Hospital

Ashley Medical Center

Ashley Medical Center in Ashley, ND publishes cash prices for 251 common procedures listed here, from its own machine-readable price file updated Oct 9, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the North Dakota median for 185 of 247 procedures and below it for 59. By typical cash price it ranks #29 of 33 North Dakota hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

612 Center Avenue North, PO Box 450, Ashley, ND, 58413 Collected Oct 17, 2026 Source price file Check a bill from this hospital (701) 288-3433

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 351322 · CMS hospital register NPI 1740286616

The price file shows no self-pay discount

For 696 of the 696 prices listed here, the cash price in Ashley Medical Center's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

Financial assistance

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

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

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

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

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named Ashley Medical Center in Ashley, ND:

Sep 11, 2025 Warning notice
Nov 24, 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 North Dakota	Off list
Abdominal CT scan without and with contrast CPT 74170 CT ABD W&W/O CONT	$2,411.00	$2,411.00	—	17% above	—
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABD W&W/O CONT	$2,411.00	$2,411.00	—	—	—
Abdominal X-ray, 2 views CPT 74019 XR ABD 2 VIEW	$167.00	$167.00	—	4% below	—
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABD 2 VIEW	$167.00	$167.00	—	—	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE LT 3VIEWS,Left	$157.00	$157.00	—	2% above	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE RT 3VIEWS,Right	$157.00	$157.00	—	2% above	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE LT 3VIEWS,Left	$157.00	$157.00	—	—	—
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE RT 3VIEWS,Right	$157.00	$157.00	—	—	—
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPP EXT RT W/O CONT,Right	$1,514.00	$1,514.00	—	20% above	—
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UPP EXT LT W/O CONT,Left	$1,514.00	$1,514.00	—	20% above	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPP EXT RT W/O CONT,Right	$1,514.00	$1,514.00	—	—	—
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UPP EXT LT W/O CONT,Left	$1,514.00	$1,514.00	—	—	—
Breast ultrasound, complete, one breast one side CPT 76641 US B-SCAN RT COMPLETE - BREAST SCAN,Right	$502.00	$502.00	—	42% above	—
Breast ultrasound, complete, one breast one side CPT 76641 US B-SCAN LT COMPLETE - BREAST SCAN,Left	$502.00	$502.00	—	42% above	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US B-SCAN RT COMPLETE - BREAST SCAN,Right	$502.00	$502.00	—	—	—
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US B-SCAN LT COMPLETE - BREAST SCAN,Left	$502.00	$502.00	—	—	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US B-SCAN LT LIMITED - BREAST SCAN,Left	$385.00	$385.00	—	29% above	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US B-SCAN RT LIMITED - BREAST SCAN,Right	$385.00	$385.00	—	29% above	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US B-SCAN RT LIMITED - BREAST SCAN,Right	$385.00	$385.00	—	—	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US B-SCAN LT LIMITED - BREAST SCAN,Left	$385.00	$385.00	—	—	—
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD/PEL W	$3,497.00	$3,497.00	—	23% above	—
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD/PEL W	$3,497.00	$3,497.00	—	—	—
CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD W	$2,403.00	$2,403.00	—	20% above	—
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIO HEAD W	$2,403.00	$2,403.00	—	—	—
CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK W	$2,572.00	$2,572.00	—	28% above	—
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIO NECK W	$2,572.00	$2,572.00	—	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W	$2,468.00	$2,468.00	—	18% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W	$2,468.00	$2,468.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PEL W/O CONTRAST	$1,361.00	$1,361.00	—	17% below	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PEL W/O CONTRAST	$1,361.00	$1,361.00	—	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PEL W CONT	$2,578.00	$2,578.00	—	5% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PEL W CONT	$2,578.00	$2,578.00	—	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PEL W&W/O CONT	$2,959.00	$2,959.00	—	1% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PEL W&W/O CONT	$2,959.00	$2,959.00	—	—	—
CT scan of the abdomen with contrast CPT 74160 CT ABD W/CONT	$1,957.00	$1,957.00	—	20% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/CONT	$1,957.00	$1,957.00	—	—	—
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O CONT	$1,258.00	$1,258.00	—	1% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O CONT	$1,258.00	$1,258.00	—	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACE/SIN/JAW W/O	$1,328.00	$1,328.00	—	25% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACE/SIN/JAW W/O	$1,328.00	$1,328.00	—	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONT	$1,045.00	$1,045.00	—	3% below	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONT	$1,045.00	$1,045.00	—	—	—
CT scan of the head with contrast CPT 70460 CT HEAD W CONT	$1,274.00	$1,274.00	—	at median	—
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONT	$1,274.00	$1,274.00	—	—	—
CT scan of the head without and with contrast CPT 70470 CT HEAD W&W/O CONT	$1,591.00	$1,591.00	—	4% above	—
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W&W/O CONT	$1,591.00	$1,591.00	—	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O	$1,519.00	$1,519.00	—	17% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O	$1,519.00	$1,519.00	—	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O	$1,534.00	$1,534.00	—	14% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O	$1,534.00	$1,534.00	—	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIC W CONTRAST	$1,962.00	$1,962.00	—	23% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIC W CONTRAST	$1,962.00	$1,962.00	—	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DUPLEX BILATERAL	$1,210.00	$1,210.00	—	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID DUPLEX BILATERAL	$1,210.00	$1,210.00	—	—	—
Chest CT scan without and with contrast CPT 71270 CT CHEST W&W/O CON	$2,401.00	$2,401.00	—	40% above	—
Chest CT scan without and with contrast inpatient CPT 71270 CT CHEST W&W/O CON	$2,401.00	$2,401.00	—	—	—
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEW	$182.00	$182.00	—	5% above	—
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEW	$182.00	$182.00	—	—	—
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$182.00	$182.00	—	26% above	—
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$182.00	$182.00	—	—	—
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE LT COMP,Left	$134.00	$134.00	—	5% below	—
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE RT COMP,Right	$134.00	$134.00	—	5% below	—
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE RT COMP,Right	$134.00	$134.00	—	—	—
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR CLAVICLE LT COMP,Left	$134.00	$134.00	—	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL/AORTA/NODES	$622.00	$622.00	—	43% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL/AORTA/NODES	$622.00	$622.00	—	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD BONE DENSITY	$497.00	$497.00	—	96% above	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD BONE DENSITY	$497.00	$497.00	—	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONT	$1,510.00	$1,510.00	—	24% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONT	$1,510.00	$1,510.00	—	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W CONT	$1,951.00	$1,951.00	—	39% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W CONT	$1,951.00	$1,951.00	—	—	—
Diagnostic mammogram, both breasts both sides CPT 77066 MA BILAT DIAGNOSTIC	$655.00	$655.00	—	—	—
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA BILAT DIAGNOSTIC	$655.00	$655.00	—	—	—
Diagnostic mammogram, one breast one side CPT 77065 MA UNI DIAG LT DIG W/CAD - MAMMO,Left	$511.00	$511.00	—	31% above	—
