Hospital

Choctaw Memorial Hospital

Listed in its price file as “Choctaw County-City of Hugo Hospital Trust Authority”.

Choctaw Memorial Hospital in Hugo, OK publishes cash prices for 231 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Oklahoma median for 155 of 227 procedures and above it for 66. By typical cash price it ranks #13 of 43 Oklahoma hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1405 E. Kirk Street, Hugo, OK, 74743 Collected Sep 27, 2026 Source price file (580) 317-9500

Acute care hospital Emergency department CMS star rating 1 of 5 CCN 370100 · CMS hospital register

Scans and imaging

ProcedureCash price List priceInsurers payvs OklahomaOff list
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W/WO CONTRAST $785.00 $1,570.00 $275.00–$362.10 48% below 50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W/WO CONTRAST $785.00 $1,570.00 $275.00–$362.10 — 50%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CALCIUM SCORING $90.00 $180.00 $275.00 10% below 50%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CALCIUM SCORING $90.00 $180.00 $275.00 — 50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST $1,321.00 $2,642.00 $258.89–$275.00 1% below 50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT RENAL FOR CALCULI $1,321.00 $2,642.00 $258.89–$275.00 1% below 50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT RENAL FOR CALCULI $1,321.00 $2,642.00 $258.89–$275.00 — 50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST $1,321.00 $2,642.00 $258.89–$275.00 — 50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS WITH CONTRAST $1,502.00 $3,004.00 $275.00–$428.06 7% below 50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS WITH CONTRAST $1,502.00 $3,004.00 $275.00–$428.06 — 50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN W/WO & PELVIS W CONTRAST $1,576.00 $3,152.00 $275.00–$479.22 17% below 50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN/PELVIS W/WO CONTRAST $1,631.50 $3,263.00 $275.00–$479.22 14% below 50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN W/WO & PELVIS W CONTRAST $1,576.00 $3,152.00 $275.00–$479.22 — 50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN/PELVIS W/WO CONTRAST $1,631.50 $3,263.00 $275.00–$479.22 — 50%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST $1,029.50 $2,059.00 $275.00–$325.77 8% below 50%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CONTRAST $1,029.50 $2,059.00 $275.00–$325.77 — 50%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST $1,029.50 $2,059.00 $192.29–$275.00 2% above 50%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST $1,029.50 $2,059.00 $192.29–$275.00 — 50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST $610.00 $1,220.00 $179.46–$275.00 31% below 50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST $610.00 $1,220.00 $179.46–$275.00 — 50%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST $790.00 $1,580.00 $149.15–$275.00 16% below 50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST $790.00 $1,580.00 $149.15–$275.00 — 50%
CT scan of the head with contrast CPT 70460 CT HEAD W/ CONTRAST $790.00 $1,580.00 $207.75–$275.00 35% below 50%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/ CONTRAST $790.00 $1,580.00 $207.75–$275.00 — 50%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST $790.00 $1,580.00 $243.62–$275.00 38% below 50%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST $790.00 $1,580.00 $243.62–$275.00 — 50%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST $829.00 $1,658.00 $181.19–$275.00 18% below 50%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST $829.00 $1,658.00 $181.19–$275.00 — 50%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST $664.50 $1,329.00 $182.07–$275.00 33% below 50%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST $664.50 $1,329.00 $182.07–$275.00 — 50%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST $1,029.50 $2,059.00 $275.00–$318.17 5% below 50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST $1,029.50 $2,059.00 $275.00–$318.17 — 50%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US CAROTID $724.50 $1,449.00 $150.00–$185.89 47% above 50%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US CAROTID $724.50 $1,449.00 $150.00–$185.89 — 50%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS $105.50 $211.00 $45.54–$55.00 11% below 50%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2 VIEWS $105.50 $211.00 $45.54–$55.00 — 50%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW $90.00 $180.00 $35.21–$55.00 49% below 50%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW $90.00 $180.00 $35.21–$55.00 — 50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL $202.00 $404.00 $80.00–$147.20 50% below 50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL $202.00 $404.00 $80.00–$147.20 — 50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST $699.50 $1,399.00 $187.26–$275.00 27% below 50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST $699.50 $1,399.00 $187.26–$275.00 — 50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX W/ CONTRAST $715.00 $1,430.00 $233.81–$275.00 36% below 50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX W/ CONTRAST $715.00 $1,430.00 $233.81–$275.00 — 50%
Diagnostic mammogram, both breasts both sides CPT 77066 MM MAMMOGRAM W.R. DIGITAL DIAG. BILAT $45.00 $90.00 $72.00–$213.71 — 50%
Diagnostic mammogram, both breasts both sides CPT 77066 MM MAMMOGRAM OPW DIGITAL DIAG. BILAT $50.00 $100.00 $72.00–$213.71 — 50%
Diagnostic mammogram, both breasts both sides CPT 77066 MM MAMMOGRAM DIGITAL DIAG. BILAT $235.50 $471.00 $72.00–$213.71 — 50%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMOGRAM OPW DIGITAL DIAG. RIGHT $39.00 $78.00 $72.00–$169.56 79% below 50%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMOGRAM OPW DIGITAL DIAG. LEFT $39.00 $78.00 $72.00–$169.56 79% below 50%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMOGRAM W.R. DIGITAL DIAG. RIGHT $45.00 $90.00 $72.00–$169.56 75% below 50%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMOGRAM W.R. DIGITAL DIAG. LEFT $45.00 $90.00 $72.00–$169.56 75% below 50%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMOGRAM DIGITAL DIAG. RIGHT $185.50 $371.00 $72.00–$169.56 2% above 50%
Diagnostic mammogram, one breast one side CPT 77065 MM MAMMOGRAM DIGITAL DIAG. LEFT $185.50 $371.00 $72.00–$169.56 2% above 50%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERIAL DUPLEX LOWER EXT BILAT $684.00 $1,368.00 $150.00–$232.86 — 50%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US ARTERIAL DUPLEX LOWER EXT BILAT $684.00 $1,368.00 $150.00–$232.86 — 50%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS DUPLEX EXTREMITIES BIL $684.00 $1,368.00 $150.00–$182.96 13% above 50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS DUPLEX EXTREMITIES BIL $684.00 $1,368.00 $150.00–$182.96 — 50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHO COMPLETE $1,050.00 $2,100.00 $138.00–$193.16 3% below 50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHO COMPLETE $1,050.00 $2,100.00 $138.00–$193.16 — 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER $202.00 $404.00 $80.00–$119.55 48% below 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SOFT TISSUE LOWER BACK $202.00 $404.00 $80.00–$119.55 48% below 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS $202.00 $404.00 $80.00–$119.55 48% below 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALLBLADDER $202.00 $404.00 $80.00–$119.55 48% below 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER $202.00 $404.00 $80.00–$119.55 — 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SOFT TISSUE LOWER BACK $202.00 $404.00 $80.00–$119.55 — 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS $202.00 $404.00 $80.00–$119.55 — 50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALLBLADDER $202.00 $404.00 $80.00–$119.55 — 50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED (NON-OB) $92.50 $185.00 $66.84–$80.00 69% below 50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED (NON-OB) $92.50 $185.00 $66.84–$80.00 — 50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE (NON-OB) $208.50 $417.00 $80.00–$143.40 57% below 50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE (NON-OB) $208.50 $417.00 $80.00–$143.40 — 50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB LEVEL 1, 2-3 TRIMESTER $202.00 $404.00 $80.00–$184.61 52% below 50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB LEVEL 1, 2-3 TRIMESTER $202.00 $404.00 $80.00–$184.61 — 50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED $202.00 $404.00 $80.00–$111.11 42% below 50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED $202.00 $404.00 $80.00–$111.11 — 50%
Screening mammogram, both breasts both sides CPT 77067 MM MAMMOGRAM OPW DIGITAL SCREEN BILAT $41.50 $83.00 $72.00–$173.24 — 50%
Screening mammogram, both breasts both sides CPT 77067 MM MAMMOGRAM W.R. DIGITAL SCREEN BILAT $45.00 $90.00 $72.00–$173.24 — 50%
Screening mammogram, both breasts both sides CPT 77067 MM MAMMOGRAM DIGITAL SCREEN BILATERAL $174.50 $349.00 $72.00–$173.24 — 50%
Screening mammogram, both breasts CPT 77067 MM MAMMOGRAM CASH SPECIAL $35.00 $70.00 $72.00–$173.24 78% below 50%
Screening mammogram, both breasts CPT 77067 MM MAMMOGRAM OCTOBER SPECIAL $75.00 $150.00 $72.00–$173.24 53% below 50%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON-OB $202.00 $404.00 $80.00–$162.30 47% below 50%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON-OB $202.00 $404.00 $80.00–$162.30 — 50%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL $202.00 $404.00 $80.00–$126.62 29% below 50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL $202.00 $404.00 $80.00–$126.62 — 50%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE $309.50 $619.00 $80.00–$158.58 41% below 50%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE $309.50 $619.00 $80.00–$158.58 — 50%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM AND CONTENTS $202.00 $404.00 $80.00–$136.97 41% below 50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM AND CONTENTS $202.00 $404.00 $80.00–$136.97 — 50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE OF HEAD & NECK $202.00 $404.00 $80.00–$150.14 50% below 50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID $202.00 $404.00 $80.00–$150.14 50% below 50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE OF HEAD & NECK $202.00 $404.00 $80.00–$150.14 — 50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID $202.00 $404.00 $80.00–$150.14 — 50%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW $90.00 $180.00 $40.47–$55.00 47% below 50%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW $90.00 $180.00 $40.47–$55.00 — 50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L-SPINE 2-3 VIEWS $169.50 $339.00 $53.88–$55.00 20% below 50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 L-SPINE 2-3 VIEWS $169.50 $339.00 $53.88–$55.00 — 50%
X-ray of the lower back, 4 or more views CPT 72110 L-SPINE (4+) COMPLETE $169.50 $339.00 $55.00–$69.05 42% below 50%
X-ray of the lower back, 4 or more views inpatient CPT 72110 L-SPINE (4+) COMPLETE $169.50 $339.00 $55.00–$69.05 — 50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 T-SPINE 2 VIEWS $169.50 $339.00 $44.54–$55.00 10% below 50%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 T-SPINE 2 VIEWS $169.50 $339.00 $44.54–$55.00 — 50%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL (3+) COMPLETE $90.00 $180.00 $51.41–$55.00 45% below 50%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL (3+) COMPLETE $90.00 $180.00 $51.41–$55.00 — 50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C-SPINE 2-3 VIEWS $136.50 $273.00 $53.45–$55.00 31% below 50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C-SPINE 2-3 VIEWS $136.50 $273.00 $53.45–$55.00 — 50%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1-2 VIEWS $169.50 $339.00 $37.79–$55.00 11% below 50%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1-2 VIEWS $169.50 $339.00 $37.79–$55.00 — 50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND COCCYX (2+) VIEWS $90.00 $180.00 $43.94–$55.00 49% below 50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM AND COCCYX (2+) VIEWS $90.00 $180.00 $43.94–$55.00 — 50%

