Hospital Brainerd, MN

Cuyuna Regional Medical Center

Cuyuna Regional Medical Center in Crosby, MN publishes cash prices for 368 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Minnesota median for 175 of 339 procedures and below it for 163. By typical cash price it ranks #46 of 86 Minnesota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

320 E Main St, Crosby, MN, 56441 Collected Sep 27, 2026 Source price file Check a bill from this hospital (218) 546-2300

Critical access hospital (rural, 25 beds or fewer) Government-owned hospital Emergency department CMS star rating 3 of 5 CCN 241353 · CMS hospital register NPI 1538143896

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

Cuyuna Regional Medical Center is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

State law

This state limits hospital bills for lower-income patients

Minnesota law (Minn. Stat. §144.589): a hospital may not charge an uninsured patient whose household income is under $125,000 more than the lowest amount it would be paid for the same service by a private insurer, counting the insured patient's share. If the cash price below is higher, ask the billing office to apply this limit. Each hospital's page here shows the range of insurer rates in its own file (the "Insurers pay" column), a starting point when you ask. Other states' laws.

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 Cuyuna Regional Medical Center in Crosby, MN:

Jan 28, 2026 Warning notice
May 5, 2026 Corrective action plan requested
Jun 11, 2026 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 Minnesota	Off list
Abdominal CT scan without and with contrast CPT 74170 PR CT ABDOMEN W/O & W/CONTRAST MATERIAL	$2,493.90	$7,335.00	$237.00–$3,168.72	43% above	66%
Abdominal CT scan without and with contrast CPT 74170 HCHG RAD CT ABDOMEN WWO	$2,493.90	$7,335.00	$237.00–$3,168.72	43% above	66%
Abdominal CT scan without and with contrast CPT 74170 (IA) RAD CT ABDOMEN WWO	$2,493.90	$7,335.00	$237.00–$3,168.72	43% above	66%
Abdominal X-ray, 2 views CPT 74019 HCHG RAD XRAY ABDOMEN COMPLETE PORTABLE	$493.68	$1,452.00	$243.00–$627.26	75% above	66%
Abdominal X-ray, 2 views CPT 74019 (IA) RAD XR ABDOMEN COMPLETE	$493.68	$1,452.00	$243.00–$627.26	75% above	66%
Abdominal X-ray, 2 views CPT 74019 HCHG RAD XRAY ABDOMEN COMPLETE	$493.68	$1,452.00	$243.00–$627.26	75% above	66%
Abdominal X-ray, 2 views CPT 74019 (IA) RAD XR ABDOMEN COMPLETE PORTABLE	$493.68	$1,452.00	$243.00–$627.26	75% above	66%
Abdominal X-ray, 2 views CPT 74019 PR RADIOLOGIC EXAM ABDOMEN 2 VIEWS	$493.68	$1,452.00	$243.00–$627.26	75% above	66%
Ankle X-ray, complete, 3 or more views CPT 73610 PR RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$320.28	$942.00	$221.56–$415.00	39% above	66%
Ankle X-ray, complete, 3 or more views CPT 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE PORTABLE	$320.28	$942.00	$221.56–$415.00	39% above	66%
Ankle X-ray, complete, 3 or more views CPT 73610 (IA) RAD XR ANKLE COMPLETE 3 VIEWS OR MORE	$320.28	$942.00	$221.56–$415.00	39% above	66%
Ankle X-ray, complete, 3 or more views CPT 73610 HCHG RAD XRAY ANKLE COMPLETE 3 VIEWS OR MORE	$320.28	$942.00	$221.56–$415.00	39% above	66%
Ankle X-ray, complete, 3 or more views CPT 73610 (IA) RAD XR ANKLE COMPLETE 3 VIEWS OR MORE PORTABLE	$320.28	$942.00	$221.56–$415.00	39% above	66%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$236.98	$697.00	$157.52–$391.02	32% below	66%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HCHG NONINV EXT ART SINGLE LEVEL BILAT	$118.66	$349.00	$78.87–$195.79	—	66%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HCHG NONINV EXT ART SINGLE LEVEL UNI	$118.66	$349.00	$78.87–$195.79	—	66%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$236.98	$697.00	$157.52–$391.02	—	66%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 (IA) RAD CT UPPER EXTREMITY WO	$1,505.18	$4,427.00	$237.00–$1,912.46	19% above	66%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 PR CT UPPER EXTREMITY W/O CONTRAST MATERIAL	$1,505.18	$4,427.00	$237.00–$1,912.46	19% above	66%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HCHG RAD CT UPPER EXTREMITY WO	$1,505.18	$4,427.00	$237.00–$1,912.46	19% above	66%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HCHG RAD XRAY ESOPHAGUS	$212.16	$624.00	$146.76–$415.00	32% below	66%
Barium swallow (esophagus X-ray with contrast) CPT 74220 (IA) RAD XR ESOPHAGUS	$212.16	$624.00	$146.76–$415.00	32% below	66%
Barium swallow (esophagus X-ray with contrast) CPT 74220 PR RADEX ESOPHAGUS	$212.16	$624.00	$146.76–$415.00	32% below	66%
Bone scan, whole body (nuclear medicine) CPT 78306 HCHG RAD NM BONE SCAN WHOLE BODY	$1,223.66	$3,599.00	$813.37–$2,019.04	at median	66%
Bone scan, whole body (nuclear medicine) CPT 78306 (IA) RAD NM BONE SCAN WHOLE BODY	$1,223.66	$3,599.00	$813.37–$2,019.04	at median	66%
Breast ultrasound, complete, one breast CPT 76641 PR US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$958.80	$2,820.00	$324.00–$1,218.24	142% above	66%
Breast ultrasound, complete, one breast CPT 76641 HCHG RAD US BREAST COMPLETE	$958.80	$2,820.00	$324.00–$1,218.24	142% above	66%
Breast ultrasound, complete, one breast CPT 76641 (IA) RAD US BREAST COMPLETE	$958.80	$2,820.00	$324.00–$1,218.24	142% above	66%
Breast ultrasound, limited (one breast or one area) CPT 76642 HCHG RAD US BREAST LIMITED	$861.56	$2,534.00	$324.00–$1,094.69	174% above	66%
Breast ultrasound, limited (one breast or one area) CPT 76642 (IA) RAD US BREAST LIMITED	$861.56	$2,534.00	$324.00–$1,094.69	174% above	66%
Breast ultrasound, limited (one breast or one area) CPT 76642 PR US BREAST UNI REAL TIME WITH IMAGE LIMITED	$861.56	$2,534.00	$324.00–$1,094.69	174% above	66%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 (IA) RAD CT ANGIO ABDOMEN PELVIS	$1,743.52	$5,128.00	$237.00–$2,215.30	31% below	66%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HCHG RAD CT ANGIO ABDOMEN PELVIS	$1,743.52	$5,128.00	$237.00–$2,215.30	31% below	66%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG	$1,743.52	$5,128.00	$237.00–$2,215.30	31% below	66%
CT angiography (CTA) of the head CPT 70496 PR CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST	$1,912.84	$5,626.00	$237.00–$2,430.43	7% above	66%
CT angiography (CTA) of the head CPT 70496 HCHG RAD CT ANGIO HEAD W CONTRAST	$1,912.84	$5,626.00	$237.00–$2,430.43	7% above	66%
CT angiography (CTA) of the head CPT 70496 (IA) RAD CT ANGIO HEAD	$1,912.84	$5,626.00	$237.00–$2,430.43	7% above	66%
CT angiography (CTA) of the neck CPT 70498 (IA) RAD CT ANGIO NECK	$2,527.22	$7,433.00	$237.00–$3,211.06	44% above	66%
CT angiography (CTA) of the neck CPT 70498 HCHG RAD CT ANGIO NECK W CONTRAST	$2,527.22	$7,433.00	$237.00–$3,211.06	44% above	66%
CT angiography (CTA) of the neck CPT 70498 PR CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST	$2,527.22	$7,433.00	$237.00–$3,211.06	44% above	66%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 (IA) RAD CT ANGIO CHEST	$2,527.22	$7,433.00	$237.00–$3,211.06	39% above	66%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 PR CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	$2,527.22	$7,433.00	$237.00–$3,211.06	39% above	66%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HCHG RAD CT ANGIO CHEST	$2,527.22	$7,433.00	$237.00–$3,211.06	39% above	66%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HCHG RAD CT ABDOMEN PELVIS WO	$2,576.18	$7,577.00	$237.00–$3,273.26	24% above	66%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 (IA) RAD CT ABDOMEN PELVIS WO	$2,576.18	$7,577.00	$237.00–$3,273.26	24% above	66%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 PR CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	$2,576.18	$7,577.00	$237.00–$3,273.26	24% above	66%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 PR CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$2,576.18	$7,577.00	$237.00–$3,273.26	3% above	66%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 (IA) RAD CT ABDOMEN PELVIS W	$2,576.18	$7,577.00	$237.00–$3,273.26	3% above	66%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HCHG RAD CT ABDOMEN PELVIS W	$2,576.18	$7,577.00	$237.00–$3,273.26	3% above	66%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 PR CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE	$2,576.18	$7,577.00	$237.00–$3,273.26	5% below	66%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HCHG RAD CT ABDOMEN PELVIS WWO	$2,576.18	$7,577.00	$237.00–$3,273.26	5% below	66%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 (IA) RAD CT ABDOMEN PELVIS WWO	$2,576.18	$7,577.00	$237.00–$3,273.26	5% below	66%
CT scan of the abdomen with contrast CPT 74160 HCHG RAD CT ABDOMEN W	$1,786.70	$5,255.00	$237.00–$2,270.16	29% above	66%
CT scan of the abdomen with contrast CPT 74160 (IA) RAD CT ABDOMEN W	$1,786.70	$5,255.00	$237.00–$2,270.16	29% above	66%
CT scan of the abdomen with contrast CPT 74160 PR CT ABDOMEN W/CONTRAST MATERIAL	$1,803.36	$5,304.00	$237.00–$2,291.33	30% above	66%
CT scan of the abdomen without contrast CPT 74150 PR CT ABDOMEN W/O CONTRAST MATERIAL	$1,681.64	$4,946.00	$237.00–$2,136.67	43% above	66%
CT scan of the abdomen without contrast CPT 74150 HCHG RAD CT ABDOMEN WO	$1,681.64	$4,946.00	$237.00–$2,136.67	43% above	66%
CT scan of the abdomen without contrast CPT 74150 HCHG RAD CT ABDOMEN WO LIMITED	$1,681.64	$4,946.00	$237.00–$2,136.67	43% above	66%
CT scan of the abdomen without contrast CPT 74150 (IA) RAD CT ABDOMEN WO	$1,681.64	$4,946.00	$237.00–$2,136.67	43% above	66%
CT scan of the face and sinuses, no contrast dye CPT 70486 HCHG RAD CT FACIAL BONES AND SINUS WO	$1,681.64	$4,946.00	$237.00–$2,136.67	34% above	66%
CT scan of the face and sinuses, no contrast dye CPT 70486 HCHG CT MAXILLOFACIAL WO CONTRAST	$1,681.64	$4,946.00	$237.00–$2,136.67	34% above	66%
CT scan of the face and sinuses, no contrast dye CPT 70486 PR CT MAXILLOFACIAL W/O CONTRAST MATERIAL	$1,681.64	$4,946.00	$237.00–$2,136.67	34% above	66%
CT scan of the face and sinuses, no contrast dye CPT 70486 (IA) RAD CT FACIAL BONES AND SINUS WO	$1,681.64	$4,946.00	$237.00–$2,136.67	34% above	66%
CT scan of the head or brain, no contrast dye CPT 70450 (IA) RAD CT HEAD BRAIN WO	$1,627.92	$4,788.00	$237.00–$2,068.42	29% above	66%
CT scan of the head or brain, no contrast dye CPT 70450 PR CT HEAD/BRAIN W/O CONTRAST MATERIAL	$1,627.92	$4,788.00	$237.00–$2,068.42	29% above	66%
CT scan of the head or brain, no contrast dye CPT 70450 HCHG RAD CT HEAD BRAIN WO	$1,627.92	$4,788.00	$237.00–$2,068.42	29% above	66%
CT scan of the head with contrast CPT 70460 HCHG RAD CT HEAD BRAIN W	$1,627.92	$4,788.00	$237.00–$2,068.42	25% above	66%
CT scan of the head with contrast CPT 70460 (IA) RAD CT HEAD BRAIN W	$1,627.92	$4,788.00	$237.00–$2,068.42	25% above	66%
CT scan of the head with contrast CPT 70460 PR CT HEAD/BRAIN W/CONTRAST MATERIAL	$1,627.92	$4,788.00	$237.00–$2,068.42	25% above	66%
CT scan of the head without and with contrast CPT 70470 HCHG RAD CT HEAD BRAIN WWO	$1,786.70	$5,255.00	$237.00–$2,270.16	12% above	66%
CT scan of the head without and with contrast CPT 70470 (IA) RAD CT HEAD BRAIN WWO	$1,786.70	$5,255.00	$237.00–$2,270.16	12% above	66%
CT scan of the head without and with contrast CPT 70470 PR CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	$1,786.70	$5,255.00	$237.00–$2,270.16	12% above	66%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 PR CT LUMBAR SPINE W/O CONTRAST MATERIAL	$2,007.70	$5,905.00	$237.00–$2,550.96	48% above	66%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 (IA) RAD CT SPINE LUMBAR OR SACRUM WO	$2,007.70	$5,905.00	$237.00–$2,550.96	48% above	66%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HCHG RAD CT SPINE LUMBAR OR SACRUM WO	$2,007.70	$5,905.00	$237.00–$2,550.96	48% above	66%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 (IA) RAD CT SPINE CERVICAL WO	$1,675.52	$4,928.00	$237.00–$2,128.90	17% above	66%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HCHG RAD CT SPINE CERVICAL WO	$1,675.52	$4,928.00	$237.00–$2,128.90	17% above	66%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 PR CT CERVICAL SPINE W/O CONTRAST MATERIAL	$1,675.52	$4,928.00	$237.00–$2,128.90	17% above	66%
CT scan of the pelvis, with contrast dye CPT 72193 HCHG RAD CT PELVIS W	$1,726.86	$5,079.00	$237.00–$2,194.13	17% above	66%
CT scan of the pelvis, with contrast dye CPT 72193 (IA) RAD CT PELVIS W	$1,726.86	$5,079.00	$237.00–$2,194.13	17% above	66%
CT scan of the pelvis, with contrast dye CPT 72193 PR CT PELVIS W/CONTRAST MATERIAL	$1,726.86	$5,079.00	$237.00–$2,194.13	17% above	66%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HCHG RAD US CAROTID DUPLEX BILATERAL PORTABLE	$837.42	$2,463.00	$556.64–$1,381.74	—	66%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 (IA) RAD US CAROTID DUPLEX BILATERAL PORTABLE	$837.42	$2,463.00	$556.64–$1,381.74	—	66%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$837.42	$2,463.00	$556.64–$1,381.74	—	66%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HCHG RAD US CAROTID DUPLEX BILATERAL	$837.42	$2,463.00	$556.64–$1,381.74	—	66%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 (IA) RAD US CAROTID DUPLEX BILATERAL	$837.42	$2,463.00	$556.64–$1,381.74	—	66%
Chest CT scan without and with contrast CPT 71270 PR DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+	$2,077.74	$6,111.00	$237.00–$2,639.95	31% above	66%
Chest CT scan without and with contrast CPT 71270 (IA) RAD CT CHEST WWO CONTRAST DIAGNOSTIC	$2,077.74	$6,111.00	$237.00–$2,639.95	31% above	66%
Chest CT scan without and with contrast CPT 71270 HCHG RAD CT CHEST WWO CONTRAST DIAGNOSTIC ADD-ON	$2,077.74	$6,111.00	$237.00–$2,639.95	31% above	66%
Chest CT scan without and with contrast CPT 71270 HCHG RAD CT CHEST WWO CONTRAST DIAGNOSTIC	$2,077.74	$6,111.00	$237.00–$2,639.95	31% above	66%
Chest CT scan without and with contrast CPT 71270 (IA) RAD CT CHEST WWO CONTRAST ADD ON DIAGNOSTIC	$2,077.74	$6,111.00	$237.00–$2,639.95	31% above	66%
Chest X-ray, 2 views CPT 71046 (IA) RAD XR CHEST 2 VIEWS PA AND LATERAL	$237.32	$698.00	$164.17–$415.00	6% above	66%
Chest X-ray, 2 views CPT 71046 PR RADIOLOGIC EXAM CHEST 2 VIEWS	$237.32	$698.00	$164.17–$415.00	6% above	66%
Chest X-ray, 2 views CPT 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LAT PORTABLE	$237.32	$698.00	$164.17–$415.00	6% above	66%
Chest X-ray, 2 views CPT 71046 HCHG RAD XRAY CHEST 2 VIEWS PA AND LATERAL	$237.32	$698.00	$164.17–$415.00	6% above	66%
Chest X-ray, 2 views CPT 71046 (IA) RAD XR CHEST 2 VIEWS PA AND LAT PORTABLE	$237.32	$698.00	$164.17–$415.00	6% above	66%
Chest X-ray, single view CPT 71045 (IA) RAD XR CHEST FRONTAL 1 VIEW PORTABLE	$197.88	$582.00	$136.89–$415.00	2% below	66%
Chest X-ray, single view CPT 71045 PR RADIOLOGIC EXAM CHEST SINGLE VIEW	$197.88	$582.00	$136.89–$415.00	2% below	66%
Chest X-ray, single view CPT 71045 (IA) RAD XR CHEST FRONTAL 1 VIEW	$197.88	$582.00	$136.89–$415.00	2% below	66%
Chest X-ray, single view CPT 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW PORTABLE	$197.88	$582.00	$136.89–$415.00	2% below	66%
Chest X-ray, single view CPT 71045 HCHG RAD XRAY CHEST FRONTAL 1 VIEW	$197.88	$582.00	$136.89–$415.00	2% below	66%
Collarbone (clavicle) X-ray, complete CPT 73000 PR RADEX CLAVICLE COMPLETE	$380.12	$1,118.00	$243.00–$482.98	89% above	66%
Collarbone (clavicle) X-ray, complete CPT 73000 HCHG RAD XRAY CLAVICLE COMPLETE	$380.12	$1,118.00	$243.00–$482.98	89% above	66%
Collarbone (clavicle) X-ray, complete CPT 73000 (IA) RAD XR CLAVICLE COMPLETE PORTABLE	$380.12	$1,118.00	$243.00–$482.98	89% above	66%
Collarbone (clavicle) X-ray, complete CPT 73000 (IA) RAD XR CLAVICLE COMPLETE	$380.12	$1,118.00	$243.00–$482.98	89% above	66%
Collarbone (clavicle) X-ray, complete CPT 73000 HCHG RAD XRAY CLAVICLE COMPLETE PORTABLE	$380.12	$1,118.00	$243.00–$482.98	89% above	66%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 (IA) RAD US RETROPERITONEAL COMPLETE PORTABLE	$599.08	$1,762.00	$324.00–$761.18	16% above	66%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HCHG RAD US RETROPERITONEAL COMPLETE PORTABLE	$599.08	$1,762.00	$324.00–$761.18	16% above	66%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 (IA) RAD US RETROPERITONEAL COMPLETE	$599.08	$1,762.00	$324.00–$761.18	16% above	66%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 PR US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	$599.08	$1,762.00	$324.00–$761.18	16% above	66%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HCHG RAD US RETROPERITONEAL COMPLETE	$599.08	$1,762.00	$324.00–$761.18	16% above	66%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HCHG RAD DEXA BONE DENSITY 1/> SITE AXIAL SKELETON	$123.42	$363.00	$85.38–$415.00	65% below	66%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 (IA) RAD XR DEXA BONE DENSITY 1 SITE AXIAL SKELETON	$123.42	$363.00	$85.38–$415.00	65% below	66%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 PR DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	$174.08	$512.00	$120.42–$415.00	50% below	66%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 (IA) RAD XR DEXA BONE DENSITY 2 SITES AXIAL SKELETON	$174.08	$512.00	$120.42–$415.00	50% below	66%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HCHG RAD DEXA BONE DENSITY 1/> PERIPHERAL SKELETON	$123.42	$363.00	$85.38–$415.00	37% below	66%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 (IA) RAD XR DEXA BONE DENSITY PERIPHERAL SKELETON	$123.42	$363.00	$85.38–$415.00	37% below	66%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 PR DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$123.42	$363.00	$85.38–$415.00	37% below	66%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 PR US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION	$343.06	$1,009.00	$237.32–$679.00	25% below	66%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 (IA) RAD US OB FETAL ANATOMY SINGLE GESTATION	$343.06	$1,009.00	$237.32–$679.00	25% below	66%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HCHG RAD US OB FETAL ANATOMY SINGLE GESTATION	$343.06	$1,009.00	$237.32–$679.00	25% below	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 (IA) RAD CT CHEST WO CONTRAST LOW DOSE DIAGNOSTIC	$406.64	$1,196.00	$237.00–$1,443.00	68% below	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 (IA) RAD CT CHEST LTD WO CONTRAST DIAGNOSTIC	$406.64	$1,196.00	$237.00–$1,443.00	68% below	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC LOW DOSE	$406.64	$1,196.00	$237.00–$1,443.00	68% below	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC LIMITED	$406.64	$1,196.00	$237.00–$1,443.00	68% below	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC	$1,803.36	$5,304.00	$237.00–$2,291.33	42% above	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 (IA) RAD CT CHEST WO CONTRAST ADD ON DIAGNOSTIC	$1,803.36	$5,304.00	$237.00–$2,291.33	42% above	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC ADD-ON	$1,803.36	$5,304.00	$237.00–$2,291.33	42% above	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 (IA) RAD CT CHEST WO CONTRAST DIAGNOSTIC	$1,803.36	$5,304.00	$237.00–$2,291.33	42% above	66%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 PR DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	$2,086.24	$6,136.00	$237.00–$2,650.75	64% above	66%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HCHG RAD CT CHEST WO CONTRAST DIAGNOSTIC LOW DOSE	$405.96	$1,194.00	$237.00–$1,443.00	—	66%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 (IA) RAD CT CHEST WO CONTRAST LOW DOSE DIAGNOSTIC	$405.96	$1,194.00	$237.00–$1,443.00	—	66%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC ADD-ON	$2,086.24	$6,136.00	$237.00–$2,650.75	40% above	66%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HCHG RAD CT CHEST W CONTRAST DIAGNOSTIC	$2,086.24	$6,136.00	$237.00–$2,650.75	40% above	66%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 (IA) RAD CT CHEST W CONTRAST DIAGNOSTIC	$2,086.24	$6,136.00	$237.00–$2,650.75	40% above	66%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 (IA) RAD CT CHEST W CONTRAST ADD ON DIAGNOSTIC	$2,086.24	$6,136.00	$237.00–$2,650.75	40% above	66%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 PR DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST	$2,086.24	$6,136.00	$237.00–$2,650.75	40% above	66%