Diagnostic mammogram, one breast one side CPT 77065 MA UNI DIAG RT DIG W/CAD - MAMMO,Right	$511.00	$511.00	—	31% above	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA UNI DIAG RT DIG W/CAD - MAMMO,Right	$511.00	$511.00	—	—	—
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA UNI DIAG LT DIG W/CAD - MAMMO,Left	$511.00	$511.00	—	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS DOPP BILAT - DOPPLER VEN	$1,269.00	$1,269.00	—	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS DOPP BILAT - DOPPLER VEN	$1,269.00	$1,269.00	—	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM	$1,230.00	$1,230.00	—	60% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARDIOGRAM	$1,230.00	$1,230.00	—	—	—
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW RT 2 VIEWS,Right	$134.00	$134.00	—	2% below	—
Elbow X-ray, 2 views one side CPT 73070 XR ELBOW LT 2 VIEWS,Left	$134.00	$134.00	—	2% below	—
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW LT 2 VIEWS,Left	$134.00	$134.00	—	—	—
Elbow X-ray, 2 views inpatient one side CPT 73070 XR ELBOW RT 2 VIEWS,Right	$134.00	$134.00	—	—	—
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW LT COMPLETE,Left	$165.00	$165.00	—	2% above	—
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW RT COMPLETE,Right	$165.00	$165.00	—	2% above	—
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW RT COMPLETE,Right	$165.00	$165.00	—	—	—
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR ELBOW LT COMPLETE,Left	$165.00	$165.00	—	—	—
Eye socket (orbit) CT scan without contrast CPT 70480 CT EAR/ORB/SEL W/O CONT	$1,977.00	$1,977.00	—	43% above	—
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT EAR/ORB/SEL W/O CONT	$1,977.00	$1,977.00	—	—	—
Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL BONES 4V	$196.00	$196.00	—	at median	—
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR FACIAL BONES 4V	$196.00	$196.00	—	—	—
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM RT 2 VIEWS,Right	$125.00	$125.00	—	15% below	—
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM LT 2 VIEWS,Left	$125.00	$125.00	—	15% below	—
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM RT 2 VIEWS,Right	$125.00	$125.00	—	—	—
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR FOREARM LT 2 VIEWS,Left	$125.00	$125.00	—	—	—
Hand X-ray, 2 views one side CPT 73120 XR HAND LT 2 VIEWS,Left	$129.00	$129.00	—	8% below	—
Hand X-ray, 2 views one side CPT 73120 XR HAND RT 2 VIEWS,Right	$129.00	$129.00	—	8% below	—
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND RT 2 VIEWS,Right	$129.00	$129.00	—	—	—
Hand X-ray, 2 views inpatient one side CPT 73120 XR HAND LT 2 VIEWS,Left	$129.00	$129.00	—	—	—
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR HEEL LT 2V - CALCANEOUS,Left	$132.00	$132.00	—	9% below	—
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR HEEL RT 2V - CALCANEOUS,Right	$132.00	$132.00	—	9% below	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR HEEL RT 2V - CALCANEOUS,Right	$132.00	$132.00	—	—	—
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR HEEL LT 2V - CALCANEOUS,Left	$132.00	$132.00	—	—	—
Knee X-ray, 3 views one side CPT 73562 XR KNEE LT 3 VIEW,Left	$184.00	$184.00	—	at median	—
Knee X-ray, 3 views one side CPT 73562 XR KNEE RT 3 VIEW,Right	$184.00	$184.00	—	at median	—
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE RT 3 VIEW,Right	$184.00	$184.00	—	—	—
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE LT 3 VIEW,Left	$184.00	$184.00	—	—	—
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE LT 4+ VIEWS - PATELLA ETC,Left	$196.00	$196.00	—	1% above	—
Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE RT 4+ VIEWS - PATELLA ETC,Right	$196.00	$196.00	—	1% above	—
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE LT 4+ VIEWS - PATELLA ETC,Left	$196.00	$196.00	—	—	—
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR KNEE RT 4+ VIEWS - PATELLA ETC,Right	$196.00	$196.00	—	—	—
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOW EXT RT W/O CONT,Right	$1,519.00	$1,519.00	—	25% above	—
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOW EXT LT W/O CONT,Left	$1,519.00	$1,519.00	—	25% above	—
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOW EXT RT W/O CONT,Right	$1,519.00	$1,519.00	—	—	—
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LOW EXT LT W/O CONT,Left	$1,519.00	$1,519.00	—	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED - ABDOMINAL	$488.00	$488.00	—	26% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED - ABDOMINAL	$488.00	$488.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT UPR NONVAS LT LIMITED,Left	$213.00	$213.00	—	12% below	—
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT UPR NONVAS RT LIMITED,Right	$213.00	$213.00	—	12% below	—
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT LWR NONVAS RT LIMITED,Right	$213.00	$213.00	—	12% below	—
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT LWR NONVAS LT LIMITED,Left	$213.00	$213.00	—	12% below	—
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT UPR NONVAS RT LIMITED,Right	$213.00	$213.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT LWR NONVAS RT LIMITED,Right	$213.00	$213.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT UPR NONVAS LT LIMITED,Left	$213.00	$213.00	—	—	—
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT LWR NONVAS LT LIMITED,Left	$213.00	$213.00	—	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LOW DOSE CHEST W/O SCREENING	$710.00	$710.00	—	5% below	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LOW DOSE CHEST W/O SCREENING	$710.00	$710.00	—	—	—
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR LOWER LEG LT,Left	$142.00	$142.00	—	10% below	—
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR LOWER LEG RT,Right	$142.00	$142.00	—	10% below	—
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR LOWER LEG RT,Right	$142.00	$142.00	—	—	—
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR LOWER LEG LT,Left	$142.00	$142.00	—	—	—
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$3,568.00	$3,568.00	—	62% above	—
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRAST	$3,568.00	$3,568.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI EXT LOWER LT JOINT W/O,Left	$2,990.00	$2,990.00	—	55% above	—
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI EXT LOWER RT JOINT W/O,Right	$2,990.00	$2,990.00	—	55% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI EXT LOWER LT JOINT W/O,Left	$2,990.00	$2,990.00	—	—	—
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI EXT LOWER RT JOINT W/O,Right	$2,990.00	$2,990.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI EXT LOWER LT JOINT W&W/O,Left	$4,677.00	$4,677.00	—	50% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI EXT LOWER RT JOINT W&W/O,Right	$4,677.00	$4,677.00	—	50% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI EXT LOWER RT JOINT W&W/O,Right	$4,677.00	$4,677.00	—	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI EXT LOWER LT JOINT W&W/O,Left	$4,677.00	$4,677.00	—	—	—
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$3,032.00	$3,032.00	—	57% above	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$3,032.00	$3,032.00	—	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W&W/O	$4,693.00	$4,693.00	—	46% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W&W/O	$4,693.00	$4,693.00	—	—	—
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$2,889.00	$2,889.00	—	65% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$2,889.00	$2,889.00	—	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W&W/O CONTRAST	$4,763.00	$4,763.00	—	58% above	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W&W/O CONTRAST	$4,763.00	$4,763.00	—	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE W/O - LUMBAR	$2,511.00	$2,511.00	—	30% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE W/O - LUMBAR	$2,511.00	$2,511.00	—	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W&W/O - LUMBAR	$4,763.00	$4,763.00	—	53% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE W&W/O - LUMBAR	$4,763.00	$4,763.00	—	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE W/O - THORACIC	$2,513.00	$2,513.00	—	21% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE W/O - THORACIC	$2,513.00	$2,513.00	—	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W&W/O - CERVICAL	$4,401.00	$4,401.00	—	43% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W&W/O - CERVICAL	$4,401.00	$4,401.00	—	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE W/O - CERVICAL	$2,776.00	$2,776.00	—	44% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE W/O - CERVICAL	$2,776.00	$2,776.00	—	—	—
