Douglas County Memorial Hospital
Douglas County Memorial Hospital in Armour, SD publishes cash prices for 380 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 234 of 372 procedures and below it for 135. By typical cash price it ranks #22 of 24 South Dakota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.
708 8th St Armour, SD 57313 Collected Sep 27, 2026 Source price file Check a bill from this hospital (605) 724-2159
Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 431305 · CMS hospital register NPI 1336144021
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
Douglas County Memorial Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
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 |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN WO THEN W CONT | $3,364.20 | $3,738.00 | $1,831.62–$3,738.00 | 5% above | 10% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN WO THEN W CONT | $3,177.30 | $3,738.00 | $3,177.30–$3,738.00 | — | 15% |
| Abdominal X-ray, 2 views CPT 74019 RADIOLOGIC EXAMINATION, ABDOMEN; 2 VIEWS | $566.10 | $629.00 | $308.21–$629.00 | 27% above | 10% |
| Abdominal X-ray, 2 views CPT 74019 RAD EXAM ABDOMEN 2 VWS | $837.00 | $930.00 | $455.70–$930.00 | 87% above | 10% |
| Abdominal X-ray, 2 views inpatient CPT 74019 RADIOLOGIC EXAMINATION, ABDOMEN; 2 VIEWS | $534.65 | $629.00 | $534.65–$629.00 | — | 15% |
| Abdominal X-ray, 2 views inpatient CPT 74019 RAD EXAM ABDOMEN 2 VWS | $790.50 | $930.00 | $790.50–$930.00 | — | 15% |
| Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS | $514.80 | $572.00 | $280.28–$572.00 | 76% 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 | 106% 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% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT EXT UPPER WO CONT | $2,700.00 | $3,000.00 | $1,470.00–$3,000.00 | 31% above | 10% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT EXT UPPER WO CONT | $2,550.00 | $3,000.00 | $2,550.00–$3,000.00 | — | 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 (CTA) of the abdomen and pelvis CPT 74174 CTA ABD PELVIS W CONTRAST+WO IF PERFORM | $6,587.10 | $7,319.00 | $3,586.31–$7,319.00 | 63% above | 10% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD PELVIS W CONTRAST+WO IF PERFORM | $6,221.15 | $7,319.00 | $6,221.15–$7,319.00 | — | 15% |
| CT angiography (CTA) of the head CPT 70496 CTA HEAD W CONT WO IF PERF | $3,523.50 | $3,915.00 | $1,918.35–$3,915.00 | 20% above | 10% |
| CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD W CONT WO IF PERF | $3,327.75 | $3,915.00 | $3,327.75–$3,915.00 | — | 15% |
| CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W CON+WO IF PERF | $3,523.50 | $3,915.00 | $1,918.35–$3,915.00 | 20% above | 10% |
| CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W CON+WO IF PERF | $3,327.75 | $3,915.00 | $3,327.75–$3,915.00 | — | 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 | 29% 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 | 2% above | 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 CT scan without and with contrast CPT 71270 CT THORAX DIAGNOSTIC WO THEN W CONTRAST | $2,832.30 | $3,147.00 | $1,542.03–$3,147.00 | 3% below | 10% |
| Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX DIAGNOSTIC WO THEN W CONTRAST | $2,674.95 | $3,147.00 | $2,674.95–$3,147.00 | — | 15% |
| Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAMINIATION, CHEST; 2 VIEWS | $450.00 | $500.00 | $245.00–$500.00 | 22% above | 10% |
| Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS | $600.30 | $667.00 | $326.83–$667.00 | 62% 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 | 1% below | 10% |
| Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW | $335.70 | $373.00 | $182.77–$373.00 | 13% 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% |
| Collarbone (clavicle) X-ray, complete CPT 73000 RADIOLOGIC EXAM CLAVICLE COMP | $505.80 | $562.00 | $275.38–$562.00 | 101% above | 10% |
| Collarbone (clavicle) X-ray, complete CPT 73000 RAD EXAM CLAVICLE COMPL | $505.80 | $562.00 | $275.38–$562.00 | 101% above | 10% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RADIOLOGIC EXAM CLAVICLE COMP | $477.70 | $562.00 | $477.70–$562.00 | — | 15% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RAD EXAM CLAVICLE COMPL | $477.70 | $562.00 | $477.70–$562.00 | — | 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 | 124% 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 | 124% above | 10% |
| 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% |
| 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% |
| 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 | 9% 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 | 40% 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% |
| Elbow X-ray, 2 views CPT 73070 RADIOLOGIC EXAM ELBOW 2 VIEWS | $411.30 | $457.00 | $223.93–$457.00 | 52% above | 10% |
| Elbow X-ray, 2 views CPT 73070 RAD EXAM ELBOW 2 VWS | $452.70 | $503.00 | $246.47–$503.00 | 67% above | 10% |
| Elbow X-ray, 2 views inpatient CPT 73070 RADIOLOGIC EXAM ELBOW 2 VIEWS | $388.45 | $457.00 | $388.45–$457.00 | — | 15% |
| Elbow X-ray, 2 views inpatient CPT 73070 RAD EXAM ELBOW 2 VWS | $427.55 | $503.00 | $427.55–$503.00 | — | 15% |
| Elbow X-ray, complete, 3 or more views CPT 73080 RADIOLOGIC EXAM ELBOW COMP 3+ VIEWS | $450.90 | $501.00 | $245.49–$501.00 | 34% above | 10% |
| Elbow X-ray, complete, 3 or more views CPT 73080 RAD EXAM ELBOW COMPL MIN 3 VWS | $520.20 | $578.00 | $283.22–$578.00 | 54% above | 10% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RADIOLOGIC EXAM ELBOW COMP 3+ VIEWS | $425.85 | $501.00 | $425.85–$501.00 | — | 15% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RAD EXAM ELBOW COMPL MIN 3 VWS | $491.30 | $578.00 | $491.30–$578.00 | — | 15% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT SELLA FOSSA EAR WO CONTRAST | $3,015.90 | $3,351.00 | $1,641.99–$3,351.00 | 44% above | 10% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT SELLA FOSSA EAR WO CONTRAST | $2,848.35 | $3,351.00 | $2,848.35–$3,351.00 | — | 15% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 RAD EXAM FACIAL BONES COMPL MIN 3 VWS | $399.60 | $444.00 | $217.56–$444.00 | 10% above | 10% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RAD EXAM FACIAL BONES COMPL MIN 3 VWS | $377.40 | $444.00 | $377.40–$444.00 | — | 15% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 RADIOLOGIC EXAM FOREARM 2 VIEWS | $491.40 | $546.00 | $267.54–$546.00 | 59% above | 10% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 RAD EXAM FOREARM 2 VWS | $670.50 | $745.00 | $365.05–$745.00 | 117% above | 10% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RADIOLOGIC EXAM FOREARM 2 VIEWS | $464.10 | $546.00 | $464.10–$546.00 | — | 15% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RAD EXAM FOREARM 2 VWS | $633.25 | $745.00 | $633.25–$745.00 | — | 15% |
| Hand X-ray, 2 views CPT 73120 RAD EXAM HAND 2 VWS | $364.50 | $405.00 | $198.45–$405.00 | 37% above | 10% |
| Hand X-ray, 2 views CPT 73120 RADIOLOGIC EXAM HAND 2 VIEWS | $364.50 | $405.00 | $198.45–$405.00 | 37% above | 10% |
| Hand X-ray, 2 views inpatient CPT 73120 RAD EXAM HAND 2 VWS | $344.25 | $405.00 | $344.25–$405.00 | — | 15% |
| Hand X-ray, 2 views inpatient CPT 73120 RADIOLOGIC EXAM HAND 2 VIEWS | $344.25 | $405.00 | $344.25–$405.00 | — | 15% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RAD EXAM CALCANEUS MIN 2 VWS | $359.10 | $399.00 | $195.51–$399.00 | 71% above | 10% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RADIOLOGIC EXAM CALCANEUS 2+ VIEWS | $359.10 | $399.00 | $195.51–$399.00 | 71% above | 10% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RADIOLOGIC EXAM CALCANEUS 2+ VIEWS | $339.15 | $399.00 | $339.15–$399.00 | — | 15% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RAD EXAM CALCANEUS MIN 2 VWS | $339.15 | $399.00 | $339.15–$399.00 | — | 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 | 11% 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 | 71% above | 10% |
| Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS | $566.10 | $629.00 | $308.21–$629.00 | 71% above | 10% |
| Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS | $534.65 | $629.00 | $534.65–$629.00 | — | 15% |
| 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, complete, 4 or more views CPT 73564 RAD EXAM KNEE COMPL 4 + VWS | $601.20 | $668.00 | $327.32–$668.00 | 71% above | 10% |
| Knee X-ray, complete, 4 or more views CPT 73564 RADIOLOGIC EXAM KNEE COMP 4+ VIEWS | $601.20 | $668.00 | $327.32–$668.00 | 71% above | 10% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 RADIOLOGIC EXAM KNEE COMP 4+ VIEWS | $567.80 | $668.00 | $567.80–$668.00 | — | 15% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 RAD EXAM KNEE COMPL 4 + VWS | $567.80 | $668.00 | $567.80–$668.00 | — | 15% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT EXT LOWER WO CONT | $3,147.30 | $3,497.00 | $1,713.53–$3,497.00 | 55% above | 10% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT EXT LOWER WO CONT | $2,972.45 | $3,497.00 | $2,972.45–$3,497.00 | — | 15% |
| 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 | 67% above | 10% |
| 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 | 67% above | 10% |
| 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% |
| 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 ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC | $553.50 | $615.00 | $301.35–$615.00 | 8% below | 10% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JNT OR FOC EVAL REAL TIME WIMAGE DOC | $522.75 | $615.00 | $522.75–$615.00 | — | 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% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RADIOLOGIC EXAM TIBIA & FIBULA TWO VIEWS | $482.40 | $536.00 | $262.64–$536.00 | 44% above | 10% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RAD EXAM TIBIA FIBULA 2 VWS | $1,161.90 | $1,291.00 | $632.59–$1,291.00 | 247% above | 10% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RADIOLOGIC EXAM TIBIA & FIBULA TWO VIEWS | $455.60 | $536.00 | $455.60–$536.00 | — | 15% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RAD EXAM TIBIA FIBULA 2 VWS | $1,097.35 | $1,291.00 | $1,097.35–$1,291.00 | — | 15% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD WO CONTRAST | $4,392.00 | $4,880.00 | $2,391.20–$4,880.00 | 49% above | 10% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WO CONTRAST | $4,148.00 | $4,880.00 | $4,148.00–$4,880.00 | — | 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% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RADIOLOGIC EXAM SPINE CERVICAL 4-5 VIEWS | $886.50 | $985.00 | $482.65–$985.00 | 66% above | 10% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RAD EXAM SPINE CERV 4 OR 5 VWS | $1,282.50 | $1,425.00 | $698.25–$1,425.00 | 141% above | 10% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RADIOLOGIC EXAM SPINE CERVICAL 4-5 VIEWS | $837.25 | $985.00 | $837.25–$985.00 | — | 15% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RAD EXAM SPINE CERV 4 OR 5 VWS | $1,211.25 | $1,425.00 | $1,211.25–$1,425.00 | — | 15% |
| Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W CONTRAST | $3,015.90 | $3,351.00 | $1,641.99–$3,351.00 | 20% above | 10% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W CONTRAST | $2,848.35 | $3,351.00 | $2,848.35–$3,351.00 | — | 15% |
| Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK WO CON | $2,148.30 | $2,387.00 | $1,169.63–$2,387.00 | 5% above | 10% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK WO CON | $2,028.95 | $2,387.00 | $2,028.95–$2,387.00 | — | 15% |
| Neck soft tissue X-ray CPT 70360 RADIOLOGIC EXAM NECK SOFT TISSUE | $430.20 | $478.00 | $234.22–$478.00 | 36% above | 10% |
| Neck soft tissue X-ray CPT 70360 RAD EXAM NECK SOFT TISSUE | $430.20 | $478.00 | $234.22–$478.00 | 36% above | 10% |
| Neck soft tissue X-ray inpatient CPT 70360 RADIOLOGIC EXAM NECK SOFT TISSUE | $406.30 | $478.00 | $406.30–$478.00 | — | 15% |
| Neck soft tissue X-ray inpatient CPT 70360 RAD EXAM NECK SOFT TISSUE | $406.30 | $478.00 | $406.30–$478.00 | — | 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 | 20% 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 CT scan without contrast CPT 72192 CT PELVIS WO CONTRAST | $3,147.30 | $3,497.00 | $1,713.53–$3,497.00 | 63% above | 10% |
| Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS WO CONTRAST | $2,972.45 | $3,497.00 | $2,972.45–$3,497.00 | — | 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 | 6% below | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED | $429.30 | $477.00 | $233.73–$477.00 | 6% 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 ECHOGRAPHY PELVIC(NONOBSTETRIC) B-SCAN & OR REAL TIME WIMAGE DOCATION | $1,084.50 | $1,205.00 | $590.45–$1,205.00 | 9% above | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE | $1,084.50 | $1,205.00 | $590.45–$1,205.00 | 9% above | 10% |
| 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% |
| 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% |
| 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 | 19% above | 10% |
| 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 | 19% above | 10% |
| 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 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, limited (heartbeat, position, fluid) CPT 76815 US OB REAL TIME LTD | $659.70 | $733.00 | $359.17–$733.00 | 32% 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 | 32% above | 10% |
| 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% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB REAL TIME LTD | $623.05 | $733.00 | $623.05–$733.00 | — | 15% |
| Rib X-ray, one side, 2 views one side CPT 71100 RADIOLOGIC EXAM RIBS UNILAT 2 VIEWS | $672.30 | $747.00 | $366.03–$747.00 | 101% above | 10% |
| Rib X-ray, one side, 2 views one side CPT 71100 RAD EXAM RIBS UNILAT 2 VWS | $672.30 | $747.00 | $366.03–$747.00 | 101% above | 10% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RADIOLOGIC EXAM RIBS UNILAT 2 VIEWS | $634.95 | $747.00 | $634.95–$747.00 | — | 15% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 RAD EXAM RIBS UNILAT 2 VWS | $634.95 | $747.00 | $634.95–$747.00 | — | 15% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS | $831.60 | $924.00 | $452.76–$924.00 | 76% above | 10% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 RADIOLOGIC EXAM RIBS UNILAT WPOSTEROANTERIOR CHEST 3+ VIEWS | $831.60 | $924.00 | $452.76–$924.00 | 76% above | 10% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS | $785.40 | $924.00 | $785.40–$924.00 | — | 15% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RADIOLOGIC EXAM RIBS UNILAT WPOSTEROANTERIOR CHEST 3+ VIEWS | $785.40 | $924.00 | $785.40–$924.00 | — | 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% |
| Sinus X-ray, complete, 3 or more views CPT 70220 RADIOLOGIC EXAM SINUSES PARANASAL COMP MINIMUM 3 VIEWS | $421.20 | $468.00 | $229.32–$468.00 | 3% above | 10% |
| Sinus X-ray, complete, 3 or more views CPT 70220 RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS | $421.20 | $468.00 | $229.32–$468.00 | 3% above | 10% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS | $397.80 | $468.00 | $397.80–$468.00 | — | 15% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RADIOLOGIC EXAM SINUSES PARANASAL COMP MINIMUM 3 VIEWS | $397.80 | $468.00 | $397.80–$468.00 | — | 15% |
| Skull X-ray, fewer than 4 views CPT 70250 RADIOLOGIC EXAM SKULL < 4 VIEWS | $307.80 | $342.00 | $167.58–$342.00 | 26% below | 10% |
| Skull X-ray, fewer than 4 views CPT 70250 RAD EXAM SKULL < 4 VWS | $307.80 | $342.00 | $167.58–$342.00 | 26% below | 10% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 RAD EXAM SKULL < 4 VWS | $290.70 | $342.00 | $290.70–$342.00 | — | 15% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 RADIOLOGIC EXAM SKULL < 4 VIEWS | $290.70 | $342.00 | $290.70–$342.00 | — | 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% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 RAD EXAM FEMUR MIN 2 VWS | $675.00 | $750.00 | $367.50–$750.00 | 114% above | 10% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 RADIOLOGIC EXAMINATION, FEMUR; MINIMUM 2 VIEWS | $675.00 | $750.00 | $367.50–$750.00 | 114% above | 10% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RAD EXAM FEMUR MIN 2 VWS | $637.50 | $750.00 | $637.50–$750.00 | — | 15% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RADIOLOGIC EXAMINATION, FEMUR; MINIMUM 2 VIEWS | $637.50 | $750.00 | $637.50–$750.00 | — | 15% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE WO CONT | $3,029.40 | $3,366.00 | $1,649.34–$3,366.00 | 33% above | 10% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE WO CONT | $2,861.10 | $3,366.00 | $2,861.10–$3,366.00 | — | 15% |
| Toe X-ray, 2 or more views CPT 73660 RADIOLOGIC EXAM TOE(S) 2+ VIEWS | $349.20 | $388.00 | $190.12–$388.00 | 40% above | 10% |
| Toe X-ray, 2 or more views CPT 73660 RAD EXAM TOES MIN 2 VWS | $1,688.40 | $1,876.00 | $919.24–$1,876.00 | 579% above | 10% |
| Toe X-ray, 2 or more views inpatient CPT 73660 RADIOLOGIC EXAM TOE(S) 2+ VIEWS | $329.80 | $388.00 | $329.80–$388.00 | — | 15% |
| Toe X-ray, 2 or more views inpatient CPT 73660 RAD EXAM TOES MIN 2 VWS | $1,594.60 | $1,876.00 | $1,594.60–$1,876.00 | — | 15% |
| Transvaginal pelvic ultrasound CPT 76830 ECHOGRAPHY TRANSVAGINAL | $661.50 | $735.00 | $360.15–$735.00 | 14% above | 10% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $661.50 | $735.00 | $360.15–$735.00 | 14% above | 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 | 9% above | 10% |
| Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG | $1,324.80 | $1,472.00 | $721.28–$1,472.00 | 118% 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 | 22% 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 | 22% above | 10% |
| 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 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 scrotum and testicles CPT 76870 ECHOGRAPHY SCROTUM & CONTENTS | $976.50 | $1,085.00 | $531.65–$1,085.00 | 18% above | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM | $976.50 | $1,085.00 | $531.65–$1,085.00 | 18% 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 ULTRASOUND HEAD NECK TISSUES B-SCAN REAL TIME WIMAGE DOCUMENTATION | $867.60 | $964.00 | $472.36–$964.00 | 7% above | 10% |
| 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 | 7% 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% |
| Upper arm X-ray (humerus), 2 views CPT 73060 RAD EXAM HUMERUS MIN 2 VWS | $473.40 | $526.00 | $257.74–$526.00 | 61% above | 10% |
| Upper arm X-ray (humerus), 2 views CPT 73060 RADIOLOGIC EXAM HUMERUS 2+ VIEWS | $475.20 | $528.00 | $258.72–$528.00 | 62% above | 10% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RAD EXAM HUMERUS MIN 2 VWS | $447.10 | $526.00 | $447.10–$526.00 | — | 15% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RADIOLOGIC EXAM HUMERUS 2+ VIEWS | $448.80 | $528.00 | $448.80–$528.00 | — | 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, 2 views CPT 73100 RADIOLOGIC EXAM WRIST 2 VIEWS | $437.40 | $486.00 | $238.14–$486.00 | 83% above | 10% |
| Wrist X-ray, 2 views CPT 73100 RAD EXAM WRIST 2 VWS | $1,132.20 | $1,258.00 | $616.42–$1,258.00 | 373% above | 10% |
| Wrist X-ray, 2 views inpatient CPT 73100 RADIOLOGIC EXAM WRIST 2 VIEWS | $413.10 | $486.00 | $413.10–$486.00 | — | 15% |
| Wrist X-ray, 2 views inpatient CPT 73100 RAD EXAM WRIST 2 VWS | $1,069.30 | $1,258.00 | $1,069.30–$1,258.00 | — | 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 | 37% 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 | 102% 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 | 56% above | 10% |
| X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW | $531.90 | $591.00 | $289.59–$591.00 | 67% 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 RAD EXAM ANKLE 2 VWS | $252.90 | $281.00 | $137.69–$281.00 | 9% below | 10% |
| X-ray of the ankle, 2 views CPT 73600 RADIOLOGIC EXAM ANKLE 2 VIEWS | $252.90 | $281.00 | $137.69–$281.00 | 9% 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 | 80% 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 | 80% above | 10% |
| 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 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 foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS | $366.30 | $407.00 | $199.43–$407.00 | 31% above | 10% |
| X-ray of the foot, 2 views CPT 73620 RADIOLOGIC EXAM FOOT 2 VIEWS | $366.30 | $407.00 | $199.43–$407.00 | 31% 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 | 96% 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 | 96% above | 10% |
| 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 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 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 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 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 | 70% 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 | 70% above | 10% |
| 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 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 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 | 76% 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 | 76% above | 10% |
| 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 (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, 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 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 inpatient CPT 72110 RADIOLOGIC EXAM SPINE LUMBOSACRAL 4+ VIEWS | $578.85 | $681.00 | $578.85–$681.00 | — | 15% |
| 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 mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS | $616.50 | $685.00 | $335.65–$685.00 | 67% above | 10% |
| 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 | 67% 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 | 2% below | 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 | 2% below | 10% |
| 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% |
| 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% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs South Dakota | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH SO | $672.30 | $747.00 | $366.03–$747.00 | 285% above | 10% |
| ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH SO 82024.900 | $672.30 | $747.00 | $366.03–$747.00 | 285% above | 10% |
| ACTH blood test CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH | $672.30 | $747.00 | $366.03–$747.00 | 285% above | 10% |
| ACTH blood test inpatient CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH | $634.95 | $747.00 | $634.95–$747.00 | — | 15% |
| ACTH blood test inpatient CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH SO 82024.900 | $634.95 | $747.00 | $634.95–$747.00 | — | 15% |
| ACTH blood test inpatient CPT 82024 ADRENOCORTICOTROPIC HORMONE ACTH SO | $634.95 | $747.00 | $634.95–$747.00 | — | 15% |
| 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 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 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 | 244% above | 10% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450 | $256.50 | $285.00 | $139.65–$285.00 | 244% 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% |
| Albumin blood test CPT 82040 ALBUMIN SERUM 82040 | $90.00 | $100.00 | $49.00–$100.00 | 46% above | 10% |
| Albumin blood test CPT 82040 ALBUMIN SERUM | $90.00 | $100.00 | $49.00–$100.00 | 46% above | 10% |
| Albumin blood test inpatient CPT 82040 ALBUMIN SERUM 82040 | $85.00 | $100.00 | $85.00–$100.00 | — | 15% |
| Albumin blood test inpatient CPT 82040 ALBUMIN SERUM | $85.00 | $100.00 | $85.00–$100.00 | — | 15% |
| Aldosterone blood test CPT 82088 ALDOSTERONE 24 HR URINE | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE SERUM SO 82088.902 | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE 24 HR URINE 82088.900 | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE ACT RATIO 82088.903 | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE SO 82088.901 | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE SO | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE ACT RATIO | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test CPT 82088 ALDOSTERONE SERUM SO | $572.40 | $636.00 | $311.64–$636.00 | 430% above | 10% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SERUM SO | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE 24 HR URINE | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE ACT RATIO 82088.903 | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SO 82088.901 | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE ACT RATIO | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SERUM SO 82088.902 | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE 24 HR URINE 82088.900 | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Aldosterone blood test inpatient CPT 82088 ALDOSTERONE SO | $540.60 | $636.00 | $540.60–$636.00 | — | 15% |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE FOR ISOENZYMES | $82.80 | $92.00 | $45.08–$92.00 | 14% above | 10% |
| Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE ALKALINE 84075 | $82.80 | $92.00 | $45.08–$92.00 | 14% above | 10% |
| Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE ALKALINE | $82.80 | $92.00 | $45.08–$92.00 | 14% above | 10% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE FOR ISOENZYMES | $78.20 | $92.00 | $78.20–$92.00 | — | 15% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE ALKALINE | $78.20 | $92.00 | $78.20–$92.00 | — | 15% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE ALKALINE 84075 | $78.20 | $92.00 | $78.20–$92.00 | — | 15% |
| 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 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 ALLERGEN ON PANEL 86003 | $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 ALLERG MOLD | $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 GLUTEN | $45.90 | $51.00 | $24.99–$51.00 | 33% above | 10% |
| 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 FOOD ALLERGY PANEL 2 | $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 inpatient CPT 86003 ALLERG MOLD | $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 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 ALLERG GLUTEN | $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 CHAMP ALLERGY PR ALLERGEN | $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 IGE SERUM | $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% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM 82105 | $242.10 | $269.00 | $131.81–$269.00 | 81% above | 10% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM | $242.10 | $269.00 | $131.81–$269.00 | 81% above | 10% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM | $228.65 | $269.00 | $228.65–$269.00 | — | 15% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM 82105 | $228.65 | $269.00 | $228.65–$269.00 | — | 15% |
| Ammonia blood test CPT 82140 AMMONIA 82140 | $468.90 | $521.00 | $255.29–$521.00 | 178% above | 10% |
| Ammonia blood test CPT 82140 AMMONIA | $468.90 | $521.00 | $255.29–$521.00 | 178% above | 10% |
| Ammonia blood test inpatient CPT 82140 AMMONIA 82140 | $442.85 | $521.00 | $442.85–$521.00 | — | 15% |
| Ammonia blood test inpatient CPT 82140 AMMONIA | $442.85 | $521.00 | $442.85–$521.00 | — | 15% |
| Amylase blood test CPT 82150 AMYLASE | $164.70 | $183.00 | $89.67–$183.00 | 63% above | 10% |
| Amylase blood test CPT 82150 AMYLASE 82150 | $164.70 | $183.00 | $89.67–$183.00 | 63% above | 10% |
| Amylase blood test inpatient CPT 82150 AMYLASE | $155.55 | $183.00 | $155.55–$183.00 | — | 15% |
| Amylase blood test inpatient CPT 82150 AMYLASE 82150 | $155.55 | $183.00 | $155.55–$183.00 | — | 15% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODIES | $283.50 | $315.00 | $154.35–$315.00 | 98% above | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE (CCP) ANTIBODY | $283.50 | $315.00 | $154.35–$315.00 | 98% above | 10% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEP AB(CCP) 86200 | $283.50 | $315.00 | $154.35–$315.00 | 98% 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 | 141% above | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038 | $175.50 | $195.00 | $95.55–$195.00 | 141% above | 10% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES (ANA) | $175.50 | $195.00 | $95.55–$195.00 | 141% above | 10% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038 | $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 SCREEN WITH REFLEX | $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 | 83% below | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE | $296.10 | $329.00 | $161.21–$329.00 | 39% 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 | 39% above | 10% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BRAIN NATRIURETIC PEPTIDE | $296.10 | $329.00 | $161.21–$329.00 | 39% above | 10% |
| 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 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 NT-PRO B-TYPE NATRIURETIC PEPTIDE | $279.65 | $329.00 | $279.65–$329.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BACTERIAL OTHER | $8.79 | $9.76 | $4.78–$9.76 | 90% below | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SPUTUM 87070 | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE: BACT OTHER 87070 | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE: BACT RESPITOR 87070 | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULT BACTERIAL SRC XCPT URINE BLD STL AEROBIC WISOLATN PRESUMPT ID | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE CYSTIC FIBROSIS | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 BACTERIAL CULTURE RESPIR | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 BACTERIAL CULTURE OTHER | $233.10 | $259.00 | $126.91–$259.00 | 173% above | 10% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE BACTERIAL OTHER | $8.30 | $9.76 | $8.30–$9.76 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE: BACT OTHER 87070 | $220.15 | $259.00 | $220.15–$259.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULT BACTERIAL SRC XCPT URINE BLD STL AEROBIC WISOLATN PRESUMPT ID | $220.15 | $259.00 | $220.15–$259.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE SPUTUM 87070 | $220.15 | $259.00 | $220.15–$259.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE CYSTIC FIBROSIS | $220.15 | $259.00 | $220.15–$259.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE: BACT RESPITOR 87070 | $220.15 | $259.00 | $220.15–$259.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 BACTERIAL CULTURE OTHER | $220.15 | $259.00 | $220.15–$259.00 | — | 15% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 BACTERIAL CULTURE RESPIR | $220.15 | $259.00 | $220.15–$259.00 | — | 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% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL | $214.20 | $238.00 | $116.62–$238.00 | 157% above | 10% |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL 82247 | $214.20 | $238.00 | $116.62–$238.00 | 157% above | 10% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL 82247 | $202.30 | $238.00 | $202.30–$238.00 | — | 15% |
| Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL | $202.30 | $238.00 | $202.30–$238.00 | — | 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 | $219.60 | $244.00 | $119.56–$244.00 | 34% above | 10% |
| Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040 | $219.60 | $244.00 | $119.56–$244.00 | 34% above | 10% |
| Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES | $207.40 | $244.00 | $207.40–$244.00 | — | 15% |
| 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 draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE | $38.70 | $43.00 | $21.07–$43.00 | 39% above | 10% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE 36415 | $38.70 | $43.00 | $21.07–$43.00 | 39% 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 | 24% below | 10% |
| Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947 | $45.00 | $50.00 | $24.50–$50.00 | 24% below | 10% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) | $42.50 | $50.00 | $42.50–$50.00 | — | 15% |
| Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947 | $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 | 111% above | 10% |
| Blood lead test CPT 83655 LEAD 83655 | $121.50 | $135.00 | $66.15–$135.00 | 119% above | 10% |
| Blood lead test CPT 83655 LEAD | $121.50 | $135.00 | $66.15–$135.00 | 119% above | 10% |
| Blood lead test CPT 83655 LEAD BLOOD | $121.50 | $135.00 | $66.15–$135.00 | 119% above | 10% |
| Blood lead test CPT 83655 LEAD 24 HR URINE | $121.50 | $135.00 | $66.15–$135.00 | 119% above | 10% |
| Blood lead test CPT 83655 HEAVY METAL SCREEN LEAD | $121.50 | $135.00 | $66.15–$135.00 | 119% 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 83655 | $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 HEAVY METAL SCREEN LEAD | $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 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 GONADOTROPIN CHORIONIC (HCG) QUALITATIVE | $178.50 | $210.00 | $178.50–$210.00 | — | 15% |
| 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 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 | 90% 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 | 90% above | 10% |
| 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% |
| 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 urea nitrogen (BUN) test CPT 84520 BUN BODY FLUID | $110.70 | $123.00 | $60.27–$123.00 | 77% above | 10% |
| Blood urea nitrogen (BUN) test CPT 84520 POST BUN UREA REDUCTION | $110.70 | $123.00 | $60.27–$123.00 | 77% above | 10% |
| Blood urea nitrogen (BUN) test CPT 84520 BUN UREA NITROGEN | $110.70 | $123.00 | $60.27–$123.00 | 77% above | 10% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN QUANTITATIVE 84520 | $110.70 | $123.00 | $60.27–$123.00 | 77% above | 10% |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN QUANTITATIVE | $110.70 | $123.00 | $60.27–$123.00 | 77% above | 10% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN QUANTITATIVE 84520 | $104.55 | $123.00 | $104.55–$123.00 | — | 15% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 POST BUN UREA REDUCTION | $104.55 | $123.00 | $104.55–$123.00 | — | 15% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 UREA NITROGEN QUANTITATIVE | $104.55 | $123.00 | $104.55–$123.00 | — | 15% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN UREA NITROGEN | $104.55 | $123.00 | $104.55–$123.00 | — | 15% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN BODY FLUID | $104.55 | $123.00 | $104.55–$123.00 | — | 15% |
| C-peptide blood test CPT 84681 ASSAY OF C PEPTIDE 84681 | $185.40 | $206.00 | $100.94–$206.00 | 24% above | 10% |
| C-peptide blood test CPT 84681 ASSAY OF C PEPTIDE | $187.20 | $208.00 | $101.92–$208.00 | 25% above | 10% |
| C-peptide blood test inpatient CPT 84681 ASSAY OF C PEPTIDE 84681 | $175.10 | $206.00 | $175.10–$206.00 | — | 15% |
| C-peptide blood test inpatient CPT 84681 ASSAY OF C PEPTIDE | $176.80 | $208.00 | $176.80–$208.00 | — | 15% |
| 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) 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) inpatient CPT 86140 C REACTIVE PROTEIN QUANT 86140 | $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 | $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 | 12% 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 | 105% 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 | 115% above | 10% |
| CA 19-9 blood test (tumor marker) CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301 | $249.30 | $277.00 | $135.73–$277.00 | 115% 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 CA125 (OVARIAN CANCER) | $323.10 | $359.00 | $175.91–$359.00 | 73% above | 10% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR CA 125 86304 | $323.10 | $359.00 | $175.91–$359.00 | 73% 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 | 73% 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 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 | $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% |
| 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% |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL 82310 | $97.20 | $108.00 | $52.92–$108.00 | 28% above | 10% |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL | $97.20 | $108.00 | $52.92–$108.00 | 28% above | 10% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL | $91.80 | $108.00 | $91.80–$108.00 | — | 15% |
| Calcium blood test, total inpatient CPT 82310 CALCIUM TOTAL 82310 | $91.80 | $108.00 | $91.80–$108.00 | — | 15% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CDMR CARCINOEMBRYONIC ANTIGEN (CEA) 82378 | $264.60 | $294.00 | $144.06–$294.00 | 59% above | 10% |
| Carcinoembryonic antigen (CEA) test CPT 82378 CDMR CARCINOEMBRYONIC ANTIGEN (CEA) | $264.60 | $294.00 | $144.06–$294.00 | 59% above | 10% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CDMR CARCINOEMBRYONIC ANTIGEN (CEA) 82378 | $249.90 | $294.00 | $249.90–$294.00 | — | 15% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CDMR CARCINOEMBRYONIC ANTIGEN (CEA) | $249.90 | $294.00 | $249.90–$294.00 | — | 15% |
