Hospital

Faulkton Area Medical Center

Faulkton Area Medical Center in Faulkton, SD publishes cash prices for 363 common procedures listed here, from its own machine-readable price file updated Jul 17, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the South Dakota median for 201 of 358 procedures and above it for 147. By typical cash price it ranks #6 of 24 South Dakota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1300 Oak Street, Faulkton, SD 57438 Collected Oct 6, 2026 Source price file Check a bill from this hospital (605) 598-6262

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 431301 · CMS hospital register NPI 1245212877

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Faulkton Area Medical Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Faulkton Area Medical Center in Faulkton, SD:

Jun 10, 2026 Warning notice

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Cont	$3,190.53	$3,988.16	$2,129.60–$3,988.16	at median	20%
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen With and Without Contrast	$3,346.40	$4,183.00	$2,129.60–$4,183.00	5% above	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Cont	$3,190.53	$3,988.16	$3,788.75–$3,988.16	—	20%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen With and Without Contrast	$3,346.40	$4,183.00	$3,908.40–$4,183.00	—	20%
Abdominal X-ray, 2 views CPT 74019 Abdomen Decub/Flat or Upright	$347.63	$386.25	$206.25–$386.25	22% below	10%
Abdominal X-ray, 2 views inpatient CPT 74019 Abdomen Decub/Flat or Upright	$347.63	$386.25	$366.94–$386.25	—	10%
Ankle X-ray, complete, 3 or more views CPT 73610 Ankle Minimum 3 views	$585.86	$650.96	$347.60–$650.96	100% above	10%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle Minimum 3 views (Left)	$292.93	$325.48	$173.80–$325.48	at median	10%
Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle Minimum 3 views (Right)	$292.93	$325.48	$173.80–$325.48	at median	10%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Ankle Minimum 3 views	$585.86	$650.96	$618.41–$650.96	—	10%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Ankle Minimum 3 views (Right)	$292.93	$325.48	$309.21–$325.48	—	10%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Ankle Minimum 3 views (Left)	$292.93	$325.48	$309.21–$325.48	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 TOE BRACHIAL INDEX	$394.20	$438.00	$233.75–$438.00	23% below	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI	$648.90	$721.00	$385.00–$721.00	27% above	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 TOE BRACHIAL INDEX	$394.20	$438.00	$416.10–$438.00	—	10%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ABI	$648.90	$721.00	$684.95–$721.00	—	10%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT Extremity Upper (Elbow) Without Contrast	$2,577.60	$3,222.00	$1,772.10–$3,904.36	25% above	20%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Extremity Upper (Elbow) Without Contrast (Right)	$2,738.70	$3,222.00	$1,063.70–$3,222.00	32% above	15%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Extremity Upper (Elbow) Without Contrast (Left)	$2,738.70	$3,222.00	$1,063.70–$3,222.00	32% above	15%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT Extremity Upper (Elbow) Without Contrast	$2,577.60	$3,222.00	$3,060.90–$3,904.36	—	20%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Extremity Upper (Elbow) Without Contrast (Left)	$2,738.70	$3,222.00	$1,952.18–$3,222.00	—	15%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Extremity Upper (Elbow) Without Contrast (Right)	$2,738.70	$3,222.00	$1,952.18–$3,222.00	—	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Whole Body	$3,233.40	$3,804.00	$857.45–$3,804.00	64% above	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Whole Body	$3,233.40	$3,804.00	$1,573.65–$3,804.00	—	15%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Lt	$1,574.10	$1,749.00	$542.30–$1,749.00	179% above	10%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Rt	$1,574.10	$1,749.00	$542.30–$1,749.00	179% above	10%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Rt	$1,574.10	$1,749.00	$995.27–$1,749.00	—	10%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Lt	$1,574.10	$1,749.00	$995.27–$1,749.00	—	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Rt	$1,019.70	$1,133.00	$451.00–$1,133.00	81% above	10%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Ltd Lt	$1,019.70	$1,133.00	$451.00–$1,133.00	81% above	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Lt	$1,019.70	$1,133.00	$827.71–$1,133.00	—	10%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Ltd Rt	$1,019.70	$1,133.00	$827.71–$1,133.00	—	10%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abdomen and Pelvis	$3,588.00	$4,485.00	$2,394.70–$4,485.00	11% below	20%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abdomen and Pelvis	$3,588.00	$4,485.00	$4,260.75–$4,485.00	—	20%
CT angiography (CTA) of the head CPT 70496 CT Angio Head	$4,113.60	$5,142.00	$1,777.05–$5,142.00	40% above	20%
CT angiography (CTA) of the head CPT 70496 CTA Head	$4,113.60	$5,142.00	$1,777.05–$5,142.00	40% above	20%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head	$4,113.60	$5,142.00	$3,261.37–$5,142.00	—	20%
CT angiography (CTA) of the head inpatient CPT 70496 CTA Head	$4,113.60	$5,142.00	$3,261.37–$5,142.00	—	20%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck	$2,654.10	$3,317.63	$1,771.55–$3,317.63	10% below	20%
CT angiography (CTA) of the neck CPT 70498 CTA Neck	$4,113.60	$5,142.00	$1,771.55–$5,142.00	40% above	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck	$2,654.10	$3,317.63	$3,151.75–$3,317.63	—	20%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck	$4,113.60	$5,142.00	$3,251.28–$5,142.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest	$2,389.60	$2,987.00	$1,595.00–$2,987.00	17% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest (PE Protocol)	$3,191.20	$3,989.00	$1,595.00–$3,989.00	11% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest	$2,389.60	$2,987.00	$2,837.65–$2,987.00	—	20%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest (PE Protocol)	$3,191.20	$3,989.00	$2,927.26–$3,989.00	—	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Chest Abdomen and Pelvis Withou Contrast	$3,190.53	$3,988.16	$2,129.60–$3,988.16	16% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis Without Contrast	$4,047.20	$5,059.00	$2,129.60–$5,059.00	6% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen +Pelvis w/ Oral Cont Only	$4,867.20	$6,084.00	$2,129.60–$6,084.00	28% above	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Chest Abdomen and Pelvis Withou Contrast	$3,190.53	$3,988.16	$3,788.75–$3,988.16	—	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis Without Contrast	$4,047.20	$5,059.00	$3,908.40–$5,059.00	—	20%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen +Pelvis w/ Oral Cont Only	$4,867.20	$6,084.00	$3,908.40–$6,084.00	—	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen Pelvis w Contrast	$3,664.33	$4,580.41	$2,445.85–$4,580.41	22% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis With Contrast	$4,867.20	$6,084.00	$2,445.85–$6,084.00	4% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Chest +Abdomen +Pelvis w/ Cont	$4,867.20	$6,084.00	$2,445.85–$6,084.00	4% above	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen Pelvis w Contrast	$3,664.33	$4,580.41	$4,351.39–$4,580.41	—	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis With Contrast	$4,867.20	$6,084.00	$4,488.80–$6,084.00	—	20%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Chest +Abdomen +Pelvis w/ Cont	$4,867.20	$6,084.00	$4,488.80–$6,084.00	—	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis With and Without Contrast	$7,388.80	$9,236.00	$4,259.20–$9,236.00	48% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis With and Without Contrast	$7,388.80	$9,236.00	$7,816.79–$9,236.00	—	20%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen With Contrast	$3,346.40	$4,183.00	$1,307.90–$4,183.00	16% above	20%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen With Contrast	$3,346.40	$4,183.00	$2,400.35–$4,183.00	—	20%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen Without Contrast	$1,888.80	$2,361.00	$1,200.10–$2,361.00	4% below	20%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen Without Contrast	$1,888.80	$2,361.00	$2,202.51–$2,361.00	—	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial Without Contrast	$2,262.70	$2,662.00	$1,082.95–$2,662.00	16% above	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial Without Contrast	$2,262.70	$2,662.00	$1,987.51–$2,662.00	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head Without Contrast	$2,209.60	$2,762.00	$1,383.25–$2,762.00	12% above	20%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head Without Contrast	$2,209.60	$2,762.00	$2,538.64–$2,762.00	—	20%
CT scan of the head with contrast CPT 70460 CT Head With Contrast	$2,348.80	$2,936.00	$1,493.25–$2,936.00	5% above	20%
CT scan of the head with contrast inpatient CPT 70460 CT Head With Contrast	$2,348.80	$2,936.00	$2,740.52–$2,936.00	—	20%
CT scan of the head without and with contrast CPT 70470 CT Head With and Without Contrast	$3,494.40	$4,368.00	$2,129.60–$4,368.00	25% above	20%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head With and Without Contrast	$3,494.40	$4,368.00	$3,908.40–$4,368.00	—	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lspine Without Contrast	$2,631.60	$3,096.00	$1,063.70–$3,096.00	11% above	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lspine Without Contrast	$2,631.60	$3,096.00	$1,952.18–$3,096.00	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cspine Without Contrast	$2,631.60	$3,096.00	$1,063.70–$3,096.00	17% above	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Cspine Without Contrast	$2,631.60	$3,096.00	$1,952.18–$3,096.00	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis With Contrast	$2,808.80	$3,511.00	$1,576.30–$3,511.00	25% above	20%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis With Contrast	$2,808.80	$3,511.00	$2,892.94–$3,511.00	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Bilateral with Doppler	$864.00	$960.00	$512.60–$960.00	—	10%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Bilateral with Doppler	$864.00	$960.00	$912.00–$960.00	—	10%
Chest CT scan without and with contrast CPT 71270 CT Chest With and Without Contrast	$3,350.40	$4,188.00	$2,129.60–$4,188.00	15% above	20%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Cont	$3,350.40	$4,188.00	$2,129.60–$4,188.00	15% above	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest w/ + w/o Cont	$3,350.40	$4,188.00	$3,908.40–$4,188.00	—	20%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest With and Without Contrast	$3,350.40	$4,188.00	$3,908.40–$4,188.00	—	20%
Chest X-ray, 2 views CPT 71046 Chest Special Views (Lateral Decub)	$407.70	$453.00	$147.40–$453.00	10% above	10%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$407.70	$453.00	$180.95–$453.00	10% above	10%
Chest X-ray, 2 views CPT 71046 Chest 2 views	$407.70	$453.00	$180.95–$453.00	10% above	10%
Chest X-ray, 2 views inpatient CPT 71046 Chest 2 views	$407.70	$453.00	$332.09–$453.00	—	10%
Chest X-ray, 2 views inpatient CPT 71046 Chest Special Views (Lateral Decub)	$407.70	$453.00	$270.52–$453.00	—	10%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$407.70	$453.00	$332.09–$453.00	—	10%
Chest X-ray, single view CPT 71045 Chest Single View Frontal	$333.90	$371.00	$118.80–$371.00	13% above	10%
Chest X-ray, single view CPT 71045 Chest Portable Single View	$333.90	$371.00	$118.80–$371.00	13% above	10%
Chest X-ray, single view inpatient CPT 71045 Chest Portable Single View	$333.90	$371.00	$218.03–$371.00	—	10%
Chest X-ray, single view inpatient CPT 71045 Chest Single View Frontal	$333.90	$371.00	$218.03–$371.00	—	10%
Collarbone (clavicle) X-ray, complete CPT 73000 Clavicle 2 views	$324.90	$361.00	$183.70–$361.00	29% above	10%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Clavicle 2 views (Right)	$162.00	$180.00	$91.85–$180.00	36% below	10%
Collarbone (clavicle) X-ray, complete one side CPT 73000 Clavicle 2 views (Left)	$162.00	$180.00	$91.85–$180.00	36% below	10%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Clavicle 2 views	$324.90	$361.00	$337.14–$361.00	—	10%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Clavicle 2 views (Right)	$162.00	$180.00	$168.57–$180.00	—	10%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Clavicle 2 views (Left)	$162.00	$180.00	$168.57–$180.00	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys both sides CPT 76770 US Renal Bilateral With Bladder	$2,053.80	$2,282.00	$308.00–$2,282.00	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$2,053.80	$2,282.00	$368.50–$2,282.00	133% above	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient both sides CPT 76770 US Renal Bilateral With Bladder	$2,053.80	$2,282.00	$565.26–$2,282.00	—	10%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$2,053.80	$2,282.00	$676.30–$2,282.00	—	10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXASCAN PROFESSIONAL INTERP/NON ME	$40.79	$45.32	$11.66–$86.90	93% below	10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 FAMC Dexa Interp	$55.80	$62.00	$11.66–$86.90	91% below	10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 FAMC Dexa Interp	$55.80	$62.00	$24.20–$62.00	91% below	10%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dexascan	$676.80	$752.00	$257.95–$752.00	15% above	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXASCAN PROFESSIONAL INTERP/NON ME	$40.79	$45.32	$11.66–$86.90	—	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 FAMC Dexa Interp	$55.80	$62.00	$11.66–$86.90	—	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 FAMC Dexa Interp	$55.80	$62.00	$44.41–$62.00	—	10%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dexascan	$676.80	$752.00	$473.41–$752.00	—	10%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest Without Contrast	$2,912.80	$3,641.00	$1,944.25–$3,641.00	39% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Cont	$4,711.20	$5,889.00	$3,144.35–$5,889.00	125% above	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest Without Contrast	$2,912.80	$3,641.00	$3,458.95–$3,641.00	—	20%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Cont	$4,711.20	$5,889.00	$5,594.55–$5,889.00	—	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest With Contrast	$2,919.20	$3,649.00	$1,948.65–$3,649.00	9% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 72160 CT Chest w/cont	$2,919.43	$3,649.29	$1,948.65–$3,649.29	9% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Cont	$4,879.20	$6,099.00	$3,256.55–$6,099.00	83% above	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest With Contrast	$2,919.20	$3,649.00	$3,466.55–$3,649.00	—	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 72160 CT Chest w/cont	$2,919.43	$3,649.29	$3,466.83–$3,649.29	—	20%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Cont	$4,879.20	$6,099.00	$5,794.05–$6,099.00	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Arterial Lower Extremity Bilateral	$828.00	$920.00	$491.15–$920.00	—	10%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Arterial Lower Extremity Bilateral	$828.00	$920.00	$874.00–$920.00	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Insufficiency Bilateral	$897.30	$997.00	$532.40–$997.00	—	10%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Bilateral Extremity	$897.30	$997.00	$532.40–$997.00	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Insufficiency Bilateral	$897.30	$997.00	$947.15–$997.00	—	10%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Bilateral Extremity	$897.30	$997.00	$947.15–$997.00	—	10%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Complete	$1,473.05	$1,733.00	$925.65–$1,733.00	39% below	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo Complete	$1,473.05	$1,733.00	$1,646.35–$1,733.00	—	15%
Elbow X-ray, 2 views CPT 73070 Elbow AP Lateral	$428.27	$475.86	$254.10–$475.86	58% above	10%
Elbow X-ray, 2 views one side CPT 73070 Elbow AP Lateral (Left)	$214.14	$237.93	$127.05–$237.93	21% below	10%
Elbow X-ray, 2 views one side CPT 73070 Elbow AP Lateral (Right)	$214.14	$237.93	$127.05–$237.93	21% below	10%
Elbow X-ray, 2 views inpatient CPT 73070 Elbow AP Lateral	$428.27	$475.86	$452.07–$475.86	—	10%
Elbow X-ray, 2 views inpatient one side CPT 73070 Elbow AP Lateral (Left)	$214.14	$237.93	$226.03–$237.93	—	10%
Elbow X-ray, 2 views inpatient one side CPT 73070 Elbow AP Lateral (Right)	$214.14	$237.93	$226.03–$237.93	—	10%
Elbow X-ray, complete, 3 or more views CPT 73080 Elbow Minimum 3 views	$628.51	$698.34	$372.90–$698.34	87% above	10%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Elbow Minimum 3 views (Left)	$314.25	$349.17	$186.45–$349.17	7% below	10%
Elbow X-ray, complete, 3 or more views one side CPT 73080 Elbow Minimum 3 views (Right)	$314.25	$349.17	$186.45–$349.17	7% below	10%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 Elbow Minimum 3 views	$628.51	$698.34	$663.42–$698.34	—	10%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Elbow Minimum 3 views (Right)	$314.25	$349.17	$331.71–$349.17	—	10%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Elbow Minimum 3 views (Left)	$314.25	$349.17	$331.71–$349.17	—	10%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Ear Out, Middle or Inner Without	$2,836.00	$3,545.00	$1,490.50–$3,545.00	35% above	20%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Ear Out, Middle or Inner Without	$2,836.00	$3,545.00	$2,735.47–$3,545.00	—	20%
Facial bones X-ray, complete, 3 or more views CPT 70150 Facial Bones Minimum 3 views	$245.70	$273.00	$137.50–$273.00	32% below	10%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Facial Bones Minimum 3 views	$245.70	$273.00	$252.35–$273.00	—	10%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Forearm AP Lateral (Left)	$292.93	$325.48	$173.80–$325.48	5% below	10%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Forearm AP Lateral (Right)	$292.93	$325.48	$173.80–$325.48	5% below	10%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Forearm AP Lateral (Left)	$292.93	$325.48	$309.21–$325.48	—	10%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Forearm AP Lateral (Right)	$292.93	$325.48	$309.21–$325.48	—	10%
Hand X-ray, 2 views CPT 73120 Hand 2 views	$678.56	$753.96	$402.60–$753.96	155% above	10%
Hand X-ray, 2 views one side CPT 73120 Hand 2 views (Left)	$339.28	$376.98	$201.30–$376.98	27% above	10%
Hand X-ray, 2 views one side CPT 73120 Hand 2 views (Right)	$339.28	$376.98	$201.30–$376.98	27% above	10%
Hand X-ray, 2 views inpatient CPT 73120 Hand 2 views	$678.56	$753.96	$716.26–$753.96	—	10%
Hand X-ray, 2 views inpatient one side CPT 73120 Hand 2 views (Left)	$339.28	$376.98	$358.13–$376.98	—	10%
Hand X-ray, 2 views inpatient one side CPT 73120 Hand 2 views (Right)	$339.28	$376.98	$358.13–$376.98	—	10%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Heel (Calcaneus) Minimum 2 views	$246.58	$273.98	$146.30–$273.98	18% above	10%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Heel (Calcaneus) Minimum 2 views (Right)	$123.29	$136.99	$73.15–$136.99	41% below	10%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Heel (Calcaneus) Minimum 2 views (Left)	$123.29	$136.99	$73.15–$136.99	41% below	10%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 Heel (Calcaneus) Minimum 2 views	$246.58	$273.98	$260.28–$273.98	—	10%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Heel (Calcaneus) Minimum 2 views (Left)	$123.29	$136.99	$130.14–$136.99	—	10%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Heel (Calcaneus) Minimum 2 views (Right)	$123.29	$136.99	$130.14–$136.99	—	10%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY WITH TITRATION	$4,590.40	$5,738.00	$2,058.10–$5,738.00	at median	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 95811 SLEEP STUDY WITH TITRATION CHARGE	$4,592.00	$5,740.00	$2,058.10–$5,740.00	at median	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY WITH TITRATION	$4,590.40	$5,738.00	$3,777.17–$5,738.00	—	20%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 95811 SLEEP STUDY WITH TITRATION CHARGE	$4,592.00	$5,740.00	$3,777.17–$5,740.00	—	20%
Knee X-ray, 3 views CPT 73562 Knee 3 views	$678.56	$753.96	$402.60–$753.96	105% above	10%
Knee X-ray, 3 views one side CPT 73562 Knee 3 views (Right)	$339.28	$376.98	$201.30–$376.98	2% above	10%
Knee X-ray, 3 views one side CPT 73562 Knee 3 Views (Left)	$339.28	$376.98	$201.30–$376.98	2% above	10%
Knee X-ray, 3 views inpatient CPT 73562 Knee 3 views	$678.56	$753.96	$716.26–$753.96	—	10%
Knee X-ray, 3 views inpatient one side CPT 73562 Knee 3 Views (Left)	$339.28	$376.98	$358.13–$376.98	—	10%
Knee X-ray, 3 views inpatient one side CPT 73562 Knee 3 views (Right)	$339.28	$376.98	$358.13–$376.98	—	10%
Knee X-ray, complete, 4 or more views CPT 73564 Knee 4+ Views with Sunrise	$732.33	$813.70	$434.50–$813.70	108% above	10%
Knee X-ray, complete, 4 or more views one side CPT 73564 Knee 4+ Views with Sunrise (Left)	$366.17	$406.85	$217.25–$406.85	4% above	10%
Knee X-ray, complete, 4 or more views one side CPT 73564 Knee 4+ Views with Sunrise (Right)	$366.17	$406.85	$217.25–$406.85	4% above	10%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 Knee 4+ Views with Sunrise	$732.33	$813.70	$773.02–$813.70	—	10%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Knee 4+ Views with Sunrise (Left)	$366.17	$406.85	$386.51–$406.85	—	10%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Knee 4+ Views with Sunrise (Right)	$366.17	$406.85	$386.51–$406.85	—	10%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Extremity Lower Without Contrast	$3,187.23	$3,984.04	$2,127.40–$3,984.04	57% above	20%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Extremity Lower Without Contrast (Right)	$2,849.20	$3,352.00	$1,063.70–$3,352.00	40% above	15%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Extremity Lower Without Contrast (Left)	$2,849.20	$3,352.00	$1,063.70–$3,352.00	40% above	15%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Extremity Lower Without Contrast	$3,187.23	$3,984.04	$3,784.84–$3,984.04	—	20%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Extremity Lower Without Contrast (Right)	$2,849.20	$3,352.00	$1,952.18–$3,352.00	—	15%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Extremity Lower Without Contrast (Left)	$2,849.20	$3,352.00	$1,952.18–$3,352.00	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Fast Scan (Limited Abdominal)	$1,244.70	$1,383.00	$260.15–$1,383.00	51% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder	$1,244.70	$1,383.00	$348.15–$1,383.00	51% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Liver	$1,244.70	$1,383.00	$348.15–$1,383.00	51% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pancreas	$1,244.70	$1,383.00	$348.15–$1,383.00	51% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Spleen	$1,244.70	$1,383.00	$348.15–$1,383.00	51% above	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Liver	$1,244.70	$1,383.00	$638.95–$1,383.00	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Fast Scan (Limited Abdominal)	$1,244.70	$1,383.00	$477.45–$1,383.00	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Gallbladder	$1,244.70	$1,383.00	$638.95–$1,383.00	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Spleen	$1,244.70	$1,383.00	$638.95–$1,383.00	—	10%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Pancreas	$1,244.70	$1,383.00	$638.95–$1,383.00	—	10%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Extremity Limited	$451.80	$502.00	$240.35–$502.00	25% below	10%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US Extremity Limited	$451.80	$502.00	$441.11–$502.00	—	10%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Tib/Fib AP Lateral	$598.84	$665.38	$355.30–$665.38	79% above	10%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Tib/Fib AP Lateral (Left)	$299.42	$332.69	$177.65–$332.69	11% below	10%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Tib/Fib AP Lateral (Right)	$299.42	$332.69	$177.65–$332.69	11% below	10%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 Tib/Fib AP Lateral	$598.84	$665.38	$632.11–$665.38	—	10%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Tib/Fib AP Lateral (Left)	$299.42	$332.69	$316.06–$332.69	—	10%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Tib/Fib AP Lateral (Right)	$299.42	$332.69	$316.06–$332.69	—	10%