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W&W/O	$4,693.00	$4,693.00	—	53% above	—
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W&W/O	$4,693.00	$4,693.00	—	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$3,525.00	$3,525.00	—	59% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$3,525.00	$3,525.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI EXT UPPER LT JOINT W/O,Left	$2,914.00	$2,914.00	—	51% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI EXT UPPER RT JOINT W/O,Right	$2,914.00	$2,914.00	—	51% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI EXT UPPER RT JOINT W/O,Right	$2,914.00	$2,914.00	—	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI EXT UPPER LT JOINT W/O,Left	$2,914.00	$2,914.00	—	—	—
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR C SPINE 4V - CERVICAL	$233.00	$233.00	—	3% above	—
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR C SPINE 4V - CERVICAL	$233.00	$233.00	—	—	—
Neck soft tissue CT scan with contrast CPT 70491 CT NECK W CONTRAST	$1,937.00	$1,937.00	—	35% above	—
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W CONTRAST	$1,937.00	$1,937.00	—	—	—
Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CONTRAST	$1,503.00	$1,503.00	—	22% above	—
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O CONTRAST	$1,503.00	$1,503.00	—	—	—
Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUE 2V	$139.00	$139.00	—	5% below	—
Neck soft tissue X-ray inpatient CPT 70360 XR NECK SOFT TISSUE 2V	$139.00	$139.00	—	—	—
Pelvic CT scan without contrast CPT 72192 CT PELVIC W/O CONT	$1,298.00	$1,298.00	—	5% above	—
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIC W/O CONT	$1,298.00	$1,298.00	—	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$453.00	$453.00	—	37% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$453.00	$453.00	—	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$537.00	$537.00	—	19% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$537.00	$537.00	—	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OBSTETRICA FETAL EVAL	$555.00	$555.00	—	38% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OBSTETRICA FETAL EVAL	$555.00	$555.00	—	—	—
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS UNI RT 2V,Right	$176.00	$176.00	—	3% above	—
Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS UNI LT 2V,Left	$176.00	$176.00	—	3% above	—
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS UNI RT 2V,Right	$176.00	$176.00	—	—	—
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR RIBS UNI LT 2V,Left	$176.00	$176.00	—	—	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS UNI LT INC CHEST,Left	$167.00	$167.00	—	11% below	—
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS UNI RT INC CHEST,Right	$167.00	$167.00	—	11% below	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS UNI LT INC CHEST,Left	$167.00	$167.00	—	—	—
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR RIBS UNI RT INC CHEST,Right	$167.00	$167.00	—	—	—
Screening mammogram, both breasts both sides CPT 77067 MA MAMMO BILAT SCREENING	$541.00	$541.00	—	—	—
Screening mammogram, both breasts inpatient both sides CPT 77067 MA MAMMO BILAT SCREENING	$541.00	$541.00	—	—	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER LT COMP,Left	$182.00	$182.00	—	3% above	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER RT COMP,Right	$182.00	$182.00	—	3% above	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER LT COMP,Left	$182.00	$182.00	—	—	—
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER RT COMP,Right	$182.00	$182.00	—	—	—
Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUS 3V	$175.00	$175.00	—	2% below	—
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR SINUS 3V	$175.00	$175.00	—	—	—
Skull X-ray, fewer than 4 views CPT 70250 XR SKULL 3V	$165.00	$165.00	—	1% below	—
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR SKULL 3V	$165.00	$165.00	—	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 PT SPEECH SWALLOW BARRIUM (MBS) EVAL	$640.00	$640.00	—	27% above	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 PT SPEECH SWALLOW BARRIUM (MBS) EVAL	$640.00	$640.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR LT 2V,Left	$161.00	$161.00	—	3% below	—
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR FEMUR RT 2V,Right	$161.00	$161.00	—	3% below	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR LT 2V,Left	$161.00	$161.00	—	—	—
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR FEMUR RT 2V,Right	$161.00	$161.00	—	—	—
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O	$1,527.00	$1,527.00	—	18% above	—
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O	$1,527.00	$1,527.00	—	—	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 1ST DIG LT,Left	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 5TH DIG RT,Right	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 4TH DIG RT,Right	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 3RD DIG RT,Right	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 2ND DIG RT,Right	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 1ST DIG RT,Right	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 5TH DIG LT,Left	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 4TH DIG LT,Left	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 3RD DIG LT,Left	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOE 2ND DIG LT,Left	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOES LT,Left	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views one side CPT 73660 XR TOES RT,Right	$140.00	$140.00	—	10% above	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 5TH DIG LT,Left	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 5TH DIG RT,Right	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 4TH DIG LT,Left	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES RT,Right	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 3RD DIG LT,Left	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOES LT,Left	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 2ND DIG LT,Left	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 1ST DIG LT,Left	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 4TH DIG RT,Right	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 2ND DIG RT,Right	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 3RD DIG RT,Right	$140.00	$140.00	—	—	—
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR TOE 1ST DIG RT,Right	$140.00	$140.00	—	—	—
Transvaginal pelvic ultrasound CPT 76830 US PELVIS EVAL TRANSVAGINAL	$618.00	$618.00	—	28% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIS EVAL TRANSVAGINAL	$618.00	$618.00	—	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US OB EVAL TRANSVAGINAL	$406.00	$406.00	—	23% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB EVAL TRANSVAGINAL	$406.00	$406.00	—	—	—
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE - ABDOMINAL	$634.00	$634.00	—	23% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE - ABDOMINAL	$634.00	$634.00	—	—	—
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$543.00	$543.00	—	31% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$543.00	$543.00	—	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID B-SCAN/HEAD	$623.00	$623.00	—	30% above	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID B-SCAN/HEAD	$623.00	$623.00	—	—	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS RT 2 VIEWS,Right	$146.00	$146.00	—	2% above	—
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS LT 2 VIEWS,Left	$146.00	$146.00	—	2% above	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS RT 2 VIEWS,Right	$146.00	$146.00	—	—	—
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR HUMERUS LT 2 VIEWS,Left	$146.00	$146.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DOPP RT UNILAT - DOPPLER,Right	$839.00	$839.00	—	61% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS DOPP LT UNILAT - DOPPLER,Left	$839.00	$839.00	—	61% above	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DOPP RT UNILAT - DOPPLER,Right	$839.00	$839.00	—	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS DOPP LT UNILAT - DOPPLER,Left	$839.00	$839.00	—	—	—
