Guttenberg Municipal Hospital
Guttenberg Municipal Hospital in Guttenberg, IA publishes cash prices for 211 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Iowa median for 179 of 206 procedures and below it for 25. By typical cash price it ranks #74 of 85 Iowa hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
200 Main Street, Box 550, Guttenberg, IA 52052-0550 Collected Sep 27, 2026 Source price file (563) 252-1121
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 161312 · CMS hospital register NPI 1932139359
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 2 actions for a hospital named Guttenberg Municipal Hospital in Guttenberg, IA:
- Jul 11, 2025 Warning notice
- Nov 12, 2025 Case closed
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. 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 Iowa | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 HC CT ABDOMEN W WO CONTRAST | $2,685.60 | $3,357.00 | $747.00–$2,887.00 | 38% above | 20% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABDOMEN W WO CONTRAST | $2,685.60 | $3,357.00 | $2,249.00–$3,357.00 | — | 20% |
| Abdominal X-ray, 2 views CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS | $382.40 | $478.00 | $248.00–$411.00 | 53% above | 20% |
| Abdominal X-ray, 2 views inpatient CPT 74019 HC X-RAY EXAM ABDOMEN 2 VIEWS | $382.40 | $478.00 | $320.00–$478.00 | — | 20% |
| Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE MIN 3 VIEWS | $276.00 | $345.00 | $179.00–$345.00 | 24% above | 20% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE MIN 3 VIEWS | $276.00 | $345.00 | $231.00–$345.00 | — | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS | $152.80 | $191.00 | $99.00–$191.00 | 55% below | 20% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS | $152.80 | $191.00 | $127.00–$191.00 | — | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTR WO CONTRAST | $2,085.60 | $2,607.00 | $747.00–$2,242.00 | 72% above | 20% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTR WO CONTRAST | $2,085.60 | $2,607.00 | $1,746.00–$2,607.00 | — | 20% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE IMAGING WHOLE BODY | $1,228.00 | $1,535.00 | $747.00–$1,320.00 | at median | 20% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE IMAGING WHOLE BODY | $1,228.00 | $1,535.00 | $1,028.00–$1,535.00 | — | 20% |
| Breast ultrasound, complete, one breast CPT 76641 HC US BREAST COMPLETE | $789.60 | $987.00 | $513.00–$848.00 | 120% above | 20% |
| Breast ultrasound, complete, one breast inpatient CPT 76641 HC US BREAST COMPLETE | $789.60 | $987.00 | $661.00–$987.00 | — | 20% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST LIMITED | $516.80 | $646.00 | $335.00–$646.00 | 42% above | 20% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST LIMITED | $516.80 | $646.00 | $432.00–$646.00 | — | 20% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC CT ANGIO ABD AND PELV WO W CONTRAST | $3,339.20 | $4,174.00 | $747.00–$3,589.00 | 12% above | 20% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC CT ANGIO ABD AND PELV WO W CONTRAST | $3,339.20 | $4,174.00 | $2,796.00–$4,174.00 | — | 20% |
| CT angiography (CTA) of the head CPT 70496 HC CT ANGIOGRAPHY HEAD W WO CONTRAST | $2,365.60 | $2,957.00 | $1,537.00–$2,543.00 | 22% above | 20% |
| CT angiography (CTA) of the head inpatient CPT 70496 HC CT ANGIOGRAPHY HEAD W WO CONTRAST | $2,365.60 | $2,957.00 | $1,981.00–$2,957.00 | — | 20% |
| CT angiography (CTA) of the neck CPT 70498 HC CT ANGIOGRAPHY NECK W WO CONTRAST | $2,590.40 | $3,238.00 | $1,683.00–$2,784.00 | 23% above | 20% |
| CT angiography (CTA) of the neck inpatient CPT 70498 HC CT ANGIOGRAPHY NECK W WO CONTRAST | $2,590.40 | $3,238.00 | $2,169.00–$3,238.00 | — | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST W WO CONTRAST | $2,364.00 | $2,955.00 | $1,536.00–$2,541.00 | 11% above | 20% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST W WO CONTRAST | $2,364.00 | $2,955.00 | $1,979.00–$2,955.00 | — | 20% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $3,630.40 | $4,538.00 | $2,359.00–$3,902.00 | 39% above | 20% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $3,630.40 | $4,538.00 | $3,040.00–$4,538.00 | — | 20% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $4,392.00 | $5,490.00 | $2,854.00–$4,721.00 | 37% above | 20% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $4,392.00 | $5,490.00 | $3,678.00–$5,490.00 | — | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD & PELVIS W WO CONTR 1+ REG/SEC | $4,511.20 | $5,639.00 | $2,932.00–$4,849.00 | 32% above | 20% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD & PELVIS W WO CONTR 1+ REG/SEC | $4,511.20 | $5,639.00 | $3,778.00–$5,639.00 | — | 20% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST | $2,315.20 | $2,894.00 | $747.00–$2,488.00 | 38% above | 20% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST | $2,315.20 | $2,894.00 | $1,938.00–$2,894.00 | — | 20% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,808.80 | $2,261.00 | $747.00–$1,944.00 | 37% above | 20% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,808.80 | $2,261.00 | $1,514.00–$2,261.00 | — | 20% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $1,825.60 | $2,282.00 | $1,186.00–$1,962.00 | 42% above | 20% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $1,825.60 | $2,282.00 | $1,528.00–$2,282.00 | — | 20% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD OR BRAIN WO CONTRAST | $1,851.20 | $2,314.00 | $1,203.00–$1,990.00 | 38% above | 20% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD OR BRAIN WO CONTRAST | $1,851.20 | $2,314.00 | $1,550.00–$2,314.00 | — | 20% |
| CT scan of the head with contrast CPT 70460 HC CT HEAD OR BRAIN W CONTRAST | $2,374.40 | $2,968.00 | $747.00–$2,552.00 | 57% above | 20% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD OR BRAIN W CONTRAST | $2,374.40 | $2,968.00 | $1,988.00–$2,968.00 | — | 20% |
| CT scan of the head without and with contrast CPT 70470 HC CT HEAD OR BRAIN W WO CONTRAST | $2,592.00 | $3,240.00 | $747.00–$2,786.00 | 44% above | 20% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD OR BRAIN W WO CONTRAST | $2,592.00 | $3,240.00 | $2,170.00–$3,240.00 | — | 20% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $2,021.60 | $2,527.00 | $1,314.00–$2,173.00 | 33% above | 20% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $2,021.60 | $2,527.00 | $1,693.00–$2,527.00 | — | 20% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE WO CONTRAST | $2,126.40 | $2,658.00 | $1,382.00–$2,285.00 | 41% above | 20% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE WO CONTRAST | $2,126.40 | $2,658.00 | $1,780.00–$2,658.00 | — | 20% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $2,368.80 | $2,961.00 | $747.00–$2,546.00 | 36% above | 20% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $2,368.80 | $2,961.00 | $1,983.00–$2,961.00 | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC CAROTID DUPLEX SCAN; BILAT | $834.40 | $1,043.00 | $542.00–$896.00 | — | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC CAROTID DUPLEX SCAN; BILAT | $834.40 | $1,043.00 | $698.00–$1,043.00 | — | 20% |
