
Ultrasound of the scrotum and testicles CPT 76870 ECHOGRAPHY SCROTUM & CONTENTS	$976.50	$1,085.00	$531.65–$1,085.00	7% above	10%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$976.50	$1,085.00	$531.65–$1,085.00	7% above	10%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$922.25	$1,085.00	$922.25–$1,085.00	—	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 ECHOGRAPHY SCROTUM & CONTENTS	$922.25	$1,085.00	$922.25–$1,085.00	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$867.60	$964.00	$472.36–$964.00	6% above	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ULTRASOUND HEAD NECK TISSUES B-SCAN REAL TIME WIMAGE DOCUMENTATION	$867.60	$964.00	$472.36–$964.00	6% above	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 ULTRASOUND HEAD NECK TISSUES B-SCAN REAL TIME WIMAGE DOCUMENTATION	$819.40	$964.00	$819.40–$964.00	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$819.40	$964.00	$819.40–$964.00	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX SCAN VEINS EXTREMITY UNILAT LIMITED STUDY	$851.40	$946.00	$463.54–$946.00	13% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$851.40	$946.00	$463.54–$946.00	13% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$804.10	$946.00	$804.10–$946.00	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX SCAN VEINS EXTREMITY UNILAT LIMITED STUDY	$804.10	$946.00	$804.10–$946.00	—	15%
Wrist X-ray, complete, 3 or more views CPT 73110 RADIOLOGIC EXAM WRIST COMP 3+ VIEWS	$520.20	$578.00	$283.22–$578.00	74% above	10%
Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$2,162.70	$2,403.00	$1,177.47–$2,403.00	625% above	10%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RADIOLOGIC EXAM WRIST COMP 3+ VIEWS	$491.30	$578.00	$491.30–$578.00	—	15%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$2,042.55	$2,403.00	$2,042.55–$2,403.00	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-RAY EXAM, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 2-3 VIEWS	$420.30	$467.00	$228.83–$467.00	36% above	10%
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	$621.00	$690.00	$338.10–$690.00	101% above	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-RAY EXAM, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 2-3 VIEWS	$396.95	$467.00	$396.95–$467.00	—	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	$586.50	$690.00	$586.50–$690.00	—	15%
X-ray of the abdomen, 1 view CPT 74018 RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW	$495.90	$551.00	$269.99–$551.00	52% above	10%
X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW	$531.90	$591.00	$289.59–$591.00	63% above	10%
X-ray of the abdomen, 1 view inpatient CPT 74018 RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW	$468.35	$551.00	$468.35–$551.00	—	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN 1 VW	$502.35	$591.00	$502.35–$591.00	—	15%
X-ray of the ankle, 2 views CPT 73600 RADIOLOGIC EXAM ANKLE 2 VIEWS	$252.90	$281.00	$137.69–$281.00	12% below	10%
X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VWS	$252.90	$281.00	$137.69–$281.00	12% below	10%
X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VWS	$238.85	$281.00	$238.85–$281.00	—	15%
X-ray of the ankle, 2 views inpatient CPT 73600 RADIOLOGIC EXAM ANKLE 2 VIEWS	$238.85	$281.00	$238.85–$281.00	—	15%
X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$427.50	$475.00	$232.75–$475.00	81% above	10%
X-ray of the finger(s), 2 or more views CPT 73140 RADIOLOGIC EXAM FINGER(S) 2+ VIEWS	$427.50	$475.00	$232.75–$475.00	81% above	10%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RADIOLOGIC EXAM FINGER(S) 2+ VIEWS	$403.75	$475.00	$403.75–$475.00	—	15%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$403.75	$475.00	$403.75–$475.00	—	15%
X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS	$366.30	$407.00	$199.43–$407.00	30% above	10%
X-ray of the foot, 2 views CPT 73620 RADIOLOGIC EXAM FOOT 2 VIEWS	$366.30	$407.00	$199.43–$407.00	30% above	10%
X-ray of the foot, 2 views inpatient CPT 73620 RADIOLOGIC EXAM FOOT 2 VIEWS	$345.95	$407.00	$345.95–$407.00	—	15%
X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VWS	$345.95	$407.00	$345.95–$407.00	—	15%
X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT MIN 3 VWS	$567.90	$631.00	$309.19–$631.00	85% above	10%
X-ray of the foot, complete, 3 or more views CPT 73630 RADIOLOGIC EXAM FOOT COMP 3+ VIEWS	$567.90	$631.00	$309.19–$631.00	85% above	10%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RADIOLOGIC EXAM FOOT COMP 3+ VIEWS	$536.35	$631.00	$536.35–$631.00	—	15%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT MIN 3 VWS	$536.35	$631.00	$536.35–$631.00	—	15%
X-ray of the hand, 3 or more views CPT 73130 RADIOLOGIC EXAM HAND 3+ VIEWS	$486.90	$541.00	$265.09–$541.00	62% above	10%
X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND MIN 3 VWS	$486.90	$541.00	$265.09–$541.00	62% above	10%
X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND MIN 3 VWS	$199.07	$234.19	$199.06–$234.19	—	15%
X-ray of the hand, 3 or more views inpatient CPT 73130 RADIOLOGIC EXAM HAND 3+ VIEWS	$459.85	$541.00	$459.85–$541.00	—	15%
X-ray of the knee, 1 or 2 views CPT 73560 RADIOLOGIC EXAM KNEE 1 2 VIEWS	$470.70	$523.00	$256.27–$523.00	66% above	10%
X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$470.70	$523.00	$256.27–$523.00	66% above	10%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$444.55	$523.00	$444.55–$523.00	—	15%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RADIOLOGIC EXAM KNEE 1 2 VIEWS	$444.55	$523.00	$444.55–$523.00	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RADIOLOGIC EXAM SPINE LUMBOSACRAL 2 OR 3 VIEWS	$705.60	$784.00	$384.16–$784.00	66% above	10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$705.60	$784.00	$384.16–$784.00	66% above	10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$666.40	$784.00	$666.40–$784.00	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RADIOLOGIC EXAM SPINE LUMBOSACRAL 2 OR 3 VIEWS	$666.40	$784.00	$666.40–$784.00	—	15%
X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$612.90	$681.00	$333.69–$681.00	5% above	10%
X-ray of the lower back, 4 or more views CPT 72110 RADIOLOGIC EXAM SPINE LUMBOSACRAL 4+ VIEWS	$612.90	$681.00	$333.69–$681.00	5% above	10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$578.85	$681.00	$578.85–$681.00	—	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RADIOLOGIC EXAM SPINE LUMBOSACRAL 4+ VIEWS	$578.85	$681.00	$578.85–$681.00	—	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RADIOLOGIC EXAM SPINE THORACIC 2 VIEWS	$616.50	$685.00	$335.65–$685.00	70% above	10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS	$616.50	$685.00	$335.65–$685.00	70% above	10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THOR 2 VWS	$582.25	$685.00	$582.25–$685.00	—	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RADIOLOGIC EXAM SPINE THORACIC 2 VIEWS	$582.25	$685.00	$582.25–$685.00	—	15%
X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$318.60	$354.00	$173.46–$354.00	1% above	10%
X-ray of the nasal bones, 3 or more views CPT 70160 RADIOLOGIC EXAM NASAL BONES COMP MINIMUM 3 VIEWS	$318.60	$354.00	$173.46–$354.00	1% above	10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RADIOLOGIC EXAM NASAL BONES COMP MINIMUM 3 VIEWS	$300.90	$354.00	$300.90–$354.00	—	15%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$300.90	$354.00	$300.90–$354.00	—	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RADIOLOGIC EXAM NECK SPINE 2-3 VIEWS	$603.90	$671.00	$328.79–$671.00	63% above	10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$603.90	$671.00	$328.79–$671.00	63% above	10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RADIOLOGIC EXAM NECK SPINE 2-3 VIEWS	$570.35	$671.00	$570.35–$671.00	—	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$570.35	$671.00	$570.35–$671.00	—	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$200.50	$222.77	$109.16–$222.77	37% below	10%
X-ray of the pelvis, 1 or 2 views CPT 72170 RADIOLOGIC EXAM PELVIS 1 OR 2 VIEWS	$425.70	$473.00	$231.77–$473.00	34% above	10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$402.05	$473.00	$402.05–$473.00	—	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RADIOLOGIC EXAM PELVIS 1 OR 2 VIEWS	$402.05	$473.00	$402.05–$473.00	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$315.00	$350.00	$171.50–$350.00	4% above	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RADIOLOGIC EXAM SACRUM & COCCYX 2+ VIEWS	$315.00	$350.00	$171.50–$350.00	4% above	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$297.50	$350.00	$297.50–$350.00	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RADIOLOGIC EXAM SACRUM & COCCYX 2+ VIEWS	$297.50	$350.00	$297.50–$350.00	—	15%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$115.20	$128.00	$62.72–$128.00	58% above	10%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINOTRANSFERASE	$115.20	$128.00	$62.72–$128.00	58% above	10%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT	$115.20	$128.00	$62.72–$128.00	58% above	10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$4.60	$5.41	$4.60–$5.41	—	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT	$108.80	$128.00	$108.80–$128.00	—	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINOTRANSFERASE	$108.80	$128.00	$108.80–$128.00	—	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE ASPARTATE AMINO AST SGOT	$256.50	$285.00	$139.65–$285.00	252% above	10%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450	$256.50	$285.00	$139.65–$285.00	252% above	10%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST 84450	$242.25	$285.00	$242.25–$285.00	—	15%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE ASPARTATE AMINO AST SGOT	$242.25	$285.00	$242.25–$285.00	—	15%
Allergy blood test, specific IgE, per allergen CPT 86003 CHAMP ALLERGY PR ALLERGEN	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG GLUTEN	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 FOOD ALLERGY PANEL 2	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 FOOD ALLERGY PANEL 1	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 IGE SERUM	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 FOOD PROFILE 1	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 NORTH CENTRAL PROFILE	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG MOLD	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ON PANEL 86003	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 URD ALLERGENS	$45.90	$51.00	$24.99–$51.00	33% above	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 NORTH CENTRAL PROFILE	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 URD ALLERGENS	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ON PANEL 86003	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FOOD ALLERGY PANEL 1	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG GLUTEN	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FOOD ALLERGY PANEL 2	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 IGE SERUM	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FOOD PROFILE 1	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG MOLD	$43.35	$51.00	$43.35–$51.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CHAMP ALLERGY PR ALLERGEN	$43.35	$51.00	$43.35–$51.00	—	15%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODIES	$283.50	$315.00	$154.35–$315.00	141% above	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$283.50	$315.00	$154.35–$315.00	141% above	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE (CCP) ANTIBODY	$283.50	$315.00	$154.35–$315.00	141% above	10%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE (CCP) ANTIBODY	$267.75	$315.00	$267.75–$315.00	—	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$267.75	$315.00	$267.75–$315.00	—	15%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODIES	$267.75	$315.00	$267.75–$315.00	—	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCREEN WITH REFLEX	$175.50	$195.00	$95.55–$195.00	117% above	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$175.50	$195.00	$95.55–$195.00	117% above	10%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES (ANA)	$175.50	$195.00	$95.55–$195.00	117% above	10%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCREEN WITH REFLEX	$165.75	$195.00	$165.75–$195.00	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES (ANA)	$165.75	$195.00	$165.75–$195.00	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$165.75	$195.00	$165.75–$195.00	—	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE 83880	$36.05	$40.05	$19.62–$40.05	81% below	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$296.10	$329.00	$161.21–$329.00	57% above	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO B-TYPE NATRIURETIC PEPTIDE	$296.10	$329.00	$161.21–$329.00	57% above	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BRAIN NATRIURETIC PEPTIDE	$296.10	$329.00	$161.21–$329.00	57% above	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BRAIN NATRIURETIC PEPTIDE	$279.65	$329.00	$279.65–$329.00	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE 83880	$279.65	$329.00	$279.65–$329.00	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE	$279.65	$329.00	$279.65–$329.00	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO B-TYPE NATRIURETIC PEPTIDE	$279.65	$329.00	$279.65–$329.00	—	15%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$155.70	$173.00	$84.77–$173.00	9% above	10%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$147.05	$173.00	$147.05–$173.00	—	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV - SURGICAL PATHOLOGY GROSS & MICROSCOPIC EXAM	$279.90	$311.00	$152.39–$311.00	74% above	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV 88305	$412.20	$458.00	$224.42–$458.00	156% above	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV - SURGICAL PATHOLOGY GROSS & MICROSCOPIC EXAM	$264.35	$311.00	$264.35–$311.00	—	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV 88305	$389.30	$458.00	$389.30–$458.00	—	15%
Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$219.60	$244.00	$119.56–$244.00	21% above	10%
Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$219.60	$244.00	$119.56–$244.00	21% above	10%
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$207.40	$244.00	$207.40–$244.00	—	15%