| Chickenpox (varicella) immunity blood test CPT 86787 ANTIBODY VARICELLA-ZOSTER 86787 | $111.60 | $124.00 | $60.76–$124.00 | 105% above | 10% |
| Chickenpox (varicella) immunity blood test CPT 86787 ANTIBODY VARICELLA-ZOSTER | $111.60 | $124.00 | $60.76–$124.00 | 105% above | 10% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 ANTIBODY VARICELLA-ZOSTER 86787 | $105.40 | $124.00 | $105.40–$124.00 | — | 15% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 ANTIBODY VARICELLA-ZOSTER | $105.40 | $124.00 | $105.40–$124.00 | — | 15% |
| 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 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 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) 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) 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 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 TRACHOMATIS AMPLIF PROBE | $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% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 80061 | $12.30 | $13.66 | $6.69–$13.66 | 89% below | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $258.30 | $287.00 | $140.63–$287.00 | 139% 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 | $155.70 | $173.00 | $84.77–$173.00 | 45% above | 10% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025 | $155.70 | $173.00 | $84.77–$173.00 | 45% 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 | $263.50 | $310.00 | $263.50–$310.00 | — | 15% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053 | $263.50 | $310.00 | $263.50–$310.00 | — | 15% |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL | $146.70 | $163.00 | $79.87–$163.00 | 59% above | 10% |
| Cortisol blood test, total CPT 82533 CORTISOL SALIVA | $146.70 | $163.00 | $79.87–$163.00 | 59% above | 10% |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL 82533 | $146.70 | $163.00 | $79.87–$163.00 | 59% above | 10% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL 82533 | $138.55 | $163.00 | $138.55–$163.00 | — | 15% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL | $138.55 | $163.00 | $138.55–$163.00 | — | 15% |
| Cortisol blood test, total inpatient CPT 82533 CORTISOL SALIVA | $138.55 | $163.00 | $138.55–$163.00 | — | 15% |
| Creatine kinase (CK) blood test, total CPT 82550 CPK 82550 | $5.98 | $6.64 | $3.25–$6.64 | 92% below | 10% |
| Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE (CK) (CPK) TOTAL | $104.40 | $116.00 | $56.84–$116.00 | 37% above | 10% |
| Creatine kinase (CK) blood test, total CPT 82550 CK (CPK) TOTAL BY ENZY | $104.40 | $116.00 | $56.84–$116.00 | 37% above | 10% |
| Creatine kinase (CK) blood test, total CPT 82550 CK | $104.40 | $116.00 | $56.84–$116.00 | 37% above | 10% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK 82550 | $5.65 | $6.64 | $5.64–$6.64 | — | 15% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE (CK) (CPK) TOTAL | $98.60 | $116.00 | $98.60–$116.00 | — | 15% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK (CPK) TOTAL BY ENZY | $98.60 | $116.00 | $98.60–$116.00 | — | 15% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 CK | $98.60 | $116.00 | $98.60–$116.00 | — | 15% |
| Creatinine blood test CPT 82565 CREATININE BLOOD 82565 | $4.70 | $5.22 | $2.56–$5.22 | 93% below | 10% |
| Creatinine blood test CPT 82565 CREATININE BLOOD | $89.10 | $99.00 | $48.51–$99.00 | 32% above | 10% |
| Creatinine blood test inpatient CPT 82565 CREATININE BLOOD | $84.15 | $99.00 | $84.15–$99.00 | — | 15% |
| Creatinine blood test inpatient CPT 82565 CREATININE BLOOD 82565 | $84.15 | $99.00 | $84.15–$99.00 | — | 15% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG CHEMILLUMINESENCE | $161.10 | $179.00 | $87.71–$179.00 | 129% above | 10% |
| Cytomegalovirus (CMV) antibody test CPT 86644 ANTIBODY CYTOMEGALOVIRUS (CMV) | $161.10 | $179.00 | $87.71–$179.00 | 129% above | 10% |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG AB 86644 | $161.10 | $179.00 | $87.71–$179.00 | 129% above | 10% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 ANTIBODY CYTOMEGALOVIRUS (CMV) | $152.15 | $179.00 | $152.15–$179.00 | — | 15% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG CHEMILLUMINESENCE | $152.15 | $179.00 | $152.15–$179.00 | — | 15% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG AB 86644 | $152.15 | $179.00 | $152.15–$179.00 | — | 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 QUANTITATIVE | $286.45 | $337.00 | $286.45–$337.00 | — | 15% |
| 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% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S) | $299.70 | $333.00 | $163.17–$333.00 | 90% above | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE 82627 | $299.70 | $333.00 | $163.17–$333.00 | 90% above | 10% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE BY IMMUNOASY | $299.70 | $333.00 | $163.17–$333.00 | 90% above | 10% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE BY IMMUNOASY | $283.05 | $333.00 | $283.05–$333.00 | — | 15% |
| 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% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUGS OF ABUSE SCREEN MECONIUM 80307.905 | $163.80 | $182.00 | $89.18–$182.00 | 9% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRESUMPTIVE, ANY NUMBER INSTRUMENT CHEM ANALYZER, PER DOS | $163.80 | $182.00 | $89.18–$182.00 | 9% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUGS OF ABUSE SCREEN MECONIUM | $163.80 | $182.00 | $89.18–$182.00 | 9% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCR PRESUMP CHEM ANALYZER | $163.80 | $182.00 | $89.18–$182.00 | 9% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCREEN PRESUMP CHEM ANALYZER 80307 | $163.80 | $182.00 | $89.18–$182.00 | 9% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL NOT BREATH 80307 | $255.60 | $284.00 | $139.16–$284.00 | 70% above | 10% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 COMPLIANCE UR DRUG SCR | $258.30 | $287.00 | $140.63–$287.00 | 72% above | 10% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUGS OF ABUSE SCREEN MECONIUM 80307.905 | $154.70 | $182.00 | $154.70–$182.00 | — | 15% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRESUMPTIVE, ANY NUMBER INSTRUMENT CHEM ANALYZER, PER DOS | $154.70 | $182.00 | $154.70–$182.00 | — | 15% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCR PRESUMP CHEM ANALYZER | $154.70 | $182.00 | $154.70–$182.00 | — | 15% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCREEN PRESUMP CHEM ANALYZER 80307 | $154.70 | $182.00 | $154.70–$182.00 | — | 15% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUGS OF ABUSE SCREEN MECONIUM | $154.70 | $182.00 | $154.70–$182.00 | — | 15% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ALCOHOL NOT BREATH 80307 | $241.40 | $284.00 | $241.40–$284.00 | — | 15% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 COMPLIANCE UR DRUG SCR | $243.95 | $287.00 | $243.95–$287.00 | — | 15% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL 80051 | $6.44 | $7.15 | $3.50–$7.15 | 94% below | 10% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $80.10 | $89.00 | $43.61–$89.00 | 24% below | 10% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL | $75.65 | $89.00 | $75.65–$89.00 | — | 15% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL 80051 | $75.65 | $89.00 | $75.65–$89.00 | — | 15% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS CAPSID ANTIGEN (VCA) AB IGM | $163.80 | $182.00 | $89.18–$182.00 | 138% above | 10% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 86665 | $171.00 | $190.00 | $93.10–$190.00 | 149% above | 10% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV IGG AND IGM | $171.00 | $190.00 | $93.10–$190.00 | 149% above | 10% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | $171.00 | $190.00 | $93.10–$190.00 | 149% above | 10% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS CAPSID ANTIGEN (VCA) AB IGM | $154.70 | $182.00 | $154.70–$182.00 | — | 15% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA | $161.50 | $190.00 | $161.50–$190.00 | — | 15% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA 86665 | $161.50 | $190.00 | $161.50–$190.00 | — | 15% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV IGG AND IGM | $161.50 | $190.00 | $161.50–$190.00 | — | 15% |
| Estradiol blood test CPT 82670 ESTRADIOL WITH TANNER STAGES | $268.20 | $298.00 | $146.02–$298.00 | 82% above | 10% |
| Estradiol blood test CPT 82670 ESTRADIOL TOTAL 82670 | $268.20 | $298.00 | $146.02–$298.00 | 82% above | 10% |
| Estradiol blood test CPT 82670 ESTRADIOL (E2) SERUM | $268.20 | $298.00 | $146.02–$298.00 | 82% above | 10% |
| Estradiol blood test CPT 82670 ESTRADIOL | $268.20 | $298.00 | $146.02–$298.00 | 82% above | 10% |
| 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% |
| 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 | $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 FSH W TANNER STAGES | $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 inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) | $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 FSH W TANNER STAGES | $363.80 | $428.00 | $363.80–$428.00 | — | 15% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN STOOL | $469.80 | $522.00 | $255.78–$522.00 | 98% above | 10% |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN 83993 | $469.80 | $522.00 | $255.78–$522.00 | 98% above | 10% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $469.80 | $522.00 | $255.78–$522.00 | 98% 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 82728 | $283.50 | $315.00 | $154.35–$315.00 | 132% above | 10% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $283.50 | $315.00 | $154.35–$315.00 | 132% above | 10% |
| Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN 82728 | $267.75 | $315.00 | $267.75–$315.00 | — | 15% |
| Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN | $267.75 | $315.00 | $267.75–$315.00 | — | 15% |
| Fibrinogen blood test CPT 85384 CDMR FIBRINOGEN ACTIVITY | $113.40 | $126.00 | $61.74–$126.00 | at median | 10% |
| Fibrinogen blood test CPT 85384 CDMR FIBRINOGEN ACTIVITY 85384 | $113.40 | $126.00 | $61.74–$126.00 | at median | 10% |
| Fibrinogen blood test inpatient CPT 85384 CDMR FIBRINOGEN ACTIVITY | $107.10 | $126.00 | $107.10–$126.00 | — | 15% |
| Fibrinogen blood test inpatient CPT 85384 CDMR FIBRINOGEN ACTIVITY 85384 | $107.10 | $126.00 | $107.10–$126.00 | — | 15% |
| Folate (folic acid) blood test CPT 82746 FOLATE 82746 | $13.50 | $14.99 | $7.35–$14.99 | 88% below | 10% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM | $262.80 | $292.00 | $143.08–$292.00 | 135% 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 TRIIODOTHYRONINE T3 FREE | $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 FREE T3 | $244.80 | $272.00 | $133.28–$272.00 | 49% above | 10% |
| Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE T3 FREE | $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 FREE T3 | $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 | 99% above | 10% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $189.00 | $210.00 | $102.90–$210.00 | 99% 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 | 99% 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 | 99% 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 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 | $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% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA GGT | $258.30 | $287.00 | $140.63–$287.00 | 271% above | 10% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA GGT 82977 | $258.30 | $287.00 | $140.63–$287.00 | 271% above | 10% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA GGT 82977 | $243.95 | $287.00 | $243.95–$287.00 | — | 15% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 ASSAY OF GLUTAMYLTRASE GAMMA GGT | $243.95 | $287.00 | $243.95–$287.00 | — | 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 | 35% 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 | 153% 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 | 153% 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 | 153% above | 10% |
