Hospital Lebanon-Claremont, NH-VT

Gifford Medical Center

Gifford Medical Center in Randolph, VT publishes cash prices for 338 common procedures listed here, from its own machine-readable price file updated Feb 12, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Vermont median for 295 of 333 procedures and above it for 25. By typical cash price it ranks #1 of 10 Vermont hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

44 South Main Street, Randolph, VT 05060 Collected Sep 27, 2026 Source price file (802) 728-4441

Critical access hospital (rural, 25 beds or fewer) Emergency department CMS star rating 5 of 5 CCN 471301 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Gifford Medical Center in Randolph, VT:

Jun 13, 2023 Warning notice
Sep 28, 2023 Corrective action plan requested
Oct 16, 2023 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 X-RAY EXAM OF ANKLE- BILATERAL	$236.78	$473.57	$122.61–$449.89	—	50%
Ankle X-ray, complete, 3 or more views CPT 73610 XR ANKLE COMPL MIN 3 VIEWS	$277.63	$555.26	$122.61–$527.50	32% below	50%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 X-RAY EXAM OF ANKLE- BILATERAL	$236.78	$473.57	$350.49–$449.89	—	50%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 XR ANKLE COMPL MIN 3 VIEWS	$277.63	$555.26	$410.95–$527.50	—	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$67.21	$134.42	$59.53–$127.70	76% below	50%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 UPR/L XTREMITY ART 2 LEVELS	$67.21	$134.42	$99.48–$127.70	—	50%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST	$428.08	$856.15	$300.35–$813.34	51% below	50%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST	$428.08	$856.15	$633.64–$813.34	—	50%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE & JNT IMG WHOLE BODY	$975.42	$1,950.85	$864.03–$1,853.31	47% below	50%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE & JNT IMG WHOLE BODY	$975.42	$1,950.85	$1,443.82–$1,853.31	—	50%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED UNILAT	$342.77	$685.54	$229.55–$651.26	8% below	50%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST LIMITED UNILAT	$342.77	$685.54	$507.37–$651.26	—	50%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST W/O&W/DYE	$1,278.03	$2,556.05	$772.42–$2,428.25	51% below	50%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST W/O&W/DYE	$1,278.03	$2,556.05	$1,891.73–$2,428.25	—	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE	$1,302.84	$2,605.68	$771.01–$2,475.40	—	50%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT ANGIO HRT W/3D IMAGE	$1,302.84	$2,605.68	$1,928.46–$2,475.40	—	50%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDMN & PELVIS W/O CONTRAST	$1,578.40	$3,156.80	$460.55–$2,998.96	44% below	50%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDMN & PELVIS W/O CONTRAST	$1,578.40	$3,156.80	$2,336.35–$2,998.96	—	50%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST	$1,948.06	$3,896.11	$980.67–$3,701.30	45% below	50%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST	$1,948.06	$3,896.11	$2,883.51–$3,701.30	—	50%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ADB & PLEV W/O DYE 1/> REGN	$2,463.50	$4,927.01	$1,107.63–$4,680.66	40% below	50%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ADB & PLEV W/O DYE 1/> REGN	$2,463.50	$4,927.01	$3,646.48–$4,680.66	—	50%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$1,268.65	$2,537.31	$772.63–$2,410.44	45% below	50%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$1,268.65	$2,537.31	$1,877.86–$2,410.44	—	50%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,048.99	$2,097.99	$365.34–$1,993.09	48% below	50%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,048.99	$2,097.99	$1,552.72–$1,993.09	—	50%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,010.22	$2,020.44	$395.73–$1,919.42	43% below	50%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,010.22	$2,020.44	$1,495.33–$1,919.42	—	50%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST	$848.92	$1,697.83	$298.90–$1,612.94	52% below	50%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST	$848.92	$1,697.83	$1,256.56–$1,612.94	—	50%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/CONTRAST	$1,106.51	$2,213.02	$428.93–$2,102.37	44% below	50%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/CONTRAST	$1,106.51	$2,213.02	$1,637.86–$2,102.37	—	50%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/CONTRAST	$1,268.20	$2,536.40	$512.57–$2,409.58	49% below	50%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/CONTRAST	$1,268.20	$2,536.40	$1,877.19–$2,409.58	—	50%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,027.80	$2,055.59	$371.14–$1,952.81	50% below	50%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST	$1,027.80	$2,055.59	$1,521.34–$1,952.81	—	50%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,078.46	$2,156.92	$375.45–$2,049.07	47% below	50%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST	$1,078.46	$2,156.92	$1,596.34–$2,049.07	—	50%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST	$1,195.31	$2,390.61	$772.63–$2,271.08	49% below	50%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST	$1,195.31	$2,390.61	$1,769.29–$2,271.08	—	50%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US DUPLEX SCN EXTRACRANIAL BI	$496.91	$993.82	$440.16–$944.13	—	50%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US DUPLEX SCN EXTRACRANIAL BI	$496.91	$993.82	$735.53–$944.13	—	50%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$226.96	$453.93	$100.97–$431.23	51% below	50%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$226.96	$453.93	$335.95–$431.23	—	50%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$170.61	$341.22	$74.94–$324.16	53% below	50%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$170.61	$341.22	$252.54–$324.16	—	50%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$423.94	$847.88	$319.12–$805.49	37% below	50%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE	$423.94	$847.88	$627.52–$805.49	—	50%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 XR DXA BONE DENSITY AXIAL SKEL	$369.14	$738.28	$128.41–$701.37	37% below	50%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 XR DXA BONE DENSITY AXIAL SKEL	$369.14	$738.28	$546.40–$701.37	—	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 XR DXA BONE DENSITY PERIPH SKL	$196.46	$392.92	$96.62–$373.27	45% below	50%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 XR DXA BONE DENSITY PERIPH SKL	$196.46	$392.92	$290.80–$373.27	—	50%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT DX THORAX W/O CONTRAST	$992.64	$1,985.28	$371.14–$1,886.02	50% below	50%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT DX THORAX W/O CONTRAST	$992.64	$1,985.28	$1,469.31–$1,886.02	—	50%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT DX THORAX W/CONTRAST	$1,230.90	$2,461.81	$505.31–$2,338.72	46% below	50%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT DX THORAX W/CONTRAST	$1,230.90	$2,461.81	$1,821.99–$2,338.72	—	50%
Diagnostic mammogram, both breasts both sides CPT 77066 MM MAMMO DX INCL CAD BILAT	$342.00	$683.99	$302.94–$649.79	—	50%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM MAMMO DX INCL CAD BILAT	$342.00	$683.99	$506.22–$649.79	—	50%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US DUPLEX SCN LOWER EXTREM BI	$449.79	$899.58	$398.42–$854.60	—	50%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US DUPLEX SCN LOWER EXTREM BI	$449.79	$899.58	$665.78–$854.60	—	50%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$662.28	$1,324.55	$586.64–$1,258.32	16% below	50%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$662.28	$1,324.55	$980.30–$1,258.32	—	50%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE	$539.13	$1,078.26	$477.56–$1,024.35	77% below	50%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W/DOPPLER COMPLETE	$539.13	$1,078.26	$798.02–$1,024.35	—	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SYSTEM IMAGNG	$864.81	$1,729.62	$766.05–$1,643.14	50% below	50%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SYSTEM IMAGNG	$864.81	$1,729.62	$1,280.09–$1,643.14	—	50%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$244.02	$488.05	$216.16–$463.65	at median	50%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATT&RESP EFFT	$244.02	$488.05	$361.21–$463.65	—	50%
Knee X-ray, 3 views CPT 73562 XR KNEE 3 VIEWS	$298.82	$597.65	$138.52–$567.77	33% below	50%
Knee X-ray, 3 views inpatient CPT 73562 XR KNEE 3 VIEWS	$298.82	$597.65	$442.32–$567.77	—	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL LIMITED	$359.32	$718.63	$258.44–$682.70	28% below	50%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL LIMITED	$359.32	$718.63	$531.86–$682.70	—	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CA SCR W/O DYE	$575.29	$1,150.58	$391.16–$1,093.05	49% below	50%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CA SCR W/O DYE	$575.29	$1,150.58	$851.54–$1,093.05	—	50%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,409.86	$2,819.72	$576.11–$2,678.73	46% below	50%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,409.86	$2,819.72	$2,086.87–$2,678.73	—	50%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O & W/CONTRAST	$2,119.18	$4,238.37	$1,061.41–$4,026.45	42% below	50%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/O & W/CONTRAST	$2,119.18	$4,238.37	$3,136.82–$4,026.45	—	50%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE	$1,622.87	$3,245.73	$573.25–$3,083.44	43% below	50%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN STEM W/O DYE	$1,622.87	$3,245.73	$2,402.16–$3,083.44	—	50%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE	$2,236.02	$4,472.05	$954.47–$4,248.45	48% below	50%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE	$2,236.02	$4,472.05	$3,309.76–$4,248.45	—	50%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINAL CANL LUMBAR W/O DYE	$1,642.12	$3,284.24	$550.12–$3,120.03	44% below	50%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINAL CANL LUMBAR W/O DYE	$1,642.12	$3,284.24	$2,430.67–$3,120.03	—	50%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR W/O & W/DYE	$2,245.33	$4,490.66	$957.37–$4,266.13	43% below	50%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINE LUMBAR W/O & W/DYE	$2,245.33	$4,490.66	$3,323.54–$4,266.13	—	50%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE CNL THORACIC W/O DYE	$1,611.49	$3,222.98	$547.22–$3,061.83	46% below	50%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINE CNL THORACIC W/O DYE	$1,611.49	$3,222.98	$2,385.33–$3,061.83	—	50%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERVICAL W/O & W/DYE	$2,293.16	$4,586.31	$960.27–$4,356.99	42% below	50%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINE CERVICAL W/O & W/DYE	$2,293.16	$4,586.31	$3,394.33–$4,356.99	—	50%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CAN CERVICAL SPINE W/O DYE	$1,596.74	$3,193.48	$548.67–$3,033.81	48% below	50%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CAN CERVICAL SPINE W/O DYE	$1,596.74	$3,193.48	$2,363.49–$3,033.81	—	50%
