Hospital

Kittson Memorial Hospital Association

Kittson Memorial Hospital Association in Hallock, MN publishes cash prices for 241 common procedures listed here, from its own machine-readable price file updated Jun 26, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Minnesota median for 210 of 237 procedures and below it for 27. By typical cash price it ranks #68 of 79 Minnesota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1010 S Birch Ave, Hallock, MN 56728 Collected Sep 27, 2026 Source price file (218) 843-3612

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 241336 · CMS hospital register

The price file shows no self-pay discount

For 648 of the 648 prices listed here, the cash price in Kittson Memorial Hospital Association's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$280.00	$280.00	$95.20–$232.90	28% above	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$280.00	$280.00	$89.60–$232.90	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,423.00	$1,423.00	$483.82–$1,183.65	16% above	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,423.00	$1,423.00	$455.36–$1,183.65	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,464.00	$2,464.00	$837.76–$2,049.56	49% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WCONT +WO IF PERF	$2,464.00	$2,464.00	$788.48–$2,049.56	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST	$2,755.00	$2,755.00	$936.70–$2,291.61	44% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST	$2,755.00	$2,755.00	$881.60–$2,291.61	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W CONTRAST	$3,563.00	$3,563.00	$1,211.42–$2,963.70	45% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W CONTRAST	$3,563.00	$3,563.00	$1,140.16–$2,963.70	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS WO THEN W CONT	$3,542.00	$3,542.00	$1,204.28–$2,946.24	38% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS WO THEN W CONT	$3,542.00	$3,542.00	$1,133.44–$2,946.24	—	—
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST	$1,986.00	$1,986.00	$675.24–$1,651.95	36% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST	$1,986.00	$1,986.00	$635.52–$1,651.95	—	—
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$2,025.00	$2,025.00	$688.50–$1,684.40	72% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$2,025.00	$2,025.00	$648.00–$1,684.40	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONT	$1,397.00	$1,397.00	$474.98–$1,162.02	12% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONT	$1,397.00	$1,397.00	$447.04–$1,162.02	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$1,533.00	$1,533.00	$521.22–$1,275.15	22% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$1,533.00	$1,533.00	$490.56–$1,275.15	—	—
CT scan of the head with contrast CPT 70460 CT HEAD W CONTRAST	$1,415.00	$1,415.00	$481.10–$1,177.00	9% above	—
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONTRAST	$1,415.00	$1,415.00	$452.80–$1,177.00	—	—
CT scan of the head without and with contrast CPT 70470 CT HEAD WO THEN W CONTRAST	$1,726.00	$1,726.00	$586.84–$1,435.69	9% above	—
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO THEN W CONTRAST	$1,726.00	$1,726.00	$552.32–$1,435.69	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONT	$1,677.00	$1,677.00	$570.18–$1,394.93	23% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONT	$1,677.00	$1,677.00	$536.64–$1,394.93	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$1,688.00	$1,688.00	$573.92–$1,404.08	25% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$1,688.00	$1,688.00	$540.16–$1,404.08	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$1,577.00	$1,577.00	$536.18–$1,311.75	7% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$1,577.00	$1,577.00	$504.64–$1,311.75	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUP CAROTID BILAT	$969.00	$969.00	$329.46–$806.01	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUP CAROTID BILAT	$969.00	$969.00	$310.08–$806.01	—	—
Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS	$318.00	$318.00	$108.12–$264.51	37% above	—
Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VWS	$318.00	$318.00	$101.76–$264.51	—	—
Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW	$213.00	$213.00	$72.42–$177.17	20% above	—
Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VW	$213.00	$213.00	$68.16–$177.17	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM	$557.00	$557.00	$189.38–$463.31	7% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM	$557.00	$557.00	$178.24–$463.31	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$612.00	$612.00	$208.08–$509.06	95% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$612.00	$612.00	$195.84–$509.06	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY DEXA APPEND SKEL	$247.00	$247.00	$83.98–$205.45	28% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY DEXA APPEND SKEL	$247.00	$247.00	$79.04–$205.45	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$1,527.00	$1,527.00	$519.18–$1,270.16	22% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$1,527.00	$1,527.00	$488.64–$1,270.16	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$1,918.00	$1,918.00	$652.12–$1,595.39	28% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$1,918.00	$1,918.00	$613.76–$1,595.39	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DX BILAT INCL CAD	$400.00	$400.00	$136.00–$332.72	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO DX BILAT INCL CAD	$400.00	$400.00	$128.00–$332.72	—	—
Diagnostic mammogram, one breast one side CPT 77065 MAMMO DX UNILAT INCL CAD	$317.00	$317.00	$107.78–$263.68	2% above	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO DX UNILAT INCL CAD	$317.00	$317.00	$101.44–$263.68	—	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$687.00	$687.00	$233.58–$571.45	—	—
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$687.00	$687.00	$219.84–$571.45	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,005.00	$1,005.00	$341.70–$835.96	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,005.00	$1,005.00	$321.60–$835.96	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,241.00	$2,241.00	$761.94–$1,864.06	78% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,241.00	$2,241.00	$717.12–$1,864.06	—	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,514.00	$1,514.00	$514.76–$1,259.35	13% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$1,514.00	$1,514.00	$484.48–$1,259.35	—	—
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 UNATTENDED SLEEP STUDY 95806	$2,827.00	$2,827.00	$961.18–$2,351.50	361% above	—
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 UNATTENDED SLEEP STUDY 95806	$2,827.00	$2,827.00	$904.64–$2,351.50	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,238.00	$4,238.00	$1,440.92–$3,525.17	22% above	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$4,238.00	$4,238.00	$1,440.92–$3,525.17	22% above	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY SPLT NGHT 95811	$4,238.00	$4,238.00	$1,356.16–$3,525.17	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$4,238.00	$4,238.00	$1,356.16–$3,525.17	—	—
Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS	$280.00	$280.00	$95.20–$232.90	21% above	—
Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS	$280.00	$280.00	$89.60–$232.90	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$426.00	$426.00	$144.84–$354.35	2% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$426.00	$426.00	$136.32–$354.35	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$1,832.00	$1,832.00	$622.88–$1,523.86	217% above	—
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	$1,832.00	$1,832.00	$586.24–$1,523.86	—	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JT WO CONTRAST	$2,214.00	$2,214.00	$752.76–$1,841.61	24% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JT WO CONTRAST	$2,214.00	$2,214.00	$708.48–$1,841.61	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$2,977.00	$2,977.00	$1,012.18–$2,476.27	16% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$2,977.00	$2,977.00	$952.64–$2,476.27	—	—