Wrist X-ray, 2 views one side CPT 73100 XR WRIST LT 2VIEWS,Left	$147.00	$147.00	—	6% below	—
Wrist X-ray, 2 views one side CPT 73100 XR WRIST RT 2VIEWS,Right	$147.00	$147.00	—	6% below	—
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST RT 2VIEWS,Right	$147.00	$147.00	—	—	—
Wrist X-ray, 2 views inpatient one side CPT 73100 XR WRIST LT 2VIEWS,Left	$147.00	$147.00	—	—	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST RT 3VIEWS,Right	$186.00	$186.00	—	7% above	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST LT 3VIEWS,Left	$186.00	$186.00	—	7% above	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST RT 3VIEWS,Right	$186.00	$186.00	—	—	—
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST LT 3VIEWS,Left	$186.00	$186.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP UNI LT 2V - PELVIS,Left	$204.00	$204.00	—	at median	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP UNI RT 2V - PELVIS,Right	$204.00	$204.00	—	at median	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNI LT 2V - PELVIS,Left	$204.00	$204.00	—	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP UNI RT 2V - PELVIS,Right	$204.00	$204.00	—	—	—
X-ray of the abdomen, 1 view CPT 74018 XR ABD 1 VIEW	$117.00	$117.00	—	16% below	—
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABD 1 VIEW	$117.00	$117.00	—	—	—
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE LT 2VIEW,Left	$153.00	$153.00	—	5% above	—
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE RT 2VIEW,Right	$153.00	$153.00	—	5% above	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE LT 2VIEW,Left	$153.00	$153.00	—	—	—
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE RT 2VIEW,Right	$153.00	$153.00	—	—	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 5TH DIG LT,Left	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 2ND DIG RT,Right	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3RD DIG RT,Right	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 4TH DIG LT,Left	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3RD DIG LT,Left	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 2ND DIG LT,Left	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 1ST DIG LT,Left	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGERS RT,Right	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGERS LT,Left	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 5TH DIG RT,Right	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 4TH DIG RT,Right	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 1ST DIG RT,Right	$173.00	$173.00	—	11% above	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 2ND DIG RT,Right	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGERS LT,Left	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGERS RT,Right	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 1ST DIG LT,Left	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 2ND DIG LT,Left	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 3RD DIG LT,Left	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 4TH DIG LT,Left	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 5TH DIG LT,Left	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 1ST DIG RT,Right	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 3RD DIG RT,Right	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 4TH DIG RT,Right	$173.00	$173.00	—	—	—
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 5TH DIG RT,Right	$173.00	$173.00	—	—	—
X-ray of the foot, 2 views one side CPT 73620 XR FOOT LT 2 VIEW,Left	$130.00	$130.00	—	7% below	—
X-ray of the foot, 2 views one side CPT 73620 XR FOOT RT 2 VIEW,Right	$130.00	$130.00	—	7% below	—
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT RT 2 VIEW,Right	$130.00	$130.00	—	—	—
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT LT 2 VIEW,Left	$130.00	$130.00	—	—	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT RT 3 VIEWS,Right	$144.00	$144.00	—	2% below	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT LT 3 VIEWS,Left	$144.00	$144.00	—	2% below	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT RT 3 VIEWS,Right	$144.00	$144.00	—	—	—
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT LT 3 VIEWS,Left	$144.00	$144.00	—	—	—
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND RT 3 VIEWS,Right	$155.00	$155.00	—	6% below	—
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND LT 3 VIEWS,Left	$155.00	$155.00	—	6% below	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND RT 3 VIEWS,Right	$155.00	$155.00	—	—	—
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND LT 3 VIEWS,Left	$155.00	$155.00	—	—	—
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE LT 1-2 VIEWS,Left	$141.00	$141.00	—	12% below	—
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE RT 1-2 VIEWS,Right	$141.00	$141.00	—	12% below	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE LT 1-2 VIEWS,Left	$141.00	$141.00	—	—	—
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE RT 1-2 VIEWS,Right	$141.00	$141.00	—	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR L SPINE 2V - LUMBAR	$177.00	$177.00	—	8% below	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR L SPINE 2V - LUMBAR	$177.00	$177.00	—	—	—
X-ray of the lower back, 4 or more views CPT 72110 XR L SPINE 4V - LUMBAR	$246.00	$246.00	—	4% above	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR L SPINE 4V - LUMBAR	$246.00	$246.00	—	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR T SPINE 2V - THORACIC	$220.00	$220.00	—	45% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR T SPINE 2V - THORACIC	$220.00	$220.00	—	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES 3V	$166.00	$166.00	—	9% above	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES 3V	$166.00	$166.00	—	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR C SPINE 2-3V - CERVICAL	$182.00	$182.00	—	12% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR C SPINE 2-3V - CERVICAL	$182.00	$182.00	—	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1-2 VIEWS	$161.00	$161.00	—	4% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1-2 VIEWS	$161.00	$161.00	—	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX	$134.00	$134.00	—	13% below	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM/COCCYX	$134.00	$134.00	—	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT)	$49.50	$49.50	—	22% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT (SGPT)	$49.50	$49.50	—	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT)	$48.50	$48.50	—	17% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST (SGOT)	$48.50	$48.50	—	—	—
Albumin blood test CPT 82040 ALBUMIN	$46.00	$46.00	—	31% above	—
Albumin blood test inpatient CPT 82040 ALBUMIN	$46.00	$46.00	—	—	—
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-TET PROTEIN SERUM	$133.50	$133.50	—	39% above	—
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-TET PROTEIN SERUM	$133.50	$133.50	—	—	—
Amylase blood test CPT 82150 AMYLASE	$60.50	$60.50	—	33% above	—
Amylase blood test CPT 82150 BODY FLUID AMYLASE	$60.50	$60.50	—	33% above	—
Amylase blood test inpatient CPT 82150 BODY FLUID AMYLASE	$60.50	$60.50	—	—	—
Amylase blood test inpatient CPT 82150 AMYLASE	$60.50	$60.50	—	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT- PRO NATRIUTIETIC PEPTIDE B (ProBNP)	$305.00	$305.00	—	32% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT- PRO NATRIUTIETIC PEPTIDE B (ProBNP)	$305.00	$305.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL	$79.00	$79.00	—	22% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE EYE / EAR	$79.00	$79.00	—	22% above	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE EYE / EAR	$79.00	$79.00	—	—	—
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE GENITAL	$79.00	$79.00	—	—	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL (BMP) CHEM 8	$77.00	$77.00	—	4% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL (BMP) CHEM 8	$77.00	$77.00	—	—	—
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL-SEND OUT	$43.50	$43.50	—	24% above	—
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$46.00	$46.00	—	31% above	—
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL-SEND OUT	$43.50	$43.50	—	—	—