MRI of the pelvis without and with contrast CPT 72197 MR SI JOINT WO/W CONTRAST	$2,118.66	$4,237.33	$1,055.61–$4,025.46	46% below	50%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/CONTRAST	$2,118.66	$4,237.33	$1,055.61–$4,025.46	46% below	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR SI JOINT WO/W CONTRAST	$2,118.66	$4,237.33	$3,136.05–$4,025.46	—	50%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/CONTRAST	$2,118.66	$4,237.33	$3,136.05–$4,025.46	—	50%
MRI of the pelvis, no contrast dye CPT 72195 MR SI JOINT W/O CONTRAST	$1,541.69	$3,083.39	$723.51–$2,929.22	25% below	50%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$1,541.69	$3,083.39	$723.51–$2,929.22	25% below	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$1,541.69	$3,083.39	$2,282.02–$2,929.22	—	50%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR SI JOINT W/O CONTRAST	$1,541.69	$3,083.39	$2,282.02–$2,929.22	—	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXTREM W/O DYE	$1,568.58	$3,137.16	$628.13–$2,980.30	47% below	50%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI JOINT UPR EXTREM W/O DYE	$1,568.58	$3,137.16	$2,321.81–$2,980.30	—	50%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYCARD SPECT MULTIPL STUDY	$2,038.02	$4,076.03	$1,553.16–$3,872.23	33% below	50%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYCARD SPECT MULTIPL STUDY	$2,038.02	$4,076.03	$3,016.67–$3,872.23	—	50%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED /FOLLOWUP	$319.12	$638.24	$113.94–$606.33	39% below	50%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED /FOLLOWUP	$319.12	$638.24	$472.36–$606.33	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE NONOB	$389.82	$779.64	$317.67–$740.66	40% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE	$390.00	$780.00	$345.46–$741.00	40% below	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE NONOB	$389.82	$779.64	$577.01–$740.66	—	50%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM PELVIC COMPLETE	$390.00	$780.00	$577.28–$741.00	—	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >= 14 WKS 1/1ST GESTAT	$415.17	$830.34	$367.76–$788.82	36% below	50%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 WKS SNGL FETUS	$415.50	$831.00	$368.05–$789.45	36% below	50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >= 14 WKS 1/1ST GESTAT	$415.17	$830.34	$614.53–$788.82	—	50%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >= 14 WKS SNGL FETUS	$415.50	$831.00	$615.02–$789.45	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB US < 14 WKS 1/1ST GESTAT	$446.43	$892.86	$307.56–$848.22	32% below	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS	$446.50	$893.00	$395.51–$848.35	32% below	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB US < 14 WKS 1/1ST GESTAT	$446.43	$892.86	$660.81–$848.22	—	50%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS	$446.50	$893.00	$660.91–$848.35	—	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB US LIMITED 1/> FETUSES	$281.38	$562.75	$219.43–$534.61	44% below	50%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB US LIMITED 1/> FETUSES	$281.38	$562.75	$416.49–$534.61	—	50%
Screening mammogram, both breasts both sides CPT 77067 MM MAMMO SCR INCL CAD BILAT	$261.60	$523.20	$231.73–$497.04	—	50%
Screening mammogram, both breasts one side CPT 77067 MM MAMMO SCR INCL CAD UNILAT	$261.60	$523.20	$123.07–$497.04	19% below	50%
Screening mammogram, both breasts inpatient both sides CPT 77067 MM MAMMO SCR INCL CAD BILAT	$261.60	$523.20	$387.22–$497.04	—	50%
Screening mammogram, both breasts inpatient one side CPT 77067 MM MAMMO SCR INCL CAD UNILAT	$261.60	$523.20	$387.22–$497.04	—	50%
Shoulder X-ray, complete, 2 or more views CPT 73030 XR SHOULDER COMPL MIN 2 VIEW	$257.46	$514.93	$112.49–$489.18	39% below	50%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR SHOULDER COMPL MIN 2 VIEW	$257.46	$514.93	$381.10–$489.18	—	50%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS TTE COMPLETE	$1,075.30	$2,150.60	$952.50–$2,043.07	60% below	50%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS TTE COMPLETE	$1,075.30	$2,150.60	$1,591.66–$2,043.07	—	50%
Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY XM SWLNG FUNCJ C+	$479.26	$958.52	$424.53–$910.59	32% below	50%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-RAY XM SWLNG FUNCJ C+	$479.26	$958.52	$709.40–$910.59	—	50%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON-OB	$450.30	$900.61	$376.73–$855.58	31% below	50%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$450.50	$901.00	$399.05–$855.95	31% below	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL NON-OB	$450.30	$900.61	$666.54–$855.58	—	50%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$450.50	$901.00	$666.83–$855.95	—	50%
Transvaginal ultrasound during pregnancy CPT 76817 US OB US TRANSVAGINAL	$328.30	$656.59	$248.33–$623.76	41% below	50%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB US TRANSVAGINAL	$328.30	$656.59	$485.94–$623.76	—	50%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMINAL COMPLETE	$449.79	$899.58	$340.59–$854.60	33% below	50%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMINAL COMPLETE	$449.79	$899.58	$665.78–$854.60	—	50%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENTS	$504.72	$1,009.44	$304.66–$958.97	25% below	50%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENTS	$504.72	$1,009.44	$747.09–$958.97	—	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD & NECK	$440.48	$880.97	$363.93–$836.92	35% below	50%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD & NECK	$440.48	$880.97	$652.01–$836.92	—	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$474.09	$948.18	$368.24–$900.77	56% below	50%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$474.09	$948.18	$701.75–$900.77	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$355.70	$711.39	$315.07–$675.82	31% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP-SCAN XTR VEINS UNILATERAL	$181.50	$363.00	$160.77–$344.85	65% below	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY	$355.70	$711.39	$526.50–$675.82	—	50%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUP-SCAN XTR VEINS UNILATERAL	$181.50	$363.00	$268.66–$344.85	—	50%
Wrist X-ray, complete, 3 or more views CPT 73110 XR WRIST COMPL MIN 3 VIEWS	$278.66	$557.33	$142.83–$529.46	32% below	50%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 XR WRIST COMPL MIN 3 VIEWS	$278.66	$557.33	$412.48–$529.46	—	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP UNILAT W PELVIS 2-3 VWS	$242.99	$485.98	$160.20–$461.68	57% below	50%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNILAT W PELVIS 2-3 VWS	$242.99	$485.98	$359.67–$461.68	—	50%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$216.10	$432.21	$93.71–$410.60	43% below	50%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$216.10	$432.21	$319.88–$410.60	—	50%
X-ray of the ankle, 2 views CPT 73600 XR ANKLE 2 VIEWS	$224.90	$449.79	$106.73–$427.30	46% below	50%
X-ray of the ankle, 2 views inpatient CPT 73600 XR ANKLE 2 VIEWS	$224.90	$449.79	$332.89–$427.30	—	50%
X-ray of the finger(s), 2 or more views CPT 73140 XR FINGER MIN 2 VIEWS	$229.55	$459.10	$137.07–$436.14	39% below	50%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 XR FINGER MIN 2 VIEWS	$229.55	$459.10	$339.78–$436.14	—	50%
X-ray of the foot, 2 views CPT 73620 XR FOOT 2 VIEWS	$234.72	$469.44	$92.26–$445.97	42% below	50%
X-ray of the foot, 2 views inpatient CPT 73620 XR FOOT 2 VIEWS	$234.72	$469.44	$347.43–$445.97	—	50%
X-ray of the foot, complete, 3 or more views CPT 73630 XR FOOT COMPL MIN 3 VIEWS	$256.95	$513.90	$113.94–$488.20	37% below	50%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 XR FOOT COMPL MIN 3 VIEWS	$256.95	$513.90	$380.34–$488.20	—	50%
X-ray of the hand, 3 or more views CPT 73130 XR HAND MIN 3 VIEWS	$264.70	$529.41	$125.51–$502.94	34% below	50%
X-ray of the hand, 3 or more views inpatient CPT 73130 XR HAND MIN 3 VIEWS	$264.70	$529.41	$391.82–$502.94	—	50%
X-ray of the knee, 1 or 2 views CPT 73560 XR KNEE 1/2 VIEWS	$248.68	$497.35	$113.94–$472.48	36% below	50%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 XR KNEE 1/2 VIEWS	$248.68	$497.35	$368.09–$472.48	—	50%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR LUMBOSACRAL 2/3 VIEWS	$298.69	$597.38	$126.96–$567.51	50% below	50%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR LUMBOSACRAL 2/3 VIEWS	$298.69	$597.38	$442.12–$567.51	—	50%