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$2,927.00	$2,927.00	$995.18–$2,434.68	35% above	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$2,927.00	$2,927.00	$936.64–$2,434.68	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO THEN W CONT	$3,661.00	$3,661.00	$1,244.74–$3,045.22	24% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO THEN W CONT	$3,661.00	$3,661.00	$1,171.52–$3,045.22	—	—
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$2,401.00	$2,401.00	$816.34–$1,997.15	18% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$2,401.00	$2,401.00	$768.32–$1,997.15	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO THEN W CONT	$3,495.00	$3,495.00	$1,188.30–$2,907.14	30% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO THEN W CONT	$3,495.00	$3,495.00	$1,118.40–$2,907.14	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST	$2,778.00	$2,778.00	$944.52–$2,310.74	33% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST	$2,778.00	$2,778.00	$888.96–$2,310.74	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE WO THEN W CONT	$3,655.00	$3,655.00	$1,242.70–$3,040.23	43% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE WO THEN W CONT	$3,655.00	$3,655.00	$1,169.60–$3,040.23	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST	$2,881.00	$2,881.00	$979.54–$2,396.42	36% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST	$2,881.00	$2,881.00	$921.92–$2,396.42	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE WO THEN W CONT	$3,209.00	$3,209.00	$1,091.06–$2,669.25	28% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE WO THEN W CONT	$3,209.00	$3,209.00	$1,026.88–$2,669.25	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE WO CONTRAST	$2,406.00	$2,406.00	$818.04–$2,001.31	14% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE WO CONTRAST	$2,406.00	$2,406.00	$769.92–$2,001.31	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS WO THEN W CONT	$2,217.00	$2,217.00	$753.78–$1,844.10	17% below	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS WO THEN W CONT	$2,217.00	$2,217.00	$709.44–$1,844.10	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$2,226.00	$2,226.00	$756.84–$1,851.59	5% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$2,226.00	$2,226.00	$712.32–$1,851.59	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT WO CONTRAST	$2,376.00	$2,376.00	$807.84–$1,976.36	12% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT WO CONTRAST	$2,376.00	$2,376.00	$760.32–$1,976.36	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$360.00	$360.00	$122.40–$299.45	18% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$360.00	$360.00	$115.20–$299.45	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$539.00	$539.00	$183.26–$448.34	15% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$539.00	$539.00	$172.48–$448.34	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG UTR 2-3TRI SGL 1ST	$332.00	$332.00	$112.88–$276.16	31% below	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG UTR 2-3TRI SGL 1ST	$332.00	$332.00	$106.24–$276.16	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTER 1ST TRI SGL	$549.00	$549.00	$186.66–$456.66	31% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTER 1ST TRI SGL	$549.00	$549.00	$175.68–$456.66	—	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB REAL TIME LTD	$322.00	$322.00	$109.48–$267.84	at median	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB REAL TIME LTD	$322.00	$322.00	$103.04–$267.84	—	—
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$327.00	$327.00	$111.18–$272.00	—	—
Screening mammogram, both breasts one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$327.00	$327.00	$111.18–$272.00	3% below	—
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$327.00	$327.00	$104.64–$272.00	—	—
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO SCREEN UNILAT INCL CAD M52	$327.00	$327.00	$104.64–$272.00	—	—
Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$281.00	$281.00	$95.54–$233.74	25% above	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$281.00	$281.00	$89.92–$233.74	—	—
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY PARTIAL 95810 M52	$3,672.00	$3,672.00	$1,248.48–$3,054.37	19% above	—
Sleep study in a lab (polysomnography) CPT 95810 PSG 4+ PARAMETERS	$3,977.00	$3,977.00	$1,352.18–$3,308.07	29% above	—
Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STUDY PARTIAL 95810 M52	$3,672.00	$3,672.00	$1,175.04–$3,054.37	—	—
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4+ PARAMETERS	$3,977.00	$3,977.00	$1,272.64–$3,308.07	—	—
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$488.00	$488.00	$165.92–$405.92	26% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$488.00	$488.00	$156.16–$405.92	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG	$558.00	$558.00	$189.72–$464.14	67% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PG UTR TRANSVAG	$558.00	$558.00	$178.56–$464.14	—	—
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$604.00	$604.00	$205.36–$502.41	3% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$604.00	$604.00	$193.28–$502.41	—	—
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$395.00	$395.00	$134.30–$328.56	14% below	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$395.00	$395.00	$126.40–$328.56	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$475.00	$475.00	$161.50–$395.11	4% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$475.00	$475.00	$152.00–$395.11	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$758.00	$758.00	$257.72–$630.50	38% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$758.00	$758.00	$242.56–$630.50	—	—
Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$269.00	$269.00	$91.46–$223.75	23% above	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$269.00	$269.00	$86.08–$223.75	—	—
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	$284.00	$284.00	$96.56–$236.23	3% above	—
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	$284.00	$284.00	$90.88–$236.23	—	—
X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW	$292.00	$292.00	$99.28–$242.89	39% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN 1 VW	$292.00	$292.00	$93.44–$242.89	—	—
X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VWS	$226.00	$226.00	$76.84–$187.99	39% above	—
X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VWS	$226.00	$226.00	$72.32–$187.99	—	—
X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$224.00	$224.00	$76.16–$186.32	16% above	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$224.00	$224.00	$71.68–$186.32	—	—
X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS	$223.00	$223.00	$75.82–$185.49	34% above	—
X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VWS	$223.00	$223.00	$71.36–$185.49	—	—
X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT MIN 3 VWS	$292.00	$292.00	$99.28–$242.89	40% above	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT MIN 3 VWS	$292.00	$292.00	$93.44–$242.89	—	—
X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND MIN 3 VWS	$280.00	$280.00	$95.20–$232.90	30% above	—
X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND MIN 3 VWS	$280.00	$280.00	$89.60–$232.90	—	—
X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$280.00	$280.00	$95.20–$232.90	49% above	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$280.00	$280.00	$89.60–$232.90	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$380.00	$380.00	$129.20–$316.08	44% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$380.00	$380.00	$121.60–$316.08	—	—