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$46.00	$46.00	—	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$25.00	$25.00	—	46% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$25.00	$25.00	—	—	—
Blood glucose (sugar) test CPT 82947 GLUCOSE	$37.00	$37.00	—	26% above	—
Blood glucose (sugar) test CPT 82947 GLUCOSE 2 HR POST 100G	$37.00	$37.00	—	26% above	—
Blood glucose (sugar) test CPT 82947 GLUCOSE 3 HR POST DOSE	$37.00	$37.00	—	26% above	—
Blood glucose (sugar) test CPT 82947 GLUCOSE FASTING	$37.00	$37.00	—	26% above	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$37.00	$37.00	—	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE FASTING	$37.00	$37.00	—	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 2 HR POST 100G	$37.00	$37.00	—	—	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE 3 HR POST DOSE	$37.00	$37.00	—	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO RH AND ANTIBODY SCREEN	$36.50	$36.50	—	7% below	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 TYPE	$39.50	$39.50	—	1% above	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO RH AND ANTIBODY SCREEN	$36.50	$36.50	—	—	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 TYPE	$39.50	$39.50	—	—	—
Blood urea nitrogen (BUN) test CPT 84520 BUN	$37.00	$37.00	—	at median	—
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$37.00	$37.00	—	—	—
Calcium blood test, total CPT 82310 CALCIUM	$48.50	$48.50	—	52% above	—
Calcium blood test, total inpatient CPT 82310 CALCIUM	$48.50	$48.50	—	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$148.50	$148.50	—	101% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$148.50	$148.50	—	—	—
Complete blood count (CBC) with differential CPT 85025 .CBC & AUTO DIFFERENTIAL (CHARGE)	$66.00	$66.00	—	13% above	—
Complete blood count (CBC) with differential CPT 85025 CBC WITH AUTO DIFF NPL SEND OUT	$70.50	$70.50	—	21% above	—
Complete blood count (CBC) with differential CPT 85025 CBC W AUTO DIFF	$70.50	$70.50	—	21% above	—
Complete blood count (CBC) with differential inpatient CPT 85025 .CBC & AUTO DIFFERENTIAL (CHARGE)	$66.00	$66.00	—	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 CBC WITH AUTO DIFF NPL SEND OUT	$70.50	$70.50	—	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W AUTO DIFF	$70.50	$70.50	—	—	—
Complete blood count (CBC), no differential CPT 85027 .CBC NO DIFF (CHARGE)	$55.00	$55.00	—	20% above	—
Complete blood count (CBC), no differential CPT 85027 CBC NO DIFF	$70.50	$70.50	—	53% above	—
Complete blood count (CBC), no differential inpatient CPT 85027 .CBC NO DIFF (CHARGE)	$55.00	$55.00	—	—	—
Complete blood count (CBC), no differential inpatient CPT 85027 CBC NO DIFF	$70.50	$70.50	—	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL (CMP)	$96.00	$96.00	—	2% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL (CMP)	$96.00	$96.00	—	—	—
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE TOTAL	$60.50	$60.50	—	29% above	—
Creatine kinase (CK) blood test, total inpatient CPT 82550 CREATINE KINASE TOTAL	$60.50	$60.50	—	—	—
Creatinine blood test CPT 82565 CREATININE	$47.00	$47.00	—	19% above	—
Creatinine blood test inpatient CPT 82565 CREATININE	$47.00	$47.00	—	—	—
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$87.50	$87.50	—	19% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$87.50	$87.50	—	—	—
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES PANEL	$65.00	$65.00	—	17% above	—
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTES PANEL	$65.00	$65.00	—	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 FT4 (THYROXINE FREE)	$78.00	$78.00	—	25% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FT4 (THYROXINE FREE)	$78.00	$78.00	—	—	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PLAN PANEL	$299.00	$299.00	—	27% above	—
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PLAN PANEL	$299.00	$299.00	—	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1 HR POST 50G LOAD	$43.50	$43.50	—	23% above	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1 HR POST 100G LOAD	$43.50	$43.50	—	23% above	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1 HR POST 50G LOAD	$43.50	$43.50	—	—	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE 1 HR POST 100G LOAD	$43.50	$43.50	—	—	—
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE (3)	$116.50	$116.50	—	28% above	—
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE (3)	$116.50	$116.50	—	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1 2 AB-REFLEX TO CONFIRM	$204.00	$204.00	—	75% above	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1 2 AB-REFLEX TO CONFIRM	$204.00	$204.00	—	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB-A1C	$88.50	$88.50	—	27% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 NPL - GLYCOSYLATED HEMOGLOBIN (HA1C)	$88.50	$88.50	—	27% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB-A1C	$88.50	$88.50	—	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 NPL - GLYCOSYLATED HEMOGLOBIN (HA1C)	$88.50	$88.50	—	—	—
Hemoglobin blood test CPT 85018 HGB	$22.50	$22.50	—	3% below	—
Hemoglobin blood test inpatient CPT 85018 HGB	$22.50	$22.50	—	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C VIRUS QUANTITATIVE PCR	$490.50	$490.50	—	274% above	—
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA QUANT	$505.50	$505.50	—	285% above	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRUS QUANTITATIVE PCR	$490.50	$490.50	—	—	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA QUANT	$505.50	$505.50	—	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN, HIGH SENSITIVITY	$108.00	$108.00	—	39% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN, HIGH SENSITIVITY	$108.00	$108.00	—	—	—
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$79.00	$79.00	—	18% above	—
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$79.00	$79.00	—	—	—
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$97.00	$97.00	—	26% above	—
Lactate (lactic acid) blood test inpatient CPT 83605 LACTIC ACID	$97.00	$97.00	—	—	—
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$63.50	$63.50	—	18% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$63.50	$63.50	—	—	—
Liver function blood test panel CPT 80076 LIVER FUNCTION PANEL	$74.50	$74.50	—	5% above	—
Liver function blood test panel inpatient CPT 80076 LIVER FUNCTION PANEL	$74.50	$74.50	—	—	—
Magnesium blood test CPT 83735 MAGNESIUM URINE	$61.50	$61.50	—	94% above	—
Magnesium blood test CPT 83735 MAGNESIUM	$116.00	$116.00	—	266% above	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM URINE	$61.50	$61.50	—	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$116.00	$116.00	—	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SPOT	$48.50	$48.50	—	10% above	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SPOT	$48.50	$48.50	—	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$147.50	$147.50	—	128% above	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$147.50	$147.50	—	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC	$167.00	$167.00	—	73% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC	$167.00	$167.00	—	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATHOLOGY IN PRESERVATIVE	$72.00	$72.00	$123.74–$286.73	37% below	—
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH CERVICAL OR VAGINAL	$70.00	$70.00	$123.74–$286.73	32% below	—
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT	$55.50	$55.50	—	68% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT	$55.50	$55.50	—	—	—
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$43.50	$43.50	—	29% above	—
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS	$43.50	$43.50	—	—	—
Potassium blood test CPT 84132 POTASSIUM	$42.50	$42.50	—	4% above	—
Potassium blood test inpatient CPT 84132 POTASSIUM	$42.50	$42.50	—	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR	$37.00	$37.00	—	43% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR	$37.00	$37.00	—	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 WAIVED DRUG SCREEN 12 PANEL	$97.00	$97.00	—	12% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 WAIVED DRUG SCREEN 12 PANEL	$97.00	$97.00	—	—	—
Rapid flu test (influenza antigen) CPT 87804 RAPID INFLUENZA A & B	$126.50	$126.50	—	51% above	—
Rapid flu test (influenza antigen) inpatient CPT 87804 RAPID INFLUENZA A & B	$126.50	$126.50	—	—	—