X-ray of the lower back, 4 or more views CPT 72110 XR LUMBOSACRAL MIN 4 VIEWS	$382.06	$764.13	$171.77–$725.92	49% below	50%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBOSACRAL MIN 4 VIEWS	$382.06	$764.13	$565.53–$725.92	—	50%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR THORACIC SPINE 2 VIEWS	$246.60	$493.19	$100.97–$468.53	52% below	50%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR THORACIC SPINE 2 VIEWS	$246.60	$493.19	$365.01–$468.53	—	50%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES COMP MIN 3 VIEW	$235.75	$471.50	$128.41–$447.93	46% below	50%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES COMP MIN 3 VIEW	$235.75	$471.50	$348.96–$447.93	—	50%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERVICAL 2 OR 3 VIEWS	$206.80	$413.60	$125.51–$392.92	50% below	50%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR SPINE CERVICAL 2 OR 3 VIEWS	$206.80	$413.60	$306.11–$392.92	—	50%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1/2 VIEWS	$205.64	$411.27	$85.05–$390.71	50% below	50%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1/2 VIEWS	$205.64	$411.27	$304.38–$390.71	—	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM & COCCYX MIN 2 VIEWS	$219.72	$439.45	$105.28–$417.48	52% below	50%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM & COCCYX MIN 2 VIEWS	$219.72	$439.45	$325.24–$417.48	—	50%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$33.44	$66.88	$5.30–$63.54	14% below	50%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT)	$33.44	$66.88	$49.50–$63.54	—	50%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT)	$30.38	$60.75	$5.18–$57.71	36% below	50%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT)	$30.38	$60.75	$44.96–$57.71	—	50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGY TESTING	$5.17	$10.34	$4.58–$25.72	89% below	50%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$33.50	$67.00	$5.22–$63.65	32% below	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGY TESTING	$5.17	$10.34	$7.65–$9.82	—	50%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLG SPEC IGE CRUDE XTRC EA	$33.50	$67.00	$49.59–$63.65	—	50%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$115.29	$230.58	$12.95–$219.05	7% above	50%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$115.29	$230.58	$170.65–$219.05	—	50%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES ANA	$50.02	$100.04	$12.09–$95.04	44% below	50%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES ANA	$50.02	$100.04	$74.04–$95.04	—	50%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE	$161.13	$322.26	$39.26–$306.15	10% below	50%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE	$161.13	$322.26	$238.50–$306.15	—	50%
Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA	$43.77	$87.55	$8.46–$83.17	52% below	50%
Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL TOTAL CA	$43.77	$87.55	$64.80–$83.17	—	50%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$131.38	$262.76	$68.92–$249.62	46% below	50%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST	$131.38	$262.76	$194.47–$249.62	—	50%
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA	$78.06	$156.13	$10.32–$148.32	56% below	50%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA	$78.06	$156.13	$115.55–$148.32	—	50%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$14.22	$28.44	$9.09–$43.51	22% below	50%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE	$14.22	$28.44	$21.05–$27.02	—	50%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$21.45	$42.91	$3.93–$40.76	42% below	50%
Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$21.45	$42.91	$31.76–$40.76	—	50%
Blood lead test CPT 83655 ASSAY OF LEAD	$64.26	$128.53	$12.11–$122.10	at median	50%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$64.26	$128.53	$95.13–$122.10	—	50%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO	$72.38	$144.76	$2.99–$137.52	20% below	50%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO	$72.38	$144.76	$107.14–$137.52	—	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$36.19	$72.38	$5.18–$68.76	41% below	50%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$36.19	$72.38	$53.57–$68.76	—	50%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE	$110.51	$221.02	$37.27–$209.97	47% below	50%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLIFIED PROBE	$110.51	$221.02	$163.58–$209.97	—	50%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$133.38	$266.77	$20.81–$253.43	39% below	50%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$133.38	$266.77	$197.44–$253.43	—	50%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125	$111.16	$222.31	$20.81–$211.19	23% below	50%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR CA 125	$111.16	$222.31	$164.53–$211.19	—	50%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$64.62	$129.25	$51.31–$252.83	14% below	50%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$64.62	$129.25	$95.66–$122.79	—	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE	$80.89	$161.78	$35.09–$172.91	31% below	50%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLMYD TRACH DNA AMP PROBE	$80.89	$161.78	$119.73–$153.69	—	50%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$56.87	$113.74	$13.39–$108.05	42% below	50%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$56.87	$113.74	$84.18–$108.05	—	50%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$42.40	$84.79	$7.77–$80.55	33% below	50%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$42.40	$84.79	$62.75–$80.55	—	50%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$57.91	$115.81	$10.56–$110.02	53% below	50%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$57.91	$115.81	$85.71–$110.02	—	50%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT	$76.00	$152.00	$10.18–$144.40	20% below	50%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT	$76.00	$152.00	$112.50–$144.40	—	50%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE	$141.68	$283.37	$22.23–$269.20	46% below	50%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE-SULFATE	$141.68	$283.37	$209.72–$269.20	—	50%
Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL	$87.38	$174.75	$27.94–$166.01	43% below	50%
Estradiol blood test inpatient CPT 82670 ASSAY OF TOTAL ESTRADIOL	$87.38	$174.75	$129.33–$166.01	—	50%
FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$70.75	$141.49	$18.58–$134.42	52% below	50%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$70.75	$141.49	$104.72–$134.42	—	50%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$184.74	$369.49	$19.63–$351.02	38% below	50%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$184.74	$369.49	$273.46–$351.02	—	50%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$61.22	$122.43	$13.63–$116.31	51% below	50%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN	$61.22	$122.43	$90.61–$116.31	—	50%
Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM	$71.34	$142.69	$14.70–$135.56	36% below	50%
Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM	$71.34	$142.69	$105.60–$135.56	—	50%
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3)	$121.36	$242.71	$16.94–$230.57	20% below	50%
Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3)	$121.36	$242.71	$179.63–$230.57	—	50%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$67.21	$134.42	$9.02–$127.70	34% below	50%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE	$67.21	$134.42	$99.48–$127.70	—	50%
Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE	$104.03	$208.07	$25.47–$197.67	13% above	50%
Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE	$104.03	$208.07	$153.99–$197.67	—	50%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$119.96	$239.92	$106.26–$243.12	57% below	50%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$119.96	$239.92	$177.56–$227.92	—	50%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE	$30.38	$60.75	$4.75–$57.71	44% below	50%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE	$30.38	$60.75	$44.96–$57.71	—	50%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$89.96	$179.92	$12.87–$170.92	37% below	50%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$89.96	$179.92	$133.16–$170.92	—	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB	$80.89	$161.78	$35.09–$172.91	34% below	50%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA AMP PROB	$80.89	$161.78	$119.73–$153.69	—	50%
H. pylori stool antigen test CPT 87338 IAAD IA HPYLORI STOOL	$107.53	$215.07	$14.38–$204.32	50% below	50%
H. pylori stool antigen test inpatient CPT 87338 IAAD IA HPYLORI STOOL	$107.53	$215.07	$159.17–$204.32	—	50%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$300.90	$601.79	$85.10–$571.70	19% below	50%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$300.90	$601.79	$445.38–$571.70	—	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA	$41.36	$82.72	$24.08–$118.65	55% below	50%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA	$41.36	$82.72	$61.22–$78.58	—	50%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH-RISK TYPES	$88.92	$177.85	$35.09–$172.91	45% below	50%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV HIGH-RISK TYPES	$88.92	$177.85	$131.63–$168.96	—	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$52.22	$104.43	$9.71–$99.21	9% below	50%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C	$52.22	$104.43	$77.29–$99.21	—	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURF ANTIBODY HBSA	$77.55	$155.10	$10.74–$147.34	19% below	50%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURF ANTIBODY HBSA	$77.55	$155.10	$114.79–$147.34	—	50%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$73.54	$147.08	$10.33–$139.73	2% below	50%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA	$73.54	$147.08	$108.85–$139.73	—	50%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$77.55	$155.10	$14.27–$147.34	7% below	50%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$77.55	$155.10	$114.79–$147.34	—	50%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$246.09	$492.18	$42.84–$467.57	46% below	50%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$246.09	$492.18	$364.26–$467.57	—	50%
Herpes blood test, HSV-1 antibody CPT 86695 ANTIBODY HERPES SMPLX TYPE 1	$75.48	$150.96	$13.19–$143.41	31% below	50%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 ANTIBODY HERPES SMPLX TYPE 1	$75.48	$150.96	$111.73–$143.41	—	50%