X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$441.00	$441.00	$149.94–$366.82	29% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$441.00	$441.00	$141.12–$366.82	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS	$379.00	$379.00	$128.86–$315.25	54% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THOR 2 VWS	$379.00	$379.00	$121.28–$315.25	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$389.00	$389.00	$132.26–$323.57	78% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$389.00	$389.00	$124.48–$323.57	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$341.00	$341.00	$115.94–$283.64	37% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$341.00	$341.00	$109.12–$283.64	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$280.00	$280.00	$95.20–$232.90	40% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$280.00	$280.00	$89.60–$232.90	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$280.00	$280.00	$95.20–$232.90	23% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$280.00	$280.00	$89.60–$232.90	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$77.00	$77.00	$26.18–$64.05	71% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$77.00	$77.00	$24.64–$64.05	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450	$76.00	$76.00	$25.84–$63.22	70% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST 84450	$76.00	$76.00	$24.32–$63.22	—	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL 80074	$330.00	$330.00	$112.20–$274.49	41% above	—
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL 80074	$330.00	$330.00	$105.60–$274.49	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 RESPIRATORY PANEL REGION 9 (KS, ND, NE, SD)	$24.00	$24.00	$8.16–$19.96	58% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$26.00	$26.00	$8.84–$21.63	71% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ON PANEL 86003	$34.80	$34.80	$11.83–$28.95	129% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALERGEN SPEC IGE QNT SO 86003	$77.00	$77.00	$26.18–$64.05	407% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE	$79.00	$79.00	$26.86–$65.71	420% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RESPIRATORY PANEL REGION 9 (KS, ND, NE, SD)	$24.00	$24.00	$7.68–$19.96	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$26.00	$26.00	$8.32–$21.63	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ON PANEL 86003	$34.80	$34.80	$11.14–$28.95	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALERGEN SPEC IGE QNT SO 86003	$77.00	$77.00	$24.64–$64.05	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE	$79.00	$79.00	$25.28–$65.71	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CONNECTIVE TISSUE DISEASES CASCADE SERUM 86200.900	$106.00	$106.00	$36.04–$88.17	153% above	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYC CITRULLIN PEPTIDE AB	$184.00	$184.00	$62.56–$153.05	340% above	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$184.00	$184.00	$62.56–$153.05	340% above	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CONNECTIVE TISSUE DISEASES CASCADE SERUM 86200.900	$106.00	$106.00	$33.92–$88.17	—	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYC CITRULLIN PEPTIDE AB	$184.00	$184.00	$58.88–$153.05	—	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$184.00	$184.00	$58.88–$153.05	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 CONNECTIVE TISSUE DISEASES CASCADE SERUM 86038.901	$92.00	$92.00	$31.28–$76.53	104% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN WITH REFLEX	$123.00	$123.00	$41.82–$102.31	173% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR AB (IFA)	$123.00	$123.00	$41.82–$102.31	173% above	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$133.00	$133.00	$45.22–$110.63	195% above	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CONNECTIVE TISSUE DISEASES CASCADE SERUM 86038.901	$92.00	$92.00	$29.44–$76.53	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA SCREEN WITH REFLEX	$123.00	$123.00	$39.36–$102.31	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR AB (IFA)	$123.00	$123.00	$39.36–$102.31	—	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$133.00	$133.00	$42.56–$110.63	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE 83880	$363.00	$363.00	$123.42–$301.94	169% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE 83880	$363.00	$363.00	$116.16–$301.94	—	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL 80048	$186.00	$186.00	$63.24–$154.71	108% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL 80048	$186.00	$186.00	$59.52–$154.71	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV 88305	$218.00	$218.00	$74.12–$181.33	108% above	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV 88305	$218.00	$218.00	$69.76–$181.33	—	—
Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$169.00	$169.00	$57.46–$140.57	53% above	—
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$169.00	$169.00	$54.08–$140.57	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE 36415	$29.00	$29.00	$9.86–$24.12	39% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE 36415	$29.00	$29.00	$9.28–$24.12	—	—
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$66.00	$66.00	$22.44–$54.90	49% above	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$66.00	$66.00	$21.12–$54.90	—	—
Blood lead test CPT 83655 LEAD 83655	$106.00	$106.00	$36.04–$88.17	240% above	—
Blood lead test inpatient CPT 83655 LEAD 83655	$106.00	$106.00	$33.92–$88.17	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY	$85.00	$85.00	$28.90–$70.70	23% above	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY SERUM	$85.00	$85.00	$28.90–$70.70	23% above	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL 84703	$90.00	$90.00	$30.60–$74.86	30% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY SERUM	$85.00	$85.00	$27.20–$70.70	—	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY	$85.00	$85.00	$27.20–$70.70	—	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL 84703	$90.00	$90.00	$28.80–$74.86	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$93.00	$93.00	$31.62–$77.36	76% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$93.00	$93.00	$29.76–$77.36	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN QUANT 86140	$108.00	$108.00	$36.72–$89.83	98% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN QUANT 86140	$108.00	$108.00	$34.56–$89.83	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$256.00	$256.00	$87.04–$212.94	93% above	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$256.00	$256.00	$81.92–$212.94	—	—
CA 19-9 blood test (tumor marker) CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$171.00	$171.00	$58.14–$142.24	68% above	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$171.00	$171.00	$54.72–$142.24	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER ANTIGEN 125	$156.00	$156.00	$53.04–$129.76	54% above	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR CA 125 86304	$158.00	$158.00	$53.72–$131.42	56% above	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CANCER ANTIGEN 125	$156.00	$156.00	$49.92–$129.76	—	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CDMR CA 125 86304	$158.00	$158.00	$50.56–$131.42	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$130.00	$130.00	$44.20–$108.13	8% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$130.00	$130.00	$41.60–$108.13	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$223.00	$223.00	$75.82–$185.49	137% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$223.00	$223.00	$75.82–$185.49	137% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$223.00	$223.00	$75.82–$185.49	137% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$223.00	$223.00	$71.36–$185.49	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$223.00	$223.00	$71.36–$185.49	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$223.00	$223.00	$71.36–$185.49	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 80061	$164.00	$164.00	$55.76–$136.42	78% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 80061	$164.00	$164.00	$52.48–$136.42	—	—
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$161.00	$161.00	$54.74–$133.92	94% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$161.00	$161.00	$51.52–$133.92	—	—
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$137.00	$137.00	$46.58–$113.96	109% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$137.00	$137.00	$43.84–$113.96	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$252.00	$252.00	$85.68–$209.61	167% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$252.00	$252.00	$80.64–$209.61	—	—