Diagnostic mammogram, both breasts both sides CPT 77066 (IA) RAD XR MAMMO BILAT DIAGNOSTIC WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 (IA) RAD XR MAMMO BILAT ADDL VIEWS WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 PR DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 HCHG RAD MAMMO BILAT ADDL VIEWS WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 HCHG RAD MAMMO BILAT DIAGNOSTIC 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, both breasts both sides CPT 77066 (IA) RAD XR MAMMO BILAT DIAGNOSTIC 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC ADDL VIEWS WWO CAD	$212.50	$625.00	$147.00–$356.00	32% below	66%
Diagnostic mammogram, one breast CPT 77065 PR DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$212.50	$625.00	$147.00–$356.00	32% below	66%
Diagnostic mammogram, one breast CPT 77065 (IA) RAD XR MAMMO UNI DIAGNOSTIC ADDL VIEWS WWO CAD	$212.50	$625.00	$147.00–$356.00	32% below	66%
Diagnostic mammogram, one breast CPT 77065 (IA) RAD XR MAMMO UNI DIAGNOSTIC 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	32% below	66%
Diagnostic mammogram, one breast CPT 77065 (IA) RAD XR MAMMO UNI DIAGNOSTIC WWO CAD	$212.50	$625.00	$147.00–$356.00	32% below	66%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	32% below	66%
Diagnostic mammogram, one breast CPT 77065 HCHG RAD MAMMO UNI DIAGNOSTIC WWO CAD	$212.50	$625.00	$147.00–$356.00	32% below	66%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 (IA) RAD US LOWER EXTREMITY BILATERAL COMPLETE PORTABLE	$566.44	$1,666.00	$376.52–$934.63	—	66%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$566.44	$1,666.00	$376.52–$934.63	—	66%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 (IA) RAD US LOWER EXTREMITY BILATERAL COMPLETE	$566.44	$1,666.00	$376.52–$934.63	—	66%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE PORTABLE	$566.44	$1,666.00	$376.52–$934.63	—	66%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HCHG RAD US LOWER EXTREMITY BILATERAL COMPLETE	$566.44	$1,666.00	$376.52–$934.63	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 (IA) RAD US DUPLEX SCAN EXTREMITY BILATERAL COMPLETE	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 (IA) RAD US VENOUS INSUFFICIENCY LOWER EXTREMITY BILATERAL	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 (IA) RAD US VEIN MAPPING EXTREMITY BILATERAL	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 (IA) RAD US DUPLEX SCAN EXTREMITY BILAT COMPLETE PORTABLE	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US VEIN MAPPING EXTREMITY BILATERAL	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILATERAL COMPLETE	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US DUPLEX SCAN EXTREMITY BILAT COMPLETE PORTABLE	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HCHG RAD US VENOUS INSUFFICIENCY LOWER EXTREMITY BILATERAL	$937.72	$2,758.00	$623.31–$1,547.24	—	66%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG ECHO 2D COMP WO CONT W BUBBLE-SPECTRAL-COLOR	$918.68	$2,702.00	$610.65–$1,515.82	37% below	66%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG RAD ECHO 2D COMP WO CONT W SPECTRAL-COLOR	$918.68	$2,702.00	$610.65–$1,515.82	37% below	66%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HCHG ECHO 2D COMP WO CONT W SPECTRAL-COLOR	$918.68	$2,702.00	$610.65–$1,515.82	37% below	66%
Elbow X-ray, 2 views CPT 73070 PR RADEX ELBOW 2 VIEWS	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, 2 views CPT 73070 HCHG RAD XRAY ELBOW 2 VIEWS	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, 2 views CPT 73070 HCHG RAD XRAY ELBOW 2 VIEWS PORTABLE	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, 2 views CPT 73070 HCHG RAD XRAY ELBOW 2 VIEWS LIMITED	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, 2 views CPT 73070 (IA) RAD XR ELBOW 2 VIEWS	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, 2 views CPT 73070 (IA) RAD XR ELBOW 2 VIEWS PORTABLE	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, 2 views CPT 73070 (IA) RAD XR ELBOW 2 VIEWS LTD	$210.46	$619.00	$145.59–$415.00	3% above	66%
Elbow X-ray, complete, 3 or more views CPT 73080 (IA) RAD XR ELBOW COMPLETE THREE VIEWS OR MORE	$337.96	$994.00	$233.79–$429.41	46% above	66%
Elbow X-ray, complete, 3 or more views CPT 73080 HCHG RAD XRAY ELBOW COMPLETE THREE VIEWS OR MORE	$337.96	$994.00	$233.79–$429.41	46% above	66%
Elbow X-ray, complete, 3 or more views CPT 73080 PR RADEX ELBOW COMPLETE MINIMUM 3 VIEWS	$337.96	$994.00	$233.79–$429.41	46% above	66%
Eye socket (orbit) CT scan without contrast CPT 70480 HCHG RAD CT ORBITS OR TEMPORAL BONES WO	$1,861.84	$5,476.00	$237.00–$2,365.63	56% above	66%
Eye socket (orbit) CT scan without contrast CPT 70480 (IA) RAD CT ORBITS OR TEMPORAL BONES WO	$1,861.84	$5,476.00	$237.00–$2,365.63	56% above	66%
Eye socket (orbit) CT scan without contrast CPT 70480 PR CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL	$1,861.84	$5,476.00	$237.00–$2,365.63	56% above	66%
Facial bones X-ray, complete, 3 or more views CPT 70150 (IA) RAD XR FACIAL BONES COMPLETE MINIMUM OF THREE VIEWS	$520.20	$1,530.00	$243.00–$660.96	104% above	66%
Facial bones X-ray, complete, 3 or more views CPT 70150 HCHG RAD XRAY FACIAL BONES COMPLETE MINIMUM OF THREE VIEWS	$520.20	$1,530.00	$243.00–$660.96	104% above	66%
Facial bones X-ray, complete, 3 or more views CPT 70150 PR RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS	$520.20	$1,530.00	$243.00–$660.96	104% above	66%
Forearm X-ray (radius and ulna), 2 views CPT 73090 (IA) RAD XR FOREARM 2 VIEWS	$295.80	$870.00	$204.62–$415.00	45% above	66%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HCHG RAD XRAY FOREARM 2 VIEWS	$295.80	$870.00	$204.62–$415.00	45% above	66%
Forearm X-ray (radius and ulna), 2 views CPT 73090 (IA) RAD XR FOREARM 2 VIEWS PORTABLE	$295.80	$870.00	$204.62–$415.00	45% above	66%
Forearm X-ray (radius and ulna), 2 views CPT 73090 PR RADEX FOREARM 2 VIEWS	$295.80	$870.00	$204.62–$415.00	45% above	66%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HCHG RAD XRAY FOREARM 2 VIEWS PORTABLE	$295.80	$870.00	$204.62–$415.00	45% above	66%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HCHG RAD NM HEPATOBILIARY	$457.30	$1,345.00	$303.97–$754.54	63% below	66%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 (IA) RAD NM HEPATOBILIARY	$457.30	$1,345.00	$303.97–$754.54	63% below	66%
Hand X-ray, 2 views CPT 73120 PR RADEX HAND 2 VIEWS	$295.80	$870.00	$204.62–$415.00	54% above	66%
Hand X-ray, 2 views CPT 73120 HCHG RAD XRAY HAND 2 VIEWS	$295.80	$870.00	$204.62–$415.00	54% above	66%
Hand X-ray, 2 views CPT 73120 HCHG RAD XRAY HAND 2 VIEWS PORTABLE	$295.80	$870.00	$204.62–$415.00	54% above	66%
Hand X-ray, 2 views CPT 73120 HCHG RAD XRAY HAND 2 VIEWS LIMITED	$295.80	$870.00	$204.62–$415.00	54% above	66%
Hand X-ray, 2 views CPT 73120 (IA) RAD XR HAND 2 VIEWS	$295.80	$870.00	$204.62–$415.00	54% above	66%
Hand X-ray, 2 views CPT 73120 (IA) RAD XR HAND 2 VIEWS PORTABLE	$295.80	$870.00	$204.62–$415.00	54% above	66%
Hand X-ray, 2 views CPT 73120 (IA) RAD XR HAND 2 VIEWS LTD	$295.80	$870.00	$204.62–$415.00	54% above	66%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 (IA) RAD XR CALCANEUS 2 VIEWS	$199.92	$588.00	$138.30–$415.00	12% above	66%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HCHG RAD XRAY CALCANEUS 2 VIEWS	$199.92	$588.00	$138.30–$415.00	12% above	66%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 PR RADEX CALCANEUS MINIMUM 2 VIEWS	$233.24	$686.00	$161.35–$415.00	30% above	66%
Knee X-ray, 3 views CPT 73562 HCHG RAD XRAY KNEE 3 VIEWS	$233.24	$686.00	$161.35–$415.00	1% below	66%
Knee X-ray, 3 views CPT 73562 (IA) RAD XR KNEE 3 VIEWS	$233.24	$686.00	$161.35–$415.00	1% below	66%
Knee X-ray, 3 views CPT 73562 PR RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$233.24	$686.00	$161.35–$415.00	1% below	66%
Knee X-ray, complete, 4 or more views CPT 73564 HCHG RAD XRAY KNEE COMPLETE 4 VIEWS OR MORE	$399.84	$1,176.00	$243.00–$508.03	42% above	66%
Knee X-ray, complete, 4 or more views CPT 73564 PR RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS	$399.84	$1,176.00	$243.00–$508.03	42% above	66%
Knee X-ray, complete, 4 or more views CPT 73564 (IA) RAD XR KNEE COMPLETE 4 VIEWS OR MORE	$399.84	$1,176.00	$243.00–$508.03	42% above	66%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 PR CT LOWER EXTREMITY W/O CONTRAST MATERIAL	$1,575.22	$4,633.00	$237.00–$2,001.46	20% above	66%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 (IA) RAD CT LOWER EXTREMITY WO	$1,575.22	$4,633.00	$237.00–$2,001.46	20% above	66%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HCHG RAD CT LOWER EXTREMITY WO	$1,575.22	$4,633.00	$237.00–$2,001.46	20% above	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 PR US ABDOMINAL REAL TIME W/IMAGE LIMITED	$560.66	$1,649.00	$324.00–$712.37	28% above	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 (IA) RAD US ABDOMEN LIMITED	$560.66	$1,649.00	$324.00–$712.37	28% above	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HCHG RAD US ABDOMEN LIMITED PORTABLE	$560.66	$1,649.00	$324.00–$712.37	28% above	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HCHG RAD US ABDOMEN LIMITED	$560.66	$1,649.00	$324.00–$712.37	28% above	66%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 (IA) RAD US ABDOMEN LIMITED PORTABLE	$560.66	$1,649.00	$324.00–$712.37	28% above	66%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 (IA) RAD US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$522.24	$1,536.00	$324.00–$679.00	52% above	66%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HCHG RAD US EXTREMITY FOCAL EVAL NONVASCULAR LTD STUDY	$522.24	$1,536.00	$324.00–$679.00	52% above	66%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 PR US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG	$522.24	$1,536.00	$324.00–$679.00	52% above	66%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HCHG ED US GROIN	$522.24	$1,536.00	$324.00–$679.00	—	66%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HCHG RAD CT THORAX LOW DOSE LUNG CANCER SCREEN WO	$405.96	$1,194.00	$237.00–$1,443.00	49% below	66%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 (IA) RAD CT THORAX LOW DOSE LUNG CANCER SCREEN	$405.96	$1,194.00	$237.00–$1,443.00	49% below	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 PR RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$295.80	$870.00	$204.62–$415.00	39% above	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HCHG RAD XRAY TIBIA AND FIBULA 2 VIEWS	$295.80	$870.00	$204.62–$415.00	39% above	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HCHG RAD XRAY TIBIA AND FIBULA 2 VIEWS PORTABLE	$295.80	$870.00	$204.62–$415.00	39% above	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HCHG RAD XRAY TIBIA AND FIBULA 2 VIEWS LIMITED	$295.80	$870.00	$204.62–$415.00	39% above	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 (IA) RAD XR TIBIA AND FIBULA 2 VIEWS	$295.80	$870.00	$204.62–$415.00	39% above	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 (IA) RAD XR TIBIA AND FIBULA 2 VIEWS PORTABLE	$295.80	$870.00	$204.62–$415.00	39% above	66%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 (IA) RAD XR TIBIA AND FIBULA 2 VIEWS LTD	$295.80	$870.00	$204.62–$415.00	39% above	66%
MR angiography (MRA) of the head without contrast CPT 70544 (IA) RAD MR ANGIO HEAD WO	$2,212.04	$6,506.00	$709.00–$2,810.59	4% above	66%
MR angiography (MRA) of the head without contrast CPT 70544 PR MRA HEAD W/O CONTRST MATERIAL	$2,212.04	$6,506.00	$709.00–$2,810.59	4% above	66%
MR angiography (MRA) of the head without contrast CPT 70544 HCHG RAD MRI ANGIO HEAD WO	$2,212.04	$6,506.00	$709.00–$2,810.59	4% above	66%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HCHG RAD MRI JOINT LOWER EXTREMITY WO	$1,844.84	$5,426.00	$709.00–$2,344.03	5% below	66%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 PR MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	5% below	66%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 (IA) RAD MR JOINT LOWER EXTREMITY WO	$1,844.84	$5,426.00	$709.00–$2,344.03	5% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 PR MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	28% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HCHG RAD MRI JOINT OF LOWER EXTREMITY WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	28% below	66%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 (IA) RAD MR JOINT OF LOWER EXTREMITY WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	28% below	66%
MRI of the abdomen without contrast CPT 74181 HCHG RAD MRI ABDOMEN WO	$1,844.84	$5,426.00	$709.00–$2,344.03	14% below	66%
MRI of the abdomen without contrast CPT 74181 (IA) RAD MR ABDOMEN WO	$1,844.84	$5,426.00	$709.00–$2,344.03	14% below	66%
MRI of the abdomen without contrast CPT 74181 PR MRI ABDOMEN W/O CONTRAST MATERIAL	$1,844.84	$5,426.00	$709.00–$2,344.03	14% below	66%
MRI of the abdomen, without and then with contrast dye CPT 74183 HCHG RAD MRI ABDOMEN WWO	$2,212.04	$6,506.00	$709.00–$2,810.59	25% below	66%
MRI of the abdomen, without and then with contrast dye CPT 74183 (IA) RAD MR ABDOMEN WWO	$2,212.04	$6,506.00	$709.00–$2,810.59	25% below	66%
MRI of the abdomen, without and then with contrast dye CPT 74183 PR MRI ABDOMEN W/O & W/CONTRAST MATERIAL	$2,325.60	$6,840.00	$709.00–$2,954.88	21% below	66%
MRI of the brain, no contrast dye CPT 70551 PR MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$1,844.84	$5,426.00	$709.00–$2,344.03	11% below	66%
MRI of the brain, no contrast dye CPT 70551 HCHG RAD MRI HEAD BRAIN WO	$1,844.84	$5,426.00	$709.00–$2,344.03	11% below	66%
MRI of the brain, no contrast dye CPT 70551 HCHG RAD MRI HEAD BRAIN WO LIMITED	$1,844.84	$5,426.00	$709.00–$2,344.03	11% below	66%
MRI of the brain, no contrast dye CPT 70551 (IA) RAD MR HEAD BRAIN WO LTD	$1,844.84	$5,426.00	$709.00–$2,344.03	11% below	66%
MRI of the brain, no contrast dye CPT 70551 (IA) RAD MR HEAD BRAIN WO	$1,844.84	$5,426.00	$709.00–$2,344.03	11% below	66%
MRI of the brain, no contrast dye CPT 70551 HCHG MRI BRAIN WO CONTRAST	$1,846.54	$5,431.00	$709.00–$2,346.19	11% below	66%
MRI of the brain, with and without contrast dye CPT 70553 HCHG RAD MRI HEAD BRAIN WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	36% below	66%
MRI of the brain, with and without contrast dye CPT 70553 (IA) RAD MR HEAD BRAIN WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	36% below	66%
MRI of the brain, with and without contrast dye CPT 70553 PR MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$1,844.84	$5,426.00	$709.00–$2,344.03	36% below	66%
MRI of the lower back, no contrast dye CPT 72148 HCHG RAD MRI SPINE LUMBAR WO	$1,844.84	$5,426.00	$709.00–$2,344.03	7% below	66%
MRI of the lower back, no contrast dye CPT 72148 (IA) RAD MR SPINE LUMBAR WO	$1,844.84	$5,426.00	$709.00–$2,344.03	7% below	66%
MRI of the lower back, no contrast dye CPT 72148 PR MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$1,844.84	$5,426.00	$709.00–$2,344.03	7% below	66%
MRI of the lower back, without and then with contrast dye CPT 72158 HCHG RAD MRI SPINE LUMBAR WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	31% below	66%
MRI of the lower back, without and then with contrast dye CPT 72158 PR MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	31% below	66%
MRI of the lower back, without and then with contrast dye CPT 72158 (IA) RAD MR SPINE LUMBAR WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	31% below	66%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 (IA) RAD MR SPINE THORACIC WO	$1,844.84	$5,426.00	$709.00–$2,344.03	8% below	66%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 PR MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	8% below	66%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HCHG RAD MRI SPINE THORACIC WO	$1,844.84	$5,426.00	$709.00–$2,344.03	8% below	66%
MRI of the neck (cervical spine) without and with contrast CPT 72156 (IA) RAD MR SPINE CERVICAL WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	26% below	66%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HCHG RAD MRI SPINE CERVICAL WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	26% below	66%