Herpes blood test, HSV-2 antibody CPT 86696 ANTIBODY HERPES SMPLX TYPE 2	$78.54	$157.09	$19.35–$149.24	34% below	50%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 ANTIBODY HERPES SMPLX TYPE 2	$78.54	$157.09	$116.26–$149.24	—	50%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENSIT	$44.59	$89.18	$12.95–$84.72	54% below	50%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENSIT	$44.59	$89.18	$66.00–$84.72	—	50%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE	$120.72	$241.44	$17.92–$229.37	41% below	50%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTEINE	$120.72	$241.44	$178.69–$229.37	—	50%
Insulin blood test CPT 83525 ASSAY OF INSULIN TOTAL	$69.28	$138.56	$11.43–$131.63	30% below	50%
Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN TOTAL	$69.28	$138.56	$102.55–$131.63	—	50%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$32.37	$64.74	$6.47–$61.50	52% below	50%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON	$32.37	$64.74	$47.91–$61.50	—	50%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY	$45.96	$91.92	$8.74–$87.32	44% below	50%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY	$45.96	$91.92	$68.03–$87.32	—	50%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$77.44	$154.89	$8.68–$147.15	36% below	50%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$77.44	$154.89	$114.63–$147.15	—	50%
LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH)	$87.94	$175.88	$18.52–$167.09	38% below	50%
LH (luteinizing hormone) test inpatient CPT 83002 ASSAY OF GONADOTROPIN (LH)	$87.94	$175.88	$130.17–$167.09	—	50%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$41.48	$82.97	$6.89–$78.82	15% below	50%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE	$41.48	$82.97	$61.41–$78.82	—	50%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$59.81	$119.63	$8.17–$113.65	41% below	50%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$59.81	$119.63	$88.54–$113.65	—	50%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$54.48	$108.95	$17.03–$103.50	44% below	50%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY	$54.48	$108.95	$80.63–$103.50	—	50%
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$49.38	$98.75	$6.70–$93.81	12% below	50%
Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM	$49.38	$98.75	$73.08–$93.81	—	50%
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA	$69.28	$138.56	$12.88–$131.63	13% below	50%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA	$69.28	$138.56	$102.55–$131.63	—	50%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES SCREEN	$41.23	$82.46	$5.18–$78.34	at median	50%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES SCREEN	$41.23	$82.46	$61.03–$78.34	—	50%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$272.98	$545.95	$47.81–$518.65	7% below	50%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$272.98	$545.95	$404.06–$518.65	—	50%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE	$103.92	$207.83	$18.39–$197.44	at median	50%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE	$103.92	$207.83	$153.81–$197.44	—	50%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL DIAGNOSTIC	$79.62	$159.24	$18.39–$151.28	41% below	50%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL DIAGNOSTIC	$79.62	$159.24	$117.85–$151.28	—	50%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$55.84	$111.67	$26.61–$131.12	42% below	50%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$55.84	$111.67	$82.65–$106.09	—	50%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER	$38.77	$77.55	$20.26–$99.83	53% below	50%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 CYTOPATH C/V THIN LAYER	$38.77	$77.55	$57.39–$73.67	—	50%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE	$145.56	$291.13	$41.28–$276.57	22% below	50%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE	$145.56	$291.13	$215.47–$276.57	—	50%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$44.98	$89.96	$6.01–$85.46	18% below	50%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$44.98	$89.96	$66.58–$85.46	—	50%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE	$148.39	$296.78	$20.86–$281.94	at median	50%
Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE	$148.39	$296.78	$219.65–$281.94	—	50%
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN	$73.87	$147.74	$19.38–$140.35	49% below	50%
Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN	$73.87	$147.74	$109.34–$140.35	—	50%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$26.73	$53.45	$4.29–$50.78	12% below	50%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$26.73	$53.45	$39.56–$50.78	—	50%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$25.73	$51.46	$12.60–$62.09	32% below	50%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST PRSMV DIR OPT OBS	$25.73	$51.46	$38.09–$48.89	—	50%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$31.15	$62.30	$16.53–$81.45	27% below	50%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC	$31.15	$62.30	$46.11–$59.19	—	50%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$46.53	$93.06	$5.67–$88.41	18% below	50%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANTITATIVE	$46.53	$93.06	$68.87–$88.41	—	50%
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA	$84.27	$168.54	$14.39–$160.11	14% below	50%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA	$84.27	$168.54	$124.74–$160.11	—	50%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED	$21.20	$42.39	$2.70–$40.27	50% below	50%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED	$21.20	$42.39	$31.37–$40.27	—	50%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANAL VOL/COUNT/MOT	$88.92	$177.85	$12.31–$168.96	24% below	50%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SEMEN ANAL VOL/COUNT/MOT	$88.92	$177.85	$131.63–$168.96	—	50%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$57.91	$115.81	$8.90–$110.02	45% below	50%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS	$57.91	$115.81	$85.71–$110.02	—	50%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL	$42.91	$85.82	$15.92–$81.53	56% below	50%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ASSAY TEST FOR BLOOD FECAL	$42.91	$85.82	$63.52–$81.53	—	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$40.48	$80.95	$4.27–$76.90	44% below	50%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL	$40.48	$80.95	$59.91–$76.90	—	50%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE	$149.56	$299.11	$61.98–$305.41	25% below	50%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUN MEASURE	$149.56	$299.11	$221.37–$284.15	—	50%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$110.00	$220.00	$25.81–$209.00	19% below	50%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$110.00	$220.00	$162.82–$209.00	—	50%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES EACH	$108.57	$217.14	$14.55–$206.28	at median	50%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES EACH	$108.57	$217.14	$160.71–$206.28	—	50%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$96.83	$193.66	$16.80–$183.98	46% below	50%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE	$96.83	$193.66	$143.33–$183.98	—	50%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$50.66	$101.33	$35.09–$172.91	3% above	50%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$50.66	$101.33	$74.99–$96.26	—	50%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$31.47	$62.94	$4.52–$59.79	42% below	50%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID	$31.47	$62.94	$46.58–$59.79	—	50%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$39.81	$79.62	$3.17–$75.64	24% below	50%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$39.81	$79.62	$58.93–$75.64	—	50%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE	$29.98	$59.97	$4.02–$56.97	82% above	50%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTO W/SCOPE	$29.98	$59.97	$44.38–$56.97	—	50%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$15.51	$31.02	$2.25–$29.47	57% below	50%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE	$15.51	$31.02	$22.96–$29.47	—	50%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$6.72	$13.44	$3.48–$17.15	26% below	50%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$6.72	$13.44	$9.95–$12.77	—	50%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$38.19	$76.37	$8.07–$72.55	47% below	50%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT	$38.19	$76.37	$56.52–$72.55	—	50%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$24.57	$49.14	$8.61–$46.68	38% below	50%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$24.57	$49.14	$36.37–$46.68	—	50%
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12	$56.35	$112.71	$15.08–$107.07	44% below	50%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12	$56.35	$112.71	$83.42–$107.07	—	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$110.12	$220.24	$29.60–$209.23	41% below	50%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$110.12	$220.24	$163.00–$209.23	—	50%
Zinc blood test CPT 84630 ASSAY OF ZINC	$72.29	$144.58	$11.39–$137.35	45% below	50%
Zinc blood test inpatient CPT 84630 ASSAY OF ZINC	$72.29	$144.58	$107.00–$137.35	—	50%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST	$112.40	$224.80	$15.05–$213.56	10% below	50%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN TEST	$112.40	$224.80	$166.37–$213.56	—	50%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRD ANT NTRBDY CERVICAL	$1,914.50	$3,829.00	$1,695.86–$3,637.55	26% below	50%
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 ARTHRD ANT NTRBDY CERVICAL	$1,914.50	$3,829.00	$2,833.84–$3,637.55	—	50%