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$207.40	$244.00	$207.40–$244.00	—	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE	$38.70	$43.00	$21.07–$43.00	51% above	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE 36415	$38.70	$43.00	$21.07–$43.00	51% above	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE 36415	$36.55	$43.00	$36.55–$43.00	—	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE	$36.55	$43.00	$36.55–$43.00	—	15%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP)	$45.00	$50.00	$24.50–$50.00	23% below	10%
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$45.00	$50.00	$24.50–$50.00	23% below	10%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$42.50	$50.00	$42.50–$50.00	—	15%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP)	$42.50	$50.00	$42.50–$50.00	—	15%
Blood lead test CPT 83655 LEAD BLOOD VENOUS	$117.00	$130.00	$63.70–$130.00	160% above	10%
Blood lead test CPT 83655 HEAVY METAL SCREEN LEAD	$121.50	$135.00	$66.15–$135.00	170% above	10%
Blood lead test CPT 83655 LEAD 24 HR URINE	$121.50	$135.00	$66.15–$135.00	170% above	10%
Blood lead test CPT 83655 LEAD 83655	$121.50	$135.00	$66.15–$135.00	170% above	10%
Blood lead test CPT 83655 LEAD BLOOD	$121.50	$135.00	$66.15–$135.00	170% above	10%
Blood lead test CPT 83655 LEAD	$121.50	$135.00	$66.15–$135.00	170% above	10%
Blood lead test inpatient CPT 83655 LEAD BLOOD VENOUS	$110.50	$130.00	$110.50–$130.00	—	15%
Blood lead test inpatient CPT 83655 LEAD	$114.75	$135.00	$114.75–$135.00	—	15%
Blood lead test inpatient CPT 83655 LEAD BLOOD	$114.75	$135.00	$114.75–$135.00	—	15%
Blood lead test inpatient CPT 83655 LEAD 83655	$114.75	$135.00	$114.75–$135.00	—	15%
Blood lead test inpatient CPT 83655 LEAD 24 HR URINE	$114.75	$135.00	$114.75–$135.00	—	15%
Blood lead test inpatient CPT 83655 HEAVY METAL SCREEN LEAD	$114.75	$135.00	$114.75–$135.00	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL 84703	$189.00	$210.00	$102.90–$210.00	61% above	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN CHORIONIC (HCG) QUALITATIVE	$189.00	$210.00	$102.90–$210.00	61% above	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG (HUMAN CHORIONIC GONA	$189.00	$210.00	$102.90–$210.00	61% above	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG (HUMAN CHORIONIC GONA	$178.50	$210.00	$178.50–$210.00	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL 84703	$178.50	$210.00	$178.50–$210.00	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 GONADOTROPIN CHORIONIC (HCG) QUALITATIVE	$178.50	$210.00	$178.50–$210.00	—	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$106.20	$118.00	$57.82–$118.00	108% above	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$106.20	$118.00	$57.82–$118.00	108% above	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$100.30	$118.00	$100.30–$118.00	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$100.30	$118.00	$100.30–$118.00	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN QUANT	$129.60	$144.00	$70.56–$144.00	56% above	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN QUANT 86140	$129.60	$144.00	$70.56–$144.00	56% above	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN QUANT	$122.40	$144.00	$122.40–$144.00	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN QUANT 86140	$122.40	$144.00	$122.40–$144.00	—	15%
C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$182.70	$203.00	$99.47–$203.00	14% below	10%
C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$425.70	$473.00	$231.77–$473.00	101% above	10%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$32.32	$38.02	$32.32–$38.02	—	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$172.55	$203.00	$172.55–$203.00	—	15%
CA 19-9 blood test (tumor marker) CPT 86301 CDMR MMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$249.30	$277.00	$135.73–$277.00	145% above	10%
CA 19-9 blood test (tumor marker) CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$249.30	$277.00	$135.73–$277.00	145% above	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$235.45	$277.00	$235.45–$277.00	—	15%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CDMR MMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$235.45	$277.00	$235.45–$277.00	—	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR CA 125 86304	$323.10	$359.00	$175.91–$359.00	98% above	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR CA125 (OVARIAN CANCER)	$323.10	$359.00	$175.91–$359.00	98% above	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$323.10	$359.00	$175.91–$359.00	98% above	10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CDMR CA125 (OVARIAN CANCER)	$305.15	$359.00	$305.15–$359.00	—	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CDMR CA 125 86304	$305.15	$359.00	$305.15–$359.00	—	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CDMR IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$305.15	$359.00	$305.15–$359.00	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$170.10	$189.00	$92.61–$189.00	36% above	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB	$171.90	$191.00	$93.59–$191.00	38% above	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$160.65	$189.00	$160.65–$189.00	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB	$162.35	$191.00	$162.35–$191.00	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$140.40	$156.00	$76.44–$156.00	23% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$140.40	$156.00	$76.44–$156.00	23% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACHOMATIS AMPLIF PROBE	$140.40	$156.00	$76.44–$156.00	23% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA	$140.40	$156.00	$76.44–$156.00	23% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$140.40	$156.00	$76.44–$156.00	23% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$132.60	$156.00	$132.60–$156.00	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$132.60	$156.00	$132.60–$156.00	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA	$132.60	$156.00	$132.60–$156.00	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$132.60	$156.00	$132.60–$156.00	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACHOMATIS AMPLIF PROBE	$132.60	$156.00	$132.60–$156.00	—	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 80061	$12.30	$13.66	$6.69–$13.66	88% below	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$258.30	$287.00	$140.63–$287.00	143% above	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 80061	$11.62	$13.66	$11.61–$13.66	—	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$243.95	$287.00	$243.95–$287.00	—	15%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$155.70	$173.00	$84.77–$173.00	44% above	10%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$155.70	$173.00	$84.77–$173.00	44% above	10%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$147.05	$173.00	$147.05–$173.00	—	15%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$147.05	$173.00	$147.05–$173.00	—	15%
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$139.50	$155.00	$75.95–$155.00	63% above	10%
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED	$139.50	$155.00	$75.95–$155.00	63% above	10%
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$5.61	$6.60	$5.61–$6.60	—	15%
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED	$131.75	$155.00	$131.75–$155.00	—	15%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$279.00	$310.00	$151.90–$310.00	71% above	10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$263.50	$310.00	$263.50–$310.00	—	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$263.50	$310.00	$263.50–$310.00	—	15%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$303.30	$337.00	$165.13–$337.00	115% above	10%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANTITATIVE	$303.30	$337.00	$165.13–$337.00	115% above	10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$286.45	$337.00	$286.45–$337.00	—	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANTITATIVE	$286.45	$337.00	$286.45–$337.00	—	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE BY IMMUNOASY	$299.70	$333.00	$163.17–$333.00	106% above	10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE 82627	$299.70	$333.00	$163.17–$333.00	106% above	10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)	$299.70	$333.00	$163.17–$333.00	106% above	10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE 82627	$283.05	$333.00	$283.05–$333.00	—	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)	$283.05	$333.00	$283.05–$333.00	—	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE BY IMMUNOASY	$283.05	$333.00	$283.05–$333.00	—	15%
Estradiol blood test CPT 82670 ESTRADIOL (E2) SERUM	$268.20	$298.00	$146.02–$298.00	72% above	10%
Estradiol blood test CPT 82670 ESTRADIOL TOTAL 82670	$268.20	$298.00	$146.02–$298.00	72% above	10%
Estradiol blood test CPT 82670 ESTRADIOL WITH TANNER STAGES	$268.20	$298.00	$146.02–$298.00	72% above	10%
Estradiol blood test CPT 82670 ESTRADIOL	$268.20	$298.00	$146.02–$298.00	72% above	10%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$253.30	$298.00	$253.30–$298.00	—	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL WITH TANNER STAGES	$253.30	$298.00	$253.30–$298.00	—	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL (E2) SERUM	$253.30	$298.00	$253.30–$298.00	—	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL 82670	$253.30	$298.00	$253.30–$298.00	—	15%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH)	$385.20	$428.00	$209.72–$428.00	254% above	10%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$385.20	$428.00	$209.72–$428.00	254% above	10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH W TANNER STAGES	$385.20	$428.00	$209.72–$428.00	254% above	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH W TANNER STAGES	$363.80	$428.00	$363.80–$428.00	—	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$363.80	$428.00	$363.80–$428.00	—	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH)	$363.80	$428.00	$363.80–$428.00	—	15%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$469.80	$522.00	$255.78–$522.00	91% above	10%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN 83993	$469.80	$522.00	$255.78–$522.00	91% above	10%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN STOOL	$469.80	$522.00	$255.78–$522.00	91% above	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN 83993	$443.70	$522.00	$443.70–$522.00	—	15%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$443.70	$522.00	$443.70–$522.00	—	15%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN STOOL	$443.70	$522.00	$443.70–$522.00	—	15%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$283.50	$315.00	$154.35–$315.00	134% above	10%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN 82728	$283.50	$315.00	$154.35–$315.00	134% above	10%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN	$267.75	$315.00	$267.75–$315.00	—	15%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN 82728	$267.75	$315.00	$267.75–$315.00	—	15%
Folate (folic acid) blood test CPT 82746 FOLATE 82746	$13.50	$14.99	$7.35–$14.99	87% below	10%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM	$262.80	$292.00	$143.08–$292.00	155% above	10%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE 82746	$248.20	$292.00	$248.20–$292.00	—	15%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM	$248.20	$292.00	$248.20–$292.00	—	15%
Free T3 thyroid hormone test CPT 84481 FREE T3	$244.80	$272.00	$133.28–$272.00	49% above	10%
Free T3 thyroid hormone test CPT 84481 T3 FREE 84481	$244.80	$272.00	$133.28–$272.00	49% above	10%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE T3 FREE	$244.80	$272.00	$133.28–$272.00	49% above	10%
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$231.20	$272.00	$231.20–$272.00	—	15%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE 84481	$231.20	$272.00	$231.20–$272.00	—	15%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3 FREE	$231.20	$272.00	$231.20–$272.00	—	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE 84439	$189.00	$210.00	$102.90–$210.00	112% above	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 BY EQ DIALYSIS SO 84439.900	$189.00	$210.00	$102.90–$210.00	112% above	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 BY EQ DIALYSIS SO	$189.00	$210.00	$102.90–$210.00	112% above	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$189.00	$210.00	$102.90–$210.00	112% above	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE 84439	$7.82	$9.20	$7.82–$9.20	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 BY EQ DIALYSIS SO	$178.50	$210.00	$178.50–$210.00	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE	$178.50	$210.00	$178.50–$210.00	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 BY EQ DIALYSIS SO 84439.900	$178.50	$210.00	$178.50–$210.00	—	15%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$216.90	$241.00	$118.09–$241.00	262% above	10%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$204.85	$241.00	$204.85–$241.00	—	15%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$166.50	$185.00	$90.65–$185.00	32% below	10%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$157.25	$185.00	$157.25–$185.00	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$205.20	$228.00	$111.72–$228.00	154% above	10%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE	$205.20	$228.00	$111.72–$228.00	154% above	10%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE GESTATIONAL DIAB	$205.20	$228.00	$111.72–$228.00	154% above	10%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE	$193.80	$228.00	$193.80–$228.00	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$193.80	$228.00	$193.80–$228.00	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE GESTATIONAL DIAB	$193.80	$228.00	$193.80–$228.00	—	15%
Glucose tolerance test, 3 samples CPT 82951 GLUC GEST DIABETES TOL 3HR	$309.60	$344.00	$168.56–$344.00	89% above	10%