MRI of the neck (cervical spine) without and with contrast CPT 72156 PR MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	26% below	66%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HCHG RAD MRI SPINE CERVICAL WO	$1,844.84	$5,426.00	$709.00–$2,344.03	7% below	66%
MRI of the neck (cervical spine), no contrast dye CPT 72141 (IA) RAD MR SPINE CERVICAL WO	$1,844.84	$5,426.00	$709.00–$2,344.03	7% below	66%
MRI of the neck (cervical spine), no contrast dye CPT 72141 PR MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	7% below	66%
MRI of the pelvis without and with contrast CPT 72197 HCHG RAD MRI PELVIS WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	31% below	66%
MRI of the pelvis without and with contrast CPT 72197 (IA) RAD MR PELVIS WWO	$1,844.84	$5,426.00	$709.00–$2,344.03	31% below	66%
MRI of the pelvis without and with contrast CPT 72197 PR MRI PELVIS W/O & W/CONTRAST MATERIAL	$1,844.84	$5,426.00	$709.00–$2,344.03	31% below	66%
MRI of the pelvis, no contrast dye CPT 72195 PR MRI PELVIS W/O CONTRAST MATERIAL	$1,844.84	$5,426.00	$709.00–$2,344.03	13% below	66%
MRI of the pelvis, no contrast dye CPT 72195 (IA) RAD MR PELVIS WO	$1,844.84	$5,426.00	$709.00–$2,344.03	13% below	66%
MRI of the pelvis, no contrast dye CPT 72195 HCHG RAD MRI PELVIS WO	$1,844.84	$5,426.00	$709.00–$2,344.03	13% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HCHG RAD MRI JOINT OF UPPER EXTREMITY WO	$1,844.84	$5,426.00	$709.00–$2,344.03	13% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 (IA) RAD MR JOINT OF UPPER EXTREMITY WO	$1,844.84	$5,426.00	$709.00–$2,344.03	13% below	66%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 PR MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	$1,844.84	$5,426.00	$709.00–$2,344.03	13% below	66%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 PR RADEX SPINE CERVICAL 4 OR 5 VIEWS	$494.02	$1,453.00	$243.00–$627.70	56% above	66%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 (IA) RAD XR SPINE CERVICAL FOUR OR FIVE VIEWS	$494.02	$1,453.00	$243.00–$627.70	56% above	66%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HCHG RAD XRAY SPINE CERVICAL FOUR OR FIVE VIEWS	$494.02	$1,453.00	$243.00–$627.70	56% above	66%
Neck soft tissue CT scan with contrast CPT 70491 HCHG RAD CT NECK SOFT TISSUE W	$1,701.02	$5,003.00	$237.00–$2,161.30	24% above	66%
Neck soft tissue CT scan with contrast CPT 70491 PR CT SOFT TISSUE NECK W/CONTRAST MATERIAL	$1,701.02	$5,003.00	$237.00–$2,161.30	24% above	66%
Neck soft tissue CT scan with contrast CPT 70491 (IA) RAD CT NECK SOFT TISSUE W	$1,701.02	$5,003.00	$237.00–$2,161.30	24% above	66%
Neck soft tissue CT scan without contrast CPT 70490 HCHG RAD CT NECK SOFT TISSUE WO	$1,612.28	$4,742.00	$237.00–$2,048.54	41% above	66%
Neck soft tissue CT scan without contrast CPT 70490 PR CT SOFT TISSUE NECK W/O CONTRAST MATERIAL	$1,612.28	$4,742.00	$237.00–$2,048.54	41% above	66%
Neck soft tissue CT scan without contrast CPT 70490 (IA) RAD CT NECK SOFT TISSUE WO	$1,612.28	$4,742.00	$237.00–$2,048.54	41% above	66%
Neck soft tissue X-ray CPT 70360 HCHG RAD XRAY NECK SOFT TISSUE	$124.10	$365.00	$85.85–$415.00	30% below	66%
Neck soft tissue X-ray CPT 70360 (IA) RAD XR NECK SOFT TISSUE PORTABLE	$124.10	$365.00	$85.85–$415.00	30% below	66%
Neck soft tissue X-ray CPT 70360 (IA) RAD XR NECK SOFT TISSUE	$124.10	$365.00	$85.85–$415.00	30% below	66%
Neck soft tissue X-ray CPT 70360 PR RADIOLOGIC EXAMINATION NECK SOFT TISSUE	$124.10	$365.00	$85.85–$415.00	30% below	66%
Neck soft tissue X-ray CPT 70360 HCHG RAD XRAY NECK SOFT TISSUE PORTABLE	$124.10	$365.00	$85.85–$415.00	30% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 (IA) RAD NM CARDIAC MYOCARD MULT SPECT W VIABILITY	$1,441.60	$4,240.00	$958.24–$2,378.64	45% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HCHG RAD NM CARDIAC MYOCARD MULT SPECT WWO EF AND WM	$1,441.60	$4,240.00	$958.24–$2,378.64	45% below	66%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 (IA) RAD NM CARDIAC MYOCARD MULT SPECT WWO EF AND WM	$1,441.60	$4,240.00	$958.24–$2,378.64	45% below	66%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 (IA) RAD PET CT SKULL BASE TO MID THIGH SUBSEQUENT TREAT	$2,555.44	$7,516.00	$1,698.62–$4,216.48	8% below	66%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH SUBSEQUENT TREAT	$2,555.44	$7,516.00	$1,698.62–$4,216.48	8% below	66%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PR PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	$2,555.44	$7,516.00	$1,698.62–$4,216.48	8% below	66%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HCHG RAD PET CT SKULL BASE TO MID THIGH INITIAL TREAT	$2,555.44	$7,516.00	$1,698.62–$4,216.48	8% below	66%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 (IA) RAD PET CT SKULL BASE TO MID THIGH INITIAL TREAT	$2,555.44	$7,516.00	$1,698.62–$4,216.48	8% below	66%
Pelvic CT scan without contrast CPT 72192 (IA) RAD CT PELVIS WO	$1,968.26	$5,789.00	$237.00–$2,500.85	52% above	66%
Pelvic CT scan without contrast CPT 72192 PR CT PELVIS W/O CONTRAST MATERIAL	$1,968.26	$5,789.00	$237.00–$2,500.85	52% above	66%
Pelvic CT scan without contrast CPT 72192 HCHG RAD CT PELVIS WO	$1,968.26	$5,789.00	$237.00–$2,500.85	52% above	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 (IA) RAD US PELVIS LIMITED STUDY PORTABLE	$99.28	$292.00	$68.68–$679.00	71% below	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 (IA) RAD US PELVIS LIMITED STUDY	$99.28	$292.00	$68.68–$679.00	71% below	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 PR US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$99.28	$292.00	$68.68–$679.00	71% below	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HCHG RAD US PELVIS LIMITED STUDY PORTABLE	$99.28	$292.00	$68.68–$679.00	71% below	66%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HCHG RAD US PELVIS LIMITED STUDY	$99.28	$292.00	$68.68–$679.00	71% below	66%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PR US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$583.10	$1,715.00	$324.00–$740.88	19% above	66%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 (IA) RAD US PELVIS COMPLETE NONOBSTETRIC PORTABLE	$583.10	$1,715.00	$324.00–$740.88	19% above	66%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC PORTABLE	$583.10	$1,715.00	$324.00–$740.88	19% above	66%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HCHG RAD US PELVIS COMPLETE NONOBSTETRIC	$583.10	$1,715.00	$324.00–$740.88	19% above	66%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 (IA) RAD US PELVIS COMPLETE NONOBSTETRIC	$583.10	$1,715.00	$324.00–$740.88	19% above	66%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PR US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$548.42	$1,613.00	$324.00–$696.82	10% above	66%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST	$548.42	$1,613.00	$324.00–$696.82	10% above	66%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HCHG RAD US OB EQUAL OR GREATER THAN 14 WKS SNGL GEST PORTABLE	$548.42	$1,613.00	$324.00–$696.82	10% above	66%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 (IA) RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST	$548.42	$1,613.00	$324.00–$696.82	10% above	66%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 (IA) RAD US OB EQUAL OR GREATER THAN 14 WKS SINGLE GEST PORTABLE	$548.42	$1,613.00	$324.00–$696.82	10% above	66%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HCHG RAD US OB 1ST TRI SINGLE TRANSABD	$548.42	$1,613.00	$324.00–$696.82	27% above	66%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 PR US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$548.42	$1,613.00	$324.00–$696.82	27% above	66%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 (IA) RAD US OB 1ST TRI SINGLE TRANSABD	$548.42	$1,613.00	$324.00–$696.82	27% above	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HCHG RAD US OB LIMITED ANY TRI 1 OR MORE FETUSES	$115.26	$339.00	$79.73–$679.00	65% below	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 PR US PREGNANT UTERUS LIMITED 1/> FETUSES	$115.26	$339.00	$79.73–$679.00	65% below	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 (IA) RAD US OB LIMITED ANY TRI 1 OR MORE FETUSES	$115.26	$339.00	$79.73–$679.00	65% below	66%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HCHG US OB LIMITED 1 OR MORE FETUSES	$118.66	$349.00	$82.08–$679.00	64% below	66%
Rib X-ray, one side, 2 views one side CPT 71100 HCHG RAD XRAY RIBS 2 VIEWS UNILATERAL	$136.68	$402.00	$94.55–$415.00	33% below	66%
Rib X-ray, one side, 2 views one side CPT 71100 PR RADEX RIBS UNILATERAL 2 VIEWS	$136.68	$402.00	$94.55–$415.00	33% below	66%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 PR RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$429.42	$1,263.00	$243.00–$545.62	48% above	66%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HCHG RAD XRAY RIBS UNI INCLUDING PA CHEST MINIMUM OF 3 VIEWS	$429.42	$1,263.00	$243.00–$545.62	48% above	66%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 (IA) RAD XR RIBS UNI INCLUDING PA CHEST MINIMUM OF 3 VIEWS	$429.42	$1,263.00	$243.00–$545.62	48% above	66%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING LTD WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 (IA) RAD XR MAMMO BILAT SCREENING 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 (IA) RAD XR MAMMO BILAT SCREENING LTD WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 (IA) RAD XR MAMMO BILAT SCREENING W IMPLANT WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 PR SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 (IA) RAD XR MAMMO BILAT SCREENING WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts both sides CPT 77067 HCHG RAD MAMMO BILAT SCREENING W IMPLANT WWO CAD	$212.50	$625.00	$147.00–$356.00	—	66%
Screening mammogram, both breasts CPT 77067 (IA) RAD XR MAMMO UNI SCREENING 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	36% below	66%
Screening mammogram, both breasts CPT 77067 HCHG RAD MAMMO UNI SCREENING 3D WWO CAD	$212.50	$625.00	$147.00–$356.00	36% below	66%
Shoulder X-ray, complete, 2 or more views CPT 73030 PR RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$358.70	$1,055.00	$243.00–$455.76	53% above	66%
Shoulder X-ray, complete, 2 or more views CPT 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE PORTABLE	$358.70	$1,055.00	$243.00–$455.76	53% above	66%
Shoulder X-ray, complete, 2 or more views CPT 73030 HCHG RAD XRAY SHOULDER COMPLETE 2 VIEWS OR MORE	$358.70	$1,055.00	$243.00–$455.76	53% above	66%
Shoulder X-ray, complete, 2 or more views CPT 73030 (IA) RAD XR SHOULDER COMPLETE 2 VIEWS OR MORE PORTABLE	$358.70	$1,055.00	$243.00–$455.76	53% above	66%
Shoulder X-ray, complete, 2 or more views CPT 73030 (IA) RAD XR SHOULDER COMPLETE 2 VIEWS OR MORE	$358.70	$1,055.00	$243.00–$455.76	53% above	66%
Sinus X-ray, complete, 3 or more views CPT 70220 (IA) RAD XR SINUSES COMPLETE MINIMUM OF THREE VIEWS	$447.44	$1,316.00	$243.00–$568.51	92% above	66%
Sinus X-ray, complete, 3 or more views CPT 70220 HCHG RAD XRAY SINUSES COMPLETE MINIMUM OF THREE VIEWS	$447.44	$1,316.00	$243.00–$568.51	92% above	66%
Sinus X-ray, complete, 3 or more views CPT 70220 PR RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	$447.44	$1,316.00	$243.00–$568.51	92% above	66%
Skull X-ray, fewer than 4 views CPT 70250 (IA) RAD XR SKULL THREE VIEWS OR LESS	$302.94	$891.00	$209.56–$415.00	35% above	66%
Skull X-ray, fewer than 4 views CPT 70250 HCHG RAD XRAY SKULL THREE VIEWS OR LESS	$302.94	$891.00	$209.56–$415.00	35% above	66%
Skull X-ray, fewer than 4 views CPT 70250 HCHG RAD XRAY SKULL THREE VIEWS OR LESS PORTABLE	$302.94	$891.00	$209.56–$415.00	35% above	66%
Skull X-ray, fewer than 4 views CPT 70250 PR RADIOLOGIC EXAMINATION, SKULL; LESS THAN 4 VIEWS	$302.94	$891.00	$209.56–$415.00	35% above	66%
Skull X-ray, fewer than 4 views CPT 70250 (IA) RAD XR SKULL THREE VIEWS OR LESS PORTABLE	$302.94	$891.00	$209.56–$415.00	35% above	66%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 HCHG RAD ECHO STRESS EXER OR PHARM WO CONT W CONTIN MONITOR	$918.68	$2,702.00	$610.65–$1,515.82	44% below	66%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 (IA) HCHG STRESS ECHO 2D EXERCISE W STRESS TEST WO CONTRAST	$918.68	$2,702.00	$610.65–$1,515.82	44% below	66%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 (IA) HCHG STRESS ECHO 2D PHARMACOLOGIC W STRESS TEST WO	$918.68	$2,702.00	$610.65–$1,515.82	44% below	66%
Swallow study (modified barium swallow, video X-ray) CPT 74230 (IA) RAD XR VIDEO SWALLOW STUDY	$477.02	$1,403.00	$243.00–$606.10	25% above	66%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HCHG RAD XRAY VIDEO SWALLOW STUDY	$477.02	$1,403.00	$243.00–$606.10	25% above	66%
Swallow study (modified barium swallow, video X-ray) CPT 74230 PR SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG	$477.02	$1,403.00	$243.00–$606.10	25% above	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HCHG RAD XRAY FEMUR 2 VIEWS PORTABLE	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HCHG RAD XRAY FEMUR 2 VIEWS	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 (IA) RAD XR FEMUR 2 VIEWS	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HCHG RAD XRAY FEMUR 2 VIEWS LIMITED	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 (IA) RAD XR FEMUR 2 VIEWS PORTABLE	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 (IA) RAD XR FEMUR 2 VIEWS LTD	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 PR RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$218.96	$644.00	$151.47–$415.00	3% below	66%
Thoracic spine (mid back) CT scan without contrast CPT 72128 PR CT THORACIC SPINE W/O CONTRAST MATERIAL	$1,696.94	$4,991.00	$237.00–$2,156.11	27% above	66%
Thoracic spine (mid back) CT scan without contrast CPT 72128 (IA) RAD CT SPINE THORACIC WO	$1,696.94	$4,991.00	$237.00–$2,156.11	27% above	66%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HCHG RAD CT SPINE THORACIC WO	$1,696.94	$4,991.00	$237.00–$2,156.11	27% above	66%
Toe X-ray, 2 or more views CPT 73660 (IA) RAD XR TOE(S) MINIMUM OF 2 VIEWS PORTABLE	$233.24	$686.00	$161.35–$415.00	26% above	66%
Toe X-ray, 2 or more views CPT 73660 PR RADEX TOE MINIMUM 2 VIEWS	$233.24	$686.00	$161.35–$415.00	26% above	66%
Toe X-ray, 2 or more views CPT 73660 HCHG RAD XRAY TOE(S) MINIMUM OF 2 VIEWS	$233.24	$686.00	$161.35–$415.00	26% above	66%
Toe X-ray, 2 or more views CPT 73660 (IA) RAD XR TOE(S) MINIMUM OF 2 VIEWS	$233.24	$686.00	$161.35–$415.00	26% above	66%
Toe X-ray, 2 or more views CPT 73660 HCHG RAD XRAY TOE(S) MINIMUM OF 2 VIEWS PORTABLE	$233.24	$686.00	$161.35–$415.00	26% above	66%
Transvaginal pelvic ultrasound CPT 76830 PR US TRANSVAGINAL	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 (IA) RAD US TRANSVAGINAL FOLLICLE STUDY	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 (IA) RAD US PELVIS COMPLETE TV ADD ON	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 (IA) RAD US TRANSVAGINAL	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 HCHG RAD US TRANSVAGINAL FOLLICLE STUDY	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 HCHG RAD US TRANSVAGINAL	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 HCHG US PELVIS TRANSVAGINAL NON OB	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal pelvic ultrasound CPT 76830 HCHG RAD US PELVIS COMPLETE TV ADD ON	$178.84	$526.00	$123.72–$679.00	55% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 (IA) RAD US OB TRANSVAGINAL LTD	$178.84	$526.00	$123.72–$679.00	49% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 HCHG US OB TRANSVAGINAL	$178.84	$526.00	$123.72–$679.00	49% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 HCHG RAD US OB TRANSVAGINAL LTD	$178.84	$526.00	$123.72–$679.00	49% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 HCHG RAD US OB TRANSVAGINAL	$214.88	$632.00	$148.65–$679.00	38% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 (IA) RAD US OB TRANSVAGINAL	$214.88	$632.00	$148.65–$679.00	38% below	66%
Transvaginal ultrasound during pregnancy CPT 76817 PR US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$538.90	$1,585.00	$324.00–$684.72	55% above	66%
Ultrasound of the abdomen, complete CPT 76700 PR US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$456.28	$1,342.00	$315.64–$679.00	24% below	66%
Ultrasound of the abdomen, complete CPT 76700 HCHG RAD US ABDOMEN COMPLETE	$456.28	$1,342.00	$315.64–$679.00	24% below	66%
Ultrasound of the abdomen, complete CPT 76700 HCHG RAD US ABDOMEN COMPLETE PORTABLE	$456.28	$1,342.00	$315.64–$679.00	24% below	66%
Ultrasound of the abdomen, complete CPT 76700 (IA) RAD US ABDOMEN COMPLETE	$456.28	$1,342.00	$315.64–$679.00	24% below	66%
Ultrasound of the abdomen, complete CPT 76700 (IA) RAD US ABDOMEN COMPLETE PORTABLE	$456.28	$1,342.00	$315.64–$679.00	24% below	66%
Ultrasound of the scrotum and testicles CPT 76870 HCHG RAD US SCROTUM	$516.12	$1,518.00	$324.00–$679.00	14% above	66%
Ultrasound of the scrotum and testicles CPT 76870 (IA) RAD US SCROTUM	$516.12	$1,518.00	$324.00–$679.00	14% above	66%
Ultrasound of the scrotum and testicles CPT 76870 PR US SCROTUM & CONTENTS	$516.12	$1,518.00	$324.00–$679.00	14% above	66%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 (IA) RAD US NECK OR HEAD SOFT TISSUE	$789.14	$2,321.00	$324.00–$1,002.67	78% above	66%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 PR US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$789.14	$2,321.00	$324.00–$1,002.67	78% above	66%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HCHG RAD US NECK OR HEAD SOFT TISSUE	$789.14	$2,321.00	$324.00–$1,002.67	78% above	66%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 PR RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB	$564.40	$1,660.00	$243.00–$717.12	38% above	66%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HCHG RAD XRAY UPPER GI	$564.40	$1,660.00	$243.00–$717.12	38% above	66%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 (IA) RAD XR UPPER GI	$564.40	$1,660.00	$243.00–$717.12	38% above	66%