Lab tests

ProcedureCash price List priceInsurers payvs OklahomaOff list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT(SGPT) $26.50 $53.00 $5.30–$6.66 18% below 50%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT(SGPT) $26.50 $53.00 $5.30–$6.66 — 50%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT $26.50 $53.00 $5.18–$6.50 30% below 50%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT $26.50 $53.00 $5.18–$6.50 — 50%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PROFILE $132.00 $264.00 $47.63–$59.89 29% below 50%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PROFILE $132.00 $264.00 $47.63–$59.89 — 50%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT $16.00 $32.00 $5.22–$6.57 35% below 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE QUANTITATIVE $16.00 $32.00 $5.22–$6.57 35% below 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE PEDIATRIC, 6+YRS $80.00 $160.00 $5.22–$6.57 223% above 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE PEDIATRIC, 0-3YRS $80.00 $160.00 $5.22–$6.57 223% above 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, SUMMER-GRASS $160.00 $320.00 $5.22–$6.57 545% above 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, SPRING-TREE $192.00 $384.00 $5.22–$6.57 675% above 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FALL-WEED $208.00 $416.00 $5.22–$6.57 739% above 50%
Allergy blood test, specific IgE, per allergen CPT 86003 charge component for ALLERGEN PROFILE $400.00 $800.00 $5.22–$6.57 1514% above 50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE REGIONAL ZONE 7 $480.00 $960.00 $5.22–$6.57 1836% above 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT $16.00 $32.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE QUANTITATIVE $16.00 $32.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE PEDIATRIC, 6+YRS $80.00 $160.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE PEDIATRIC, 0-3YRS $80.00 $160.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, SUMMER-GRASS $160.00 $320.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, SPRING-TREE $192.00 $384.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FALL-WEED $208.00 $416.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 charge component for ALLERGEN PROFILE $400.00 $800.00 $5.22–$6.57 — 50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE REGIONAL ZONE 7 $480.00 $960.00 $5.22–$6.57 — 50%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANTI CCP, IgG/IgA ANTIBODIES $29.00 $58.00 $12.95–$16.28 59% below 50%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 ANTI CCP, IgG/IgA ANTIBODIES $29.00 $58.00 $12.95–$16.28 — 50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA, DIRECT $25.00 $50.00 $12.90–$15.20 42% below 50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA W/REFLEX CONFIRMATION $25.00 $50.00 $12.90–$15.20 42% below 50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA ANTIBODIES $25.00 $50.00 $12.90–$15.20 42% below 50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA ANTIBODIES $25.00 $50.00 $12.90–$15.20 — 50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA W/REFLEX CONFIRMATION $25.00 $50.00 $12.90–$15.20 — 50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA, DIRECT $25.00 $50.00 $12.90–$15.20 — 50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP - LABCORP $148.00 $296.00 $39.26–$42.69 32% above 50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-proBNP $148.00 $296.00 $39.26–$42.69 32% above 50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 XPAND - NT-proBNP $148.00 $296.00 $39.26–$42.69 32% above 50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP - LABCORP $148.00 $296.00 $39.26–$42.69 — 50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 XPAND - NT-proBNP $148.00 $296.00 $39.26–$42.69 — 50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-proBNP $148.00 $296.00 $39.26–$42.69 — 50%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL $62.00 $124.00 $8.46–$10.65 94% above 50%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL $62.00 $124.00 $8.46–$10.65 — 50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY SURGICAL 88305 $101.00 $202.00 $22.20–$77.84 21% below 50%
Blood culture for bacteria CPT 87040 CULTURE BLOOD $47.00 $94.00 $1.32–$12.98 24% below 50%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD $47.00 $94.00 $1.32–$12.98 — 50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE $5.00 $10.00 $2.70–$8.57 47% below 50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE $5.00 $10.00 $2.70–$8.57 — 50%
Blood glucose (sugar) test CPT 82947 GLUCOSE $29.00 $58.00 $3.93–$4.93 14% above 50%
Blood glucose (sugar) test CPT 82947 GTT 2HR (75g) $63.00 $126.00 $3.93–$4.93 149% above 50%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE $29.00 $58.00 $3.93–$4.93 — 50%
Blood glucose (sugar) test inpatient CPT 82947 GTT 2HR (75g) $63.00 $126.00 $3.93–$4.93 — 50%
Blood lead test CPT 83655 LEAD URINE $38.50 $77.00 $12.11–$15.22 9% below 50%
Blood lead test CPT 83655 LEAD, BLOOD (ADULT) $38.50 $77.00 $12.11–$15.22 9% below 50%
Blood lead test CPT 83655 LEAD, BLOOD (PEDIATRIC) $38.50 $77.00 $12.11–$15.22 9% below 50%
Blood lead test inpatient CPT 83655 LEAD, BLOOD (PEDIATRIC) $38.50 $77.00 $12.11–$15.22 — 50%
Blood lead test inpatient CPT 83655 LEAD URINE $38.50 $77.00 $12.11–$15.22 — 50%
Blood lead test inpatient CPT 83655 LEAD, BLOOD (ADULT) $38.50 $77.00 $12.11–$15.22 — 50%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY SERUM $29.00 $58.00 $7.52–$9.44 28% below 50%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 PREGNANCY SERUM $29.00 $58.00 $7.52–$9.44 — 50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO GROUP $82.00 $164.00 $2.99–$3.75 44% above 50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB ABO GROUP $82.00 $164.00 $2.99–$3.75 — 50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN, QUANT $22.00 $44.00 $5.18–$6.51 19% below 50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN, QUANT $22.00 $44.00 $5.18–$6.51 — 50%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE PCR $107.00 $214.00 $37.27–$45.24 19% above 50%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE PCR $107.00 $214.00 $37.27–$45.24 — 50%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 $106.50 $213.00 $2.81–$26.16 17% above 50%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 $106.50 $213.00 $2.81–$26.16 — 50%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA -125 $49.00 $98.00 $2.81–$26.16 20% below 50%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA -125 $49.00 $98.00 $2.81–$26.16 — 50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 charge forCOVID-19 TWO DAY TAT - LABCORP $37.50 $75.00 $51.31 49% below 50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 - LABCORP $102.50 $205.00 $51.31 40% above 50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 ID NOW SARS-COV-2 RNA, PCR RAPID $102.50 $205.00 $51.31 40% above 50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 charge forCOVID-19 TWO DAY TAT - LABCORP $37.50 $75.00 $51.31 — 50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 ID NOW SARS-COV-2 RNA, PCR RAPID $102.50 $205.00 $51.31 — 50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 - LABCORP $102.50 $205.00 $51.31 — 50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA (ONLY), NAAT $94.50 $189.00 $35.90–$44.14 21% above 50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA (ONLY), NAAT $94.50 $189.00 $35.90–$44.14 — 50%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE $76.50 $153.00 $13.39–$16.85 17% above 50%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE $76.50 $153.00 $13.39–$16.85 — 50%