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$309.60	$344.00	$168.56–$344.00	89% above	10%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS (INCLUDES GLUCOSE)	$309.60	$344.00	$168.56–$344.00	89% above	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC GEST DIABETES TOL 3HR	$292.40	$344.00	$292.40–$344.00	—	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$292.40	$344.00	$292.40–$344.00	—	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS (INCLUDES GLUCOSE)	$292.40	$344.00	$292.40–$344.00	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$137.70	$153.00	$74.97–$153.00	59% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT	$137.70	$153.00	$74.97–$153.00	59% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE OCULAR PERITONEAL NAA	$137.70	$153.00	$74.97–$153.00	59% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE	$137.70	$153.00	$74.97–$153.00	59% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$137.70	$153.00	$74.97–$153.00	59% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE OCULAR PERITONEAL NAA 87591.900	$137.70	$153.00	$74.97–$153.00	59% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$130.05	$153.00	$130.05–$153.00	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE OCULAR PERITONEAL NAA 87591.900	$130.05	$153.00	$130.05–$153.00	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT	$130.05	$153.00	$130.05–$153.00	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE	$130.05	$153.00	$130.05–$153.00	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$130.05	$153.00	$130.05–$153.00	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE OCULAR PERITONEAL NAA	$130.05	$153.00	$130.05–$153.00	—	15%
H. pylori antibody blood test CPT 86677 H PYLORI IGG 86677	$348.30	$387.00	$189.63–$387.00	189% above	10%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI IGG A	$348.30	$387.00	$189.63–$387.00	189% above	10%
H. pylori antibody blood test CPT 86677 ANTIBODY HELICOBACTER PYLORI	$348.30	$387.00	$189.63–$387.00	189% above	10%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI IGM ANTIBODY	$348.30	$387.00	$189.63–$387.00	189% above	10%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGG 86677	$14.62	$17.19	$14.61–$17.19	—	15%
H. pylori antibody blood test inpatient CPT 86677 ANTIBODY HELICOBACTER PYLORI	$328.95	$387.00	$328.95–$387.00	—	15%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI IGG A	$328.95	$387.00	$328.95–$387.00	—	15%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI IGM ANTIBODY	$328.95	$387.00	$328.95–$387.00	—	15%
H. pylori stool antigen test CPT 87338 ENZYME IMMUNO EIA QUAL SEMIQUANT MULTI STEP HELICOBACTER PYLORI STL	$245.70	$273.00	$133.77–$273.00	32% above	10%
H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL 87338	$245.70	$273.00	$133.77–$273.00	32% above	10%
H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN STOOL	$245.70	$273.00	$133.77–$273.00	32% above	10%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI ANTIGEN STOOL	$232.05	$273.00	$232.05–$273.00	—	15%
H. pylori stool antigen test inpatient CPT 87338 ENZYME IMMUNO EIA QUAL SEMIQUANT MULTI STEP HELICOBACTER PYLORI STL	$232.05	$273.00	$232.05–$273.00	—	15%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG STOOL 87338	$232.05	$273.00	$232.05–$273.00	—	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV1 RNA PCR QNT	$430.20	$478.00	$234.22–$478.00	10% above	10%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV1 RNA PCR QNT	$406.30	$478.00	$406.30–$478.00	—	15%
HIV-1 and HIV-2 antibody test CPT 86703 HIV1 2 AB RAPID	$112.50	$125.00	$61.25–$125.00	4% above	10%
HIV-1 and HIV-2 antibody test CPT 86703 ANTIBODY HIV-1 & HIV-2 SINGLE ASSAY	$112.50	$125.00	$61.25–$125.00	4% above	10%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 HIV-2 ANTIBODY 86703	$112.50	$125.00	$61.25–$125.00	4% above	10%
HIV-1 and HIV-2 antibody test CPT 86703 HIV SCREEN REFLEX TO CONFIRMATION	$112.50	$125.00	$61.25–$125.00	4% above	10%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 HIV-2 ANTIBODY 86703	$106.25	$125.00	$106.25–$125.00	—	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 ANTIBODY HIV-1 & HIV-2 SINGLE ASSAY	$106.25	$125.00	$106.25–$125.00	—	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV1 2 AB RAPID	$106.25	$125.00	$106.25–$125.00	—	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV SCREEN REFLEX TO CONFIRMATION	$106.25	$125.00	$106.25–$125.00	—	15%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB	$140.40	$156.00	$76.44–$156.00	32% above	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$142.20	$158.00	$77.42–$158.00	34% above	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB	$132.60	$156.00	$132.60–$156.00	—	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	$134.30	$158.00	$134.30–$158.00	—	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV MRNA E6E7 VAGINAL REFLEX HPV 16/18/45	$135.90	$151.00	$73.99–$151.00	11% below	10%
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$179.10	$199.00	$97.51–$199.00	18% above	10%
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$179.10	$199.00	$97.51–$199.00	18% above	10%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV MRNA E6E7 VAGINAL REFLEX HPV 16/18/45	$128.35	$151.00	$128.35–$151.00	—	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$169.15	$199.00	$169.15–$199.00	—	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES	$169.15	$199.00	$169.15–$199.00	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$130.50	$145.00	$71.05–$145.00	65% above	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$130.50	$145.00	$71.05–$145.00	65% above	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$123.25	$145.00	$123.25–$145.00	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$123.25	$145.00	$123.25–$145.00	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB)	$175.50	$195.00	$95.55–$195.00	60% above	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$175.50	$195.00	$95.55–$195.00	60% above	10%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB)	$165.75	$195.00	$165.75–$195.00	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$165.75	$195.00	$165.75–$195.00	—	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$134.10	$149.00	$73.01–$149.00	89% above	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN	$134.10	$149.00	$73.01–$149.00	89% above	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN	$126.65	$149.00	$126.65–$149.00	—	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$126.65	$149.00	$126.65–$149.00	—	15%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY 86803	$338.40	$376.00	$184.24–$376.00	150% above	10%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$338.40	$376.00	$184.24–$376.00	150% above	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY 86803	$319.60	$376.00	$319.60–$376.00	—	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$319.60	$376.00	$319.60–$376.00	—	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$331.20	$368.00	$180.32–$368.00	69% above	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT	$334.80	$372.00	$182.28–$372.00	71% above	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$312.80	$368.00	$312.80–$368.00	—	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT	$316.20	$372.00	$316.20–$372.00	—	15%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES TYPE 1 IGG	$79.20	$88.00	$43.12–$88.00	10% below	10%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES TYPE 1 IGG	$74.80	$88.00	$74.80–$88.00	—	15%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES TYPE 2 IGG	$96.30	$107.00	$52.43–$107.00	4% above	10%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES TYPE 2 IGG	$90.95	$107.00	$90.95–$107.00	—	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$65.70	$73.00	$35.77–$73.00	38% below	10%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY (HSCRP)	$65.70	$73.00	$35.77–$73.00	38% below	10%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$62.05	$73.00	$62.05–$73.00	—	15%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY (HSCRP)	$62.05	$73.00	$62.05–$73.00	—	15%
Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE	$272.70	$303.00	$148.47–$303.00	184% above	10%
Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE 83090	$272.70	$303.00	$148.47–$303.00	184% above	10%
Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE	$257.55	$303.00	$257.55–$303.00	—	15%
Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE 83090	$257.55	$303.00	$257.55–$303.00	—	15%
Insulin blood test CPT 83525 INSULIN TOTAL	$176.40	$196.00	$96.04–$196.00	102% above	10%
Insulin blood test CPT 83525 INSULIN LEVEL 83525	$176.40	$196.00	$96.04–$196.00	102% above	10%
Insulin blood test CPT 83525 INSULIN LEVEL	$176.40	$196.00	$96.04–$196.00	102% above	10%
Insulin blood test inpatient CPT 83525 INSULIN TOTAL	$166.60	$196.00	$166.60–$196.00	—	15%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL 83525	$166.60	$196.00	$166.60–$196.00	—	15%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL	$166.60	$196.00	$166.60–$196.00	—	15%
Iron blood test (serum iron) CPT 83540 IRON	$97.20	$108.00	$52.92–$108.00	34% above	10%
Iron blood test (serum iron) CPT 83540 IRON 83540	$117.00	$130.00	$63.70–$130.00	61% above	10%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$91.80	$108.00	$91.80–$108.00	—	15%
Iron blood test (serum iron) inpatient CPT 83540 IRON 83540	$110.50	$130.00	$110.50–$130.00	—	15%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY 83550	$8.91	$9.90	$4.85–$9.90	90% below	10%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$117.00	$130.00	$63.70–$130.00	36% above	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$110.50	$130.00	$110.50–$130.00	—	15%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY 83550	$110.50	$130.00	$110.50–$130.00	—	15%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$180.90	$201.00	$98.49–$201.00	30% above	10%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$170.85	$201.00	$170.85–$201.00	—	15%
LH (luteinizing hormone) test CPT 83002 LUTENIZING HORMONE W TANNER STAGES	$250.20	$278.00	$136.22–$278.00	42% above	10%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH)	$250.20	$278.00	$136.22–$278.00	42% above	10%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$250.20	$278.00	$136.22–$278.00	42% above	10%
LH (luteinizing hormone) test inpatient CPT 83002 LUTENIZING HORMONE W TANNER STAGES	$236.30	$278.00	$236.30–$278.00	—	15%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$236.30	$278.00	$236.30–$278.00	—	15%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH)	$236.30	$278.00	$236.30–$278.00	—	15%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE 83690	$198.90	$221.00	$108.29–$221.00	66% above	10%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$198.90	$221.00	$108.29–$221.00	66% above	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE 83690	$187.85	$221.00	$187.85–$221.00	—	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$187.85	$221.00	$187.85–$221.00	—	15%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL 80076	$150.30	$167.00	$81.83–$167.00	8% above	10%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$168.30	$187.00	$91.63–$187.00	21% above	10%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL 80076	$141.95	$167.00	$141.95–$167.00	—	15%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$158.95	$187.00	$158.95–$187.00	—	15%
Lyme disease antibody test CPT 86618 LYMES DISEASE ANTIBODY REFLEX TO CONFIRMATION	$312.30	$347.00	$170.03–$347.00	199% above	10%
Lyme disease antibody test CPT 86618 LYMES BY EIA CSF	$312.30	$347.00	$170.03–$347.00	199% above	10%
Lyme disease antibody test CPT 86618 ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE)	$312.30	$347.00	$170.03–$347.00	199% above	10%
Lyme disease antibody test CPT 86618 LYMES IGG & IGM ANTIBODY	$312.30	$347.00	$170.03–$347.00	199% above	10%
Lyme disease antibody test CPT 86618 LYMES TOTAL 86618	$312.30	$347.00	$170.03–$347.00	199% above	10%
Lyme disease antibody test inpatient CPT 86618 LYMES BY EIA CSF	$294.95	$347.00	$294.95–$347.00	—	15%
Lyme disease antibody test inpatient CPT 86618 LYMES IGG & IGM ANTIBODY	$294.95	$347.00	$294.95–$347.00	—	15%
Lyme disease antibody test inpatient CPT 86618 LYMES DISEASE ANTIBODY REFLEX TO CONFIRMATION	$294.95	$347.00	$294.95–$347.00	—	15%
Lyme disease antibody test inpatient CPT 86618 ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE)	$294.95	$347.00	$294.95–$347.00	—	15%
Lyme disease antibody test inpatient CPT 86618 LYMES TOTAL 86618	$294.95	$347.00	$294.95–$347.00	—	15%
Magnesium blood test CPT 83735 MAGNESIUM	$140.40	$156.00	$76.44–$156.00	93% above	10%
Magnesium blood test CPT 83735 MAGNESIUM 83735	$140.40	$156.00	$76.44–$156.00	93% above	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$132.60	$156.00	$132.60–$156.00	—	15%
Magnesium blood test inpatient CPT 83735 MAGNESIUM 83735	$132.60	$156.00	$132.60–$156.00	—	15%
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA	$110.70	$123.00	$60.27–$123.00	40% above	10%
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA 86765	$141.30	$157.00	$76.93–$157.00	78% above	10%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA	$104.55	$123.00	$104.55–$123.00	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA 86765	$133.45	$157.00	$133.45–$157.00	—	15%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES SCREENING	$161.10	$179.00	$87.71–$179.00	146% above	10%
Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONONUCLEOSIS	$161.10	$179.00	$87.71–$179.00	146% above	10%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN 86308	$161.10	$179.00	$87.71–$179.00	146% above	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN 86308	$152.15	$179.00	$152.15–$179.00	—	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES SCREENING	$152.15	$179.00	$152.15–$179.00	—	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 INFECTIOUS MONONUCLEOSIS	$152.15	$179.00	$152.15–$179.00	—	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA	$150.30	$167.00	$81.83–$167.00	24% above	10%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE 84154	$150.30	$167.00	$81.83–$167.00	24% above	10%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA	$141.95	$167.00	$141.95–$167.00	—	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE 84154	$141.95	$167.00	$141.95–$167.00	—	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 CDMR ASSAY OF PSA TOTAL	$155.70	$173.00	$84.77–$173.00	at median	10%