MR angiography (MRA) of the head without contrast CPT 70544 MRA-Head Without Contrast	$2,228.80	$2,786.00	$1,415.15–$2,786.00	24% below	20%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA-Head Without Contrast	$2,228.80	$2,786.00	$2,597.19–$2,786.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Lower Extremity Joint Without Contrast	$5,273.60	$6,592.00	$2,827.00–$6,592.00	66% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Lower Extremity Joint Without Contrast (Right)	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Lt	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Lt	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Cont Rt	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Cont Rt	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Lt	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Cont Rt	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Lower Extremity Joint Without Contrast (Left)	$2,636.80	$3,296.00	$1,413.50–$3,296.00	17% below	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Lower Extremity Joint Without Contrast	$5,273.60	$6,592.00	$5,188.32–$6,592.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Lt	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Lt	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Ankle w/o Cont Rt	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Lt	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Knee w/o Cont Rt	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Hip w/o Cont Rt	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Lower Extremity Joint Without Contrast (Left)	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Lower Extremity Joint Without Contrast (Right)	$2,636.80	$3,296.00	$2,594.16–$3,296.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Joint Lower Extremity With and Without Contrast	$9,393.60	$11,742.00	$3,044.80–$11,742.00	125% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Joint Lower Extremity With and Without Contrast (Right)	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Joint Lower Extremity With and Without Contrast (Left)	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$4,284.80	$5,356.00	$1,522.40–$5,356.00	3% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Joint Lower Extremity With and Without Contrast	$9,393.60	$11,742.00	$5,588.04–$11,742.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Rt	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Lt	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Ankle w/ + w/o Cont Rt	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Lt	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Hip w/ + w/o Cont Rt	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Joint Lower Extremity With and Without Contrast (Left)	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Joint Lower Extremity With and Without Contrast (Right)	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Knee w/ + w/o Cont Lt	$4,284.80	$5,356.00	$2,794.02–$5,356.00	—	20%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen Without Contrast	$2,748.80	$3,436.00	$1,747.35–$3,436.00	16% below	20%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen Without Contrast	$2,748.80	$3,436.00	$3,206.86–$3,436.00	—	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen With and Without Contrast	$6,050.40	$7,563.00	$2,404.60–$7,563.00	39% above	20%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen With and Without Contrast	$6,050.40	$7,563.00	$4,413.10–$7,563.00	—	20%
MRI of the brain, no contrast dye CPT 70551 MRI Pituitary Without Contrast	$2,472.00	$3,090.00	$1,400.30–$3,090.00	21% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI-Brain Without Contrast	$2,472.00	$3,090.00	$1,400.30–$3,090.00	21% below	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI-Brain Without Contrast	$2,472.00	$3,090.00	$2,569.93–$3,090.00	—	20%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Pituitary Without Contrast	$2,472.00	$3,090.00	$2,569.93–$3,090.00	—	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain With and Without Contrast	$5,273.60	$6,592.00	$1,841.95–$6,592.00	22% above	20%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain With and Without Contrast	$5,273.60	$6,592.00	$3,380.48–$6,592.00	—	20%
MRI of the lower back, no contrast dye CPT 72148 MRI Lspine Without Contrast	$4,566.40	$5,708.00	$1,502.60–$5,708.00	40% above	20%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Lspine Without Contrast	$4,566.40	$5,708.00	$2,757.68–$5,708.00	—	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Lspine With and Without Contrast	$5,224.80	$6,531.00	$1,801.25–$6,531.00	18% above	20%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Lspine With and Without Contrast	$5,224.80	$6,531.00	$3,305.79–$6,531.00	—	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Tspine Without Contrast	$4,034.40	$5,043.00	$1,553.20–$5,043.00	23% above	20%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Tspine Without Contrast	$4,034.40	$5,043.00	$2,850.55–$5,043.00	—	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Cspine With and Without Contrast	$5,224.80	$6,531.00	$1,841.95–$6,531.00	22% above	20%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Cspine With and Without Contrast	$5,224.80	$6,531.00	$3,380.48–$6,531.00	—	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Cspine Without Contrast	$4,034.40	$5,043.00	$1,501.50–$5,043.00	23% above	20%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Cspine Without Contrast	$4,034.40	$5,043.00	$2,755.66–$5,043.00	—	20%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Cont	$5,019.20	$6,274.00	$2,307.25–$6,274.00	16% above	20%
MRI of the pelvis without and with contrast CPT 72197 MRI Prostate w/ + w/o Cont	$5,019.20	$6,274.00	$2,307.25–$6,274.00	16% above	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Cont	$5,019.20	$6,274.00	$4,234.43–$6,274.00	—	20%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Prostate w/ + w/o Cont	$5,019.20	$6,274.00	$4,234.43–$6,274.00	—	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI Sacrum w/o Contrast	$2,660.80	$3,326.00	$1,691.80–$3,326.00	26% below	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis Without Contrast	$2,660.80	$3,326.00	$1,691.80–$3,326.00	26% below	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Sacrum w/o Contrast	$2,660.80	$3,326.00	$3,104.91–$3,326.00	—	20%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis Without Contrast	$2,660.80	$3,326.00	$3,104.91–$3,326.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI Upper Extremity Joint Without Contrast	$5,108.80	$6,386.00	$2,968.90–$6,386.00	56% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Rt	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Rt	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Cont Lt	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Upper Extremity Joint Without Contrast (Right)	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Upper Extremity Joint Without Contrast (Left)	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Cont Lt	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Lt	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Cont Rt	$2,554.40	$3,193.00	$1,484.45–$3,193.00	22% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI Upper Extremity Joint Without Contrast	$5,108.80	$6,386.00	$5,448.74–$6,386.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Lt	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Upper Extremity Joint Without Contrast (Left)	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Upper Extremity Joint Without Contrast (Right)	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Shoulder w/o Cont Rt	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Lt	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Wrist w/o Cont Rt	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Lt	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Elbow w/o Cont Rt	$2,554.40	$3,193.00	$2,724.37–$3,193.00	—	20%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Cervical Spine Minimum 4 Views	$618.30	$687.00	$275.00–$687.00	16% above	10%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Cervical Spine Minimum 4 Views	$618.30	$687.00	$504.70–$687.00	—	10%
Neck soft tissue CT scan with contrast CPT 70491 CT Neck with Contrast	$3,190.40	$3,988.00	$2,193.40–$4,100.18	27% above	20%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck with Contrast	$3,190.40	$3,988.00	$3,788.60–$4,100.18	—	20%
Neck soft tissue CT scan without contrast CPT 70490 CT Neck Without Contrast	$1,838.55	$2,163.00	$1,063.70–$2,163.00	10% below	15%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Without Contrast	$1,838.55	$2,163.00	$1,952.18–$2,163.00	—	15%
Neck soft tissue X-ray CPT 70360 Neck/Soft Tissue	$171.90	$191.00	$96.80–$191.00	46% below	10%
Neck soft tissue X-ray inpatient CPT 70360 Neck/Soft Tissue	$171.90	$191.00	$177.65–$191.00	—	10%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial Thallium Stress Test	$6,092.80	$7,616.00	$1,228.70–$7,616.00	50% above	20%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocardial Thallium Stress Test	$6,092.80	$7,616.00	$2,255.00–$7,616.00	—	20%
Pelvic CT scan without contrast CPT 72192 CT Pelvis Without Contrast	$2,479.20	$3,099.00	$1,407.45–$3,099.00	29% above	20%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis Without Contrast	$2,479.20	$3,099.00	$2,583.05–$3,099.00	—	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Bladder Only (Limited or Follow Up)	$391.50	$435.00	$232.10–$435.00	14% below	10%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Non-OB Pelvic Limited or Follow Up	$391.50	$435.00	$232.10–$435.00	14% below	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Bladder Only (Limited or Follow Up)	$391.50	$435.00	$413.25–$435.00	—	10%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Non-OB Pelvic Limited or Follow Up	$391.50	$435.00	$413.25–$435.00	—	10%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis	$868.50	$965.00	$515.35–$965.00	12% below	10%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis	$868.50	$965.00	$916.75–$965.00	—	10%
Rib X-ray, one side, 2 views one side CPT 71100 Ribs Unilateral 2 Views (Right)	$414.90	$461.00	$246.40–$461.00	24% above	10%
Rib X-ray, one side, 2 views one side CPT 71100 Ribs Unilateral 2 Views (Left)	$414.90	$461.00	$246.40–$461.00	24% above	10%
Rib X-ray, one side, 2 views one side CPT 71100 Ribs Unilateral 2 Views	$830.70	$923.00	$492.80–$923.00	149% above	10%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Unilateral 2 Views (Left)	$414.90	$461.00	$437.95–$461.00	—	10%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Unilateral 2 Views (Right)	$414.90	$461.00	$437.95–$461.00	—	10%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 Ribs Unilateral 2 Views	$830.70	$923.00	$876.85–$923.00	—	10%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs Unilateral with PA Chest, Minimum 3 views (Right)	$482.40	$536.00	$270.05–$536.00	2% above	10%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Ribs Unilateral with PA Chest, Minimum 3 views (Left)	$482.40	$536.00	$270.05–$536.00	2% above	10%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs Unilateral with PA Chest, Minimum 3 views (Left)	$482.40	$536.00	$495.62–$536.00	—	10%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Ribs Unilateral with PA Chest, Minimum 3 views (Right)	$482.40	$536.00	$495.62–$536.00	—	10%
Screening mammogram, both breasts both sides CPT 77067 Mammogram Screening Bilateral with CAD	$730.80	$812.00	$200.20–$812.00	—	10%
Screening mammogram, both breasts one side CPT 77067 Mammogram Screening Unilateral Right with CAD	$463.50	$515.00	$190.30–$515.00	4% below	10%
Screening mammogram, both breasts one side CPT 77067 Mammogram Screening Unilateral Left with CAD	$463.50	$515.00	$190.30–$515.00	4% below	10%
Screening mammogram, both breasts inpatient both sides CPT 77067 Mammogram Screening Bilateral with CAD	$730.80	$812.00	$367.42–$812.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 Mammogram Screening Unilateral Left with CAD	$463.50	$515.00	$349.25–$515.00	—	10%
Screening mammogram, both breasts inpatient one side CPT 77067 Mammogram Screening Unilateral Right with CAD	$463.50	$515.00	$349.25–$515.00	—	10%
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulder Complete Minimum 2 Views	$582.16	$646.84	$345.40–$646.84	70% above	10%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Shoulder Complete Minimum 2 Views (Right)	$291.08	$323.42	$172.70–$323.42	15% below	10%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Shoulder Complete Minimum 2 Views (Left)	$291.08	$323.42	$172.70–$323.42	15% below	10%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Shoulder Complete Minimum 2 Views	$582.16	$646.84	$614.50–$646.84	—	10%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Shoulder Complete Minimum 2 Views (Right)	$291.08	$323.42	$307.25–$323.42	—	10%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Shoulder Complete Minimum 2 Views (Left)	$291.08	$323.42	$307.25–$323.42	—	10%
Sinus X-ray, complete, 3 or more views CPT 70220 Sinuses Minimum 3 Views	$384.30	$427.00	$208.45–$427.00	6% below	10%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Sinuses Minimum 3 Views	$384.30	$427.00	$382.56–$427.00	—	10%
Skull X-ray, fewer than 4 views CPT 70250 Skull <4 Views	$447.74	$497.49	$265.65–$497.49	8% above	10%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Skull <4 Views	$447.74	$497.49	$472.62–$497.49	—	10%
Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY	$4,152.80	$5,191.00	$1,750.10–$5,191.00	5% below	20%
Sleep study in a lab (polysomnography) inpatient CPT 95810 SLEEP STUDY	$4,152.80	$5,191.00	$3,211.91–$5,191.00	—	20%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Cine/Video Swallow Study	$523.80	$582.00	$310.75–$582.00	26% below	10%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Cine/Video Swallow Study	$523.80	$582.00	$552.90–$582.00	—	10%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 Femur AP Lateral	$424.57	$471.74	$251.90–$471.74	34% above	10%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Femur AP Lateral (Left)	$212.28	$235.87	$125.95–$235.87	33% below	10%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Femur AP Lateral (Right)	$212.28	$235.87	$125.95–$235.87	33% below	10%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 Femur AP Lateral	$424.57	$471.74	$448.15–$471.74	—	10%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Femur AP Lateral (Right)	$212.28	$235.87	$224.08–$235.87	—	10%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Femur AP Lateral (Left)	$212.28	$235.87	$224.08–$235.87	—	10%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Tspine Without Contrast	$2,631.60	$3,096.00	$1,063.70–$3,096.00	15% above	15%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Tspine Without Contrast	$2,631.60	$3,096.00	$1,952.18–$3,096.00	—	15%
Toe X-ray, 2 or more views CPT 73660 Toe(s) Minimum 2 Views	$246.58	$273.98	$146.30–$273.98	1% below	10%
Toe X-ray, 2 or more views one side CPT 73660 Toe(s) Minimum 2 Views (Left)	$123.29	$136.99	$73.15–$136.99	50% below	10%
Toe X-ray, 2 or more views one side CPT 73660 Toe(s) Minimum 2 Views (Right)	$222.30	$247.00	$73.15–$247.00	11% below	10%
Toe X-ray, 2 or more views inpatient CPT 73660 Toe(s) Minimum 2 Views	$246.58	$273.98	$260.28–$273.98	—	10%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Toe(s) Minimum 2 Views (Left)	$123.29	$136.99	$130.14–$136.99	—	10%
Toe X-ray, 2 or more views inpatient one side CPT 73660 Toe(s) Minimum 2 Views (Right)	$222.30	$247.00	$134.25–$247.00	—	10%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non OB	$435.60	$484.00	$258.50–$484.00	25% below	10%
Transvaginal pelvic ultrasound CPT 76830 FAMC US Pelvis Transvaginal	$435.60	$484.00	$258.50–$484.00	25% below	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non OB	$435.60	$484.00	$459.80–$484.00	—	10%
Transvaginal pelvic ultrasound inpatient CPT 76830 FAMC US Pelvis Transvaginal	$435.60	$484.00	$459.80–$484.00	—	10%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$2,030.65	$2,389.00	$553.30–$2,389.00	83% above	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$2,030.65	$2,389.00	$1,015.46–$2,389.00	—	15%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum	$1,616.40	$1,796.00	$451.00–$1,796.00	96% above	10%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum	$1,616.40	$1,796.00	$827.71–$1,796.00	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue (Head and Neck)	$1,096.20	$1,218.00	$325.60–$1,218.00	36% above	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$1,096.20	$1,218.00	$325.60–$1,218.00	36% above	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue (Head and Neck)	$1,096.20	$1,218.00	$597.56–$1,218.00	—	10%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$1,096.20	$1,218.00	$597.56–$1,218.00	—	10%
Upper arm X-ray (humerus), 2 views CPT 73060 Humerus Minimum 2 views	$565.47	$628.30	$335.50–$628.30	93% above	10%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Humerus Minimum 2 views (Right)	$282.74	$314.15	$167.75–$314.15	4% below	10%
Upper arm X-ray (humerus), 2 views one side CPT 73060 Humerus Minimum 2 views (Left)	$282.74	$314.15	$167.75–$314.15	4% below	10%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 Humerus Minimum 2 views	$565.47	$628.30	$596.89–$628.30	—	10%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Humerus Minimum 2 views (Right)	$282.74	$314.15	$298.44–$314.15	—	10%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Humerus Minimum 2 views (Left)	$282.74	$314.15	$298.44–$314.15	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Unilateral Extremity (Right)	$558.90	$621.00	$331.65–$621.00	43% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Unilateral Extremity (Left)	$558.90	$621.00	$331.65–$621.00	43% below	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Unilateral Extremity (Left)	$558.90	$621.00	$589.95–$621.00	—	10%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Unilateral Extremity (Right)	$558.90	$621.00	$589.95–$621.00	—	10%
Wrist X-ray, 2 views CPT 73100 Wrist AP Lateral	$279.95	$311.06	$166.10–$311.06	17% above	10%
Wrist X-ray, 2 views one side CPT 73100 Wrist AP Lateral (Right)	$139.98	$155.53	$83.05–$155.53	41% below	10%
Wrist X-ray, 2 views one side CPT 73100 Wrist AP Lateral (Left)	$139.98	$155.53	$83.05–$155.53	41% below	10%
Wrist X-ray, 2 views inpatient CPT 73100 Wrist AP Lateral	$279.95	$311.06	$295.51–$311.06	—	10%
Wrist X-ray, 2 views inpatient one side CPT 73100 Wrist AP Lateral (Right)	$139.98	$155.53	$147.75–$155.53	—	10%
Wrist X-ray, 2 views inpatient one side CPT 73100 Wrist AP Lateral (Left)	$139.98	$155.53	$147.75–$155.53	—	10%
Wrist X-ray, complete, 3 or more views CPT 73110 Wrist Complete Minimum 3 Views	$520.97	$578.86	$309.10–$578.86	75% above	10%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Wrist Complete Minimum 3 Views (Right)	$260.49	$289.43	$154.55–$289.43	13% below	10%
Wrist X-ray, complete, 3 or more views one side CPT 73110 Wrist Complete Minimum 3 Views (Left)	$260.49	$289.43	$154.55–$289.43	13% below	10%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Wrist Complete Minimum 3 Views	$520.97	$578.86	$549.92–$578.86	—	10%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Wrist Complete Minimum 3 Views (Left)	$260.49	$289.43	$274.96–$289.43	—	10%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Wrist Complete Minimum 3 Views (Right)	$260.49	$289.43	$274.96–$289.43	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip Complete 2-3 view Minimum (Left)	$231.75	$257.50	$137.50–$257.50	25% below	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip Complete 2-3 view Minimum (Right)	$231.75	$257.50	$137.50–$257.50	25% below	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hip Complete 2-3 view Minimum (Left)	$231.75	$257.50	$244.63–$257.50	—	10%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hip Complete 2-3 view Minimum (Right)	$231.75	$257.50	$244.63–$257.50	—	10%
X-ray of the abdomen, 1 view CPT 74018 Abdomen Single AP View	$249.36	$277.07	$147.95–$277.07	21% below	10%
X-ray of the abdomen, 1 view inpatient CPT 74018 Abdomen Single AP View	$249.36	$277.07	$263.22–$277.07	—	10%
X-ray of the ankle, 2 views CPT 73600 Ankle-AP Lateral	$420.86	$467.62	$249.70–$467.62	51% above	10%
X-ray of the ankle, 2 views one side CPT 73600 Ankle-AP Lateral (Left)	$210.43	$233.81	$124.85–$233.81	24% below	10%
X-ray of the ankle, 2 views one side CPT 73600 Ankle-AP Lateral (Right)	$210.43	$233.81	$124.85–$233.81	24% below	10%
X-ray of the ankle, 2 views inpatient CPT 73600 Ankle-AP Lateral	$420.86	$467.62	$444.24–$467.62	—	10%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Ankle-AP Lateral (Right)	$210.43	$233.81	$222.12–$233.81	—	10%
X-ray of the ankle, 2 views inpatient one side CPT 73600 Ankle-AP Lateral (Left)	$210.43	$233.81	$222.12–$233.81	—	10%
X-ray of the finger(s), 2 or more views both sides CPT 73140 Finger Minimum 2 views bilateral	$519.12	$576.80	$308.00–$576.80	—	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 Finger Minimum 2 views (Left)	$259.56	$288.40	$154.00–$288.40	9% above	10%
X-ray of the finger(s), 2 or more views one side CPT 73140 Finger Minimum 2 views (Right)	$259.56	$288.40	$154.00–$288.40	9% above	10%
X-ray of the finger(s), 2 or more views inpatient both sides CPT 73140 Finger Minimum 2 views bilateral	$519.12	$576.80	$547.96–$576.80	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Finger Minimum 2 views (Left)	$259.56	$288.40	$273.98–$288.40	—	10%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Finger Minimum 2 views (Right)	$259.56	$288.40	$273.98–$288.40	—	10%
X-ray of the foot, 2 views CPT 73620 Foot AP Lateral	$647.05	$718.94	$383.90–$718.94	131% above	10%
X-ray of the foot, 2 views one side CPT 73620 Foot AP Lateral (Right)	$323.52	$359.47	$191.95–$359.47	16% above	10%
X-ray of the foot, 2 views one side CPT 73620 Foot AP Lateral (Left)	$323.52	$359.47	$191.95–$359.47	16% above	10%
X-ray of the foot, 2 views inpatient CPT 73620 Foot AP Lateral	$647.05	$718.94	$682.99–$718.94	—	10%
X-ray of the foot, 2 views inpatient one side CPT 73620 Foot AP Lateral (Left)	$323.52	$359.47	$341.50–$359.47	—	10%
X-ray of the foot, 2 views inpatient one side CPT 73620 Foot AP Lateral (Right)	$323.52	$359.47	$341.50–$359.47	—	10%
X-ray of the foot, complete, 3 or more views CPT 73630 Foot Minimum 3 views	$647.05	$718.94	$383.90–$718.94	123% above	10%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot Minimum 3 views (Right)	$323.52	$359.47	$191.95–$359.47	12% above	10%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot Minimum 3 views (Left)	$323.52	$359.47	$191.95–$359.47	12% above	10%
X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot Minimum 3 views (Left)	$323.52	$359.47	$14.25–$352.28	12% above	10%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Foot Minimum 3 views	$647.05	$718.94	$682.99–$718.94	—	10%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Foot Minimum 3 views (Left)	$323.52	$359.47	$341.50–$359.47	—	10%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Foot Minimum 3 views (Right)	$323.52	$359.47	$341.50–$359.47	—	10%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Foot Minimum 3 views (Left)	$323.52	$359.47	$14.25–$352.28	—	10%