Complete blood count (CBC) with differential CPT 85025 AP-CBC $30.00 $60.00 $7.77–$9.77 34% below 50%
Complete blood count (CBC) with differential CPT 85025 charge Automated CBC w/Diff $30.00 $60.00 $7.77–$9.77 34% below 50%
Complete blood count (CBC) with differential inpatient CPT 85025 AP-CBC $30.00 $60.00 $7.77–$9.77 — 50%
Complete blood count (CBC) with differential inpatient CPT 85025 charge Automated CBC w/Diff $30.00 $60.00 $7.77–$9.77 — 50%
Complete blood count (CBC), no differential CPT 85027 charge for HEMOGRAM $30.00 $60.00 $6.47–$8.14 1% above 50%
Complete blood count (CBC), no differential inpatient CPT 85027 charge for HEMOGRAM $30.00 $60.00 $6.47–$8.14 — 50%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL $88.00 $176.00 $7.80–$13.29 94% above 50%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL $88.00 $176.00 $7.80–$13.29 — 50%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER $99.00 $198.00 $1.18–$12.80 9% above 50%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER $99.00 $198.00 $1.18–$12.80 — 50%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE SULFATE $50.00 $100.00 $22.23–$27.96 34% below 50%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE SULFATE $50.00 $100.00 $22.23–$27.96 — 50%
Estradiol blood test CPT 82670 ESTRADIOL (E2) $68.50 $137.00 $27.94–$35.14 8% below 50%
Estradiol blood test inpatient CPT 82670 ESTRADIOL (E2) $68.50 $137.00 $27.94–$35.14 — 50%
FSH (follicle-stimulating hormone) test CPT 83001 FSH $54.50 $109.00 $18.58–$23.37 20% below 50%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH $54.50 $109.00 $18.58–$23.37 — 50%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN STOOL $33.00 $66.00 $19.63–$24.68 73% below 50%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN STOOL $33.00 $66.00 $19.63–$24.68 — 50%
Ferritin blood test (iron stores) CPT 82728 FERRITIN $46.50 $93.00 $13.63–$17.13 5% below 50%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN $46.50 $93.00 $13.63–$17.13 — 50%
Folate (folic acid) blood test CPT 82746 FOLATE,SERUM $44.00 $88.00 $14.70–$18.49 25% below 50%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE,SERUM $44.00 $88.00 $14.70–$18.49 — 50%
Free T3 thyroid hormone test CPT 84481 T3 FREE $68.50 $137.00 $16.94–$21.30 24% below 50%
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE $68.50 $137.00 $16.94–$21.30 — 50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 - LOCI $41.00 $82.00 $9.20–$11.34 33% below 50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 XPAND - FREE T4 $41.00 $82.00 $9.20–$11.34 33% below 50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 XPAND - FREE T4 $41.00 $82.00 $9.20–$11.34 — 50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4 - LOCI $41.00 $82.00 $9.20–$11.34 — 50%
Free testosterone test CPT 84402 TESTOSTERONE FREE $85.50 $171.00 $25.47–$32.01 1% below 50%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE $85.50 $171.00 $25.47–$32.01 — 50%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 _____GENERAL HEALTH PROFILE $174.00 $348.00 $34.36–$38.88 8% above 50%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 _____GENERAL HEALTH PROFILE $174.00 $348.00 $34.36–$38.88 — 50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUC, POST GLUCOSE LOAD $49.50 $99.00 $4.75–$5.98 69% above 50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GTT 1HR (50g) GESTATIONAL $49.50 $99.00 $4.75–$5.98 69% above 50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUC, POST GLUCOSE LOAD $49.50 $99.00 $4.75–$5.98 — 50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GTT 1HR (50g) GESTATIONAL $49.50 $99.00 $4.75–$5.98 — 50%
Glucose tolerance test, 3 samples CPT 82951 GTT 3HR (100g) GESTATIONAL $63.00 $126.00 $12.87–$16.19 3% below 50%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 3HR (100g) GESTATIONAL $63.00 $126.00 $12.87–$16.19 — 50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NAAT $94.50 $189.00 $35.90–$44.14 23% above 50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NAAT $94.50 $189.00 $35.90–$44.14 — 50%
H. pylori antibody blood test CPT 86677 H. pylori (QUANT) Ab, IgA $53.50 $107.00 $16.85–$18.25 22% below 50%
H. pylori antibody blood test CPT 86677 H. pylori (QUANT) Ab, IgM $53.50 $107.00 $16.85–$18.25 22% below 50%
H. pylori antibody blood test CPT 86677 H. pylori (QUANT) Ab, IgG $53.50 $107.00 $16.85–$18.25 22% below 50%
H. pylori antibody blood test inpatient CPT 86677 H. pylori (QUANT) Ab, IgA $53.50 $107.00 $16.85–$18.25 — 50%
H. pylori antibody blood test inpatient CPT 86677 H. pylori (QUANT) Ab, IgM $53.50 $107.00 $16.85–$18.25 — 50%
H. pylori antibody blood test inpatient CPT 86677 H. pylori (QUANT) Ab, IgG $53.50 $107.00 $16.85–$18.25 — 50%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL AG, EIA $28.00 $56.00 $14.38–$18.09 75% below 50%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL AG, EIA $28.00 $56.00 $14.38–$18.09 — 50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 QUANT $363.50 $727.00 $85.10–$107.00 86% above 50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV RNA VIRAL LOAD $363.50 $727.00 $85.10–$107.00 86% above 50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 charge component for CPT CODE 87536 $363.50 $727.00 $85.10–$107.00 86% above 50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV RNA VIRAL LOAD $363.50 $727.00 $85.10–$107.00 — 50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 charge component for CPT CODE 87536 $363.50 $727.00 $85.10–$107.00 — 50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 QUANT $363.50 $727.00 $85.10–$107.00 — 50%