| 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 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 POST GLUCOSE DOSE | $193.80 | $228.00 | $193.80–$228.00 | — | 15% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) 3 SPECIMENS (INCLUDES GLUCOSE) | $309.60 | $344.00 | $168.56–$344.00 | 114% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUC TOL 3 SPEC & DOSE 82951 | $309.60 | $344.00 | $168.56–$344.00 | 114% above | 10% |
| Glucose tolerance test, 3 samples CPT 82951 GLUC GEST DIABETES TOL 3HR | $309.60 | $344.00 | $168.56–$344.00 | 114% 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 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) 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 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 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 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 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) 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% |
| 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% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI IGM ANTIBODY | $348.30 | $387.00 | $189.63–$387.00 | 149% above | 10% |
| H. pylori antibody blood test CPT 86677 H PYLORI IGG 86677 | $348.30 | $387.00 | $189.63–$387.00 | 149% above | 10% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI IGG A | $348.30 | $387.00 | $189.63–$387.00 | 149% above | 10% |
| H. pylori antibody blood test CPT 86677 ANTIBODY HELICOBACTER PYLORI | $348.30 | $387.00 | $189.63–$387.00 | 149% 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 HELICOBACTER PYLORI IGM ANTIBODY | $328.95 | $387.00 | $328.95–$387.00 | — | 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 stool antigen test CPT 87338 ENZYME IMMUNO EIA QUAL SEMIQUANT MULTI STEP HELICOBACTER PYLORI STL | $245.70 | $273.00 | $133.77–$273.00 | 30% above | 10% |
| H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL 87338 | $245.70 | $273.00 | $133.77–$273.00 | 30% above | 10% |
| H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN STOOL | $245.70 | $273.00 | $133.77–$273.00 | 30% 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 | 4% 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 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 HIV1 2 AB RAPID | $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 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 inpatient CPT 86703 HIV SCREEN REFLEX TO CONFIRMATION | $106.25 | $125.00 | $106.25–$125.00 | — | 15% |
| 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-1/2 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 | at median | 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 | 32% 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 | 32% 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 83036 | $130.50 | $145.00 | $71.05–$145.00 | 61% above | 10% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $130.50 | $145.00 | $71.05–$145.00 | 61% 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% |
| Hemoglobin blood test CPT 85018 BLOOD COUNT HEMOGLOBIN 85018 | $70.20 | $78.00 | $38.22–$78.00 | 49% above | 10% |
| Hemoglobin blood test CPT 85018 BLOOD COUNT HEMOGLOBIN | $70.20 | $78.00 | $38.22–$78.00 | 49% above | 10% |
| Hemoglobin blood test inpatient CPT 85018 BLOOD COUNT HEMOGLOBIN 85018 | $66.30 | $78.00 | $66.30–$78.00 | — | 15% |
| Hemoglobin blood test inpatient CPT 85018 BLOOD COUNT HEMOGLOBIN | $66.30 | $78.00 | $66.30–$78.00 | — | 15% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL | $156.60 | $174.00 | $85.26–$174.00 | 74% above | 10% |
| Hepatitis B core antibody test (total) CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL 86704 | $156.60 | $174.00 | $85.26–$174.00 | 74% above | 10% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL 86704 | $147.90 | $174.00 | $147.90–$174.00 | — | 15% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 HEPATITIS B CORE ANTIBODY HBCAB TOTAL | $147.90 | $174.00 | $147.90–$174.00 | — | 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) 86706 | $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) | $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 | 60% 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 | 60% 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 | 173% above | 10% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY | $338.40 | $376.00 | $184.24–$376.00 | 173% above | 10% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY | $319.60 | $376.00 | $319.60–$376.00 | — | 15% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY 86803 | $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 | 30% 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 | 31% 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 | 2% 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 HIGH SENSITIVITY (HSCRP) | $65.70 | $73.00 | $35.77–$73.00 | 36% below | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HISEN 86141 | $65.70 | $73.00 | $35.77–$73.00 | 36% below | 10% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENSITIVITY (HSCRP) | $62.05 | $73.00 | $62.05–$73.00 | — | 15% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HISEN 86141 | $62.05 | $73.00 | $62.05–$73.00 | — | 15% |
| Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE 83090 | $272.70 | $303.00 | $148.47–$303.00 | 184% above | 10% |
| Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE | $272.70 | $303.00 | $148.47–$303.00 | 184% above | 10% |
| Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE 83090 | $257.55 | $303.00 | $257.55–$303.00 | — | 15% |
| Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE | $257.55 | $303.00 | $257.55–$303.00 | — | 15% |
| Insulin blood test CPT 83525 INSULIN TOTAL | $176.40 | $196.00 | $96.04–$196.00 | 66% above | 10% |
| Insulin blood test CPT 83525 INSULIN LEVEL 83525 | $176.40 | $196.00 | $96.04–$196.00 | 66% above | 10% |
| Insulin blood test CPT 83525 INSULIN LEVEL | $176.40 | $196.00 | $96.04–$196.00 | 66% 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 | $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% |
| 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 83550 | $110.50 | $130.00 | $110.50–$130.00 | — | 15% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY | $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 | 44% above | 10% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002 | $250.20 | $278.00 | $136.22–$278.00 | 44% above | 10% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) | $250.20 | $278.00 | $136.22–$278.00 | 44% above | 10% |
| LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) | $236.30 | $278.00 | $236.30–$278.00 | — | 15% |
| 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% |
| Lactate (lactic acid) blood test CPT 83605 LACTATE (LACTIC ACID) | $171.00 | $190.00 | $93.10–$190.00 | 64% above | 10% |
| Lactate (lactic acid) blood test CPT 83605 LACTATE (LACTIC ACID) 83605 | $171.00 | $190.00 | $93.10–$190.00 | 64% above | 10% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE (LACTIC ACID) 83605 | $10.30 | $12.11 | $10.29–$12.11 | — | 15% |
| Lactate (lactic acid) blood test inpatient CPT 83605 LACTATE (LACTIC ACID) | $161.50 | $190.00 | $161.50–$190.00 | — | 15% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE (LD) (LDH) 83615 | $101.70 | $113.00 | $55.37–$113.00 | 40% above | 10% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE (LD) (LDH) | $101.70 | $113.00 | $55.37–$113.00 | 40% above | 10% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE (LD) (LDH) 83615 | $96.05 | $113.00 | $96.05–$113.00 | — | 15% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LACTATE DEHYDROGENASE (LD) (LDH) | $96.05 | $113.00 | $96.05–$113.00 | — | 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 | $187.85 | $221.00 | $187.85–$221.00 | — | 15% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE 83690 | $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 BY EIA CSF | $312.30 | $347.00 | $170.03–$347.00 | 179% above | 10% |
| Lyme disease antibody test CPT 86618 LYMES IGG & IGM ANTIBODY | $312.30 | $347.00 | $170.03–$347.00 | 179% above | 10% |
| Lyme disease antibody test CPT 86618 ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE) | $312.30 | $347.00 | $170.03–$347.00 | 179% above | 10% |
| Lyme disease antibody test CPT 86618 LYMES TOTAL 86618 | $312.30 | $347.00 | $170.03–$347.00 | 179% above | 10% |
| Lyme disease antibody test CPT 86618 LYMES DISEASE ANTIBODY REFLEX TO CONFIRMATION | $312.30 | $347.00 | $170.03–$347.00 | 179% above | 10% |
| Lyme disease antibody test inpatient CPT 86618 LYMES TOTAL 86618 | $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 LYMES IGG & IGM ANTIBODY | $294.95 | $347.00 | $294.95–$347.00 | — | 15% |
| 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 ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE) | $294.95 | $347.00 | $294.95–$347.00 | — | 15% |
| Magnesium blood test CPT 83735 MAGNESIUM | $140.40 | $156.00 | $76.44–$156.00 | 104% above | 10% |
| Magnesium blood test CPT 83735 MAGNESIUM 83735 | $140.40 | $156.00 | $76.44–$156.00 | 104% 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 MONOSCREEN 86308 | $161.10 | $179.00 | $87.71–$179.00 | 134% above | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONONUCLEOSIS | $161.10 | $179.00 | $87.71–$179.00 | 134% above | 10% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES SCREENING | $161.10 | $179.00 | $87.71–$179.00 | 134% 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% |
| Mumps immunity blood test CPT 86735 ANTIBODY MUMPS | $170.10 | $189.00 | $92.61–$189.00 | 36% above | 10% |
| Mumps immunity blood test CPT 86735 ANTIBODY MUMPS 86735 | $170.10 | $189.00 | $92.61–$189.00 | 36% above | 10% |
| Mumps immunity blood test inpatient CPT 86735 ANTIBODY MUMPS | $160.65 | $189.00 | $160.65–$189.00 | — | 15% |
| Mumps immunity blood test inpatient CPT 86735 ANTIBODY MUMPS 86735 | $160.65 | $189.00 | $160.65–$189.00 | — | 15% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA | $150.30 | $167.00 | $81.83–$167.00 | 28% above | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE 84154 | $150.30 | $167.00 | $81.83–$167.00 | 28% 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 | 17% above | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 CDMR ASSAY OF PSA TOTAL 84153 | $155.70 | $173.00 | $84.77–$173.00 | 17% above | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CDMR ASSAY OF PSA TOTAL | $147.05 | $173.00 | $147.05–$173.00 | — | 15% |
| 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% |
| 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 PTH INTACT | $381.60 | $424.00 | $207.76–$424.00 | 75% above | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) | $381.60 | $424.00 | $207.76–$424.00 | 75% above | 10% |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT 83970 | $381.60 | $424.00 | $207.76–$424.00 | 75% 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) | $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) 85730 | $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) | $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) 85730 | $151.30 | $178.00 | $151.30–$178.00 | — | 15% |
| Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS INORGANIC | $102.60 | $114.00 | $55.86–$114.00 | 76% above | 10% |
| Phosphorus (phosphate) blood test CPT 84100 ASSAY OF PHOSPHORUS INORGANIC 84100 | $102.60 | $114.00 | $55.86–$114.00 | 76% above | 10% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS INORGANIC 84100 | $96.90 | $114.00 | $96.90–$114.00 | — | 15% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 ASSAY OF PHOSPHORUS INORGANIC | $96.90 | $114.00 | $96.90–$114.00 | — | 15% |
| Potassium blood test CPT 84132 POTASSIUM SERUM 84132 | $99.00 | $110.00 | $53.90–$110.00 | 71% above | 10% |
| Potassium blood test CPT 84132 POTASSIUM SERUM | $99.00 | $110.00 | $53.90–$110.00 | 71% above | 10% |
| Potassium blood test inpatient CPT 84132 POTASSIUM SERUM 84132 | $93.50 | $110.00 | $93.50–$110.00 | — | 15% |
| Potassium blood test inpatient CPT 84132 POTASSIUM SERUM | $93.50 | $110.00 | $93.50–$110.00 | — | 15% |
| Progesterone blood test CPT 84144 PROGESTERONE | $227.70 | $253.00 | $123.97–$253.00 | 58% above | 10% |
| Progesterone blood test CPT 84144 PROGESTERONE 84144 | $227.70 | $253.00 | $123.97–$253.00 | 58% above | 10% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE 84144 | $215.05 | $253.00 | $215.05–$253.00 | — | 15% |