X-ray of the hand, 3 or more views CPT 73130 Hand Minimum 3 views	$678.56	$753.96	$402.60–$753.96	125% above	10%
X-ray of the hand, 3 or more views one side CPT 73130 Hand Minimum 3 views (Right)	$339.28	$376.98	$201.30–$376.98	13% above	10%
X-ray of the hand, 3 or more views one side CPT 73130 Hand Minimum 3 views (Left)	$339.28	$376.98	$201.30–$376.98	13% above	10%
X-ray of the hand, 3 or more views inpatient CPT 73130 Hand Minimum 3 views	$678.56	$753.96	$716.26–$753.96	—	10%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hand Minimum 3 views (Right)	$339.28	$376.98	$358.13–$376.98	—	10%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 Hand Minimum 3 views (Left)	$339.28	$376.98	$358.13–$376.98	—	10%
X-ray of the knee, 1 or 2 views CPT 73560 Knee 1-2 Views	$422.71	$469.68	$250.80–$469.68	52% above	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 1-2 Views (Right)	$211.36	$234.84	$125.40–$234.84	24% below	10%
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 1-2 Views (Left)	$211.36	$234.84	$125.40–$234.84	24% below	10%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Knee 1-2 Views	$422.71	$469.68	$446.20–$469.68	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Knee 1-2 Views (Left)	$211.36	$234.84	$223.10–$234.84	—	10%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Knee 1-2 Views (Right)	$211.36	$234.84	$223.10–$234.84	—	10%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L-Spine AP Lateral	$401.39	$445.99	$238.15–$445.99	at median	10%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 L-Spine AP Lateral	$401.39	$445.99	$423.69–$445.99	—	10%
X-ray of the lower back, 4 or more views CPT 72110 L-Spine Minimum 4 Views	$575.10	$639.00	$341.00–$639.00	1% below	10%
X-ray of the lower back, 4 or more views inpatient CPT 72110 L-Spine Minimum 4 Views	$575.10	$639.00	$607.05–$639.00	—	10%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 T-Spine AP Lateral	$303.13	$336.81	$179.85–$336.81	18% below	10%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 T-Spine AP Lateral	$303.13	$336.81	$319.97–$336.81	—	10%
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones Minimum 3 Views	$226.80	$252.00	$127.60–$252.00	28% below	10%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Nasal Bones Minimum 3 Views	$226.80	$252.00	$234.18–$252.00	—	10%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical Spine AP Lateral	$423.64	$470.71	$251.35–$470.71	14% above	10%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Cervical Spine AP Lateral	$423.64	$470.71	$447.17–$470.71	—	10%
X-ray of the pelvis, 1 or 2 views CPT 72170 Pelvis AP Only	$403.20	$448.00	$138.05–$448.00	27% above	10%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Pelvis AP Only	$403.20	$448.00	$253.36–$448.00	—	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum Coccyx Minimum 2 Views	$258.63	$287.37	$153.45–$287.37	19% below	10%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Sacrum Coccyx Minimum 2 Views	$258.63	$287.37	$273.00–$287.37	—	10%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
ACTH blood test CPT 82024 PLASMA ACTH LEVEL	$228.60	$254.00	$27.02–$248.92	31% above	10%
ACTH blood test CPT 82024 PLASMA ACTH LEVEL	$228.60	$254.00	$129.25–$254.00	31% above	10%
ACTH blood test inpatient CPT 82024 PLASMA ACTH LEVEL	$228.60	$254.00	$237.21–$254.00	—	10%
ACTH blood test inpatient CPT 82024 PLASMA ACTH LEVEL	$228.60	$254.00	$27.02–$248.92	—	10%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT	$49.50	$55.00	$27.50–$55.00	32% below	10%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT	$49.50	$55.00	$3.71–$53.90	32% below	10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT	$49.50	$55.00	$50.47–$55.00	—	10%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT	$49.50	$55.00	$3.71–$53.90	—	10%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST/SGOT	$64.80	$72.00	$3.62–$70.56	13% below	10%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST/SGOT	$64.80	$72.00	$36.30–$72.00	13% below	10%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST/SGOT	$64.80	$72.00	$66.62–$72.00	—	10%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST/SGOT	$64.80	$72.00	$3.62–$70.56	—	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL TOTAL (ACUTE)	$171.00	$190.00	$96.25–$190.00	36% below	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL TOTAL (ACUTE)	$171.00	$190.00	$32.87–$186.20	36% below	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HIV 1 and 2 Screen ATL (Annual Medicare Visits)	$231.75	$257.50	$137.50–$257.50	13% below	10%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HIV 1 and 2 Screen ATL (Annual Medicare Visits)	$231.75	$257.50	$32.87–$252.35	13% below	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL TOTAL (ACUTE)	$171.00	$190.00	$176.65–$190.00	—	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS PANEL TOTAL (ACUTE)	$171.00	$190.00	$32.87–$186.20	—	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HIV 1 and 2 Screen ATL (Annual Medicare Visits)	$231.75	$257.50	$244.63–$257.50	—	10%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HIV 1 and 2 Screen ATL (Annual Medicare Visits)	$231.75	$257.50	$32.87–$252.35	—	10%
Albumin blood test CPT 82040 ALBUMIN	$68.40	$76.00	$38.50–$76.00	11% above	10%
Albumin blood test CPT 82040 ALBUMIN	$68.40	$76.00	$3.46–$74.48	11% above	10%
Albumin blood test inpatient CPT 82040 ALBUMIN	$68.40	$76.00	$3.46–$74.48	—	10%
Albumin blood test inpatient CPT 82040 ALBUMIN	$68.40	$76.00	$70.66–$76.00	—	10%
Aldosterone blood test CPT 82088 Aldosterone/Renin Activity Ratio ATL	$102.60	$114.00	$57.75–$114.00	5% below	10%
Aldosterone blood test CPT 82088 Aldosterone/Renin Activity Ratio ATL	$102.60	$114.00	$27.83–$111.72	5% below	10%
Aldosterone blood test CPT 82088 ALDOSTERONE/SERUM	$318.60	$354.00	$28.51–$346.92	195% above	10%
Aldosterone blood test CPT 82088 ALDOSTERONE/SERUM	$318.60	$354.00	$179.85–$354.00	195% above	10%
Aldosterone blood test inpatient CPT 82088 Aldosterone/Renin Activity Ratio ATL	$102.60	$114.00	$27.83–$111.72	—	10%
Aldosterone blood test inpatient CPT 82088 Aldosterone/Renin Activity Ratio ATL	$102.60	$114.00	$105.99–$114.00	—	10%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE/SERUM	$318.60	$354.00	$28.51–$346.92	—	10%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE/SERUM	$318.60	$354.00	$330.07–$354.00	—	10%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE, ALKALINE	$46.80	$52.00	$3.62–$50.96	36% below	10%
Alkaline phosphatase (ALP) blood test CPT 84075 PHOSPHATASE, ALKALINE	$46.80	$52.00	$25.85–$52.00	36% below	10%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE, ALKALINE	$46.80	$52.00	$3.62–$50.96	—	10%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 PHOSPHATASE, ALKALINE	$46.80	$52.00	$47.44–$52.00	—	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ADULT ALLERGY PANEL	$4.50	$5.00	$2.20–$5.00	87% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ADULT ALLERGY PANEL	$4.50	$5.00	$1.06–$9.24	87% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 WESTERN PROFILE	$10.80	$12.00	$6.05–$12.00	69% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 WESTERN PROFILE	$10.80	$12.00	$2.92–$11.76	69% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ENVIRONMENTAL PANEL	$11.70	$13.00	$7.15–$13.12	66% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IgE: RESPIRATORY	$18.54	$20.60	$11.00–$20.60	46% below	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific IgE ATL	$36.90	$41.00	$20.90–$41.00	7% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Peanut ATL	$36.90	$41.00	$20.90–$41.00	7% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific IgE ATL	$36.90	$41.00	$3.35–$40.18	7% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Milk (Cow) ATL	$36.90	$41.00	$20.90–$41.00	7% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IgE: PEDIATRIC	$53.77	$59.74	$31.90–$59.74	56% above	10%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IgE: PEDIATRIC	$53.77	$59.74	$3.35–$58.55	56% above	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ADULT ALLERGY PANEL	$4.50	$5.00	$4.04–$5.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ADULT ALLERGY PANEL	$4.50	$5.00	$1.06–$9.24	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WESTERN PROFILE	$10.80	$12.00	$2.92–$11.76	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 WESTERN PROFILE	$10.80	$12.00	$11.10–$12.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ENVIRONMENTAL PANEL	$11.70	$13.00	$12.35–$13.12	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IgE: RESPIRATORY	$18.54	$20.60	$19.57–$20.60	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Specific IgE ATL	$36.90	$41.00	$3.35–$40.18	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Milk (Cow) ATL	$36.90	$41.00	$38.36–$41.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen, Peanut ATL	$36.90	$41.00	$38.36–$41.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Specific IgE ATL	$36.90	$41.00	$38.36–$41.00	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IgE: PEDIATRIC	$53.77	$59.74	$3.35–$58.55	—	10%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IgE: PEDIATRIC	$53.77	$59.74	$56.75–$59.74	—	10%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP - ALPHA-FETOPROTEIN (SERUM)	$92.70	$103.00	$52.25–$103.00	31% below	10%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP - ALPHA-FETOPROTEIN (SERUM)	$92.70	$103.00	$11.74–$100.94	31% below	10%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP - ALPHA-FETOPROTEIN (SERUM)	$92.70	$103.00	$11.74–$100.94	—	10%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP - ALPHA-FETOPROTEIN (SERUM)	$92.70	$103.00	$95.89–$103.00	—	10%
Ammonia blood test CPT 82140 AMMONIA LEVEL	$137.70	$153.00	$77.55–$153.00	18% below	10%
Ammonia blood test CPT 82140 AMMONIA LEVEL	$137.70	$153.00	$10.19–$149.94	18% below	10%
Ammonia blood test inpatient CPT 82140 AMMONIA LEVEL	$137.70	$153.00	$142.33–$153.00	—	10%
Ammonia blood test inpatient CPT 82140 AMMONIA LEVEL	$137.70	$153.00	$10.19–$149.94	—	10%
Amylase blood test CPT 82150 AMYLASE ISOEMZYMES (USE ONLY WITH EXPLO)	$63.96	$71.07	$37.95–$71.07	37% below	10%
Amylase blood test CPT 82150 Amylase, Isoenzymes ATL	$67.50	$75.00	$37.95–$75.00	33% below	10%
Amylase blood test CPT 82150 Amylase, Isoenzymes ATL	$67.50	$75.00	$4.53–$73.50	33% below	10%
Amylase blood test CPT 82150 AMYLASE, SERUM	$109.80	$122.00	$61.60–$122.00	9% above	10%
Amylase blood test CPT 82150 Amylase ATL	$109.80	$122.00	$61.60–$122.00	9% above	10%
Amylase blood test CPT 82150 Amylase ATL	$109.80	$122.00	$4.53–$119.56	9% above	10%
Amylase blood test CPT 82150 AMYLASE, SERUM	$109.80	$122.00	$4.53–$119.56	9% above	10%
Amylase blood test inpatient CPT 82150 AMYLASE ISOEMZYMES (USE ONLY WITH EXPLO)	$63.96	$71.07	$67.52–$71.07	—	10%
Amylase blood test inpatient CPT 82150 Amylase, Isoenzymes ATL	$67.50	$75.00	$69.65–$75.00	—	10%
Amylase blood test inpatient CPT 82150 Amylase, Isoenzymes ATL	$67.50	$75.00	$4.53–$73.50	—	10%
Amylase blood test inpatient CPT 82150 Amylase ATL	$109.80	$122.00	$4.53–$119.56	—	10%
Amylase blood test inpatient CPT 82150 AMYLASE, SERUM	$109.80	$122.00	$113.05–$122.00	—	10%
Amylase blood test inpatient CPT 82150 Amylase ATL	$109.80	$122.00	$113.05–$122.00	—	10%
Amylase blood test inpatient CPT 82150 AMYLASE, SERUM	$109.80	$122.00	$4.53–$119.56	—	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTI	$197.10	$219.00	$9.06–$214.62	37% above	10%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTI	$197.10	$219.00	$111.10–$219.00	37% above	10%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTI	$197.10	$219.00	$9.06–$214.62	—	10%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULLINATED PEPTIDE ANTI	$197.10	$219.00	$203.90–$219.00	—	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$216.90	$241.00	$122.10–$241.00	2% above	10%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$216.90	$241.00	$23.75–$236.18	2% above	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP	$216.90	$241.00	$23.75–$236.18	—	10%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP	$216.90	$241.00	$224.09–$241.00	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture GS ATL	$90.85	$100.94	$6.03–$98.92	7% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Sputum Culture GS ATL	$90.85	$100.94	$53.90–$100.94	7% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture ATL	$95.40	$106.00	$6.03–$103.88	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture ATL	$95.40	$106.00	$53.90–$106.00	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture ATL	$95.40	$106.00	$53.90–$106.00	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture ATL	$95.40	$106.00	$53.90–$106.00	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Culture ATL	$95.40	$106.00	$53.90–$106.00	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Throat Culture ATL	$95.40	$106.00	$6.03–$103.88	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture ATL	$95.40	$106.00	$6.03–$103.88	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture ATL	$95.40	$106.00	$6.03–$103.88	12% above	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sputum Culture GS ATL	$90.85	$100.94	$6.03–$98.92	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Sputum Culture GS ATL	$90.85	$100.94	$95.89–$100.94	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture ATL	$95.40	$106.00	$98.92–$106.00	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture ATL	$95.40	$106.00	$6.03–$103.88	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture ATL	$95.40	$106.00	$6.03–$103.88	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Throat Culture ATL	$95.40	$106.00	$6.03–$103.88	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture ATL	$95.40	$106.00	$6.03–$103.88	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture ATL	$95.40	$106.00	$98.92–$106.00	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture ATL	$95.40	$106.00	$98.92–$106.00	—	10%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Culture ATL	$95.40	$106.00	$98.92–$106.00	—	10%
Basic metabolic panel (blood test) CPT 80048 BMP (NA,K,CL,CO2,BUN,GLUC,CREAT)	$144.90	$161.00	$5.92–$157.78	1% above	10%
Basic metabolic panel (blood test) CPT 80048 BMP (NA,K,CL,CO2,BUN,GLUC,CREAT)	$144.90	$161.00	$81.40–$161.00	1% above	10%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP (NA,K,CL,CO2,BUN,GLUC,CREAT)	$144.90	$161.00	$149.39–$161.00	—	10%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP (NA,K,CL,CO2,BUN,GLUC,CREAT)	$144.90	$161.00	$5.92–$157.78	—	10%
Bilirubin blood test, total CPT 82247 Bilirubin,Total ATL	$44.10	$49.00	$24.75–$49.00	47% below	10%
Bilirubin blood test, total CPT 82247 Bilirubin,Total ATL	$44.10	$49.00	$3.51–$48.02	47% below	10%
Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL	$44.10	$49.00	$3.51–$48.02	47% below	10%
Bilirubin blood test, total CPT 82247 BILIRUBIN, TOTAL	$44.10	$49.00	$24.75–$49.00	47% below	10%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL	$44.10	$49.00	$3.51–$48.02	—	10%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin,Total ATL	$44.10	$49.00	$45.42–$49.00	—	10%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin,Total ATL	$44.10	$49.00	$3.51–$48.02	—	10%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN, TOTAL	$44.10	$49.00	$45.42–$49.00	—	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY LEVEL IV (OP)	$196.52	$218.36	$116.60–$218.36	22% above	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY LEVEL IV (OP)	$196.52	$218.36	$55.18–$213.99	22% above	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 Pathology Level IV	$196.52	$218.36	$55.18–$213.99	22% above	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology Level IV	$207.00	$230.00	$55.18–$225.40	28% above	10%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology Level IV	$207.00	$230.00	$116.60–$230.00	28% above	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 Pathology Level IV	$196.52	$218.36	$55.18–$213.99	—	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATHOLOGY LEVEL IV (OP)	$196.52	$218.36	$207.44–$218.36	—	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATHOLOGY LEVEL IV (OP)	$196.52	$218.36	$55.18–$213.99	—	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Pathology Level IV	$207.00	$230.00	$213.99–$230.00	—	10%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Pathology Level IV	$207.00	$230.00	$55.18–$225.40	—	10%
Blood culture for bacteria CPT 87040 Culture, bacterial; blood ATL	$152.96	$169.95	$90.75–$169.95	7% below	10%
Blood culture for bacteria CPT 87040 Culture, bacterial; blood ATL	$152.96	$169.95	$6.51–$166.55	7% below	10%
Blood culture for bacteria CPT 87040 Blood Culture ATL	$161.10	$179.00	$90.75–$179.00	2% below	10%
Blood culture for bacteria CPT 87040 Blood Culture ATL	$161.10	$179.00	$6.51–$175.42	2% below	10%
Blood culture for bacteria inpatient CPT 87040 Culture, bacterial; blood ATL	$152.96	$169.95	$6.51–$166.55	—	10%
Blood culture for bacteria inpatient CPT 87040 Culture, bacterial; blood ATL	$152.96	$169.95	$161.45–$169.95	—	10%
Blood culture for bacteria inpatient CPT 87040 Blood Culture ATL	$161.10	$179.00	$6.51–$175.42	—	10%
Blood culture for bacteria inpatient CPT 87040 Blood Culture ATL	$161.10	$179.00	$166.55–$179.00	—	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venous Draw	$25.03	$27.81	$14.85–$27.81	10% below	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venous Draw	$25.03	$27.81	$3.00–$27.25	10% below	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$27.00	$30.00	$14.85–$30.00	3% below	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$27.00	$30.00	$3.00–$29.40	3% below	10%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD ALCOHOL DRAW	$60.30	$67.00	$35.75–$67.00	117% above	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venous Draw	$25.03	$27.81	$26.42–$27.81	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venous Draw	$25.03	$27.81	$3.00–$27.25	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$27.00	$30.00	$27.25–$30.00	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$27.00	$30.00	$3.00–$29.40	—	10%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD ALCOHOL DRAW	$60.30	$67.00	$63.65–$67.00	—	10%
Blood glucose (sugar) test CPT 82947 Epoc Glucose	$56.70	$63.00	$31.90–$63.00	4% below	10%
Blood glucose (sugar) test CPT 82947 Epoc Glucose	$56.70	$63.00	$3.93–$61.74	4% below	10%
Blood glucose (sugar) test CPT 82947 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$3.93–$61.74	4% below	10%
Blood glucose (sugar) test CPT 82947 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$31.90–$63.00	4% below	10%
Blood glucose (sugar) test CPT 82947 82947301 GLUCOSE, SERUM OR BODY FLUID	$81.58	$90.64	$48.40–$90.64	38% above	10%
Blood glucose (sugar) test inpatient CPT 82947 Epoc Glucose	$56.70	$63.00	$58.55–$63.00	—	10%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$58.55–$63.00	—	10%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$3.93–$61.74	—	10%
Blood glucose (sugar) test inpatient CPT 82947 Epoc Glucose	$56.70	$63.00	$3.93–$61.74	—	10%
Blood glucose (sugar) test inpatient CPT 82947 82947301 GLUCOSE, SERUM OR BODY FLUID	$81.58	$90.64	$86.11–$90.64	—	10%
Blood lead test CPT 83655 LEAD (CHARGE FOR HEAVY METALS PANEL 4)	$34.30	$38.11	$20.35–$38.11	38% below	10%
Blood lead test CPT 83655 Lead,Whole Blood Venous ATL	$63.90	$71.00	$35.75–$71.00	15% above	10%
Blood lead test CPT 83655 Lead,Whole Blood Venous ATL	$63.90	$71.00	$8.47–$69.58	15% above	10%
Blood lead test CPT 83655 LEAD, BLOOD--VENOUS	$63.90	$71.00	$35.75–$71.00	15% above	10%
Blood lead test CPT 83655 LEAD, BLOOD--VENOUS	$63.90	$71.00	$8.47–$69.58	15% above	10%
Blood lead test CPT 83655 LEAD	$66.74	$74.16	$39.60–$74.16	20% above	10%
Blood lead test inpatient CPT 83655 LEAD (CHARGE FOR HEAVY METALS PANEL 4)	$34.30	$38.11	$36.20–$38.11	—	10%
Blood lead test inpatient CPT 83655 LEAD, BLOOD--VENOUS	$63.90	$71.00	$65.61–$71.00	—	10%
Blood lead test inpatient CPT 83655 Lead,Whole Blood Venous ATL	$63.90	$71.00	$8.47–$69.58	—	10%
Blood lead test inpatient CPT 83655 LEAD, BLOOD--VENOUS	$63.90	$71.00	$8.47–$69.58	—	10%
Blood lead test inpatient CPT 83655 Lead,Whole Blood Venous ATL	$63.90	$71.00	$65.61–$71.00	—	10%
Blood lead test inpatient CPT 83655 LEAD	$66.74	$74.16	$70.45–$74.16	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUALITATIVE-SERUM	$116.10	$129.00	$65.45–$129.00	1% below	10%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUALITATIVE-SERUM	$116.10	$129.00	$5.26–$126.42	1% below	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUALITATIVE-SERUM	$116.10	$129.00	$5.26–$126.42	—	10%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUALITATIVE-SERUM	$116.10	$129.00	$120.12–$129.00	—	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO Type ATL	$62.10	$69.00	$34.65–$69.00	11% above	10%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO Type ATL	$62.10	$69.00	$2.09–$67.62	11% above	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO Type ATL	$62.10	$69.00	$63.59–$69.00	—	10%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO Type ATL	$62.10	$69.00	$2.09–$67.62	—	10%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$64.80	$72.00	$36.30–$72.00	4% above	10%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$64.80	$72.00	$2.76–$70.56	4% above	10%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$64.80	$72.00	$66.62–$72.00	—	10%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$64.80	$72.00	$2.76–$70.56	—	10%
C-peptide blood test CPT 84681 C-PEPTIDE (SERUM)	$177.30	$197.00	$99.55–$197.00	19% above	10%
C-peptide blood test CPT 84681 C-PEPTIDE (SERUM)	$177.30	$197.00	$14.56–$193.06	19% above	10%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE (SERUM)	$177.30	$197.00	$182.70–$197.00	—	10%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE (SERUM)	$177.30	$197.00	$14.56–$193.06	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$128.70	$143.00	$72.60–$143.00	55% above	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$128.70	$143.00	$2.88–$140.14	55% above	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP,Quantitative ATL	$128.70	$143.00	$2.88–$140.14	55% above	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP,Quantitative ATL	$128.70	$143.00	$72.60–$143.00	55% above	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$128.70	$143.00	$133.24–$143.00	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP,Quantitative ATL	$128.70	$143.00	$2.88–$140.14	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP,Quantitative ATL	$128.70	$143.00	$133.24–$143.00	—	10%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$128.70	$143.00	$2.88–$140.14	—	10%
C. difficile toxin gene test (stool PCR) CPT 87493 C.DIFFICILLE TOXIN	$175.50	$195.00	$99.00–$195.00	16% below	10%
C. difficile toxin gene test (stool PCR) CPT 87493 C.DIFFICILLE TOXIN	$175.50	$195.00	$24.55–$191.10	16% below	10%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C.DIFFICILLE TOXIN	$175.50	$195.00	$24.55–$191.10	—	10%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C.DIFFICILLE TOXIN	$175.50	$195.00	$181.69–$195.00	—	10%
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN-GI (CA 19-9 ATL	$163.80	$182.00	$92.40–$182.00	41% above	10%