HIV-1 and HIV-2 antibody test CPT 86703 DO NOT ORDER-PANEL 3000189 $38.50 $77.00 $13.71–$17.25 15% below 50%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 DO NOT ORDER-PANEL 3000189 $38.50 $77.00 $13.71–$17.25 — 50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV ANTIGEN/ANTIBODY WITH RELFEX $40.00 $80.00 $24.80–$30.71 17% below 50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 PANEL 083935 $54.50 $109.00 $24.80–$30.71 13% above 50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV ANTIGEN/ANTIBODY WITH RELFEX $40.00 $80.00 $24.80–$30.71 — 50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 PANEL 083935 $54.50 $109.00 $24.80–$30.71 — 50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED (A1C) HEMOGLOBIN $35.50 $71.00 $9.71–$12.20 17% below 50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED (A1C) HEMOGLOBIN WITH eAG $35.50 $71.00 $9.71–$12.20 17% below 50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED (A1C) HEMOGLOBIN WITH eAG $35.50 $71.00 $9.71–$12.20 — 50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED (A1C) HEMOGLOBIN $35.50 $71.00 $9.71–$12.20 — 50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HBV VACCINE FOLLOW-UP (PRO XI) $24.50 $49.00 $1.74–$13.51 44% below 50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY $24.50 $49.00 $1.74–$13.51 44% below 50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 EMPLOYEE - HEP B SURFACE AB $24.50 $49.00 $1.74–$13.51 44% below 50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY $24.50 $49.00 $1.74–$13.51 — 50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 EMPLOYEE - HEP B SURFACE AB $24.50 $49.00 $1.74–$13.51 — 50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HBV VACCINE FOLLOW-UP (PRO XI) $24.50 $49.00 $1.74–$13.51 — 50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN $46.50 $93.00 $1.33–$12.99 19% above 50%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN $46.50 $93.00 $1.33–$12.99 — 50%
Hepatitis C antibody blood test (screening) CPT 86803 HEP C ANTIBODY $134.00 $268.00 $14.27–$17.95 173% above 50%
Hepatitis C antibody blood test (screening) CPT 86803 ANTI HCV (RIBA), CONFIRMATORY $134.00 $268.00 $14.27–$17.95 173% above 50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 ANTI HCV (RIBA), CONFIRMATORY $134.00 $268.00 $14.27–$17.95 — 50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEP C ANTIBODY $134.00 $268.00 $14.27–$17.95 — 50%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C PCR QUANT $210.50 $421.00 $42.84–$53.87 5% below 50%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPC QUANTASURE $210.50 $421.00 $42.84–$53.87 5% below 50%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C PCR QUANT WITH REFLEX TO GENOTYPIN $210.50 $421.00 $42.84–$53.87 5% below 50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C PCR QUANT $210.50 $421.00 $42.84–$53.87 — 50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C PCR QUANT WITH REFLEX TO GENOTYPIN $210.50 $421.00 $42.84–$53.87 — 50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPC QUANTASURE $210.50 $421.00 $42.84–$53.87 — 50%
Herpes blood test, HSV-1 antibody CPT 86695 ___HERPES SIMPLEX 1 Antibodies $51.50 $103.00 $13.19–$16.59 16% below 50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 ___HERPES SIMPLEX 1 Antibodies $51.50 $103.00 $13.19–$16.59 — 50%
Herpes blood test, HSV-2 antibody CPT 86696 ___HERPES SIMPLEX 2 Antibodies $51.50 $103.00 $19.35–$24.35 21% below 50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 ___HERPES SIMPLEX 2 Antibodies $51.50 $103.00 $19.35–$24.35 — 50%
High-sensitivity CRP (hs-CRP) test CPT 86141 CARDIAC C-REACTIVE PROTEIN $40.50 $81.00 $12.95–$16.28 21% below 50%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CARDIAC C-REACTIVE PROTEIN $40.50 $81.00 $12.95–$16.28 — 50%
Homocysteine blood test CPT 83090 HOMOCYSTEINE TITER $103.50 $207.00 $17.92–$21.21 17% below 50%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE TITER $103.50 $207.00 $17.92–$21.21 — 50%
Insulin blood test CPT 83525 INSULIN LEVEL $41.00 $82.00 $11.43–$14.38 8% below 50%
Insulin blood test inpatient CPT 83525 INSULIN LEVEL $41.00 $82.00 $11.43–$14.38 — 50%
Iron blood test (serum iron) CPT 83540 IRON $18.50 $37.00 $6.47–$8.15 42% below 50%
Iron blood test (serum iron) inpatient CPT 83540 IRON $18.50 $37.00 $6.47–$8.15 — 50%
Iron-binding capacity (TIBC) test CPT 83550 NON_ORDERABLE TIBC $54.00 $108.00 $8.74–$10.99 38% above 50%
Iron-binding capacity (TIBC) test inpatient CPT 83550 NON_ORDERABLE TIBC $54.00 $108.00 $8.74–$10.99 — 50%
Kidney function blood test panel CPT 80069 RENAL PANEL $65.00 $130.00 $8.68–$10.92 23% above 50%
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL $65.00 $130.00 $8.68–$10.92 — 50%
LH (luteinizing hormone) test CPT 83002 LH $53.50 $107.00 $18.52–$23.29 27% below 50%
LH (luteinizing hormone) test inpatient CPT 83002 LH $53.50 $107.00 $18.52–$23.29 — 50%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE, BODY FLUID $41.00 $82.00 $6.89–$8.66 4% below 50%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE, SERUM OR PLASMA $41.00 $82.00 $6.89–$8.66 4% below 50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE, BODY FLUID $41.00 $82.00 $6.89–$8.66 — 50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE, SERUM OR PLASMA $41.00 $82.00 $6.89–$8.66 — 50%
Liver function blood test panel CPT 80076 LIVER FIBROSIS RISK PROFILE $78.50 $157.00 $8.17–$10.28 77% above 50%
Liver function blood test panel CPT 80076 LIVER PROFILE $78.50 $157.00 $8.17–$10.28 77% above 50%
Liver function blood test panel inpatient CPT 80076 LIVER PROFILE $78.50 $157.00 $8.17–$10.28 — 50%
Liver function blood test panel inpatient CPT 80076 LIVER FIBROSIS RISK PROFILE $78.50 $157.00 $8.17–$10.28 — 50%
Lyme disease antibody test CPT 86618 LYME TOTAL ANITBODY w/Reflex, 1st STEP $75.00 $150.00 $17.30–$21.42 5% above 50%
Lyme disease antibody test CPT 86618 DISCONTINUED_LYME IgG/IgM Ab w/Reflex $75.00 $150.00 $17.30–$21.42 5% above 50%
Lyme disease antibody test inpatient CPT 86618 LYME TOTAL ANITBODY w/Reflex, 1st STEP $75.00 $150.00 $17.30–$21.42 — 50%
Lyme disease antibody test inpatient CPT 86618 DISCONTINUED_LYME IgG/IgM Ab w/Reflex $75.00 $150.00 $17.30–$21.42 — 50%
Magnesium blood test CPT 83735 MAGNESIUM $31.50 $63.00 $6.70–$8.42 12% above 50%
Magnesium blood test inpatient CPT 83735 MAGNESIUM $31.50 $63.00 $6.70–$8.42 — 50%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM AB $32.00 $64.00 $12.88–$16.20 30% below 50%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IGG AB $32.00 $64.00 $12.88–$16.20 30% below 50%
Measles (rubeola) antibody test CPT 86765 EMPLOYEE - RUBEOLA IGG AB $32.00 $64.00 $12.88–$16.20 30% below 50%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGG AB $32.00 $64.00 $12.88–$16.20 — 50%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA IGM AB $32.00 $64.00 $12.88–$16.20 — 50%
Measles (rubeola) antibody test inpatient CPT 86765 EMPLOYEE - RUBEOLA IGG AB $32.00 $64.00 $12.88–$16.20 — 50%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO $32.00 $64.00 $5.18–$6.51 3% below 50%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO $32.00 $64.00 $5.18–$6.51 — 50%
PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA $183.00 $366.00 $18.39–$23.13 82% above 50%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA $183.00 $366.00 $18.39–$23.13 — 50%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA ULTRASENSITIVE $41.50 $83.00 $18.39–$23.13 46% below 50%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL $41.50 $83.00 $18.39–$23.13 46% below 50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA ULTRASENSITIVE $41.50 $83.00 $18.39–$23.13 — 50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL $41.50 $83.00 $18.39–$23.13 — 50%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT $104.00 $208.00 $41.28–$51.90 25% below 50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT $104.00 $208.00 $41.28–$51.90 — 50%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME $22.00 $44.00 $6.10–$7.54 29% below 50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME $22.00 $44.00 $6.10–$7.54 — 50%