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$174.00	$174.00	$59.16–$144.73	76% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$174.00	$174.00	$55.68–$144.73	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S	$148.00	$148.00	$50.32–$123.11	156% above	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE 82627	$148.00	$148.00	$50.32–$123.11	156% above	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE 82627	$148.00	$148.00	$47.36–$123.11	—	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S	$148.00	$148.00	$47.36–$123.11	—	—
Estradiol blood test CPT 82670 ESTRADIOL TOTAL 82670	$181.00	$181.00	$61.54–$150.56	174% above	—
Estradiol blood test CPT 82670 ESTRADIOL 82670.900	$198.00	$198.00	$67.32–$164.70	200% above	—
Estradiol blood test CPT 82670 ESTRADIOL WITH TANNER STAGES 82670.901	$213.00	$213.00	$72.42–$177.17	222% above	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL 82670	$181.00	$181.00	$57.92–$150.56	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL 82670.900	$198.00	$198.00	$63.36–$164.70	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL WITH TANNER STAGES 82670.901	$213.00	$213.00	$68.16–$177.17	—	—
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$146.00	$146.00	$49.64–$121.44	106% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$146.00	$146.00	$46.72–$121.44	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN 83993	$100.00	$100.00	$34.00–$83.18	19% above	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN 83993	$100.00	$100.00	$32.00–$83.18	—	—
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN 82728	$138.00	$138.00	$46.92–$114.79	54% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN 82728	$138.00	$138.00	$44.16–$114.79	—	—
Folate (folic acid) blood test CPT 82746 FOLATE	$117.00	$117.00	$39.78–$97.32	46% above	—
Folate (folic acid) blood test CPT 82746 FOLATE 82746	$126.00	$126.00	$42.84–$104.81	58% above	—
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$117.00	$117.00	$37.44–$97.32	—	—
Folate (folic acid) blood test inpatient CPT 82746 FOLATE 82746	$126.00	$126.00	$40.32–$104.81	—	—
Free T3 thyroid hormone test CPT 84481 T3 FREE 84481	$226.00	$226.00	$76.84–$187.99	121% above	—
Free T3 thyroid hormone test CPT 84481 FREE T3	$226.00	$226.00	$76.84–$187.99	121% above	—
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE 84481	$226.00	$226.00	$72.32–$187.99	—	—
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$226.00	$226.00	$72.32–$187.99	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE 84439	$111.00	$111.00	$37.74–$92.33	63% above	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 BY EQ DIALYSIS SO 84439.900	$111.00	$111.00	$37.74–$92.33	63% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE 84439	$111.00	$111.00	$35.52–$92.33	—	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 BY EQ DIALYSIS SO 84439.900	$111.00	$111.00	$35.52–$92.33	—	—
Free testosterone test CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$223.00	$223.00	$75.82–$185.49	257% above	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$223.00	$223.00	$71.36–$185.49	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$80.00	$80.00	$27.20–$66.54	90% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$80.00	$80.00	$25.60–$66.54	—	—
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$175.00	$175.00	$59.50–$145.57	82% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$175.00	$175.00	$56.00–$145.57	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$248.00	$248.00	$84.32–$206.29	193% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$248.00	$248.00	$84.32–$206.29	193% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$248.00	$248.00	$79.36–$206.29	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$248.00	$248.00	$79.36–$206.29	—	—
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI IGG	$74.00	$74.00	$25.16–$61.55	37% below	—
H. pylori antibody blood test CPT 86677 H PYLORI IGM	$146.00	$146.00	$49.64–$121.44	24% above	—
H. pylori antibody blood test CPT 86677 H PYLORI IGG 86677	$163.00	$163.00	$55.42–$135.58	39% above	—
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI IGG	$74.00	$74.00	$23.68–$61.55	—	—
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGM	$146.00	$146.00	$46.72–$121.44	—	—
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGG 86677	$163.00	$163.00	$52.16–$135.58	—	—
H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL 87338	$163.00	$163.00	$55.42–$135.58	51% above	—
H. pylori stool antigen test CPT 87338 HELICOBACTER PYLORI AG F	$267.00	$267.00	$90.78–$222.09	147% above	—
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG STOOL 87338	$163.00	$163.00	$52.16–$135.58	—	—
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTER PYLORI AG F	$267.00	$267.00	$85.44–$222.09	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA DETECTION QUANTIFICATION 87536.900	$113.88	$113.88	$38.72–$94.73	1% below	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA PCR QNT 87536	$426.00	$426.00	$144.84–$354.35	271% above	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA DETECTION QUANTIFICATION 87536.900	$113.88	$113.88	$36.44–$94.73	—	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA PCR QNT 87536	$426.00	$426.00	$136.32–$354.35	—	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 & 2 RAPID 86703	$110.00	$110.00	$37.40–$91.50	66% above	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 HIV-2	$110.00	$110.00	$37.40–$91.50	66% above	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 HIV-2	$110.00	$110.00	$35.20–$91.50	—	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 & 2 RAPID 86703	$110.00	$110.00	$35.20–$91.50	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$107.00	$107.00	$36.38–$89.00	69% above	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$107.00	$107.00	$34.24–$89.00	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$181.00	$181.00	$61.54–$150.56	40% above	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$181.00	$181.00	$57.92–$150.56	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$91.00	$91.00	$30.94–$75.69	58% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$91.00	$91.00	$29.12–$75.69	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$108.00	$108.00	$36.72–$89.83	64% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$108.00	$108.00	$34.56–$89.83	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$107.00	$107.00	$36.38–$89.00	101% above	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$107.00	$107.00	$34.24–$89.00	—	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY 86803	$166.00	$166.00	$56.44–$138.08	108% above	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY 86803	$166.00	$166.00	$53.12–$138.08	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$404.00	$404.00	$137.36–$336.05	226% above	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$404.00	$404.00	$129.28–$336.05	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HSV TYPE 1 AB IGG	$45.00	$45.00	$15.30–$37.43	3% below	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$159.00	$159.00	$54.06–$132.26	243% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV TYPE 1 AB IGG	$45.00	$45.00	$14.40–$37.43	—	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$159.00	$159.00	$50.88–$132.26	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 2 AB IGG	$67.00	$67.00	$22.78–$55.73	16% above	—
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$159.00	$159.00	$54.06–$132.26	176% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 2 AB IGG	$67.00	$67.00	$21.44–$55.73	—	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$159.00	$159.00	$50.88–$132.26	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP HS (CARDIAC)	$110.00	$110.00	$37.40–$91.50	55% above	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$110.00	$110.00	$37.40–$91.50	55% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$110.00	$110.00	$35.20–$91.50	—	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP HS (CARDIAC)	$110.00	$110.00	$35.20–$91.50	—	—
Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE 83090	$175.00	$175.00	$59.50–$145.57	95% above	—
Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE 83090	$175.00	$175.00	$56.00–$145.57	—	—
Insulin blood test CPT 83525 INSULIN LEVEL 83525	$148.00	$148.00	$50.32–$123.11	170% above	—
Insulin blood test CPT 83525 INSULIN	$169.00	$169.00	$57.46–$140.57	209% above	—