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN-GI (CA 19-9 ATL	$163.80	$182.00	$14.56–$178.36	41% above	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN-GI (CA 19-9 ATL	$163.80	$182.00	$14.56–$178.36	—	10%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CANCER ANTIGEN-GI (CA 19-9 ATL	$163.80	$182.00	$169.58–$182.00	—	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125 CANCER ANTIGEN TEST	$259.20	$288.00	$146.30–$288.00	39% above	10%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125 CANCER ANTIGEN TEST	$259.20	$288.00	$14.56–$282.24	39% above	10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125 CANCER ANTIGEN TEST	$259.20	$288.00	$14.56–$282.24	—	10%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125 CANCER ANTIGEN TEST	$259.20	$288.00	$268.50–$288.00	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 Molecular (ID NOW)	$185.40	$206.00	$26.17–$201.88	49% above	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 Molecular (ID NOW)	$185.40	$206.00	$104.50–$206.00	49% above	10%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Coronavirus COVID19 PCR ATL	$243.90	$271.00	$137.50–$271.00	95% above	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 Molecular (ID NOW)	$185.40	$206.00	$191.79–$206.00	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 Molecular (ID NOW)	$185.40	$206.00	$26.17–$201.88	—	10%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Coronavirus COVID19 PCR ATL	$243.90	$271.00	$252.35–$271.00	—	10%
Calcium blood test, total CPT 82310 CALCIUM, SERUM	$75.60	$84.00	$42.90–$84.00	at median	10%
Calcium blood test, total CPT 82310 CALCIUM, SERUM	$75.60	$84.00	$3.61–$82.32	at median	10%
Calcium blood test, total inpatient CPT 82310 CALCIUM, SERUM	$75.60	$84.00	$3.61–$82.32	—	10%
Calcium blood test, total inpatient CPT 82310 CALCIUM, SERUM	$75.60	$84.00	$78.73–$84.00	—	10%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA	$174.60	$194.00	$13.27–$190.12	5% above	10%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA	$174.60	$194.00	$98.45–$194.00	5% above	10%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA	$174.60	$194.00	$13.27–$190.12	—	10%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA	$174.60	$194.00	$180.68–$194.00	—	10%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER; IgG	$45.00	$50.00	$25.30–$50.00	17% below	10%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER; IgG	$45.00	$50.00	$7.43–$49.00	17% below	10%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus IgM ATL	$57.60	$64.00	$25.30–$64.00	6% above	10%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus IgM ATL	$57.60	$64.00	$7.43–$62.72	6% above	10%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA TITRE/IGG IGM	$107.53	$119.48	$7.43–$117.09	98% above	10%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA TITRE/IGG IGM	$107.53	$119.48	$63.80–$119.48	98% above	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER; IgG	$45.00	$50.00	$7.43–$49.00	—	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER; IgG	$45.00	$50.00	$46.43–$50.00	—	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus IgM ATL	$57.60	$64.00	$7.43–$62.72	—	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus IgM ATL	$57.60	$64.00	$46.43–$64.00	—	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA TITRE/IGG IGM	$107.53	$119.48	$113.51–$119.48	—	10%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA TITRE/IGG IGM	$107.53	$119.48	$7.43–$117.09	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA, URINE	$134.42	$149.35	$24.55–$146.36	18% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA, URINE	$134.42	$149.35	$79.75–$149.35	18% above	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA, URINE	$134.42	$149.35	$141.88–$149.35	—	10%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA, URINE	$134.42	$149.35	$24.55–$146.36	—	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL-CHOL,TRIG,HDL,CALDL,VLDL	$104.75	$116.39	$62.15–$116.39	3% below	10%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL-CHOL,TRIG,HDL,CALDL,VLDL	$104.75	$116.39	$9.37–$114.06	3% below	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL-CHOL,TRIG,HDL,CALDL,VLDL	$104.75	$116.39	$9.37–$114.06	—	10%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL-CHOL,TRIG,HDL,CALDL,VLDL	$104.75	$116.39	$110.57–$116.39	—	10%
Complete blood count (CBC) with differential CPT 85025 CBC w/ AUTO DIFF	$121.44	$134.93	$72.05–$134.93	13% above	10%
Complete blood count (CBC) with differential CPT 85025 CBC w/ AUTO DIFF	$121.44	$134.93	$5.44–$132.23	13% above	10%
Complete blood count (CBC) with differential CPT 85025 CBC With Automated Diff ATL	$127.80	$142.00	$72.05–$142.00	19% above	10%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTOMATED DIFF	$127.80	$142.00	$5.44–$139.16	19% above	10%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTOMATED DIFF	$127.80	$142.00	$72.05–$142.00	19% above	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ AUTO DIFF	$121.44	$134.93	$5.44–$132.23	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ AUTO DIFF	$121.44	$134.93	$128.18–$134.93	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC With Automated Diff ATL	$127.80	$142.00	$132.23–$142.00	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTOMATED DIFF	$127.80	$142.00	$132.23–$142.00	—	10%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTOMATED DIFF	$127.80	$142.00	$5.44–$139.16	—	10%
Complete blood count (CBC), no differential CPT 85027 Hemogram	$91.80	$102.00	$51.70–$102.00	7% above	10%
Complete blood count (CBC), no differential CPT 85027 Hemogram	$91.80	$102.00	$4.52–$99.96	7% above	10%
Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram	$91.80	$102.00	$4.52–$99.96	—	10%
Complete blood count (CBC), no differential inpatient CPT 85027 Hemogram	$91.80	$102.00	$94.88–$102.00	—	10%
Comprehensive metabolic panel (blood test) CPT 80053 CMP-NA,K,CL,GLUC,BUN,CREAT,AST,ALK+6	$192.60	$214.00	$7.39–$209.72	18% above	10%
Comprehensive metabolic panel (blood test) CPT 80053 CMP-NA,K,CL,GLUC,BUN,CREAT,AST,ALK+6	$192.60	$214.00	$108.90–$214.00	18% above	10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP-NA,K,CL,GLUC,BUN,CREAT,AST,ALK+6	$192.60	$214.00	$199.86–$214.00	—	10%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP-NA,K,CL,GLUC,BUN,CREAT,AST,ALK+6	$192.60	$214.00	$7.39–$209.72	—	10%
Cortisol blood test, total CPT 82533 CORTISOL - AM or PM	$58.50	$65.00	$9.25–$63.70	36% below	10%
Cortisol blood test, total CPT 82533 Cortisol 30 Min ATL	$58.50	$65.00	$9.25–$63.70	36% below	10%
Cortisol blood test, total CPT 82533 Cortisol 60 Min ATL	$58.50	$65.00	$9.25–$63.70	36% below	10%
Cortisol blood test, total CPT 82533 Cortisol 60 Min ATL	$58.50	$65.00	$33.00–$65.00	36% below	10%
Cortisol blood test, total CPT 82533 Cortisol 30 Min ATL	$58.50	$65.00	$33.00–$65.00	36% below	10%
Cortisol blood test, total CPT 82533 CORTISOL - AM or PM	$58.50	$65.00	$33.00–$65.00	36% below	10%
Cortisol blood test, total CPT 82533 Cortisol Total	$146.70	$163.00	$82.50–$163.00	59% above	10%
Cortisol blood test, total CPT 82533 Cortisol Total	$146.70	$163.00	$9.25–$159.74	59% above	10%
Cortisol blood test, total inpatient CPT 82533 Cortisol 60 Min ATL	$58.50	$65.00	$9.25–$63.70	—	10%
Cortisol blood test, total inpatient CPT 82533 Cortisol 30 Min ATL	$58.50	$65.00	$60.56–$65.00	—	10%
Cortisol blood test, total inpatient CPT 82533 Cortisol 60 Min ATL	$58.50	$65.00	$60.56–$65.00	—	10%
Cortisol blood test, total inpatient CPT 82533 CORTISOL - AM or PM	$58.50	$65.00	$9.25–$63.70	—	10%
Cortisol blood test, total inpatient CPT 82533 CORTISOL - AM or PM	$58.50	$65.00	$60.56–$65.00	—	10%
Cortisol blood test, total inpatient CPT 82533 Cortisol 30 Min ATL	$58.50	$65.00	$9.25–$63.70	—	10%
Cortisol blood test, total inpatient CPT 82533 Cortisol Total	$146.70	$163.00	$9.25–$159.74	—	10%
Cortisol blood test, total inpatient CPT 82533 Cortisol Total	$146.70	$163.00	$151.41–$163.00	—	10%
Creatine kinase (CK) blood test, total CPT 82550 CPK, TOTAL	$75.60	$84.00	$42.90–$84.00	1% below	10%
Creatine kinase (CK) blood test, total CPT 82550 CPK, TOTAL	$75.60	$84.00	$4.55–$82.32	1% below	10%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK, TOTAL	$75.60	$84.00	$78.73–$84.00	—	10%
Creatine kinase (CK) blood test, total inpatient CPT 82550 CPK, TOTAL	$75.60	$84.00	$4.55–$82.32	—	10%
Creatinine blood test CPT 82565 EPOC Creat	$56.70	$63.00	$3.59–$61.74	16% below	10%
Creatinine blood test CPT 82565 CREATNINE, BLOOD	$56.70	$63.00	$3.59–$61.74	16% below	10%
Creatinine blood test CPT 82565 EPOC Creat	$56.70	$63.00	$31.90–$63.00	16% below	10%
Creatinine blood test CPT 82565 CREATNINE, BLOOD	$56.70	$63.00	$31.90–$63.00	16% below	10%
Creatinine blood test inpatient CPT 82565 EPOC Creat	$56.70	$63.00	$3.59–$61.74	—	10%
Creatinine blood test inpatient CPT 82565 EPOC Creat	$56.70	$63.00	$58.55–$63.00	—	10%
Creatinine blood test inpatient CPT 82565 CREATNINE, BLOOD	$56.70	$63.00	$3.59–$61.74	—	10%
Creatinine blood test inpatient CPT 82565 CREATNINE, BLOOD	$56.70	$63.00	$58.55–$63.00	—	10%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IgG Antibody ATL	$102.60	$114.00	$57.75–$114.00	46% above	10%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IgG Antibody ATL	$102.60	$114.00	$105.99–$114.00	—	10%
D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation products, D-dimer; quantitative	$151.10	$167.89	$89.65–$167.89	7% above	10%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER TEST	$194.40	$216.00	$5.67–$211.68	38% above	10%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER TEST	$194.40	$216.00	$110.00–$216.00	38% above	10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrin degradation products, D-dimer; quantitative	$151.10	$167.89	$159.50–$167.89	—	10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER TEST	$194.40	$216.00	$201.88–$216.00	—	10%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER TEST	$194.40	$216.00	$5.67–$211.68	—	10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS SULFACE SERUM	$115.88	$128.75	$15.56–$126.18	27% below	10%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS SULFACE SERUM	$115.88	$128.75	$68.75–$128.75	27% below	10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEAS SULFACE SERUM	$115.88	$128.75	$15.56–$126.18	—	10%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEAS SULFACE SERUM	$115.88	$128.75	$122.31–$128.75	—	10%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Ethyl Glucuronide Screen with Reflex, Urine	$191.70	$213.00	$108.35–$213.00	27% above	10%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Ethyl Glucuronide Screen with Reflex, Urine	$191.70	$213.00	$198.85–$213.00	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES PANEL NA,K,CL,CO2	$106.20	$118.00	$4.91–$115.64	at median	10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 EPOC Lytes	$106.20	$118.00	$4.91–$115.64	at median	10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES PANEL NA,K,CL,CO2	$106.20	$118.00	$59.95–$118.00	at median	10%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 EPOC Lytes	$106.20	$118.00	$59.95–$118.00	at median	10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 EPOC Lytes	$106.20	$118.00	$4.91–$115.64	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES PANEL NA,K,CL,CO2	$106.20	$118.00	$110.02–$118.00	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 EPOC Lytes	$106.20	$118.00	$110.02–$118.00	—	10%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES PANEL NA,K,CL,CO2	$106.20	$118.00	$4.91–$115.64	—	10%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN-BARR VIRUS, VIRAL CAPSID (VC)	$62.11	$69.01	$36.85–$69.01	10% below	10%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV Panel II IGM	$101.97	$113.30	$60.50–$113.30	48% above	10%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV Panel II	$107.10	$119.00	$60.50–$119.00	56% above	10%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN-BARR VIRUS, VIRAL CAPSID (VC)	$62.11	$69.01	$65.56–$69.01	—	10%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV Panel II IGM	$101.97	$113.30	$107.64–$113.30	—	10%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV Panel II	$107.10	$119.00	$111.03–$119.00	—	10%
Estradiol blood test CPT 82670 ESTRADIOL LEVEL	$114.30	$127.00	$64.35–$127.00	22% below	10%
Estradiol blood test CPT 82670 ESTRADIOL LEVEL	$114.30	$127.00	$19.54–$124.46	22% below	10%
Estradiol blood test inpatient CPT 82670 ESTRADIOL LEVEL	$114.30	$127.00	$118.10–$127.00	—	10%
Estradiol blood test inpatient CPT 82670 ESTRADIOL LEVEL	$114.30	$127.00	$19.54–$124.46	—	10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH, GONADOTROPIN LEVEL	$85.50	$95.00	$47.85–$95.00	21% below	10%
FSH (follicle-stimulating hormone) test CPT 83001 FSH, GONADOTROPIN LEVEL	$85.50	$95.00	$13.00–$93.10	21% below	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, GONADOTROPIN LEVEL	$85.50	$95.00	$87.82–$95.00	—	10%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH, GONADOTROPIN LEVEL	$85.50	$95.00	$13.00–$93.10	—	10%
Fecal calprotectin (stool inflammation test) CPT 83993 Fecal Calprotectin	$258.63	$287.37	$153.45–$287.37	9% above	10%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool ATL	$491.40	$546.00	$13.73–$535.08	107% above	10%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool ATL	$491.40	$546.00	$153.45–$546.00	107% above	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Fecal Calprotectin	$258.63	$287.37	$273.00–$287.37	—	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool ATL	$491.40	$546.00	$13.73–$535.08	—	10%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Stool ATL	$491.40	$546.00	$281.62–$546.00	—	10%
Ferritin blood test (iron stores) CPT 82728 Ferritin ATL	$122.40	$136.00	$68.75–$136.00	at median	10%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$122.40	$136.00	$68.75–$136.00	at median	10%
Ferritin blood test (iron stores) CPT 82728 Ferritin ATL	$122.40	$136.00	$9.54–$133.28	at median	10%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$122.40	$136.00	$9.54–$133.28	at median	10%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin ATL	$122.40	$136.00	$9.54–$133.28	—	10%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$122.40	$136.00	$9.54–$133.28	—	10%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin ATL	$122.40	$136.00	$126.18–$136.00	—	10%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$122.40	$136.00	$126.18–$136.00	—	10%
Fibrinogen blood test CPT 85384 Fibrinogen; activity	$164.08	$182.31	$97.35–$182.31	44% above	10%
Fibrinogen blood test CPT 85384 FIBRINOGEN (FBG) LEVEL	$172.80	$192.00	$5.94–$188.16	52% above	10%
Fibrinogen blood test CPT 85384 FIBRINOGEN (FBG) LEVEL	$172.80	$192.00	$97.35–$192.00	52% above	10%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen; activity	$164.08	$182.31	$173.19–$182.31	—	10%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN (FBG) LEVEL	$172.80	$192.00	$5.94–$188.16	—	10%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN (FBG) LEVEL	$172.80	$192.00	$178.66–$192.00	—	10%
Folate (folic acid) blood test CPT 82746 FOLIC ACID,(FOLATE-SERUM)	$101.70	$113.00	$57.20–$113.00	9% below	10%
Folate (folic acid) blood test CPT 82746 FOLIC ACID,(FOLATE-SERUM)	$101.70	$113.00	$10.29–$110.74	9% below	10%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID,(FOLATE-SERUM)	$101.70	$113.00	$104.98–$113.00	—	10%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID,(FOLATE-SERUM)	$101.70	$113.00	$10.29–$110.74	—	10%
Free T3 thyroid hormone test CPT 84481 T-3 FREE	$137.70	$153.00	$77.55–$153.00	16% below	10%
Free T3 thyroid hormone test CPT 84481 T-3 FREE	$137.70	$153.00	$11.85–$149.94	16% below	10%
Free T3 thyroid hormone test inpatient CPT 84481 T-3 FREE	$137.70	$153.00	$11.85–$149.94	—	10%
Free T3 thyroid hormone test inpatient CPT 84481 T-3 FREE	$137.70	$153.00	$142.33–$153.00	—	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE T4	$110.70	$123.00	$62.15–$123.00	17% above	10%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE T4	$110.70	$123.00	$4.95–$120.54	17% above	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE T4	$110.70	$123.00	$114.06–$123.00	—	10%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE T4	$110.70	$123.00	$4.95–$120.54	—	10%
Free testosterone test CPT 84402 TESTOSTRONE LEVEL (FREE)	$163.80	$182.00	$17.82–$178.36	173% above	10%
Free testosterone test CPT 84402 Testosterone Free, Adult Male ATL	$163.80	$182.00	$92.40–$182.00	173% above	10%
Free testosterone test CPT 84402 Testosterone Free, Adult Male ATL	$163.80	$182.00	$17.82–$178.36	173% above	10%
Free testosterone test CPT 84402 TESTOSTRONE LEVEL (FREE)	$163.80	$182.00	$92.40–$182.00	173% above	10%
Free testosterone test inpatient CPT 84402 TESTOSTRONE LEVEL (FREE)	$163.80	$182.00	$169.58–$182.00	—	10%
Free testosterone test inpatient CPT 84402 Testosterone Free, Adult Male ATL	$163.80	$182.00	$17.82–$178.36	—	10%
Free testosterone test inpatient CPT 84402 Testosterone Free, Adult Male ATL	$163.80	$182.00	$169.58–$182.00	—	10%
Free testosterone test inpatient CPT 84402 TESTOSTRONE LEVEL (FREE)	$163.80	$182.00	$17.82–$178.36	—	10%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT-GAMMA GLUTAMYL TRANSFERASE	$95.40	$106.00	$5.04–$103.88	37% above	10%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT-GAMMA GLUTAMYL TRANSFERASE	$95.40	$106.00	$53.90–$106.00	37% above	10%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT-GAMMA GLUTAMYL TRANSFERASE	$95.40	$106.00	$98.92–$106.00	—	10%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT-GAMMA GLUTAMYL TRANSFERASE	$95.40	$106.00	$5.04–$103.88	—	10%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 80050 General Health Panel - CBC w/ diff, CMP, TSH	$202.09	$224.54	$119.90–$224.54	22% below	10%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 80050 General Health Panel - CBC w/ diff, CMP, TSH	$202.09	$224.54	$23.98–$220.05	22% below	10%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel: CBC w/diff, CMP, TSC	$212.40	$236.00	$23.98–$231.28	18% below	10%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel: CBC w/diff, CMP, TSC	$212.40	$236.00	$119.90–$236.00	18% below	10%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 80050 General Health Panel - CBC w/ diff, CMP, TSH	$202.09	$224.54	$213.31–$224.54	—	10%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 80050 General Health Panel - CBC w/ diff, CMP, TSH	$202.09	$224.54	$23.98–$220.05	—	10%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel: CBC w/diff, CMP, TSC	$212.40	$236.00	$23.98–$231.28	—	10%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel: CBC w/diff, CMP, TSC	$212.40	$236.00	$220.05–$236.00	—	10%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Post Glucose Dose	$81.58	$90.64	$48.40–$90.64	at median	10%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Post Glucose Dose	$81.58	$90.64	$86.11–$90.64	—	10%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$12.87–$61.74	61% below	10%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$31.90–$63.00	61% below	10%
Glucose tolerance test, 3 samples CPT 82951 GTT 2 HOUR	$210.60	$234.00	$118.80–$234.00	45% above	10%
Glucose tolerance test, 3 samples CPT 82951 GTT 1 HOUR	$210.60	$234.00	$12.87–$229.32	45% above	10%
Glucose tolerance test, 3 samples CPT 82951 GTT 2 HOUR	$210.60	$234.00	$12.87–$229.32	45% above	10%
Glucose tolerance test, 3 samples CPT 82951 GTT 1 HOUR	$210.60	$234.00	$118.80–$234.00	45% above	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$12.87–$61.74	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE, SERUM OR BODY FLUID	$56.70	$63.00	$58.55–$63.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 2 HOUR	$210.60	$234.00	$12.87–$229.32	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 1 HOUR	$210.60	$234.00	$12.87–$229.32	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 2 HOUR	$210.60	$234.00	$218.03–$234.00	—	10%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 1 HOUR	$210.60	$234.00	$218.03–$234.00	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gonorrhea, Urine	$134.42	$149.35	$79.75–$149.35	56% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gonorrhea, Urine	$134.42	$149.35	$24.55–$146.36	56% above	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Gonorrhea, Urine	$134.42	$149.35	$24.55–$146.36	—	10%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Gonorrhea, Urine	$134.42	$149.35	$141.88–$149.35	—	10%
H. pylori stool antigen test CPT 87338 HELIOBACTOR PYLORIC, STOOL ANTIGEN	$139.50	$155.00	$8.39–$151.90	26% below	10%
H. pylori stool antigen test CPT 87338 HELIOBACTOR PYLORIC, STOOL ANTIGEN	$139.50	$155.00	$78.10–$155.00	26% below	10%
H. pylori stool antigen test inpatient CPT 87338 HELIOBACTOR PYLORIC, STOOL ANTIGEN	$139.50	$155.00	$143.33–$155.00	—	10%
H. pylori stool antigen test inpatient CPT 87338 HELIOBACTOR PYLORIC, STOOL ANTIGEN	$139.50	$155.00	$8.39–$151.90	—	10%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT REAL-TIME PCR ATL	$368.10	$409.00	$207.90–$409.00	11% below	10%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT REAL-TIME PCR ATL	$368.10	$409.00	$381.55–$409.00	—	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Combo w/ Reflex Confirm	$112.50	$125.00	$63.25–$125.00	6% above	10%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Combo w/ Reflex Confirm	$112.50	$125.00	$116.08–$125.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C ATL	$81.00	$90.00	$6.51–$88.20	at median	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HgbA1c	$81.00	$90.00	$6.51–$88.20	at median	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C ATL	$81.00	$90.00	$45.10–$90.00	at median	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HgbA1c	$81.00	$90.00	$45.10–$90.00	at median	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HgbA1c	$81.00	$90.00	$82.77–$90.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C ATL	$81.00	$90.00	$82.77–$90.00	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HgbA1c	$81.00	$90.00	$6.51–$88.20	—	10%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C ATL	$81.00	$90.00	$6.51–$88.20	—	10%
Hemoglobin blood test CPT 85018 HEMOGLOBIN,WHOLE BLOOD	$47.70	$53.00	$26.40–$53.00	1% above	10%
Hemoglobin blood test CPT 85018 HEMOGLOBIN,WHOLE BLOOD	$47.70	$53.00	$2.37–$51.94	1% above	10%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN,WHOLE BLOOD	$47.70	$53.00	$48.45–$53.00	—	10%
Hemoglobin blood test inpatient CPT 85018 HEMOGLOBIN,WHOLE BLOOD	$47.70	$53.00	$2.37–$51.94	—	10%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab, (Total) ATL	$119.70	$133.00	$8.43–$130.34	33% above	10%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab, (Total) ATL	$119.70	$133.00	$67.10–$133.00	33% above	10%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab, (Total) ATL	$119.70	$133.00	$123.15–$133.00	—	10%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab, (Total) ATL	$119.70	$133.00	$8.43–$130.34	—	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$104.40	$116.00	$6.77–$113.68	24% above	10%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$104.40	$116.00	$58.85–$116.00	24% above	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN	$104.40	$116.00	$6.77–$113.68	—	10%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN	$104.40	$116.00	$108.01–$116.00	—	10%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C	$194.40	$216.00	$9.98–$211.68	57% above	10%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C	$194.40	$216.00	$110.00–$216.00	57% above	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C	$194.40	$216.00	$9.98–$211.68	—	10%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C	$194.40	$216.00	$201.88–$216.00	—	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA, Quant By PCR ATL	$256.50	$285.00	$144.65–$285.00	1% above	10%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA, Quant By PCR ATL	$256.50	$285.00	$29.97–$279.30	1% above	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA, Quant By PCR ATL	$256.50	$285.00	$29.97–$279.30	—	10%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C RNA, Quant By PCR ATL	$256.50	$285.00	$265.47–$285.00	—	10%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN-HIGH SENSITIVITY	$76.50	$85.00	$43.45–$85.00	25% below	10%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN-HIGH SENSITIVITY	$76.50	$85.00	$9.06–$83.30	25% below	10%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN-HIGH SENSITIVITY	$76.50	$85.00	$9.06–$83.30	—	10%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN-HIGH SENSITIVITY	$76.50	$85.00	$79.74–$85.00	—	10%