Progesterone blood test CPT 84144 PROGESTERONE TOTAL $53.00 $106.00 $2.86–$26.24 30% below 50%
Progesterone blood test inpatient CPT 84144 PROGESTERONE TOTAL $53.00 $106.00 $2.86–$26.24 — 50%
Prolactin blood test CPT 84146 PROLACTIN $64.00 $128.00 $19.38–$24.37 25% below 50%
Prolactin blood test inpatient CPT 84146 PROLACTIN $64.00 $128.00 $19.38–$24.37 — 50%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME $18.50 $37.00 $4.29–$4.94 16% below 50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME $18.50 $37.00 $4.29–$4.94 — 50%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 URINE DRUG SCREEN 12 PANEL $36.00 $72.00 $12.60–$13.46 8% below 50%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 __URINE DRUG SCREEN $36.00 $72.00 $12.60–$13.46 8% below 50%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 URINE DRUG SCREEN 12 PANEL $36.00 $72.00 $12.60–$13.46 — 50%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 __URINE DRUG SCREEN $36.00 $72.00 $12.60–$13.46 — 50%
Rapid flu test (influenza antigen) CPT 87804 charge for INFLUENZA A $34.50 $69.00 $15.08–$16.55 38% below 50%
Rapid flu test (influenza antigen) inpatient CPT 87804 charge for INFLUENZA A $34.50 $69.00 $15.08–$16.55 — 50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RAPID STREP $27.00 $54.00 $15.08–$16.53 44% below 50%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RAPID STREP $27.00 $54.00 $15.08–$16.53 — 50%
Rheumatoid factor (RF) test CPT 86431 RA FACTOR $16.00 $32.00 $5.67–$7.14 39% below 50%
Rheumatoid factor (RF) test inpatient CPT 86431 RA FACTOR $16.00 $32.00 $5.67–$7.14 — 50%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG AB $35.50 $71.00 $14.39–$18.10 31% below 50%
Rubella antibody test (immunity check) CPT 86762 EMPLOYEE - RUBELLA IGG AB $35.50 $71.00 $14.39–$18.10 31% below 50%
Rubella antibody test (immunity check) inpatient CPT 86762 EMPLOYEE - RUBELLA IGG AB $35.50 $71.00 $14.39–$18.10 — 50%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG AB $35.50 $71.00 $14.39–$18.10 — 50%
Stool ova and parasites exam CPT 87177 OVA & PARASITES STOOL $53.50 $107.00 $8.90–$11.19 7% below 50%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES STOOL $53.50 $107.00 $8.90–$11.19 — 50%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD, STOOL $10.00 $20.00 $4.09–$4.38 56% below 50%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD, STOOL $10.00 $20.00 $4.09–$4.38 — 50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 DO NOT ORDER - VDRL $26.50 $53.00 $4.27–$5.36 3% above 50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR $26.50 $53.00 $4.27–$5.36 3% above 50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR $26.50 $53.00 $4.27–$5.36 — 50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 DO NOT ORDER - VDRL $26.50 $53.00 $4.27–$5.36 — 50%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON-TB GOLD $139.50 $279.00 $61.98–$77.93 16% below 50%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON-TB GOLD $139.50 $279.00 $61.98–$77.93 — 50%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE $74.50 $149.00 $25.81–$32.47 9% below 50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE $74.50 $149.00 $25.81–$32.47 — 50%
Thyroid peroxidase (TPO) antibody test CPT 86376 __ANTIMICROSOMAL ANTIBODIES $59.50 $119.00 $14.55–$18.30 8% above 50%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE (TPO) ANTIBODIES $59.50 $119.00 $14.55–$18.30 8% above 50%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTI THYROID ANTIBODIES $59.50 $119.00 $14.55–$18.30 8% above 50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE (TPO) ANTIBODIES $59.50 $119.00 $14.55–$18.30 — 50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 __ANTIMICROSOMAL ANTIBODIES $59.50 $119.00 $14.55–$18.30 — 50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTI THYROID ANTIBODIES $59.50 $119.00 $14.55–$18.30 — 50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH - LOCI $56.50 $113.00 $16.80–$21.12 27% above 50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 XPAND - TSH $56.50 $113.00 $16.80–$21.12 27% above 50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH - LOCI $56.50 $113.00 $16.80–$21.12 — 50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 XPAND - TSH $56.50 $113.00 $16.80–$21.12 — 50%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS NAA $60.00 $120.00 $35.90–$43.08 32% below 50%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS NAA $60.00 $120.00 $35.90–$43.08 — 50%
Uric acid blood test CPT 84550 URIC ACID, BLOOD $27.00 $54.00 $4.52–$5.68 7% above 50%
Uric acid blood test inpatient CPT 84550 URIC ACID, BLOOD $27.00 $54.00 $4.52–$5.68 — 50%
Urinalysis with microscope exam, automated CPT 81001 charge for Complete UA $21.00 $42.00 $3.17–$3.99 13% below 50%
Urinalysis with microscope exam, automated inpatient CPT 81001 charge for Complete UA $21.00 $42.00 $3.17–$3.99 — 50%
Urinalysis without microscope exam, automated CPT 81003 charge for UA w/o Micro $9.00 $18.00 $2.25–$2.83 21% below 50%
Urinalysis without microscope exam, automated inpatient CPT 81003 charge for UA w/o Micro $9.00 $18.00 $2.25–$2.83 — 50%
Urinalysis without microscope exam, manual CPT 81002 URINE GLUCOSE BY DIPSTICK $9.00 $18.00 $3.21–$3.48 49% below 50%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE GLUCOSE BY DIPSTICK $9.00 $18.00 $3.21–$3.48 — 50%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE,ROUTINE $47.00 $94.00 $8.70–$10.15 2% below 50%
Urine culture for bacteria, with colony count CPT 87086 COMPREHENSIVE URINE CULTURE $47.00 $94.00 $8.70–$10.15 2% below 50%
Urine culture for bacteria, with colony count inpatient CPT 87086 COMPREHENSIVE URINE CULTURE $47.00 $94.00 $8.70–$10.15 — 50%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE,ROUTINE $47.00 $94.00 $8.70–$10.15 — 50%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY URINE $29.00 $58.00 $7.96–$8.61 7% above 50%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY URINE $29.00 $58.00 $7.96–$8.61 — 50%
Vitamin B12 (cobalamin) blood test CPT 82607 B-12 $43.00 $86.00 $15.80–$18.95 27% below 50%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B-12 $43.00 $86.00 $15.80–$18.95 — 50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY (D2+D3), LCMS-MS $66.50 $133.00 $29.60–$37.22 49% below 50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY $66.50 $133.00 $29.60–$37.22 49% below 50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY (D2+D3), LCMS-MS $66.50 $133.00 $29.60–$37.22 — 50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY $66.50 $133.00 $29.60–$37.22 — 50%
Zinc blood test CPT 84630 ZINC, WHOLE BLOOD $25.50 $51.00 $11.39–$14.32 56% below 50%
Zinc blood test inpatient CPT 84630 ZINC, WHOLE BLOOD $25.50 $51.00 $11.39–$14.32 — 50%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANTITATIVE $49.50 $99.00 $15.50–$18.93 8% below 50%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG QUANTITATIVE $49.50 $99.00 $15.50–$18.93 — 50%