| Chest CT scan without and with contrast CPT 71270 HC CT CHEST W WO CONTRAST DIAG | $2,488.80 | $3,111.00 | $747.00–$2,675.00 | 28% above | 20% |
| Chest CT scan without and with contrast inpatient CPT 71270 HC CT CHEST W WO CONTRAST DIAG | $2,488.80 | $3,111.00 | $2,084.00–$3,111.00 | — | 20% |
| Chest X-ray, 2 views CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS | $285.60 | $357.00 | $185.00–$307.00 | 38% above | 20% |
| Chest X-ray, 2 views inpatient CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS | $285.60 | $357.00 | $239.00–$357.00 | — | 20% |
| Chest X-ray, single view CPT 71045 HC X-RAY EXAM CHEST 1 VIEW | $259.20 | $324.00 | $168.00–$324.00 | 55% above | 20% |
| Chest X-ray, single view inpatient CPT 71045 HC X-RAY EXAM CHEST 1 VIEW | $259.20 | $324.00 | $217.00–$324.00 | — | 20% |
| Collarbone (clavicle) X-ray, complete CPT 73000 HC CLAVICLE COMPLETE | $291.20 | $364.00 | $189.00–$364.00 | 55% above | 20% |
| Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC CLAVICLE COMPLETE | $291.20 | $364.00 | $243.00–$364.00 | — | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US EXAM RETROPERITONEAL COMPL | $809.60 | $1,012.00 | $526.00–$870.00 | 32% above | 20% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US EXAM RETROPERITONEAL COMPL | $809.60 | $1,012.00 | $678.00–$1,012.00 | — | 20% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL | $619.20 | $774.00 | $402.00–$665.00 | 56% above | 20% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY AXIAL | $619.20 | $774.00 | $518.00–$774.00 | — | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC MM DXA BONE DENSITY/PERIPHERAL 1+ SITES | $528.00 | $660.00 | $343.00–$660.00 | 110% above | 20% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC MM DXA BONE DENSITY/PERIPHERAL 1+ SITES | $528.00 | $660.00 | $442.00–$660.00 | — | 20% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST WO CONTRAST DIAG | $1,748.00 | $2,185.00 | $1,136.00–$1,879.00 | 27% above | 20% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST WO CONTRAST DIAG | $1,748.00 | $2,185.00 | $1,463.00–$2,185.00 | — | 20% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W CONTRAST DIAG | $2,118.40 | $2,648.00 | $1,376.00–$2,277.00 | 19% above | 20% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W CONTRAST DIAG | $2,118.40 | $2,648.00 | $1,774.00–$2,648.00 | — | 20% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BILAT | $532.00 | $665.00 | $345.00–$665.00 | — | 20% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BILAT | $532.00 | $665.00 | $445.00–$665.00 | — | 20% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNIL | $450.40 | $563.00 | $292.00–$563.00 | 54% above | 20% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNIL | $450.40 | $563.00 | $377.00–$563.00 | — | 20% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX LE ART/BPG; BILAT | $681.60 | $852.00 | $443.00–$783.00 | — | 20% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX LE ART/BPG; BILAT | $681.60 | $852.00 | $570.00–$852.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX EXT VEINS; BILAT | $1,216.00 | $1,520.00 | $747.00–$1,398.00 | — | 20% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX EXT VEINS; BILAT | $1,216.00 | $1,520.00 | $1,018.00–$1,520.00 | — | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/ DOPPLER COMPLETE | $3,180.80 | $3,976.00 | $2,067.00–$3,419.00 | 108% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE W/ DOPPLER COMPLETE | $3,180.80 | $3,976.00 | $2,663.00–$3,976.00 | — | 20% |
| Elbow X-ray, 2 views CPT 73070 HC ELBOW 2 VIEWS | $219.20 | $274.00 | $142.00–$274.00 | 39% above | 20% |
| Elbow X-ray, 2 views inpatient CPT 73070 HC ELBOW 2 VIEWS | $219.20 | $274.00 | $183.00–$274.00 | — | 20% |
| Elbow X-ray, complete, 3 or more views CPT 73080 HC ELBOW MIN 3 VIEWS | $286.40 | $358.00 | $186.00–$358.00 | 32% above | 20% |
| Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC ELBOW MIN 3 VIEWS | $286.40 | $358.00 | $239.00–$358.00 | — | 20% |
| Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBIT SELLA MID INNER EAR WO CONTR | $1,628.80 | $2,036.00 | $747.00–$1,750.00 | 25% above | 20% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBIT SELLA MID INNER EAR WO CONTR | $1,628.80 | $2,036.00 | $1,364.00–$2,036.00 | — | 20% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 HC FACIAL BONES MIN 3 VIEWS | $395.20 | $494.00 | $256.00–$494.00 | 47% above | 20% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC FACIAL BONES MIN 3 VIEWS | $395.20 | $494.00 | $330.00–$494.00 | — | 20% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 HC FOREARM 2 VIEWS | $269.60 | $337.00 | $175.00–$337.00 | 39% above | 20% |
| Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC FOREARM 2 VIEWS | $269.60 | $337.00 | $225.00–$337.00 | — | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING | $1,311.20 | $1,639.00 | $747.00–$1,409.00 | 9% above | 20% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING | $1,311.20 | $1,639.00 | $1,098.00–$1,639.00 | — | 20% |
| Hand X-ray, 2 views CPT 73120 HC HAND 2 VIEWS | $252.80 | $316.00 | $164.00–$316.00 | 56% above | 20% |
| Hand X-ray, 2 views inpatient CPT 73120 HC HAND 2 VIEWS | $252.80 | $316.00 | $211.00–$316.00 | — | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC CALCANEUS MIN 2 VIEWS | $219.20 | $274.00 | $142.00–$274.00 | 32% above | 20% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC CALCANEUS MIN 2 VIEWS | $219.20 | $274.00 | $183.00–$274.00 | — | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC PSS W 4/> PARAM W CPAP/BIPAP 6+ YRS | $3,444.00 | $4,305.00 | $747.00–$3,960.00 | 9% above | 20% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC PSS W 4/> PARAM W CPAP/BIPAP 6+ YRS | $3,444.00 | $4,305.00 | $2,884.00–$4,305.00 | — | 20% |
| Knee X-ray, 3 views CPT 73562 HC KNEE 3 VIEWS | $317.60 | $397.00 | $206.00–$397.00 | 49% above | 20% |
| Knee X-ray, 3 views inpatient CPT 73562 HC KNEE 3 VIEWS | $317.60 | $397.00 | $265.00–$397.00 | — | 20% |
| Knee X-ray, complete, 4 or more views CPT 73564 HC KNEE MIN 4 VIEWS | $412.00 | $515.00 | $267.00–$515.00 | 51% above | 20% |
| Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC KNEE MIN 4 VIEWS | $412.00 | $515.00 | $345.00–$515.00 | — | 20% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTR WO CONTRAST | $1,915.20 | $2,394.00 | $747.00–$2,058.00 | 43% above | 20% |
| Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTR WO CONTRAST | $1,915.20 | $2,394.00 | $1,603.00–$2,394.00 | — | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US EXAM ABDOMEN LIMITED | $642.40 | $803.00 | $417.00–$690.00 | 33% above | 20% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US EXAM ABDOMEN LIMITED | $642.40 | $803.00 | $538.00–$803.00 | — | 20% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US XTR NON-VASC LTD | $516.80 | $646.00 | $335.00–$646.00 | 47% above | 20% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US XTR NON-VASC LTD | $516.80 | $646.00 | $432.00–$646.00 | — | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LUNG CANCER SCREEN | $509.60 | $637.00 | $331.00–$547.00 | 18% above | 20% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LUNG CANCER SCREEN | $509.60 | $637.00 | $426.00–$637.00 | — | 20% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC TIBIA FIBULA 2 VIEWS | $231.20 | $289.00 | $150.00–$289.00 | 21% above | 20% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC TIBIA FIBULA 2 VIEWS | $231.20 | $289.00 | $193.00–$289.00 | — | 20% |
| MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD WO CONTRAST | $2,775.20 | $3,469.00 | $747.00–$3,191.00 | 23% above | 20% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD WO CONTRAST | $2,775.20 | $3,469.00 | $2,324.00–$3,469.00 | — | 20% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOW EXTR ANY JOINT WO CONTRAST | $2,660.00 | $3,325.00 | $747.00–$2,859.00 | 19% above | 20% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOW EXTR ANY JOINT WO CONTRAST | $2,660.00 | $3,325.00 | $2,227.00–$3,325.00 | — | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOW EXTR ANY JOINT W WO CONTR | $3,991.20 | $4,989.00 | $747.00–$4,290.00 | 26% above | 20% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOW EXTR ANY JOINT W WO CONTR | $3,991.20 | $4,989.00 | $3,342.00–$4,989.00 | — | 20% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST | $2,487.20 | $3,109.00 | $747.00–$2,673.00 | 20% above | 20% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST | $2,487.20 | $3,109.00 | $2,083.00–$3,109.00 | — | 20% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W WO CONTRAST | $3,472.00 | $4,340.00 | $2,256.00–$3,732.00 | 2% above | 20% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W WO CONTRAST | $3,472.00 | $4,340.00 | $2,907.00–$4,340.00 | — | 20% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CONTRAST | $3,092.80 | $3,866.00 | $2,010.00–$3,324.00 | 35% above | 20% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN WO CONTRAST | $3,092.80 | $3,866.00 | $2,590.00–$3,866.00 | — | 20% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W WO CONTRAST | $4,937.60 | $6,172.00 | $3,209.00–$5,307.00 | 40% above | 20% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W WO CONTRAST | $4,937.60 | $6,172.00 | $4,135.00–$6,172.00 | — | 20% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST | $2,725.60 | $3,407.00 | $1,771.00–$2,930.00 | 14% above | 20% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST | $2,725.60 | $3,407.00 | $2,282.00–$3,407.00 | — | 20% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI SPINE LUMBAR W WO CONTRAST | $3,466.40 | $4,333.00 | $747.00–$3,726.00 | 1% above | 20% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI SPINE LUMBAR W WO CONTRAST | $3,466.40 | $4,333.00 | $2,903.00–$4,333.00 | — | 20% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI SPINE THORACIC WO CONTRAST | $2,659.20 | $3,324.00 | $747.00–$2,858.00 | 15% above | 20% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI SPINE THORACIC WO CONTRAST | $2,659.20 | $3,324.00 | $2,227.00–$3,324.00 | — | 20% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI SPINE CERVICAL W WO CONTRAST | $3,462.40 | $4,328.00 | $747.00–$3,722.00 | 5% above | 20% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI SPINE CERVICAL W WO CONTRAST | $3,462.40 | $4,328.00 | $2,899.00–$4,328.00 | — | 20% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI SPINE CERVICAL WO CONTRAST | $2,659.20 | $3,324.00 | $1,728.00–$2,858.00 | 17% above | 20% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI SPINE CERVICAL WO CONTRAST | $2,659.20 | $3,324.00 | $2,227.00–$3,324.00 | — | 20% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W WO CONTRAST | $4,087.20 | $5,109.00 | $747.00–$4,393.00 | 26% above | 20% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W WO CONTRAST | $4,087.20 | $5,109.00 | $3,423.00–$5,109.00 | — | 20% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST | $2,630.40 | $3,288.00 | $747.00–$2,827.00 | 27% above | 20% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST | $2,630.40 | $3,288.00 | $2,202.00–$3,288.00 | — | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UP EXTR ANY JOINT WO CONTRAST | $2,562.40 | $3,203.00 | $747.00–$2,754.00 | 16% above | 20% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UP EXTR ANY JOINT WO CONTRAST | $2,562.40 | $3,203.00 | $2,146.00–$3,203.00 | — | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC CERVICAL SPINE MIN 4 VIEWS | $344.80 | $431.00 | $224.00–$431.00 | 6% above | 20% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC CERVICAL SPINE MIN 4 VIEWS | $344.80 | $431.00 | $288.00–$431.00 | — | 20% |
| Neck soft tissue CT scan with contrast CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $2,404.00 | $3,005.00 | $1,562.00–$2,584.00 | 50% above | 20% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT SOFT TISSUE NECK W CONTRAST | $2,404.00 | $3,005.00 | $2,013.00–$3,005.00 | — | 20% |
| Neck soft tissue CT scan without contrast CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST | $1,949.60 | $2,437.00 | $747.00–$2,095.00 | 54% above | 20% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT SOFT TISSUE NECK WO CONTRAST | $1,949.60 | $2,437.00 | $1,632.00–$2,437.00 | — | 20% |
| Neck soft tissue X-ray CPT 70360 HC SOFT TISSUE NECK | $216.80 | $271.00 | $140.00–$271.00 | 24% above | 20% |
| Neck soft tissue X-ray inpatient CPT 70360 HC SOFT TISSUE NECK | $216.80 | $271.00 | $181.00–$271.00 | — | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM HEART MUSCLE SPECT MULT | $3,509.60 | $4,387.00 | $2,281.00–$3,772.00 | 25% above | 20% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM HEART MUSCLE SPECT MULT | $3,509.60 | $4,387.00 | $2,939.00–$4,387.00 | — | 20% |
| Pelvic CT scan without contrast CPT 72192 HC CT PELVIS WO CONTRAST | $1,924.80 | $2,406.00 | $747.00–$2,069.00 | 49% above | 20% |
| Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS WO CONTRAST | $1,924.80 | $2,406.00 | $1,612.00–$2,406.00 | — | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LTD TRANSABDOMINAL | $436.80 | $546.00 | $283.00–$546.00 | 24% above | 20% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LTD TRANSABDOMINAL | $436.80 | $546.00 | $365.00–$546.00 | — | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US EXAM PELVIC COMP TRANSABDOMINAL | $490.40 | $613.00 | $318.00–$613.00 | 9% below | 20% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US EXAM PELVIC COMP TRANSABDOMINAL | $490.40 | $613.00 | $410.00–$613.00 | — | 20% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB COMPLETE SNGL FETUS | $897.60 | $1,122.00 | $583.00–$964.00 | 63% above | 20% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB COMPLETE SNGL FETUS | $897.60 | $1,122.00 | $751.00–$1,122.00 | — | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB LESS THAN 14 WKS SNGL FETUS | $536.00 | $670.00 | $348.00–$670.00 | 16% above | 20% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB LESS THAN 14 WKS SNGL FETUS | $536.00 | $670.00 | $448.00–$670.00 | — | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) | $518.40 | $648.00 | $336.00–$648.00 | 53% above | 20% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) | $518.40 | $648.00 | $434.00–$648.00 | — | 20% |
| Rib X-ray, one side, 2 views one side CPT 71100 HC RIBS UNILATERAL 2 VIEWS | $286.40 | $358.00 | $186.00–$358.00 | 35% above | 20% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC RIBS UNILATERAL 2 VIEWS | $286.40 | $358.00 | $239.00–$358.00 | — | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC RIBS CHEST UNIL MIN 3 VIEWS | $358.40 | $448.00 | $232.00–$448.00 | 25% above | 20% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC RIBS CHEST UNIL MIN 3 VIEWS | $358.40 | $448.00 | $300.00–$448.00 | — | 20% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO INCL CAD BILAT | $487.20 | $609.00 | $316.00–$523.00 | — | 20% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO INCL CAD BILAT | $487.20 | $609.00 | $408.00–$609.00 | — | 20% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER MIN 2 VIEWS | $300.00 | $375.00 | $195.00–$375.00 | 30% above | 20% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER MIN 2 VIEWS | $300.00 | $375.00 | $251.00–$375.00 | — | 20% |
| Sinus X-ray, complete, 3 or more views CPT 70220 HC SINUSES MIN 3 VIEWS | $309.60 | $387.00 | $201.00–$387.00 | 26% above | 20% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC SINUSES MIN 3 VIEWS | $309.60 | $387.00 | $259.00–$387.00 | — | 20% |
| Skull X-ray, fewer than 4 views CPT 70250 HC SKULL LESS THAN 4 VIEWS | $309.60 | $387.00 | $201.00–$387.00 | 51% above | 20% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 HC SKULL LESS THAN 4 VIEWS | $309.60 | $387.00 | $259.00–$387.00 | — | 20% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PSS W 4/> PARAM W TECH 6+ YRS | $3,029.60 | $3,787.00 | $747.00–$3,484.00 | 5% above | 20% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PSS W 4/> PARAM W TECH 6+ YRS | $3,029.60 | $3,787.00 | $2,537.00–$3,787.00 | — | 20% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOWING FUNCTION W CINE VIDEO | $305.60 | $382.00 | $198.00–$382.00 | 26% below | 20% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC SWALLOWING FUNCTION W CINE VIDEO | $305.60 | $382.00 | $255.00–$382.00 | — | 20% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM OF FEMUR 2/> VW | $249.60 | $312.00 | $162.00–$312.00 | 28% above | 20% |
| Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY EXAM OF FEMUR 2/> VW | $249.60 | $312.00 | $209.00–$312.00 | — | 20% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT THORACIC SPINE WO CONTRAST | $2,021.60 | $2,527.00 | $747.00–$2,173.00 | 46% above | 20% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT THORACIC SPINE WO CONTRAST | $2,021.60 | $2,527.00 | $1,693.00–$2,527.00 | — | 20% |
| Toe X-ray, 2 or more views CPT 73660 HC TOE OR TOES MIN 2 VIEWS | $250.40 | $313.00 | $162.00–$313.00 | 46% above | 20% |
| Toe X-ray, 2 or more views inpatient CPT 73660 HC TOE OR TOES MIN 2 VIEWS | $250.40 | $313.00 | $209.00–$313.00 | — | 20% |
| Transvaginal pelvic ultrasound CPT 76830 HC US NON OB TRANSVAG | $744.00 | $930.00 | $483.00–$799.00 | 45% above | 20% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US NON OB TRANSVAG | $744.00 | $930.00 | $623.00–$930.00 | — | 20% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL | $505.60 | $632.00 | $328.00–$632.00 | 11% above | 20% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL | $505.60 | $632.00 | $423.00–$632.00 | — | 20% |
| Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE | $994.40 | $1,243.00 | $646.00–$1,068.00 | 44% above | 20% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE | $994.40 | $1,243.00 | $832.00–$1,243.00 | — | 20% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM AND CONTENTS | $708.00 | $885.00 | $460.00–$761.00 | 30% above | 20% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM AND CONTENTS | $708.00 | $885.00 | $592.00–$885.00 | — | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK | $677.60 | $847.00 | $440.00–$728.00 | 46% above | 20% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK | $677.60 | $847.00 | $567.00–$847.00 | — | 20% |
| Upper arm X-ray (humerus), 2 views CPT 73060 HC HUMERUS MIN 2 VIEWS | $244.80 | $306.00 | $159.00–$306.00 | 31% above | 20% |
| Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC HUMERUS MIN 2 VIEWS | $244.80 | $306.00 | $205.00–$306.00 | — | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX EXT VEINS UNIL/LIMIT | $756.00 | $945.00 | $491.00–$869.00 | 17% above | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX EXT VEINS UNIL/LIMIT | $756.00 | $945.00 | $633.00–$945.00 | — | 20% |
| Wrist X-ray, 2 views CPT 73100 HC WRIST 2 VIEWS | $232.80 | $291.00 | $151.00–$291.00 | 28% above | 20% |
| Wrist X-ray, 2 views inpatient CPT 73100 HC WRIST 2 VIEWS | $232.80 | $291.00 | $194.00–$291.00 | — | 20% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST COMPL MIN 3 VIEWS | $274.40 | $343.00 | $178.00–$343.00 | 24% above | 20% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST COMPL MIN 3 VIEWS | $274.40 | $343.00 | $229.00–$343.00 | — | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS | $272.00 | $340.00 | $176.00–$340.00 | 31% above | 20% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS | $272.00 | $340.00 | $227.00–$340.00 | — | 20% |
| X-ray of the abdomen, 1 view CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW | $338.40 | $423.00 | $219.00–$423.00 | 92% above | 20% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW | $338.40 | $423.00 | $283.00–$423.00 | — | 20% |
| X-ray of the ankle, 2 views CPT 73600 HC ANKLE 2 VIEWS | $171.20 | $214.00 | $111.00–$214.00 | 2% above | 20% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE 2 VIEWS | $171.20 | $214.00 | $143.00–$214.00 | — | 20% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC FINGER OR FINGERS MIN 2 VIEWS | $236.00 | $295.00 | $153.00–$295.00 | 40% above | 20% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGER OR FINGERS MIN 2 VIEWS | $236.00 | $295.00 | $197.00–$295.00 | — | 20% |
| X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VIEWS | $171.20 | $214.00 | $111.00–$214.00 | 5% above | 20% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VIEWS | $171.20 | $214.00 | $143.00–$214.00 | — | 20% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT MIN 3 VIEWS | $239.20 | $299.00 | $155.00–$299.00 | 10% above | 20% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT MIN 3 VIEWS | $239.20 | $299.00 | $200.00–$299.00 | — | 20% |