Homocysteine blood test CPT 83090 Homocysteine	$47.28	$52.53	$28.05–$52.53	51% below	10%
Homocysteine blood test CPT 83090 Homocystine ATL	$120.60	$134.00	$67.65–$134.00	26% above	10%
Homocysteine blood test CPT 83090 Homocystine ATL	$120.60	$134.00	$11.80–$131.32	26% above	10%
Homocysteine blood test inpatient CPT 83090 Homocysteine	$47.28	$52.53	$49.90–$52.53	—	10%
Homocysteine blood test inpatient CPT 83090 Homocystine ATL	$120.60	$134.00	$11.80–$131.32	—	10%
Homocysteine blood test inpatient CPT 83090 Homocystine ATL	$120.60	$134.00	$124.16–$134.00	—	10%
Insulin blood test CPT 83525 Insulin,Random ATL	$63.96	$71.07	$8.00–$69.65	40% below	10%
Insulin blood test CPT 83525 Insulin,Random ATL	$63.96	$71.07	$37.95–$71.07	40% below	10%
Insulin blood test inpatient CPT 83525 Insulin,Random ATL	$63.96	$71.07	$8.00–$69.65	—	10%
Insulin blood test inpatient CPT 83525 Insulin,Random ATL	$63.96	$71.07	$67.52–$71.07	—	10%
Iron blood test (serum iron) CPT 83540 Iron Serum	$64.89	$72.10	$4.35–$70.66	11% below	10%
Iron blood test (serum iron) CPT 83540 Iron Serum	$64.89	$72.10	$38.50–$72.10	11% below	10%
Iron blood test (serum iron) CPT 83540 Iron ATL	$68.40	$76.00	$38.50–$76.00	6% below	10%
Iron blood test (serum iron) CPT 83540 IRON, SERUM	$68.40	$76.00	$38.50–$76.00	6% below	10%
Iron blood test (serum iron) CPT 83540 IRON, SERUM	$68.40	$76.00	$4.35–$74.48	6% below	10%
Iron blood test (serum iron) CPT 83540 Iron ATL	$68.40	$76.00	$4.35–$74.48	6% below	10%
Iron blood test (serum iron) inpatient CPT 83540 Iron Serum	$64.89	$72.10	$68.50–$72.10	—	10%
Iron blood test (serum iron) inpatient CPT 83540 Iron Serum	$64.89	$72.10	$4.35–$70.66	—	10%
Iron blood test (serum iron) inpatient CPT 83540 IRON, SERUM	$68.40	$76.00	$4.35–$74.48	—	10%
Iron blood test (serum iron) inpatient CPT 83540 Iron ATL	$68.40	$76.00	$4.35–$74.48	—	10%
Iron blood test (serum iron) inpatient CPT 83540 IRON, SERUM	$68.40	$76.00	$70.66–$76.00	—	10%
Iron blood test (serum iron) inpatient CPT 83540 Iron ATL	$68.40	$76.00	$70.66–$76.00	—	10%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$68.40	$76.00	$38.50–$76.00	21% below	10%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$68.40	$76.00	$5.97–$74.48	21% below	10%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING	$83.70	$93.00	$46.75–$93.00	3% below	10%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING	$83.70	$93.00	$5.97–$91.14	3% below	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$68.40	$76.00	$70.66–$76.00	—	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$68.40	$76.00	$5.97–$74.48	—	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING	$83.70	$93.00	$5.97–$91.14	—	10%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING	$83.70	$93.00	$85.80–$93.00	—	10%
Kidney function blood test panel CPT 80069 RENAL PANEL: BMP/ALBUMIN/PHOSPHORUS	$109.80	$122.00	$6.07–$119.56	21% below	10%
Kidney function blood test panel CPT 80069 RENAL PANEL: BMP/ALBUMIN/PHOSPHORUS	$109.80	$122.00	$61.60–$122.00	21% below	10%
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL: BMP/ALBUMIN/PHOSPHORUS	$109.80	$122.00	$113.05–$122.00	—	10%
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL: BMP/ALBUMIN/PHOSPHORUS	$109.80	$122.00	$6.07–$119.56	—	10%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN, LH	$186.30	$207.00	$12.95–$202.86	7% above	10%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN, LH	$186.30	$207.00	$105.05–$207.00	7% above	10%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN, LH	$186.30	$207.00	$12.95–$202.86	—	10%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN, LH	$186.30	$207.00	$192.80–$207.00	—	10%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid iStat	$103.82	$115.36	$7.47–$113.05	at median	10%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid iStat	$103.82	$115.36	$61.60–$115.36	at median	10%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID LEVEL	$109.80	$122.00	$7.47–$119.56	6% above	10%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID LEVEL	$109.80	$122.00	$61.60–$122.00	6% above	10%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid iStat	$103.82	$115.36	$109.59–$115.36	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid iStat	$103.82	$115.36	$7.47–$113.05	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID LEVEL	$109.80	$122.00	$113.05–$122.00	—	10%
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID LEVEL	$109.80	$122.00	$7.47–$119.56	—	10%
Lactate dehydrogenase (LDH) blood test CPT 83615 Body Fluid LDH ATL	$80.10	$89.00	$44.55–$89.00	10% above	10%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, TOTAL	$80.10	$89.00	$44.55–$89.00	10% above	10%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH, TOTAL	$80.10	$89.00	$4.22–$87.22	10% above	10%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, TOTAL	$80.10	$89.00	$4.22–$87.22	—	10%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH, TOTAL	$80.10	$89.00	$81.76–$89.00	—	10%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Body Fluid LDH ATL	$80.10	$89.00	$81.76–$89.00	—	10%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$168.30	$187.00	$4.82–$183.26	40% above	10%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$168.30	$187.00	$95.15–$187.00	40% above	10%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$168.30	$187.00	$95.15–$187.00	40% above	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$168.30	$187.00	$174.63–$187.00	—	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$168.30	$187.00	$4.82–$183.26	—	10%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$168.30	$187.00	$174.63–$187.00	—	10%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$92.70	$103.00	$52.25–$103.00	33% below	10%
Liver function blood test panel CPT 80076 Hepatic Function Panel Standard	$92.70	$103.00	$52.25–$103.00	33% below	10%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$92.70	$103.00	$95.89–$103.00	—	10%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel Standard	$92.70	$103.00	$95.89–$103.00	—	10%
Lyme disease antibody test CPT 86618 LYME DIEASE ANTIBODY/TITER	$81.00	$90.00	$11.91–$88.20	28% below	10%
Lyme disease antibody test CPT 86618 LYME DIEASE ANTIBODY/TITER	$81.00	$90.00	$45.10–$90.00	28% below	10%
Lyme disease antibody test inpatient CPT 86618 LYME DIEASE ANTIBODY/TITER	$81.00	$90.00	$82.77–$90.00	—	10%
Lyme disease antibody test inpatient CPT 86618 LYME DIEASE ANTIBODY/TITER	$81.00	$90.00	$11.91–$88.20	—	10%
Magnesium blood test CPT 83735 Urine Magnesium	$45.42	$50.47	$4.69–$49.46	34% below	10%
Magnesium blood test CPT 83735 Urine Magnesium	$45.42	$50.47	$26.95–$50.47	34% below	10%
Magnesium blood test CPT 83735 MAGNESIUM, URINE	$48.60	$54.00	$26.95–$54.00	29% below	10%
Magnesium blood test CPT 83735 MAGNESIUM, URINE	$48.60	$54.00	$4.69–$52.92	29% below	10%
Magnesium blood test CPT 83735 MAGNESIUM	$89.10	$99.00	$4.69–$97.02	30% above	10%
Magnesium blood test CPT 83735 MAGNESIUM	$89.10	$99.00	$50.05–$99.00	30% above	10%
Magnesium blood test inpatient CPT 83735 Urine Magnesium	$45.42	$50.47	$4.69–$49.46	—	10%
Magnesium blood test inpatient CPT 83735 Urine Magnesium	$45.42	$50.47	$47.95–$50.47	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, URINE	$48.60	$54.00	$4.69–$52.92	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, URINE	$48.60	$54.00	$49.46–$54.00	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$89.10	$99.00	$91.86–$99.00	—	10%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$89.10	$99.00	$4.69–$97.02	—	10%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Ab, IgG ATL	$85.50	$95.00	$7.43–$93.10	8% above	10%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Ab, IgG ATL	$85.50	$95.00	$47.85–$95.00	8% above	10%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Ab, IgG ATL	$85.50	$95.00	$87.82–$95.00	—	10%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Ab, IgG ATL	$85.50	$95.00	$7.43–$93.10	—	10%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSPOT	$38.70	$43.00	$5.18–$42.14	44% below	10%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSPOT	$38.70	$43.00	$22.00–$43.00	44% below	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSPOT	$38.70	$43.00	$40.38–$43.00	—	10%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSPOT	$38.70	$43.00	$5.18–$42.14	—	10%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgG ATL	$62.10	$69.00	$34.65–$69.00	50% below	10%
Mumps immunity blood test CPT 86735 Mumps IGG	$62.10	$69.00	$7.43–$67.62	50% below	10%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgM ATL	$62.10	$69.00	$34.65–$69.00	50% below	10%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgG ATL	$62.10	$69.00	$7.43–$67.62	50% below	10%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgM ATL	$62.10	$69.00	$7.43–$67.62	50% below	10%
Mumps immunity blood test CPT 86735 Mumps IGG	$62.10	$69.00	$34.65–$69.00	50% below	10%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgM ATL	$62.10	$69.00	$7.43–$67.62	—	10%
Mumps immunity blood test inpatient CPT 86735 Mumps IGG	$62.10	$69.00	$63.59–$69.00	—	10%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgG ATL	$62.10	$69.00	$63.59–$69.00	—	10%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgM ATL	$62.10	$69.00	$63.59–$69.00	—	10%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgG ATL	$62.10	$69.00	$7.43–$67.62	—	10%
Mumps immunity blood test inpatient CPT 86735 Mumps IGG	$62.10	$69.00	$7.43–$67.62	—	10%
Obstetric blood test panel CPT 80055 OB Panel With CBC-MKOB ATL	$70.20	$78.00	$19.08–$84.62	68% below	10%
Obstetric blood test panel CPT 80055 OB Panel With CBC-MKOB ATL	$70.20	$78.00	$39.60–$78.00	68% below	10%
Obstetric blood test panel inpatient CPT 80055 OB Panel With CBC-MKOB ATL	$70.20	$78.00	$72.68–$78.00	—	10%
Obstetric blood test panel inpatient CPT 80055 OB Panel With CBC-MKOB ATL	$70.20	$78.00	$19.08–$84.62	—	10%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (FREE)	$129.60	$144.00	$12.87–$141.12	10% above	10%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (FREE)	$129.60	$144.00	$73.15–$144.00	10% above	10%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (FREE)	$129.60	$144.00	$12.87–$141.12	—	10%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (FREE)	$129.60	$144.00	$134.25–$144.00	—	10%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP	$69.53	$77.25	$19.88–$75.71	at median	10%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP	$69.53	$77.25	$41.25–$77.25	at median	10%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP	$69.53	$77.25	$19.88–$75.71	—	10%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP	$69.53	$77.25	$73.39–$77.25	—	10%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE PTH INTACT CALCA	$220.50	$245.00	$28.88–$240.10	1% above	10%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE PTH INTACT CALCA	$220.50	$245.00	$124.30–$245.00	1% above	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE PTH INTACT CALCA	$220.50	$245.00	$28.88–$240.10	—	10%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE PTH INTACT CALCA	$220.50	$245.00	$228.12–$245.00	—	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$27.81	$30.90	$16.50–$30.90	69% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$27.81	$30.90	$4.20–$30.28	69% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thrombostic risk, Inherited Etiologies Panel	$29.70	$33.00	$4.20–$32.34	67% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thrombostic risk, Inherited Etiologies Panel	$29.70	$33.00	$16.50–$33.00	67% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$88.20	$98.00	$49.50–$98.00	2% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$88.20	$98.00	$4.20–$96.04	2% below	10%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time ATL	$88.20	$98.00	$49.50–$98.00	2% below	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$27.81	$30.90	$29.36–$30.90	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$27.81	$30.90	$4.20–$30.28	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thrombostic risk, Inherited Etiologies Panel	$29.70	$33.00	$4.20–$32.34	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thrombostic risk, Inherited Etiologies Panel	$29.70	$33.00	$30.28–$33.00	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$88.20	$98.00	$90.85–$98.00	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$88.20	$98.00	$4.20–$96.04	—	10%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Partial Thromboplastin Time ATL	$88.20	$98.00	$90.85–$98.00	—	10%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS, SERUM/TOTAL	$55.80	$62.00	$3.32–$60.76	4% below	10%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS, SERUM/TOTAL	$55.80	$62.00	$31.35–$62.00	4% below	10%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS, SERUM/TOTAL	$55.80	$62.00	$57.54–$62.00	—	10%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS, SERUM/TOTAL	$55.80	$62.00	$3.32–$60.76	—	10%
Potassium blood test CPT 84132 POTASSIUM (K), SERUM	$54.90	$61.00	$3.22–$59.78	5% below	10%
Potassium blood test CPT 84132 POTASSIUM (K), SERUM	$54.90	$61.00	$30.80–$61.00	5% below	10%
Potassium blood test inpatient CPT 84132 POTASSIUM (K), SERUM	$54.90	$61.00	$56.53–$61.00	—	10%
Potassium blood test inpatient CPT 84132 POTASSIUM (K), SERUM	$54.90	$61.00	$3.22–$59.78	—	10%
Progesterone blood test CPT 84144 PROGESTERONE	$91.80	$102.00	$14.60–$99.96	36% below	10%
Progesterone blood test CPT 84144 PROGESTERONE	$91.80	$102.00	$51.70–$102.00	36% below	10%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$91.80	$102.00	$94.88–$102.00	—	10%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$91.80	$102.00	$14.60–$99.96	—	10%
Prolactin blood test CPT 84146 PROLACTIN	$88.20	$98.00	$49.50–$98.00	36% below	10%
Prolactin blood test CPT 84146 PROLACTIN	$88.20	$98.00	$13.56–$96.04	36% below	10%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$88.20	$98.00	$90.85–$98.00	—	10%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$88.20	$98.00	$13.56–$96.04	—	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$27.81	$30.90	$16.50–$30.90	25% below	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME (PT)	$63.96	$71.07	$4.29–$69.65	72% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME (PT)	$63.96	$71.07	$37.95–$71.07	72% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 Protime With INR ATL	$67.50	$75.00	$4.29–$73.50	82% above	10%
Prothrombin time (PT/INR) clotting test CPT 85610 Protime With INR ATL	$67.50	$75.00	$37.95–$75.00	82% above	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$27.81	$30.90	$29.36–$30.90	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME (PT)	$63.96	$71.07	$67.52–$71.07	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME (PT)	$63.96	$71.07	$4.29–$69.65	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime With INR ATL	$67.50	$75.00	$69.65–$75.00	—	10%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime With INR ATL	$67.50	$75.00	$4.29–$73.50	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen	$190.80	$212.00	$113.30–$212.00	227% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Tox POC	$190.80	$212.00	$113.30–$212.00	227% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Tox POC	$190.80	$212.00	$7.63–$207.94	227% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Urine Drug Screen	$190.80	$212.00	$7.63–$207.94	227% above	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Screen	$190.80	$212.00	$7.63–$207.94	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Tox POC	$190.80	$212.00	$7.63–$207.94	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Screen	$190.80	$212.00	$201.40–$212.00	—	10%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Urine Drug Tox POC	$190.80	$212.00	$201.40–$212.00	—	10%
Rapid flu test (influenza antigen) CPT 87804 Influenza AB 1 Add-On	$64.89	$72.10	$38.50–$72.10	19% below	10%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A/B ANTIGEN	$68.40	$76.00	$14.00–$74.48	14% below	10%
Rapid flu test (influenza antigen) CPT 87804 Influenza AB	$68.40	$76.00	$14.00–$74.48	14% below	10%
Rapid flu test (influenza antigen) CPT 87804 Influenza AB	$68.40	$76.00	$38.50–$76.00	14% below	10%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A/B ANTIGEN	$68.40	$76.00	$38.50–$76.00	14% below	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza AB 1 Add-On	$64.89	$72.10	$68.50–$72.10	—	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza AB	$68.40	$76.00	$14.00–$74.48	—	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A/B ANTIGEN	$68.40	$76.00	$14.00–$74.48	—	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 Influenza AB	$68.40	$76.00	$70.66–$76.00	—	10%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A/B ANTIGEN	$68.40	$76.00	$70.66–$76.00	—	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A/QUICK STREP	$78.30	$87.00	$44.00–$87.00	4% above	10%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A/QUICK STREP	$78.30	$87.00	$13.15–$85.26	4% above	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A/QUICK STREP	$78.30	$87.00	$80.75–$87.00	—	10%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A/QUICK STREP	$78.30	$87.00	$13.15–$85.26	—	10%
Renin blood test CPT 84244 84244 Aldosterone/Renin Activity Ratio ATL	$92.70	$103.00	$15.39–$100.94	9% above	10%
Renin blood test CPT 84244 84244 Aldosterone/Renin Activity Ratio ATL	$92.70	$103.00	$55.00–$103.00	9% above	10%
Renin blood test CPT 84244 Renin, Plasma	$199.80	$222.00	$15.39–$217.56	135% above	10%
Renin blood test CPT 84244 Renin, Plasma	$199.80	$222.00	$112.75–$222.00	135% above	10%
Renin blood test inpatient CPT 84244 84244 Aldosterone/Renin Activity Ratio ATL	$92.70	$103.00	$97.85–$103.00	—	10%
Renin blood test inpatient CPT 84244 84244 Aldosterone/Renin Activity Ratio ATL	$92.70	$103.00	$15.39–$100.94	—	10%
Renin blood test inpatient CPT 84244 Renin, Plasma	$199.80	$222.00	$206.93–$222.00	—	10%
Renin blood test inpatient CPT 84244 Renin, Plasma	$199.80	$222.00	$15.39–$217.56	—	10%
Rh blood typing CPT 86901 Rh Type ATL	$62.10	$69.00	$2.09–$67.62	46% above	10%
Rh blood typing CPT 86901 Rh Type ATL	$62.10	$69.00	$34.65–$69.00	46% above	10%
Rh blood typing inpatient CPT 86901 Rh Type ATL	$62.10	$69.00	$63.59–$69.00	—	10%
Rh blood typing inpatient CPT 86901 Rh Type ATL	$62.10	$69.00	$2.09–$67.62	—	10%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$111.60	$124.00	$3.97–$121.52	35% above	10%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$111.60	$124.00	$62.70–$124.00	35% above	10%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$111.60	$124.00	$115.07–$124.00	—	10%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$111.60	$124.00	$3.97–$121.52	—	10%
Rubella antibody test (immunity check) CPT 86762 RUBELLA TITER	$72.90	$81.00	$10.07–$79.38	4% above	10%
Rubella antibody test (immunity check) CPT 86762 RUBELLA TITER	$72.90	$81.00	$41.25–$81.00	4% above	10%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITER	$72.90	$81.00	$10.07–$79.38	—	10%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA TITER	$72.90	$81.00	$75.71–$81.00	—	10%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$63.90	$71.00	$35.75–$71.00	8% below	10%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$63.90	$71.00	$1.89–$69.58	8% below	10%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE	$63.90	$71.00	$65.61–$71.00	—	10%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SED RATE	$63.90	$71.00	$1.89–$69.58	—	10%
Sodium blood test CPT 84295 SODIUM (NA), SERUM	$56.70	$63.00	$3.37–$61.74	3% below	10%
Sodium blood test CPT 84295 SODIUM (NA), SERUM	$56.70	$63.00	$31.90–$63.00	3% below	10%
Sodium blood test inpatient CPT 84295 SODIUM (NA), SERUM	$56.70	$63.00	$3.37–$61.74	—	10%
Sodium blood test inpatient CPT 84295 SODIUM (NA), SERUM	$56.70	$63.00	$58.55–$63.00	—	10%
Stool ova and parasites exam CPT 87177 Ova and Parasites, direct smears, concentration and identifi	$107.10	$119.00	$60.50–$119.00	23% above	10%
Stool ova and parasites exam CPT 87177 Ova and Parasite Exam ATL	$107.10	$119.00	$60.50–$119.00	23% above	10%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasites, direct smears, concentration and identifi	$107.10	$119.00	$111.03–$119.00	—	10%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasite Exam ATL	$107.10	$119.00	$111.03–$119.00	—	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Screening Hemoccult POC	$34.20	$38.00	$2.98–$37.35	33% below	10%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Screening Hemoccult POC	$34.20	$38.00	$20.35–$38.00	33% below	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Screening Hemoccult POC	$34.20	$38.00	$2.98–$37.35	—	10%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Screening Hemoccult POC	$34.20	$38.00	$36.10–$38.00	—	10%
Syphilis antibody test (Treponema pallidum) CPT 86780 86780 Treponema Pallidum Antibody	$63.90	$71.00	$9.26–$69.58	7% below	10%
Syphilis antibody test (Treponema pallidum) CPT 86780 86780 Treponema Pallidum Antibody	$63.90	$71.00	$35.75–$71.00	7% below	10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 86780 Treponema Pallidum Antibody	$63.90	$71.00	$65.61–$71.00	—	10%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 86780 Treponema Pallidum Antibody	$63.90	$71.00	$9.26–$69.58	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Test, non-treponemal	$68.40	$76.00	$38.50–$76.00	14% above	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Test, non-treponemal	$68.40	$76.00	$2.99–$74.48	14% above	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Test, non-treponemal	$68.40	$76.00	$70.66–$76.00	—	10%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Test, non-treponemal	$68.40	$76.00	$2.99–$74.48	—	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Adult Male	$75.09	$83.43	$44.55–$83.43	43% below	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Adult Male	$75.09	$83.43	$18.06–$81.76	43% below	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Bio/SHBG, Male ATL	$129.60	$144.00	$18.06–$141.12	1% below	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Bio/SHBG, Male ATL	$129.60	$144.00	$73.15–$144.00	1% below	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL	$137.70	$153.00	$18.06–$149.94	5% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL	$137.70	$153.00	$77.55–$153.00	5% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Female/Child ATL	$163.80	$182.00	$18.06–$178.36	25% above	10%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Female/Child ATL	$163.80	$182.00	$92.40–$182.00	25% above	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Adult Male	$75.09	$83.43	$18.06–$81.76	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Adult Male	$75.09	$83.43	$79.26–$83.43	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Bio/SHBG, Male ATL	$129.60	$144.00	$134.25–$144.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Bio/SHBG, Male ATL	$129.60	$144.00	$18.06–$141.12	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL	$137.70	$153.00	$18.06–$149.94	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL	$137.70	$153.00	$142.33–$153.00	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Female/Child ATL	$163.80	$182.00	$18.06–$178.36	—	10%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Female/Child ATL	$163.80	$182.00	$169.58–$182.00	—	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH	$55.62	$61.80	$33.00–$61.80	57% below	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver-Kidney-Micro ABS,IGG ATL	$62.10	$69.00	$10.18–$67.62	52% below	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver-Kidney-Micro ABS,IGG ATL	$62.10	$69.00	$34.65–$69.00	52% below	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE	$144.00	$160.00	$10.18–$156.80	12% above	10%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE	$144.00	$160.00	$80.85–$160.00	12% above	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EACH	$55.62	$61.80	$58.71–$61.80	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver-Kidney-Micro ABS,IGG ATL	$62.10	$69.00	$10.18–$67.62	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver-Kidney-Micro ABS,IGG ATL	$62.10	$69.00	$63.59–$69.00	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE	$144.00	$160.00	$10.18–$156.80	—	10%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE	$144.00	$160.00	$148.38–$160.00	—	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$108.90	$121.00	$11.76–$118.58	at median	10%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$108.90	$121.00	$61.05–$121.00	at median	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$108.90	$121.00	$11.76–$118.58	—	10%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$108.90	$121.00	$112.04–$121.00	—	10%