PSA (prostate-specific antigen) blood test, total CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$155.70	$173.00	$84.77–$173.00	at median	10%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$147.05	$173.00	$147.05–$173.00	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CDMR ASSAY OF PSA TOTAL	$147.05	$173.00	$147.05–$173.00	—	15%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO CERV THN AUTO 88175	$105.30	$117.00	$57.33–$117.00	2% above	10%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATHOLOGY CERVICAL OR VAGINAL	$107.10	$119.00	$58.31–$119.00	4% above	10%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO CERV THN AUTO 88175	$99.45	$117.00	$99.45–$117.00	—	15%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATHOLOGY CERVICAL OR VAGINAL	$101.15	$119.00	$101.15–$119.00	—	15%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE)	$381.60	$424.00	$207.76–$424.00	72% above	10%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$381.60	$424.00	$207.76–$424.00	72% above	10%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT 83970	$381.60	$424.00	$207.76–$424.00	72% above	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT 83970	$39.77	$46.78	$39.76–$46.78	—	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE (PARATHYROID HORMONE)	$360.40	$424.00	$360.40–$424.00	—	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$360.40	$424.00	$360.40–$424.00	—	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$160.20	$178.00	$87.22–$178.00	79% above	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT)	$160.20	$178.00	$87.22–$178.00	79% above	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$151.30	$178.00	$151.30–$178.00	—	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT)	$151.30	$178.00	$151.30–$178.00	—	15%
Progesterone blood test CPT 84144 PROGESTERONE 84144	$227.70	$253.00	$123.97–$253.00	49% above	10%
Progesterone blood test CPT 84144 PROGESTERONE	$227.70	$253.00	$123.97–$253.00	49% above	10%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$215.05	$253.00	$215.05–$253.00	—	15%
Progesterone blood test inpatient CPT 84144 PROGESTERONE 84144	$215.05	$253.00	$215.05–$253.00	—	15%
Prolactin blood test CPT 84146 PROLACTIN	$383.40	$426.00	$208.74–$426.00	199% above	10%
Prolactin blood test CPT 84146 PROLACTIN 84146	$383.40	$426.00	$208.74–$426.00	199% above	10%
Prolactin blood test CPT 84146 PROLACTIN PITUITARY MACROADENOMA	$383.40	$426.00	$208.74–$426.00	199% above	10%
Prolactin blood test CPT 84146 MACROPROLACTIN	$383.40	$426.00	$208.74–$426.00	199% above	10%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$362.10	$426.00	$362.10–$426.00	—	15%
Prolactin blood test inpatient CPT 84146 PROLACTIN 84146	$362.10	$426.00	$362.10–$426.00	—	15%
Prolactin blood test inpatient CPT 84146 MACROPROLACTIN	$362.10	$426.00	$362.10–$426.00	—	15%
Prolactin blood test inpatient CPT 84146 PROLACTIN PITUITARY MACROADENOMA	$362.10	$426.00	$362.10–$426.00	—	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$118.80	$132.00	$64.68–$132.00	276% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 BCH PROTIME	$118.80	$132.00	$64.68–$132.00	276% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 AD PROTIME INR	$118.80	$132.00	$64.68–$132.00	276% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME 85610	$118.80	$132.00	$64.68–$132.00	276% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME	$118.80	$132.00	$64.68–$132.00	276% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT)	$118.80	$132.00	$64.68–$132.00	276% above	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 BCH PROTIME	$112.20	$132.00	$112.20–$132.00	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME 85610	$112.20	$132.00	$112.20–$132.00	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME	$112.20	$132.00	$112.20–$132.00	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$112.20	$132.00	$112.20–$132.00	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT)	$112.20	$132.00	$112.20–$132.00	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 AD PROTIME INR	$112.20	$132.00	$112.20–$132.00	—	15%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$382.50	$425.00	$208.25–$425.00	491% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS	$382.50	$425.00	$208.25–$425.00	491% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS	$361.25	$425.00	$361.25–$425.00	—	15%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$361.25	$425.00	$361.25–$425.00	—	15%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A B DIRECT 87804	$83.70	$93.00	$45.57–$93.00	14% above	10%
Rapid flu test (influenza antigen) CPT 87804 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION INFLUENZA	$83.70	$93.00	$45.57–$93.00	14% above	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A B DIRECT 87804	$79.05	$93.00	$79.05–$93.00	—	15%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION INFLUENZA	$79.05	$93.00	$79.05–$93.00	—	15%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION STREPOCOCCUS GROUP A	$123.30	$137.00	$67.13–$137.00	63% above	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RPD GROUP A STREP SCREEN 87880	$123.30	$137.00	$67.13–$137.00	63% above	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION STREPOCOCCUS GROUP A	$116.45	$137.00	$116.45–$137.00	—	15%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RPD GROUP A STREP SCREEN 87880	$116.45	$137.00	$116.45–$137.00	—	15%
Rheumatoid factor (RF) test CPT 86431 RA FACTOR QUANTITATIVE	$99.90	$111.00	$54.39–$111.00	16% above	10%
Rheumatoid factor (RF) test CPT 86431 RA FACTOR SYNOVIAL FLUID	$99.90	$111.00	$54.39–$111.00	16% above	10%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT 86431	$99.90	$111.00	$54.39–$111.00	16% above	10%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$99.90	$111.00	$54.39–$111.00	16% above	10%
Rheumatoid factor (RF) test CPT 86431 LO RF TITER SYNOVIAL FLUID	$99.90	$111.00	$54.39–$111.00	16% above	10%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT 86431	$94.35	$111.00	$94.35–$111.00	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RA FACTOR QUANTITATIVE	$94.35	$111.00	$94.35–$111.00	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 LO RF TITER SYNOVIAL FLUID	$94.35	$111.00	$94.35–$111.00	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RA FACTOR SYNOVIAL FLUID	$94.35	$111.00	$94.35–$111.00	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$94.35	$111.00	$94.35–$111.00	—	15%
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA 86762	$112.50	$125.00	$61.25–$125.00	60% above	10%
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA	$112.50	$125.00	$61.25–$125.00	60% above	10%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM AB	$112.50	$125.00	$61.25–$125.00	60% above	10%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM AB	$106.25	$125.00	$106.25–$125.00	—	15%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA	$106.25	$125.00	$106.25–$125.00	—	15%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA 86762	$106.25	$125.00	$106.25–$125.00	—	15%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AUTOMATED	$25.20	$28.00	$13.72–$28.00	61% below	10%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED	$23.80	$28.00	$23.80–$28.00	—	15%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES	$86.40	$96.00	$47.04–$96.00	1% below	10%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES 87177	$86.40	$96.00	$47.04–$96.00	1% below	10%
Stool ova and parasites exam CPT 87177 OVA & PARASITES DIRECT SMEARS CONCENTRATION & IDENTIFICATION	$86.40	$96.00	$47.04–$96.00	1% below	10%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES 87177	$81.60	$96.00	$81.60–$96.00	—	15%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES DIRECT SMEARS CONCENTRATION & IDENTIFICATION	$81.60	$96.00	$81.60–$96.00	—	15%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES	$81.60	$96.00	$81.60–$96.00	—	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$14.62	$16.24	$7.96–$16.24	75% below	10%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR OCCULT BLOOD CRC SCREEN (FIT IMMUNOCHEMICAL) G0328	$118.80	$132.00	$64.68–$132.00	106% above	10%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$118.80	$132.00	$64.68–$132.00	106% above	10%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$112.20	$132.00	$112.20–$132.00	—	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR OCCULT BLOOD CRC SCREEN (FIT IMMUNOCHEMICAL) G0328	$112.20	$132.00	$112.20–$132.00	—	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$112.20	$132.00	$112.20–$132.00	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$104.40	$116.00	$56.84–$116.00	78% above	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$104.40	$116.00	$56.84–$116.00	78% above	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$98.60	$116.00	$98.60–$116.00	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL	$98.60	$116.00	$98.60–$116.00	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB	$275.40	$306.00	$149.94–$306.00	at median	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL MEAS GAMMA INTERFERON ANTIGEN RESPONSE	$275.40	$306.00	$149.94–$306.00	at median	10%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$277.20	$308.00	$150.92–$308.00	1% above	10%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL MEAS GAMMA INTERFERON ANTIGEN RESPONSE	$260.10	$306.00	$260.10–$306.00	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB	$260.10	$306.00	$260.10–$306.00	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$261.80	$308.00	$261.80–$308.00	—	15%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE WITH TANNER STAGES	$245.70	$273.00	$133.77–$273.00	138% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$245.70	$273.00	$133.77–$273.00	138% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$245.70	$273.00	$133.77–$273.00	138% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$245.70	$273.00	$133.77–$273.00	138% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL	$245.70	$273.00	$133.77–$273.00	138% above	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE WITH TANNER STAGES	$232.05	$273.00	$232.05–$273.00	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$232.05	$273.00	$232.05–$273.00	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL	$232.05	$273.00	$232.05–$273.00	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$232.05	$273.00	$232.05–$273.00	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL	$232.05	$273.00	$232.05–$273.00	—	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY TYPE 1 AB	$176.40	$196.00	$96.04–$196.00	47% above	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB ANTI TPO 86376	$176.40	$196.00	$96.04–$196.00	47% above	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-THYROID PEROX ABY	$176.40	$196.00	$96.04–$196.00	47% above	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID AB ANTI TPO 86376	$166.60	$196.00	$166.60–$196.00	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI-THYROID PEROX ABY	$166.60	$196.00	$166.60–$196.00	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY TYPE 1 AB	$166.60	$196.00	$166.60–$196.00	—	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH)	$241.20	$268.00	$131.32–$268.00	122% above	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$241.20	$268.00	$131.32–$268.00	122% above	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$14.57	$17.14	$14.57–$17.14	—	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH)	$227.80	$268.00	$227.80–$268.00	—	15%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION	$108.90	$121.00	$59.29–$121.00	1% below	10%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION	$102.85	$121.00	$102.85–$121.00	—	15%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$110.70	$123.00	$60.27–$123.00	66% above	10%
Uric acid blood test CPT 84550 URIC ACID SERUM	$110.70	$123.00	$60.27–$123.00	66% above	10%
Uric acid blood test inpatient CPT 84550 URIC ACID SERUM	$104.55	$123.00	$104.55–$123.00	—	15%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$104.55	$123.00	$104.55–$123.00	—	15%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID	$104.55	$123.00	$104.55–$123.00	—	15%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$121.50	$135.00	$66.15–$135.00	111% above	10%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$121.50	$135.00	$66.15–$135.00	111% above	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$114.75	$135.00	$114.75–$135.00	—	15%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$114.75	$135.00	$114.75–$135.00	—	15%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS DIP STICK TABLET REAGENT NON-AUTOMATED WMICROSCOPY	$53.10	$59.00	$28.91–$59.00	36% above	10%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS DIP STICK TABLET REAGENT NON-AUTOMATED WMICROSCOPY	$50.15	$59.00	$50.15–$59.00	—	15%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIP STICK TABLET REAGENT AUTOMATED WO MICROSCOPY	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINE PH	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINE PROTEIN RANDOM	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS MACROSCOPIC	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS REFLEX MICRO	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINE BLOOD	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated CPT 81003 URINE KETONE	$70.20	$78.00	$38.22–$78.00	77% above	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE PROTEIN RANDOM	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY URINE	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS MACROSCOPIC	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE PH	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE KETONE	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS REFLEX MICRO	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIP STICK TABLET REAGENT AUTOMATED WO MICROSCOPY	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE BLOOD	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$66.30	$78.00	$66.30–$78.00	—	15%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIP STICK TABLET REAGENT NON-AUTOMATED WO MICROSCOPY	$15.30	$17.00	$8.33–$17.00	58% below	10%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS DIP STICK TABLET REAGENT NON-AUTOMATED WO MICROSCOPY	$14.45	$17.00	$14.45–$17.00	—	15%
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$167.40	$186.00	$91.14–$186.00	62% above	10%