Insulin blood test inpatient CPT 83525 INSULIN LEVEL 83525	$148.00	$148.00	$47.36–$123.11	—	—
Insulin blood test inpatient CPT 83525 INSULIN	$169.00	$169.00	$54.08–$140.57	—	—
Iron blood test (serum iron) CPT 83540 IRON 83540	$104.00	$104.00	$35.36–$86.51	102% above	—
Iron blood test (serum iron) inpatient CPT 83540 IRON 83540	$104.00	$104.00	$33.28–$86.51	—	—
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY 83550	$104.00	$104.00	$35.36–$86.51	61% above	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY 83550	$104.00	$104.00	$33.28–$86.51	—	—
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL 80069	$179.00	$179.00	$60.86–$148.89	70% above	—
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL 80069	$179.00	$179.00	$57.28–$148.89	—	—
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$146.00	$146.00	$49.64–$121.44	80% above	—
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$146.00	$146.00	$46.72–$121.44	—	—
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE 83690	$101.00	$101.00	$34.34–$84.01	71% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE 83690	$101.00	$101.00	$32.32–$84.01	—	—
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL 80076	$187.00	$187.00	$63.58–$155.55	83% above	—
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL 80076	$187.00	$187.00	$59.84–$155.55	—	—
Lyme disease antibody test CPT 86618 LYME DISEASE SEROLOGY SERUM 86618.901	$133.20	$133.20	$45.29–$110.80	106% above	—
Lyme disease antibody test CPT 86618 LYMES TOTAL 86618	$185.00	$185.00	$62.90–$153.88	186% above	—
Lyme disease antibody test CPT 86618 LYME ANTIBODY SCREEN	$190.00	$190.00	$64.60–$158.04	194% above	—
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE SEROLOGY SERUM 86618.901	$133.20	$133.20	$42.62–$110.80	—	—
Lyme disease antibody test inpatient CPT 86618 LYMES TOTAL 86618	$185.00	$185.00	$59.20–$153.88	—	—
Lyme disease antibody test inpatient CPT 86618 LYME ANTIBODY SCREEN	$190.00	$190.00	$60.80–$158.04	—	—
Magnesium blood test CPT 83735 MAGNESIUM 83735	$98.00	$98.00	$33.32–$81.52	214% above	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM 83735	$98.00	$98.00	$31.36–$81.52	—	—
Measles (rubeola) antibody test CPT 86765 MEASLES (RUBEOLA) IGM ANTIBODY ACUTE 86765.900	$35.00	$35.00	$11.90–$29.11	4% below	—
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA 86765	$158.00	$158.00	$53.72–$131.42	333% above	—
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES (RUBEOLA) IGM ANTIBODY ACUTE 86765.900	$35.00	$35.00	$11.20–$29.11	—	—
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA 86765	$158.00	$158.00	$50.56–$131.42	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN 86308	$98.00	$98.00	$33.32–$81.52	91% above	—
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN WHOLE BLD-QW 86308	$98.00	$98.00	$33.32–$81.52	91% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN 86308	$98.00	$98.00	$31.36–$81.52	—	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN WHOLE BLD-QW 86308	$98.00	$98.00	$31.36–$81.52	—	—
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL 80055	$26.00	$26.00	$8.84–$21.63	90% below	—
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL 80055	$26.00	$26.00	$8.32–$21.63	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE 84154	$85.00	$85.00	$28.90–$70.70	136% above	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE 84154	$85.00	$85.00	$27.20–$70.70	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$169.00	$169.00	$57.46–$140.57	109% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$169.00	$169.00	$54.08–$140.57	—	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT	$294.00	$294.00	$99.96–$244.55	151% above	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT 83970	$303.00	$303.00	$103.02–$252.04	158% above	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT	$294.00	$294.00	$94.08–$244.55	—	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT 83970	$303.00	$303.00	$96.96–$252.04	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTICOAG PANEL PTT 85730.900	$47.00	$47.00	$15.98–$39.09	20% below	—
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$100.00	$100.00	$34.00–$83.18	70% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTICOAG PANEL PTT 85730.900	$47.00	$47.00	$15.04–$39.09	—	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$100.00	$100.00	$32.00–$83.18	—	—
Progesterone blood test CPT 84144 PROGESTERONE	$162.00	$162.00	$55.08–$134.75	101% above	—
Progesterone blood test CPT 84144 PROGESTERONE 84144	$162.00	$162.00	$55.08–$134.75	101% above	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE 84144	$162.00	$162.00	$51.84–$134.75	—	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$162.00	$162.00	$51.84–$134.75	—	—
Prolactin blood test CPT 84146 PROLACTIN POOL	$162.00	$162.00	$55.08–$134.75	148% above	—
Prolactin blood test CPT 84146 PROLACTIN	$162.00	$162.00	$55.08–$134.75	148% above	—
Prolactin blood test CPT 84146 PROLACTIN 84146	$162.00	$162.00	$55.08–$134.75	148% above	—
Prolactin blood test inpatient CPT 84146 PROLACTIN	$162.00	$162.00	$51.84–$134.75	—	—
Prolactin blood test inpatient CPT 84146 PROLACTIN POOL	$162.00	$162.00	$51.84–$134.75	—	—
Prolactin blood test inpatient CPT 84146 PROLACTIN 84146	$162.00	$162.00	$51.84–$134.75	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 LUPUS ANTICOAG PANEL PT 85610.900	$34.00	$34.00	$11.56–$28.28	12% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 PT INR FINGERSTICK-QW 85610	$64.00	$64.00	$21.76–$53.24	111% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$82.00	$82.00	$27.88–$68.21	171% above	—
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME 85610	$82.00	$82.00	$27.88–$68.21	171% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LUPUS ANTICOAG PANEL PT 85610.900	$34.00	$34.00	$10.88–$28.28	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT INR FINGERSTICK-QW 85610	$64.00	$64.00	$20.48–$53.24	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$82.00	$82.00	$26.24–$68.21	—	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME 85610	$82.00	$82.00	$26.24–$68.21	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$227.00	$227.00	$77.18–$188.82	289% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$227.00	$227.00	$72.64–$188.82	—	—
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A B DIRECT 87804	$100.00	$100.00	$34.00–$83.18	79% above	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A B DIRECT 87804	$100.00	$100.00	$32.00–$83.18	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RPD GROUP A STREP SCREEN 87880	$113.00	$113.00	$38.42–$93.99	111% above	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 GROUP A STREP SCN:THT	$113.00	$113.00	$38.42–$93.99	111% above	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RPD GROUP A STREP SCREEN 87880	$113.00	$113.00	$36.16–$93.99	—	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 GROUP A STREP SCN:THT	$113.00	$113.00	$36.16–$93.99	—	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$62.00	$62.00	$21.08–$51.57	28% above	—
Rheumatoid factor (RF) test CPT 86431 RA FACTOR QUANT 86431	$85.00	$85.00	$28.90–$70.70	75% above	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT 86431	$89.00	$89.00	$30.26–$74.03	84% above	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR PANEL SERUM 86431.900	$99.60	$99.60	$33.86–$82.85	106% above	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$62.00	$62.00	$19.84–$51.57	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RA FACTOR QUANT 86431	$85.00	$85.00	$27.20–$70.70	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT 86431	$89.00	$89.00	$28.48–$74.03	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR PANEL SERUM 86431.900	$99.60	$99.60	$31.87–$82.85	—	—
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA 86762	$116.00	$116.00	$39.44–$96.49	145% above	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG AB 86762.901	$138.00	$138.00	$46.92–$114.79	192% above	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM AB 86762.903	$195.00	$195.00	$66.30–$162.20	312% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA 86762	$116.00	$116.00	$37.12–$96.49	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG AB 86762.901	$138.00	$138.00	$44.16–$114.79	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM AB 86762.903	$195.00	$195.00	$62.40–$162.20	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$42.00	$42.00	$14.28–$34.94	11% above	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$42.00	$42.00	$13.44–$34.94	—	—