Total IgE blood test CPT 82785 ALLERGY PROFILE: PEDIATRIC ALLERGY	$36.90	$41.00	$20.90–$41.00	56% below	10%
Total IgE blood test CPT 82785 ALLERGY PROFILE: PEDIATRIC ALLERGY	$36.90	$41.00	$10.07–$40.18	56% below	10%
Total IgE blood test CPT 82785 IMMUNOGLOBULIN IGE	$162.90	$181.00	$11.52–$177.38	92% above	10%
Total IgE blood test CPT 82785 IMMUNOGLOBULIN IGE	$162.90	$181.00	$91.85–$181.00	92% above	10%
Total IgE blood test CPT 82785 Comprehensive Allergy Panel ATL	$569.70	$633.00	$11.52–$620.34	572% above	10%
Total IgE blood test CPT 82785 Comprehensive Allergy Panel ATL	$569.70	$633.00	$321.75–$633.00	572% above	10%
Total IgE blood test inpatient CPT 82785 ALLERGY PROFILE: PEDIATRIC ALLERGY	$36.90	$41.00	$10.07–$40.18	—	10%
Total IgE blood test inpatient CPT 82785 ALLERGY PROFILE: PEDIATRIC ALLERGY	$36.90	$41.00	$38.36–$41.00	—	10%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN IGE	$162.90	$181.00	$168.57–$181.00	—	10%
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN IGE	$162.90	$181.00	$11.52–$177.38	—	10%
Total IgE blood test inpatient CPT 82785 Comprehensive Allergy Panel ATL	$569.70	$633.00	$11.52–$620.34	—	10%
Total IgE blood test inpatient CPT 82785 Comprehensive Allergy Panel ATL	$569.70	$633.00	$590.50–$633.00	—	10%
Total cholesterol blood test CPT 82465 CHOLESTEROL, SERUM TOTAL	$49.50	$55.00	$27.50–$55.00	5% below	10%
Total cholesterol blood test CPT 82465 CHOLESTEROL, SERUM TOTAL	$49.50	$55.00	$3.04–$53.90	5% below	10%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL, SERUM TOTAL	$49.50	$55.00	$3.04–$53.90	—	10%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL, SERUM TOTAL	$49.50	$55.00	$50.47–$55.00	—	10%
Total thyroxine (T4) blood test CPT 84436 THYROXINE (T-4) TOTAL	$61.20	$68.00	$34.10–$68.00	5% above	10%
Total thyroxine (T4) blood test CPT 84436 THYROXINE (T-4) TOTAL	$61.20	$68.00	$3.90–$66.64	5% above	10%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE (T-4) TOTAL	$61.20	$68.00	$3.90–$66.64	—	10%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE (T-4) TOTAL	$61.20	$68.00	$62.58–$68.00	—	10%
Total triiodothyronine (T3) blood test CPT 84480 T-3 TOTAL	$81.90	$91.00	$45.65–$91.00	34% below	10%
Total triiodothyronine (T3) blood test CPT 84480 T-3 TOTAL	$81.90	$91.00	$9.92–$89.18	34% below	10%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T-3 TOTAL	$81.90	$91.00	$83.78–$91.00	—	10%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T-3 TOTAL	$81.90	$91.00	$9.92–$89.18	—	10%
Transferrin blood test CPT 84466 TRANSFERRIN	$258.30	$287.00	$8.93–$281.26	134% above	10%
Transferrin blood test CPT 84466 TRANSFERRIN	$258.30	$287.00	$78.65–$287.00	134% above	10%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$258.30	$287.00	$8.93–$281.26	—	10%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$258.30	$287.00	$144.34–$287.00	—	10%
Troponin test, quantitative CPT 84484 High Sensitivity Troponin	$148.50	$165.00	$4.68–$161.70	at median	10%
Troponin test, quantitative CPT 84484 TROPONIN QUANTITATIVE	$148.50	$165.00	$83.60–$165.00	at median	10%
Troponin test, quantitative CPT 84484 High Sensitivity Troponin	$148.50	$165.00	$83.60–$165.00	at median	10%
Troponin test, quantitative CPT 84484 TROPONIN QUANTITATIVE	$148.50	$165.00	$4.68–$161.70	at median	10%
Troponin test, quantitative inpatient CPT 84484 TROPONIN QUANTITATIVE	$148.50	$165.00	$4.68–$161.70	—	10%
Troponin test, quantitative inpatient CPT 84484 High Sensitivity Troponin	$148.50	$165.00	$153.43–$165.00	—	10%
Troponin test, quantitative inpatient CPT 84484 High Sensitivity Troponin	$148.50	$165.00	$4.68–$161.70	—	10%
Troponin test, quantitative inpatient CPT 84484 TROPONIN QUANTITATIVE	$148.50	$165.00	$153.43–$165.00	—	10%
Uric acid blood test CPT 84550 URIC ACID, BLOOD	$74.70	$83.00	$42.35–$83.00	28% above	10%
Uric acid blood test CPT 84550 URIC ACID, BLOOD	$74.70	$83.00	$3.16–$81.34	28% above	10%
Uric acid blood test inpatient CPT 84550 URIC ACID, BLOOD	$74.70	$83.00	$77.72–$83.00	—	10%
Uric acid blood test inpatient CPT 84550 URIC ACID, BLOOD	$74.70	$83.00	$3.16–$81.34	—	10%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dipstick; automated, with microscopy	$67.67	$75.19	$40.15–$75.19	17% above	10%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dipstick; automated, with microscopy	$67.67	$75.19	$3.17–$73.69	17% above	10%
Urinalysis with microscope exam, automated CPT 81001 UA AUTOMATED WITH MICRO	$71.10	$79.00	$40.15–$79.00	23% above	10%
Urinalysis with microscope exam, automated CPT 81001 UA AUTOMATED WITH MICRO	$71.10	$79.00	$3.17–$77.42	23% above	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis, by dipstick; automated, with microscopy	$67.67	$75.19	$71.43–$75.19	—	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis, by dipstick; automated, with microscopy	$67.67	$75.19	$3.17–$73.69	—	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA AUTOMATED WITH MICRO	$71.10	$79.00	$3.17–$77.42	—	10%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA AUTOMATED WITH MICRO	$71.10	$79.00	$73.69–$79.00	—	10%
Urinalysis without microscope exam, automated CPT 81003 UA AUTOMATED WITHOUT MICRO	$50.40	$56.00	$2.25–$54.88	27% above	10%
Urinalysis without microscope exam, automated CPT 81003 UA AUTOMATED WITHOUT MICRO	$50.40	$56.00	$28.05–$56.00	27% above	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA AUTOMATED WITHOUT MICRO	$50.40	$56.00	$51.48–$56.00	—	10%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA AUTOMATED WITHOUT MICRO	$50.40	$56.00	$2.25–$54.88	—	10%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture ATL	$82.80	$92.00	$46.20–$92.00	2% above	10%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture ATL	$82.80	$92.00	$5.65–$90.16	2% above	10%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture ATL	$82.80	$92.00	$84.79–$92.00	—	10%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture ATL	$82.80	$92.00	$5.65–$90.16	—	10%
Urine microalbumin (albumin) test CPT 82043 RANDOM OR 24 HR URINE MICROALB / CREAT	$109.80	$122.00	$4.04–$119.56	at median	10%
Urine microalbumin (albumin) test CPT 82043 RANDOM OR 24 HR URINE MICROALB / CREAT	$109.80	$122.00	$61.60–$122.00	at median	10%
Urine microalbumin (albumin) test inpatient CPT 82043 RANDOM OR 24 HR URINE MICROALB / CREAT	$109.80	$122.00	$113.05–$122.00	—	10%
Urine microalbumin (albumin) test inpatient CPT 82043 RANDOM OR 24 HR URINE MICROALB / CREAT	$109.80	$122.00	$4.04–$119.56	—	10%
Urine pregnancy test, read by color change CPT 81025 URINE, PREGNANCY	$111.60	$124.00	$62.70–$124.00	37% above	10%
Urine pregnancy test, read by color change CPT 81025 URINE, PREGNANCY	$111.60	$124.00	$6.94–$121.52	37% above	10%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE, PREGNANCY	$111.60	$124.00	$6.94–$121.52	—	10%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE, PREGNANCY	$111.60	$124.00	$115.07–$124.00	—	10%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$112.17	$124.63	$10.55–$122.14	3% below	10%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$112.17	$124.63	$66.55–$124.63	3% below	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$112.17	$124.63	$118.40–$124.63	—	10%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$112.17	$124.63	$10.55–$122.14	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY	$153.00	$170.00	$20.71–$166.60	1% below	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY	$153.00	$170.00	$86.35–$170.00	1% below	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY	$153.00	$170.00	$158.48–$170.00	—	10%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY	$153.00	$170.00	$20.71–$166.60	—	10%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D,1,25-DIHYDROXY	$220.50	$245.00	$26.93–$240.10	66% above	10%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D,1,25-DIHYDROXY	$220.50	$245.00	$124.30–$245.00	66% above	10%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D,1,25-DIHYDROXY	$220.50	$245.00	$26.93–$240.10	—	10%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VITAMIN D,1,25-DIHYDROXY	$220.50	$245.00	$228.12–$245.00	—	10%
Zinc blood test CPT 84630 ZINC, SERUM	$124.20	$138.00	$69.85–$138.00	199% above	10%
Zinc blood test CPT 84630 ZINC, SERUM	$124.20	$138.00	$7.97–$135.24	199% above	10%
Zinc blood test inpatient CPT 84630 ZINC, SERUM	$124.20	$138.00	$128.19–$138.00	—	10%
Zinc blood test inpatient CPT 84630 ZINC, SERUM	$124.20	$138.00	$7.97–$135.24	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Quantitative, Serum/Plasma ATL	$126.00	$140.00	$70.95–$140.00	7% below	10%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Quantitative, Serum/Plasma ATL	$126.00	$140.00	$15.05–$137.20	7% below	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Quantitative, Serum/Plasma ATL	$126.00	$140.00	$130.21–$140.00	—	10%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Quantitative, Serum/Plasma ATL	$126.00	$140.00	$15.05–$137.20	—	10%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ER CLOSED TX DISTAL RAD FX	$482.40	$536.00	$286.00–$536.00	19% below	10%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOS TX FX DISTAL RADIUS NO MANIPULA	$626.65	$696.28	$179.14–$860.45	5% above	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ER CLOSED TX DISTAL RAD FX	$482.40	$536.00	$509.20–$536.00	—	10%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOS TX FX DISTAL RADIUS NO MANIPULA	$626.65	$696.28	$179.14–$860.45	—	10%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY/POLYP REMOVAL	$1,475.22	$1,735.55	$249.32–$1,700.84	49% below	15%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY/POLYP REMOVAL	$1,475.22	$1,735.55	$249.32–$1,700.84	—	15%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY WITH BIOPSY	$1,308.87	$1,539.85	$197.06–$1,509.05	26% below	15%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY ROOM W/BIOPSY	$2,636.80	$3,296.00	$1,359.60–$3,296.00	49% above	20%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY WITH BIOPSY	$1,308.87	$1,539.85	$197.06–$1,509.05	—	15%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY ROOM W/BIOPSY	$2,636.80	$3,296.00	$2,495.24–$3,296.00	—	20%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY BEYOND SPLENIC FLEX	$1,213.44	$1,427.58	$181.42–$1,399.03	43% below	15%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY ROOM W/O BIOPSY	$2,142.40	$2,678.00	$1,321.10–$2,678.00	at median	20%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY BEYOND SPLENIC FLEX	$1,213.44	$1,427.58	$181.42–$1,399.03	—	15%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY ROOM W/O BIOPSY	$2,142.40	$2,678.00	$2,424.58–$2,678.00	—	20%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$576.90	$641.00	$342.10–$641.00	63% below	10%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$576.90	$641.00	$608.95–$641.00	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction; 1 LESION	$114.95	$127.72	$32.86–$168.81	53% below	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction of lesion; 1st lesion	$114.95	$127.72	$32.86–$168.81	53% below	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 WART RETREATMENT	$192.60	$214.00	$114.40–$214.00	21% below	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destruction; 1 LESION	$114.95	$127.72	$32.86–$168.81	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 Destruction of lesion; 1st lesion	$114.95	$127.72	$32.86–$168.81	—	10%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 WART RETREATMENT	$192.60	$214.00	$203.30–$214.00	—	10%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 69209 Bilateral Ear Lavage	$153.88	$170.98	$13.97–$167.56	—	10%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 69209 Bilateral Ear Lavage	$153.88	$170.98	$13.97–$167.56	—	10%
Earwax removal with instruments, one ear both sides CPT 69210 69210 Bilateral Ear Lavage with Instrumentation	$177.06	$196.73	$32.29–$192.80	—	10%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR TechFee	$76.50	$85.00	$45.65–$85.00	54% below	10%
Earwax removal with instruments, one ear CPT 69210 REMOV IMPACT CERUMEN	$76.94	$85.49	$22.00–$118.45	54% below	10%
Earwax removal with instruments, one ear CPT 69210 69210 Removal impacted cerumen requiring instrumentation,uni	$177.06	$196.73	$32.29–$192.80	6% above	10%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR	$177.06	$196.73	$32.29–$192.80	6% above	10%
Earwax removal with instruments, one ear inpatient both sides CPT 69210 69210 Bilateral Ear Lavage with Instrumentation	$177.06	$196.73	$32.29–$192.80	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR TechFee	$76.50	$85.00	$80.75–$85.00	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOV IMPACT CERUMEN	$76.94	$85.49	$22.00–$118.45	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR	$177.06	$196.73	$32.29–$192.80	—	10%
Earwax removal with instruments, one ear inpatient CPT 69210 69210 Removal impacted cerumen requiring instrumentation,uni	$177.06	$196.73	$32.29–$192.80	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 THERAPEUTIC INJECTION-PROVIDER FEE	$234.53	$260.59	$67.05–$697.22	88% below	10%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION DX/THER SUBSTANCE WITH IMG.	$1,318.35	$1,551.00	$853.05–$1,565.58	31% below	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJECTION DX/THER SUBSTANCE WITH IMG	$1,358.30	$1,598.00	$853.05–$1,598.00	29% below	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 THERAPEUTIC INJECTION-PROVIDER FEE	$234.53	$260.59	$67.05–$697.22	—	10%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJECTION DX/THER SUBSTANCE WITH IMG.	$1,318.35	$1,551.00	$1,473.45–$1,565.58	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJECTION DX/THER SUBSTANCE WITH IMG	$1,358.30	$1,598.00	$1,518.10–$1,598.00	—	15%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 PARA VERTEBRAL LUMBAR JOINT	$191.89	$213.21	$54.86–$458.41	90% below	10%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FAMC 1st Level Lumbar/Sacral	$1,168.75	$1,375.00	$734.25–$1,375.00	41% below	15%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJECTION- 1ST LEVEL LUMBAR/SACRAL	$1,168.75	$1,375.00	$734.25–$1,375.00	41% below	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 PARA VERTEBRAL LUMBAR JOINT	$191.89	$213.21	$54.86–$458.41	—	10%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJECTION- 1ST LEVEL LUMBAR/SACRAL	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 FAMC 1st Level Lumbar/Sacral	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY	$984.94	$1,158.75	$56.26–$1,135.58	14% below	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 SIGMOIDOSCOPY-ROOM CHARGE	$1,838.55	$2,163.00	$605.55–$2,163.00	61% above	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY	$984.94	$1,158.75	$56.26–$1,135.58	—	15%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 SIGMOIDOSCOPY-ROOM CHARGE	$1,838.55	$2,163.00	$1,111.35–$2,163.00	—	15%
Incision and drainage of a simple or single skin abscess CPT 10060 ER ID ABSCESS; SIMPLE/SINGLE	$187.20	$208.00	$111.10–$208.00	59% below	10%
Incision and drainage of a simple or single skin abscess CPT 10060 ID ABSCESS-ONE LESI	$198.00	$220.00	$56.71–$314.54	57% below	10%
Incision and drainage of a simple or single skin abscess CPT 10060 ID ABSCESS-ONE LESI	$198.00	$220.00	$117.70–$220.00	57% below	10%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision and Drainage of Abscess	$228.04	$253.38	$65.19–$314.54	50% below	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ER ID ABSCESS; SIMPLE/SINGLE	$187.20	$208.00	$197.60–$208.00	—	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ID ABSCESS-ONE LESI	$198.00	$220.00	$209.00–$220.00	—	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ID ABSCESS-ONE LESI	$198.00	$220.00	$56.71–$314.54	—	10%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and Drainage of Abscess	$228.04	$253.38	$65.19–$314.54	—	10%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")	$185.40	$206.00	$110.00–$206.00	62% below	10%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")	$185.40	$206.00	$195.70–$206.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ; MAJOR JOINT	$233.60	$259.56	$45.27–$254.37	66% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or	$233.60	$259.56	$45.27–$254.37	66% below	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance	$913.10	$1,014.55	$541.75–$1,014.55	33% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ;MAJOR JOINT	$913.50	$1,015.00	$45.27–$994.70	33% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ;MAJOR JOINT	$913.50	$1,015.00	$541.75–$1,015.00	33% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ER ASPIR/INJ MAJOR JOINT-HIP/KNEE/SH	$913.50	$1,015.00	$541.75–$1,015.00	33% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 INJECTION MAJOR JOINT OR BURSA - LEFT	$913.50	$1,015.00	$541.75–$1,015.00	33% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 INJECTION MAJOR JOINT OR BURSA - RIGHT	$913.50	$1,015.00	$541.75–$1,015.00	33% above	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ; MAJOR JOINT	$233.60	$259.56	$45.27–$254.37	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or	$233.60	$259.56	$45.27–$254.37	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance	$913.10	$1,014.55	$963.82–$1,014.55	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ;MAJOR JOINT	$913.50	$1,015.00	$45.27–$994.70	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ;MAJOR JOINT	$913.50	$1,015.00	$964.25–$1,015.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ER ASPIR/INJ MAJOR JOINT-HIP/KNEE/SH	$913.50	$1,015.00	$964.25–$1,015.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 INJECTION MAJOR JOINT OR BURSA - LEFT	$913.50	$1,015.00	$964.25–$1,015.00	—	10%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 INJECTION MAJOR JOINT OR BURSA - RIGHT	$913.50	$1,015.00	$964.25–$1,015.00	—	10%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion; drug delivery implant	$255.85	$284.28	$62.25–$278.59	17% below	10%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 11981 Insertion; drug delivery implant	$255.85	$284.28	$62.25–$278.59	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 EMERGENCY ROOM - ASPIRATION CHARGE	$192.60	$214.00	$114.40–$214.00	60% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Phys Arthrocentesis, Asp and/or inj, Intermed joint or	$230.82	$256.47	$36.62–$251.34	52% below	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance	$1,168.79	$1,375.05	$734.25–$1,375.05	141% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 INJECTION- AC JOINT- RIGHT	$1,168.75	$1,375.00	$734.25–$1,375.00	141% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 INJECTION - AC JOINT - LEFT	$1,168.75	$1,375.00	$734.25–$1,375.00	141% above	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 EMERGENCY ROOM - ASPIRATION CHARGE	$192.60	$214.00	$203.30–$214.00	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 Phys Arthrocentesis, Asp and/or inj, Intermed joint or	$230.82	$256.47	$36.62–$251.34	—	10%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance	$1,168.79	$1,375.05	$1,306.30–$1,375.05	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 INJECTION - AC JOINT - LEFT	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 INJECTION- AC JOINT- RIGHT	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Bilat. Asp/Inject Small Joint/Bursa	$187.25	$208.06	$35.62–$203.90	—	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Small joint (Finger, Toe, etc)	$192.60	$214.00	$114.40–$214.00	60% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASPIR/INJ SMALL JOINT	$192.60	$214.00	$114.40–$214.00	60% below	10%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance	$192.82	$214.24	$114.40–$214.24	60% below	10%
Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 Bilat. Asp/Inject Small Joint/Bursa	$187.25	$208.06	$35.62–$203.90	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASPIR/INJ SMALL JOINT	$192.60	$214.00	$203.30–$214.00	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Small joint (Finger, Toe, etc)	$192.60	$214.00	$203.30–$214.00	—	10%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance	$192.82	$214.24	$203.53–$214.24	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERMEDIATE	$111.60	$124.00	$66.00–$124.00	84% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ER LAC REPAIR/INTER/EXTR; <2.5 CM	$298.80	$332.00	$177.10–$332.00	57% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAC/LAY/EXT;TO 2.5CM	$522.83	$580.92	$149.46–$678.61	25% below	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTERMEDIATE	$111.60	$124.00	$117.80–$124.00	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ER LAC REPAIR/INTER/EXTR; <2.5 CM	$298.80	$332.00	$315.40–$332.00	—	10%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAC/LAY/EXT;TO 2.5CM	$522.83	$580.92	$149.46–$678.61	—	10%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION - LUMBAR/SACRAL WITH IMAGE	$133.49	$148.32	$38.16–$688.60	92% below	10%
Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION - LUMBAR/SACRAL - EPIDURAL	$1,173.85	$1,381.00	$759.55–$1,393.98	32% below	15%
Lower-back epidural injection, with imaging guidance CPT 62323 FAMC Lumbar/Sacral Epidural	$1,208.70	$1,422.00	$759.55–$1,422.00	30% below	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION - LUMBAR/SACRAL WITH IMAGE	$133.49	$148.32	$38.16–$688.60	—	10%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION - LUMBAR/SACRAL - EPIDURAL	$1,173.85	$1,381.00	$1,311.95–$1,393.98	—	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 FAMC Lumbar/Sacral Epidural	$1,208.70	$1,422.00	$1,350.90–$1,422.00	—	15%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 PF-TFESI-Bilateral	$407.88	$453.20	$110.51–$642.32	—	10%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Injection-TFESI-Bilateral	$2,397.60	$2,997.00	$1,600.50–$2,997.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s), anesthetic agent and/or steroid, transforamina	$203.94	$226.60	$58.30–$642.32	89% below	10%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s), anesthetic agent and/or steroid, transforamina	$203.94	$226.60	$121.00–$226.60	89% below	10%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 INJECTION - TFESI - RIGHT	$1,274.15	$1,499.00	$800.25–$1,499.00	32% below	15%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 INJECTION - TFESI - LEFT	$1,274.15	$1,499.00	$800.25–$1,499.00	32% below	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 PF-TFESI-Bilateral	$407.88	$453.20	$110.51–$642.32	—	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Injection-TFESI-Bilateral	$2,397.60	$2,997.00	$2,847.15–$2,997.00	—	20%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection(s), anesthetic agent and/or steroid, transforamina	$203.94	$226.60	$58.30–$642.32	—	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection(s), anesthetic agent and/or steroid, transforamina	$203.94	$226.60	$215.27–$226.60	—	10%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 INJECTION - TFESI - RIGHT	$1,274.15	$1,499.00	$1,424.05–$1,499.00	—	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 INJECTION - TFESI - LEFT	$1,274.15	$1,499.00	$1,424.05–$1,499.00	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 PF EXC TR-EXT B9+MARG 0.5<	$289.22	$321.36	$82.68–$330.84	57% below	10%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 PF EXC TR-EXT B9+MARG 0.5<	$289.22	$321.36	$82.68–$330.84	—	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 Phys Exc face-mm b9+marg 0.5 cm/<	$310.55	$345.05	$88.78–$370.87	62% below	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION < .5CM/FACE,LIPS,EAR,EYE	$310.55	$345.05	$88.78–$370.87	62% below	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION < .5CM/FACE,LIPS,EAR,EYE	$310.55	$345.05	$88.78–$370.87	—	10%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440 Phys Exc face-mm b9+marg 0.5 cm/<	$310.55	$345.05	$88.78–$370.87	—	10%