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTITATIVE COLONY COUNT URINE	$167.40	$186.00	$91.14–$186.00	62% above	10%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTITATIVE COLONY COUNT URINE	$158.10	$186.00	$158.10–$186.00	—	15%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$158.10	$186.00	$158.10–$186.00	—	15%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$129.60	$144.00	$70.56–$144.00	59% above	10%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST 81025	$129.60	$144.00	$70.56–$144.00	59% above	10%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST 81025	$122.40	$144.00	$122.40–$144.00	—	15%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$122.40	$144.00	$122.40–$144.00	—	15%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$13.85	$15.38	$7.54–$15.38	88% below	10%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12	$208.80	$232.00	$113.68–$232.00	81% above	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$13.08	$15.38	$13.07–$15.38	—	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12	$197.20	$232.00	$197.20–$232.00	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CDMR VITAMIN D 25 HYDROXY	$187.20	$208.00	$101.92–$208.00	22% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$187.20	$208.00	$101.92–$208.00	22% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3)	$187.20	$208.00	$101.92–$208.00	22% above	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3)	$176.80	$208.00	$176.80–$208.00	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$176.80	$208.00	$176.80–$208.00	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CDMR VITAMIN D 25 HYDROXY	$176.80	$208.00	$176.80–$208.00	—	15%
Zinc blood test CPT 84630 ZINC 24 HR URINE	$142.20	$158.00	$77.42–$158.00	421% above	10%
Zinc blood test CPT 84630 ZINC	$142.20	$158.00	$77.42–$158.00	421% above	10%
Zinc blood test CPT 84630 ZINC 84630.900	$142.20	$158.00	$77.42–$158.00	421% above	10%
Zinc blood test CPT 84630 ZINC 24 HR URINE 84630.901	$143.10	$159.00	$77.91–$159.00	424% above	10%
Zinc blood test inpatient CPT 84630 ZINC 24 HR URINE	$134.30	$158.00	$134.30–$158.00	—	15%
Zinc blood test inpatient CPT 84630 ZINC	$134.30	$158.00	$134.30–$158.00	—	15%
Zinc blood test inpatient CPT 84630 ZINC 84630.900	$134.30	$158.00	$134.30–$158.00	—	15%
Zinc blood test inpatient CPT 84630 ZINC 24 HR URINE 84630.901	$135.15	$159.00	$135.15–$159.00	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$226.80	$252.00	$123.48–$252.00	70% above	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE	$226.80	$252.00	$123.48–$252.00	70% above	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$214.20	$252.00	$214.20–$252.00	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE	$214.20	$252.00	$214.20–$252.00	—	15%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIGRAINE	$403.20	$448.00	$219.52–$448.00	41% below	10%
Botox injections for chronic migraine CPT 64615 ANES 64615 CHEMODENERV MUSC MIGRAINE	$701.10	$779.00	$123.52–$779.00	2% above	10%
Botox injections for chronic migraine CPT 64615 PF 64615 CHEM NRV MUSC FAC	$701.10	$779.00	$123.52–$779.00	2% above	10%
Botox injections for chronic migraine CPT 64615 TX RM 64615 CHEMODENERVATE MUSCLE MIGRAINE	$738.00	$820.00	$401.80–$820.00	8% above	10%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIGRAINE	$380.80	$448.00	$380.80–$448.00	—	15%
Botox injections for chronic migraine inpatient CPT 64615 TX RM 64615 CHEMODENERVATE MUSCLE MIGRAINE	$697.00	$820.00	$697.00–$820.00	—	15%
Botox injections for chronic migraine inpatient CPT 64615 ANES 64615 CHEMODENERV MUSC MIGRAINE	$701.10	$779.00	$123.52–$779.00	—	10%
Botox injections for chronic migraine inpatient CPT 64615 PF 64615 CHEM NRV MUSC FAC	$701.10	$779.00	$123.52–$779.00	—	10%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOSED TREAT METATARSAL FX WO MANIP EACH	$435.60	$484.00	$237.16–$484.00	24% below	10%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TREAT METATARSAL FX WO MANIP EACH	$411.40	$484.00	$411.40–$484.00	—	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$494.10	$549.00	$269.01–$549.00	66% below	10%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE EXTERNAL	$466.65	$549.00	$466.65–$549.00	—	15%
Cervical biopsy CPT 57500 BX EXC CERVIX LESN WWO FULGURATION (SEP PROC)	$339.30	$377.00	$184.73–$377.00	79% below	10%
Cervical biopsy inpatient CPT 57500 BX EXC CERVIX LESN WWO FULGURATION (SEP PROC)	$320.45	$377.00	$320.45–$377.00	—	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION USING CLAMP OTHER DEVICE NEWBORN	$317.70	$353.00	$172.97–$353.00	82% below	10%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION USING CLAMP OTHER DEVICE NEWBORN	$300.05	$353.00	$300.05–$353.00	—	15%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED TREAT DISTAL RADIAL FX EPIPHYSEAL SEPARATION WO MANIP	$646.20	$718.00	$351.82–$718.00	8% above	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TREAT DISTAL RADIAL FX EPIPHYSEAL SEPARATION WO MANIP	$610.30	$718.00	$610.30–$718.00	—	15%
Colonoscopy with polyp removal CPT 45385 PF 45385 COLONOSC W POLYPECT	$2,094.30	$2,327.00	$266.49–$2,327.00	29% below	10%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEXIBLE WREMVL LESN SNARE	$2,094.30	$2,327.00	$1,140.23–$2,327.00	29% below	10%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEXIBLE WREMVL LESN SNARE	$1,977.95	$2,327.00	$1,977.95–$2,327.00	—	15%
Colonoscopy with polyp removal inpatient CPT 45385 PF 45385 COLONOSC W POLYPECT	$2,094.30	$2,327.00	$266.49–$2,327.00	—	10%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEXIBLE PROXIMAL TO SPLENIC FLEXURE WBX SNGL MULTIPLE	$1,749.60	$1,944.00	$952.56–$1,944.00	1% below	10%
Colonoscopy with tissue sample CPT 45380 PF 45380 COLONOSCOPY W BX	$1,749.60	$1,944.00	$210.90–$1,944.00	1% below	10%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEXIBLE PROXIMAL TO SPLENIC FLEXURE WBX SNGL MULTIPLE	$1,652.40	$1,944.00	$1,652.40–$1,944.00	—	15%
Colonoscopy with tissue sample inpatient CPT 45380 PF 45380 COLONOSCOPY W BX	$1,749.60	$1,944.00	$210.90–$1,944.00	—	10%
Colonoscopy, diagnostic CPT 45378 PF 45378 COLONOSCOPY FLEXIBLE	$1,562.40	$1,736.00	$193.96–$1,736.00	27% below	10%
Colonoscopy, diagnostic CPT 45378 COLONOSCPY FLEXIBLE PROXIMAL TO SPLENIC FLEXURE DX WWO SPECIMENS COLO	$1,562.40	$1,736.00	$850.64–$1,736.00	27% below	10%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCPY FLEXIBLE PROXIMAL TO SPLENIC FLEXURE DX WWO SPECIMENS COLO	$1,475.60	$1,736.00	$1,475.60–$1,736.00	—	15%
Colonoscopy, diagnostic inpatient CPT 45378 PF 45378 COLONOSCOPY FLEXIBLE	$1,562.40	$1,736.00	$193.96–$1,736.00	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALIG LESNS EXCPT SKIN TAGS CUTANEOUS VASC PROLIFERAT LESN	$161.10	$179.00	$87.71–$179.00	55% below	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALIG LESNS EXCPT SKIN TAGS CUTANEOUS VASC PROLIFERAT LESN	$152.15	$179.00	$152.15–$179.00	—	15%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ED 69209 RMVL IMPACTED CERUMEN IRRIGATION LAVAGE UNI	$1,267.20	$1,408.00	$689.92–$1,408.00	658% above	10%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL	$44.10	$49.00	$24.01–$49.00	74% below	10%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 ED 69209 RMVL IMPACTED CERUMEN IRRIGATION LAVAGE UNI	$1,196.80	$1,408.00	$1,196.80–$1,408.00	—	15%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL	$41.65	$49.00	$41.65–$49.00	—	15%
Earwax removal with instruments, one ear one side CPT 69210 REMVL IMPACTED CERUMEN (SEP PROC) UNILATERAL	$103.50	$115.00	$56.35–$115.00	45% below	10%
Earwax removal with instruments, one ear inpatient one side CPT 69210 REMVL IMPACTED CERUMEN (SEP PROC) UNILATERAL	$97.75	$115.00	$97.75–$115.00	—	15%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BX WWO ENDOCERVICAL BX WO DILATION ANY METH (SEP PROC)	$224.10	$249.00	$122.01–$249.00	50% below	10%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BX WWO ENDOCERVICAL BX WO DILATION ANY METH (SEP PROC)	$211.65	$249.00	$211.65–$249.00	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 PF 62321 INJ INTERLAMINAR CRV/THRC WITH IMAGING GUIDANCE	$1,718.10	$1,909.00	$115.26–$1,909.00	10% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ INTERLAMINAR CRV/THRC WITH IMAGING GUIDANCE	$1,718.10	$1,909.00	$935.41–$1,909.00	10% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 ANES 62321 INJ IL NDL CATH CERV THOR W GUID	$1,718.10	$1,909.00	$115.26–$1,909.00	10% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 TX RM 62321 INJ IL NDL CATH CERV THOR W GUID	$1,809.00	$2,010.00	$984.90–$2,010.00	5% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ INTERLAMINAR CRV/THRC WITH IMAGING GUIDANCE	$1,622.65	$1,909.00	$1,622.65–$1,909.00	—	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	$1,708.50	$2,010.00	$1,708.50–$2,010.00	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 PF 62321 INJ INTERLAMINAR CRV/THRC WITH IMAGING GUIDANCE	$1,718.10	$1,909.00	$115.26–$1,909.00	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 ANES 62321 INJ IL NDL CATH CERV THOR W GUID	$1,718.10	$1,909.00	$115.26–$1,909.00	—	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ AGNT JOINT LUM SAC 1ST LVL	$1,113.30	$1,237.00	$606.13–$1,237.00	44% below	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PF 64493 INJECT PARAVERT JOINT	$2,162.70	$2,403.00	$97.88–$2,403.00	9% above	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 ANES 64493 INJ FACET JNT LUM SAC 1LV	$2,162.70	$2,403.00	$97.88–$2,403.00	9% above	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 TX RM 64493 INJ FACET JNT LUM SACRAL 1 LVL	$2,277.00	$2,530.00	$1,239.70–$2,530.00	15% above	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ AGNT JOINT LUM SAC 1ST LVL	$1,051.45	$1,237.00	$1,051.45–$1,237.00	—	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 TX RM 64493 INJ FACET JNT LUM SACRAL 1 LVL	$2,150.50	$2,530.00	$2,150.50–$2,530.00	—	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PF 64493 INJECT PARAVERT JOINT	$2,162.70	$2,403.00	$97.88–$2,403.00	—	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 ANES 64493 INJ FACET JNT LUM SAC 1LV	$2,162.70	$2,403.00	$97.88–$2,403.00	—	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY FLEXIBLE DX WWO SPECIMENS BRUSHING WASHING(SEP PROC)	$451.80	$502.00	$245.98–$502.00	61% below	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 PF 45330 SIGMOIDOSCOPY FLEXIBL	$451.80	$502.00	$60.62–$502.00	61% below	10%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY FLEXIBLE DX WWO SPECIMENS BRUSHING WASHING(SEP PROC)	$426.70	$502.00	$426.70–$502.00	—	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 PF 45330 SIGMOIDOSCOPY FLEXIBL	$451.80	$502.00	$60.62–$502.00	—	10%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY SURGICAL CHOLECYSTECTOMY	$1,881.90	$2,091.00	$1,024.59–$2,091.00	68% below	10%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPY SURGICAL CHOLECYSTECTOMY	$1,777.35	$2,091.00	$1,777.35–$2,091.00	—	15%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPAROSCOPY SURGICAL CHOLECYSTECTOMY WCHOLANGIOGRAPHY	$2,117.70	$2,353.00	$1,152.97–$2,353.00	64% below	10%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 PF 47563 LAP CHOLECYSTECT CHOL	$2,117.70	$2,353.00	$744.87–$2,353.00	64% below	10%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPAROSCOPY SURGICAL CHOLECYSTECTOMY WCHOLANGIOGRAPHY	$2,000.05	$2,353.00	$2,000.05–$2,353.00	—	15%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 PF 47563 LAP CHOLECYSTECT CHOL	$2,117.70	$2,353.00	$744.87–$2,353.00	—	10%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE	$231.30	$257.00	$125.93–$257.00	39% below	10%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE	$218.45	$257.00	$218.45–$257.00	—	15%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$280.80	$312.00	$152.88–$312.00	38% below	10%
Incision and drainage of a simple or single skin abscess CPT 10060 PF 10060 I&D ABSCESS SIMP	$280.80	$312.00	$117.53–$312.00	38% below	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$265.20	$312.00	$265.20–$312.00	—	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PF 10060 I&D ABSCESS SIMP	$280.80	$312.00	$117.53–$312.00	—	10%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 RPR INITIAL INGUINAL HERNIA AGE 5+ REDUCIBLE	$1,600.20	$1,778.00	$871.22–$1,778.00	—	10%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 RPR INITIAL INGUINAL HERNIA AGE 5+ REDUCIBLE	$1,511.30	$1,778.00	$1,511.30–$1,778.00	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ANES 20550 INJ(S) SNGL TEND SHEATH LIG APONEUROSIS	$461.70	$513.00	$41.23–$513.00	8% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ(S) SNGL TENDON SHEATH LIG APONEUROSIS	$461.70	$513.00	$251.37–$513.00	8% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 TX RM 20550 INJ SINGLE TENDON LIGAMENT	$486.00	$540.00	$264.60–$540.00	3% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ(S) SNGL TENDON SHEATH LIG APONEUROSIS	$436.05	$513.00	$436.05–$513.00	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 TX RM 20550 INJ SINGLE TENDON LIGAMENT	$459.00	$540.00	$459.00–$540.00	—	15%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ANES 20550 INJ(S) SNGL TEND SHEATH LIG APONEUROSIS	$461.70	$513.00	$41.23–$513.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENT ASP INJ MAJOR JOINT BURSA WO US GUID	$1,409.40	$1,566.00	$767.34–$1,566.00	105% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ANES 20610 ARTHRO ASPIR&/INJ MAJOR JT/BURSA W/O US	$1,409.40	$1,566.00	$47.60–$1,566.00	105% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MD 20610 ARTHRO ASP INJ MAJOR JOINT BURSA WO US GUID	$1,485.00	$1,650.00	$47.60–$1,650.00	116% above	10%
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	$1,485.00	$1,650.00	$808.50–$1,650.00	116% above	10%
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	$1,485.00	$1,650.00	$808.50–$1,650.00	116% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENT ASP INJ MAJOR JOINT BURSA WO US GUID	$1,331.10	$1,566.00	$1,331.10–$1,566.00	—	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	$1,402.50	$1,650.00	$1,402.50–$1,650.00	—	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	$1,402.50	$1,650.00	$1,402.50–$1,650.00	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ANES 20610 ARTHRO ASPIR&/INJ MAJOR JT/BURSA W/O US	$1,409.40	$1,566.00	$47.60–$1,566.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 MD 20610 ARTHRO ASP INJ MAJOR JOINT BURSA WO US GUID	$1,485.00	$1,650.00	$47.60–$1,650.00	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG DELIVERY IMPLANT	$284.40	$316.00	$154.84–$316.00	8% below	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG DELIVERY IMPLANT	$268.60	$316.00	$268.60–$316.00	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENT ASP INJ INTMDTE JOINT BURSA WO US GUID	$118.80	$132.00	$64.68–$132.00	75% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENT ASP INJ INTMDTE JOINT BURSA WO US GUID	$112.20	$132.00	$112.20–$132.00	—	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP INJ SMALL JOINT BURSA WO US GUID	$100.80	$112.00	$54.88–$112.00	79% below	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP INJ SMALL JOINT BURSA WO US GUID	$95.20	$112.00	$95.20–$112.00	—	15%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPAROSCOPY SURGICAL RPR INGUINAL HERNIA INITIAL	$1,317.60	$1,464.00	$717.36–$1,464.00	at median	10%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAPAROSCOPY SURGICAL RPR INGUINAL HERNIA INITIAL	$1,244.40	$1,464.00	$1,244.40–$1,464.00	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM <	$504.00	$560.00	$274.40–$560.00	27% below	10%