Appendectomy, open surgery CPT 44950 APPENDECTOMY	$904.50	$1,809.00	$801.21–$1,718.55	5% below	50%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY	$904.50	$1,809.00	$1,338.84–$1,718.55	—	50%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY	$1,184.50	$2,369.00	$1,049.23–$2,250.55	47% below	50%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 KNEE ARTHROSCOPY/SURGERY	$1,184.50	$2,369.00	$1,753.30–$2,250.55	—	50%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR	$1,361.00	$2,722.00	$1,205.57–$2,585.90	24% below	50%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR	$1,361.00	$2,722.00	$2,014.55–$2,585.90	—	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST 1ST LESION STRTCTC	$3,279.33	$6,558.66	$2,904.83–$6,230.73	13% above	50%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST 1ST LESION STRTCTC	$3,279.33	$6,558.66	$4,854.06–$6,230.73	—	50%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE	$151.52	$303.04	$134.22–$287.89	74% below	50%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT OF ANKLE FRACTURE	$151.52	$303.04	$224.28–$287.89	—	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLTX METATARSAL FX W/O MANIP	$151.52	$303.04	$134.22–$287.89	53% below	50%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE	$152.00	$304.00	$134.64–$288.80	53% below	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLTX METATARSAL FX W/O MANIP	$151.52	$303.04	$224.28–$287.89	—	50%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREAT METATARSAL FRACTURE	$152.00	$304.00	$224.99–$288.80	—	50%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 CORRECTION HALLUX VALGUS	$879.00	$1,758.00	$778.62–$1,670.10	18% below	50%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 CORRECTION HALLUX VALGUS	$879.00	$1,758.00	$1,301.10–$1,670.10	—	50%
Bunion correction with removal of part of the big toe joint CPT 28292 CORRECTION HALLUX VALGUS	$838.50	$1,677.00	$742.74–$1,593.15	21% below	50%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 CORRECTION HALLUX VALGUS	$838.50	$1,677.00	$1,241.15–$1,593.15	—	50%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT	$831.34	$1,662.67	$736.40–$1,579.54	38% below	50%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTRIC EXT	$831.34	$1,662.67	$1,230.54–$1,579.54	—	50%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY	$1,699.50	$3,399.00	$1,505.42–$3,229.05	10% above	50%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SURGERY	$1,699.50	$3,399.00	$2,515.60–$3,229.05	—	50%
Cervical biopsy CPT 57500 BIOPSY OF CERVIX	$114.00	$228.00	$100.98–$216.60	48% below	50%
Cervical biopsy inpatient CPT 57500 BIOPSY OF CERVIX	$114.00	$228.00	$168.74–$216.60	—	50%
Cesarean delivery, including prenatal and postpartum care CPT 59510 OB ANTEP CESAREAN DLVR & POSTP	$2,576.00	$5,152.00	$2,281.82–$4,894.40	18% below	50%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 OB ANTEP CESAREAN DLVR & POSTP	$2,576.00	$5,152.00	$3,813.00–$4,894.40	—	50%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUM 28 DAYS OR OLDER	$261.50	$523.00	$231.64–$496.85	22% below	50%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUM 28 DAYS OR OLDER	$261.50	$523.00	$387.07–$496.85	—	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION NEONATE	$195.00	$390.00	$172.73–$370.50	92% below	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$3,696.50	$7,393.00	$3,274.36–$7,023.35	51% above	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION NEONATE	$195.00	$390.00	$288.64–$370.50	—	50%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION W/REGIONL BLOCK	$3,696.50	$7,393.00	$5,471.56–$7,023.35	—	50%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 TREAT FRACTURE RADIUS/ULNA	$183.02	$366.04	$162.12–$347.74	58% below	50%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 TREAT FRACTURE RADIUS/ULNA	$183.02	$366.04	$270.91–$347.74	—	50%
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL	$607.00	$1,214.00	$537.68–$1,153.30	47% below	50%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W/LESION REMOVAL	$607.00	$1,214.00	$898.48–$1,153.30	—	50%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$479.00	$958.00	$424.30–$910.10	59% below	50%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$479.00	$958.00	$709.02–$910.10	—	50%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$354.50	$709.00	$314.02–$673.55	65% below	50%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$354.50	$709.00	$524.73–$673.55	—	50%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP	$1,034.00	$2,068.00	$915.92–$1,964.60	124% above	50%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 BX OF CERVIX W/SCOPE LEEP	$1,034.00	$2,068.00	$1,530.53–$1,964.60	—	50%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$106.00	$212.00	$93.89–$201.40	57% below	50%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 BX/CURETT OF CERVIX W/SCOPE	$106.00	$212.00	$156.90–$201.40	—	50%
Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT	$1,785.00	$3,570.00	$1,581.15–$3,391.50	39% above	50%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTOSCOPY AND TREATMENT	$1,785.00	$3,570.00	$2,642.16–$3,391.50	—	50%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$370.00	$740.00	$327.75–$703.00	at median	50%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY	$370.00	$740.00	$547.67–$703.00	—	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$45.50	$91.00	$40.30–$86.45	46% below	50%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$45.50	$91.00	$67.35–$86.45	—	50%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING	$402.50	$805.00	$356.53–$764.75	15% above	50%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 CREATE EARDRUM OPENING	$402.50	$805.00	$595.78–$764.75	—	50%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$58.62	$117.23	$51.92–$111.37	1% below	50%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$58.62	$117.23	$86.76–$111.37	—	50%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$51.19	$102.37	$45.34–$97.25	64% below	50%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI	$51.19	$102.37	$75.76–$97.25	—	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$79.50	$159.00	$70.42–$151.05	58% below	50%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 BIOPSY OF UTERUS LINING	$79.50	$159.00	$117.68–$151.05	—	50%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC	$803.50	$1,607.00	$711.74–$1,526.65	11% below	50%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN 1ST < 3 CM RDC	$803.50	$1,607.00	$1,189.34–$1,526.65	—	50%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$756.37	$1,512.74	$669.99–$1,437.10	40% below	50%
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY	$756.37	$1,512.74	$1,119.58–$1,437.10	—	50%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$750.00	$1,500.00	$664.35–$1,425.00	33% below	50%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY	$750.00	$1,500.00	$1,110.15–$1,425.00	—	50%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$1,069.00	$2,138.00	$946.92–$2,031.10	9% below	50%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH	$1,069.00	$2,138.00	$1,582.33–$2,031.10	—	50%
Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY	$1,377.00	$2,754.00	$1,219.75–$2,616.30	5% below	50%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY	$1,377.00	$2,754.00	$2,038.24–$2,616.30	—	50%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE	$1,063.00	$2,126.00	$941.61–$2,019.70	13% above	50%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE	$1,063.00	$2,126.00	$1,573.45–$2,019.70	—	50%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S)	$300.50	$601.00	$266.18–$570.95	67% below	50%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID(S)	$300.50	$601.00	$444.80–$570.95	—	50%
Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP	$542.50	$1,085.00	$480.55–$1,030.75	24% below	50%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 REMOVE INT/EXT HEM 1 GROUP	$542.50	$1,085.00	$803.01–$1,030.75	—	50%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY	$3,361.50	$6,723.00	$2,977.62–$6,386.85	10% above	50%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 TOTAL HIP ARTHROPLASTY	$3,361.50	$6,723.00	$4,975.69–$6,386.85	—	50%
Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY	$1,271.50	$2,543.00	$1,126.29–$2,415.85	20% below	50%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL HYSTERECTOMY	$1,271.50	$2,543.00	$1,882.07–$2,415.85	—	50%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY ABLATION	$1,578.50	$3,157.00	$1,398.24–$2,999.15	50% below	50%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSCOPY ABLATION	$1,578.50	$3,157.00	$2,336.50–$2,999.15	—	50%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BIOPSY	$2,663.00	$5,326.00	$2,358.89–$5,059.70	15% above	50%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY BIOPSY	$2,663.00	$5,326.00	$3,941.77–$5,059.70	—	50%
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE	$76.00	$152.00	$67.32–$144.40	86% below	50%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE	$76.00	$152.00	$112.50–$144.40	—	50%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$132.01	$264.03	$116.94–$250.83	71% below	50%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$132.01	$264.03	$195.41–$250.83	—	50%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR	$649.50	$1,299.00	$575.33–$1,234.05	17% below	50%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PRP I/HERN INIT REDUC >5 YR	$649.50	$1,299.00	$961.39–$1,234.05	—	50%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$68.25	$136.49	$60.45–$129.67	77% below	50%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$68.25	$136.49	$101.02–$129.67	—	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$49.63	$99.26	$43.96–$94.30	91% below	50%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$49.63	$99.26	$73.46–$94.30	—	50%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSJ NON-BIOD DRUG IMPLANT DEV	$79.50	$159.00	$70.42–$151.05	58% below	50%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSJ NON-BIOD DRUG IMPLANT DEV	$79.50	$159.00	$117.68–$151.05	—	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$163.89	$327.78	$145.17–$311.39	at median	50%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$163.89	$327.78	$242.59–$311.39	—	50%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$50.66	$101.33	$44.88–$96.26	86% below	50%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$50.66	$101.33	$74.99–$96.26	—	50%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY	$1,531.00	$3,062.00	$1,356.16–$2,908.90	1% below	50%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 KNEE ARTHROSCOPY/SURGERY	$1,531.00	$3,062.00	$2,266.19–$2,908.90	—	50%
Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY	$679.50	$1,359.00	$601.90–$1,291.05	47% below	50%
Knee arthroscopy with meniscus trim inpatient CPT 29881 KNEE ARTHROSCOPY/SURGERY	$679.50	$1,359.00	$1,005.80–$1,291.05	—	50%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY	$706.00	$1,412.00	$625.37–$1,341.40	49% below	50%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 KNEE ARTHROSCOPY/SURGERY	$706.00	$1,412.00	$1,045.02–$1,341.40	—	50%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY	$1,256.00	$2,512.00	$1,112.56–$2,386.40	1% below	50%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 KNEE ARTHROSCOPY/SURGERY	$1,256.00	$2,512.00	$1,859.13–$2,386.40	—	50%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPIC APPENDECTOMY	$900.00	$1,800.00	$797.22–$1,710.00	at median	50%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPIC APPENDECTOMY	$900.00	$1,800.00	$1,332.18–$1,710.00	—	50%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 TLH UTERUS 250 G OR LESS	$1,218.50	$2,437.00	$1,079.35–$2,315.15	—	50%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 TLH UTERUS 250 G OR LESS	$1,218.50	$2,437.00	$1,803.62–$2,315.15	—	50%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 TLH W/T/O 250 G OR LESS	$1,371.50	$2,743.00	$1,214.87–$2,605.85	11% below	50%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 TLH W/T/O 250 G OR LESS	$1,371.50	$2,743.00	$2,030.09–$2,605.85	—	50%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT	$980.50	$1,961.00	$868.53–$1,862.95	18% above	50%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP ING HERNIA REPAIR INIT	$980.50	$1,961.00	$1,451.34–$1,862.95	—	50%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR	$891.00	$1,782.00	$789.25–$1,692.90	1% above	50%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAP ING HERNIA REPAIR RECUR	$891.00	$1,782.00	$1,318.86–$1,692.90	—	50%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$869.50	$1,739.00	$770.20–$1,652.05	20% below	50%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY REMOVE ADNEXA	$869.50	$1,739.00	$1,287.03–$1,652.05	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 RPR INTMD S/A/T/E 2.5 CM/<	$173.71	$347.42	$153.87–$330.05	40% below	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$174.00	$348.00	$154.13–$330.60	40% below	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 RPR INTMD S/A/T/E 2.5 CM/<	$173.71	$347.42	$257.13–$330.05	—	50%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/<	$174.00	$348.00	$257.55–$330.60	—	50%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY PARTIAL	$3,400.50	$6,801.00	$3,012.16–$6,460.95	at median	50%
Lumpectomy (partial mastectomy) inpatient CPT 19301 MASTECTOMY PARTIAL	$3,400.50	$6,801.00	$5,033.42–$6,460.95	—	50%
Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE	$1,711.50	$3,423.00	$1,516.05–$3,251.85	9% above	50%
Mastectomy (total removal of the breast) inpatient CPT 19303 MAST SIMPLE COMPLETE	$1,711.50	$3,423.00	$2,533.36–$3,251.85	—	50%
Miscarriage treatment with D&C, first trimester CPT 59820 CARE OF MISCARRIAGE	$429.00	$858.00	$380.01–$815.10	81% below	50%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 CARE OF MISCARRIAGE	$429.00	$858.00	$635.01–$815.10	—	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$87.50	$175.00	$77.51–$166.25	59% below	50%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT B9+MARG 0.5 CM<	$87.50	$175.00	$129.52–$166.25	—	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$257.50	$515.00	$228.09–$489.25	17% below	50%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/<	$257.50	$515.00	$381.15–$489.25	—	50%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$76.62	$153.24	$67.87–$145.58	77% below	50%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$76.62	$153.24	$113.41–$145.58	—	50%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$58.68	$117.36	$51.98–$111.49	82% below	50%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA&/STRD GR OCPL NRV	$58.68	$117.36	$86.86–$111.49	—	50%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$920.26	$1,840.52	$815.17–$1,748.49	at median	50%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$920.26	$1,840.52	$1,362.17–$1,748.49	—	50%
Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT	$2,058.00	$4,116.00	$1,822.98–$3,910.20	4% below	50%
Partial knee replacement (one compartment) inpatient CPT 27446 REVISION OF KNEE JOINT	$2,058.00	$4,116.00	$3,046.25–$3,910.20	—	50%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$148.64	$297.28	$131.67–$282.42	81% below	50%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$148.64	$297.28	$220.02–$282.42	—	50%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$220.00	$440.00	$194.88–$418.00	41% below	50%
Prostate biopsy CPT 55700 US biopsy prostate	$548.07	$1,096.14	$485.48–$1,041.33	47% above	50%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$220.00	$440.00	$325.64–$418.00	—	50%
Prostate biopsy inpatient CPT 55700 US biopsy prostate	$548.07	$1,096.14	$811.25–$1,041.33	—	50%
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$2,820.50	$5,641.00	$2,498.40–$5,358.95	at median	50%
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVAL OF BREAST LESION	$2,820.50	$5,641.00	$4,174.90–$5,358.95	—	50%
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FOREIGN BODY	$147.34	$294.69	$130.52–$279.96	60% below	50%
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FOREIGN BODY	$147.34	$294.69	$218.10–$279.96	—	50%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REMOVAL OF THYROID	$1,225.00	$2,450.00	$1,085.11–$2,327.50	at median	50%
Removal of one lobe of the thyroid (lobectomy) inpatient CPT 60220 PARTIAL REMOVAL OF THYROID	$1,225.00	$2,450.00	$1,813.24–$2,327.50	—	50%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$497.00	$994.00	$440.24–$944.30	13% below	50%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$497.00	$994.00	$735.66–$944.30	—	50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$536.00	$1,072.00	$474.79–$1,018.40	10% below	50%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$536.00	$1,072.00	$793.39–$1,018.40	—	50%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 FRAGMENTING OF KIDNEY STONE	$1,304.00	$2,608.00	$1,155.08–$2,477.60	17% below	50%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 FRAGMENTING OF KIDNEY STONE	$1,304.00	$2,608.00	$1,930.18–$2,477.60	—	50%
Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST	$57.38	$114.77	$50.83–$109.03	86% below	50%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION OF FOREARM CAST	$57.38	$114.77	$84.94–$109.03	—	50%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$114.78	$229.55	$101.67–$218.07	19% below	50%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$114.78	$229.55	$169.89–$218.07	—	50%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$177.34	$354.69	$157.09–$336.96	35% below	50%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST	$177.34	$354.69	$262.51–$336.96	—	50%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$120.22	$240.43	$106.49–$228.41	53% below	50%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION LOWER LEG SPLINT	$120.22	$240.43	$177.94–$228.41	—	50%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHO ARTHRS SRG DSTL CLAVICLC	$828.00	$1,656.00	$733.44–$1,573.20	22% below	50%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 SHO ARTHRS SRG DSTL CLAVICLC	$828.00	$1,656.00	$1,225.61–$1,573.20	—	50%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESSION	$832.50	$1,665.00	$737.43–$1,581.75	42% below	50%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SHO ARTHRS SRG DECOMPRESSION	$832.50	$1,665.00	$1,232.27–$1,581.75	—	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$145.22	$290.44	$128.64–$275.92	33% below	50%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/<	$145.22	$290.44	$214.95–$275.92	—	50%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$136.50	$273.00	$120.91–$259.35	61% below	50%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$136.50	$273.00	$202.05–$259.35	—	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$427.50	$855.00	$378.68–$812.25	23% above	50%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/<	$427.50	$855.00	$632.79–$812.25	—	50%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS <W/15	$52.06	$104.12	$46.11–$98.91	85% below	50%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS <W/15	$52.06	$104.12	$77.06–$98.91	—	50%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR	$190.78	$381.55	$168.99–$362.47	61% below	50%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DX LMBR SPI PNXR	$190.78	$381.55	$282.39–$362.47	—	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$209.54	$419.09	$185.61–$398.14	12% below	50%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM	$209.54	$419.09	$310.17–$398.14	—	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5CM/<	$208.35	$416.70	$184.56–$395.87	19% below	50%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR F/E/E/N/L/M 2.5CM/<	$208.35	$416.70	$308.40–$395.87	—	50%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP)	$1,187.50	$2,375.00	$1,051.89–$2,256.25	4% below	50%