Upper arm X-ray (humerus), 2 views CPT 73060 (IA) RAD XR HUMERUS TWO VIEWS OR MORE	$253.64	$746.00	$175.46–$415.00	19% above	66%
Upper arm X-ray (humerus), 2 views CPT 73060 (IA) RAD XR HUMERUS TWO VIEWS OR MORE PORTABLE	$253.64	$746.00	$175.46–$415.00	19% above	66%
Upper arm X-ray (humerus), 2 views CPT 73060 PR RADEX HUMERUS MINIMUM 2 VIEWS	$253.64	$746.00	$175.46–$415.00	19% above	66%
Upper arm X-ray (humerus), 2 views CPT 73060 HCHG RAD XRAY HUMERUS TWO VIEWS OR MORE PORTABLE	$253.64	$746.00	$175.46–$415.00	19% above	66%
Upper arm X-ray (humerus), 2 views CPT 73060 HCHG RAD XRAY HUMERUS TWO VIEWS OR MORE	$253.64	$746.00	$175.46–$415.00	19% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 (IA) RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 (IA) RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY PORTABLE	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HCHG RAD US DUPLEX SCAN EXTREMITY UNI OR LTD STUDY PORTABLE	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$118.66	$349.00	$78.87–$195.79	78% below	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HCHG RAD US VENOUS INSUFF OR VEIN MAPPING EXTREMITY UNILATERAL	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 (IA) RAD US VENOUS INSUFF OR VEIN MAPPING EXTREMITY UNILATERAL	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$611.32	$1,798.00	$406.35–$1,008.68	13% above	66%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$118.66	$349.00	$78.87–$195.79	—	66%
Wrist X-ray, 2 views CPT 73100 (IA) RAD XR WRIST 2 VIEWS PORTABLE	$216.24	$636.00	$149.59–$415.00	10% above	66%
Wrist X-ray, 2 views CPT 73100 HCHG RAD XRAY WRIST 2 VIEWS PORTABLE	$216.24	$636.00	$149.59–$415.00	10% above	66%
Wrist X-ray, 2 views CPT 73100 HCHG RAD XRAY WRIST 2 VIEWS	$216.24	$636.00	$149.59–$415.00	10% above	66%
Wrist X-ray, 2 views CPT 73100 PR RADEX WRIST 2 VIEWS	$216.24	$636.00	$149.59–$415.00	10% above	66%
Wrist X-ray, 2 views CPT 73100 (IA) RAD XR WRIST 2 VIEWS	$216.24	$636.00	$149.59–$415.00	10% above	66%
Wrist X-ray, complete, 3 or more views CPT 73110 (IA) RAD XR WRIST THREE VIEWS OR MORE PORTABLE	$301.58	$887.00	$208.62–$415.00	31% above	66%
Wrist X-ray, complete, 3 or more views CPT 73110 PR RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$301.58	$887.00	$208.62–$415.00	31% above	66%
Wrist X-ray, complete, 3 or more views CPT 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE PORTABLE	$301.58	$887.00	$208.62–$415.00	31% above	66%
Wrist X-ray, complete, 3 or more views CPT 73110 (IA) RAD XR WRIST THREE VIEWS OR MORE	$301.58	$887.00	$208.62–$415.00	31% above	66%
Wrist X-ray, complete, 3 or more views CPT 73110 HCHG RAD XRAY WRIST THREE VIEWS OR MORE	$301.58	$887.00	$208.62–$415.00	31% above	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 (IA) RAD XR HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS PORTABLE	$237.32	$698.00	$164.17–$415.00	14% below	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS	$237.32	$698.00	$164.17–$415.00	14% below	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HCHG RAD XRAY HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS PORTABLE	$237.32	$698.00	$164.17–$415.00	14% below	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 (IA) RAD XR HIP WWO PELVIS UNILATERAL 2 OR 3 VIEWS	$237.32	$698.00	$164.17–$415.00	14% below	66%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 PR RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$237.32	$698.00	$164.17–$415.00	14% below	66%
X-ray of the abdomen, 1 view CPT 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW	$229.50	$675.00	$158.76–$415.00	9% above	66%
X-ray of the abdomen, 1 view CPT 74018 PR RADIOLOGIC EXAM ABDOMEN 1 VIEW	$229.50	$675.00	$158.76–$415.00	9% above	66%
X-ray of the abdomen, 1 view CPT 74018 HCHG RAD XRAY ABDOMEN SINGLE AP VIEW PORTABLE	$229.50	$675.00	$158.76–$415.00	9% above	66%
X-ray of the abdomen, 1 view CPT 74018 (IA) RAD XR ABDOMEN SINGLE AP VIEW	$229.50	$675.00	$158.76–$415.00	9% above	66%
X-ray of the abdomen, 1 view CPT 74018 (IA) RAD XR ABDOMEN SINGLE AP VIEW PORTABLE	$229.50	$675.00	$158.76–$415.00	9% above	66%
X-ray of the ankle, 2 views CPT 73600 (IA) RAD XR ANKLE 2 VIEWS	$199.92	$588.00	$138.30–$415.00	3% below	66%
X-ray of the ankle, 2 views CPT 73600 HCHG RAD XRAY ANKLE 2 VIEWS PORTABLE	$199.92	$588.00	$138.30–$415.00	3% below	66%
X-ray of the ankle, 2 views CPT 73600 HCHG RAD XRAY ANKLE 2 VIEWS	$199.92	$588.00	$138.30–$415.00	3% below	66%
X-ray of the ankle, 2 views CPT 73600 PR RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$199.92	$588.00	$138.30–$415.00	3% below	66%
X-ray of the ankle, 2 views CPT 73600 (IA) RAD XR ANKLE 2 VIEWS PORTABLE	$199.92	$588.00	$138.30–$415.00	3% below	66%
X-ray of the finger(s), 2 or more views CPT 73140 PR RADEX FINGR MINIMUM 2 VIEWS	$233.24	$686.00	$161.35–$415.00	20% above	66%
X-ray of the finger(s), 2 or more views CPT 73140 (IA) RAD XR FINGER TWO VIEWS OR MORE	$233.24	$686.00	$161.35–$415.00	20% above	66%
X-ray of the finger(s), 2 or more views CPT 73140 (IA) RAD XR FINGER TWO VIEWS OR MORE PORTABLE	$233.24	$686.00	$161.35–$415.00	20% above	66%
X-ray of the finger(s), 2 or more views CPT 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE	$233.24	$686.00	$161.35–$415.00	20% above	66%
X-ray of the finger(s), 2 or more views CPT 73140 HCHG RAD XRAY FINGER TWO VIEWS OR MORE PORTABLE	$233.24	$686.00	$161.35–$415.00	20% above	66%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE LIMITED	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 PR RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 (IA) RAD XR FOOT 2 VIEWS LTD	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 (IA) RAD XR FOOT 2 VIEWS PORTABLE LIMITED	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 (IA) RAD XR FOOT 2 VIEWS PORTABLE	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 (IA) RAD XR FOOT 2 VIEWS	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS LIMITED	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS PORTABLE	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, 2 views CPT 73620 HCHG RAD XRAY FOOT 2 VIEWS	$199.92	$588.00	$138.30–$415.00	4% above	66%
X-ray of the foot, complete, 3 or more views CPT 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS	$317.56	$934.00	$219.68–$415.00	44% above	66%
X-ray of the foot, complete, 3 or more views CPT 73630 PR RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$317.56	$934.00	$219.68–$415.00	44% above	66%
X-ray of the foot, complete, 3 or more views CPT 73630 (IA) RAD XR FOOT COMPLETE MINIMUM OF 3 VIEWS PORTABLE	$317.56	$934.00	$219.68–$415.00	44% above	66%
X-ray of the foot, complete, 3 or more views CPT 73630 (IA) RAD XR FOOT COMPLETE MINIMUM OF 3 VIEWS	$317.56	$934.00	$219.68–$415.00	44% above	66%
X-ray of the foot, complete, 3 or more views CPT 73630 HCHG RAD XRAY FOOT COMPLETE MINIMUM OF 3 VIEWS PORTABLE	$317.56	$934.00	$219.68–$415.00	44% above	66%
X-ray of the hand, 3 or more views CPT 73130 (IA) RAD XR HAND 3 VIEWS OR MORE	$295.80	$870.00	$204.62–$415.00	34% above	66%
X-ray of the hand, 3 or more views CPT 73130 HCHG RAD XRAY HAND 3 VIEWS OR MORE	$295.80	$870.00	$204.62–$415.00	34% above	66%
X-ray of the hand, 3 or more views CPT 73130 PR RADEX HAND MINIMUM 3 VIEWS	$295.80	$870.00	$204.62–$415.00	34% above	66%
X-ray of the knee, 1 or 2 views CPT 73560 (IA) RAD XR KNEE 1 OR 2 VIEWS PORTABLE	$131.24	$386.00	$90.79–$415.00	39% below	66%
X-ray of the knee, 1 or 2 views CPT 73560 PR RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$131.24	$386.00	$90.79–$415.00	39% below	66%
X-ray of the knee, 1 or 2 views CPT 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS	$131.24	$386.00	$90.79–$415.00	39% below	66%
X-ray of the knee, 1 or 2 views CPT 73560 HCHG RAD XRAY KNEE 1 OR 2 VIEWS PORTABLE	$131.24	$386.00	$90.79–$415.00	39% below	66%
X-ray of the knee, 1 or 2 views CPT 73560 (IA) RAD XR KNEE 1 OR 2 VIEWS	$131.24	$386.00	$90.79–$415.00	39% below	66%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS	$396.44	$1,166.00	$243.00–$503.71	55% above	66%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HCHG RAD XRAY LUMBOSACRAL SPINE 2 OR 3 VIEWS PORTABLE	$396.44	$1,166.00	$243.00–$503.71	55% above	66%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 (IA) RAD XR LUMBOSACRAL SPINE 2 OR 3 VIEWS	$396.44	$1,166.00	$243.00–$503.71	55% above	66%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 PR RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$396.44	$1,166.00	$243.00–$503.71	55% above	66%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 (IA) RAD XR LUMBOSACRAL SPINE 2 OR 3 VIEWS PORTABLE	$396.44	$1,166.00	$243.00–$503.71	55% above	66%
X-ray of the lower back, 4 or more views CPT 72110 HCHG RAD XRAY LUMBOSACRAL MINIMUM OF 4 VIEWS	$633.08	$1,862.00	$243.00–$804.38	88% above	66%
X-ray of the lower back, 4 or more views CPT 72110 PR RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$633.08	$1,862.00	$243.00–$804.38	88% above	66%
X-ray of the lower back, 4 or more views CPT 72110 (IA) RAD XR LUMBOSACRAL MINIMUM OF 4 VIEWS	$633.08	$1,862.00	$243.00–$804.38	88% above	66%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 PR RADEX SPINE THORACIC 2 VIEWS	$396.44	$1,166.00	$243.00–$503.71	70% above	66%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 (IA) RAD XR SPINE THORACIC 2 VIEWS PORTABLE	$413.44	$1,216.00	$243.00–$525.31	77% above	66%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HCHG RAD XRAY SPINE THORACIC 2 VIEWS PORTABLE	$413.44	$1,216.00	$243.00–$525.31	77% above	66%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 (IA) RAD XR SPINE THORACIC 2 VIEWS	$413.44	$1,216.00	$243.00–$525.31	77% above	66%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HCHG RAD XRAY SPINE THORACIC 2 VIEWS	$413.44	$1,216.00	$243.00–$525.31	77% above	66%
X-ray of the nasal bones, 3 or more views CPT 70160 PR RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$301.58	$887.00	$208.62–$415.00	38% above	66%
X-ray of the nasal bones, 3 or more views CPT 70160 HCHG RAD XRAY NASAL BONES COMPLETE MINIMUM OF THREE VIEWS	$301.58	$887.00	$208.62–$415.00	38% above	66%
X-ray of the nasal bones, 3 or more views CPT 70160 (IA) RAD XR NASAL BONES COMPLETE MINIMUM OF THREE VIEWS	$301.58	$887.00	$208.62–$415.00	38% above	66%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 (IA) RAD XR SPINE CERVICAL 2 OR 3 VIEWS	$279.82	$823.00	$193.57–$415.00	14% above	66%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 PR RADEX SPINE CERVICAL 2 OR 3 VIEWS	$279.82	$823.00	$193.57–$415.00	14% above	66%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 (IA) RAD XR SPINE CERVICAL 2 OR 3 VIEWS PORTABLE	$279.82	$823.00	$193.57–$415.00	14% above	66%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS PORTABLE	$279.82	$823.00	$193.57–$415.00	14% above	66%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HCHG RAD XRAY SPINE CERVICAL 2 OR 3 VIEWS	$279.82	$823.00	$193.57–$415.00	14% above	66%
X-ray of the pelvis, 1 or 2 views CPT 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS	$221.00	$650.00	$152.88–$415.00	at median	66%
X-ray of the pelvis, 1 or 2 views CPT 72170 PR RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$221.00	$650.00	$152.88–$415.00	at median	66%
X-ray of the pelvis, 1 or 2 views CPT 72170 (IA) RAD XR PELVIS 1 OR 2 VIEWS PORTABLE	$221.00	$650.00	$152.88–$415.00	at median	66%
X-ray of the pelvis, 1 or 2 views CPT 72170 (IA) RAD XR PELVIS 1 OR 2 VIEWS	$221.00	$650.00	$152.88–$415.00	at median	66%
X-ray of the pelvis, 1 or 2 views CPT 72170 HCHG RAD XRAY PELVIS 1 OR 2 VIEWS PORTABLE	$221.00	$650.00	$152.88–$415.00	at median	66%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 PR RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$396.44	$1,166.00	$243.00–$503.71	82% above	66%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HCHG RAD XRAY SACRUM AND COCCYX TWO VIEWS OR MORE	$447.44	$1,316.00	$243.00–$568.51	105% above	66%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 (IA) RAD XR SACRUM AND COCCYX TWO VIEWS OR MORE	$447.44	$1,316.00	$243.00–$568.51	105% above	66%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ACTH blood test CPT 82024 PR ADRENOCORTICOTROPIC HORMONE ACTH	$66.64	$196.00	$44.30–$109.96	36% below	66%
ACTH blood test CPT 82024 HCHG ACTH, PLASMA LC	$66.64	$196.00	$44.30–$109.96	36% below	66%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HCHG ALT (SGPT)	$34.34	$101.00	$22.83–$56.66	30% below	66%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 PR TRANSFERASE ALANINE AMINO ALT SGPT	$42.50	$125.00	$28.25–$70.12	13% below	66%
AST (aspartate aminotransferase) enzyme test CPT 84450 HCHG AST (SGOT)	$42.16	$124.00	$28.02–$69.56	16% below	66%
AST (aspartate aminotransferase) enzyme test CPT 84450 PR TRANSFERASE ASPARTATE AMINO AST SGOT	$46.92	$138.00	$31.19–$77.42	6% below	66%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HCHG GENERAL LAB 8007401 LCC	$264.52	$778.00	$175.83–$436.46	10% above	66%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HCHG GENERAL LAB 8007400	$264.52	$778.00	$175.83–$436.46	10% above	66%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 PR GENERAL LAB 8007400	$264.52	$778.00	$175.83–$436.46	10% above	66%
Albumin blood test CPT 82040 HCHG ALBUMIN SERUM	$116.62	$343.00	$77.52–$192.42	308% above	66%
Albumin blood test CPT 82040 HCHG ALBUMIN	$116.62	$343.00	$77.52–$192.42	308% above	66%
Albumin blood test CPT 82040 PR ALBUMIN SERUM PLASMA/WHOLE BLOOD	$116.62	$343.00	$77.52–$192.42	308% above	66%
Aldosterone blood test CPT 82088 PR ASSAY OF ALDOSTERONE	$67.32	$198.00	$44.75–$111.08	5% below	66%
Aldosterone blood test CPT 82088 HCHG ALDOSTERONE, SERUM LC	$67.32	$198.00	$44.75–$111.08	5% below	66%
Aldosterone blood test CPT 82088 HCHG ALDOSTERONE, URINE LC	$67.32	$198.00	$44.75–$111.08	5% below	66%
Alkaline phosphatase (ALP) blood test CPT 84075 PR ASSAY OF PHOSPHATASE ALKALINE	$124.10	$365.00	$82.49–$204.76	218% above	66%
Alkaline phosphatase (ALP) blood test CPT 84075 HCHG ALK PHOSPHATASE	$124.10	$365.00	$82.49–$204.76	218% above	66%
Alkaline phosphatase (ALP) blood test CPT 84075 HCHG ALK PHOS TOTAL LC	$124.10	$365.00	$82.49–$204.76	218% above	66%
Allergy blood test, specific IgE, per allergen CPT 86003 HCHG ALLERGEN LC	$29.58	$87.00	$19.66–$48.81	42% above	66%
Allergy blood test, specific IgE, per allergen CPT 86003 HCHG RAST IN-HOUSE	$29.58	$87.00	$19.66–$48.81	42% above	66%
Allergy blood test, specific IgE, per allergen CPT 86003 PR ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH	$29.58	$87.00	$19.66–$48.81	42% above	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 HCHG AFP TUMOR MARKER SERUM	$42.16	$124.00	$28.02–$69.56	12% below	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 PR ALPHA-FETOPROTEIN SERUM	$42.16	$124.00	$28.02–$69.56	12% below	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 HCHG AFP-PRENATAL	$42.16	$124.00	$28.02–$69.56	12% below	66%
Alpha-fetoprotein (AFP) blood test CPT 82105 HCHG AFP BLOOD OPEN SPINA BIFIDA LC	$42.16	$124.00	$28.02–$69.56	12% below	66%
Ammonia blood test CPT 82140 HCHG AMMONIA	$112.88	$332.00	$75.03–$186.25	23% above	66%
Ammonia blood test CPT 82140 PR ASSAY OF AMMONIA	$112.88	$332.00	$75.03–$186.25	23% above	66%
Amylase blood test CPT 82150 HCHG AMYLASE URINE	$164.90	$485.00	$109.61–$272.08	150% above	66%
Amylase blood test CPT 82150 PR ASSAY OF AMYLASE	$164.90	$485.00	$109.61–$272.08	150% above	66%
Amylase blood test CPT 82150 HCHG AMYLASE	$164.90	$485.00	$109.61–$272.08	150% above	66%
Amylase blood test CPT 82150 HCHG AMYLASE BODY FLUID	$164.90	$485.00	$109.61–$272.08	150% above	66%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HCHG CCP ANTIBODY IGG	$144.16	$424.00	$95.82–$237.86	152% above	66%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 PR CYCLIC CITRULLINATED PEPTIDE ANTIBODY	$144.16	$424.00	$95.82–$237.86	152% above	66%
Antinuclear antibody (ANA) blood test, screen CPT 86038 PR ANTINUCLEAR ANTIBODIES ANA	$80.58	$237.00	$53.56–$132.96	55% above	66%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HCHG ANA	$80.58	$237.00	$53.56–$132.96	55% above	66%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 PR NATRIURETIC PEPTIDE	$169.66	$499.00	$112.77–$279.94	4% above	66%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HCHG PRO-BNP	$246.16	$724.00	$163.62–$406.16	52% above	66%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HCHG BRAIN NATRIURETIC PEPTIDE	$246.16	$724.00	$163.62–$406.16	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG VAG CERV CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG MISCELLANEOUS BACTERIAL CULT	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG WOUND CULTURE AFFILIATE ONLY	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG SPUTUM CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG STERILITY CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG IV CATHETER CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 PR CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG HARDWARE CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG THROAT CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG NASAL CULTURE AFFILIATE ONLY	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG URETHREAL CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG BODY FLUID CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG SPINAL FLUID CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG ENVIRONMENTAL CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG BRONCH CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HCHG TISSUE CULTURE	$107.78	$317.00	$71.64–$177.84	52% above	66%
Basic metabolic panel (blood test) CPT 80048 HCHG BASIC METABOLIC RTR	$65.28	$192.00	$43.39–$107.71	35% below	66%
Basic metabolic panel (blood test) CPT 80048 HCHG BASIC METABOLIC PANEL	$65.28	$192.00	$43.39–$107.71	35% below	66%
Basic metabolic panel (blood test) CPT 80048 PR BASIC METABOLIC PANEL CALCIUM TOTAL	$82.96	$244.00	$55.14–$136.88	17% below	66%
Bilirubin blood test, total CPT 82247 HCHG BILIRUBIN, TOTAL	$59.50	$175.00	$39.55–$98.18	20% above	66%
Bilirubin blood test, total CPT 82247 PR BILIRUBIN TOTAL	$59.50	$175.00	$39.55–$98.18	20% above	66%