| Progesterone blood test inpatient CPT 84144 PROGESTERONE | $215.05 | $253.00 | $215.05–$253.00 | — | 15% |
| Prolactin blood test CPT 84146 MACROPROLACTIN | $383.40 | $426.00 | $208.74–$426.00 | 178% above | 10% |
| Prolactin blood test CPT 84146 PROLACTIN | $383.40 | $426.00 | $208.74–$426.00 | 178% above | 10% |
| Prolactin blood test CPT 84146 PROLACTIN PITUITARY MACROADENOMA | $383.40 | $426.00 | $208.74–$426.00 | 178% above | 10% |
| Prolactin blood test CPT 84146 PROLACTIN 84146 | $383.40 | $426.00 | $208.74–$426.00 | 178% above | 10% |
| Prolactin blood test inpatient CPT 84146 PROLACTIN | $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 84146 | $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 AD PROTIME INR | $118.80 | $132.00 | $64.68–$132.00 | 220% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $118.80 | $132.00 | $64.68–$132.00 | 220% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT) | $118.80 | $132.00 | $64.68–$132.00 | 220% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 BCH PROTIME | $118.80 | $132.00 | $64.68–$132.00 | 220% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME 85610 | $118.80 | $132.00 | $64.68–$132.00 | 220% above | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $118.80 | $132.00 | $64.68–$132.00 | 220% above | 10% |
| 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 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% |
| 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 | $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% |
| 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 | 555% 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 | 555% 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 | 5% above | 10% |
| Rapid flu test (influenza antigen) CPT 87804 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION INFLUENZA | $83.70 | $93.00 | $45.57–$93.00 | 5% 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 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 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 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% |
| Renin blood test CPT 84244 RENIN ACTIVITY | $152.10 | $169.00 | $82.81–$169.00 | 79% above | 10% |
| Renin blood test CPT 84244 RENIN ACT RATIO | $424.80 | $472.00 | $231.28–$472.00 | 400% above | 10% |
| Renin blood test CPT 84244 RENIN | $424.80 | $472.00 | $231.28–$472.00 | 400% above | 10% |
| Renin blood test inpatient CPT 84244 RENIN ACTIVITY | $143.65 | $169.00 | $143.65–$169.00 | — | 15% |
| Renin blood test inpatient CPT 84244 RENIN ACT RATIO | $401.20 | $472.00 | $401.20–$472.00 | — | 15% |
| Renin blood test inpatient CPT 84244 RENIN | $401.20 | $472.00 | $401.20–$472.00 | — | 15% |
| Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH (D) 86901 | $106.20 | $118.00 | $57.82–$118.00 | 150% above | 10% |
| Rh blood typing CPT 86901 BLOOD TYPING SEROLOGIC RH (D) | $106.20 | $118.00 | $57.82–$118.00 | 150% above | 10% |
| Rh blood typing inpatient CPT 86901 BLOOD TYPING SEROLOGIC RH (D) 86901 | $100.30 | $118.00 | $100.30–$118.00 | — | 15% |
| Rh blood typing inpatient CPT 86901 BLOOD TYPING SEROLOGIC RH (D) | $100.30 | $118.00 | $100.30–$118.00 | — | 15% |
| Rheumatoid factor (RF) test CPT 86431 LO RF TITER SYNOVIAL FLUID | $99.90 | $111.00 | $54.39–$111.00 | 21% above | 10% |
| Rheumatoid factor (RF) test CPT 86431 RA FACTOR SYNOVIAL FLUID | $99.90 | $111.00 | $54.39–$111.00 | 21% above | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT 86431 | $99.90 | $111.00 | $54.39–$111.00 | 21% above | 10% |
| Rheumatoid factor (RF) test CPT 86431 RA FACTOR QUANTITATIVE | $99.90 | $111.00 | $54.39–$111.00 | 21% above | 10% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE | $99.90 | $111.00 | $54.39–$111.00 | 21% above | 10% |
| 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 QUANT 86431 | $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 RUBELLA IGM AB | $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) 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% |
| Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM AB | $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 | 64% below | 10% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED | $23.80 | $28.00 | $23.80–$28.00 | — | 15% |
| Sodium blood test CPT 84295 SODIUM SERUM | $93.60 | $104.00 | $50.96–$104.00 | 60% above | 10% |
| Sodium blood test CPT 84295 SODIUM SERUM 84295 | $93.60 | $104.00 | $50.96–$104.00 | 60% above | 10% |
| Sodium blood test inpatient CPT 84295 SODIUM SERUM | $88.40 | $104.00 | $88.40–$104.00 | — | 15% |
| Sodium blood test inpatient CPT 84295 SODIUM SERUM 84295 | $88.40 | $104.00 | $88.40–$104.00 | — | 15% |
| 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 CPT 87177 OVA AND PARASITES | $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 AND PARASITES | $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 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 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) 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) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 | $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 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% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM 86780 | $107.10 | $119.00 | $58.31–$119.00 | 56% above | 10% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM | $107.10 | $119.00 | $58.31–$119.00 | 56% above | 10% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM | $101.15 | $119.00 | $101.15–$119.00 | — | 15% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 TREPONEMA PALLIDUM 86780 | $101.15 | $119.00 | $101.15–$119.00 | — | 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 | 74% 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 | 74% above | 10% |
| 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% |
| 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% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB | $275.40 | $306.00 | $149.94–$306.00 | 1% below | 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 | 1% below | 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 | at median | 10% |
| 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 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 TB TEST CELL MEDIATED IMMUNITY 86480 | $261.80 | $308.00 | $261.80–$308.00 | — | 15% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403 | $245.70 | $273.00 | $133.77–$273.00 | 88% above | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $245.70 | $273.00 | $133.77–$273.00 | 88% above | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE WITH TANNER STAGES | $245.70 | $273.00 | $133.77–$273.00 | 88% above | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902 | $245.70 | $273.00 | $133.77–$273.00 | 88% above | 10% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL | $245.70 | $273.00 | $133.77–$273.00 | 88% above | 10% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL | $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 WITH TANNER STAGES | $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% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB ANTI TPO 86376 | $176.40 | $196.00 | $96.04–$196.00 | 37% above | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY TYPE 1 AB | $176.40 | $196.00 | $96.04–$196.00 | 37% above | 10% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI-THYROID PEROX ABY | $176.40 | $196.00 | $96.04–$196.00 | 37% above | 10% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY TYPE 1 AB | $166.60 | $196.00 | $166.60–$196.00 | — | 15% |
| 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-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) | $241.20 | $268.00 | $131.32–$268.00 | 121% above | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443 | $241.20 | $268.00 | $131.32–$268.00 | 121% 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% |
| Total IgE blood test CPT 82785 ASSAY OF GAMMAGLOBULIN IGE 82785 | $185.40 | $206.00 | $100.94–$206.00 | 119% above | 10% |
| Total IgE blood test CPT 82785 IGE SERUM | $185.40 | $206.00 | $100.94–$206.00 | 119% above | 10% |
| Total IgE blood test CPT 82785 URD IGE | $185.40 | $206.00 | $100.94–$206.00 | 119% above | 10% |
| Total IgE blood test CPT 82785 ASSAY OF GAMMAGLOBULIN IGE | $185.40 | $206.00 | $100.94–$206.00 | 119% above | 10% |
| Total IgE blood test CPT 82785 FOOD PROFILE 2 | $185.40 | $206.00 | $100.94–$206.00 | 119% above | 10% |
| Total IgE blood test inpatient CPT 82785 ASSAY OF GAMMAGLOBULIN IGE | $175.10 | $206.00 | $175.10–$206.00 | — | 15% |
| Total IgE blood test inpatient CPT 82785 FOOD PROFILE 2 | $175.10 | $206.00 | $175.10–$206.00 | — | 15% |
| Total IgE blood test inpatient CPT 82785 URD IGE | $175.10 | $206.00 | $175.10–$206.00 | — | 15% |
| Total IgE blood test inpatient CPT 82785 ASSAY OF GAMMAGLOBULIN IGE 82785 | $175.10 | $206.00 | $175.10–$206.00 | — | 15% |
| Total IgE blood test inpatient CPT 82785 IGE SERUM | $175.10 | $206.00 | $175.10–$206.00 | — | 15% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL | $52.20 | $58.00 | $28.42–$58.00 | at median | 10% |
| Total cholesterol blood test CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL 82465 | $52.20 | $58.00 | $28.42–$58.00 | at median | 10% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL | $49.30 | $58.00 | $49.30–$58.00 | — | 15% |
| Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL SERUM WHOLE BLOOD TOTAL 82465 | $49.30 | $58.00 | $49.30–$58.00 | — | 15% |
| Total thyroxine (T4) blood test CPT 84436 THYROXINE TOTAL | $213.30 | $237.00 | $116.13–$237.00 | 265% above | 10% |
| Total thyroxine (T4) blood test CPT 84436 T4 TO ES | $213.30 | $237.00 | $116.13–$237.00 | 265% above | 10% |
| Total thyroxine (T4) blood test CPT 84436 T4 84436 | $213.30 | $237.00 | $116.13–$237.00 | 265% above | 10% |
| Total thyroxine (T4) blood test CPT 84436 T4 TOTAL (THYROXINE) | $213.30 | $237.00 | $116.13–$237.00 | 265% above | 10% |
| Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE TOTAL | $201.45 | $237.00 | $201.45–$237.00 | — | 15% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 84436 | $201.45 | $237.00 | $201.45–$237.00 | — | 15% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 TO ES | $201.45 | $237.00 | $201.45–$237.00 | — | 15% |
| Total thyroxine (T4) blood test inpatient CPT 84436 T4 TOTAL (THYROXINE) | $201.45 | $237.00 | $201.45–$237.00 | — | 15% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL | $196.20 | $218.00 | $106.82–$218.00 | 58% above | 10% |
| Total triiodothyronine (T3) blood test CPT 84480 TRIIODOTHYRONINE T3 TOTAL (TT-3) | $196.20 | $218.00 | $106.82–$218.00 | 58% above | 10% |
| Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL (TRIIODOTHYRON) 84480 | $196.20 | $218.00 | $106.82–$218.00 | 58% above | 10% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODOTHYRONINE T3 TOTAL (TT-3) | $185.30 | $218.00 | $185.30–$218.00 | — | 15% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL | $185.30 | $218.00 | $185.30–$218.00 | — | 15% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 TOTAL (TRIIODOTHYRON) 84480 | $185.30 | $218.00 | $185.30–$218.00 | — | 15% |
| Transferrin blood test CPT 84466 TRANSFERRIN | $98.10 | $109.00 | $53.41–$109.00 | 11% below | 10% |
| Transferrin blood test CPT 84466 TRANSFERRIN 84466 | $98.10 | $109.00 | $53.41–$109.00 | 11% below | 10% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN | $92.65 | $109.00 | $92.65–$109.00 | — | 15% |
| Transferrin blood test inpatient CPT 84466 TRANSFERRIN 84466 | $92.65 | $109.00 | $92.65–$109.00 | — | 15% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION | $108.90 | $121.00 | $59.29–$121.00 | at median | 10% |
| Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION | $102.85 | $121.00 | $102.85–$121.00 | — | 15% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES 84478 | $177.30 | $197.00 | $96.53–$197.00 | 155% above | 10% |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $177.30 | $197.00 | $96.53–$197.00 | 155% above | 10% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES | $167.45 | $197.00 | $167.45–$197.00 | — | 15% |
| Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDES 84478 | $167.45 | $197.00 | $167.45–$197.00 | — | 15% |
| Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANTITATIVE 84484 | $11.45 | $12.72 | $6.23–$12.72 | 92% below | 10% |
| Troponin test, quantitative CPT 84484 ASSAY OF TROPONIN QUANTITATIVE | $251.10 | $279.00 | $136.71–$279.00 | 69% above | 10% |
| Troponin test, quantitative inpatient CPT 84484 ASSAY OF TROPONIN QUANTITATIVE 84484 | $237.15 | $279.00 | $237.15–$279.00 | — | 15% |
| Troponin test, quantitative inpatient CPT 84484 ASSAY OF TROPONIN QUANTITATIVE | $237.15 | $279.00 | $237.15–$279.00 | — | 15% |
| Uric acid blood test CPT 84550 URIC ACID SERUM | $110.70 | $123.00 | $60.27–$123.00 | 90% above | 10% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $110.70 | $123.00 | $60.27–$123.00 | 90% above | 10% |
| Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID | $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 URIC ACID SERUM | $104.55 | $123.00 | $104.55–$123.00 | — | 15% |
| 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 CPT 81001 URINALYSIS AUTO W/SCOPE 81001 | $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 URINE PROTEIN RANDOM | $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 URINALYSIS MACROSCOPIC | $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 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 SPECIFIC GRAVITY URINE | $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 URINALYSIS-DIPSTICK ONLY 81003 | $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 URINE KETONE | $70.20 | $78.00 | $38.22–$78.00 | 77% above | 10% |
| 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 URINE PH | $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 SPECIFIC GRAVITY URINE | $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, 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 URINALYSIS REFLEX MICRO | $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 URINE PROTEIN RANDOM | $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, 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 QUANTITATIVE COLONY COUNT URINE | $167.40 | $186.00 | $91.14–$186.00 | 106% above | 10% |
| Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086 | $167.40 | $186.00 | $91.14–$186.00 | 106% above | 10% |
| 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 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 microalbumin (albumin) test CPT 82043 ALBUMIN URINE MICROALBUMIN QUANT 82043 | $5.31 | $5.90 | $2.89–$5.90 | 95% below | 10% |
| Urine microalbumin (albumin) test CPT 82043 ALBUMIN URINE MICROALBUMIN QUANTITATIVE | $157.50 | $175.00 | $85.75–$175.00 | 43% above | 10% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE MICROALBUMIN QUANT 82043 | $5.02 | $5.90 | $5.02–$5.90 | — | 15% |
| Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN URINE MICROALBUMIN QUANTITATIVE | $148.75 | $175.00 | $148.75–$175.00 | — | 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 | 80% 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 CALCIFEDIOL (25-OH VITAMIN D-3) | $187.20 | $208.00 | $101.92–$208.00 | 21% above | 10% |
| 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 | 21% 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 | 21% 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% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIOH SO | $358.20 | $398.00 | $195.02–$398.00 | 170% above | 10% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 CDMR DIHYDROXYVITAMIN D 1 25 | $358.20 | $398.00 | $195.02–$398.00 | 170% above | 10% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 1 25-DIHYDROXY VITAMIN D | $358.20 | $398.00 | $195.02–$398.00 | 170% above | 10% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25-DIHYDROXY SER 82652 | $358.20 | $398.00 | $195.02–$398.00 | 170% above | 10% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 DIHYDROXYVITAMIN D 1 25- | $358.20 | $398.00 | $195.02–$398.00 | 170% above | 10% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 CDMR DIHYDROXYVITAMIN D 1 25 | $338.30 | $398.00 | $338.30–$398.00 | — | 15% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25-DIOH SO | $338.30 | $398.00 | $338.30–$398.00 | — | 15% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 DIHYDROXYVITAMIN D 1 25- | $338.30 | $398.00 | $338.30–$398.00 | — | 15% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 1 25-DIHYDROXY VITAMIN D | $338.30 | $398.00 | $338.30–$398.00 | — | 15% |
| Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25-DIHYDROXY SER 82652 | $338.30 | $398.00 | $338.30–$398.00 | — | 15% |
| Zinc blood test CPT 84630 ZINC 84630.900 | $142.20 | $158.00 | $77.42–$158.00 | 243% above | 10% |
| Zinc blood test CPT 84630 ZINC | $142.20 | $158.00 | $77.42–$158.00 | 243% above | 10% |
| Zinc blood test CPT 84630 ZINC 24 HR URINE | $142.20 | $158.00 | $77.42–$158.00 | 243% above | 10% |
| Zinc blood test CPT 84630 ZINC 24 HR URINE 84630.901 | $143.10 | $159.00 | $77.91–$159.00 | 245% above | 10% |
| 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 | $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 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 | 68% 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 | 68% above | 10% |
| 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% |
| 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% |
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 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% |
| 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 | 78% 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 COLONOSCOPY FLEXIBLE WREMVL LESN SNARE | $2,094.30 | $2,327.00 | $1,140.23–$2,327.00 | 28% 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 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 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, 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% |
| 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 | 34% 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 | 675% 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 | 73% 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 | 38% 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 | 47% 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 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 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% |
| 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 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% |
| 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) inpatient CPT 45330 SIGMOIDOSCOPY FLEXIBLE DX WWO SPECIMENS BRUSHING WASHING(SEP PROC) | $426.70 | $502.00 | $426.70–$502.00 | — | 15% |
| 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 | 75% 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% |
| 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 | 39% 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% |
| 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 | 49% below | 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 INJ(S) SNGL TENDON SHEATH LIG APONEUROSIS | $461.70 | $513.00 | $251.37–$513.00 | 6% 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 | 2% 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 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 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 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 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% |
| 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 | 73% below | 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 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 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 inpatient CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR < | $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 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM < | $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 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, 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 | at median | 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 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% |
| 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 | 62% 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 | 66% 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 | 37% 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 INJ ANESTHETIC AGENT GREATER OCCIPITAL NERVE | $628.20 | $698.00 | $342.02–$698.00 | 18% 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 | 13% 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 | 13% 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 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 ED 64405 INJ NERVE BLOCK GR OCCPTAL | $624.75 | $735.00 | $624.75–$735.00 | — | 15% |
| 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 foreign object under the skin, simple CPT 10120 INCISION & REMVL FB SUBQ TISSUES SMPL | $514.80 | $572.00 | $280.28–$572.00 | 20% 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 | 20% below | 10% |
| 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% |
| 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% |
| 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 ED 29125 APPL SPLINT FOREARM | $192.60 | $214.00 | $104.86–$214.00 | 25% below | 10% |
| Short arm splint (forearm and hand) CPT 29125 APPLN SHORT ARM SPLINT (FOREARM TO HAND) STATIC | $192.60 | $214.00 | $104.86–$214.00 | 25% below | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM | $181.90 | $214.00 | $181.90–$214.00 | — | 15% |
| 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 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 APPLN SHORT LEG SPLINT (CALF TO FOOT) | $189.00 | $210.00 | $102.90–$210.00 | 29% below | 10% |
| Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG | $189.00 | $210.00 | $102.90–$210.00 | 29% below | 10% |
| 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% |
| Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG | $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 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 | 21% 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% |
| 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 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 | 54% 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 | 11% 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 | 11% 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 SMPL RPR SUPERL WNDS FACEUS MEMBRANES 2.5 CM < | $386.10 | $429.00 | $210.21–$429.00 | 16% 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 | 11% 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% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION | $198.00 | $220.00 | $107.80–$220.00 | 50% 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 ASPIRATE PLEURA W IMAGING | $865.80 | $962.00 | $471.38–$962.00 | 53% below | 10% |
| Thoracentesis with imaging guidance CPT 32555 SURG 32555 THORACENTESIS W IMAGING | $865.80 | $962.00 | $471.38–$962.00 | 53% 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 | 77% 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 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 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 inpatient CPT 43249 EGD WBALLOON DIL | $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 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 biopsy CPT 43239 UPPER GI ENDOSCOPY WBX SNGL MULTIPLE | $1,609.20 | $1,788.00 | $876.12–$1,788.00 | 9% 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 polyp removal by snare CPT 43251 UPPER GI ENDOSCOPY WREMVL LESN SNARE | $1,043.10 | $1,159.00 | $567.91–$1,159.00 | 45% 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% |
| 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 | 5% 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 | 73% 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 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) 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) 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 INITIAL TX | $140.40 | $156.00 | $76.44–$156.00 | 35% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 DIAGNOSTIC SPUTUM | $140.40 | $156.00 | $76.44–$156.00 | 35% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB INITIAL TX | $140.40 | $156.00 | $76.44–$156.00 | 35% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TENT HOURLY | $140.40 | $156.00 | $76.44–$156.00 | 35% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUBSEQ TX | $140.40 | $156.00 | $76.44–$156.00 | 35% 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 | 35% below | 10% |