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 <	$504.00	$560.00	$274.40–$560.00	27% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM <	$476.00	$560.00	$476.00–$560.00	—	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 <	$476.00	$560.00	$476.00–$560.00	—	15%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ INTERLAMINAR LMBR/SAC WITH IMAGING GUIDANCE	$751.50	$835.00	$409.15–$835.00	57% below	10%
Lower-back epidural injection, with imaging guidance CPT 62323 ANES 62323 INJ IL NDL CATH LUMB SACR W GUID	$1,585.80	$1,762.00	$106.57–$1,762.00	8% below	10%
Lower-back epidural injection, with imaging guidance CPT 62323 PF 62323 INJ INTERLAMINAR LMBR/SAC WITH IMAGING GUIDANCE	$1,612.80	$1,792.00	$106.57–$1,792.00	7% below	10%
Lower-back epidural injection, with imaging guidance CPT 62323 TX RM 62323 TR RM INJ INTERLAMINAR LUMBR SAC W IMAG GUID	$1,669.50	$1,855.00	$908.95–$1,855.00	3% below	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ INTERLAMINAR LMBR/SAC WITH IMAGING GUIDANCE	$709.75	$835.00	$709.75–$835.00	—	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 TX RM 62323 TR RM INJ INTERLAMINAR LUMBR SAC W IMAG GUID	$1,576.75	$1,855.00	$1,576.75–$1,855.00	—	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 ANES 62323 INJ IL NDL CATH LUMB SACR W GUID	$1,585.80	$1,762.00	$106.57–$1,762.00	—	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PF 62323 INJ INTERLAMINAR LMBR/SAC WITH IMAGING GUIDANCE	$1,612.80	$1,792.00	$106.57–$1,792.00	—	10%
Lower-back epidural injection, without imaging guidance CPT 62322 TX RM 62322 INJ IL NDL CATH LUMB SACR WO GUID	$1,316.70	$1,463.00	$716.87–$1,463.00	10% below	10%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 TX RM 62322 INJ IL NDL CATH LUMB SACR WO GUID	$1,172.19	$1,379.04	$1,172.18–$1,379.04	—	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANESTHETC STEROID TRANSFORAMINAL EPIDURAL LUMBAR SACRAL SNGL LEVEL	$1,688.40	$1,876.00	$919.24–$1,876.00	10% below	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PF 64483 TRN EPID L S SGL1LVL	$1,688.40	$1,876.00	$120.20–$1,876.00	10% below	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 ANES 64483 INJ LUMB SACRAL SNGL LVL	$1,688.40	$1,876.00	$120.20–$1,876.00	10% below	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 ED 64483 INJ EPIDURAL LUMB SINGLE	$1,777.50	$1,975.00	$967.75–$1,975.00	6% below	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TX RM 64483 INJ TRNFRM EPID LUM SNGL 1LVL	$1,777.50	$1,975.00	$967.75–$1,975.00	6% below	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANESTHETC STEROID TRANSFORAMINAL EPIDURAL LUMBAR SACRAL SNGL LEVEL	$1,594.60	$1,876.00	$1,594.60–$1,876.00	—	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TX RM 64483 INJ TRNFRM EPID LUM SNGL 1LVL	$1,678.75	$1,975.00	$1,678.75–$1,975.00	—	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 ED 64483 INJ EPIDURAL LUMB SINGLE	$1,678.75	$1,975.00	$1,678.75–$1,975.00	—	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 ANES 64483 INJ LUMB SACRAL SNGL LVL	$1,688.40	$1,876.00	$120.20–$1,876.00	—	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 PF 64483 TRN EPID L S SGL1LVL	$1,688.40	$1,876.00	$120.20–$1,876.00	—	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENGN SKN LESN INC MARGIN NO SKN TAG TRNK ARM LEG EXC DIA 0.5 CM <	$253.80	$282.00	$138.18–$282.00	69% below	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENGN SKN LESN INC MARGIN NO SKN TAG TRNK ARM LEG EXC DIA 0.5 CM <	$239.70	$282.00	$239.70–$282.00	—	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BENIGN SKIN LESN INCL MARGINS FACE EXC DIAM 0.5 CM <	$274.50	$305.00	$149.45–$305.00	70% below	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BENIGN SKIN LESN INCL MARGINS FACE EXC DIAM 0.5 CM <	$259.25	$305.00	$259.25–$305.00	—	15%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL COMP SMPL SNGL	$193.50	$215.00	$105.35–$215.00	41% below	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE PARTIAL COMP SMPL SNGL	$182.75	$215.00	$182.75–$215.00	—	15%
Occipital nerve block (injection for headaches) CPT 64405 PF 64405 INJ ANES BLOCK GREAT	$628.20	$698.00	$54.08–$698.00	20% below	10%
Occipital nerve block (injection for headaches) CPT 64405 ANES 64405 OCCIPITAL NERVE INJECTION	$628.20	$698.00	$54.08–$698.00	20% below	10%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANESTHETIC AGENT GREATER OCCIPITAL NERVE	$628.20	$698.00	$342.02–$698.00	20% below	10%
Occipital nerve block (injection for headaches) CPT 64405 TX RM 64405 INJ ANES NRV GREAT OCCIPITAL	$661.50	$735.00	$360.15–$735.00	16% below	10%
Occipital nerve block (injection for headaches) CPT 64405 ED 64405 INJ NERVE BLOCK GR OCCPTAL	$661.50	$735.00	$360.15–$735.00	16% below	10%
Occipital nerve block (injection for headaches) CPT 64405 MD 64405 INJ NERVE BLOCK OCCIPITAL	$661.50	$735.00	$54.08–$735.00	16% below	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJ ANESTHETIC AGENT GREATER OCCIPITAL NERVE	$593.30	$698.00	$593.30–$698.00	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ED 64405 INJ NERVE BLOCK GR OCCPTAL	$624.75	$735.00	$624.75–$735.00	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 TX RM 64405 INJ ANES NRV GREAT OCCIPITAL	$624.75	$735.00	$624.75–$735.00	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ANES 64405 OCCIPITAL NERVE INJECTION	$628.20	$698.00	$54.08–$698.00	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 PF 64405 INJ ANES BLOCK GREAT	$628.20	$698.00	$54.08–$698.00	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 MD 64405 INJ NERVE BLOCK OCCIPITAL	$661.50	$735.00	$54.08–$735.00	—	10%
Paracentesis with imaging guidance CPT 49083 PF 49083 ABD PARACENTESIS WIMG	$786.60	$874.00	$112.57–$874.00	60% below	10%
Paracentesis with imaging guidance inpatient CPT 49083 PF 49083 ABD PARACENTESIS WIMG	$786.60	$874.00	$112.57–$874.00	—	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL NAIL MATRIX PERM REMVL	$462.60	$514.00	$251.86–$514.00	46% below	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ED 11750 REMV OF NAIL BED	$462.60	$514.00	$251.86–$514.00	46% below	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ED 11750 REMV OF NAIL BED	$436.90	$514.00	$436.90–$514.00	—	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL NAIL MATRIX PERM REMVL	$436.90	$514.00	$436.90–$514.00	—	15%
Removal of a breast lump, open surgery CPT 19120 PF 19120 EXC CYST LSN BREAST	$1,217.70	$1,353.00	$441.09–$1,353.00	72% below	10%
Removal of a breast lump, open surgery inpatient CPT 19120 PF 19120 EXC CYST LSN BREAST	$1,217.70	$1,353.00	$441.09–$1,353.00	—	10%
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMVL FB SUBQ TISSUES SMPL	$514.80	$572.00	$280.28–$572.00	18% below	10%
Removal of a foreign object under the skin, simple CPT 10120 ED 10120 INC&REMV FB SMPL	$514.80	$572.00	$280.28–$572.00	18% below	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED 10120 INC&REMV FB SMPL	$486.20	$572.00	$486.20–$572.00	—	15%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMVL FB SUBQ TISSUES SMPL	$486.20	$572.00	$486.20–$572.00	—	15%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 PF G0121 COLON CANC SCR NON-HR	$1,358.10	$1,509.00	$194.11–$1,509.00	12% above	10%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 PF G0121 COLON CANC SCR NON-HR	$1,358.10	$1,509.00	$194.11–$1,509.00	—	10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 PF G0105 COLON CANCER SCR HIGH	$1,451.70	$1,613.00	$193.96–$1,613.00	53% above	10%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 PF G0105 COLON CANCER SCR HIGH	$1,451.70	$1,613.00	$193.96–$1,613.00	—	10%
Short arm cast (elbow to hand) CPT 29075 APPLN CAST ELBOW TO FINGER (SHORT ARM)	$234.00	$260.00	$127.40–$260.00	24% below	10%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLN CAST ELBOW TO FINGER (SHORT ARM)	$221.00	$260.00	$221.00–$260.00	—	15%
Short arm splint (forearm and hand) CPT 29125 APPLN SHORT ARM SPLINT (FOREARM TO HAND) STATIC	$192.60	$214.00	$104.86–$214.00	36% below	10%
Short arm splint (forearm and hand) CPT 29125 ED 29125 APPL SPLINT FOREARM	$192.60	$214.00	$104.86–$214.00	36% below	10%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLN SHORT ARM SPLINT (FOREARM TO HAND) STATIC	$181.90	$214.00	$181.90–$214.00	—	15%
Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM	$181.90	$214.00	$181.90–$214.00	—	15%
Short leg cast (below the knee) CPT 29405 APPLN SHORT LEG CAST (BELOW KNEE TO TOES)	$202.50	$225.00	$110.25–$225.00	35% below	10%
Short leg cast (below the knee) inpatient CPT 29405 APPLN SHORT LEG CAST (BELOW KNEE TO TOES)	$191.25	$225.00	$191.25–$225.00	—	15%
Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$189.00	$210.00	$102.90–$210.00	32% below	10%
Short leg splint (calf to foot) CPT 29515 APPLN SHORT LEG SPLINT (CALF TO FOOT)	$189.00	$210.00	$102.90–$210.00	32% below	10%
Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$178.50	$210.00	$178.50–$210.00	—	15%
Short leg splint (calf to foot) inpatient CPT 29515 APPLN SHORT LEG SPLINT (CALF TO FOOT)	$178.50	$210.00	$178.50–$210.00	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 MD 12001 SMPL RPR S N A G T 2.5 CM <	$349.20	$388.00	$46.17–$388.00	24% below	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITALIA TRNK EXTREM 2.5 CM <	$349.20	$388.00	$190.12–$388.00	24% below	10%
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<	$366.30	$407.00	$199.43–$407.00	20% below	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITALIA TRNK EXTREM 2.5 CM <	$329.80	$388.00	$329.80–$388.00	—	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<	$345.95	$407.00	$345.95–$407.00	—	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 MD 12001 SMPL RPR S N A G T 2.5 CM <	$349.20	$388.00	$46.17–$388.00	—	10%
Skin biopsy, punch, one lesion CPT 11104 PF 11104 PUNCH BX SKIN SINGLE LESION	$292.50	$325.00	$49.78–$325.00	37% below	10%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$292.50	$325.00	$159.25–$325.00	37% below	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$276.25	$325.00	$276.25–$325.00	—	15%
Skin biopsy, punch, one lesion inpatient CPT 11104 PF 11104 PUNCH BX SKIN SINGLE LESION	$292.50	$325.00	$49.78–$325.00	—	10%
Skin tag removal, up to 15 tags CPT 11200 REMVL SKIN TAGS MULT FIBROCUTANEOUS TAGS ANY AREA UP TO & INCL 15 LESN	$180.90	$201.00	$98.49–$201.00	55% below	10%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMVL SKIN TAGS MULT FIBROCUTANEOUS TAGS ANY AREA UP TO & INCL 15 LESN	$170.85	$201.00	$170.85–$201.00	—	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	$442.80	$492.00	$241.08–$492.00	13% below	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITAL TRNK EXTREM 2.6-7.5 CM	$442.80	$492.00	$241.08–$492.00	13% below	10%
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	$418.20	$492.00	$418.20–$492.00	—	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 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITAL TRNK EXTREM 2.6-7.5 CM	$418.20	$492.00	$418.20–$492.00	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 MD 12011 RPR SMPL FCE <2.5CM	$386.10	$429.00	$57.29–$429.00	18% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SMPL RPR SUPERL WNDS FACEUS MEMBRANES 2.5 CM <	$386.10	$429.00	$210.21–$429.00	18% below	10%
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<	$405.00	$450.00	$220.50–$450.00	14% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SMPL RPR SUPERL WNDS FACEUS MEMBRANES 2.5 CM <	$364.65	$429.00	$364.65–$429.00	—	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<	$382.50	$450.00	$382.50–$450.00	—	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 MD 12011 RPR SMPL FCE <2.5CM	$386.10	$429.00	$57.29–$429.00	—	10%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION	$198.00	$220.00	$107.80–$220.00	41% below	10%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION	$187.00	$220.00	$187.00–$220.00	—	15%
Thoracentesis with imaging guidance CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$865.80	$962.00	$471.38–$962.00	55% below	10%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W IMAGING	$865.80	$962.00	$471.38–$962.00	55% below	10%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W IMAGING	$817.70	$962.00	$817.70–$962.00	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$817.70	$962.00	$817.70–$962.00	—	15%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ(S) SNGL MULTIPLE TRIGGER POINT(S) 1-2 MUSCLES	$114.30	$127.00	$62.23–$127.00	81% below	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ(S) SNGL MULTIPLE TRIGGER POINT(S) 1-2 MUSCLES	$107.95	$127.00	$107.95–$127.00	—	15%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD WBALLOON DIL	$1,957.50	$2,175.00	$1,065.75–$2,175.00	23% below	10%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 UPPER GI ENDOSCOPY WBALLOON DILATION (< 30 MM DIAM)	$1,957.50	$2,175.00	$1,065.75–$2,175.00	23% below	10%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 UPPER GI ENDOSCOPY WBALLOON DILATION (< 30 MM DIAM)	$1,848.75	$2,175.00	$1,848.75–$2,175.00	—	15%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD WBALLOON DIL	$1,848.75	$2,175.00	$1,848.75–$2,175.00	—	15%
Upper endoscopy (EGD) with biopsy CPT 43239 PF 43239 EGD W BIOPSY	$1,609.20	$1,788.00	$145.84–$1,788.00	15% above	10%
Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY WBX SNGL MULTIPLE	$1,609.20	$1,788.00	$876.12–$1,788.00	15% above	10%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY WBX SNGL MULTIPLE	$1,519.80	$1,788.00	$1,519.80–$1,788.00	—	15%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PF 43239 EGD W BIOPSY	$1,609.20	$1,788.00	$145.84–$1,788.00	—	10%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 UPPER GI ENDOSCOPY WREMVL LESN SNARE	$1,043.10	$1,159.00	$567.91–$1,159.00	27% below	10%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 PF 43251 OPERATIVE UPPER GI ENDO	$1,043.10	$1,159.00	$205.86–$1,159.00	27% below	10%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 UPPER GI ENDOSCOPY WREMVL LESN SNARE	$985.15	$1,159.00	$985.15–$1,159.00	—	15%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 PF 43251 OPERATIVE UPPER GI ENDO	$1,043.10	$1,159.00	$205.86–$1,159.00	—	10%