| X-ray of the hand, 3 or more views CPT 73130 HC HAND MIN 3 VIEWS | $272.00 | $340.00 | $176.00–$340.00 | 34% above | 20% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND MIN 3 VIEWS | $272.00 | $340.00 | $227.00–$340.00 | — | 20% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 1 OR 2 VIEWS | $252.00 | $315.00 | $163.00–$315.00 | 29% above | 20% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 1 OR 2 VIEWS | $252.00 | $315.00 | $211.00–$315.00 | — | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBOSACR SPINE 2 OR 3 VIEWS | $301.60 | $377.00 | $196.00–$324.00 | 6% above | 20% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBOSACR SPINE 2 OR 3 VIEWS | $301.60 | $377.00 | $252.00–$377.00 | — | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 HC LUMBOSACR SPINE MIN 4 VIEWS | $416.80 | $521.00 | $270.00–$521.00 | 18% above | 20% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBOSACR SPINE MIN 4 VIEWS | $416.80 | $521.00 | $349.00–$521.00 | — | 20% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC THORACIC SPINE 2 VIEWS | $304.00 | $380.00 | $197.00–$380.00 | 22% above | 20% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC THORACIC SPINE 2 VIEWS | $304.00 | $380.00 | $254.00–$380.00 | — | 20% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES MIN 3 VIEWS | $246.40 | $308.00 | $160.00–$308.00 | 25% above | 20% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES MIN 3 VIEWS | $246.40 | $308.00 | $206.00–$308.00 | — | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE 2 OR 3 VIEWS | $295.20 | $369.00 | $191.00–$317.00 | 19% above | 20% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE 2 OR 3 VIEWS | $295.20 | $369.00 | $247.00–$369.00 | — | 20% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS 1 OR 2 VIEWS | $220.80 | $276.00 | $143.00–$276.00 | 12% above | 20% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS 1 OR 2 VIEWS | $220.80 | $276.00 | $184.00–$276.00 | — | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM COCCYX MIN 2 VIEWS | $256.80 | $321.00 | $166.00–$276.00 | 18% above | 20% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM COCCYX MIN 2 VIEWS | $256.80 | $321.00 | $215.00–$321.00 | — | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE | $22.40 | $28.00 | $14.00–$24.00 | 6% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE | $22.40 | $28.00 | $18.00–$28.00 | — | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19 LAB TEST NON-CDC AMP PRB | $118.40 | $148.00 | $76.00–$148.00 | at median | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC COVID-19 LAB TEST NON-CDC AMP PRB | $118.40 | $148.00 | $99.00–$148.00 | — | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC HEMOGLOBIN GLYCOSYLATED TEST (A1C) | $93.60 | $117.00 | $60.00–$100.00 | 44% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC HEMOGLOBIN GLYCOSYLATED TEST (A1C) | $93.60 | $117.00 | $78.00–$117.00 | — | 20% |
| Hemoglobin blood test CPT 85018 HC HEMOGLOBIN | $46.40 | $58.00 | $30.00–$49.00 | 63% above | 20% |
| Hemoglobin blood test inpatient CPT 85018 HC HEMOGLOBIN | $46.40 | $58.00 | $38.00–$58.00 | — | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC PROTHROMBIN TIME | $47.20 | $59.00 | $30.00–$50.00 | 44% above | 20% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC PROTHROMBIN TIME | $47.20 | $59.00 | $39.00–$59.00 | — | 20% |
| Rapid flu test (influenza antigen) CPT 87804 HC INFLUENZA IA W DO | $90.40 | $113.00 | $58.00–$113.00 | 85% above | 20% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 HC INFLUENZA IA W DO | $90.40 | $113.00 | $75.00–$113.00 | — | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC STREP A ASSAY W/OPTIC | $73.60 | $92.00 | $47.00–$92.00 | 42% above | 20% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC STREP A ASSAY W/OPTIC | $73.60 | $92.00 | $61.00–$92.00 | — | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 HC OCCULT BLOOD FECES | $52.00 | $65.00 | $33.00–$65.00 | 57% above | 20% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC OCCULT BLOOD FECES | $52.00 | $65.00 | $43.00–$65.00 | — | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC OCCULT BLD IA SCRN CRC | $56.00 | $70.00 | $36.00–$70.00 | 4% below | 20% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC OCCULT BLD IA SCRN CRC | $56.00 | $70.00 | $46.00–$70.00 | — | 20% |
| Urinalysis with microscope exam, automated CPT 81001 HC AUTOM URINE DIP W MICRO | $47.20 | $59.00 | $30.00–$50.00 | 10% above | 20% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC AUTOM URINE DIP W MICRO | $47.20 | $59.00 | $39.00–$59.00 | — | 20% |
| Urinalysis without microscope exam, automated CPT 81003 HC AUTOM URINALYSIS WO MICRO | $24.00 | $30.00 | $15.00–$25.00 | 9% below | 20% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC AUTOM URINALYSIS WO MICRO | $24.00 | $30.00 | $20.00–$30.00 | — | 20% |
| Urinalysis without microscope exam, manual CPT 81002 HC N-AUTOM URINALYS WO MICRO | $24.00 | $30.00 | $15.00–$30.00 | 3% above | 20% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC N-AUTOM URINALYS WO MICRO | $24.00 | $30.00 | $20.00–$30.00 | — | 20% |
| Urine pregnancy test, read by color change CPT 81025 HC URINE PREGNANCY, VISUAL COLOR | $52.00 | $65.00 | $33.00–$65.00 | 23% above | 20% |
| Urine pregnancy test, read by color change inpatient CPT 81025 HC URINE PREGNANCY, VISUAL COLOR | $52.00 | $65.00 | $43.00–$65.00 | — | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC BX BREAST 1ST LESION STEREOTACTIC | $3,715.20 | $4,644.00 | $747.00–$4,272.00 | 14% above | 20% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC BX BREAST 1ST LESION STEREOTACTIC | $3,715.20 | $4,644.00 | $3,111.00–$4,644.00 | — | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION | $974.40 | $1,218.00 | $633.00–$1,120.00 | 18% above | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION | $974.40 | $1,218.00 | $816.00–$1,218.00 | — | 20% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 HC REMOVE IMPACTED EAR WAX UNI | $32.80 | $41.00 | $21.00–$41.00 | 52% below | 20% |
| Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC REMOVE IMPACTED EAR WAX UNI | $32.80 | $41.00 | $27.00–$41.00 | — | 20% |
| Earwax removal with instruments, one ear CPT 69210 HC REMOVAL IMPACTED CERUMEN (EARWAX) | $198.40 | $248.00 | $128.00–$248.00 | 89% above | 20% |
| Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVAL IMPACTED CERUMEN (EARWAX) | $198.40 | $248.00 | $166.00–$248.00 | — | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ INTERLAM C/T W IMG | $1,892.80 | $2,366.00 | $1,230.00–$2,176.00 | 54% above | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ INTERLAM C/T W IMG | $1,892.80 | $2,366.00 | $1,585.00–$2,366.00 | — | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $1,840.80 | $2,301.00 | $747.00–$2,116.00 | 42% above | 20% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $1,840.80 | $2,301.00 | $1,541.00–$2,301.00 | — | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 HC LIGATION OF HEMORRHOID(S) | $773.60 | $967.00 | $502.00–$889.00 | 24% above | 20% |
| Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HC LIGATION OF HEMORRHOID(S) | $773.60 | $967.00 | $647.00–$967.00 | — | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC INJ SALINE HYSTEROGRAM | $308.80 | $386.00 | $200.00–$386.00 | 11% below | 20% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC INJ SALINE HYSTEROGRAM | $308.80 | $386.00 | $258.00–$386.00 | — | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSC SMPL OR SGL | $356.80 | $446.00 | $231.00–$446.00 | 40% above | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSC SMPL OR SGL | $356.80 | $446.00 | $298.00–$446.00 | — | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ SGL TENDON SHTH OR LIGAMENT | $676.80 | $846.00 | $439.00–$821.00 | 150% above | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ SGL TENDON SHTH OR LIGAMENT | $676.80 | $846.00 | $566.00–$846.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC DRAIN/INJ MAJOR JNT/BURSA | $677.60 | $847.00 | $440.00–$821.00 | 97% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC DRAIN/INJ MAJOR JNT/BURSA | $677.60 | $847.00 | $567.00–$847.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJ INTERM JNT/BURSA | $677.60 | $847.00 | $440.00–$821.00 | 116% above | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJ INTERM JNT/BURSA | $677.60 | $847.00 | $567.00–$847.00 | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJ JOINT/BURSA W/O US | $677.60 | $847.00 | $440.00–$821.00 | 146% above | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJ JOINT/BURSA W/O US | $677.60 | $847.00 | $567.00–$847.00 | — | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 HC ARTHROSC KNEE W MEN REP-MED&LAT | $2,526.40 | $3,158.00 | $747.00–$2,905.00 | 23% above | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 HC ARTHROSC KNEE W MEN REP-MED&LAT | $2,526.40 | $3,158.00 | $2,115.00–$3,158.00 | — | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 HC KNEE ARTHROSCOPY/SURGERY | $2,892.00 | $3,615.00 | $747.00–$3,325.00 | 20% above | 20% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 HC KNEE ARTHROSCOPY/SURGERY | $2,892.00 | $3,615.00 | $2,422.00–$3,615.00 | — | 20% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 HC KNEE ARTHROSCOPY/SURGERY | $3,457.60 | $4,322.00 | $747.00–$3,976.00 | 55% above | 20% |
| Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 HC KNEE ARTHROSCOPY/SURGERY | $3,457.60 | $4,322.00 | $2,895.00–$4,322.00 | — | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC INT REP S/A/T/EX 2.5 CM/< | $451.20 | $564.00 | $293.00–$518.00 | 27% above | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC INT REP S/A/T/EX 2.5 CM/< | $451.20 | $564.00 | $377.00–$564.00 | — | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAM L/S W IMG | $1,892.80 | $2,366.00 | $1,230.00–$2,176.00 | 56% above | 20% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAM L/S W IMG | $1,892.80 | $2,366.00 | $1,585.00–$2,366.00 | — | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV | $1,840.80 | $2,301.00 | $747.00–$2,116.00 | 40% above | 20% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV | $1,840.80 | $2,301.00 | $1,541.00–$2,301.00 | — | 20% |
| Nail removal (partial or complete), one nail CPT 11730 HC SPL AVULSE NP SGL | $407.20 | $509.00 | $264.00–$509.00 | 99% above | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC SPL AVULSE NP SGL | $407.20 | $509.00 | $341.00–$509.00 | — | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 HC INJ ANESTH/STER GREATER OCCIPITAL NERVE | $968.80 | $1,211.00 | $629.00–$1,114.00 | 132% above | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ ANESTH/STER GREATER OCCIPITAL NERVE | $968.80 | $1,211.00 | $811.00–$1,211.00 | — | 20% |
| Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W/IMAGING | $712.00 | $890.00 | $462.00–$821.00 | 35% below | 20% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W/IMAGING | $712.00 | $890.00 | $596.00–$890.00 | — | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC REMOVAL OF NAIL BED | $1,007.20 | $1,259.00 | $654.00–$1,158.00 | 135% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC REMOVAL OF NAIL BED | $1,007.20 | $1,259.00 | $843.00–$1,259.00 | — | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JNT UNIL | $1,346.40 | $1,683.00 | $747.00–$1,548.00 | 39% below | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JNT UNIL | $1,346.40 | $1,683.00 | $1,127.00–$1,683.00 | — | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 HC INC & REM FB SQ SMPL | $637.60 | $797.00 | $414.00–$797.00 | 114% above | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 HC INC & REM FB SQ SMPL | $637.60 | $797.00 | $533.00–$797.00 | — | 20% |
| Short arm cast (elbow to hand) CPT 29075 HC APPLY SHORT ARM CAST | $237.60 | $297.00 | $154.00–$297.00 | 3% above | 20% |
| Short arm cast (elbow to hand) inpatient CPT 29075 HC APPLY SHORT ARM CAST | $237.60 | $297.00 | $198.00–$297.00 | — | 20% |
| Short arm splint (forearm and hand) CPT 29125 HC APPLY SHORT ARM SPLINT STATIC | $237.60 | $297.00 | $154.00–$297.00 | 36% above | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY SHORT ARM SPLINT STATIC | $237.60 | $297.00 | $198.00–$297.00 | — | 20% |
| Short leg splint (calf to foot) CPT 29515 HC APPLY SHORT LEG SPLINT | $158.40 | $198.00 | $102.00–$198.00 | 8% below | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SHORT LEG SPLINT | $158.40 | $198.00 | $132.00–$198.00 | — | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SREP S/N/A/G/TR/E 2.5 CM/< | $234.40 | $293.00 | $152.00–$269.00 | 2% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SREP S/N/A/G/TR/E 2.5 CM/< | $234.40 | $293.00 | $196.00–$293.00 | — | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAG | $884.80 | $1,106.00 | $575.00–$1,017.00 | 90% above | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAG | $884.80 | $1,106.00 | $741.00–$1,106.00 | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SREP S/N/A/G/TR/E 2.6-7.5 CM | $323.20 | $404.00 | $210.00–$347.00 | 32% above | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC SREP S/N/A/G/TR/E 2.6-7.5 CM | $323.20 | $404.00 | $270.00–$404.00 | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SREP F/E/N/L/MM 2.5 CM/< | $323.20 | $404.00 | $210.00–$404.00 | 29% above | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SREP F/E/N/L/MM 2.5 CM/< | $323.20 | $404.00 | $270.00–$404.00 | — | 20% |