Surgery and procedures

ProcedureCash price List priceInsurers payvs OklahomaOff list
Appendectomy, open surgery CPT 44950 APPENDECTOMY - OPEN $4,294.50 $8,589.00 $821.42 at median 50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL - OP $722.50 $1,445.00 $109.52 30% above 50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL - ER $722.50 $1,445.00 $109.52–$300.00 30% above 50%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL RELEASE $2,345.50 $4,691.00 $555.53 14% below 50%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION SURGICAL EXCIS >28 DAYS OLD $2,603.50 $5,207.00 $251.73 23% below 50%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY WITH BIOPSY $1,065.00 $2,130.00 $254.84 61% below 50%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY W/SUCTION DIAGNOSTIC $982.50 $1,965.00 $234.37 27% below 50%
D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION & CURETTAGE NON-OB $3,128.50 $6,257.00 $299.67 at median 50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 ER PHYS. DESTRUCTION OF LESION $85.50 $171.00 $68.82 7% above 50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION OF LESION PREMALIGNANT 1ST $230.00 $460.00 $68.82 189% above 50%
Earwax removal by irrigation (rinsing), one ear CPT 69209 ER PHYS. REMOVAL OF EAR WAX - LAVAGE/IRR $53.00 $106.00 $18.56 14% below 50%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL EAR WAX IRRIGATION/LAVAGE UNILAT $84.00 $168.00 $18.56–$300.00 36% above 50%
Earwax removal with instruments, one ear CPT 69210 ER PHYS. REMOVAL OF EAR WAX - INSTRUMENT $53.00 $106.00 $42.06 28% below 50%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL EAR WAX USING INSTRUMENT UNILAT $82.00 $164.00 $42.06–$300.00 11% above 50%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY ENDOMETRIAL $284.50 $569.00 $81.53 18% below 50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 PRO INJECTION(S) SPINE CERVICAL/THORACIC $163.50 $327.00 $136.72 75% below 50%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION(S) SPINE C/T W/IMAGING $793.50 $1,587.00 $136.72 20% above 50%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJECT PARAVERT F JNT L/S LEV 1 W/IMAGE $1,114.50 $2,229.00 $115.15 at median 50%
Gallbladder removal, laparoscopic CPT 47562 LAP CHOLECYSTECTOMY $6,299.00 $12,598.00 $842.93 37% below 50%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAP CHOLECYSTECTOMY WITH CHOLANGIO $6,299.00 $12,598.00 $919.00 38% below 50%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY OPEN $1,725.00 $3,450.00 $1,366.68 — 50%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY INTERNAL BAND LIGATION $1,002.00 $2,004.00 $244.11 15% below 50%
Hysterectomy through an abdominal incision (total) CPT 58150 HYSTERECTOMY TOTAL ABDOMINAL $3,517.50 $7,035.00 $1,305.05 20% above 50%
Hysteroscopy with endometrial ablation CPT 58563 ENDOMETRIAL ABLATION WITH HYSTEROCSCOPY $5,716.50 $11,433.00 $316.57 29% below 50%
Incision and drainage of a simple or single skin abscess CPT 10060 ER PHYS. I & D ABCESS SIMPLE/SINGLE $148.00 $296.00 $132.80 31% below 50%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABCESS SIMPLE/SINGLE ER $239.50 $479.00 $132.80–$300.00 12% above 50%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABCESS SIMPLE/SINGLE $239.50 $479.00 $132.80 12% above 50%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABCESS SIMPLE/SINGLE OP $239.50 $479.00 $132.80 12% above 50%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HERNIA REPAIR INGUINAL INITIAL REDUC. $4,294.50 $8,589.00 $668.17 40% below 50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 PRO INJECT LIGAMENT SINGLE $69.50 $139.00 $50.38 68% below 50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT LIGAMENT SINGLE $373.00 $746.00 $50.38 71% above 50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PRO MAJOR JOINT/BURSA INJECTION - PM $71.50 $143.00 $57.79 70% below 50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER PHYS. MAJOR JOINT/BURSA INJECTION $73.50 $147.00 $57.79 69% below 50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT/BURSA INJECTION - ER $346.50 $693.00 $57.79–$300.00 46% above 50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT/BURSA INJECTION - PM $346.50 $693.00 $57.79 46% above 50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT/BURSA INJECTION - OR $346.50 $693.00 $57.79 46% above 50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ER PHYS. ARTHROCENTESIS ASP./INJ. $62.50 $125.00 $47.60 73% below 50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 PRO MINOR JOINT/BURSA INJECTION - PM $71.50 $143.00 $47.60 69% below 50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASPIRATION/INJECTION - ER $80.00 $160.00 $47.60–$300.00 65% below 50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 MINOR JOINT/BURSA INJECTION - PM $173.50 $347.00 $47.60 24% below 50%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 LAP SURGICAL TOTAL HYST $10,455.00 $20,910.00 $1,039.61 22% below 50%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 LAP SURGICAL TOTAL HYST W/TUBE REMOVAL $10,455.00 $20,910.00 $1,167.59 37% below 50%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP HERNIA REPAIR INITIAL INGUINAL $6,299.00 $12,598.00 $552.30 41% below 50%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP HERNIA REPAIR RECURRENT INGUINAL $6,299.00 $12,598.00 $721.62 42% below 50%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAP OOPHORECTOMY $6,299.00 $12,598.00 $842.08 23% below 50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER PHYS. WOUND REPAIR INTER 12031 $236.50 $473.00 $191.71 24% below 50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND REPAIR INTER. SCALP <2.5CM $439.00 $878.00 $191.71–$300.00 41% above 50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND REPAIR INTER. AXILLAE <2.5CM $439.00 $878.00 $191.71–$300.00 41% above 50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND REPAIR INTER. EXTREM <2.5CM $439.00 $878.00 $191.71–$300.00 41% above 50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 WOUND REPAIR INTER. TRUNK <2.5CM $439.00 $878.00 $191.71–$300.00 41% above 50%
Lower-back epidural injection, with imaging guidance CPT 62323 PRO INJECTION(S) SPINE LUMBAR/SACRAL $149.00 $298.00 $126.67 77% below 50%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION(S) SPINE L/S WITH IMAGING $793.50 $1,587.00 $126.67 20% above 50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 PRO INJECT LUMBAR OR SACRAL W/IMAGING $165.00 $330.00 $141.34 83% below 50%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECT LUMBAR OR SACRAL W/IMAGING $958.50 $1,917.00 $141.34 1% above 50%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY PARTIAL - LUMPECTOMY $3,749.50 $7,499.00 $842.32 at median 50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION SKIN LESION FACE BENIGN 0.5CM < $809.00 $1,618.00 $133.16 81% above 50%