Nail removal (partial or complete), one nail CPT 11730 NAIL AVULSION PLATE - PARTIAL	$99.00	$110.00	$58.85–$110.00	68% below	10%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE	$99.00	$110.00	$58.85–$110.00	68% below	10%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate; Simple/Single (Ofc)	$172.42	$191.58	$49.29–$299.96	44% below	10%
Nail removal (partial or complete), one nail CPT 11730 AVULSION/NAIL	$172.42	$191.58	$49.29–$299.96	44% below	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL AVULSION PLATE - PARTIAL	$99.00	$110.00	$104.50–$110.00	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE	$99.00	$110.00	$104.50–$110.00	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate; Simple/Single (Ofc)	$172.42	$191.58	$49.29–$299.96	—	10%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION/NAIL	$172.42	$191.58	$49.29–$299.96	—	10%
Occipital nerve block (injection for headaches) CPT 64405 64405 INJ ANES GR OCCIPITAL NERVE CHARGE	$132.56	$147.29	$37.90–$182.66	83% below	10%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION, NERVE BLOCK, G	$132.56	$147.29	$37.90–$182.66	83% below	10%
Occipital nerve block (injection for headaches) one side CPT 64405 FAMC Occipital Nerve Block Lt	$1,168.75	$1,375.00	$734.25–$1,375.00	53% above	15%
Occipital nerve block (injection for headaches) one side CPT 64405 INJECTION- OCCIPITAL NERVE BLOCK - RIGHT	$1,168.75	$1,375.00	$734.25–$1,375.00	53% above	15%
Occipital nerve block (injection for headaches) one side CPT 64405 INJECTION- OCCIPITAL NERVE BLOCK - LEFT	$1,168.75	$1,375.00	$734.25–$1,375.00	53% above	15%
Occipital nerve block (injection for headaches) one side CPT 64405 FAMC Occipital Nerve Block Rt	$1,168.75	$1,375.00	$734.25–$1,375.00	53% above	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION, NERVE BLOCK, G	$132.56	$147.29	$37.90–$182.66	—	10%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 INJ ANES GR OCCIPITAL NERVE CHARGE	$132.56	$147.29	$37.90–$182.66	—	10%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 INJECTION- OCCIPITAL NERVE BLOCK - LEFT	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 FAMC Occipital Nerve Block Lt	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 FAMC Occipital Nerve Block Rt	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Occipital nerve block (injection for headaches) inpatient one side CPT 64405 INJECTION- OCCIPITAL NERVE BLOCK - RIGHT	$1,168.75	$1,375.00	$1,306.25–$1,375.00	—	15%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS ABD WITH IMAGING	$1,035.72	$1,218.49	$103.86–$1,194.12	47% below	15%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS ABD WITH IMAGING	$1,035.72	$1,218.49	$103.86–$1,194.12	—	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal of Nail Bed	$400.46	$444.96	$101.86–$436.06	53% below	10%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 NAIL EXCISION	$400.46	$444.96	$101.86–$436.06	53% below	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 NAIL EXCISION	$400.46	$444.96	$101.86–$436.06	—	10%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Removal of Nail Bed	$400.46	$444.96	$101.86–$436.06	—	10%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JOINT	$469.06	$521.18	$134.09–$1,084.18	88% below	10%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 FAMC Dest by Neuro Agt Lumb/Sacr	$2,751.20	$3,439.00	$1,836.45–$3,439.00	27% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint	$2,751.34	$3,439.17	$1,836.45–$3,439.17	27% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST. NEURO AGENT; LUMAR/SACRAL	$2,751.34	$3,439.17	$1,836.45–$3,439.17	27% below	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JOINT	$469.06	$521.18	$134.09–$1,084.18	—	10%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 FAMC Dest by Neuro Agt Lumb/Sacr	$2,751.20	$3,439.00	$3,267.05–$3,439.00	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST. NEURO AGENT; LUMAR/SACRAL	$2,751.34	$3,439.17	$3,267.21–$3,439.17	—	20%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint	$2,751.34	$3,439.17	$3,267.21–$3,439.17	—	20%
Removal of a foreign object under the skin, simple CPT 10120 ER INCISION AND REMOVAL FB SUBQ	$181.80	$202.00	$107.80–$202.00	72% below	10%
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FOREIGN BODY - INCISION	$243.90	$271.00	$144.65–$271.00	62% below	10%
Removal of a foreign object under the skin, simple CPT 10120 INCISIONAL REMOVAL FB SUBCUT	$312.40	$347.11	$89.31–$392.27	51% below	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 ER INCISION AND REMOVAL FB SUBQ	$181.80	$202.00	$191.90–$202.00	—	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVAL FOREIGN BODY - INCISION	$243.90	$271.00	$257.45–$271.00	—	10%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISIONAL REMOVAL FB SUBCUT	$312.40	$347.11	$89.31–$392.27	—	10%
Short arm cast (elbow to hand) CPT 29075 CAST ELBOW TO FINGERS	$137.20	$152.44	$81.40–$152.44	55% below	10%
Short arm cast (elbow to hand) CPT 29075 CAST ELBOW TO FINGERS	$157.59	$175.10	$45.05–$217.29	49% below	10%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$579.60	$644.00	$159.50–$644.00	89% above	10%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST ELBOW TO FINGERS	$137.20	$152.44	$144.82–$152.44	—	10%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST ELBOW TO FINGERS	$157.59	$175.10	$45.05–$217.29	—	10%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST	$579.60	$644.00	$292.73–$644.00	—	10%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT	$151.10	$167.89	$40.61–$164.53	42% below	10%
Short arm splint (forearm and hand) CPT 29125 ER APPLICATION SHORT ARM SPLINT	$161.10	$179.00	$95.70–$179.00	38% below	10%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$206.10	$229.00	$122.10–$229.00	20% below	10%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT	$151.10	$167.89	$40.61–$164.53	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 ER APPLICATION SHORT ARM SPLINT	$161.10	$179.00	$170.05–$179.00	—	10%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$206.10	$229.00	$217.55–$229.00	—	10%
Short leg cast (below the knee) CPT 29405 CAST KNEE TO TOES	$162.23	$180.25	$96.25–$180.25	48% below	10%
Short leg cast (below the knee) CPT 29405 CAST KNEE TO TOES	$186.33	$207.03	$53.27–$202.89	40% below	10%
Short leg cast (below the knee) inpatient CPT 29405 CAST KNEE TO TOES	$162.23	$180.25	$171.24–$180.25	—	10%
Short leg cast (below the knee) inpatient CPT 29405 CAST KNEE TO TOES	$186.33	$207.03	$53.27–$202.89	—	10%
Short leg splint (calf to foot) CPT 29515 ER APPLICATION SHORT LEG SPLINT	$101.70	$113.00	$60.50–$113.00	62% below	10%
Short leg splint (calf to foot) CPT 29515 APP SHORT LEG SPLINT	$107.10	$119.00	$63.80–$119.00	60% below	10%
Short leg splint (calf to foot) CPT 29515 APP SHORT LEG SPLINT	$107.10	$119.00	$35.25–$176.89	60% below	10%
Short leg splint (calf to foot) inpatient CPT 29515 ER APPLICATION SHORT LEG SPLINT	$101.70	$113.00	$107.35–$113.00	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 APP SHORT LEG SPLINT	$107.10	$119.00	$113.05–$119.00	—	10%
Short leg splint (calf to foot) inpatient CPT 29515 APP SHORT LEG SPLINT	$107.10	$119.00	$35.25–$176.89	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LAC< 2.5 CM DR CHG	$338.36	$375.95	$44.61–$368.43	27% below	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ER LAC REPAIR/SIMP/TRUNK-EXT;2.5.>	$417.60	$464.00	$166.65–$464.00	10% below	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 LAC< 2.5 CM DR CHG	$338.36	$375.95	$44.61–$368.43	—	10%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ER LAC REPAIR/SIMP/TRUNK-EXT;2.5.>	$417.60	$464.00	$305.85–$464.00	—	10%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin	$240.09	$266.77	$46.27–$334.66	49% below	10%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy	$240.09	$266.77	$46.27–$334.66	49% below	10%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch Biopsy	$240.09	$266.77	$46.27–$334.66	49% below	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy	$240.09	$266.77	$46.27–$334.66	—	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin	$240.09	$266.77	$46.27–$334.66	—	10%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch Biopsy	$240.09	$266.77	$46.27–$334.66	—	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXCIS <.5 CM/MALIG TRUNK,ARM,LEG	$359.68	$399.64	$102.82–$514.54	57% below	10%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXCIS <.5 CM/MALIG TRUNK,ARM,LEG	$359.68	$399.64	$102.82–$514.54	—	10%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS	$86.40	$96.00	$51.15–$96.00	78% below	10%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS	$86.40	$96.00	$91.20–$96.00	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LAC EXT 2.6-7.5 CM SIMPLE REPAIR HEAD NM	$364.31	$404.79	$58.59–$396.69	27% below	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ER LAC REPAIR/SIMP/TRUNK-EXT;2.6-7.5	$440.10	$489.00	$157.30–$489.00	11% below	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 LAC EXT 2.6-7.5 CM SIMPLE REPAIR HEAD NM	$364.31	$404.79	$58.59–$396.69	—	10%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ER LAC REPAIR/SIMP/TRUNK-EXT;2.6-7.5	$440.10	$489.00	$288.69–$489.00	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ER LAC REPAIR/SIMP/FACE; <2.5 CM	$275.40	$306.00	$163.35–$306.00	40% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 Simp Repair Superficial Wound <2.5cm	$352.26	$391.40	$55.26–$383.57	23% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LAC/FACE TO 2.5CM	$353.19	$392.43	$55.26–$384.58	23% below	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ER LAC REPAIR/SIMP/FACE; <2.5 CM	$275.40	$306.00	$290.70–$306.00	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 Simp Repair Superficial Wound <2.5cm	$352.26	$391.40	$55.26–$383.57	—	10%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 LAC/FACE TO 2.5CM	$353.19	$392.43	$55.26–$384.58	—	10%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential biopsy of skin	$218.77	$243.08	$37.28–$268.46	45% below	10%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential biopsy of skin	$218.77	$243.08	$37.28–$268.46	—	10%
Thoracentesis with imaging guidance CPT 32555 32555 THORACENTESIS - PROVIDER FEE	$480.19	$533.54	$106.52–$843.46	74% below	10%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA WITH IMAGING	$1,715.20	$2,144.00	$1,145.10–$2,144.00	7% below	20%
Thoracentesis with imaging guidance CPT 32555 Aspirate Pleura w/ Imaging	$1,715.57	$2,144.46	$1,145.10–$2,144.46	7% below	20%
Thoracentesis with imaging guidance inpatient CPT 32555 32555 THORACENTESIS - PROVIDER FEE	$480.19	$533.54	$106.52–$843.46	—	10%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA WITH IMAGING	$1,715.20	$2,144.00	$2,036.80–$2,144.00	—	20%
Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate Pleura w/ Imaging	$1,715.57	$2,144.46	$2,037.24–$2,144.46	—	20%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Phys Inj trigger point	$208.58	$231.75	$36.62–$227.12	59% below	10%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION 1-2 TRIGGER POINTS	$208.58	$231.75	$36.62–$227.12	59% below	10%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION- SINGLE OR MULTIPLE TRIGGER	$1,168.79	$1,375.05	$734.25–$1,375.05	132% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$1,168.79	$1,375.05	$734.25–$1,375.05	132% above	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION 1-2 TRIGGER POINTS	$208.58	$231.75	$36.62–$227.12	—	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 Phys Inj trigger point	$208.58	$231.75	$36.62–$227.12	—	10%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION- SINGLE OR MULTIPLE TRIGGER	$1,168.79	$1,375.05	$1,306.30–$1,375.05	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$1,168.79	$1,375.05	$1,306.30–$1,375.05	—	15%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD WITH BIOPSY	$1,472.59	$1,732.46	$136.48–$1,697.81	at median	15%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD PROCEDURE ROOM WITH BIOPSY	$2,368.80	$2,961.00	$1,184.70–$2,961.00	61% above	20%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD WITH BIOPSY	$1,472.59	$1,732.46	$136.48–$1,697.81	—	15%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD PROCEDURE ROOM WITH BIOPSY	$2,368.80	$2,961.00	$2,174.25–$2,961.00	—	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Endoscopy with removal by snare technique	$2,583.15	$3,039.00	$1,045.00–$3,039.00	37% above	15%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Endoscopy with removal by snare technique	$2,583.15	$3,039.00	$1,917.86–$3,039.00	—	15%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD PANENDOSCOPY	$1,244.09	$1,463.63	$120.83–$1,434.36	at median	15%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD PROCEDURE ROOM W/O BIOPSY	$2,546.40	$3,183.00	$1,181.40–$3,183.00	105% above	20%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD PANENDOSCOPY	$1,244.09	$1,463.63	$120.83–$1,434.36	—	15%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD PROCEDURE ROOM W/O BIOPSY	$2,546.40	$3,183.00	$2,168.19–$3,183.00	—	20%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$1,024.34	$1,205.10	$230.68–$1,181.00	63% below	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$1,024.34	$1,205.10	$230.68–$1,181.00	—	15%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14	$113.40	$126.00	$67.10–$126.00	51% below	10%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14	$113.40	$126.00	$119.70–$126.00	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT OF SUBQ TISSUE	$379.80	$422.00	$225.50–$422.00	64% below	10%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 SKIN SUBCUTANE TIS	$385.63	$428.48	$60.25–$419.91	63% below	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT OF SUBQ TISSUE	$379.80	$422.00	$400.90–$422.00	—	10%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 SKIN SUBCUTANE TIS	$385.63	$428.48	$60.25–$419.91	—	10%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 3 HOURS	$720.90	$801.00	$427.90–$801.00	25% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 6 HOURS	$819.90	$911.00	$486.20–$911.00	15% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 9 HOURS	$918.00	$1,020.00	$544.50–$1,020.00	5% below	10%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 12 HOURS	$959.65	$1,129.00	$602.80–$1,129.00	1% below	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 15 HOURS	$1,052.30	$1,238.00	$661.10–$1,238.00	9% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION 18 HOURS	$1,144.95	$1,347.00	$719.40–$1,347.00	18% above	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 3 HOURS	$720.90	$801.00	$760.95–$801.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 6 HOURS	$819.90	$911.00	$865.45–$911.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 9 HOURS	$918.00	$1,020.00	$969.00–$1,020.00	—	10%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 12 HOURS	$959.65	$1,129.00	$1,072.55–$1,129.00	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 15 HOURS	$1,052.30	$1,238.00	$1,176.10–$1,238.00	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION 18 HOURS	$1,144.95	$1,347.00	$1,279.65–$1,347.00	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TREATMENT CLINIC-OUTPT	$36.90	$41.00	$22.00–$41.00	83% below	10%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEBULIZER TREATMENT CLINIC-OUTPT	$36.90	$41.00	$38.95–$41.00	—	10%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1 HOUR	$450.90	$501.00	$267.30–$501.00	40% below	10%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1 HOUR	$450.90	$501.00	$475.95–$501.00	—	10%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30-74 MIN PROV	$854.69	$949.66	$210.04–$930.67	65% below	10%
Critical care, first 30 to 74 minutes CPT 99291 E R LEVEL CRIT CARE 1ST 30-74 MIN	$1,705.95	$2,007.00	$741.95–$2,007.00	31% below	15%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 30-74 MIN PROV	$854.69	$949.66	$210.04–$930.67	—	10%
Critical care, first 30 to 74 minutes inpatient CPT 99291 E R LEVEL CRIT CARE 1ST 30-74 MIN	$1,705.95	$2,007.00	$1,361.68–$2,007.00	—	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG INTERP REPORT For Commercial	$158.52	$176.13	$14.31–$172.61	92% above	10%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ECG Interp	$158.52	$176.13	$14.31–$172.61	92% above	10%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG WITH INTERP AND REPORT	$223.20	$248.00	$95.15–$248.00	171% above	10%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ECG Interp	$158.52	$176.13	$14.31–$172.61	—	10%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG INTERP REPORT For Commercial	$158.52	$176.13	$14.31–$172.61	—	10%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG WITH INTERP AND REPORT	$223.20	$248.00	$174.63–$248.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$183.60	$204.00	$74.25–$204.00	24% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG Report	$183.60	$204.00	$74.25–$204.00	24% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG Report	$183.60	$204.00	$6.32–$199.92	24% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC	$189.00	$210.00	$6.32–$205.80	22% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC	$189.00	$210.00	$74.25–$210.00	22% below	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG Report	$183.60	$204.00	$6.32–$199.92	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$183.60	$204.00	$136.27–$204.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG Report	$183.60	$204.00	$136.27–$204.00	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG POC	$189.00	$210.00	$6.32–$205.80	—	10%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG POC	$189.00	$210.00	$136.27–$210.00	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LEVEL I ER MD/PA FEE	$111.24	$123.60	$11.32–$121.13	59% below	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 FAC ED Leve 1 - Room Charge	$244.80	$272.00	$145.20–$272.00	11% below	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 LEVEL I ER MD/PA FEE	$111.24	$123.60	$11.32–$121.13	—	10%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 FAC ED Leve 1 - Room Charge	$244.80	$272.00	$258.40–$272.00	—	10%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 FAC ED Level 2 - Room Charge	$409.50	$455.00	$142.45–$455.00	6% below	10%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 FAC ED Level 2 - Room Charge	$409.50	$455.00	$261.43–$455.00	—	10%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 FAC ED Level 3 - Room Charge	$530.10	$589.00	$219.45–$589.00	24% below	10%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 FAC ED Level 3 - Room Charge	$530.10	$589.00	$402.75–$589.00	—	10%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 FAC ED Level 4 - Room Charge	$896.40	$996.00	$309.65–$996.00	18% below	10%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 FAC ED Level 4 - Room Charge	$896.40	$996.00	$568.29–$996.00	—	10%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 E R LEVEL 5 ROOM CHG	$1,437.30	$1,597.00	$420.75–$1,597.00	10% below	10%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 E R LEVEL 5 ROOM CHG	$1,437.30	$1,597.00	$772.19–$1,597.00	—	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST - PROVIDER	$133.49	$148.32	$37.61–$145.35	89% below	10%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test-Tracing Medicare	$676.71	$751.90	$401.50–$751.90	42% below	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST - PROVIDER	$133.49	$148.32	$37.61–$145.35	—	10%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Stress Test-Tracing Medicare	$676.71	$751.90	$714.31–$751.90	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION-HYDRATION;INIT.31-60 MIN	$526.50	$585.00	$312.40–$585.00	22% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRAT. 31 MIN- 1HR - EMERG	$526.50	$585.00	$312.40–$585.00	22% above	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION-HYDRATION;INIT.31-60 MIN	$526.50	$585.00	$555.75–$585.00	—	10%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRAT. 31 MIN- 1HR - EMERG	$526.50	$585.00	$555.75–$585.00	—	10%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION 1ST MED; INIT. HOUR	$501.30	$557.00	$297.55–$557.00	13% above	10%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION 1ST MED UP TO 1 HOUR- ER	$501.30	$557.00	$297.55–$557.00	13% above	10%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION 1ST MED UP TO 1 HOUR- ER	$501.30	$557.00	$529.15–$557.00	—	10%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION 1ST MED; INIT. HOUR	$501.30	$557.00	$529.15–$557.00	—	10%
IV push of a medicine, first drug CPT 96374 IV PUSH MED INIT/SINGLE - ER	$404.10	$449.00	$239.80–$449.00	16% above	10%
IV push of a medicine, first drug CPT 96374 IV PUSH MED INIT/SINGLE	$404.10	$449.00	$239.80–$449.00	16% above	10%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH MED INIT/SINGLE	$404.10	$449.00	$426.55–$449.00	—	10%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH MED INIT/SINGLE - ER	$404.10	$449.00	$426.55–$449.00	—	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 RSV Administration	$16.69	$18.54	$4.77–$30.00	81% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM OR SQ INJECT -	$72.90	$81.00	$43.45–$81.00	18% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED Injection - IM- SUBQ	$72.90	$81.00	$43.45–$81.00	18% below	10%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION FEE IM/SUBQ CLINIC ONLY	$73.23	$81.37	$14.31–$79.74	18% below	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 RSV Administration	$16.69	$18.54	$4.77–$30.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED Injection - IM- SUBQ	$72.90	$81.00	$76.95–$81.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM OR SQ INJECT -	$72.90	$81.00	$76.95–$81.00	—	10%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION FEE IM/SUBQ CLINIC ONLY	$73.23	$81.37	$14.31–$79.74	—	10%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psychiatric Diagnostic Evaluation	$266.98	$296.64	$76.32–$290.71	13% below	10%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psychiatric Diagnostic Evaluation	$266.98	$296.64	$76.32–$290.71	—	10%
Neuromuscular re-education, 15 minutes CPT 97112 OT RE-ED OF NEUR MOVEMENT,COORD	$83.70	$93.00	$46.75–$93.00	30% below	10%
Neuromuscular re-education, 15 minutes CPT 97112 PT RE-ED OF MOVEMENT,COORDINATION	$83.70	$93.00	$46.75–$93.00	30% below	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT RE-ED OF NEUR MOVEMENT,COORD	$83.70	$93.00	$85.80–$93.00	—	10%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT RE-ED OF MOVEMENT,COORDINATION	$83.70	$93.00	$85.80–$93.00	—	10%
New patient office visit, about 30 minutes CPT 99203 Office/OP New Visit-Low MDM	$183.55	$203.94	$52.47–$199.86	4% below	10%