Bilirubin blood test, total CPT 82247 HCHG BILIRUBIN, TOTAL BODY FLUID LC	$59.50	$175.00	$39.55–$98.18	20% above	66%
Bilirubin blood test, total CPT 82247 HCHG BILIRUBIN NEONATAL TOTAL AFFILIATE ONLY	$59.50	$175.00	$39.55–$98.18	20% above	66%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HCHG TISSUE LEVEL 4 TECH ONLY	$149.26	$439.00	$99.21–$246.28	5% above	66%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PR LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM	$149.26	$439.00	$99.21–$246.28	5% above	66%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HCHG TISSUE LEVEL IV	$149.26	$439.00	$99.21–$246.28	5% above	66%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HCHG CELL BLOCK	$149.26	$439.00	$99.21–$246.28	5% above	66%
Blood culture for bacteria CPT 87040 PR CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES	$185.64	$546.00	$123.40–$306.31	59% above	66%
Blood culture for bacteria CPT 87040 HCHG BLOOD CULTURE-BACTEC	$185.64	$546.00	$123.40–$306.31	59% above	66%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HCHG ROUTINE VENIPUNCTURE	$19.04	$56.00	$12.66–$31.42	10% below	66%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HCHG VENIPUNCTURE	$19.38	$57.00	$12.88–$31.98	9% below	66%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE	$19.38	$57.00	$12.88–$31.98	9% below	66%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HCHG LEGAL BLOOD ALCOHOL DRAW	$19.38	$57.00	$12.88–$31.98	—	66%
Blood glucose (sugar) test CPT 82947 HCHG GLUCOSE	$54.40	$160.00	$36.16–$89.76	20% above	66%
Blood glucose (sugar) test CPT 82947 PR GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP	$54.40	$160.00	$36.16–$89.76	20% above	66%
Blood glucose (sugar) test CPT 82947 HCHG GLUCOSE TOLERANCE FASTING	$54.40	$160.00	$36.16–$89.76	20% above	66%
Blood glucose (sugar) test CPT 82947 HCHG FASTING GLUCOSE	$64.94	$191.00	$43.17–$107.15	43% above	66%
Blood lead test CPT 83655 HCHG LEAD, FILTER PAPER	$62.56	$184.00	$41.58–$103.22	35% above	66%
Blood lead test CPT 83655 PR ASSAY OF LEAD	$62.56	$184.00	$41.58–$103.22	35% above	66%
Blood lead test CPT 83655 HCHG LEAD, CAPILLARY, BLOOD LC	$62.56	$184.00	$41.58–$103.22	35% above	66%
Blood lead test CPT 83655 HCHG LEAD HEAVY METALS PROFILE II, URINE LC	$62.56	$184.00	$41.58–$103.22	35% above	66%
Blood lead test CPT 83655 HCHG LEAD, BLOOD LC	$62.56	$184.00	$41.58–$103.22	35% above	66%
Blood lead test CPT 83655 (IA) HCHG LEAD TEST	$66.64	$196.00	$44.30–$109.96	44% above	66%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCHG GENERAL LAB 8470300	$112.20	$330.00	$74.58–$185.13	60% above	66%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PR GENERAL LAB 8470300	$112.20	$330.00	$74.58–$185.13	60% above	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG FETAL ABO	$88.40	$260.00	$58.76–$145.86	67% above	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 PR BLOOD TYPING SEROLOGIC ABO	$88.40	$260.00	$58.76–$145.86	67% above	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG ARC-ABO TYPE	$88.40	$260.00	$58.76–$145.86	67% above	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG ABO GROUP	$88.40	$260.00	$58.76–$145.86	67% above	66%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HCHG CORD ABO GROUP	$88.40	$260.00	$58.76–$145.86	67% above	66%
Blood urea nitrogen (BUN) test CPT 84520 HCHG BUN	$50.66	$149.00	$33.67–$83.59	7% above	66%
Blood urea nitrogen (BUN) test CPT 84520 PR ASSAY OF UREA NITROGEN QUANTITATIVE	$50.66	$149.00	$33.67–$83.59	7% above	66%
C-peptide blood test CPT 84681 PR ASSAY OF C-PEPTIDE	$58.82	$173.00	$39.10–$97.05	31% below	66%
C-peptide blood test CPT 84681 HCHG C-PEPTIDE SERUM	$58.82	$173.00	$39.10–$97.05	31% below	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 PR C-REACTIVE PROTEIN	$33.32	$98.00	$22.15–$54.98	46% below	66%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HCHG C-REACTIVE PROTEIN	$50.66	$149.00	$33.67–$83.59	18% below	66%
C. difficile toxin gene test (stool PCR) CPT 87493 HCHG CLOSTRIDIUM DIFF TOXIN PCR	$123.42	$363.00	$82.04–$203.64	11% below	66%
C. difficile toxin gene test (stool PCR) CPT 87493 PR INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE	$123.42	$363.00	$82.04–$203.64	11% below	66%
CA 19-9 blood test (tumor marker) CPT 86301 PR IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9	$226.44	$666.00	$150.52–$373.63	123% above	66%
CA 19-9 blood test (tumor marker) CPT 86301 HCHG CA 19-9	$226.44	$666.00	$150.52–$373.63	123% above	66%
CA-125 blood test (ovarian cancer marker) CPT 86304 PR IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125	$144.84	$426.00	$96.28–$238.99	43% above	66%
CA-125 blood test (ovarian cancer marker) CPT 86304 HCHG CA 125	$216.24	$636.00	$143.74–$356.80	113% above	66%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HCHG COVID 19 MML	$38.08	$112.00	$25.31–$62.83	68% below	66%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HCHG COVID 19 NAA LC	$38.08	$112.00	$25.31–$62.83	68% below	66%
Calcium blood test, total CPT 82310 HCHG CALCIUM	$72.08	$212.00	$47.91–$118.93	51% above	66%
Calcium blood test, total CPT 82310 PR CALCIUM TOTAL	$72.08	$212.00	$47.91–$118.93	51% above	66%
Carcinoembryonic antigen (CEA) test CPT 82378 PR CARCINOEMBRYONIC ANTIGEN CEA	$144.84	$426.00	$96.28–$238.99	45% above	66%
Carcinoembryonic antigen (CEA) test CPT 82378 HCHG CEA	$194.14	$571.00	$129.05–$320.33	94% above	66%
Chickenpox (varicella) immunity blood test CPT 86787 PR ANTIBODY VARICELLA-ZOSTER	$42.84	$126.00	$28.48–$70.69	21% below	66%
Chickenpox (varicella) immunity blood test CPT 86787 HCHG VARICELLA-ZOSTER AB, IGM LC	$42.84	$126.00	$28.48–$70.69	21% below	66%
Chickenpox (varicella) immunity blood test CPT 86787 HCHG VZV IMMUNE ASSAY	$42.84	$126.00	$28.48–$70.69	21% below	66%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HCHG GENERAL LAB 8749101	$56.78	$167.00	$37.74–$93.69	41% below	66%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HCHG GENERAL LAB 8749100	$56.78	$167.00	$37.74–$93.69	41% below	66%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 PR GENERAL LAB 8749100	$56.78	$167.00	$37.74–$93.69	41% below	66%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 PR LIPID PANEL	$64.60	$190.00	$42.94–$106.59	31% below	66%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HCHG LIPID PANEL	$64.60	$190.00	$42.94–$106.59	31% below	66%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HCHG LIPID PANEL LCC	$64.60	$190.00	$42.94–$106.59	31% below	66%
Complete blood count (CBC) with differential CPT 85025 HCHG CBC W/DIFF	$44.20	$130.00	$29.38–$72.93	47% below	66%
Complete blood count (CBC) with differential CPT 85025 PR BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC	$50.66	$149.00	$33.67–$83.59	39% below	66%
Complete blood count (CBC), no differential CPT 85027 HCHG CBC	$41.82	$123.00	$27.80–$69.00	41% below	66%
Complete blood count (CBC), no differential CPT 85027 PR BLOOD COUNT COMPLETE AUTOMATED	$46.58	$137.00	$30.96–$76.86	34% below	66%
Comprehensive metabolic panel (blood test) CPT 80053 PR COMPREHENSIVE METABOLIC PANEL	$72.76	$214.00	$48.36–$120.05	37% below	66%
Comprehensive metabolic panel (blood test) CPT 80053 HCHG COMPREHENSIVE METABOLIC PANE	$72.76	$214.00	$48.36–$120.05	37% below	66%
Cortisol blood test, total CPT 82533 PR CORTISOL TOTAL	$109.82	$323.00	$73.00–$181.20	59% above	66%
Cortisol blood test, total CPT 82533 HCHG DEXAMETHASONE SUPP	$109.82	$323.00	$73.00–$181.20	59% above	66%
Cortisol blood test, total CPT 82533 HCHG SALIVARY CORTISOL LC	$109.82	$323.00	$73.00–$181.20	59% above	66%
Cortisol blood test, total CPT 82533 HCHG CORTISOL	$109.82	$323.00	$73.00–$181.20	59% above	66%
Creatine kinase (CK) blood test, total CPT 82550 HCHG CK TOTAL	$39.10	$115.00	$25.99–$64.52	34% below	66%
Creatine kinase (CK) blood test, total CPT 82550 PR CREATINE KINASE TOTAL	$39.10	$115.00	$25.99–$64.52	34% below	66%
Creatinine blood test CPT 82565 PR CREATININE BLOOD	$52.70	$155.00	$35.03–$86.96	6% above	66%
Creatinine blood test CPT 82565 HCHG CREATININE POCT	$52.70	$155.00	$35.03–$86.96	6% above	66%
Creatinine blood test CPT 82565 HCHG CREATININE	$52.70	$155.00	$35.03–$86.96	6% above	66%
Cytomegalovirus (CMV) antibody test CPT 86644 HCHG CMV IGG ABY	$70.72	$208.00	$47.01–$116.69	9% above	66%
Cytomegalovirus (CMV) antibody test CPT 86644 PR ANTIBODY CYTOMEGALOVIRUS CMV	$70.72	$208.00	$47.01–$116.69	9% above	66%
D-dimer blood test (blood clot marker) CPT 85379 HCHG D-DIMER QUANT	$139.06	$409.00	$92.43–$229.45	34% above	66%
D-dimer blood test (blood clot marker) CPT 85379 PR FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE	$139.06	$409.00	$92.43–$229.45	34% above	66%
DHEA sulfate (DHEA-S) blood test CPT 82627 PR DEHYDROEPIANDROSTERONE-SULFATE	$42.16	$124.00	$28.02–$69.56	27% below	66%
DHEA sulfate (DHEA-S) blood test CPT 82627 HCHG DHEA-SULFATE	$42.16	$124.00	$28.02–$69.56	27% below	66%
DHEA sulfate (DHEA-S) blood test CPT 82627 HCHG DHEA-SULFATE (DHEA-S) LCC	$42.16	$124.00	$28.02–$69.56	27% below	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG BUPRENORPHINE QUANTITATIVE URINE QUEST	$73.78	$217.00	$49.04–$121.74	2% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG DRUGS OF ABUSE WB 11	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG MECONIUM DRUG SCREEN HCMC	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG DRUGS OF ABUSE URINE MATERNITY NEWBORN D33	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG NICOTINE SCREEN URINE	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG FLUNITRAZEPAM SCREEN URINE	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG GAMMA HYDROXYBUTYRIC ACID (GHB), URINE	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG DRUG SCREEN BLOOD DSS	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG LIMITED COMPLIANCE DRUG SCREEN	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG GAMMA-HYDROXYBUTYRIC ACID (GHB)	$131.24	$386.00	$87.24–$216.55	82% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 PR DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE	$137.70	$405.00	$91.53–$227.20	91% above	66%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HCHG COMPLIANCE DRUG ANALYSIS CDS	$139.40	$410.00	$92.66–$230.01	93% above	66%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HCHG ELECTROLYTE PANEL	$72.08	$212.00	$47.91–$118.93	1% below	66%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 PR ELECTROLYTE PANEL	$94.52	$278.00	$62.83–$155.96	30% above	66%
Epstein-Barr virus (EBV) antibody test CPT 86665 HCHG EBV VCA IGM	$131.92	$388.00	$87.69–$217.67	126% above	66%
Epstein-Barr virus (EBV) antibody test CPT 86665 PR ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA	$131.92	$388.00	$87.69–$217.67	126% above	66%
Epstein-Barr virus (EBV) antibody test CPT 86665 HCHG EBV VCA IGG	$131.92	$388.00	$87.69–$217.67	126% above	66%
Estradiol blood test CPT 82670 PR ASSAY OF ESTRADIOL	$53.38	$157.00	$35.48–$88.08	20% below	66%
Estradiol blood test CPT 82670 HCHG ESTRADIOL LCC	$64.94	$191.00	$43.17–$107.15	2% below	66%
Estradiol blood test CPT 82670 HCHG ESTRADIOL, LC/MS (ENDOCRINE SCIENCES) LC	$64.94	$191.00	$43.17–$107.15	2% below	66%
Estradiol blood test CPT 82670 HCHG ESTRADIOL SERUM	$64.94	$191.00	$43.17–$107.15	2% below	66%
FSH (follicle-stimulating hormone) test CPT 83001 HCHG FSH LCC	$70.72	$208.00	$47.01–$116.69	16% below	66%
FSH (follicle-stimulating hormone) test CPT 83001 HCHG FSH-SERUM	$70.72	$208.00	$47.01–$116.69	16% below	66%
FSH (follicle-stimulating hormone) test CPT 83001 PR GONADOTROPIN FOLLICLE STIMULATING HORMONE	$93.84	$276.00	$62.38–$154.84	12% above	66%
Fecal calprotectin (stool inflammation test) CPT 83993 PR ASSAY OF CALPROTECTIN FECAL	$302.26	$889.00	$200.91–$498.73	231% above	66%
Fecal calprotectin (stool inflammation test) CPT 83993 HCHG CALPROTECTIN, FECAL LC	$302.26	$889.00	$200.91–$498.73	231% above	66%
Ferritin blood test (iron stores) CPT 82728 PR ASSAY OF FERRITIN	$71.40	$210.00	$47.46–$117.81	26% below	66%
Ferritin blood test (iron stores) CPT 82728 HCHG FERRITIN	$133.62	$393.00	$88.82–$220.47	38% above	66%
Fibrinogen blood test CPT 85384 HCHG FIBRINOGEN QUANTITATIVE	$88.74	$261.00	$58.99–$146.42	84% above	66%
Fibrinogen blood test CPT 85384 PR FIBRINOGEN ACTIVITY	$88.74	$261.00	$58.99–$146.42	84% above	66%
Folate (folic acid) blood test CPT 82746 HCHG FOLIC ACID	$46.24	$136.00	$30.74–$76.30	47% below	66%
Folate (folic acid) blood test CPT 82746 PR ASSAY OF FOLIC ACID SERUM	$46.24	$136.00	$30.74–$76.30	47% below	66%
Free T3 thyroid hormone test CPT 84481 HCHG T3, FREE	$70.72	$208.00	$47.01–$116.69	34% below	66%
Free T3 thyroid hormone test CPT 84481 PR ASSAY OF TRIIODOTHYRONINE T3 FREE	$70.72	$208.00	$47.01–$116.69	34% below	66%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HCHG T4, FREE	$70.38	$207.00	$46.78–$116.13	2% above	66%
Free T4 (free thyroxine) thyroid blood test CPT 84439 PR ASSAY OF FREE THYROXINE	$70.38	$207.00	$46.78–$116.13	2% above	66%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HCHG T4,FREE LCC	$70.38	$207.00	$46.78–$116.13	2% above	66%
Free testosterone test CPT 84402 PR ASSAY OF TESTOSTERONE FREE	$61.54	$181.00	$40.91–$101.54	3% below	66%
Free testosterone test CPT 84402 HCHG TESTOSTERONE FREE LC	$123.76	$364.00	$82.26–$204.20	95% above	66%
Free testosterone test CPT 84402 HCHG TESTOSTERONE, FREE, EQUILIBRIUM ULTRAFILTRATION LC	$123.76	$364.00	$82.26–$204.20	95% above	66%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 PR ASSAY OF GLUTAMYLTRASE GAMMA	$46.24	$136.00	$30.74–$76.30	at median	66%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HCHG GAMMA GT	$55.08	$162.00	$36.61–$90.88	19% above	66%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 PR GENERAL HEALTH PANEL	$168.30	$495.00	$111.87–$277.70	34% below	66%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HCHG GENERAL HEALTH PANEL AFFILIATE ONLY	$168.30	$495.00	$111.87–$277.70	34% below	66%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 PR GLUCOSE POST GLUCOSE DOSE	$54.40	$160.00	$36.16–$89.76	29% above	66%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HCHG GLUCOSE 2 HOUR	$54.40	$160.00	$36.16–$89.76	29% above	66%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HCHG GLUCOSE, GESTATIONAL	$54.40	$160.00	$36.16–$89.76	29% above	66%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HCHG GLUCOSE 2HPP	$62.90	$185.00	$41.81–$103.78	49% above	66%
Glucose tolerance test, 3 samples CPT 82951 HCHG GTT	$360.74	$1,061.00	$239.79–$595.22	255% above	66%
Glucose tolerance test, 3 samples CPT 82951 PR GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS	$360.74	$1,061.00	$239.79–$595.22	255% above	66%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HCHG GENERAL LAB 8759100	$123.42	$363.00	$82.04–$203.64	43% above	66%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 PR GENERAL LAB 8759100	$123.42	$363.00	$82.04–$203.64	43% above	66%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HCHG GENERAL LAB 8759102	$123.42	$363.00	$82.04–$203.64	43% above	66%
H. pylori antibody blood test CPT 86677 PR ANTIBODY HELICOBACTER PYLORI	$64.60	$190.00	$42.94–$106.59	50% below	66%
H. pylori antibody blood test CPT 86677 HCHG HELICOBACTER PYLORI IGG AFFILIATE ONLY	$64.60	$190.00	$42.94–$106.59	50% below	66%
H. pylori stool antigen test CPT 87338 HCHG H. PYLORI ANTIGEN, STOOL	$53.04	$156.00	$35.26–$87.52	53% below	66%
H. pylori stool antigen test CPT 87338 PR IAAD IA HPYLORI STOOL	$53.04	$156.00	$35.26–$87.52	53% below	66%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HCHG GENERAL LAB 8753600	$294.44	$866.00	$195.72–$485.83	156% above	66%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 PR GENERAL LAB 8753601	$294.44	$866.00	$195.72–$485.83	156% above	66%
HIV-1 and HIV-2 antibody test CPT 86703 PR GENERAL LAB 8670300	$42.16	$124.00	$28.02–$69.56	37% below	66%
HIV-1 and HIV-2 antibody test CPT 86703 HCHG GENERAL LAB 8670301	$42.16	$124.00	$28.02–$69.56	37% below	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HCHG GENERAL LAB 8738900	$59.50	$175.00	$39.55–$98.18	23% below	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 PR GENERAL LAB 8738900	$59.50	$175.00	$39.55–$98.18	23% below	66%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HCHG ANTI HIV 1/2 LCC	$59.50	$175.00	$39.55–$98.18	23% below	66%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HCHG GENERAL LAB 8762400	$98.60	$290.00	$65.54–$162.69	23% below	66%
HPV test for high-risk types, one combined (pooled) result CPT 87624 PR GENERAL LAB 8762400	$98.60	$290.00	$65.54–$162.69	23% below	66%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HCHG HEMOGLOBIN A1C	$62.56	$184.00	$41.58–$103.22	3% below	66%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 PR HEMOGLOBIN GLYCOSYLATED A1C	$73.10	$215.00	$48.59–$120.62	14% above	66%
Hemoglobin blood test CPT 85018 HCHG BLOOD GAS HGB	$66.64	$196.00	$44.30–$109.96	96% above	66%
Hemoglobin blood test CPT 85018 PR BLOOD COUNT HEMOGLOBIN	$66.64	$196.00	$44.30–$109.96	96% above	66%
Hemoglobin blood test CPT 85018 HCHG HEMOGLOBIN	$66.64	$196.00	$44.30–$109.96	96% above	66%
Hepatitis B core antibody test (total) CPT 86704 HCHG GENERAL LAB 8670400	$91.46	$269.00	$60.79–$150.91	29% above	66%
Hepatitis B core antibody test (total) CPT 86704 PR GENERAL LAB 8670400	$91.46	$269.00	$60.79–$150.91	29% above	66%
Hepatitis B core antibody test (total) CPT 86704 HCHG GENERAL LAB 8670403 LCC	$106.42	$313.00	$70.74–$175.59	50% above	66%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 PR GENERAL LAB 8670600	$70.38	$207.00	$46.78–$116.13	4% below	66%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HCHG GENERAL LAB 8670600	$70.38	$207.00	$46.78–$116.13	4% below	66%
Hepatitis B surface antigen (HBsAg) test CPT 87340 PR GENERAL LAB 8734000	$50.66	$149.00	$33.67–$83.59	15% below	66%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HCHG GENERAL LAB 8734000	$50.66	$149.00	$33.67–$83.59	15% below	66%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HCHG HBSAG LCC	$50.66	$149.00	$33.67–$83.59	15% below	66%
Hepatitis C antibody blood test (screening) CPT 86803 PR GENERAL LAB 8680300	$96.90	$285.00	$64.41–$159.88	at median	66%