Nail removal (partial or complete), one nail CPT 11730 ER PHYS. NAIL AVULSION SIMPLE/SINGLE $83.00 $166.00 $69.33 47% below 50%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION SINGLE/SIMPLE - ER ONLY $221.00 $442.00 $69.33–$300.00 42% above 50%
Occipital nerve block (injection for headaches) CPT 64405 PRO NERVE BLOCK GREATER OCCIPITAL NERVE $92.50 $185.00 $67.47 76% below 50%
Occipital nerve block (injection for headaches) CPT 64405 NERVE BLOCK GREATER OCCIPITAL NERVE $346.50 $693.00 $67.47 9% below 50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ER PHYS. EXCISION OF NAIL $271.50 $543.00 $128.60 25% below 50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL $778.50 $1,557.00 $128.60 115% above 50%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PRO DESTRUCT PARAVERT F JNT L/S W/IMAGE $327.50 $655.00 $244.85 81% below 50%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTRUCT PARAVERT F JNT L/S W/IMAGING $2,345.50 $4,691.00 $244.85 36% above 50%
Removal of a foreign object under the skin, simple CPT 10120 ER PHYS. INCISION/REMOVAL FB - SIMPLE $159.00 $318.00 $132.59 35% below 50%
Removal of a foreign object under the skin, simple CPT 10120 INCISION/REMOVAL OF FOREIGN BODY-SIMPLE $439.00 $878.00 $132.59 79% above 50%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY SCREENING LOW RISK PT $982.50 $1,965.00 — at median 50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY SCREENING HIGH RISK PT $982.50 $1,965.00 — 18% below 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER PHYS WOUND REPAIR SIMPLE 12001 $72.00 $144.00 $57.85 63% below 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE EXTREM <2.5CM $230.00 $460.00 $57.85–$300.00 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE TRUNK <2.5CM $230.00 $460.00 $57.85–$300.00 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE GENITAL <2.5CM $230.00 $460.00 $57.85–$300.00 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE EXTREM <2.5CM - OP $230.00 $460.00 $57.85 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE AXILLAE <2.5CM $230.00 $460.00 $57.85–$300.00 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE NECK <2.5CM $230.00 $460.00 $57.85–$300.00 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE SCALP <2.5CM $230.00 $460.00 $57.85–$300.00 17% above 50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 WOUND REPAIR SIMPLE EXTREM <2.5CM OR $230.00 $460.00 $57.85 17% above 50%
Skin biopsy, punch, one lesion CPT 11104 BIOPSY SKIN PUNCH SINGLE LESION $439.00 $878.00 $60.10 47% above 50%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG REMOVAL UP TO 15 LESIONS $230.00 $460.00 $96.02 48% above 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER PHYS. WOUND REPAIR SIMPLE 12002 $95.00 $190.00 $75.79 54% below 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE SCALP 2.6CM-7.5CM $230.00 $460.00 $75.79–$300.00 12% above 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE EXTREM 2.6CM-7.5CM $230.00 $460.00 $75.79–$300.00 12% above 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE TRUNK 2.6CM-7.5CM $230.00 $460.00 $75.79–$300.00 12% above 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE GENITAL 2.6CM-7.5CM $230.00 $460.00 $75.79–$300.00 12% above 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE AXILLAE 2.6CM-7.5CM $230.00 $460.00 $75.79–$300.00 12% above 50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 WOUND REPAIR SIMPLE NECK 2.6CM-7.5CM $230.00 $460.00 $75.79–$300.00 12% above 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER PHYS. WOUND REPAIR SIMPLE 12011 $90.00 $180.00 $71.06 57% below 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR SIMPLE MUC MEM <2.5CM $230.00 $460.00 $71.06–$300.00 9% above 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR SIMPLE NOSE <2.5CM $230.00 $460.00 $71.06 9% above 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR SIMPLE FACE <2.5CM $230.00 $460.00 $71.06–$300.00 9% above 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR SIMPLE EAR <2.5CM $230.00 $460.00 $71.06–$300.00 9% above 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR SIMPLE EYELID <2.5CM $230.00 $460.00 $71.06–$300.00 9% above 50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 WOUND REPAIR SIMPLE LIP <2.5CM $230.00 $460.00 $71.06–$300.00 9% above 50%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BIOPSY SKIN TANGENTIAL SINGLE LESION $439.00 $878.00 $48.42 88% above 50%
Tonsil and adenoid removal, age 12 or older CPT 42821 TONSIL & ADENOID REMOVAL >12YRS OLD $3,261.00 $6,522.00 $391.19 19% below 50%
Tonsil and adenoid removal, child under 12 CPT 42820 TONSIL & ADENOID REMOVAL <12YRS OLD $6,196.50 $12,393.00 $373.68 31% above 50%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 TONSIL REMOVAL >12YRS OLD $3,261.00 $6,522.00 $327.60 34% above 50%
Trigger point injections, 1 or 2 muscles CPT 20552 PRO INJECT TRIGGER POINT SINGLE/MULTI $69.50 $139.00 $47.58 69% below 50%
Trigger point injections, 1 or 2 muscles CPT 20552 ER PHYS. INJECT TRIGGER PT SINGLE/MULTI $69.50 $139.00 $47.58 69% below 50%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TRIGGER PT SINGLE/MULTI 1-2 MUSCL $352.00 $704.00 $47.58–$300.00 55% above 50%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TRIGGER POINT SINGLE/MULTI 20552 $352.00 $704.00 $47.58 55% above 50%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPIC TUBAL LIGATION W/WO TRANS. $6,364.50 $12,729.00 $478.76 47% above 50%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD W / DILATION OF ESOPHAGUS <30MM DIAM $2,002.50 $4,005.00 $194.83 11% above 50%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD WITH BIOPSY $1,500.00 $3,000.00 $175.38 115% above 50%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD/WITH SUCTION $1,500.00 $3,000.00 $155.35 41% above 50%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY UNILATERAL OR BILATERAL $2,603.50 $5,207.00 $290.79 — 50%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF BENIGN LESIONS 1-14 $230.00 $460.00 $84.21 41% above 50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBQ TISSUE 20CM OR LESS $439.00 $878.00 $76.31 8% above 50%