TURP (transurethral resection of the prostate) inpatient CPT 52601 PROSTATECTOMY (TURP)	$1,187.50	$2,375.00	$1,757.74–$2,256.25	—	50%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$92.50	$185.00	$81.94–$175.75	42% below	50%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$92.50	$185.00	$136.92–$175.75	—	50%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$265.00	$530.00	$234.74–$503.50	79% below	50%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS PLEURA W/IMAGING	$681.68	$1,363.35	$603.83–$1,295.18	45% below	50%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$265.00	$530.00	$392.25–$503.50	—	50%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS PLEURA W/IMAGING	$681.68	$1,363.35	$1,009.02–$1,295.18	—	50%
Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY	$1,704.50	$3,409.00	$1,509.85–$3,238.55	38% below	50%
Total hip replacement inpatient CPT 27130 TOTAL HIP ARTHROPLASTY	$1,704.50	$3,409.00	$2,523.00–$3,238.55	—	50%
Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY	$1,807.50	$3,615.00	$1,601.08–$3,434.25	40% below	50%
Total knee replacement inpatient CPT 27447 TOTAL KNEE ARTHROPLASTY	$1,807.50	$3,615.00	$2,675.46–$3,434.25	—	50%
Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT	$2,647.00	$5,294.00	$2,344.71–$5,029.30	at median	50%
Total shoulder replacement inpatient CPT 23472 RECONSTRUCT SHOULDER JOINT	$2,647.00	$5,294.00	$3,918.09–$5,029.30	—	50%
Total thyroid removal (thyroidectomy) CPT 60240 REMOVAL OF THYROID	$509.50	$1,019.00	$451.32–$968.05	56% below	50%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 REMOVAL OF THYROID	$509.50	$1,019.00	$754.16–$968.05	—	50%
Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH	$766.50	$1,533.00	$678.97–$1,456.35	24% below	50%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION	$930.50	$1,861.00	$824.24–$1,767.95	8% below	50%
Trigger finger release surgery inpatient CPT 26055 INCISE FINGER TENDON SHEATH	$766.50	$1,533.00	$1,134.57–$1,456.35	—	50%
Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION	$930.50	$1,861.00	$1,377.33–$1,767.95	—	50%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$39.42	$78.84	$34.92–$74.90	91% below	50%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$39.42	$78.84	$58.35–$74.90	—	50%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CAUTERY	$672.50	$1,345.00	$595.70–$1,277.75	8% above	50%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPAROSCOPY TUBAL CAUTERY	$672.50	$1,345.00	$995.43–$1,277.75	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION US IMAG	$855.50	$1,711.00	$757.80–$1,625.45	40% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US biopsy	$1,188.05	$2,376.10	$1,052.37–$2,257.30	17% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US guided breast biopsy RT	$1,188.05	$2,376.10	$1,052.37–$2,257.30	17% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US guided breast biopsy LT	$1,188.05	$2,376.10	$1,052.37–$2,257.30	17% below	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG	$855.50	$1,711.00	$1,266.31–$1,625.45	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US biopsy	$1,188.05	$2,376.10	$1,758.55–$2,257.30	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US guided breast biopsy LT	$1,188.05	$2,376.10	$1,758.55–$2,257.30	—	50%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US guided breast biopsy RT	$1,188.05	$2,376.10	$1,758.55–$2,257.30	—	50%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM	$856.50	$1,713.00	$758.69–$1,627.35	44% below	50%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH EGD DILATION <30 MM	$856.50	$1,713.00	$1,267.79–$1,627.35	—	50%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD TRANSORAL BX SLG/MULT	$452.00	$904.00	$400.38–$858.80	71% below	50%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD TRANSORAL BX SLG/MULT	$452.00	$904.00	$669.05–$858.80	—	50%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE	$463.50	$927.00	$410.57–$880.65	72% below	50%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVE LESION SNARE	$463.50	$927.00	$686.07–$880.65	—	50%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$293.00	$586.00	$259.54–$556.70	88% below	50%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$293.00	$586.00	$433.70–$556.70	—	50%
Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$842.00	$1,684.00	$745.84–$1,599.80	11% above	50%
Ureteroscopy with laser stone breaking (lithotripsy) inpatient CPT 52353 CYSTOURETERO W/LITHOTRIPSY	$842.00	$1,684.00	$1,246.33–$1,599.80	—	50%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$541.50	$1,083.00	$479.66–$1,028.85	10% below	50%
Ureteroscopy with laser stone breaking and stent placement inpatient CPT 52356 CYSTO/URETERO W/LITHOTRIPSY	$541.50	$1,083.00	$801.53–$1,028.85	—	50%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 VBAC DELIVERY	$2,498.50	$4,997.00	$2,213.17–$4,747.15	14% below	50%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 VBAC DELIVERY	$2,498.50	$4,997.00	$3,698.28–$4,747.15	—	50%
Vaginal delivery, including prenatal and postpartum care CPT 59400 OBSTETRICAL CARE	$2,576.50	$5,153.00	$2,282.26–$4,895.35	7% below	50%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE	$2,576.50	$5,153.00	$3,813.74–$4,895.35	—	50%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S)	$714.50	$1,429.00	$632.90–$1,357.55	at median	50%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 REMOVAL OF SPERM DUCT(S)	$714.50	$1,429.00	$1,057.60–$1,357.55	—	50%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESIONS UP TO 14	$45.50	$91.00	$40.30–$86.45	56% below	50%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$59.00	$118.00	$52.26–$112.10	43% below	50%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESIONS UP TO 14	$45.50	$91.00	$67.35–$86.45	—	50%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$59.00	$118.00	$87.33–$112.10	—	50%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$92.54	$185.09	$81.98–$175.84	75% below	50%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEB SUBQ TISSUE 20 SQ CM/<	$92.54	$185.09	$136.99–$175.84	—	50%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$1,009.00	$2,018.00	$893.77–$1,917.10	8% below	50%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 TREAT FX RAD EXTRA-ARTICUL	$1,009.00	$2,018.00	$1,493.52–$1,917.10	—	50%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION SERVICE	$592.61	$1,185.22	$524.93–$1,125.96	3% below	50%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION SERVICE	$592.61	$1,185.22	$877.18–$1,125.96	—	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AIRWAY INHALATION TREATMENT	$98.23	$196.46	$87.01–$186.64	51% below	50%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT	$98.23	$196.46	$145.40–$186.64	—	50%
Chemotherapy IV infusion, first hour CPT 96413 IV CHEMO ADMN =<1HR INIT SBST	$369.14	$738.28	$326.98–$701.37	56% below	50%
Chemotherapy IV infusion, first hour inpatient CPT 96413 IV CHEMO ADMN =<1HR INIT SBST	$369.14	$738.28	$546.40–$701.37	—	50%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30-74 MIN	$536.50	$1,073.00	$475.23–$1,019.35	64% below	50%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR	$856.67	$1,713.34	$758.84–$1,627.67	42% below	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 30-74 MIN	$536.50	$1,073.00	$794.13–$1,019.35	—	50%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST HOUR	$856.67	$1,713.34	$1,268.04–$1,627.67	—	50%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY	$280.21	$560.43	$248.21–$532.41	13% below	50%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG AWAKE AND DROWSY	$280.21	$560.43	$414.77–$532.41	—	50%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM COMPLETE	$113.47	$226.93	$100.51–$215.58	3% below	50%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM COMPLETE	$113.47	$226.93	$167.95–$215.58	—	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG ROUTINE 12LDS/> TRCG ONLY	$100.30	$200.60	$88.85–$190.57	13% below	50%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG ROUTINE 12LDS/> TRCG ONLY	$100.30	$200.60	$148.46–$190.57	—	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP	$141.13	$282.26	$125.01–$268.15	10% below	50%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMR DPT VST MAYX REQ PHY/QHP	$141.13	$282.26	$208.90–$268.15	—	50%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM	$163.37	$326.74	$144.71–$310.40	39% below	50%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT SF MDM	$163.37	$326.74	$241.82–$310.40	—	50%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$313.30	$626.60	$277.52–$595.27	4% below	50%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LOW MDM	$313.30	$626.60	$463.75–$595.27	—	50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$212.50	$425.00	$188.23–$403.75	71% below	50%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT LOW MDM	$487.79	$975.58	$432.08–$926.80	34% below	50%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT MOD MDM	$212.50	$425.00	$314.54–$403.75	—	50%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT LOW MDM	$487.79	$975.58	$722.03–$926.80	—	50%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM	$646.12	$1,292.24	$572.33–$1,227.63	39% below	50%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT HI MDM	$646.12	$1,292.24	$956.39–$1,227.63	—	50%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST	$667.94	$1,335.88	$591.66–$1,269.09	3% below	50%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIOVASCULAR STRESS TEST	$667.94	$1,335.88	$988.68–$1,269.09	—	50%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INF HYDRATION INIT 31-60MIN	$171.23	$342.46	$151.68–$325.34	30% below	50%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INF HYDRATION INIT 31-60MIN	$171.23	$342.46	$253.45–$325.34	—	50%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$324.68	$649.35	$287.60–$616.88	4% above	50%
IV infusion of a medicine, first hour CPT 96365 IV INF THERAPY/PROPH DX =<1 HR	$324.68	$649.35	$287.60–$616.88	4% above	50%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF THERAPY/PROPH DX =<1 HR	$324.68	$649.35	$480.58–$616.88	—	50%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$324.68	$649.35	$480.58–$616.88	—	50%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SUBQ/IM	$56.87	$113.74	$50.38–$108.05	15% below	50%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SUBQ/IM	$56.87	$113.74	$84.18–$108.05	—	50%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$245.57	$491.15	$217.53–$466.59	26% below	50%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$245.57	$491.15	$363.50–$466.59	—	50%