Hepatitis C antibody blood test (screening) CPT 86803 HCHG ANTI HCV LCC	$96.90	$285.00	$64.41–$159.88	at median	66%
Hepatitis C antibody blood test (screening) CPT 86803 HCHG GENERAL LAB 8680300	$96.90	$285.00	$64.41–$159.88	at median	66%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCHG GENERAL LAB 8752200	$143.48	$422.00	$95.37–$236.74	12% above	66%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCHG GENERAL LAB 87522 LCC	$143.48	$422.00	$95.37–$236.74	12% above	66%
Hepatitis C viral load (HCV RNA) test CPT 87522 PR GENERAL LAB 8752200	$143.48	$422.00	$95.37–$236.74	12% above	66%
Herpes blood test, HSV-1 antibody CPT 86695 PR GENERAL LAB 8669500	$26.18	$77.00	$17.40–$43.20	46% below	66%
Herpes blood test, HSV-1 antibody CPT 86695 HCHG GENERAL LAB 8669500	$26.86	$79.00	$17.85–$44.32	45% below	66%
Herpes blood test, HSV-2 antibody CPT 86696 HCHG GENERAL LAB 8669600	$42.84	$126.00	$28.48–$70.69	26% below	66%
Herpes blood test, HSV-2 antibody CPT 86696 PR GENERAL LAB 8669600	$42.84	$126.00	$28.48–$70.69	26% below	66%
High-sensitivity CRP (hs-CRP) test CPT 86141 HCHG HIGH SENS CRP	$77.18	$227.00	$51.30–$127.35	3% above	66%
High-sensitivity CRP (hs-CRP) test CPT 86141 PR C-REACTIVE PROTEIN HIGH SENSITIVITY	$77.18	$227.00	$51.30–$127.35	3% above	66%
Homocysteine blood test CPT 83090 HCHG HOMOCYSTEINE, CARDIAC	$174.08	$512.00	$115.71–$287.23	81% above	66%
Homocysteine blood test CPT 83090 PR ASSAY OF HOMOCYSTEINE	$174.08	$512.00	$115.71–$287.23	81% above	66%
Insulin blood test CPT 83525 HCHG INSULIN	$42.84	$126.00	$28.48–$70.69	25% below	66%
Insulin blood test CPT 83525 PR ASSAY OF INSULIN TOTAL	$42.84	$126.00	$28.48–$70.69	25% below	66%
Iron blood test (serum iron) CPT 83540 PR ASSAY OF IRON	$71.40	$210.00	$47.46–$117.81	38% above	66%
Iron blood test (serum iron) CPT 83540 HCHG IRON	$71.40	$210.00	$47.46–$117.81	38% above	66%
Iron-binding capacity (TIBC) test CPT 83550 PR IRON BINDING CAPACITY	$36.04	$106.00	$23.96–$59.47	47% below	66%
Iron-binding capacity (TIBC) test CPT 83550 HCHG IRON BINDING CAPACITY (IBC)	$36.04	$106.00	$23.96–$59.47	47% below	66%
Kidney function blood test panel CPT 80069 HCHG RENAL FUNCTION PANEL	$71.40	$210.00	$47.46–$117.81	32% below	66%
Kidney function blood test panel CPT 80069 PR RENAL FUNCTION PANEL	$71.40	$210.00	$47.46–$117.81	32% below	66%
LH (luteinizing hormone) test CPT 83002 HCHG LUTEINIZING HORMONE LCC	$160.48	$472.00	$106.67–$264.79	89% above	66%
LH (luteinizing hormone) test CPT 83002 PR GONADOTROPIN LUTEINIZING HORMONE	$160.48	$472.00	$106.67–$264.79	89% above	66%
LH (luteinizing hormone) test CPT 83002 HCHG LUTEINIZING HORMONE	$160.48	$472.00	$106.67–$264.79	89% above	66%
Lactate (lactic acid) blood test CPT 83605 PR ASSAY OF LACTATE	$52.70	$155.00	$35.03–$86.96	37% below	66%
Lactate (lactic acid) blood test CPT 83605 HCHG LACTATE, CSF	$52.70	$155.00	$35.03–$86.96	37% below	66%
Lactate (lactic acid) blood test CPT 83605 HCHG LACTATE BLOOD	$52.70	$155.00	$35.03–$86.96	37% below	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 HCHG LD, TOTAL	$103.36	$304.00	$68.70–$170.54	107% above	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 HCHG LD, BODY FLUID	$103.36	$304.00	$68.70–$170.54	107% above	66%
Lactate dehydrogenase (LDH) blood test CPT 83615 PR LACTATE DEHYDROGENASE LDH	$103.36	$304.00	$68.70–$170.54	107% above	66%
Lipase blood test (pancreas enzyme) CPT 83690 HCHG LIPASE	$64.60	$190.00	$42.94–$106.59	2% below	66%
Lipase blood test (pancreas enzyme) CPT 83690 PR ASSAY OF LIPASE	$64.60	$190.00	$42.94–$106.59	2% below	66%
Liver function blood test panel CPT 80076 PR HEPATIC FUNCTION PANEL	$112.88	$332.00	$75.03–$186.25	11% above	66%
Liver function blood test panel CPT 80076 HCHG HEPATIC FUNCTION PANEL	$155.72	$458.00	$103.51–$256.94	53% above	66%
Lyme disease antibody test CPT 86618 HCHG LYME (FIA) POLYVALENT	$64.60	$190.00	$42.94–$106.59	12% below	66%
Lyme disease antibody test CPT 86618 PR ANTIBODY BORRELIA BURGDORFERI LYME DISEASE	$64.60	$190.00	$42.94–$106.59	12% below	66%
Lyme disease antibody test CPT 86618 HCHG LYME NO REFLEX	$64.60	$190.00	$42.94–$106.59	12% below	66%
Magnesium blood test CPT 83735 HCHG MAGNESIUM URINE LC	$64.60	$190.00	$42.94–$106.59	55% above	66%
Magnesium blood test CPT 83735 PR ASSAY OF MAGNESIUM	$64.60	$190.00	$42.94–$106.59	55% above	66%
Magnesium blood test CPT 83735 HCHG MAGNESIUM BLOOD	$64.60	$190.00	$42.94–$106.59	55% above	66%
Measles (rubeola) antibody test CPT 86765 HCHG RUBEOLA IMMUNITY	$12.92	$38.00	$8.59–$21.32	69% below	66%
Measles (rubeola) antibody test CPT 86765 PR ANTIBODY RUBEOLA	$12.92	$38.00	$8.59–$21.32	69% below	66%
Mono test (heterophile antibody, Monospot) CPT 86308 PR HETEROPHILE ANTIBODIES SCREEN	$102.68	$302.00	$68.25–$169.42	90% above	66%
Mono test (heterophile antibody, Monospot) CPT 86308 HCHG HETEROPHILE	$102.68	$302.00	$68.25–$169.42	90% above	66%
Mumps immunity blood test CPT 86735 HCHG MUMPS ANTIBODIES, IGM LC	$14.96	$44.00	$9.94–$24.68	71% below	66%
Mumps immunity blood test CPT 86735 HCHG MUMPS IGG	$47.94	$141.00	$31.87–$79.10	8% below	66%
Mumps immunity blood test CPT 86735 PR ANTIBODY MUMPS	$47.94	$141.00	$31.87–$79.10	8% below	66%
Obstetric blood test panel CPT 80055 PR OBSTETRIC PANEL	$73.44	$216.00	$48.82–$121.18	74% below	66%
PSA (prostate-specific antigen) blood test, free CPT 84154 HCHG PSA,FREE	$125.80	$370.00	$83.62–$207.57	118% above	66%
PSA (prostate-specific antigen) blood test, free CPT 84154 PR ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE	$125.80	$370.00	$83.62–$207.57	118% above	66%
PSA (prostate-specific antigen) blood test, free CPT 84154 HCHG PSA,FREE LCC	$125.80	$370.00	$83.62–$207.57	118% above	66%
PSA (prostate-specific antigen) blood test, total CPT 84153 HCHG PSA-DIAGNOSTIC	$97.58	$287.00	$64.86–$161.01	9% above	66%
PSA (prostate-specific antigen) blood test, total CPT 84153 PR ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$97.58	$287.00	$64.86–$161.01	9% above	66%
PSA (prostate-specific antigen) blood test, total CPT 84153 HCHG PSA,TOTAL LCC	$97.58	$287.00	$64.86–$161.01	9% above	66%
Pap test (liquid-based, automated screening with review) CPT 88175 PR CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS	$63.58	$187.00	$42.26–$104.91	25% below	66%
Pap test (liquid-based, automated screening with review) CPT 88175 HCHG IMAGED THIN PREP PAP DIAGNOSTIC	$63.58	$187.00	$42.26–$104.91	25% below	66%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PR CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN	$67.32	$198.00	$44.75–$111.08	13% below	66%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HCHG THIN PREP PAP DIAGNOSTIC	$67.32	$198.00	$44.75–$111.08	13% below	66%
Parathyroid hormone (PTH) blood test CPT 83970 PR ASSAY OF PARATHORMONE	$97.58	$287.00	$64.86–$161.01	19% below	66%
Parathyroid hormone (PTH) blood test CPT 83970 HCHG PTH INTACT	$97.58	$287.00	$64.86–$161.01	19% below	66%
Partial thromboplastin time (PTT) clotting test CPT 85730 HCHG ACTIVATED PTT	$64.94	$191.00	$43.17–$107.15	4% above	66%
Partial thromboplastin time (PTT) clotting test CPT 85730 HCHG PTT-LA SCREEN	$64.94	$191.00	$43.17–$107.15	4% above	66%
Partial thromboplastin time (PTT) clotting test CPT 85730 PR THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD	$64.94	$191.00	$43.17–$107.15	4% above	66%
Phosphorus (phosphate) blood test CPT 84100 HCHG PHOSPHORUS	$77.18	$227.00	$51.30–$127.35	98% above	66%
Phosphorus (phosphate) blood test CPT 84100 PR ASSAY OF PHOSPHORUS INORGANIC	$77.18	$227.00	$51.30–$127.35	98% above	66%
Potassium blood test CPT 84132 PR POTASSIUM SERUM PLASMA/WHOLE BLOOD	$39.10	$115.00	$25.99–$64.52	13% below	66%
Potassium blood test CPT 84132 HCHG POTASSIUM POCT	$39.10	$115.00	$25.99–$64.52	13% below	66%
Potassium blood test CPT 84132 HCHG POTASSIUM	$39.10	$115.00	$25.99–$64.52	13% below	66%
Progesterone blood test CPT 84144 PR ASSAY OF PROGESTERONE	$41.82	$123.00	$27.80–$69.00	51% below	66%
Progesterone blood test CPT 84144 HCHG PROGESTERONE BLOOD	$41.82	$123.00	$27.80–$69.00	51% below	66%
Progesterone blood test CPT 84144 HCHG PROGESTERONE LCC	$41.82	$123.00	$27.80–$69.00	51% below	66%
Prolactin blood test CPT 84146 HCHG PROLACTIN	$47.94	$141.00	$31.87–$79.10	48% below	66%
Prolactin blood test CPT 84146 PR ASSAY OF PROLACTIN	$47.94	$141.00	$31.87–$79.10	48% below	66%
Prolactin blood test CPT 84146 HCHG PROLACTIN LCC	$48.96	$144.00	$32.54–$80.78	47% below	66%
Prothrombin time (PT/INR) clotting test CPT 85610 HCHG PROTHOMBIN TIME	$39.10	$115.00	$25.99–$64.52	20% above	66%
Prothrombin time (PT/INR) clotting test CPT 85610 PR PROTHROMBIN TIME	$39.10	$115.00	$25.99–$64.52	20% above	66%
Prothrombin time (PT/INR) clotting test CPT 85610 HCHG INR POCT	$39.10	$115.00	$25.99–$64.52	20% above	66%
Rapid flu test (influenza antigen) CPT 87804 PR IAADIADOO INFLUENZA	$49.30	$145.00	$32.77–$81.34	20% below	66%
Rapid flu test (influenza antigen) CPT 87804 HCHG INFLUENZA A&B	$49.30	$145.00	$32.77–$81.34	20% below	66%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HCHG RAPID STREP A THROAT-SAT	$87.72	$258.00	$58.31–$144.74	61% above	66%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 PR IAADIADOO STREPTOCOCCUS GROUP A	$87.72	$258.00	$58.31–$144.74	61% above	66%
Renin blood test CPT 84244 HCHG RENIN ACTIVITY, PLASMA LC	$37.40	$110.00	$24.86–$61.71	20% below	66%
Renin blood test CPT 84244 PR ASSAY OF RENIN	$37.40	$110.00	$24.86–$61.71	20% below	66%
Rh blood typing CPT 86901 PR BLOOD TYPING SEROLOGIC RH (D)	$23.46	$69.00	$15.59–$38.71	46% below	66%
Rh blood typing CPT 86901 HCHG WEAK DU	$23.46	$69.00	$15.59–$38.71	46% below	66%
Rh blood typing CPT 86901 HCHG CORD RH TYPE	$23.46	$69.00	$15.59–$38.71	46% below	66%
Rh blood typing CPT 86901 HCHG FETAL WEAK D	$23.46	$69.00	$15.59–$38.71	46% below	66%
Rh blood typing CPT 86901 HCHG CORD WEAK D	$23.46	$69.00	$15.59–$38.71	46% below	66%
Rh blood typing CPT 86901 HCHG FETAL RH TYPE	$23.46	$69.00	$15.59–$38.71	46% below	66%
Rh blood typing CPT 86901 HCHG RH (D) TYPE	$57.80	$170.00	$38.42–$95.37	33% above	66%
Rheumatoid factor (RF) test CPT 86431 PR RHEUMATOID FACTOR QUANTITATIVE	$77.18	$227.00	$51.30–$127.35	58% above	66%
Rheumatoid factor (RF) test CPT 86431 HCHG RA QUANT	$77.18	$227.00	$51.30–$127.35	58% above	66%
Rubella antibody test (immunity check) CPT 86762 HCHG RUBELLA IMMUNE STATUS	$31.96	$94.00	$21.24–$52.73	34% below	66%
Rubella antibody test (immunity check) CPT 86762 PR ANTIBODY RUBELLA	$31.96	$94.00	$21.24–$52.73	34% below	66%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 PR SEDIMENTATION RATE RBC AUTOMATED	$58.82	$173.00	$39.10–$97.05	51% above	66%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HCHG SED RATE	$70.38	$207.00	$46.78–$116.13	81% above	66%
Sodium blood test CPT 84295 HCHG SODIUM	$77.18	$227.00	$51.30–$127.35	75% above	66%
Sodium blood test CPT 84295 PR SODIUM SERUM PLASMA OR WHOLE BLOOD	$77.18	$227.00	$51.30–$127.35	75% above	66%
Stool ova and parasites exam CPT 87177 PR OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID	$88.40	$260.00	$58.76–$145.86	83% above	66%
Stool ova and parasites exam CPT 87177 (IA) HCHG O&P CONCENTRATE	$88.40	$260.00	$58.76–$145.86	83% above	66%
Stool ova and parasites exam CPT 87177 HCHG O&P EXAM LC	$88.40	$260.00	$58.76–$145.86	83% above	66%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HCHG OCCULT BLOOD, IFOBT	$46.24	$136.00	$30.74–$76.30	20% below	66%
Syphilis antibody test (Treponema pallidum) CPT 86780 PR GENERAL LAB 8678001	$149.26	$439.00	$99.21–$246.28	174% above	66%
Syphilis antibody test (Treponema pallidum) CPT 86780 HCHG GENERAL LAB 8678000	$149.26	$439.00	$99.21–$246.28	174% above	66%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HCHG GENERAL LAB 8678001	$149.94	$441.00	$99.67–$247.40	—	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HCHG GENERAL LAB 8659201	$42.16	$124.00	$28.02–$69.56	27% above	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 PR GENERAL LAB 8659200	$42.16	$124.00	$28.02–$69.56	27% above	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HCHG GENERAL LAB 8659200	$42.16	$124.00	$28.02–$69.56	27% above	66%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HCHG GENERAL LAB 8659203	$42.16	$124.00	$28.02–$69.56	27% above	66%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 PR TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON	$94.18	$277.00	$62.60–$155.40	21% below	66%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HCHG QUANTIFERON TB GOLD PLUS	$94.18	$277.00	$62.60–$155.40	21% below	66%
Testosterone blood test, total (not free testosterone) CPT 84403 HCHG TESTOSTERONE	$61.54	$181.00	$40.91–$101.54	6% below	66%
Testosterone blood test, total (not free testosterone) CPT 84403 PR ASSAY OF TESTOSTERONE TOTAL	$61.54	$181.00	$40.91–$101.54	6% below	66%
Testosterone blood test, total (not free testosterone) CPT 84403 HCHG TOTAL TESTOSTERONE, LC	$61.54	$181.00	$40.91–$101.54	6% below	66%
Thyroid peroxidase (TPO) antibody test CPT 86376 PR MICROSOMAL ANTIBODIES EACH	$109.48	$322.00	$72.77–$180.64	95% above	66%
Thyroid peroxidase (TPO) antibody test CPT 86376 HCHG THY PEROXIDASE ABY	$109.48	$322.00	$72.77–$180.64	95% above	66%
Thyroid peroxidase (TPO) antibody test CPT 86376 HCHG LIVER-KIDNEY MICROSOMAL AB LC	$109.48	$322.00	$72.77–$180.64	95% above	66%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HCHG TSH	$60.86	$179.00	$40.45–$100.42	37% below	66%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 PR ASSAY OF THYROID STIMULATING HORMONE TSH	$60.86	$179.00	$40.45–$100.42	37% below	66%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HCHG TSH LCC	$60.86	$179.00	$40.45–$100.42	37% below	66%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HCHG CONGENITAL HYPOTHYROIDISM	$60.86	$179.00	$40.45–$100.42	37% below	66%
Total IgE blood test CPT 82785 HCHG IGE	$34.00	$100.00	$22.60–$56.10	37% below	66%
Total IgE blood test CPT 82785 PR ASSAY OF GAMMAGLOBULIN IGE	$34.00	$100.00	$22.60–$56.10	37% below	66%
Total cholesterol blood test CPT 82465 PR CHOLESTEROL SERUM/WHOLE BLOOD TOTAL	$52.70	$155.00	$35.03–$86.96	48% above	66%
Total cholesterol blood test CPT 82465 HCHG CHOLESTEROL BODY FLUID	$52.70	$155.00	$35.03–$86.96	48% above	66%
Total cholesterol blood test CPT 82465 HCHG CHOLESTEROL	$52.70	$155.00	$35.03–$86.96	48% above	66%
Total thyroxine (T4) blood test CPT 84436 PR ASSAY OF THYROXINE TOTAL	$89.08	$262.00	$59.21–$146.98	112% above	66%
Total thyroxine (T4) blood test CPT 84436 HCHG T4 (THYROXINE)	$89.08	$262.00	$59.21–$146.98	112% above	66%
Total triiodothyronine (T3) blood test CPT 84480 PR ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3	$62.56	$184.00	$41.58–$103.22	12% below	66%
Total triiodothyronine (T3) blood test CPT 84480 HCHG T3 TOTAL	$62.56	$184.00	$41.58–$103.22	12% below	66%
Total triiodothyronine (T3) blood test CPT 84480 HCHG T3 TOTAL LCC	$62.56	$184.00	$41.58–$103.22	12% below	66%
Transferrin blood test CPT 84466 HCHG TRANSFERRIN (IBC)	$52.70	$155.00	$35.03–$86.96	31% below	66%
Transferrin blood test CPT 84466 PR ASSAY OF L7383TRANSFERRIN	$52.70	$155.00	$35.03–$86.96	31% below	66%
Trichomonas test (NAAT) CPT 87661 PR GENERAL LAB 8766100	$68.34	$201.00	$45.43–$112.76	36% above	66%
Trichomonas test (NAAT) CPT 87661 HCHG GENERAL LAB 8766103	$68.34	$201.00	$45.43–$112.76	36% above	66%
Trichomonas test (NAAT) CPT 87661 HCHG GENERAL LAB 87661 AFFILIATE ONLY	$68.34	$201.00	$45.43–$112.76	36% above	66%
Triglycerides blood test CPT 84478 HCHG TRIGLYCERIDES	$89.08	$262.00	$59.21–$146.98	105% above	66%
Triglycerides blood test CPT 84478 HCHG TRIGLYCERIDES, FLUID LC	$89.08	$262.00	$59.21–$146.98	105% above	66%
Triglycerides blood test CPT 84478 HCHG TRIGLYCERIDE BODY FLUID	$89.08	$262.00	$59.21–$146.98	105% above	66%
Triglycerides blood test CPT 84478 PR ASSAY OF TRIGLYCERIDES	$89.08	$262.00	$59.21–$146.98	105% above	66%
Troponin test, quantitative CPT 84484 HCHG TROPONIN I	$98.60	$290.00	$65.54–$162.69	2% below	66%
Troponin test, quantitative CPT 84484 PR ASSAY OF TROPONIN QUANTITATIVE	$98.60	$290.00	$65.54–$162.69	2% below	66%
Troponin test, quantitative CPT 84484 HCHG TROPONIN T	$98.60	$290.00	$65.54–$162.69	2% below	66%
Uric acid blood test CPT 84550 HCHG URIC ACID	$129.54	$381.00	$86.11–$213.74	184% above	66%
Uric acid blood test CPT 84550 PR ASSAY OF BLOOD/URIC ACID	$129.54	$381.00	$86.11–$213.74	184% above	66%
Urinalysis with microscope exam, automated CPT 81001 PR URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY	$41.82	$123.00	$27.80–$69.00	18% below	66%
Urinalysis with microscope exam, automated CPT 81001 HCHG URINALYSIS COMPLETE	$41.82	$123.00	$27.80–$69.00	18% below	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG SPECIFIC GRAVITY URINE	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG PROTEIN QUAL URINE	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG URINALYSIS	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG BILIRUBIN URINE	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG GLUCOSE QUAL URINE	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG KETONES URINE	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG PH URINE	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG UA MULTI	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG URINALYSIS RTR	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 PR URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, automated CPT 81003 HCHG URINALYSIS WO MICRO	$39.44	$116.00	$26.22–$65.08	53% above	66%
Urinalysis without microscope exam, manual CPT 81002 PR URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$10.88	$32.00	$7.23–$17.95	51% below	66%
Urinalysis without microscope exam, manual inpatient CPT 81002 PR URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP	$10.88	$32.00	$7.23–$17.95	—	66%
Urine culture for bacteria, with colony count CPT 87086 HCHG URINE CULTURE	$24.14	$71.00	$16.05–$39.83	58% below	66%
Urine culture for bacteria, with colony count CPT 87086 PR CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE	$24.14	$71.00	$16.05–$39.83	58% below	66%
Urine microalbumin (albumin) test CPT 82043 PR URINE ALBUMIN QUANTITATIVE	$30.26	$89.00	$20.11–$49.93	48% below	66%