Upper endoscopy (EGD), diagnostic CPT 43235 PF 43235 EGD	$649.80	$722.00	$129.57–$722.00	46% below	10%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PF 43235 EGD	$649.80	$722.00	$129.57–$722.00	—	10%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY UNILAT BILAT WPOSTOPERATIVE SEMEN EXAM (SEP PROC)	$790.20	$878.00	$430.22–$878.00	—	10%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY UNILAT BILAT WPOSTOPERATIVE SEMEN EXAM (SEP PROC)	$746.30	$878.00	$746.30–$878.00	—	15%
Vein ablation, radiofrequency, first vein CPT 36475 SURG 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$4,513.50	$5,015.00	$2,457.35–$5,015.00	13% below	10%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 SURG 36475 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN	$4,262.75	$5,015.00	$4,262.75–$5,015.00	—	15%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS 1 TO 14	$221.40	$246.00	$120.54–$246.00	49% below	10%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESIONS 1 TO 14	$209.10	$246.00	$209.10–$246.00	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN & SUBQ TISSUE	$283.50	$315.00	$154.35–$315.00	69% below	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SKIN & SUBQ TISSUE	$267.75	$315.00	$267.75–$315.00	—	15%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD	$1,365.30	$1,517.00	$743.33–$1,517.00	41% above	10%
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 TRANSFUSION BLOOD	$1,365.30	$1,517.00	$743.33–$1,517.00	41% above	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 TRANSFUSION BLOOD	$1,289.45	$1,517.00	$1,289.45–$1,517.00	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION BLOOD	$1,289.45	$1,517.00	$1,289.45–$1,517.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUBSEQ TX	$140.40	$156.00	$76.44–$156.00	36% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 DIAGNOSTIC SPUTUM	$140.40	$156.00	$76.44–$156.00	36% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB INITIAL TX	$140.40	$156.00	$76.44–$156.00	36% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB INITIAL TX	$140.40	$156.00	$76.44–$156.00	36% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TENT HOURLY	$140.40	$156.00	$76.44–$156.00	36% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PRESSURIZED NONPRESSURIZED INHALATION RX AIRWAY OBSTRUCTION DX SPUTUM	$141.30	$157.00	$76.93–$157.00	36% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB INITIAL TX	$132.60	$156.00	$132.60–$156.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB SUBSEQ TX	$132.60	$156.00	$132.60–$156.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB INITIAL TX	$132.60	$156.00	$132.60–$156.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 DIAGNOSTIC SPUTUM	$132.60	$156.00	$132.60–$156.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AEROSOL TENT HOURLY	$132.60	$156.00	$132.60–$156.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PRESSURIZED NONPRESSURIZED INHALATION RX AIRWAY OBSTRUCTION DX SPUTUM	$133.45	$157.00	$133.45–$157.00	—	15%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR	$882.90	$981.00	$480.69–$981.00	17% above	10%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR	$833.85	$981.00	$833.85–$981.00	—	15%
Critical care, first 30 to 74 minutes CPT 99291 MD 99291 CRIT CARE E&M 30-74 MIN	$941.40	$1,046.00	$226.47–$1,046.00	24% below	10%
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E&M 30-74 MIN	$941.40	$1,046.00	$512.54–$1,046.00	24% below	10%
Critical care, first 30 to 74 minutes CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$1,914.30	$2,127.00	$1,042.23–$2,127.00	54% above	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E&M 30-74 MIN	$889.10	$1,046.00	$889.10–$1,046.00	—	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 MD 99291 CRIT CARE E&M 30-74 MIN	$941.40	$1,046.00	$226.47–$1,046.00	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$1,807.95	$2,127.00	$1,807.95–$2,127.00	—	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG 12 LEAD W INTERP & REPORT	$243.90	$271.00	$132.79–$271.00	498% above	10%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS WINTERP & REPORT	$245.70	$273.00	$133.77–$273.00	502% above	10%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG 12 LEAD W INTERP & REPORT	$230.35	$271.00	$230.35–$271.00	—	15%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS WINTERP & REPORT	$232.05	$273.00	$232.05–$273.00	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING WO INTERP	$132.30	$147.00	$72.03–$147.00	45% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS TRACING ONLY WO INTERP	$232.20	$258.00	$126.42–$258.00	4% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING WO INTERP	$121.38	$142.80	$121.38–$142.80	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS TRACING ONLY WO INTERP	$219.30	$258.00	$219.30–$258.00	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 MD 99281 EMERGENCY DEPT VISIT LVL I	$155.70	$173.00	$11.96–$173.00	at median	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPT VISIT LVL I	$155.70	$173.00	$84.77–$173.00	at median	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED 99281 EMER CASE LEVEL I	$365.40	$406.00	$198.94–$406.00	134% above	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY DEPT VISIT LVL I	$147.05	$173.00	$147.05–$173.00	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 MD 99281 EMERGENCY DEPT VISIT LVL I	$155.70	$173.00	$11.96–$173.00	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED 99281 EMER CASE LEVEL I	$345.10	$406.00	$345.10–$406.00	—	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT LVL II	$252.90	$281.00	$137.69–$281.00	27% below	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 MD 99282 EMERGENCY DEPT VISIT LVL II	$252.90	$281.00	$44.19–$281.00	27% below	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED 99282 EMER CASE LEVEL II	$456.30	$507.00	$248.43–$507.00	32% above	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT LVL II	$238.85	$281.00	$238.85–$281.00	—	15%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 MD 99282 EMERGENCY DEPT VISIT LVL II	$252.90	$281.00	$44.19–$281.00	—	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED 99282 EMER CASE LEVEL II	$430.95	$507.00	$430.95–$507.00	—	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 MD 99283 EMERGENCY DEPT VISIT LVL III	$342.90	$381.00	$74.81–$381.00	23% below	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LVL III	$342.90	$381.00	$186.69–$381.00	23% below	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED 99283 EMER CASE LEVEL III	$567.00	$630.00	$308.70–$630.00	27% above	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LVL III	$323.85	$381.00	$323.85–$381.00	—	15%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 MD 99283 EMERGENCY DEPT VISIT LVL III	$342.90	$381.00	$74.81–$381.00	—	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED 99283 EMER CASE LEVEL III	$535.50	$630.00	$535.50–$630.00	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT LVL IV	$474.30	$527.00	$258.23–$527.00	44% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 MD 99284 EMERGENCY DEPT VISIT LVL IV	$474.30	$527.00	$127.25–$527.00	44% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED 99284 EMER CASE LEVEL IV	$992.70	$1,103.00	$540.47–$1,103.00	17% above	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT LVL IV	$447.95	$527.00	$447.95–$527.00	—	15%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 MD 99284 EMERGENCY DEPT VISIT LVL IV	$474.30	$527.00	$127.25–$527.00	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED 99284 EMER CASE LEVEL IV	$937.55	$1,103.00	$937.55–$1,103.00	—	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT LVL V	$555.30	$617.00	$302.33–$617.00	54% below	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 MD 99285 EMERGENCY DEPT VISIT LVL V	$555.30	$617.00	$184.29–$617.00	54% below	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED 99285 EMER CASE LEVEL V	$1,486.80	$1,652.00	$809.48–$1,652.00	24% above	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT LVL V	$524.45	$617.00	$524.45–$617.00	—	15%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 MD 99285 EMERGENCY DEPT VISIT LVL V	$555.30	$617.00	$184.29–$617.00	—	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED 99285 EMER CASE LEVEL V	$1,404.20	$1,652.00	$1,404.20–$1,652.00	—	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST TRACING	$1,324.80	$1,472.00	$721.28–$1,472.00	12% above	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST TRACING	$1,251.20	$1,472.00	$1,251.20–$1,472.00	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INITIAL 31-60MINS	$509.40	$566.00	$277.34–$566.00	18% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$509.40	$566.00	$277.34–$566.00	18% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$512.10	$569.00	$278.81–$569.00	19% above	10%
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	$481.10	$566.00	$481.10–$566.00	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRAT INITIAL 31-60MINS	$481.10	$566.00	$481.10–$566.00	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$483.65	$569.00	$483.65–$569.00	—	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$533.70	$593.00	$290.57–$593.00	20% above	10%
IV infusion of a medicine, first hour CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$533.70	$593.00	$290.57–$593.00	20% above	10%
IV infusion of a medicine, first hour CPT 96365 THER PROPH DIAG IV INF INTL	$536.40	$596.00	$292.04–$596.00	21% above	10%
IV infusion of a medicine, first hour inpatient CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$504.05	$593.00	$504.05–$593.00	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$504.05	$593.00	$504.05–$593.00	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER PROPH DIAG IV INF INTL	$506.60	$596.00	$506.60–$596.00	—	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SC IM INJECTION	$142.20	$158.00	$77.42–$158.00	53% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$142.20	$158.00	$77.42–$158.00	53% above	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER PROPHY DIAG INJ SC IM	$143.10	$159.00	$77.91–$159.00	54% above	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SC IM INJECTION	$134.30	$158.00	$134.30–$158.00	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$134.30	$158.00	$134.30–$158.00	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER PROPHY DIAG INJ SC IM	$135.15	$159.00	$135.15–$159.00	—	15%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CONDUCTION TEST 7-8 STUDIES	$526.50	$585.00	$286.65–$585.00	7% below	10%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CONDUCTION TEST 7-8 STUDIES	$497.25	$585.00	$497.25–$585.00	—	15%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$1,525.50	$1,695.00	$830.55–$1,695.00	1171% above	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$1,440.75	$1,695.00	$1,440.75–$1,695.00	—	15%
New patient office visit, about 30 minutes CPT 99203 ANES 99203 NEW PAT LVL III	$183.60	$204.00	$87.46–$204.00	17% below	10%
New patient office visit, about 30 minutes CPT 99203 OFFICE OP VISIT NEW PT LEVEL III	$188.10	$209.00	$102.41–$209.00	15% below	10%
New patient office visit, about 30 minutes CPT 99203 PF 99203 OFFICE OP VISIT NEW PT LEVEL III	$188.10	$209.00	$87.46–$209.00	15% below	10%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE OP VISIT NEW PT LEVEL III	$177.65	$209.00	$177.65–$209.00	—	15%
New patient office visit, about 30 minutes inpatient CPT 99203 ANES 99203 NEW PAT LVL III	$183.60	$204.00	$87.46–$204.00	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 PF 99203 OFFICE OP VISIT NEW PT LEVEL III	$188.10	$209.00	$87.46–$209.00	—	10%
New patient office visit, about 45 minutes CPT 99204 OFFICE OP VISIT NEW PT LEVEL IV	$285.30	$317.00	$155.33–$317.00	15% below	10%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE OP VISIT NEW PT LEVEL IV	$269.45	$317.00	$269.45–$317.00	—	15%
New patient office visit, about 60 minutes CPT 99205 OFFICE OP VISIT NEW PT LEVEL V	$358.20	$398.00	$195.02–$398.00	5% below	10%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE OP VISIT NEW PT LEVEL V	$338.30	$398.00	$338.30–$398.00	—	15%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PF 99202 OFFICE OP VISIT NEW PT LEVEL II	$130.50	$145.00	$50.47–$145.00	25% below	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE OP VISIT NEW PT LEVEL II	$130.50	$145.00	$71.05–$145.00	25% below	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE OP VISIT NEW PT LEVEL II	$123.25	$145.00	$123.25–$145.00	—	15%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PF 99202 OFFICE OP VISIT NEW PT LEVEL II	$130.50	$145.00	$50.47–$145.00	—	10%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY 97165	$298.80	$332.00	$162.68–$332.00	14% above	10%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY 97165	$282.20	$332.00	$282.20–$332.00	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$340.20	$378.00	$185.22–$378.00	15% above	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$321.30	$378.00	$321.30–$378.00	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY 97161	$277.20	$308.00	$150.92–$308.00	24% above	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY 97161	$261.80	$308.00	$261.80–$308.00	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$342.00	$380.00	$186.20–$380.00	30% above	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$323.00	$380.00	$323.00–$380.00	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN 97140	$63.00	$70.00	$34.30–$70.00	44% below	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN 97140	$59.50	$70.00	$59.50–$70.00	—	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN 97110	$1,898.10	$2,109.00	$1,033.41–$2,109.00	1487% above	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN 97110	$1,792.65	$2,109.00	$1,792.65–$2,109.00	—	15%
Preventive checkup, new patient aged 18–39 CPT 99385 PREV MED E&M NEW 18-39 Y O	$180.90	$201.00	$98.49–$201.00	8% below	10%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV MED E&M NEW 18-39 Y O	$170.85	$201.00	$170.85–$201.00	—	15%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV MED E&M NEW 40-64 Y O	$193.50	$215.00	$105.35–$215.00	26% below	10%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV MED E&M NEW 40-64 Y O	$182.75	$215.00	$182.75–$215.00	—	15%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV MED E&M EST 18-39 Y O	$151.20	$168.00	$82.32–$168.00	86% below	10%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV MED E&M EST 18-39 Y O	$142.80	$168.00	$142.80–$168.00	—	15%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV MED E&M EST 40-64 Y O	$162.00	$180.00	$88.20–$180.00	27% below	10%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV MED E&M EST 40-64 Y O	$153.00	$180.00	$153.00–$180.00	—	15%