| 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 AEROSOL TENT HOURLY | $132.60 | $156.00 | $132.60–$156.00 | — | 15% |
| 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 DIAGNOSTIC SPUTUM | $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 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 CRIT CARE E&M 30-74 MIN | $941.40 | $1,046.00 | $512.54–$1,046.00 | 62% 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 | 22% below | 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 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 | 196% 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 | 198% 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 EMERGENCY DEPT VISIT LVL I | $155.70 | $173.00 | $84.77–$173.00 | 43% below | 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 | 33% 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 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 | 42% 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 | 4% 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 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 EMERGENCY DEPT VISIT LVL III | $342.90 | $381.00 | $186.69–$381.00 | 51% 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 | 19% below | 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 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 | 57% 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 | 9% below | 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 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 | 65% 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 | 7% below | 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 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 | 13% 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 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 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 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% |
| IV push of a medicine, first drug CPT 96374 ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL | $219.60 | $244.00 | $119.56–$244.00 | 37% below | 10% |
| IV push of a medicine, first drug CPT 96374 IV PUSH INITIAL | $219.60 | $244.00 | $119.56–$244.00 | 37% below | 10% |
| IV push of a medicine, first drug CPT 96374 THER PROPHY INJ IV PUSH | $220.50 | $245.00 | $120.05–$245.00 | 37% below | 10% |
| IV push of a medicine, first drug inpatient CPT 96374 IV PUSH INITIAL | $207.40 | $244.00 | $207.40–$244.00 | — | 15% |
| IV push of a medicine, first drug inpatient CPT 96374 ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL | $207.40 | $244.00 | $207.40–$244.00 | — | 15% |
| IV push of a medicine, first drug inpatient CPT 96374 THER PROPHY INJ IV PUSH | $208.25 | $245.00 | $208.25–$245.00 | — | 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 | 60% 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 | 60% 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 | 61% 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 OFFICE OP VISIT NEW PT LEVEL III | $188.10 | $209.00 | $102.41–$209.00 | 2% 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 45 minutes CPT 99204 OFFICE OP VISIT NEW PT LEVEL IV | $285.30 | $317.00 | $155.33–$317.00 | 11% above | 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 | 14% above | 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 OFFICE OP VISIT NEW PT LEVEL II | $130.50 | $145.00 | $71.05–$145.00 | 10% 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% |
| 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 | 27% 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 | 46% 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 | 1514% 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 | 12% 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 | 57% 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 | 11% 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 | 12% 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 OFFICE OP VISIT EST PT LEVEL V | $256.50 | $285.00 | $139.65–$285.00 | at median | 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, low complexity or 20+ minutes CPT 99213 OFFICE OP VISIT EST PT LEVEL III | $135.90 | $151.00 | $73.99–$151.00 | 2% 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, moderate complexity or 30+ minutes CPT 99214 OFFICE OP VISIT EST PT LEVEL IV | $193.50 | $215.00 | $105.35–$215.00 | 5% above | 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, straightforward problem or 10+ minutes CPT 99212 OFFICE OP VISIT EST PT LEVEL II | $88.20 | $98.00 | $48.02–$98.00 | 20% 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 | 96% 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 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 | 12% 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 | 12% 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 | 1344% 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 | — | 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 | 23% 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 | 42% 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% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IVP VACC 4-6 YR IM | $78.20 | $92.00 | $78.20–$92.00 | — | 15% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diph, Acellular Pert & Tet Tox Inj 15 LF-23 MCG-5 LF/0.5ML | $70.99 | $78.87 | $38.65–$78.87 | 7% below | 10% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diph, Acellular Pert & Tet Tox Inj 25 LF-58 MCG-10 LF/0.5ML | $90.46 | $100.51 | $49.25–$100.51 | 18% above | 10% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Diph, Acellular Pert & Tet Tox Inj 15 LF-23 MCG-5 LF/0.5ML | $67.04 | $78.87 | $67.04–$78.87 | — | 15% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTHERIA TETANUS TOXOIDS & ACELLULAR PERTUSSIS VACCINE(DTAP) < 7 YEA | $77.35 | $91.00 | $77.35–$91.00 | — | 15% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Diph, Acellular Pert & Tet Tox Inj 25 LF-58 MCG-10 LF/0.5ML | $90.67 | $106.66 | $90.66–$106.66 | — | 15% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP - HIB - IPV VACCINE IM USE | $79.05 | $93.00 | $79.05–$93.00 | — | 15% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 DTAP INACTIVATED POLIO HAEMOPHILUS FLU TYPE B PRP-OMP CONJ & HEP B IM | $172.80 | $192.00 | $94.08–$192.00 | 21% below | 10% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 DTAP INACTIVATED POLIO HAEMOPHILUS FLU TYPE B PRP-OMP CONJ & HEP B IM | $163.20 | $192.00 | $163.20–$192.00 | — | 15% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 CDMR FLU VACC TRIVALENT NO PRESERV | $66.60 | $74.00 | $36.26–$74.00 | 16% above | 10% |
| Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 CDMR FLU VACC TRIVALENT NO PRESERV | $62.90 | $74.00 | $62.90–$74.00 | — | 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 | 7% 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 | 42% 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 | 28% 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% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEP B VACC ADULT 2 DOSE IM | $168.30 | $187.00 | $91.63–$187.00 | 28% below | 10% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Hepatitis B Vaccine Recomb Adjuvanted Pref Syr 20 MCG/0.5ML | $281.62 | $312.91 | $153.33–$312.91 | 21% above | 10% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEP B VACC ADULT 2 DOSE IM | $158.95 | $187.00 | $158.95–$187.00 | — | 15% |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 Hepatitis B Vaccine Recomb Adjuvanted Pref Syr 20 MCG/0.5ML | $265.98 | $312.91 | $265.97–$312.91 | — | 15% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 10 MCG/0.5ML | $94.07 | $104.52 | $51.21–$104.52 | 111% above | 10% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VACCINE PEDIATRIC ADOLESCENT (3-DOSE SCHEDULE) IM USE | $97.20 | $108.00 | $52.92–$108.00 | 118% above | 10% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B Vaccine (Recombinant) Susp Pref Syr 10 MCG/0.5ML | $88.85 | $104.52 | $88.84–$104.52 | — | 15% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE PEDIATRIC ADOLESCENT (3-DOSE SCHEDULE) IM USE | $91.80 | $108.00 | $91.80–$108.00 | — | 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 | 9% below | 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% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES MUMPS RUBELLA & VARICELLA VACCINE (MMRV) LIVE SUBQ USE | $255.60 | $284.00 | $139.16–$284.00 | 44% below | 10% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES MUMPS RUBELLA & VARICELLA VACCINE (MMRV) LIVE SUBQ USE | $241.40 | $284.00 | $241.40–$284.00 | — | 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 | 31% below | 10% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL ACWY-TT VACCINE IM | $183.60 | $204.00 | $99.96–$204.00 | 17% below | 10% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL ACWY-TT VACCINE IM | $173.40 | $204.00 | $173.40–$204.00 | — | 15% |
| 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 | at median | 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% |
| Meningococcal B vaccine (Trumenba) CPT 90621 MENINGOCOCCAL RECOMBINANT LIPOPROTEIN VACCINE SEROGROUP B 3 DOSE IM | $193.50 | $215.00 | $105.35–$215.00 | 32% below | 10% |
| Meningococcal B vaccine (Trumenba) CPT 90621 Meningococcal Group B Vac (Recomb) IM Susp Prefilled Syr | $312.84 | $347.60 | $170.32–$347.60 | 10% above | 10% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 MENINGOCOCCAL RECOMBINANT LIPOPROTEIN VACCINE SEROGROUP B 3 DOSE IM | $182.75 | $215.00 | $182.75–$215.00 | — | 15% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 Meningococcal Group B Vac (Recomb) IM Susp Prefilled Syr | $295.46 | $347.60 | $295.46–$347.60 | — | 15% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal 13-Valent Conjugate Vaccine Inj | $269.91 | $299.89 | $146.95–$299.89 | at median | 10% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal 13-Valent Conjugate Vaccine Inj | $320.42 | $376.96 | $320.42–$376.96 | — | 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 and toddlers, larger dose (1 mL, 100 mg) CPT 90381 RSV MONOC ANTB SEASN 1 ML IM | $612.00 | $680.00 | $333.20–$680.00 | 20% below | 10% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Nirsevimab-alip IM Soln Prefilled Syringe 100 MG/ML | $855.60 | $950.66 | $465.82–$950.66 | 11% above | 10% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 RSV MONOC ANTB SEASN 1 ML IM | $578.00 | $680.00 | $578.00–$680.00 | — | 15% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Nirsevimab-alip IM Soln Prefilled Syringe 100 MG/ML | $808.07 | $950.66 | $808.06–$950.66 | — | 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 | 15% below | 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 | 18% below | 10% |
| Rabies vaccine, one dose CPT 90675 Rabies Virus Vaccine, HDC For Inj Susp | $692.00 | $768.88 | $376.75–$768.88 | 34% above | 10% |
| Rabies vaccine, one dose CPT 90675 Rabies Vaccine, PCEC For Inj | $734.39 | $815.98 | $399.83–$815.98 | 42% 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% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 ROTAVIRUS VACCINE 2 DOSE ORAL | $117.00 | $130.00 | $63.70–$130.00 | 53% below | 10% |
| 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 | 43% 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 | 9% above | 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 ED 90471 IMMUNE ADMIN 1 VACCINE | $56.70 | $63.00 | $30.87–$63.00 | 9% above | 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 | 9% above | 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 | 9% above | 10% |
| 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 | 9% above | 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% above | 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 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 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 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 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 | 43% 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% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.