Stool ova and parasites exam CPT 87177 OVA AND PARASITES 87177	$123.00	$123.00	$41.82–$102.31	249% above	—
Stool ova and parasites exam CPT 87177 CONCENTRATE O+P	$123.00	$123.00	$41.82–$102.31	249% above	—
Stool ova and parasites exam inpatient CPT 87177 CONCENTRATE O+P	$123.00	$123.00	$39.36–$102.31	—	—
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES 87177	$123.00	$123.00	$39.36–$102.31	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$83.00	$83.00	$28.22–$69.04	135% above	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$83.00	$83.00	$26.56–$69.04	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$78.00	$78.00	$26.52–$64.88	35% above	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$78.00	$78.00	$24.96–$64.88	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$100.00	$100.00	$34.00–$83.18	238% above	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$100.00	$100.00	$32.00–$83.18	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON GOLD TB TEST	$113.00	$113.00	$38.42–$93.99	8% below	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$273.00	$273.00	$92.82–$227.08	121% above	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON GOLD TB TEST	$113.00	$113.00	$36.16–$93.99	—	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$273.00	$273.00	$87.36–$227.08	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.900	$64.00	$64.00	$21.76–$53.24	2% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$217.00	$217.00	$73.78–$180.50	247% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$217.00	$217.00	$73.78–$180.50	247% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.900	$64.00	$64.00	$20.48–$53.24	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$217.00	$217.00	$69.44–$180.50	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$217.00	$217.00	$69.44–$180.50	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB MICROSOM 86376	$23.02	$23.02	$7.83–$19.15	56% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME T1 AB SERUM 86376.900	$93.00	$93.00	$31.62–$77.36	76% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB ANTI TPO 86376	$122.00	$122.00	$41.48–$101.48	131% above	—
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROPEROXIDASE AB	$143.00	$143.00	$48.62–$118.95	171% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID AB MICROSOM 86376	$23.02	$23.02	$7.37–$19.15	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOME T1 AB SERUM 86376.900	$93.00	$93.00	$29.76–$77.36	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID AB ANTI TPO 86376	$122.00	$122.00	$39.04–$101.48	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROPEROXIDASE AB	$143.00	$143.00	$45.76–$118.95	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$160.00	$160.00	$54.40–$133.09	71% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$160.00	$160.00	$51.20–$133.09	—	—
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION 87661	$49.00	$49.00	$16.66–$40.76	2% below	—
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION 87661	$49.00	$49.00	$15.68–$40.76	—	—
Uric acid blood test CPT 84550 URIC ACID	$75.00	$75.00	$25.50–$62.39	72% above	—
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$75.00	$75.00	$25.50–$62.39	72% above	—
Uric acid blood test inpatient CPT 84550 URIC ACID	$75.00	$75.00	$24.00–$62.39	—	—
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$75.00	$75.00	$24.00–$62.39	—	—
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$78.00	$78.00	$26.52–$64.88	57% above	—
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$78.00	$78.00	$24.96–$64.88	—	—
Urinalysis with microscope exam, manual CPT 81000 UA NON-AUTOMATED W MICROS81000	$71.00	$71.00	$24.14–$59.06	85% above	—
Urinalysis with microscope exam, manual inpatient CPT 81000 UA NON-AUTOMATED W MICROS81000	$71.00	$71.00	$22.72–$59.06	—	—
Urinalysis without microscope exam, automated CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$3.29	$3.29	$1.12–$2.74	87% below	—
Urinalysis without microscope exam, automated CPT 81003 UA WITHOUT MICRO	$36.00	$36.00	$12.24–$29.94	41% above	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$55.00	$55.00	$18.70–$45.75	115% above	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE AUTO NO MICRO SGL ANALYT	$3.29	$3.29	$1.05–$2.74	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 UA WITHOUT MICRO	$36.00	$36.00	$11.52–$29.94	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$55.00	$55.00	$17.60–$45.75	—	—
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$132.00	$132.00	$44.88–$109.80	140% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$132.00	$132.00	$42.24–$109.80	—	—
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST 81025	$134.00	$134.00	$45.56–$111.46	244% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST 81025	$134.00	$134.00	$42.88–$111.46	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$134.00	$134.00	$45.56–$111.46	51% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$134.00	$134.00	$42.88–$111.46	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$68.00	$68.00	$23.12–$56.56	30% below	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$234.00	$234.00	$79.56–$194.64	141% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$68.00	$68.00	$21.76–$56.56	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$234.00	$234.00	$74.88–$194.64	—	—
Zinc blood test CPT 84630 ZINC 84630.900	$122.00	$122.00	$41.48–$101.48	306% above	—
Zinc blood test inpatient CPT 84630 ZINC 84630.900	$122.00	$122.00	$39.04–$101.48	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$145.00	$145.00	$49.30–$120.61	57% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$145.00	$145.00	$46.40–$120.61	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Cardioversion, elective (restoring heart rhythm) CPT 92960 ED 92960 CARDIOVERSION	$1,089.00	$1,089.00	$250.00–$905.83	6% above	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 ED 92960 CARDIOVERSION	$1,089.00	$1,089.00	$348.48–$905.83	—	—
Colonoscopy with polyp removal CPT 45385 COLON WREM TUMOR SNARE	$2,573.00	$2,573.00	$874.82–$2,140.22	106% above	—
Colonoscopy with polyp removal inpatient CPT 45385 COLON WREM TUMOR SNARE	$2,573.00	$2,573.00	$823.36–$2,140.22	—	—
Colonoscopy with tissue sample CPT 45380 SURG 45380 COLONOSCOPY WBX	$2,293.00	$2,293.00	$779.62–$1,907.32	83% above	—
Colonoscopy with tissue sample inpatient CPT 45380 SURG 45380 COLONOSCOPY WBX	$2,293.00	$2,293.00	$733.76–$1,907.32	—	—
Colonoscopy, diagnostic CPT 45378 SURG 45378 COLONOSCOPY FLEXIBLE	$1,996.00	$1,996.00	$678.64–$1,660.27	65% above	—
Colonoscopy, diagnostic inpatient CPT 45378 SURG 45378 COLONOSCOPY FLEXIBLE	$1,996.00	$1,996.00	$638.72–$1,660.27	—	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEX SIG DIAG	$1,150.00	$1,150.00	$391.00–$956.57	35% above	—
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 FLEX SIG DIAG	$1,150.00	$1,150.00	$368.00–$956.57	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$610.00	$610.00	$207.40–$507.40	112% above	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$610.00	$610.00	$195.20–$507.40	—	—
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 <	$545.00	$545.00	$185.30–$453.33	20% above	—
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 <	$545.00	$545.00	$174.40–$453.33	—	—
Nail removal (partial or complete), one nail CPT 11730 ED 11730 REMV OF NAIL PLATE	$242.00	$242.00	$82.28–$250.00	13% below	—
Nail removal (partial or complete), one nail inpatient CPT 11730 ED 11730 REMV OF NAIL PLATE	$242.00	$242.00	$77.44–$201.30	—	—
Removal of a foreign object under the skin, simple CPT 10120 ED 10120 INC&REMV FB SMPL	$550.00	$550.00	$187.00–$457.49	38% above	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED 10120 INC&REMV FB SMPL	$550.00	$550.00	$176.00–$457.49	—	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 SCREEN COLON WO HI RISK	$2,012.00	$2,012.00	$684.08–$1,673.58	84% above	—