Urine microalbumin (albumin) test CPT 82043 HCHG URINE ALBUMIN,24HR	$30.26	$89.00	$20.11–$49.93	48% below	66%
Urine microalbumin (albumin) test CPT 82043 HCHG URINE ALBUMIN TO CREATININE RATIO, RANDOM	$72.08	$212.00	$47.91–$118.93	24% above	66%
Urine pregnancy test, read by color change CPT 81025 HCHG GENERAL LAB 8102500	$39.44	$116.00	$26.22–$65.08	12% below	66%
Urine pregnancy test, read by color change CPT 81025 PR GENERAL LAB 8102500	$39.44	$116.00	$26.22–$65.08	12% below	66%
Vitamin B12 (cobalamin) blood test CPT 82607 HCHG VITAMIN B-12	$105.40	$310.00	$70.06–$173.91	18% above	66%
Vitamin B12 (cobalamin) blood test CPT 82607 PR CYANOCOBALAMIN VITAMIN B-12	$117.30	$345.00	$77.97–$193.54	31% above	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HCHG 25-HYDROXY VITAMIN D (D2+D3 FRACTIONATED) LC	$79.22	$233.00	$52.66–$130.71	23% below	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 PR 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED	$79.22	$233.00	$52.66–$130.71	23% below	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HCHG VITAMIN D D2D3 LCC	$79.22	$233.00	$52.66–$130.71	23% below	66%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HCHG VITAMIN D TOTAL	$104.72	$308.00	$69.61–$172.79	1% above	66%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 PR 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED	$189.04	$556.00	$125.66–$311.92	140% above	66%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HCHG CALCITRIOL(1,25 DI-OH VIT D) LC	$189.04	$556.00	$125.66–$311.92	140% above	66%
Zinc blood test CPT 84630 HCHG ZINC, PLASMA OR SERUM LC	$29.58	$87.00	$19.66–$48.81	2% below	66%
Zinc blood test CPT 84630 PR ASSAY OF ZINC	$29.58	$87.00	$19.66–$48.81	2% below	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470201	$112.20	$330.00	$74.58–$185.13	21% above	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470205	$112.20	$330.00	$74.58–$185.13	21% above	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 PR GENERAL LAB 8470200	$112.20	$330.00	$74.58–$185.13	21% above	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470208	$112.20	$330.00	$74.58–$185.13	21% above	66%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCHG GENERAL LAB 8470202	$112.20	$330.00	$74.58–$185.13	21% above	66%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HCHG RAD BIOPSY BREAST INC MARKER 1ST LESION STEREO GUIDE	$4,162.96	$12,244.00	$2,732.00–$5,289.41	141% above	66%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HCHG CARDIOVERSION ELECTIVE, EXTERNAL	$1,073.72	$3,158.00	$713.71–$1,771.64	—	66%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 HCHG CIRCUMCISION W REGIONAL BLOCK	$128.52	$378.00	$85.43–$212.06	—	66%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$11.90	$35.00	$7.91–$19.64	85% below	66%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$11.90	$35.00	$7.91–$19.64	85% below	66%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$11.90	$35.00	$7.91–$19.64	—	66%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HCHG RAD INJ EPIDURAL CERVICAL OR THORACIC W GUIDE	$1,320.90	$3,885.00	$913.75–$1,947.00	7% above	66%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HCHG XR INJ EPIDURAL CERVICAL OR THORACIC SPINE W GUIDE	$1,320.90	$3,885.00	$913.75–$1,947.00	7% above	66%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HCHG CT FACET JOINT INJ LUMBAR/SACRAL SNGL LEVEL W CT GUIDE	$1,320.90	$3,885.00	$913.75–$1,947.00	7% below	66%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HCHG XR INJ FACET LUMBAR OR SACRAL SINGLE LEV	$1,320.90	$3,885.00	$913.75–$1,947.00	7% below	66%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HCHG RAD INJ FACET JOINT LUMBAR/SACRAL ONE LEVEL W GUIDE	$1,320.90	$3,885.00	$913.75–$1,947.00	7% below	66%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HCHG XR INJ HYSTEROSALPINGOGRAM	$133.28	$392.00	$92.20–$982.00	57% below	66%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HCHG RAD INJ HYSTEROSALPINGOGRAM W CATHETERIZATION	$133.28	$392.00	$92.20–$982.00	57% below	66%
Incision and drainage of a simple or single skin abscess CPT 10060 HCHG RAD DRAIN SUBCUTANEOUS ABSCESS	$162.18	$477.00	$112.19–$982.00	43% below	66%
Incision and drainage of a simple or single skin abscess CPT 10060 HCHG US DRAIN SUBCUTANEOUS ABSCESS	$162.18	$477.00	$112.19–$982.00	43% below	66%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HCHG I&D ABSCESS/CARB/CYST SINGLE SIMPLE	$162.18	$477.00	$107.80–$267.60	—	66%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HCHG RAD INJECTION SINGLE TENDON SHEATH LIGAMENT	$170.68	$502.00	$118.07–$982.00	54% below	66%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HCHG US INJ SINGLE TENDON SHEATH LIGAMENT	$170.68	$502.00	$118.07–$982.00	54% below	66%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HCHG XR INJECTION SINGLE TENDON SHEATH LIGAMENT	$223.72	$658.00	$154.76–$982.00	—	66%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HCHG RAD INJECTION SINGLE TENDON SHEATH LIGAMENT	$223.72	$658.00	$154.76–$982.00	—	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG CT INJECTION MAJOR JOINT BURSA	$440.98	$1,297.00	$305.05–$982.00	22% above	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG CT ARTHROCENTESIS MAJOR JOINT OR BURSA	$440.98	$1,297.00	$305.05–$982.00	22% above	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION MAJOR JOINT BURSA	$440.98	$1,297.00	$305.05–$982.00	22% above	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HCHG XR ARTHROCENTESIS MAJOR JOINT OR BURSA	$440.98	$1,297.00	$305.05–$982.00	22% above	66%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HCHG ARTHROCENT/ASPIR/INJ MAJOR JOINT/BURSA WO US GUIDE UNILAT	$440.98	$1,297.00	$305.05–$982.00	22% above	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG RAD ARTHROCENTESIS ASPIRATION INJECTION INTERM JOINT BURSA	$170.68	$502.00	$118.07–$982.00	44% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG IR INJ OR ASP INTERMED JT OR BURSA	$170.68	$502.00	$118.07–$982.00	44% below	66%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HCHG XR ARTHROCENTESIS INTERMEDIATE JOINT OR BURSA	$170.68	$502.00	$118.07–$982.00	44% below	66%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HCHG RAD ARTHROCENTESIS ASPIRATION SMALL JOINT OR BURSA	$185.64	$546.00	$128.42–$982.00	43% below	66%
Lower-back epidural injection, with imaging guidance CPT 62323 HCHG RAD INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$1,586.44	$4,666.00	$1,019.00–$2,015.71	33% above	66%
Lower-back epidural injection, with imaging guidance CPT 62323 HCHG XR INJ EPIDURAL LUMBAR OR SACRAL W GUIDE	$1,586.44	$4,666.00	$1,019.00–$2,015.71	33% above	66%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG CT TRANSFORAMINAL LUMB OR SACRAL SNGL W CT GUIDE	$2,289.56	$6,734.00	$1,019.00–$2,909.09	76% above	66%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG RAD INJ TRANS EPIDURAL LUMBAR/SACRAL ONE LEVEL W GUIDE	$2,289.56	$6,734.00	$1,019.00–$2,909.09	76% above	66%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HCHG XR INJ TRANSFORAMINAL LUMBAR OR SACRAL SINGLE LEV	$2,289.56	$6,734.00	$1,019.00–$2,909.09	76% above	66%
Occipital nerve block (injection for headaches) CPT 64405 HCHG XR INJ NERVE BLOCK OCCIPITAL NERVE	$915.62	$2,693.00	$522.00–$1,163.38	50% above	66%
Occipital nerve block (injection for headaches) CPT 64405 HCHG RAD INJ ANES AGENT STEROID OCCIPITAL NERVE	$915.62	$2,693.00	$522.00–$1,163.38	50% above	66%
Paracentesis with imaging guidance CPT 49083 HCHG RAD PARACENTESIS ABDOMEN WITH IMAGING	$1,314.44	$3,866.00	$909.28–$2,757.00	44% above	66%
Paracentesis with imaging guidance CPT 49083 HCHG US PARACENTESIS ABDOMEN W IMAGING PORTABLE	$1,314.44	$3,866.00	$909.28–$2,757.00	44% above	66%
Paracentesis with imaging guidance CPT 49083 HCHG RAD PARACENTESIS ABDOMEN WITH IMAGING PORTABLE	$1,314.44	$3,866.00	$909.28–$2,757.00	44% above	66%
Paracentesis with imaging guidance CPT 49083 HCHG CT PARACENTESIS ABDOMEN PELVIS ASPIRATION	$1,314.44	$3,866.00	$909.28–$2,757.00	44% above	66%
Paracentesis with imaging guidance CPT 49083 HCHG US PARACENTESIS ABDOMEN WITH IMAGING	$1,314.44	$3,866.00	$909.28–$2,757.00	44% above	66%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HCHG RAD DSTR NROLYTC AGNT PARVERTEB FACET SNGL LMBR/SACRAL	$1,702.38	$5,007.00	$1,177.65–$3,749.00	20% below	66%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 HCHG DSTR PARAVERT FACET JT NRV W FLUORO LMBR/SAC SGL UNILAT	$1,702.38	$5,007.00	$1,177.65–$3,749.00	—	66%
Short arm splint (forearm and hand) inpatient CPT 29125 HCHG OT APPLICATION SHORTARM SPLINT STATIC	$109.14	$321.00	$72.55–$151.00	—	66%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HCHG SPINAL PUNCTURE LUMBAR DIAGNOSTIC	$353.60	$1,040.00	$235.04–$583.44	—	66%
Thoracentesis with imaging guidance CPT 32555 HCHG CT THORACENTESIS PLEURAL ASPIRATION	$1,111.46	$3,269.00	$768.87–$1,947.00	20% above	66%
Thoracentesis with imaging guidance CPT 32555 HCHG RAD THORACENTESIS PLEURAL SPACE NEEDLE OR CATHETER	$1,111.46	$3,269.00	$768.87–$1,947.00	20% above	66%
Thoracentesis with imaging guidance CPT 32555 HCHG US THORACENTESIS PLEURAL SPACE	$1,111.46	$3,269.00	$768.87–$1,947.00	20% above	66%
Thoracentesis with imaging guidance CPT 32555 HCHG US THORACENTESIS PLEURAL SPACE PORTABLE	$1,111.46	$3,269.00	$768.87–$1,947.00	20% above	66%
Trigger point injections, 1 or 2 muscles CPT 20552 HCHG INJ(S) SGL/MUL TRIG PT(S) 1 OR 2 MUSC	$789.14	$2,321.00	$524.55–$1,302.08	148% above	66%
Trigger point injections, 1 or 2 muscles CPT 20552 HCHG RAD INJECTION(S) SGL/MULI TRIGGER POINT(S) 1 OR 2 MUSCLE	$789.14	$2,321.00	$522.00–$1,002.67	148% above	66%
Trigger point injections, 1 or 2 muscles CPT 20552 HCHG XR INJ TRIGGER POINT EQUAL OR LESS 2	$789.14	$2,321.00	$522.00–$1,002.67	148% above	66%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HCHG RAD BIOPSY BREAST INC MARKER 1ST LESION W US GUIDE	$4,580.14	$13,471.00	$2,732.00–$5,819.47	162% above	66%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HCHG BLOOD/BLOOD PRODUCT ADMIN PER UNIT	$268.60	$790.00	$178.54–$443.19	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$31.28	$92.00	$20.79–$51.61	73% below	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$31.28	$92.00	$20.79–$51.61	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX EZPAP W NEB	$31.28	$92.00	$20.79–$51.61	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC SPUTUM INDUCTION	$31.28	$92.00	$20.79–$51.61	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX MDI/DPI	$42.84	$126.00	$28.48–$70.69	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX HELIUM	$42.84	$126.00	$28.48–$70.69	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX	$42.84	$126.00	$28.48–$70.69	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 (IA) PR INHALATION TREATMENT AIRWAY OBST	$42.84	$126.00	$28.48–$70.69	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX IPPB	$42.84	$126.00	$28.48–$70.69	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HCHG RC AIRWAY INHALATION TX MDI VENT	$42.84	$126.00	$28.48–$70.69	—	66%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$42.84	$126.00	$28.48–$70.69	—	66%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HCHG CHEMO IV ADMIN INITIAL HOUR	$283.22	$833.00	$188.26–$467.31	—	66%
Critical care, first 30 to 74 minutes CPT 99291 HCHG ED CRITICAL CARE LEVEL VI	$1,899.24	$5,586.00	$615.00–$3,430.00	19% above	66%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HCHG EEG AWAKE/DROWSY	$407.66	$1,199.00	$270.97–$672.64	—	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$82.96	$244.00	$55.14–$136.88	52% below	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$92.14	$271.00	$61.25–$152.03	47% below	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$82.96	$244.00	$55.14–$136.88	—	66%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HCHG EKG 12LEAD TRACING ONLY WO REPORT/INTERP	$92.14	$271.00	$61.25–$152.03	—	66%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED LVL 1 HCHG	$425.34	$1,251.00	$275.00–$754.00	109% above	66%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED LVL 2 HCHG	$525.64	$1,546.00	$344.00–$894.00	75% above	66%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED LVL 3 HCHG	$818.38	$2,407.00	$450.00–$1,507.00	68% above	66%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED LVL 4 HCHG	$1,165.86	$3,429.00	$520.00–$2,355.00	48% above	66%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED LVL 5 HCHG	$1,694.56	$4,984.00	$615.00–$3,430.00	47% above	66%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HCHG RAD CV STRESS TEST EXERCISE OR PHARM TRACE ONLY	$249.90	$735.00	$166.11–$412.34	—	66%
Family therapy with the patient, 50 minutes CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$225.08	$662.00	$149.61–$371.38	16% above	66%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS	$225.08	$662.00	$149.61–$371.38	—	66%
Family therapy without the patient, 50 minutes CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$178.16	$524.00	$118.42–$293.96	3% below	66%
Family therapy without the patient, 50 minutes inpatient CPT 90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS	$178.16	$524.00	$118.42–$293.96	—	66%
Group psychotherapy session CPT 90853 PR GROUP PSYCHOTHERAPY	$105.06	$309.00	$69.83–$173.35	27% above	66%
Group psychotherapy session inpatient CPT 90853 PR GROUP PSYCHOTHERAPY	$105.06	$309.00	$69.83–$173.35	—	66%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 HCHG HOLTER COMPLETE UP TO 48 HR AFFILIATE ONLY	$94.18	$277.00	$62.60–$155.40	—	66%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG IV INFUSION HYDRATION INITIAL 31-60 MIN	$199.24	$586.00	$132.44–$328.75	—	66%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HCHG ED IV INFUSION HYDRATION INITIAL 31-60 MIN	$199.24	$586.00	$132.44–$328.75	—	66%
IV infusion of a medicine, first hour inpatient CPT 96365 HCHG ED IV INF THERAPY/DX/PROPH INITIAL HR	$210.12	$618.00	$139.67–$346.70	—	66%
IV infusion of a medicine, first hour inpatient CPT 96365 HCHG IV INF THERAPY/DX/PROPH INITIAL HR	$210.12	$618.00	$139.67–$346.70	—	66%
IV push of a medicine, first drug CPT 96374 HCHG IV INJECTION TX/DX/PROPHYLAXIS INITIAL	$92.14	$271.00	$61.25–$152.03	50% below	66%
IV push of a medicine, first drug inpatient CPT 96374 HCHG IV INJECTION TX/DX/PROPH INITIAL	$94.18	$277.00	$62.60–$155.40	—	66%
IV push of a medicine, first drug inpatient CPT 96374 HCHG ED IV INJECTION TX/DX/PROPH INITIAL	$105.06	$309.00	$69.83–$173.35	—	66%
IV push of a medicine, first drug inpatient CPT 96374 HCHG IV INJECTION TX/DX/PROPHYLAXIS INITIAL	$383.18	$1,127.00	$254.70–$632.25	—	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$36.38	$107.00	$24.18–$60.03	53% below	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PR INJ SQ IM BCBS	$42.50	$125.00	$28.25–$70.12	45% below	66%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 PR INJ SQ IM BCBS	$42.50	$125.00	$28.25–$70.12	45% below	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HCHG ED INJECTION SQ/IM	$17.00	$50.00	$11.30–$28.05	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$36.38	$107.00	$24.18–$60.03	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PR INJ SQ IM BCBS	$42.50	$125.00	$28.25–$70.12	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$97.92	$288.00	$65.09–$161.57	—	66%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HCHG INJECTION SQ/IM	$102.00	$300.00	$67.80–$168.30	—	66%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$329.46	$969.00	$218.99–$543.61	28% above	66%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PR PSYCHIATRIC DIAGNOSTIC EVALUATION	$329.46	$969.00	$218.99–$543.61	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XS	$43.86	$129.00	$29.15–$147.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XE	$43.86	$129.00	$29.15–$147.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED XE	$43.86	$129.00	$29.15–$151.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED XS	$43.86	$129.00	$29.15–$151.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XU	$43.86	$129.00	$29.15–$147.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED 15MIN	$43.86	$129.00	$29.15–$147.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED XP	$43.86	$129.00	$29.15–$151.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED XU	$43.86	$129.00	$29.15–$151.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG OT NEUROMUSCULAR RE-ED 15MIN	$43.86	$129.00	$29.15–$151.00	—	66%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HCHG PT NEUROMUSCULAR RE-ED XP	$43.86	$129.00	$29.15–$147.00	—	66%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HCHG MNT INDIV INITIAL EA 15MIN	$40.12	$118.00	$27.75–$91.00	—	66%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG OT EVAL LOW COMPLEXITY XS	$80.58	$237.00	$53.56–$147.00	—	66%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG OT EVAL LOW COMPLEXITY XU	$80.58	$237.00	$53.56–$147.00	—	66%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG OT EVAL LOW COMPLEXITY	$80.58	$237.00	$53.56–$147.00	—	66%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG OT EVAL LOW COMPLEXITY XE	$80.58	$237.00	$53.56–$147.00	—	66%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HCHG OT EVAL LOW COMPLEXITY XP	$80.58	$237.00	$53.56–$147.00	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XE	$128.52	$378.00	$85.43–$163.30	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XU	$128.52	$378.00	$85.43–$163.30	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XS	$128.52	$378.00	$85.43–$163.30	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY	$128.52	$378.00	$85.43–$163.30	—	66%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HCHG PT EVAL HIGH COMPLEXITY XP	$128.52	$378.00	$85.43–$163.30	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY	$80.58	$237.00	$53.56–$147.00	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XE	$80.58	$237.00	$53.56–$147.00	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XS	$80.58	$237.00	$53.56–$147.00	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XP	$80.58	$237.00	$53.56–$147.00	—	66%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HCHG PT EVAL LOW COMPLEXITY XU	$80.92	$238.00	$53.79–$147.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY XS	$104.38	$307.00	$69.38–$147.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY XP	$104.38	$307.00	$69.38–$147.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY XE	$104.38	$307.00	$69.38–$147.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY	$104.38	$307.00	$69.38–$147.00	—	66%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HCHG PT EVAL MOD COMPLEXITY XU	$104.38	$307.00	$69.38–$147.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY XS	$38.76	$114.00	$25.76–$151.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY XE	$38.76	$114.00	$25.76–$147.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY XS	$38.76	$114.00	$25.76–$147.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY XP	$38.76	$114.00	$25.76–$147.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY XU	$38.76	$114.00	$25.76–$147.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY XE	$38.76	$114.00	$25.76–$151.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY XP	$38.76	$114.00	$25.76–$151.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY XU	$38.76	$114.00	$25.76–$151.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG PT MANUAL THERAPY 15MIN	$38.76	$114.00	$25.76–$147.00	—	66%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HCHG OT MANUAL THERAPY 15MIN	$38.76	$114.00	$25.76–$151.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE 15MIN	$42.50	$125.00	$28.25–$151.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE XU	$42.50	$125.00	$28.25–$147.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE 15MIN	$42.50	$125.00	$28.25–$147.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE XE	$42.50	$125.00	$28.25–$151.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE XS	$42.50	$125.00	$28.25–$151.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE XP	$42.50	$125.00	$28.25–$151.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG OT THERAPEUTIC EXERCISE XU	$42.50	$125.00	$28.25–$151.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE XE	$42.50	$125.00	$28.25–$147.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE XS	$42.50	$125.00	$28.25–$147.00	—	66%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HCHG PT THERAPEUTIC EXERCISE XP	$42.50	$125.00	$28.25–$147.00	—	66%