New patient office visit, about 30 minutes CPT 99203 Office Visit New Pt Level 3 - Low MDM	$183.55	$203.94	$52.47–$199.86	4% below	10%
New patient office visit, about 30 minutes inpatient CPT 99203 Office Visit New Pt Level 3 - Low MDM	$183.55	$203.94	$52.47–$199.86	—	10%
New patient office visit, about 30 minutes inpatient CPT 99203 Office/OP New Visit-Low MDM	$183.55	$203.94	$52.47–$199.86	—	10%
New patient office visit, about 45 minutes CPT 99204 Office Visit New Pt Level 4 - Moderate MDM	$227.12	$252.35	$64.93–$268.45	11% below	10%
New patient office visit, about 45 minutes CPT 99204 99204 Office/OP New Visit-Moderate MDM	$227.12	$252.35	$64.93–$268.45	11% below	10%
New patient office visit, about 45 minutes inpatient CPT 99204 Office Visit New Pt Level 4 - Moderate MDM	$227.12	$252.35	$64.93–$268.45	—	10%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office/OP New Visit-Moderate MDM	$227.12	$252.35	$64.93–$268.45	—	10%
New patient office visit, about 60 minutes CPT 99205 99205 OFFICE VISIT NEW PT- HIGH MDM	$279.03	$310.03	$79.77–$354.08	11% below	10%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 OFFICE VISIT NEW PT- HIGH MDM	$279.03	$310.03	$79.77–$354.08	—	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit New Pt Level 2 - Straightforward MDM	$150.17	$166.86	$42.93–$163.52	3% above	10%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office/OP New Visit- Straightforward MDM	$150.17	$166.86	$42.93–$163.52	3% above	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Office Visit New Pt Level 2 - Straightforward MDM	$150.17	$166.86	$42.93–$163.52	—	10%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 Office/OP New Visit- Straightforward MDM	$150.17	$166.86	$42.93–$163.52	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Self Pay Nutrition Consult/15 min	$18.54	$20.60	$5.30–$62.00	66% below	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Self Pay Nutrition Consult/15 min	$18.54	$20.60	$11.00–$20.60	66% below	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition (Medical) Individ Init./15min	$45.00	$50.00	$6.63–$62.00	17% below	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition (Medical) Individ Init./15min	$45.00	$50.00	$13.75–$50.00	17% below	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Self Pay Nutrition Consult/15 min	$18.54	$20.60	$19.57–$20.60	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Self Pay Nutrition Consult/15 min	$18.54	$20.60	$5.30–$62.00	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutrition (Medical) Individ Init./15min	$45.00	$50.00	$25.24–$50.00	—	10%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Nutrition (Medical) Individ Init./15min	$45.00	$50.00	$6.63–$62.00	—	10%
Occupational therapy evaluation, low complexity CPT 97165 OCCUPATIONAL THERPAY EVAL; LOW COMPLEX	$181.80	$202.00	$102.30–$202.00	31% below	10%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OCCUPATIONAL THERPAY EVAL; LOW COMPLEX	$181.80	$202.00	$187.75–$202.00	—	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PHYSICAL THERAPY EVAULATION; HIGH COMP	$254.70	$283.00	$143.55–$283.00	14% below	10%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PHYSICAL THERAPY EVAULATION; HIGH COMP	$254.70	$283.00	$263.45–$283.00	—	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PHYSICAL THERAPY EVALUATION; LOW COMPLEX	$181.80	$202.00	$102.30–$202.00	17% below	10%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PHYSICAL THERAPY EVALUATION; LOW COMPLEX	$181.80	$202.00	$187.75–$202.00	—	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PHYSICAL THERAPY EVALUATION; MOD COMPLEX	$206.10	$229.00	$116.05–$229.00	21% below	10%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PHYSICAL THERAPY EVALUATION; MOD COMPLEX	$206.10	$229.00	$212.98–$229.00	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY-MASSAGE OT	$85.50	$95.00	$48.40–$95.00	27% below	10%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY TECHNIQUES	$85.50	$95.00	$48.40–$95.00	27% below	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY TECHNIQUES	$85.50	$95.00	$88.83–$95.00	—	10%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY-MASSAGE OT	$85.50	$95.00	$88.83–$95.00	—	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT-THERAPEUTIC EXERCISE	$82.80	$92.00	$46.20–$92.00	30% below	10%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT VISIT- EACH 15 MIN	$82.80	$92.00	$46.20–$92.00	30% below	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT VISIT- EACH 15 MIN	$82.80	$92.00	$84.79–$92.00	—	10%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT-THERAPEUTIC EXERCISE	$82.80	$92.00	$84.79–$92.00	—	10%
Preventive checkup, new patient aged 18–39 CPT 99385 NEW PATIENT EXAM/PHYSICAL 18-39 YRS	$210.43	$233.81	$60.16–$229.13	8% above	10%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 NEW PATIENT EXAM/PHYSICAL 18-39 YRS	$210.43	$233.81	$60.16–$229.13	—	10%
Preventive checkup, new patient aged 40–64 CPT 99386 NEW PATIENT EXAM/PHYSICAL 40-64 YRS	$243.80	$270.89	$69.70–$265.47	12% above	10%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 NEW PATIENT EXAM/PHYSICAL 40-64 YRS	$243.80	$270.89	$69.70–$265.47	—	10%
Preventive checkup, new patient aged 65 or older CPT 99387 Patient Physical for Over 65 Years Old	$265.12	$294.58	$75.79–$288.69	at median	10%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Patient Physical for Over 65 Years Old	$265.12	$294.58	$75.79–$288.69	—	10%
Preventive checkup, returning patient aged 18–39 CPT 99395 EST. PATIENT EXAM/PHYSICAL 18-39 YRS	$141.83	$157.59	$40.55–$198.00	59% below	10%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 EST. PATIENT EXAM/PHYSICAL 18-39 YRS	$141.83	$157.59	$40.55–$198.00	—	10%
Preventive checkup, returning patient aged 40–64 CPT 99396 EST. PATIENT EXAM/PHYSICAL 40-64 YRS	$200.23	$222.48	$57.24–$218.03	11% above	10%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 EST. PATIENT EXAM/PHYSICAL 40-64 YRS	$200.23	$222.48	$57.24–$218.03	—	10%
Preventive checkup, returning patient aged 65 or older CPT 99397 EST PATIENT EXAM/PHYSICAL 65+ YRS	$217.85	$242.05	$62.28–$237.21	12% above	10%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 EST PATIENT EXAM/PHYSICAL 65+ YRS	$217.85	$242.05	$62.28–$237.21	—	10%
Psychiatric evaluation with medical services CPT 90792 Psychiatric Diagnostic Evaluation; with medical services	$304.06	$337.84	$86.92–$331.08	1% below	10%
Psychiatric evaluation with medical services inpatient CPT 90792 Psychiatric Diagnostic Evaluation; with medical services	$304.06	$337.84	$86.92–$331.08	—	10%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes	$127.93	$142.14	$36.57–$139.30	58% below	10%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psychotherapy, 30 minutes	$127.93	$142.14	$36.57–$139.30	—	10%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes	$151.10	$167.89	$43.20–$164.53	49% below	10%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psychotherapy, 45 minutes	$151.10	$167.89	$43.20–$164.53	—	10%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes	$174.28	$193.64	$49.82–$236.24	53% below	10%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psychotherapy, 60 minutes	$174.28	$193.64	$49.82–$236.24	—	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use cessation counseling visit; intermed	$41.72	$46.35	$11.65–$45.42	2% below	10%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use cessation counseling visit; intermed	$41.72	$46.35	$24.75–$46.35	2% below	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking and tobacco use cessation counseling visit; intermed	$41.72	$46.35	$11.65–$45.42	—	10%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking and tobacco use cessation counseling visit; intermed	$41.72	$46.35	$44.03–$46.35	—	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Treatment Room - Level V	$199.31	$221.45	$118.25–$221.45	22% below	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/OP Established Visit-High MDM	$292.01	$324.45	$83.48–$317.96	14% above	10%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Visit Est Pt Level 5 - High MDM	$292.01	$324.45	$83.48–$317.96	14% above	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Treatment Room - Level V	$199.31	$221.45	$210.38–$221.45	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office/OP Established Visit-High MDM	$292.01	$324.45	$83.48–$317.96	—	10%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Office Visit Est Pt Level 5 - High MDM	$292.01	$324.45	$83.48–$317.96	—	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Treatment Room - Level III	$132.56	$147.29	$78.65–$147.29	4% below	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office Visit Est Pt - Low MDM	$148.32	$164.80	$42.40–$161.50	7% above	10%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Visit Est Pt Level 3 - Low MDM	$148.32	$164.80	$42.40–$161.50	7% above	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Treatment Room - Level III	$132.56	$147.29	$139.93–$147.29	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office Visit Est Pt - Low MDM	$148.32	$164.80	$42.40–$161.50	—	10%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Visit Est Pt Level 3 - Low MDM	$148.32	$164.80	$42.40–$161.50	—	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Treatment Room - Level IV	$167.79	$186.43	$99.55–$186.43	9% below	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Visit Est Pt Level 4 - Moderate MDM	$217.85	$242.05	$62.28–$237.21	18% above	10%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/OP Established Pt Visit -Moderate MDM	$217.85	$242.05	$62.28–$237.21	18% above	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Treatment Room - Level IV	$167.79	$186.43	$177.11–$186.43	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Office Visit Est Pt Level 4 - Moderate MDM	$217.85	$242.05	$62.28–$237.21	—	10%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office/OP Established Pt Visit -Moderate MDM	$217.85	$242.05	$62.28–$237.21	—	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/OP Established Visit - Straightforward MDM	$103.82	$115.36	$29.68–$113.05	6% below	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Visit Est Pt Level 2 - Straightforward MDM	$103.82	$115.36	$29.68–$113.05	6% below	10%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Treatment Room - Level II	$124.22	$138.02	$73.70–$138.02	13% above	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Office Visit Est Pt Level 2 - Straightforward MDM	$103.82	$115.36	$29.68–$113.05	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office/OP Established Visit - Straightforward MDM	$103.82	$115.36	$29.68–$113.05	—	10%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Treatment Room - Level II	$124.22	$138.02	$131.12–$138.02	—	10%
Specialist consultation, low complexity or 30+ minutes CPT 99243 LEVEL III OFC CONS	$227.12	$252.35	$64.93–$247.30	11% below	10%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 LEVEL III OFC CONS	$227.12	$252.35	$64.93–$247.30	—	10%
Speech and language evaluation CPT 92523 SPEECH - EVALUATION OF LANG. COMPREHENSI	$369.90	$411.00	$131.45–$411.00	13% below	10%
Speech and language evaluation inpatient CPT 92523 SPEECH - EVALUATION OF LANG. COMPREHENSI	$369.90	$411.00	$241.25–$411.00	—	10%
Speech therapy session, individual CPT 92507 SPEECH THERAPY	$224.33	$249.26	$133.10–$249.26	20% below	10%
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY	$224.33	$249.26	$236.80–$249.26	—	10%
Spirometry (breathing test) CPT 94010 SPIROMETRY INTERP	$103.82	$115.36	$12.85–$113.05	67% below	10%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$202.50	$225.00	$119.90–$225.00	36% below	10%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY INTERP	$103.82	$115.36	$12.85–$113.05	—	10%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$202.50	$225.00	$213.75–$225.00	—	10%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY PRE POST BRONCH	$305.91	$339.90	$181.50–$339.90	44% below	10%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY PRE POST BRONCH	$305.91	$339.90	$322.91–$339.90	—	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPUTIC ACTIVITY--PT/OT	$78.30	$87.00	$46.20–$87.00	34% below	10%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPUTIC ACTIVITY--OT	$82.80	$92.00	$46.20–$92.00	30% below	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPUTIC ACTIVITY--PT/OT	$78.30	$87.00	$82.65–$87.00	—	10%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPUTIC ACTIVITY--OT	$82.80	$92.00	$84.79–$92.00	—	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEUTIC	$131.40	$146.00	$78.10–$146.00	46% below	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$139.50	$155.00	$37.63–$227.00	43% below	10%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$139.50	$155.00	$78.10–$155.00	43% below	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPEUTIC	$131.40	$146.00	$138.70–$146.00	—	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy	$139.50	$155.00	$37.63–$227.00	—	10%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Therapeutic Phlebotomy	$139.50	$155.00	$143.33–$155.00	—	10%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 EMET TREADMILL - PROVIDER	$162.23	$180.25	$46.38–$176.65	—	10%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 EMET Treadmill	$394.20	$438.00	$233.75–$438.00	—	10%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 EMET TREADMILL - PROVIDER	$162.23	$180.25	$46.38–$176.65	—	10%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 EMET Treadmill	$394.20	$438.00	$416.10–$438.00	—	10%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 91322 Moderna Covid Vaccine 12 years and up 0.5ml 20	$300.35	$333.72	$85.86–$327.05	46% above	10%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 91322 Moderna Covid Vaccine 12 years and up 0.5ml 20	$300.35	$333.72	$85.86–$327.05	—	10%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 90716 PED Varicella Vaccine (VARIVAX)	$533.95	$593.28	$152.64–$581.41	131% above	10%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 90716 PED Varicella Vaccine (VARIVAX)	$533.95	$593.28	$152.64–$581.41	—	10%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 90696 DTaP-IPV (KINRIX) VFC	$196.52	$218.36	$56.18–$213.99	112% above	10%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 90696 DTaP-IPV (KINRIX) VFC	$196.52	$218.36	$56.18–$213.99	—	10%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 90700 PED DTaP (INFANRIX)	$92.70	$103.00	$24.29–$100.94	21% above	10%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 90700 PED DTaP (INFANRIX)	$92.70	$103.00	$24.29–$100.94	—	10%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 90723 PED DTaP-Hep B-IPV (PEDIARIX)	$306.84	$340.93	$87.72–$334.11	149% above	10%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 90723 PED DTaP-Hep B-IPV (PEDIARIX)	$306.84	$340.93	$87.72–$334.11	—	10%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 90698 PED DTaP-HIB-IPV (PENTACEL)	$368.95	$409.94	$72.48–$401.74	126% above	10%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 90698 PED DTaP-HIB-IPV (PENTACEL)	$368.95	$409.94	$72.48–$401.74	—	10%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 ADULT/PED DTaP-IPV-Hib-Hep B (VAXELIS) FAMC	$486.68	$540.75	$139.13–$529.94	122% above	10%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 ADULT/PED DTaP-IPV-Hib-Hep B (VAXELIS) FAMC	$486.68	$540.75	$139.13–$529.94	—	10%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 90651 ADULT/PED HPV (GARDASIL 9)	$746.24	$829.15	$213.33–$812.57	94% above	10%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 90651 ADULT/PED HPV (GARDASIL 9)	$746.24	$829.15	$213.33–$812.57	—	10%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 90636 PED Hepatitis A-B (TWINRIX)	$404.17	$449.08	$88.42–$440.10	136% above	10%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 90636 PED Hepatitis A-B (TWINRIX)	$404.17	$449.08	$88.42–$440.10	—	10%
Hepatitis A vaccine, adult dose CPT 90632 90632 Hepatitis A Vaccine	$265.12	$294.58	$70.17–$288.69	117% above	10%
Hepatitis A vaccine, adult dose inpatient CPT 90632 90632 Hepatitis A Vaccine	$265.12	$294.58	$70.17–$288.69	—	10%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 90633 PED Hepatitis A (HAVRIX)	$123.29	$136.99	$32.26–$134.25	161% above	10%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 90633 PED Hepatitis A (HAVRIX)	$123.29	$136.99	$32.26–$134.25	—	10%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 90744 PED Hepatitis B (ENGERIX)	$90.85	$100.94	$25.97–$98.92	104% above	10%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 90744 PED Hepatitis B (ENGERIX)	$90.85	$100.94	$53.90–$100.94	104% above	10%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 90744 PED Hepatitis B (ENGERIX)	$90.85	$100.94	$95.89–$100.94	—	10%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 90744 PED Hepatitis B (ENGERIX)	$90.85	$100.94	$25.97–$98.92	—	10%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 90648 PED Haemophilus (HIBERIX)	$55.62	$61.80	$12.45–$60.56	42% above	10%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 90648 PED Haemophilus (HIBERIX)	$55.62	$61.80	$12.45–$60.56	—	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 PED MMR II Vaccine w/Diluent (MMR II)	$298.49	$331.66	$177.10–$331.66	183% above	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 Measles Mumps Rubella	$298.49	$331.66	$85.33–$325.03	183% above	10%
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 PED MMR II Vaccine w/Diluent (MMR II)	$298.49	$331.66	$85.33–$325.03	183% above	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 90707 PED MMR II Vaccine w/Diluent (MMR II)	$298.49	$331.66	$85.33–$325.03	—	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 90707 Measles Mumps Rubella	$298.49	$331.66	$85.33–$325.03	—	10%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 90707 PED MMR II Vaccine w/Diluent (MMR II)	$298.49	$331.66	$315.08–$331.66	—	10%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 90710 PED MMR/Varicella Vaccine w/Diluent (PROQUAD)	$728.62	$809.58	$208.29–$793.39	60% above	10%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 90710 PED MMR/Varicella Vaccine w/Diluent (PROQUAD)	$728.62	$809.58	$208.29–$793.39	—	10%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 90734 PED Meningococcal ACY W-135 (MENVEO)	$495.02	$550.02	$141.51–$539.02	161% above	10%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 90734 PED Meningococcal ACY W-135 (MENVEO)	$495.02	$550.02	$141.51–$539.02	—	10%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 90620 Bexsero/Meningococcal B Vaccine	$587.72	$653.02	$168.01–$639.96	121% above	10%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 90620 Bexsero/Meningococcal B Vaccine	$587.72	$653.02	$168.01–$639.96	—	10%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 90670 PED Pneumococcal 13 Vaccine (PREVNAR 13)	$628.51	$698.34	$179.67–$684.37	132% above	10%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR VACCINE 13	$628.51	$698.34	$179.67–$684.37	132% above	10%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR VACCINE 13	$628.51	$698.34	$179.67–$684.37	—	10%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 90670 PED Pneumococcal 13 Vaccine (PREVNAR 13)	$628.51	$698.34	$179.67–$684.37	—	10%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 90671 VAXNEUVANCE PNEUMOCOCCAL 15-VALENT VACCINE	$482.04	$535.60	$137.80–$524.89	44% above	10%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 ADULT/PED Pneumoccocal 15 Vaccine (VAXNEUVANC 15) FAMC	$482.04	$535.60	$137.80–$524.89	44% above	10%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 90671 VAXNEUVANCE PNEUMOCOCCAL 15-VALENT VACCINE	$482.04	$535.60	$137.80–$524.89	—	10%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 ADULT/PED Pneumoccocal 15 Vaccine (VAXNEUVANC 15) FAMC	$482.04	$535.60	$137.80–$524.89	—	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20 Vaccine (PREVNAR 20)	$705.45	$783.83	$201.67–$768.15	123% above	10%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal 20 Vaccine (PREVNAR 20)	$705.45	$783.83	$201.67–$768.15	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 90732 -Pneumococcal 23-Valent Adult Vaccine POC	$391.19	$434.66	$111.83–$425.97	176% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 90732 MEDICARE Pneumococcal 23 Vaccine (PNEUMOVAX 23)	$391.19	$434.66	$111.83–$425.97	176% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 90732 MEDICARE Pneumococcal 23 Vaccine (PNEUMOVAX 23)	$391.19	$434.66	$232.10–$434.66	176% above	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 90732 -Pneumococcal 23-Valent Adult Vaccine POC	$391.19	$434.66	$111.83–$425.97	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 90732 MEDICARE Pneumococcal 23 Vaccine (PNEUMOVAX 23)	$391.19	$434.66	$412.93–$434.66	—	10%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 90732 MEDICARE Pneumococcal 23 Vaccine (PNEUMOVAX 23)	$391.19	$434.66	$111.83–$425.97	—	10%
Polio vaccine, inactivated (IPV) CPT 90713 VFC - 90715 TDaP (Boostrix)	$135.34	$150.38	$35.83–$147.37	208% above	10%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 VFC - 90715 TDaP (Boostrix)	$135.34	$150.38	$35.83–$147.37	—	10%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 90679 Arexvy RSV Adult Vaccine	$778.68	$865.20	$222.60–$847.90	112% above	10%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 90679 Arexvy RSV Adult Vaccine	$778.68	$865.20	$222.60–$847.90	—	10%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotavirus Vaccine (Rotarix)	$449.60	$499.55	$95.38–$489.56	79% above	10%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Rotavirus Vaccine (Rotarix)	$449.60	$499.55	$95.38–$489.56	—	10%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 90750 Shringrix Vaccine	$611.82	$679.80	$156.80–$666.20	69% above	10%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 90750 Shringrix Vaccine	$611.82	$679.80	$156.80–$666.20	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 90715 PED TDaP (Boostrix)	$152.96	$169.95	$37.50–$166.55	79% above	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus, diphtheria toxoids acellular pertussis vaccine (TdaP), 7 years or old	$152.96	$169.95	$37.50–$166.55	79% above	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus, diphtheria toxoids acellular pertussis vaccine (TdaP), 7 years or old	$152.96	$169.95	$37.50–$166.55	—	10%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 90715 PED TDaP (Boostrix)	$152.96	$169.95	$37.50–$166.55	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumococcal Immunization Charge	$19.47	$21.63	$11.55–$21.63	62% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Pneumococcal Immunization Charge	$19.47	$21.63	$5.57–$32.65	62% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE INITIAL ADMIN FEE-	$19.80	$22.00	$11.55–$22.00	62% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 VACCINE ADMIN FEE- EMERGENCY ROOM	$19.80	$22.00	$11.55–$22.00	62% below	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneumococcal Immunization Charge	$19.47	$21.63	$5.57–$32.65	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Pneumococcal Immunization Charge	$19.47	$21.63	$20.55–$21.63	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE INITIAL ADMIN FEE-	$19.80	$22.00	$20.90–$22.00	—	10%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 VACCINE ADMIN FEE- EMERGENCY ROOM	$19.80	$22.00	$20.90–$22.00	—	10%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 VACCINE ADDITIONAL ADMIN FEE	$19.80	$22.00	$11.55–$22.00	60% below	10%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 VACCINE ADDITIONAL ADMIN FEE	$19.80	$22.00	$20.90–$22.00	—	10%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://faulktonmedical.org/wp-content/uploads/363317416_Faulkton-Area-Medical-Center_standardcharges.csv