Doctor visits and therapy

ProcedureCash price List priceInsurers payvs OklahomaOff list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION $532.00 $1,064.00 $47.21 20% below 50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PARI NEB INITIAL TREATMENT $243.50 $487.00 $8.59–$55.00 96% above 50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HHN INITIAL TREATMENT $243.50 $487.00 $8.59–$55.00 96% above 50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PARI NEB INITIAL TREATMENT $243.50 $487.00 $8.59–$55.00 — 50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HHN INITIAL TREATMENT $243.50 $487.00 $8.59–$55.00 — 50%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30-74 MIN $1,031.00 $2,062.00 $300.00–$401.14 27% above 50%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30-74 MINUTES $1,031.00 $2,062.00 $401.14 27% above 50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG $82.00 $164.00 $6.04–$50.00 30% below 50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG $82.00 $164.00 $6.04–$50.00 — 50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY ROOM LEVEL I $176.00 $352.00 $49.86–$300.00 55% above 50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY ROOM LEVEL II $235.00 $470.00 $88.97–$300.00 39% above 50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY ROOM LEVEL III $369.50 $739.00 $135.80–$300.00 26% above 50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY ROOM LEVEL IV $516.50 $1,033.00 $208.23–$300.00 17% above 50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY ROOM LEVEL V $801.00 $1,602.00 $286.31–$300.00 25% above 50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ADMIN. IV HYDRATION INFUSION 1ST HR - OP $270.00 $540.00 $52.24 66% above 50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ADMIN. IV HYDRATION INFUSION 1ST HR - ER $270.00 $540.00 $52.24 66% above 50%
IV infusion of a medicine, first hour CPT 96365 ADMIN. IV DRUG INF. INITIAL 1ST HR - ER $270.00 $540.00 $101.92 18% above 50%
IV infusion of a medicine, first hour CPT 96365 ADMIN. IV DRUG INF. INITIAL 1ST HR - OP $270.00 $540.00 $101.92 18% above 50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 WELLNESS - ADMIN. SUBQ/IM $80.00 $160.00 $23.24–$50.00 19% above 50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN. SUBQ/IM - ER $80.00 $160.00 $23.24–$300.00 19% above 50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN. SUBQ/IM - OP $80.00 $160.00 $23.24–$50.00 19% above 50%
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT - NEW PT 30-44 MINUTES $163.50 $327.00 $96.63 1% below 50%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT - NEW PT 45-59 MINUTES $249.00 $498.00 $155.68 10% above 50%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT - NEW PT 60-74 MINUTES $312.00 $624.00 $211.25 12% above 50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT - NEW PT 15-29 MINUTES $112.50 $225.00 $56.09 4% above 50%
Preventive checkup, new patient aged 18–39 CPT 99385 WELLNESS INITIAL PAT. VISIT 18-39 YEARS $100.00 $200.00 $130.00 7% above 50%
Preventive checkup, new patient aged 40–64 CPT 99386 WELLNESS INITIAL PAT. VISIT 40-64 YEARS $100.00 $200.00 $157.60 7% below 50%
Preventive checkup, new patient aged 65 or older CPT 99387 WELLNESS INITIAL PAT. VISIT 65(+) YEARS $100.00 $200.00 $169.75 16% below 50%
Preventive checkup, returning patient aged 18–39 CPT 99395 WELLNESS ESTAB. PAT. VISIT 18-39 YEARS $100.00 $200.00 $118.78 20% above 50%
Preventive checkup, returning patient aged 40–64 CPT 99396 WELLNESS ESTAB. PAT. VISIT 40-64 YEARS $100.00 $200.00 $128.60 3% above 50%
Preventive checkup, returning patient aged 65 or older CPT 99397 WELLNESS ESTAB. PAT. VISIT 65(+) YEARS $100.00 $200.00 $135.15 3% below 50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO-USE COUNSEL 3-10 MINUTES SYMPTO. $38.00 $76.00 $13.88–$45.00 43% above 50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO-USE COUNSEL 3-10 MINUTES ASYMPTO $38.00 $76.00 $13.88–$45.00 43% above 50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO-USE COUNSEL 3-10 MINUTES SYMPTO $38.00 $76.00 $13.88–$45.00 43% above 50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT - ESTABLISHED PT 40-54 MIN. $219.00 $438.00 $167.35 at median 50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT - ESTABLISHED PT 20-29 MIN. $110.50 $221.00 $77.16 17% below 50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT - ESTABLISHED PT 30-39 MIN. $162.00 $324.00 $113.99 5% below 50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT - ESTABLISHED PT 10-19 MIN. $66.00 $132.00 $41.53 21% below 50%
Spirometry (breathing test) CPT 94010 PEAK FLOW RATE EACH ADD'L $191.00 $382.00 $26.18–$55.00 32% above 50%
Spirometry (breathing test) CPT 94010 PEAK FLOW INITIAL TREATMENT $191.00 $382.00 $26.18–$55.00 32% above 50%
Spirometry (breathing test) inpatient CPT 94010 PEAK FLOW RATE EACH ADD'L $191.00 $382.00 $26.18–$55.00 — 50%
Spirometry (breathing test) inpatient CPT 94010 PEAK FLOW INITIAL TREATMENT $191.00 $382.00 $26.18–$55.00 — 50%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 BB PHLEBOTOMY $121.50 $243.00 $50.00–$101.72 3% below 50%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 BB PHLEBOTOMY $121.50 $243.00 $50.00–$101.72 — 50%

Vaccines

ProcedureCash price List priceInsurers payvs OklahomaOff list
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC SYRN 20MCG/1ML $75.00 $150.00 $64.95 42% below 50%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC SYRN 20MCG/1ML $75.00 $150.00 $64.95 — 50%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 WELLNESS - PNEUMOVAX 23 $51.50 $103.00 $122.93 67% below 50%
Rabies vaccine, one dose CPT 90675 RABIES VAC 2.5UN KIT $579.00 $1,158.00 $452.40 16% below 50%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VAC 2.5UN KIT $579.00 $1,158.00 $452.40 — 50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS/DIPHTHERIA TOXOID (ADULT) $49.50 $99.00 $35.38 44% below 50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS/DIPHTHERIA TOXOID (ADULT) $49.50 $99.00 $35.38 — 50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INITIAL VACCINE/TOXOID - WELLNESS $80.00 $160.00 $19.83 33% above 50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN. TETANUS - ER $80.00 $160.00 $19.83 33% above 50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INITIAL VACCINE/TOXOID - ER $80.00 $160.00 $19.83 33% above 50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INITIAL VACCINE/TOXOID - OP $80.00 $160.00 $19.83 33% above 50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN. TETANUS - OP $80.00 $160.00 $19.83 33% above 50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN. EA ADDL VACCINE/TOXOID - ER $33.50 $67.00 $14.31 16% above 50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN. EA ADDL VACCINE/TOXOID - OP $33.50 $67.00 $14.31 16% above 50%

Source file: https://choctawmemorial.com/wp-content/uploads/2026/04/736060815_choctaw-county-city-of-hugo-hospital-trust-authority-_standardcharges.csv