New patient office visit, about 30 minutes CPT 99203 OFFICE/OP NEW LOW MDM 30-44 M	$72.50	$145.00	$64.22–$137.75	55% below	50%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OP NEW LOW MDM 30-44 M	$72.50	$145.00	$107.31–$137.75	—	50%
New patient office visit, about 45 minutes CPT 99204 OFFICE/OP NEW MOD MDM 45-59 M	$104.50	$209.00	$92.57–$198.55	57% below	50%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OP NEW MOD MDM 45-59 M	$104.50	$209.00	$154.68–$198.55	—	50%
New patient office visit, about 60 minutes CPT 99205 OFFICE/OP NEW HIGH MDM 60-74 M	$111.00	$222.00	$98.32–$210.90	64% below	50%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OP NEW HIGH MDM 60-74 M	$111.00	$222.00	$164.30–$210.90	—	50%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE/OP NEW SF MDM 15-29 MIN	$53.50	$107.00	$47.39–$101.65	58% below	50%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE/OP NEW SF MDM 15-29 MIN	$53.50	$107.00	$79.19–$101.65	—	50%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN	$38.26	$76.52	$16.00–$72.69	42% below	50%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION INDIV IN	$38.26	$76.52	$56.63–$72.69	—	50%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES	$16.50	$33.00	$14.62–$31.35	85% below	50%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES	$16.50	$33.00	$24.42–$31.35	—	50%
Preventive checkup, new patient aged 18–39 CPT 99385 INIT PREVT MED NEW PT 18-39 YR	$45.00	$90.00	$39.86–$85.50	68% below	50%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT PREVT MED NEW PT 18-39 YR	$45.00	$90.00	$66.61–$85.50	—	50%
Preventive checkup, new patient aged 40–64 CPT 99386 PREV VISIT NEW AGE 40-64	$86.50	$173.00	$76.62–$164.35	54% below	50%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV VISIT NEW AGE 40-64	$86.50	$173.00	$128.04–$164.35	—	50%
Preventive checkup, new patient aged 65 or older CPT 99387 INIT PREVT MED NEW PT 65YR>	$86.50	$173.00	$76.62–$164.35	54% below	50%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 INIT PREVT MED NEW PT 65YR>	$86.50	$173.00	$128.04–$164.35	—	50%
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV VISIT EST AGE 18-39	$78.50	$157.00	$69.54–$149.15	35% below	50%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV VISIT EST AGE 18-39	$78.50	$157.00	$116.20–$149.15	—	50%
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV VISIT EST AGE 40-64	$78.50	$157.00	$69.54–$149.15	38% below	50%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV VISIT EST AGE 40-64	$78.50	$157.00	$116.20–$149.15	—	50%
Preventive checkup, returning patient aged 65 or older CPT 99397 PER PM REEVAL EST PAT 65+ YR	$78.50	$157.00	$69.54–$149.15	45% below	50%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PER PM REEVAL EST PAT 65+ YR	$78.50	$157.00	$116.20–$149.15	—	50%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 PREVENTIV COUNSL INDIV SPX 45M	$19.00	$38.00	$16.83–$36.10	16% below	50%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 PREVENTIV COUNSL INDIV SPX 45M	$19.00	$38.00	$28.12–$36.10	—	50%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE/OP EST HIGH MDM 40-54 M	$79.00	$158.00	$69.98–$150.10	70% below	50%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE/OP EST HIGH MDM 40-54 M	$79.00	$158.00	$116.94–$150.10	—	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CA SCREEN;PELVIC/BREAST EXAM	$39.50	$79.00	$34.99–$75.05	71% below	50%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OP EST LOW MDM 20-29 M	$43.00	$86.00	$38.09–$81.70	69% below	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CA SCREEN;PELVIC/BREAST EXAM	$39.50	$79.00	$58.47–$75.05	—	50%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OP EST LOW MDM 20-29 M	$43.00	$86.00	$63.65–$81.70	—	50%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE/OP EST MOD MDM 30-39 M	$57.00	$114.00	$50.49–$108.30	68% below	50%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE/OP EST MOD MDM 30-39 M	$57.00	$114.00	$84.37–$108.30	—	50%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE /OP EST SF MDM 10-19 M	$34.50	$69.00	$30.56–$65.55	73% below	50%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE /OP EST SF MDM 10-19 M	$34.50	$69.00	$51.07–$65.55	—	50%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSLT NEW/EST PT 30 M	$89.50	$179.00	$79.28–$170.05	41% below	50%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE CONSLT NEW/EST PT 30 M	$89.50	$179.00	$132.48–$170.05	—	50%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40	$173.00	$346.00	$153.24–$328.70	22% below	50%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFF/OP CNSLTJ NEW/EST MOD 40	$173.00	$346.00	$256.07–$328.70	—	50%
Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST	$179.10	$358.21	$158.65–$340.30	43% below	50%
Spirometry (breathing test) inpatient CPT 94010 BREATHING CAPACITY TEST	$179.10	$358.21	$265.11–$340.30	—	50%
Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING	$315.88	$631.77	$279.81–$600.18	52% below	50%
Spirometry before and after a bronchodilator inpatient CPT 94060 EVALUATION OF WHEEZING	$315.88	$631.77	$467.57–$600.18	—	50%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTC SEP PROC	$138.36	$276.72	$122.56–$262.88	28% below	50%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTC SEP PROC	$138.36	$276.72	$204.80–$262.88	—	50%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCV2 VAC 30MCG 12 yrs old >	$67.87	$135.74	$60.12–$428.73	35% below	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCV2 VAC 30MCG 12 yrs old >	$67.87	$135.74	$60.12–$428.73	35% below	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCV2 VAC 30MCG TRS-SUC SYR	$67.87	$135.74	$60.12–$428.73	35% below	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCV2 VAC 30MCG TRS > 65 YO	$206.01	$412.03	$182.49–$428.73	96% above	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCV2 VAC 30MCG 12 yrs old >	$67.87	$135.74	$100.46–$128.95	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCV2 VAC 30MCG 12 yrs old >	$67.87	$135.74	$100.46–$128.95	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCV2 VAC 30MCG TRS-SUC SYR	$67.87	$135.74	$100.46–$128.95	—	50%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCV2 VAC 30MCG TRS > 65 YO	$206.01	$412.03	$304.94–$391.43	—	50%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VAC TRIV NO PRSRV 0.5ML IM	$6.98	$13.96	$6.18–$61.46	81% below	50%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VAC TRIV NO PRSRV 0.5ML IM	$6.98	$13.96	$10.33–$13.26	—	50%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEP A/HEP B VACC ADULT IM	$212.52	$425.04	$188.25–$403.79	18% above	50%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEP A/HEP B VACC ADULT IM	$212.52	$425.04	$314.57–$403.79	—	50%
Hepatitis A vaccine, adult dose CPT 90632 HEP A VAC ADULT IM	$168.78	$337.55	$149.50–$320.67	30% above	50%
Hepatitis A vaccine, adult dose CPT 90632 HEP A VAC ADULT IM	$168.78	$337.55	$149.50–$320.67	30% above	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A VAC ADULT IM	$168.78	$337.55	$249.82–$320.67	—	50%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A VAC ADULT IM	$168.78	$337.55	$249.82–$320.67	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VAC NO PRSV INCREASE AG IM	$146.06	$292.11	$98.16–$277.50	61% above	50%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VAC NO PRSV INCREASE AG IM	$146.06	$292.11	$98.16–$277.50	61% above	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VAC NO PRSV INCREASE AG IM	$146.06	$292.11	$216.19–$277.50	—	50%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VAC NO PRSV INCREASE AG IM	$146.06	$292.11	$216.19–$277.50	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM	$440.43	$880.86	$390.13–$860.48	7% below	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM	$440.43	$880.86	$390.13–$860.48	7% below	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM	$440.43	$880.86	$651.92–$836.82	—	50%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE IM	$440.43	$880.86	$651.92–$836.82	—	50%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$917.44	$1,834.88	$812.67–$1,743.14	43% above	50%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$917.44	$1,834.88	$1,357.99–$1,743.14	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS/PF	$43.08	$86.16	$38.16–$93.39	8% below	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS/PF	$43.08	$86.16	$38.16–$93.39	8% below	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS/PF	$43.08	$86.16	$63.77–$81.85	—	50%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS/PF	$43.08	$86.16	$63.77–$81.85	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPTHERIA/PERTUSIS	$127.17	$254.33	$107.44–$241.61	70% above	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPTHERIA/PERTUSIS	$158.05	$316.10	$107.44–$300.30	112% above	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPTHERIA/PERTUSIS	$127.17	$254.33	$188.23–$241.61	—	50%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPTHERIA/PERTUSIS	$158.05	$316.10	$233.95–$300.30	—	50%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM PRQ ID SUBQ/IM NJXS 1 VAC	$10.50	$21.00	$9.30–$19.95	79% below	50%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM PRQ ID SUBQ/IM NJXS 1 VAC	$10.50	$21.00	$15.54–$19.95	—	50%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADM PRQ ID SUBQ/IM NJXS EA VAC	$10.50	$21.00	$9.30–$19.95	50% below	50%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADM PRQ ID SUBQ/IM NJXS EA VAC	$10.50	$21.00	$15.54–$19.95	—	50%

Source file: https://images.pricetransparency.healthcare/gifford-medical-center/030179418_gifford-medical-center_standardcharges.csv