Rh blood typing CPT 86901 RH (D)	$39.50	$39.50	—	3% above	—
Rh blood typing inpatient CPT 86901 RH (D)	$39.50	$39.50	—	—	—
Sodium blood test CPT 84295 SODIUM	$44.50	$44.50	—	14% above	—
Sodium blood test inpatient CPT 84295 SODIUM	$44.50	$44.50	—	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 LAB OCCULT BLOOD	$9.00	$9.00	$123.74–$286.73	68% below	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT ( FECAL BLOOD)	$38.00	$38.00	—	34% above	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 GUIAC / OCCULT STOOL	$38.00	$38.00	—	34% above	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD SCREENING	$38.00	$38.00	—	34% above	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT ( FECAL BLOOD)	$38.00	$38.00	—	—	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 GUIAC / OCCULT STOOL	$38.00	$38.00	—	—	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD SCREENING	$38.00	$38.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH WITH REFLUX TO FT4	$152.00	$152.00	—	48% above	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (THYROID STIMULATING HORMONE)	$152.00	$152.00	—	48% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH WITH REFLUX TO FT4	$152.00	$152.00	—	—	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (THYROID STIMULATING HORMONE)	$152.00	$152.00	—	—	—
Total IgE blood test CPT 82785 IMMUNOGLOBULIN E	$148.50	$148.50	—	75% above	—
Total IgE blood test inpatient CPT 82785 IMMUNOGLOBULIN E	$148.50	$148.50	—	—	—
Total cholesterol blood test CPT 82465 CHOLESTEROL	$40.50	$40.50	—	20% above	—
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL	$40.50	$40.50	—	—	—
Triglycerides blood test CPT 84478 TRIGLYCERIDE	$53.00	$53.00	—	24% above	—
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE	$53.00	$53.00	—	—	—
Troponin test, quantitative CPT 84484 TROPONIN I	$96.00	$96.00	—	20% above	—
Troponin test, quantitative inpatient CPT 84484 TROPONIN I	$96.00	$96.00	—	—	—
Uric acid blood test CPT 84550 URIC ACID-SEND OUT	$40.50	$40.50	—	1% above	—
Uric acid blood test CPT 84550 URIC ACID	$42.50	$42.50	—	6% above	—
Uric acid blood test inpatient CPT 84550 URIC ACID-SEND OUT	$40.50	$40.50	—	—	—
Uric acid blood test inpatient CPT 84550 URIC ACID	$42.50	$42.50	—	—	—
Urinalysis with microscope exam, manual CPT 81000 .URINALYSIS COMPLETE WITH MICRO (CHARGE)	$29.50	$29.50	—	12% above	—
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS COMPLETE	$31.50	$31.50	—	19% above	—
Urinalysis with microscope exam, manual inpatient CPT 81000 .URINALYSIS COMPLETE WITH MICRO (CHARGE)	$29.50	$29.50	—	—	—
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS COMPLETE	$31.50	$31.50	—	—	—
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIP	$7.50	$7.50	$123.74–$286.73	64% below	—
Urinalysis without microscope exam, manual CPT 81002 .URINALYSIS DIPSTICK (CHARGE)	$26.50	$26.50	—	26% above	—
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIPSTICK	$28.50	$28.50	—	36% above	—
Urinalysis without microscope exam, manual inpatient CPT 81002 .URINALYSIS DIPSTICK (CHARGE)	$26.50	$26.50	—	—	—
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS DIPSTICK	$28.50	$28.50	—	—	—
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST	$18.00	$18.00	$123.74–$286.73	68% below	—
Urine pregnancy test, read by color change CPT 81025 PREGNANCY URINE HCG	$67.00	$67.00	—	21% above	—
Urine pregnancy test, read by color change CPT 81025 HCG-QUALITATIVE URINE	$67.00	$67.00	—	21% above	—
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY URINE HCG	$67.00	$67.00	—	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 HCG-QUALITATIVE URINE	$67.00	$67.00	—	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL	$4,816.00	$4,816.00	—	29% above	—
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL	$4,816.00	$4,816.00	—	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 DISTAL RADIAL FRACTURE	$1,119.00	$1,119.00	$123.74–$286.73	151% above	—
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL	$1,219.00	$1,219.00	$123.74–$286.73	40% below	—
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/ LESION REMOVAL	$1,452.00	$1,452.00	—	28% below	—
Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W LESION REMOVAL	$3,701.00	$3,701.00	—	83% above	—
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W LESION REMOVAL	$3,701.00	$3,701.00	—	—	—
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$1,393.50	$1,393.50	$123.74–$286.73	24% below	—
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W/BIOPSY	$2,726.00	$2,726.00	—	49% above	—
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W/BIOPSY	$2,726.00	$2,726.00	—	—	—
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,098.00	$1,098.00	$123.74–$286.73	39% below	—
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY DX	$3,357.00	$3,357.00	—	88% above	—
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY DX	$3,357.00	$3,357.00	—	—	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION LESION	$193.00	$193.00	$123.74–$286.73	3% below	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALINANT LESION	$309.00	$309.00	—	56% above	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALINANT LESION	$309.00	$309.00	—	—	—
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 REMOVAL CERUMEN LAVAGE BILAT	$49.50	$49.50	$123.74–$286.73	—	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$132.00	$132.00	—	117% above	—
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED CERUMEN	$138.50	$138.50	$123.74–$286.73	20% above	—
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL IMPACTED EAR WAX(UNILATERAL)	$168.00	$168.00	—	46% above	—
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID	$1,436.00	$1,436.00	—	1% above	—
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID	$1,436.00	$1,436.00	—	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 I & D OF ABSCESS	$319.00	$319.00	—	5% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 I & D OF ABSCESS	$321.00	$321.00	—	5% above	—
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRINAGE	$373.50	$373.50	$123.74–$286.73	23% above	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D OF ABSCESS	$321.00	$321.00	—	—	—
Inguinal (groin) hernia repair, age 5 or older CPT 49505 RPR I/HERN INIT REDUC >5 YR	$1,475.00	$1,475.00	$123.74–$286.73	75% below	—
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HERNIA REPAIR	$5,348.00	$5,348.00	—	8% below	—
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HERNIA REPAIR	$5,348.00	$5,348.00	—	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH	$175.50	$175.50	$123.74–$286.73	44% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT INJECTION/ ASPIRATION	$200.00	$200.00	$123.74–$286.73	34% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 JOINT INJECTION	$412.00	$412.00	—	36% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN JOINT	$477.00	$477.00	—	57% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/JOINT INJECTION	$519.00	$519.00	—	71% above	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/JOINT INJECTION	$519.00	$519.00	—	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASP/INJ	$166.00	$166.00	$123.74–$286.73	46% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 APIRATION/INJECTION OF JOINT	$464.00	$464.00	—	51% above	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 APIRATION/INJECTION OF JOINT	$464.00	$464.00	—	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHOCENTESIS ASP/INJ JOINT	$163.00	$163.00	$123.74–$286.73	43% below	—
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 YAG LAZER	$1,494.00	$1,494.00	—	99% above	—
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 YAG LAZER	$1,494.00	$1,494.00	—	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERM REPAIR EXC 2.5CM	$551.00	$551.00	—	6% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE REPAIR 2.5 CM	$568.00	$568.00	—	10% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE UP TO 2.5 CM	$754.50	$754.50	$123.74–$286.73	46% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTERM REPAIR EXC 2.5CM	$551.00	$551.00	—	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION EXTREMILTY UNDER 0.05 CM	$1,012.00	$1,012.00	—	74% above	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION EXTREMILTY UNDER 0.05 CM	$1,012.00	$1,012.00	—	—	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION OF FACE 0.5	$1,012.00	$1,012.00	—	79% above	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION OF FACE 0.5	$1,012.00	$1,012.00	—	—	—