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 SCREEN COLON WO HI RISK	$2,012.00	$2,012.00	$643.84–$1,673.58	—	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 SCREEN COLON WHI RISK	$2,012.00	$2,012.00	$684.08–$1,673.58	71% above	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 SCREEN COLON WHI RISK	$2,012.00	$2,012.00	$643.84–$1,673.58	—	—
Short arm cast (elbow to hand) CPT 29075 ED 29075 APPL CAST FOREARM ARM	$350.00	$350.00	$119.00–$291.13	48% above	—
Short arm cast (elbow to hand) inpatient CPT 29075 ED 29075 APPL CAST FOREARM ARM	$350.00	$350.00	$112.00–$291.13	—	—
Short arm splint (forearm and hand) CPT 29125 ED 29125 APPL SPLINT FOREARM	$112.00	$112.00	$38.08–$250.00	44% below	—
Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM	$112.00	$112.00	$35.84–$93.16	—	—
Short leg cast (below the knee) CPT 29405 ED 29405 APPL CAST SHORT LEG	$172.00	$172.00	$58.48–$250.00	37% below	—
Short leg cast (below the knee) inpatient CPT 29405 ED 29405 APPL CAST SHORT LEG	$172.00	$172.00	$55.04–$143.07	—	—
Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$133.00	$133.00	$45.22–$250.00	40% below	—
Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$133.00	$133.00	$42.56–$110.63	—	—
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<	$408.00	$408.00	$138.72–$339.37	51% above	—
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<	$408.00	$408.00	$130.56–$339.37	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$230.00	$230.00	$78.20–$250.00	68% below	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$230.00	$230.00	$73.60–$191.31	—	—
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	$421.00	$421.00	$143.14–$350.19	37% above	—
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	$421.00	$421.00	$134.72–$350.19	—	—
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<	$422.00	$422.00	$143.48–$351.02	54% above	—
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<	$422.00	$422.00	$135.04–$351.02	—	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 SURG 11102 TANGENTIAL BX SKIN SINGLE LESION	$107.00	$107.00	$36.38–$89.00	56% below	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 SURG 11102 TANGENTIAL BX SKIN SINGLE LESION	$107.00	$107.00	$34.24–$89.00	—	—
Thoracentesis with imaging guidance CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$316.00	$316.00	$107.44–$262.85	65% below	—
Thoracentesis with imaging guidance inpatient CPT 32555 SURG 32555 THORACENTESIS W IMAGING	$316.00	$316.00	$101.12–$262.85	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$107.00	$107.00	$36.38–$250.00	65% below	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$107.00	$107.00	$34.24–$89.00	—	—
Upper endoscopy (EGD) with biopsy CPT 43239 EGD WBIOP SING MULT	$1,699.00	$1,699.00	$577.66–$1,413.23	61% above	—
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD WBIOP SING MULT	$1,699.00	$1,699.00	$543.68–$1,413.23	—	—
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD WREM RUMOR-SNARE	$3,068.00	$3,068.00	$1,043.12–$2,551.96	74% above	—
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD WREM RUMOR-SNARE	$3,068.00	$3,068.00	$981.76–$2,551.96	—	—
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAG	$1,955.00	$1,955.00	$664.70–$1,626.17	103% above	—
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAG	$1,955.00	$1,955.00	$625.60–$1,626.17	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 ED 11042 DEBR SKN SUBQ TISS 20 CM <	$175.00	$175.00	$59.50–$250.00	61% below	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 ED 11042 DEBR SKN SUBQ TISS 20 CM <	$175.00	$175.00	$56.00–$145.57	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 2-4 HRS	$1,154.00	$1,154.00	$392.36–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 0-2 HRS	$1,154.00	$1,154.00	$392.36–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 4-6 HRS	$1,154.00	$1,154.00	$392.36–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 6-8 HRS	$1,154.00	$1,154.00	$392.36–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN >8 HRS	$1,154.00	$1,154.00	$392.36–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 BLOOD ADMIN 4-6 HR	$1,154.00	$1,154.00	$250.00–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 BLOOD ADMIN 0-2 HR	$1,154.00	$1,154.00	$250.00–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 BLOOD ADMIN 2-4 HR	$1,154.00	$1,154.00	$250.00–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 BLOOD ADMIN >8 HR	$1,154.00	$1,154.00	$250.00–$959.90	62% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ED 36430 BLOOD ADMIN 6-8 HR	$1,154.00	$1,154.00	$250.00–$959.90	62% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 2-4 HRS	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 BLOOD ADMIN 4-6 HR	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 BLOOD ADMIN 0-2 HR	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 BLOOD ADMIN 2-4 HR	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 BLOOD ADMIN >8 HR	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 ED 36430 BLOOD ADMIN 6-8 HR	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN >8 HRS	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 0-2 HRS	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 6-8 HRS	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 4-6 HRS	$1,154.00	$1,154.00	$369.28–$959.90	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB SUBSEQ TX	$67.00	$67.00	$22.78–$55.73	43% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB INITIAL TX	$135.00	$135.00	$45.90–$112.29	15% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ED 94640 NON OR PRES'D INHALATION TX	$135.00	$135.00	$45.90–$250.00	15% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ED 94640 NEBULIZER TREATMENT	$171.00	$171.00	$58.14–$250.00	46% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB SUBSEQ TX	$67.00	$67.00	$21.44–$55.73	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB INITIAL TX	$135.00	$135.00	$43.20–$112.29	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ED 94640 NON OR PRES'D INHALATION TX	$135.00	$135.00	$43.20–$112.29	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ED 94640 NEBULIZER TREATMENT	$171.00	$171.00	$54.72–$142.24	—	—
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR	$660.00	$660.00	$224.40–$548.99	29% above	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR	$660.00	$660.00	$211.20–$548.99	—	—
Critical care, first 30 to 74 minutes CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$2,085.00	$2,085.00	$250.00–$1,734.30	35% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$2,085.00	$2,085.00	$667.20–$1,734.30	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG 12 LEAD W INTERP & REPORT	$225.00	$225.00	$76.50–$187.16	72% above	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG 12 LEAD W INTERP & REPORT	$225.00	$225.00	$72.00–$187.16	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING WO INTERP	$213.00	$213.00	$72.42–$177.17	24% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD TRACING ONLY	$361.00	$361.00	$122.74–$300.28	110% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING WO INTERP	$213.00	$213.00	$68.16–$177.17	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD TRACING ONLY	$361.00	$361.00	$115.52–$300.28	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED 99281 EMER CASE LEVEL I	$189.00	$189.00	$64.26–$250.00	2% below	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED 99281 EMER CASE LEVEL I	$189.00	$189.00	$60.48–$157.21	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED 99282 EMER CASE LEVEL II	$302.00	$302.00	$102.68–$251.20	22% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED 99282 EMER CASE LEVEL II	$302.00	$302.00	$96.64–$251.20	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED 99283 EMER CASE LEVEL III	$458.00	$458.00	$155.72–$380.96	16% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED 99283 EMER CASE LEVEL III	$458.00	$458.00	$146.56–$380.96	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED 99284 EMER CASE LEVEL IV	$763.00	$763.00	$250.00–$634.66	20% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED 99284 EMER CASE LEVEL IV	$763.00	$763.00	$244.16–$634.66	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED 99285 EMER CASE LEVEL V	$1,229.00	$1,229.00	$250.00–$1,022.28	30% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED 99285 EMER CASE LEVEL V	$1,229.00	$1,229.00	$393.28–$1,022.28	—	—