Preventive checkup, new patient aged 18–39 CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$182.24	$536.00	$121.14–$300.70	53% above	66%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS	$182.24	$536.00	$121.14–$300.70	—	66%
Preventive checkup, new patient aged 40–64 CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$197.54	$581.00	$131.31–$325.94	22% above	66%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS	$197.54	$581.00	$131.31–$325.94	—	66%
Preventive checkup, new patient aged 65 or older CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$215.90	$635.00	$143.51–$356.24	8% above	66%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>	$215.90	$635.00	$143.51–$356.24	—	66%
Preventive checkup, returning patient aged 18–39 CPT 99395 PR OCH PREVENTIVE VISIT EST 18-39	$48.62	$143.00	$32.32–$143.00	59% below	66%
Preventive checkup, returning patient aged 18–39 CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$182.24	$536.00	$121.14–$300.70	54% above	66%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PR OCH PREVENTIVE VISIT EST 18-39	$48.62	$143.00	$32.32–$143.00	—	66%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$182.24	$536.00	$121.14–$300.70	—	66%
Preventive checkup, returning patient aged 40–64 CPT 99396 PR OCH PREVENTIVE VISIT EST 40-64	$15.64	$46.00	$10.40–$46.00	91% below	66%
Preventive checkup, returning patient aged 40–64 CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$171.36	$504.00	$113.90–$282.74	at median	66%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PR OCH PREVENTIVE VISIT EST 40-64	$15.64	$46.00	$10.40–$46.00	—	66%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$171.36	$504.00	$113.90–$282.74	—	66%
Preventive checkup, returning patient aged 65 or older CPT 99397 PR OCH PREVENTIVE VISIT EST 65 AND OVER	$44.20	$130.00	$29.38–$130.00	66% below	66%
Preventive checkup, returning patient aged 65 or older CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$201.62	$593.00	$134.02–$332.67	53% above	66%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PR OCH PREVENTIVE VISIT EST 65 AND OVER	$44.20	$130.00	$29.38–$130.00	—	66%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$201.62	$593.00	$134.02–$332.67	—	66%
Psychiatric evaluation with medical services CPT 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$141.44	$416.00	$94.02–$233.38	28% below	66%
Psychiatric evaluation with medical services inpatient CPT 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES	$141.44	$416.00	$94.02–$233.38	—	66%
Psychotherapy session, 30 minutes CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$137.70	$405.00	$91.53–$227.20	21% above	66%
Psychotherapy session, 30 minutes inpatient CPT 90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES	$137.70	$405.00	$91.53–$227.20	—	66%
Psychotherapy session, 45 minutes CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$179.86	$529.00	$119.55–$296.77	19% above	66%
Psychotherapy session, 45 minutes inpatient CPT 90834 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES	$179.86	$529.00	$119.55–$296.77	—	66%
Psychotherapy session, 60 minutes CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$263.50	$775.00	$175.15–$434.78	39% above	66%
Psychotherapy session, 60 minutes inpatient CPT 90837 PR PSYCHOTHERAPY W/PATIENT 60 MINUTES	$263.50	$775.00	$175.15–$434.78	—	66%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HCHG SMOKING & TOBACCO CESSATION >3-10 MIN VISIT	$13.94	$41.00	$9.64–$91.00	—	66%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP	$216.24	$636.00	$143.74–$274.75	—	66%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP 52	$216.24	$636.00	$143.74–$274.75	—	66%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XE	$216.24	$636.00	$143.74–$274.75	—	66%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XS	$216.24	$636.00	$143.74–$274.75	—	66%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XP	$216.24	$636.00	$143.74–$274.75	—	66%
Speech and language evaluation inpatient CPT 92523 HCHG SLP EVAL SPEECH SOUND W LANGUAGE COMP XU	$216.24	$636.00	$143.74–$274.75	—	66%
Speech therapy session, individual inpatient CPT 92507 HCHG SLP INDIV TX COMMUNICATION	$81.60	$240.00	$54.24–$147.00	—	66%
Speech therapy session, individual inpatient CPT 92507 HCHG SLP INDIV TX COMMUNICATION XU	$81.60	$240.00	$54.24–$147.00	—	66%
Speech therapy session, individual inpatient CPT 92507 HCHG SLP INDIV TX COMMUNICATION XP	$81.60	$240.00	$54.24–$147.00	—	66%
Speech therapy session, individual inpatient CPT 92507 HCHG SLP INDIV TX COMMUNICATION XS	$81.60	$240.00	$54.24–$147.00	—	66%
Speech therapy session, individual inpatient CPT 92507 HCHG SLP INDIV TX COMMUNICATION XE	$81.60	$240.00	$54.24–$147.00	—	66%
Spirometry (breathing test) inpatient CPT 94010 HCHG PFT SPIROMETRY-LAB	$125.80	$370.00	$83.62–$207.57	—	66%
Spirometry (breathing test) inpatient CPT 94010 HCHG SPIROMETRY INCOMPLETE	$136.00	$400.00	$90.40–$224.40	—	66%
Spirometry (breathing test) inpatient CPT 94010 HCHG SPIROMETRY BEDSIDE	$183.60	$540.00	$122.04–$302.94	—	66%
Spirometry before and after a bronchodilator inpatient CPT 94060 HCHG BRONCHOSPASM EVAL-BEDSIDE	$147.22	$433.00	$97.86–$242.91	—	66%
Spirometry before and after a bronchodilator inpatient CPT 94060 HCHG PFT BRONCHOSPASM EVAL-LAB	$153.00	$450.00	$101.70–$252.45	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XU	$109.48	$322.00	$72.77–$147.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITY 15MIN	$109.48	$322.00	$72.77–$151.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITY 15MIN	$109.48	$322.00	$72.77–$147.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XP	$109.48	$322.00	$72.77–$147.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XS	$109.48	$322.00	$72.77–$147.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG PT THERAPEUTIC ACTIVITIES XE	$109.48	$322.00	$72.77–$147.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XU	$109.48	$322.00	$72.77–$151.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XP	$109.48	$322.00	$72.77–$151.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XS	$109.48	$322.00	$72.77–$151.00	—	66%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HCHG OT THERAPEUTIC ACTIVITIES XE	$109.48	$322.00	$72.77–$151.00	—	66%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HCHG PHLEBOTOMY THERAPEUTIC	$153.00	$450.00	$101.70–$252.45	24% below	66%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HCHG PHLEBOTOMY THERAPEUTIC	$153.00	$450.00	$101.70–$252.45	—	66%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE (MODERNA)	$190.06	$559.00	$126.33–$313.60	4% above	66%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 PR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE (MODERNA)	$190.06	$559.00	$126.33–$313.60	—	66%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$174.08	$512.00	$115.71–$287.23	11% below	66%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE	$174.08	$512.00	$115.71–$287.23	—	66%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$78.20	$230.00	$51.98–$129.03	15% below	66%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE	$78.20	$230.00	$51.98–$129.03	—	66%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM	$79.22	$233.00	$52.66–$130.71	50% above	66%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM	$79.22	$233.00	$52.66–$130.71	—	66%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR	$34.68	$102.00	$23.05–$57.22	59% below	66%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR	$34.68	$102.00	$23.05–$57.22	—	66%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE	$78.54	$231.00	$52.21–$129.59	22% below	66%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE	$78.54	$231.00	$52.21–$129.59	—	66%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE	$18.02	$53.00	$11.98–$29.73	57% below	66%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE	$18.02	$53.00	$11.98–$29.73	—	66%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$18.02	$53.00	$11.98–$29.73	19% below	66%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE	$18.02	$53.00	$11.98–$29.73	—	66%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$201.96	$594.00	$134.24–$333.23	47% below	66%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE	$201.96	$594.00	$134.24–$333.23	—	66%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$85.68	$252.00	$56.95–$141.37	41% below	66%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM	$85.68	$252.00	$56.95–$141.37	—	66%
Hepatitis A vaccine, adult dose CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$104.38	$307.00	$69.38–$172.23	1% below	66%
Hepatitis A vaccine, adult dose inpatient CPT 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE	$104.38	$307.00	$69.38–$172.23	—	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE	$46.58	$137.00	$30.96–$76.86	18% below	66%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE	$46.58	$137.00	$30.96–$76.86	—	66%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$34.68	$102.00	$23.05–$57.22	69% below	66%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE	$34.68	$102.00	$23.05–$57.22	—	66%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE	$113.56	$334.00	$75.48–$187.37	29% below	66%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE	$113.56	$334.00	$75.48–$187.37	—	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$34.68	$102.00	$23.05–$57.22	33% below	66%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM	$34.68	$102.00	$23.05–$57.22	—	66%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE	$44.20	$130.00	$29.38–$72.93	38% below	66%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE	$44.20	$130.00	$29.38–$72.93	—	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$44.20	$130.00	$29.38–$72.93	13% above	66%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE	$44.20	$130.00	$29.38–$72.93	—	66%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$54.40	$160.00	$36.16–$89.76	16% below	66%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM	$54.40	$160.00	$36.16–$89.76	—	66%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$67.66	$199.00	$44.97–$111.64	42% below	66%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ	$67.66	$199.00	$44.97–$111.64	—	66%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ	$174.08	$512.00	$115.71–$287.23	20% below	66%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ	$174.08	$512.00	$115.71–$287.23	—	66%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 PR MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM USE	$201.62	$593.00	$134.02–$332.67	3% above	66%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 PR MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM USE	$201.62	$593.00	$134.02–$332.67	—	66%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE	$63.24	$186.00	$42.04–$104.35	57% below	66%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE	$63.24	$186.00	$42.04–$104.35	—	66%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM	$204.68	$602.00	$136.05–$337.72	32% below	66%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM	$204.68	$602.00	$136.05–$337.72	—	66%
Nasal spray flu vaccine, live (FluMist) CPT 90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE	$18.02	$53.00	$11.98–$29.73	43% below	66%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE	$18.02	$53.00	$11.98–$29.73	—	66%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE	$249.90	$735.00	$166.11–$412.34	3% below	66%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE	$249.90	$735.00	$166.11–$412.34	—	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$419.22	$1,233.00	$278.66–$691.71	4% above	66%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE	$419.22	$1,233.00	$278.66–$691.71	—	66%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$118.66	$349.00	$78.87–$195.79	6% below	66%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE	$118.66	$349.00	$78.87–$195.79	—	66%
Polio vaccine, inactivated (IPV) CPT 90713 PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM	$470.56	$1,384.00	$312.78–$776.42	521% above	66%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM	$470.56	$1,384.00	$312.78–$776.42	—	66%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$742.20	$2,182.95	$493.35–$1,224.63	19% above	66%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$742.20	$2,182.95	$493.35–$1,224.63	—	66%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$742.20	$2,182.95	$493.35–$1,224.63	—	66%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$706.86	$2,079.00	$469.85–$1,166.32	25% above	66%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$706.86	$2,079.00	$469.85–$1,166.32	—	66%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE	$706.86	$2,079.00	$469.85–$1,166.32	—	66%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$421.26	$1,239.00	$280.01–$695.08	91% above	66%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$421.26	$1,239.00	$280.01–$695.08	—	66%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE	$421.26	$1,239.00	$280.01–$695.08	—	66%
Rabies vaccine, one dose CPT 90675 PR RABIES VACCINE INTRAMUSCULAR	$504.90	$1,485.00	$335.61–$833.08	1% below	66%
Rabies vaccine, one dose inpatient CPT 90675 PR RABIES VACCINE INTRAMUSCULAR	$504.90	$1,485.00	$335.61–$833.08	—	66%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE	$44.20	$130.00	$29.38–$72.93	77% below	66%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE	$44.20	$130.00	$29.38–$72.93	—	66%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE	$174.76	$514.00	$116.16–$288.35	37% above	66%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE	$174.76	$514.00	$116.16–$288.35	—	66%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$216.92	$638.00	$144.19–$357.92	3% below	66%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX	$216.92	$638.00	$144.19–$357.92	—	66%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$51.34	$151.00	$34.13–$84.71	18% below	66%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE	$51.34	$151.00	$34.13–$84.71	—	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$50.66	$149.00	$33.67–$83.59	34% below	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$51.00	$150.00	$33.90–$84.15	33% below	66%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 PR TDAP VACCINE 7 YRS/> IM	$51.00	$150.00	$33.90–$84.15	—	66%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM	$61.88	$182.00	$41.13–$102.10	55% below	66%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 PR TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM	$61.88	$182.00	$41.13–$102.10	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$33.66	$99.00	$22.37–$55.54	18% below	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$33.66	$99.00	$22.37–$55.54	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HCHG IMMUN ADMIN IM/SQ ONE VACCINE (SGL/COMBO)	$33.66	$99.00	$22.37–$55.54	—	66%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE	$33.66	$99.00	$22.37–$55.54	—	66%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$33.66	$99.00	$22.37–$55.54	32% above	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE	$33.66	$99.00	$22.37–$55.54	—	66%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HCHG IMMUN ADMIN IM/SQ EA ADDL (SGL/COMBO)	$33.66	$99.00	$22.37–$55.54	—	66%

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

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

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

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

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

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

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

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

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

Source file: https://www.cuyunamed.org/411724637_cuyuna-regional-medical-center_standardcharges.csv