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL	$324.00	$324.00	$123.74–$286.73	15% above	—
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$461.00	$461.00	—	64% above	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL	$458.00	$458.00	$123.74–$286.73	19% below	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAILBED	$551.00	$551.00	—	2% below	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$568.00	$568.00	—	1% above	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAILBED	$551.00	$551.00	—	—	—
Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION	$1,664.00	$1,664.00	$123.74–$286.73	7% below	—
Removal of a breast lump, open surgery CPT 19120 REMOVE BREAST LESION	$5,051.00	$5,051.00	—	184% above	—
Removal of a breast lump, open surgery inpatient CPT 19120 REMOVE BREAST LESION	$5,051.00	$5,051.00	—	—	—
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL FOREIGN BODY	$457.00	$457.00	$123.74–$286.73	7% above	—
Removal of a foreign object under the skin, simple CPT 10120 REMOVE FORGEIN BODY	$551.00	$551.00	—	29% above	—
Removal of a foreign object under the skin, simple CPT 10120 REMOVAL OF FORGEIN BODY	$568.00	$568.00	—	33% above	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 REMOVE FORGEIN BODY	$551.00	$551.00	—	—	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY (SCREENING)	$3,701.00	$3,701.00	—	112% above	—
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLONOSCOPY (SCREENING)	$3,701.00	$3,701.00	—	—	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY (SCREEN HI RISK)	$3,701.00	$3,701.00	—	112% above	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLONOSCOPY (SCREEN HI RISK)	$3,701.00	$3,701.00	—	—	—
Short arm cast (elbow to hand) CPT 29075 SHORT ARM CAST	$283.00	$283.00	$123.74–$286.73	9% below	—
Short arm cast (elbow to hand) CPT 29075 APPLY SHORTARM CAST	$454.00	$454.00	—	47% above	—
Short arm splint (forearm and hand) CPT 29125 APPLY SHORTARM SPLINT	$208.00	$208.00	—	8% above	—
Short arm splint (forearm and hand) CPT 29125 SHORT ARM BACK SLAB	$230.00	$230.00	$123.74–$286.73	19% above	—
Short leg cast (below the knee) CPT 29405 SHORT LEG CAST APPLICATION	$255.00	$255.00	$123.74–$286.73	28% below	—
Short leg cast (below the knee) CPT 29405 SHORT LEG CAST	$454.00	$454.00	—	29% above	—
Short leg splint (calf to foot) CPT 29515 APPLY LOWER LEG SPLINT	$372.00	$372.00	—	68% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR TRUNK 2.5 CM	$309.00	$309.00	—	at median	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR TRUNK 2.5CM	$319.00	$319.00	—	4% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LACERATION REPAIR TO 2.5 CM	$330.50	$330.50	$123.74–$286.73	7% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR TRUNK 2.5 CM	$309.00	$309.00	—	—	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SINGLE LESION	$309.00	$309.00	—	9% below	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$352.00	$352.00	$123.74–$286.73	4% above	—
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY SINGLE LESION	$309.00	$309.00	—	—	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXCISION EXTR MALIG +MARG 0.5CM	$1,012.00	$1,012.00	—	91% above	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXCISION EXTR MALIG +MARG 0.5CM	$1,012.00	$1,012.00	—	—	—
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG DESTRUCTION UP TO 15	$267.50	$267.50	$123.74–$286.73	16% above	—
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS<W15	$618.00	$618.00	—	168% above	—
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS<W15	$618.00	$618.00	—	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR OF SCALP 6.0-7.5 CM	$309.00	$309.00	—	4% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR 2.6-7.5 CM	$319.00	$319.00	—	7% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LACERATION REPAIR 2.5-7.5 CM	$404.50	$404.50	$123.74–$286.73	36% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR OF SCALP 6.0-7.5 CM	$309.00	$309.00	—	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR OF FACE BELOW 2.5CM	$309.00	$309.00	—	6% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR OF FACE BELOW 2.5CM	$319.00	$319.00	—	9% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LACERATION REPAIR TO 2.5 CM	$405.50	$405.50	$123.74–$286.73	39% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR OF FACE BELOW 2.5CM	$309.00	$309.00	—	—	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LESION	$277.50	$277.50	$123.74–$286.73	3% above	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BIOPSY SKIN LESION	$309.00	$309.00	—	15% above	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BIOPSY SKIN LESION	$309.00	$309.00	—	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 MUSCLE INJECTION	$134.00	$134.00	—	63% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE	$150.50	$150.50	$123.74–$286.73	59% below	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 MUSCLE INJECTION	$134.00	$134.00	—	—	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD DILATION <30MM	$2,859.00	$2,859.00	—	2% below	—
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30MM	$3,427.50	$3,427.50	$123.74–$286.73	18% above	—
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD DILATION <30MM	$2,859.00	$2,859.00	—	—	—
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$1,216.00	$1,216.00	$123.74–$286.73	16% below	—
Upper endoscopy (EGD) with biopsy CPT 43239 EGD/GASTROSCOPY	$2,925.00	$2,925.00	—	102% above	—
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD/GASTROSCOPY	$2,925.00	$2,925.00	—	—	—
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DX BRUSH WASH	$2,839.00	$2,839.00	—	84% above	—
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DX BRUSH WASH	$2,839.00	$2,839.00	—	—	—
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCTS	$1,006.50	$1,006.50	$123.74–$286.73	50% below	—
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$3,214.00	$3,214.00	—	58% above	—
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$3,214.00	$3,214.00	—	—	—
Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION 1-4	$307.50	$307.50	$123.74–$286.73	23% above	—
Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION 1-14	$309.00	$309.00	—	23% above	—
Wart removal, up to 14 warts CPT 17110 DESTRUCT LESION 1-4 (PHY)	$323.00	$323.00	—	29% above	—
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT LESION 1-14	$309.00	$309.00	—	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADM 1 UNIT	$1,102.00	$1,102.00	—	55% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD ADM 1 UNIT	$1,103.00	$1,103.00	—	55% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION- 2 UNITS	$1,649.00	$1,649.00	—	132% above	—
Blood transfusion (giving blood or blood components) CPT 36430 ER BLOOD ADM 2 UNITS	$1,650.00	$1,650.00	—	133% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION- 3 UNITS	$2,285.00	$2,285.00	—	222% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEBULIZER TREATMENT	$25.00	$25.00	$123.74–$286.73	76% below	—
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE EVAL 30-74 MIN	$897.00	$897.00	$123.74–$286.73	53% below	—
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30-74 MIN	$2,791.00	$2,791.00	—	47% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD	$100.00	$100.00	—	11% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD (XR/EKG Dept)	$120.00	$120.00	—	6% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD	$100.00	$100.00	—	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD (XR/EKG Dept)	$120.00	$120.00	—	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION 1ST HR	$508.00	$508.00	—	52% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER IV HYDRATION 1ST HR	$508.00	$508.00	—	52% above	—
IV infusion of a medicine, first hour CPT 96365 ER IV THERAPY 1ST HR	$508.00	$508.00	—	31% above	—
IV infusion of a medicine, first hour CPT 96365 IV THERAPY 1ST HR	$508.00	$508.00	—	31% above	—
IV push of a medicine, first drug CPT 96374 IV PUSH INFUSION	$508.00	$508.00	—	70% above	—
IV push of a medicine, first drug CPT 96374 ER IVP INFUSION	$508.00	$508.00	—	70% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC OR DIAG INJECTION	$44.50	$44.50	$123.74–$286.73	47% below	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER IM ADMINISTRATION	$180.00	$180.00	—	113% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM DRUG ADM	$180.00	$180.00	—	113% above	—