Family therapy with the patient, 50 minutes CPT 90847 PSYCH THERAPY FAMILY WPATIENT	$234.00	$234.00	$79.56–$194.64	20% above	—
Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCH THERAPY FAMILY WPATIENT	$234.00	$234.00	$74.88–$194.64	—	—
Family therapy without the patient, 50 minutes CPT 90846 PSYCH THERAPY FAMILY WO PATIENT	$225.00	$225.00	$76.50–$187.16	23% above	—
Family therapy without the patient, 50 minutes inpatient CPT 90846 PSYCH THERAPY FAMILY WO PATIENT	$225.00	$225.00	$72.00–$187.16	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INITIAL 31-60MINS	$568.00	$568.00	$193.12–$472.46	108% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$568.00	$568.00	$193.12–$472.46	108% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRAT INITIAL 31-60MINS	$568.00	$568.00	$181.76–$472.46	—	—
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	$568.00	$568.00	$181.76–$472.46	—	—
IV infusion of a medicine, first hour CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$422.00	$422.00	$143.48–$351.02	29% above	—
IV infusion of a medicine, first hour CPT 96365 INFUSION TX PROP DX 1HR 1V	$422.00	$422.00	$143.48–$351.02	29% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 INFUSION TX PROP DX 1HR 1V	$422.00	$422.00	$135.04–$351.02	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$422.00	$422.00	$135.04–$351.02	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$132.00	$132.00	$44.88–$250.00	71% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SC IM INJECTION	$132.00	$132.00	$44.88–$109.80	71% above	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SC IM INJECTION	$132.00	$132.00	$42.24–$109.80	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$132.00	$132.00	$42.24–$109.80	—	—
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCH DIAGNOSTIC EVAL	$287.00	$287.00	$97.58–$238.73	12% above	—
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCH DIAGNOSTIC EVAL	$287.00	$287.00	$91.84–$238.73	—	—
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$140.00	$140.00	$47.60–$116.45	93% above	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$140.00	$140.00	$44.80–$116.45	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$80.00	$80.00	$27.20–$66.54	28% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$80.00	$80.00	$25.60–$66.54	—	—
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY 97165	$276.00	$276.00	$93.84–$229.58	63% above	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY 97165	$276.00	$276.00	$88.32–$229.58	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$278.00	$278.00	$94.52–$231.24	39% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$278.00	$278.00	$88.96–$231.24	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY 97161	$280.00	$280.00	$95.20–$232.90	66% above	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY 97161	$280.00	$280.00	$89.60–$232.90	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$287.00	$287.00	$97.58–$238.73	55% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$287.00	$287.00	$91.84–$238.73	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN 97140	$123.00	$123.00	$41.82–$102.31	49% above	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN 97140	$123.00	$123.00	$39.36–$102.31	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN 97110	$119.00	$119.00	$40.46–$98.98	32% above	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN 97110	$119.00	$119.00	$38.08–$98.98	—	—
Psychiatric evaluation with medical services CPT 90792 PSYCH DX EVAL W MED SVCS	$321.00	$321.00	$109.14–$267.01	61% above	—
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DX EVAL W MED SVCS	$321.00	$321.00	$102.72–$267.01	—	—
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 PSYCH TEST EVAL 1ST HR 96130	$249.00	$249.00	$84.66–$207.12	50% above	—
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 PSYCH TEST EVAL 1ST HR 96130	$249.00	$249.00	$79.68–$207.12	—	—
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES	$113.00	$113.00	$38.42–$93.99	1% below	—
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES	$113.00	$113.00	$36.16–$93.99	—	—
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY W/PATIENT 38-52 MINUTES	$151.00	$151.00	$51.34–$125.60	1% above	—
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY W/PATIENT 38-52 MINUTES	$151.00	$151.00	$48.32–$125.60	—	—
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY W/PATIENT 53+ MINUTES	$186.00	$186.00	$63.24–$154.71	3% above	—
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY W/PATIENT 53+ MINUTES	$186.00	$186.00	$59.52–$154.71	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 TX RM 99212 TREATMENT RM LEVEL II	$1,076.00	$1,076.00	$365.84–$895.02	1219% above	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 TX RM 99212 TREATMENT RM LEVEL II	$1,076.00	$1,076.00	$344.32–$895.02	—	—
Speech and language evaluation CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$532.00	$532.00	$180.88–$442.52	66% above	—
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$532.00	$532.00	$170.24–$442.52	—	—
Speech therapy session, individual CPT 92507 SPEECH THERAPY TX 92507	$354.00	$354.00	$120.36–$294.46	68% above	—
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TX 92507	$354.00	$354.00	$113.28–$294.46	—	—
Spirometry (breathing test) CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$190.00	$190.00	$64.60–$158.04	20% above	—
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$190.00	$190.00	$60.80–$158.04	—	—
Spirometry before and after a bronchodilator CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$434.00	$434.00	$147.56–$361.00	49% above	—
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT SCREEN SPIROMETRY (WITH BD)	$434.00	$434.00	$138.88–$361.00	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA15 MIN 97530	$125.00	$125.00	$42.50–$103.98	61% above	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA15 MIN 97530	$125.00	$125.00	$40.00–$103.98	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$244.00	$244.00	$82.96–$202.96	15% above	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY NURSING	$264.00	$264.00	$89.76–$219.60	25% above	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY COMPLEX NURSING	$1,034.00	$1,034.00	$351.56–$860.08	389% above	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY COMPLEX	$1,034.00	$1,034.00	$351.56–$860.08	389% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$244.00	$244.00	$78.08–$202.96	—	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY NURSING	$264.00	$264.00	$84.48–$219.60	—	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY COMPLEX NURSING	$1,034.00	$1,034.00	$330.88–$860.08	—	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY COMPLEX	$1,034.00	$1,034.00	$330.88–$860.08	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2.5-18.5 LF-MCG/0.5ML	$95.66	$95.66	$32.52–$79.57	22% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2.5-18.5 LF-MCG/0.5ML	$95.66	$95.66	$30.61–$79.57	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$66.00	$66.00	$22.44–$54.90	61% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN 1 VACCINE	$66.00	$66.00	$22.44–$54.90	61% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN 1 VACCINE	$66.00	$66.00	$21.12–$54.90	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$66.00	$66.00	$21.12–$54.90	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$37.00	$37.00	$12.58–$30.78	47% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$37.00	$37.00	$12.58–$30.78	47% above	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ED 90472 IMMUN ADMIN EA ADDL VACCINE	$37.00	$37.00	$11.84–$30.78	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$37.00	$37.00	$11.84–$30.78	—	—

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8074/410724034_kittson-memorial-hospital-association_standardcharges.csv