| Thoracentesis with imaging guidance CPT 32555 HC ASPIRATE PLEURA W/ IMAGING | $1,388.00 | $1,735.00 | $747.00–$1,596.00 | 46% above | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 HC ASPIRATE PLEURA W/ IMAGING | $1,388.00 | $1,735.00 | $1,162.00–$1,735.00 | — | 20% |
| Trigger finger release surgery CPT 26055 HC TENDON SHEATH INCISION | $1,407.20 | $1,759.00 | $747.00–$1,618.00 | 22% below | 20% |
| Trigger finger release surgery inpatient CPT 26055 HC TENDON SHEATH INCISION | $1,407.20 | $1,759.00 | $1,178.00–$1,759.00 | — | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINT 1/2 MUSCL | $677.60 | $847.00 | $440.00–$779.00 | 125% above | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER POINT 1/2 MUSCL | $677.60 | $847.00 | $567.00–$847.00 | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG | $3,715.20 | $4,644.00 | $747.00–$4,272.00 | 79% above | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG | $3,715.20 | $4,644.00 | $3,111.00–$4,644.00 | — | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC DEBRIDE SKIN TO SQ TISSUE | $1,007.20 | $1,259.00 | $654.00–$1,082.00 | 136% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC DEBRIDE SKIN TO SQ TISSUE | $1,007.20 | $1,259.00 | $843.00–$1,259.00 | — | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLOOD OR COMPONENT PER UNIT | $840.80 | $1,051.00 | $546.00–$903.00 | 44% above | 20% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLOOD OR COMPONENT PER UNIT | $840.80 | $1,051.00 | $704.00–$1,051.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI AIRWAY INHALATION TX SUBQ | $200.00 | $250.00 | $130.00–$250.00 | 72% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT SUBQ | $200.00 | $250.00 | $130.00–$250.00 | 72% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT INITIAL | $210.40 | $263.00 | $136.00–$263.00 | 81% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI AIRWAY INHALATION TX INITIAL | $210.40 | $263.00 | $136.00–$263.00 | 81% above | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT SUBQ | $200.00 | $250.00 | $167.00–$250.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI AIRWAY INHALATION TX SUBQ | $200.00 | $250.00 | $167.00–$250.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT INITIAL | $210.40 | $263.00 | $176.00–$263.00 | — | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI AIRWAY INHALATION TX INITIAL | $210.40 | $263.00 | $176.00–$263.00 | — | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 30-74 MIN | $2,027.20 | $2,534.00 | $747.00–$2,331.00 | 102% above | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 30-74 MIN | $2,027.20 | $2,534.00 | $1,697.00–$2,534.00 | — | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC 12 LEAD EKG; TRACING ONLY | $216.00 | $270.00 | $140.00–$232.00 | 36% above | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC 12 LEAD EKG; TRACING ONLY | $216.00 | $270.00 | $180.00–$270.00 | — | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED LEVEL 1 VISIT | $180.80 | $226.00 | $117.00–$226.00 | 17% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED LEVEL 1 VISIT | $180.80 | $226.00 | $151.00–$226.00 | — | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED LEVEL 2 VISIT | $216.00 | $270.00 | $140.00–$232.00 | 18% below | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED LEVEL 2 VISIT | $216.00 | $270.00 | $180.00–$270.00 | — | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED LEVEL 3 VISIT | $372.80 | $466.00 | $242.00–$400.00 | 11% below | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED LEVEL 3 VISIT | $372.80 | $466.00 | $312.00–$466.00 | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED LEVEL 4 VISIT | $620.80 | $776.00 | $403.00–$667.00 | 4% below | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED LEVEL 4 VISIT | $620.80 | $776.00 | $519.00–$776.00 | — | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED LEVEL 5 VISIT | $901.60 | $1,127.00 | $586.00–$1,036.00 | 8% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED LEVEL 5 VISIT | $901.60 | $1,127.00 | $755.00–$1,127.00 | — | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CVSLR STRESS TEST; TRACING | $690.40 | $863.00 | $448.00–$742.00 | 3% above | 20% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CVSLR STRESS TEST; TRACING | $690.40 | $863.00 | $578.00–$863.00 | — | 20% |
| Family therapy with the patient, 50 minutes CPT 90847 HC FAMILY THERAPY W PT 50 MIN | $233.60 | $292.00 | $151.00–$292.00 | at median | 20% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC FAMILY THERAPY W PT 50 MIN | $233.60 | $292.00 | $195.00–$292.00 | — | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRATION IV INFUSION INIT 31-60 MIN | $277.60 | $347.00 | $180.00–$298.00 | 1% below | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRATION IV INFUSION INIT 31-60 MIN | $277.60 | $347.00 | $232.00–$347.00 | — | 20% |
| IV infusion of a medicine, first hour CPT 96365 HC THER/PROPH/DX IV INF INIT UP TO 1HR | $460.80 | $576.00 | $299.00–$495.00 | 46% above | 20% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC THER/PROPH/DX IV INF INIT UP TO 1HR | $460.80 | $576.00 | $385.00–$576.00 | — | 20% |
| IV push of a medicine, first drug CPT 96374 HC THER/PRO/DX INJ IV PUSH | $163.20 | $204.00 | $106.00–$204.00 | 14% below | 20% |
| IV push of a medicine, first drug inpatient CPT 96374 HC THER/PRO/DX INJ IV PUSH | $163.20 | $204.00 | $136.00–$204.00 | — | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPH/DIAG INJ SC/IM | $96.00 | $120.00 | $62.00–$103.00 | 5% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPH/DIAG INJ SC/IM | $96.00 | $120.00 | $80.00–$120.00 | — | 20% |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION | $307.20 | $384.00 | $199.00–$384.00 | 30% above | 20% |
| Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC PSYCH DIAGNOSTIC EVALUATION | $307.20 | $384.00 | $257.00–$384.00 | — | 20% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCLE RE-EDUC EA 15M | $96.80 | $121.00 | $62.00–$121.00 | 6% above | 20% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCLE RE-EDUC EA 15M | $96.80 | $121.00 | $81.00–$121.00 | — | 20% |
| New patient office visit, about 30 minutes CPT 99203 HC O/P VISIT NEW LEVEL 3 | $315.20 | $394.00 | $204.00–$394.00 | 92% above | 20% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC O/P VISIT NEW LEVEL 3 | $315.20 | $394.00 | $263.00–$394.00 | — | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC O/P VISIT NEW LEVEL 2 | $253.60 | $317.00 | $164.00–$317.00 | 143% above | 20% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC O/P VISIT NEW LEVEL 2 | $253.60 | $317.00 | $212.00–$317.00 | — | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC INIT NUTRITION THERAPY; EACH 15M | $50.40 | $63.00 | $32.00–$63.00 | 14% above | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC INIT NUTRITION THERAPY; EACH 15M | $50.40 | $63.00 | $42.00–$63.00 | — | 20% |
| Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX | $170.40 | $213.00 | $110.00–$213.00 | 5% below | 20% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX | $170.40 | $213.00 | $142.00–$213.00 | — | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX | $237.60 | $297.00 | $154.00–$297.00 | 11% above | 20% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX | $237.60 | $297.00 | $198.00–$297.00 | — | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX | $170.40 | $213.00 | $110.00–$213.00 | 13% below | 20% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX | $170.40 | $213.00 | $142.00–$213.00 | — | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX | $202.40 | $253.00 | $131.00–$253.00 | 2% above | 20% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX | $202.40 | $253.00 | $169.00–$253.00 | — | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY EA 15M | $96.80 | $121.00 | $62.00–$121.00 | at median | 20% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY EA 15M | $96.80 | $121.00 | $81.00–$121.00 | — | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAP EXERCISE ROM EA 15M | $96.80 | $121.00 | $62.00–$121.00 | 6% above | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAP EXERCISE ROM EA 15M | $96.80 | $121.00 | $81.00–$121.00 | — | 20% |
| Psychotherapy session, 30 minutes CPT 90832 HC PSYTX W PT 30 MIN (16-37 MIN) | $128.80 | $161.00 | $83.00–$161.00 | 23% below | 20% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC PSYTX W PT 30 MIN (16-37 MIN) | $128.80 | $161.00 | $107.00–$161.00 | — | 20% |
| Psychotherapy session, 45 minutes CPT 90834 HC PSYTX W PT 45 MIN (38-52 MIN) | $196.00 | $245.00 | $127.00–$245.00 | 11% below | 20% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC PSYTX W PT 45 MIN (38-52 MIN) | $196.00 | $245.00 | $164.00–$245.00 | — | 20% |
| Psychotherapy session, 60 minutes CPT 90837 HC PSYTX W PT 60 MIN (>53 MIN) | $292.00 | $365.00 | $189.00–$365.00 | 7% above | 20% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC PSYTX W PT 60 MIN (>53 MIN) | $292.00 | $365.00 | $244.00–$365.00 | — | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC SMOKE/TOBACCO COUNSELING 3-10 MIN | $63.20 | $79.00 | $41.00–$79.00 | 72% above | 20% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC SMOKE/TOBACCO COUNSELING 3-10 MIN | $63.20 | $79.00 | $52.00–$79.00 | — | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC O/P VISIT EST LEVEL 3 (20-29 MIN) | $309.60 | $387.00 | $201.00–$387.00 | 162% above | 20% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC O/P VISIT EST LEVEL 3 (20-29 MIN) | $309.60 | $387.00 | $259.00–$387.00 | — | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC O/P VISIT EST LEVEL 4 (30-39 MIN) | $366.40 | $458.00 | $238.00–$458.00 | 121% above | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC O/P VISIT EST LEVEL 4 (30-39 MIN) | $366.40 | $458.00 | $306.00–$458.00 | — | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC O/P VISIT EST LEVEL 2 (10-19 MIN) | $249.60 | $312.00 | $162.00–$312.00 | 208% above | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC O/P VISIT EST LEVEL 2 (10-19 MIN) | $249.60 | $312.00 | $209.00–$312.00 | — | 20% |
| Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND LANG COMPREHEN | $259.20 | $324.00 | $168.00–$324.00 | 14% below | 20% |
| Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND LANG COMPREHEN | $259.20 | $324.00 | $217.00–$324.00 | — | 20% |
| Speech therapy session, individual CPT 92507 HC SPEECH/HEARING THERAPY | $202.40 | $253.00 | $131.00–$253.00 | 7% below | 20% |
| Speech therapy session, individual inpatient CPT 92507 HC SPEECH/HEARING THERAPY | $202.40 | $253.00 | $169.00–$253.00 | — | 20% |
| Spirometry (breathing test) CPT 94010 HC SPIROMETRY | $220.00 | $275.00 | $143.00–$275.00 | 12% above | 20% |
| Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY | $220.00 | $275.00 | $184.00–$275.00 | — | 20% |
| Spirometry before and after a bronchodilator CPT 94060 HC BRONCHOSPASM PRE & POST BD | $451.20 | $564.00 | $293.00–$485.00 | 15% above | 20% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC BRONCHOSPASM PRE & POST BD | $451.20 | $564.00 | $377.00–$564.00 | — | 20% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACTIVITY DIR EA 15M | $96.80 | $121.00 | $62.00–$121.00 | 5% below | 20% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACTIVITY DIR EA 15M | $96.80 | $121.00 | $81.00–$121.00 | — | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 HC SARSCOV2 VAC 50 MCG/0.5ML IM | $339.20 | $424.00 | $220.00–$390.00 | 29% above | 20% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 HC SARSCOV2 VAC 50 MCG/0.5ML IM | $339.20 | $424.00 | $284.00–$424.00 | — | 20% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $127.00 | $127.00 | $66.00–$116.00 | 467% above | — |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $127.00 | $127.00 | $85.00–$127.00 | — | — |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HC HEP B VACC ADULT 3 DOSE IM | $175.20 | $219.00 | $113.00–$201.00 | 60% above | 20% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HC HEP B VACC ADULT 3 DOSE IM | $175.20 | $219.00 | $146.00–$219.00 | — | 20% |
| Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR | $939.01 | $939.01 | $488.00–$863.00 | 31% above | — |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR | $939.01 | $939.01 | $629.00–$939.00 | — | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $182.30 | $182.30 | $94.00–$156.00 | 115% above | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $182.30 | $182.30 | $122.00–$182.00 | — | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VACCINE | $96.00 | $120.00 | $62.00–$120.00 | 174% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADM 1 VACCINE | $96.00 | $120.00 | $62.00–$120.00 | 174% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMONIA VACCINE | $96.00 | $120.00 | $62.00–$120.00 | 174% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN HEPATITIS B VACCINE | $96.00 | $120.00 | $62.00–$120.00 | 174% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $114.00 | $114.00 | $59.00–$114.00 | 226% above | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VACCINE | $96.00 | $120.00 | $80.00–$120.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMONIA VACCINE | $96.00 | $120.00 | $80.00–$120.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN HEPATITIS B VACCINE | $96.00 | $120.00 | $80.00–$120.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADM 1 VACCINE | $96.00 | $120.00 | $80.00–$120.00 | — | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY | $114.00 | $114.00 | $76.00–$114.00 | — | — |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADM EA ADDTL VACCINE | $91.20 | $114.00 | $59.00–$114.00 | 217% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADM EA ADDTL VACCINE | $91.20 | $114.00 | $76.00–$114.00 | — | 20% |
Source file: https://www.guttenberghospital.org/download/426038728_guttenbergmunicipalhospital_standardcharges