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV MED E&M EST 65 AND OVER	$171.90	$191.00	$93.59–$191.00	27% below	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREV MED E&M EST 65 AND OVER	$162.35	$191.00	$162.35–$191.00	—	15%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PF 99215 OFFICE OP VISIT EST PT LEVEL V	$256.50	$285.00	$154.76–$285.00	20% below	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE OP VISIT EST PT LEVEL V	$256.50	$285.00	$139.65–$285.00	20% below	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE OP VISIT EST PT LEVEL V	$242.25	$285.00	$242.25–$285.00	—	15%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PF 99215 OFFICE OP VISIT EST PT LEVEL V	$256.50	$285.00	$154.76–$285.00	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ANES 99213 EST PAT LVL III	$132.30	$147.00	$70.98–$147.00	12% below	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE OP VISIT EST PT LEVEL III	$135.90	$151.00	$73.99–$151.00	9% below	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PF 99213 OFFICE OP VISIT EST PT LEVEL III	$135.90	$151.00	$70.98–$151.00	9% below	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE OP VISIT EST PT LEVEL III	$128.35	$151.00	$128.35–$151.00	—	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ANES 99213 EST PAT LVL III	$132.30	$147.00	$70.98–$147.00	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PF 99213 OFFICE OP VISIT EST PT LEVEL III	$135.90	$151.00	$70.98–$151.00	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PF 99214 OFFICE OP VISIT EST PT LEVEL IV	$193.50	$215.00	$104.43–$215.00	15% below	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE OP VISIT EST PT LEVEL IV	$193.50	$215.00	$105.35–$215.00	15% below	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE OP VISIT EST PT LEVEL IV	$182.75	$215.00	$182.75–$215.00	—	15%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PF 99214 OFFICE OP VISIT EST PT LEVEL IV	$193.50	$215.00	$104.43–$215.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE OP VISIT EST PT LEVEL II	$88.20	$98.00	$48.02–$98.00	30% below	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PF 99212 OFFICE OP VISIT EST PT LEVEL II	$88.20	$98.00	$37.90–$98.00	30% below	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 TX RM 99212 TREATMENT RM LEVEL II	$216.00	$240.00	$117.60–$240.00	72% above	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE OP VISIT EST PT LEVEL II	$83.30	$98.00	$83.30–$98.00	—	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PF 99212 OFFICE OP VISIT EST PT LEVEL II	$88.20	$98.00	$37.90–$98.00	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 TX RM 99212 TREATMENT RM LEVEL II	$204.00	$240.00	$204.00–$240.00	—	15%
Speech and language evaluation CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$213.30	$237.00	$116.13–$237.00	50% below	10%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$201.45	$237.00	$201.45–$237.00	—	15%
Speech therapy session, individual CPT 92507 SPEECH THERAPY TX 92507	$1,295.10	$1,439.00	$705.11–$1,439.00	363% above	10%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TX 92507	$1,223.15	$1,439.00	$1,223.15–$1,439.00	—	15%
Spirometry (breathing test) CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$1,837.80	$2,042.00	$1,000.58–$2,042.00	477% above	10%
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$1,735.70	$2,042.00	$1,735.70–$2,042.00	—	15%
Spirometry before and after a bronchodilator CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$486.00	$540.00	$264.60–$540.00	16% below	10%
Spirometry before and after a bronchodilator CPT 94060 BRONCHODILAT RESPONSE SPIROMETRY PRE POST BRONCHODILATOR ADMIN	$486.00	$540.00	$264.60–$540.00	16% below	10%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$459.00	$540.00	$459.00–$540.00	—	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRONCHODILAT RESPONSE SPIROMETRY PRE POST BRONCHODILATOR ADMIN	$459.00	$540.00	$459.00–$540.00	—	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA15 MIN 97530	$1,718.10	$1,909.00	$935.41–$1,909.00	1332% above	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA15 MIN 97530	$1,622.65	$1,909.00	$1,622.65–$1,909.00	—	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$348.30	$387.00	$189.63–$387.00	43% above	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC (SEP PROC)	$350.10	$389.00	$190.61–$389.00	44% above	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 LV THERAPEUTIC PHLEBOTOMY	$350.10	$389.00	$190.61–$389.00	44% above	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$328.95	$387.00	$328.95–$387.00	—	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC (SEP PROC)	$330.65	$389.00	$330.65–$389.00	—	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 LV THERAPEUTIC PHLEBOTOMY	$330.65	$389.00	$330.65–$389.00	—	15%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIOVASCULAR STRESS TEST WECG MONITR WPHYS SUPERVSN INTERP & RPT	$202.50	$225.00	$110.25–$225.00	1% above	10%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 CARDIOVASCULAR STRESS TEST WECG MONITR WPHYS SUPERVSN INTERP & RPT	$191.25	$225.00	$191.25–$225.00	—	15%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 CDMR FLU VACCINE ADJUVANT IM	$96.30	$107.00	$52.43–$107.00	42% above	10%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 CDMR FLU VACCINE ADJUVANT IM	$90.95	$107.00	$90.95–$107.00	—	15%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 CDMR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$117.90	$131.00	$64.19–$131.00	43% below	10%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 CDMR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$111.35	$131.00	$111.35–$131.00	—	15%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 CDMR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$132.30	$147.00	$72.03–$147.00	42% below	10%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 CDMR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$124.95	$147.00	$124.95–$147.00	—	15%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vac Live For Inj 1350 PFU/0.5ML	$329.08	$365.64	$179.16–$365.64	54% above	10%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE SUBQ USE	$96.90	$114.00	$96.90–$114.00	—	15%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Virus Vac Live For Inj 1350 PFU/0.5ML	$310.80	$365.64	$310.79–$365.64	—	15%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 CDMR INFLUENZA VACCINE TRIVALENT PRESER FREE 0.5 ML DOSAGE IM	$33.30	$37.00	$18.13–$37.00	22% above	10%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 CDMR INFLUENZA VACCINE TRIVALENT PRESER FREE 0.5 ML DOSAGE IM	$31.45	$37.00	$31.45–$37.00	—	15%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS 6 11 16 18 31 33 45 52 58 NONAVALENT 3 DOSE IM	$222.30	$247.00	$121.03–$247.00	27% below	10%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS 6 11 16 18 31 33 45 52 58 NONAVALENT 3 DOSE IM	$209.95	$247.00	$209.95–$247.00	—	15%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A & HEPATITIS B VACCINE (HEPA-HEPB) ADULT DOSAGE IM USE	$122.40	$136.00	$66.64–$136.00	16% below	10%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A & HEPATITIS B VACCINE (HEPA-HEPB) ADULT DOSAGE IM USE	$115.60	$136.00	$115.60–$136.00	—	15%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE ADULT DOSAGE IM USE	$117.00	$130.00	$63.70–$130.00	4% below	10%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine Inj Susp 1440 EL Unit/ML	$143.70	$159.66	$78.23–$159.66	17% above	10%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE ADULT DOSAGE IM USE	$110.50	$130.00	$110.50–$130.00	—	15%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine Inj Susp 1440 EL Unit/ML	$135.72	$159.66	$135.71–$159.66	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE ADULT DOSAGE IM USE	$97.20	$108.00	$52.92–$108.00	8% above	10%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 20 MCG/ML	$135.61	$150.67	$73.83–$150.67	51% above	10%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE ADULT DOSAGE IM USE	$91.80	$108.00	$91.80–$108.00	—	15%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 20 MCG/ML	$135.38	$159.26	$135.37–$159.26	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CDMR FLU VACC PRSV FREE INC ANTIG	$66.60	$74.00	$36.26–$74.00	5% above	10%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 CDMR FLU VACC PRSV FREE INC ANTIG	$62.90	$74.00	$62.90–$74.00	—	15%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES MUMPS AND RUBELLA VIRUS VACCINE (MMR) LIVE SUB-Q USE	$102.60	$114.00	$55.86–$114.00	3% below	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$235.70	$261.88	$128.32–$261.88	123% above	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES MUMPS AND RUBELLA VIRUS VACCINE (MMR) LIVE SUB-Q USE	$96.90	$114.00	$96.90–$114.00	—	15%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles-Mumps-Rubella Virus Vaccines For Inj Soln	$222.60	$261.88	$222.60–$261.88	—	15%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJUGATE VACCINE SEROGROUPS A C Y & W-135(4-VALENT) IM	$130.50	$145.00	$71.05–$145.00	28% below	10%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL RECOMB PROTEIN&OUTER MEMBRN VESICAL SEROGRP B 2 DOSE IM	$266.40	$296.00	$145.04–$296.00	11% above	10%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL RECOMB PROTEIN&OUTER MEMBRN VESICAL SEROGRP B 2 DOSE IM	$251.60	$296.00	$251.60–$296.00	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE FOR INTRAMUSCULAR USE	$283.50	$315.00	$154.35–$315.00	11% below	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$396.79	$440.87	$216.03–$440.87	25% above	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE FOR INTRAMUSCULAR USE	$267.75	$315.00	$267.75–$315.00	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML	$374.74	$440.87	$374.74–$440.87	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE 23-VALENT ADULT IMMUNOSUPPRESSED P	$53.10	$59.00	$28.91–$59.00	62% below	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Inj Soln 25 MCG/0.5ML	$242.10	$268.99	$131.81–$268.99	71% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$250.11	$277.89	$136.17–$277.89	77% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Inj Soln 25 MCG/0.5ML	$228.65	$268.99	$228.64–$268.99	—	15%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$236.21	$277.89	$236.21–$277.89	—	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV MONOC ANTB SEASN .5ML IM	$612.00	$680.00	$333.20–$680.00	20% below	10%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Nirsevimab-alip IM Soln Prefilled Syringe 50 MG/0.5ML	$855.60	$950.66	$465.82–$950.66	11% above	10%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 RSV MONOC ANTB SEASN .5ML IM	$578.00	$680.00	$578.00–$680.00	—	15%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 Nirsevimab-alip IM Soln Prefilled Syringe 50 MG/0.5ML	$808.07	$950.66	$808.06–$950.66	—	15%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 RSV VACC PREF RECOMB ADJT INTRAMUSCULAR	$314.10	$349.00	$171.01–$349.00	—	10%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 RSV VACC PREF RECOMB ADJT INTRAMUSCULAR	$296.65	$349.00	$296.65–$349.00	—	15%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM USE	$423.90	$471.00	$230.79–$471.00	17% below	10%
Rabies vaccine, one dose CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$692.00	$768.88	$376.75–$768.88	35% above	10%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine, PCEC For Inj	$734.39	$815.98	$399.83–$815.98	43% above	10%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM USE	$400.35	$471.00	$400.35–$471.00	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp	$653.55	$768.88	$653.55–$768.88	—	15%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine, PCEC For Inj	$693.59	$815.98	$693.58–$815.98	—	15%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD TOXOIDS ABSORBED PRESERVATIVE FREE	$36.90	$41.00	$20.09–$41.00	50% below	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LFU	$70.63	$78.47	$38.45–$78.47	5% below	10%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LFU	$66.70	$78.47	$66.70–$78.47	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML	$130.08	$144.53	$70.82–$144.53	52% above	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 7 YRS OR OLDER IM	$51.85	$61.00	$51.85–$61.00	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML	$122.86	$144.53	$122.85–$144.53	—	15%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid VI Polysaccharide Vacc IM Soln Pref Syr 25 MCG/0.5ML	$179.68	$199.64	$97.82–$199.64	32% above	10%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhoid VI Polysaccharide Vacc IM Soln Pref Syr 25 MCG/0.5ML	$169.70	$199.64	$169.69–$199.64	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN 1 VACCINE	$56.70	$63.00	$30.87–$63.00	12% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIR VAC	$56.70	$63.00	$30.87–$63.00	12% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VAC	$56.70	$63.00	$30.87–$63.00	12% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$56.70	$63.00	$30.87–$63.00	12% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION 1 SNGL COMBINATION VACCINE TOXOID	$57.60	$64.00	$31.36–$64.00	11% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VAC	$53.55	$63.00	$53.55–$63.00	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIR VAC	$53.55	$63.00	$53.55–$63.00	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN 1 VACCINE	$53.55	$63.00	$53.55–$63.00	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$53.55	$63.00	$53.55–$63.00	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION 1 SNGL COMBINATION VACCINE TOXOID	$54.40	$64.00	$54.40–$64.00	—	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION EACH ADDL SNGL COMBINATION VACCINE TOXOID	$28.80	$32.00	$15.68–$32.00	60% below	10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMINISTRATION EACH ADDL SNGL COMBINATION VACCINE TOXOID	$18.70	$22.00	$18.70–$22.00	—	15%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8041/460400557_douglas-county-memorial-hospital_standardcharges.csv