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT-NEW PATIENT	$278.50	$278.50	$123.74–$286.73	23% above	—
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT-NEW PATIENT	$420.00	$420.00	$123.74–$286.73	30% above	—
New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MINUTES	$561.00	$561.00	—	45% above	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT-NEW PATIENT	$178.00	$178.00	$123.74–$286.73	13% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRIIONAL THERAPY INITIAL/15M	$188.00	$188.00	$123.74–$286.73	88% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRITIONAL THERAPY INITIAL/15M	$194.00	$194.00	—	94% above	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRIIONAL THERAPY INITIAL/15M	$188.00	$188.00	$123.74–$286.73	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRITIONAL THERAPY INITIAL/15M	$194.00	$194.00	—	—	—
Preventive checkup, new patient aged 18–39 CPT 99385 PREV MED ADOLESCENT 18-39	$391.00	$391.00	$123.74–$286.73	258% above	—
Preventive checkup, new patient aged 40–64 CPT 99386 PREV MED VISIT NEW PT 40-64 YR	$452.00	$452.00	$123.74–$286.73	209% above	—
Preventive checkup, new patient aged 65 or older CPT 99387 PREV MED NEW PT; 65+	$490.00	$490.00	$123.74–$286.73	193% above	—
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV MED; 18-39	$353.00	$353.00	$123.74–$286.73	185% above	—
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV MED EVAL 40-64 YRS	$374.50	$374.50	$123.74–$286.73	95% above	—
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV MED EVAL > 65 YR	$403.50	$403.50	$123.74–$286.73	97% above	—
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EVAL W/MED SRVCS	$587.00	$587.00	$123.74–$286.73	112% above	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING COUNSELING 3-10 MINUTES	$44.50	$44.50	—	24% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40-54 MIN	$456.00	$456.00	$123.74–$286.73	33% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 DOT DRIVER PX UA	$217.50	$217.50	$123.74–$286.73	18% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20-29 MIN	$225.50	$225.50	$123.74–$286.73	22% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30-39 MIN	$321.50	$321.50	$123.74–$286.73	29% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 SPORTS / SCHOOL PX	$129.00	$129.00	$123.74–$286.73	48% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10-19 MIN	$141.00	$141.00	$123.74–$286.73	62% above	—
Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULATION OP-LEVEL 3	$307.50	$307.50	$123.74–$286.73	9% above	—
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULATION OP-LEVEL 4	$460.50	$460.50	$123.74–$286.73	42% above	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs North Dakota	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 SNF FLUAD VACCINE 2025-2026	$185.50	$185.50	—	154% above	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 SNF FLUAD VACCINE 2025-2026	$185.50	$185.50	—	—	—
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SNF-COVID BOOSTER 2023-2024 (MODERNA)	$328.47	$328.47	—	127% above	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SNF-COVID BOOSTER 2023-2024 (MODERNA)	$328.47	$328.47	—	—	—
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SNF COMIRNATY COVID BOOSTER 2025-26	$385.00	$385.00	—	83% above	—
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SNF COMIRNATY COVID BOOSTER 2025-26	$385.00	$385.00	—	—	—
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 IMMUNIZATION; DTAP	$39.50	$39.50	$123.74–$286.73	24% below	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 SNF FLUARIX VACCINE 2025-2026	$68.25	$68.25	—	106% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 SNF FLUARIX VACCINE 2025-2026	$68.25	$68.25	—	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B VACCINE ADULT IM	$93.00	$93.00	$123.74–$286.73	8% below	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 CLN - ENGERIX-B	$93.00	$93.00	$123.74–$286.73	8% below	—
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 IMMUNIZATION; HEPATITIS B	$38.00	$38.00	$123.74–$286.73	5% below	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CLN - FLUZONE HIGHDOSE TRIVALENT 2024-25	$79.50	$79.50	—	23% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CLN - FLUZONE HIGH DOSE QUAD	$79.50	$79.50	—	23% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CLN - FLUZONE HIGHDOSE TRIVALENT 2025-26	$111.00	$111.00	—	72% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACC PRSV FREE HIGH DOSE	$111.00	$111.00	$123.74–$286.73	72% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 SNF FLUZONE HI DOSE VACCINE 2024-2025	$133.50	$133.50	—	107% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HI DOSE VACCINE	$133.50	$133.50	—	107% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 SNF-FLUZONE HI DOSE VACCINE	$133.50	$133.50	—	107% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 CLN - FLUZONE HIGH DOSE QUAD	$79.50	$79.50	—	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HI DOSE VACCINE	$133.50	$133.50	—	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 SNF FLUZONE HI DOSE VACCINE 2024-2025	$133.50	$133.50	—	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 SNF-FLUZONE HI DOSE VACCINE	$133.50	$133.50	—	—	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR 13	$292.00	$292.00	$123.74–$286.73	4% above	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 CLN - PREVNAR 13	$292.00	$292.00	$123.74–$286.73	4% above	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 SNF-PREVNAR 13 (PNEUMO) 0.5 ML VIAL	$587.48	$587.48	—	110% above	—
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 SNF-PREVNAR 13 (PNEUMO) 0.5 ML VIAL	$587.48	$587.48	—	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 CLN - PREVNAR 20	$386.00	$386.00	—	2% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 SNF PREVNAR 20 (PNEUMO) IM 0.5 ML	$917.98	$917.98	—	143% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 CLN - PREVNAR 20	$386.00	$386.00	—	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 SNF PREVNAR 20 (PNEUMO) IM 0.5 ML	$917.98	$917.98	—	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 SNF PREVNAR 23 (PNEUMO) 0.5 ML VIAL	$151.00	$151.00	—	8% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX	$151.00	$151.00	$123.74–$286.73	8% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 CLN - PNEUMOVAX 23	$151.00	$151.00	$123.74–$286.73	8% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 SNF PREVNAR 23 (PNEUMO) 0.5 ML VIAL	$151.00	$151.00	—	—	—
Rabies vaccine, one dose CPT 90675 RABIES VACCINE INTRADERMAL US	$410.50	$410.50	$123.74–$286.73	36% below	—
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 CLN - SHINGRIX	$302.50	$302.50	$123.74–$286.73	6% above	—
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGRIX VACCINE	$302.50	$302.50	$123.74–$286.73	6% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPTHERIA-PERTUSSIS	$50.00	$50.00	$123.74–$286.73	at median	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE 7YR AND OLDER	$50.50	$50.50	$123.74–$286.73	1% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS/DIPHTHERIA TOXOID 0.5 ML VIAL	$89.58	$89.58	—	79% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS/DIPHTHERIA TOXOID 0.5 ML VIAL	$89.58	$89.58	—	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPTHERIA-PERTUSSIS	$51.50	$51.50	—	26% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 CLN - TDAP	$51.50	$51.50	$123.74–$286.73	26% below	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap ADACEL(TET-DIPT-ACE PERT)0.5ML VIAL	$172.20	$172.20	—	147% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap ADACEL(TET-DIPT-ACE PERT)0.5ML VIAL	$172.20	$172.20	—	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION INJECTION	$64.00	$64.00	$123.74–$286.73	33% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IM DRUG ADM	$180.00	$180.00	—	275% above	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ER TETANUS ADM	$180.00	$180.00	—	275% above	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMINISTRATION 2 INJECTIONS	$46.50	$46.50	$123.74–$286.73	60% above	—

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://irp.cdn-website.com/5b245649/files/uploaded/450255914_ashley-medical-center_standardcharges.csv