Hospital Rock Springs, WY

Aspen Mountain Medical

Aspen Mountain Medical in Rock Spring, WY publishes cash prices for 243 common procedures listed here, from its own machine-readable price file updated Sep 25, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Wyoming median for 120 of 237 procedures and above it for 99. By typical cash price it ranks #9 of 17 Wyoming hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

4401 COLLEGE DRIVE,ROCK SPRING,WY,82901-0000 Collected Sep 27, 2026 Source price file

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Wyoming	Off list
Ankle X-ray, complete, 3 or more views both sides CPT 73610 XR ANKLE 3+ VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3+ VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	42% below	40%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3+ VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	42% below	40%
Ankle X-ray, complete, 3 or more views inpatient both sides CPT 73610 XR ANKLE 3+ VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3+ VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE 3+ VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ULTRASOUND OF ART OF BOTH ARMS/LEGS	$510.15	$850.25	$799.22–$1,700.50	105% above	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 EXTREMITY ARTERIAL STUDY	$510.15	$850.25	$799.22–$1,700.50	105% above	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 EXTREMITY ARTERIAL STUDY	$510.15	$850.25	$799.22–$1,700.50	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ULTRASOUND OF ART OF BOTH ARMS/LEGS	$510.15	$850.25	$799.22–$1,700.50	—	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR BARIUM SWALLOW	$335.46	$559.10	$130.90–$571.46	23% below	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR BARIUM SWALLOW	$335.46	$559.10	$130.90–$571.46	—	40%
Breast ultrasound, complete, one breast both sides CPT 76641 ULTRASOUND BREAST COMPLETE BILATERAL	$697.11	$1,161.85	$119.69–$2,986.68	—	40%
Breast ultrasound, complete, one breast CPT 76641 US BREAST(S)	$332.70	$554.50	$119.69–$2,986.68	21% below	40%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE UNILATER RT	$348.30	$580.50	$119.69–$2,986.68	18% below	40%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL COMPLETE LT	$348.57	$580.95	$119.69–$2,986.68	17% below	40%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 ULTRASOUND BREAST COMPLETE BILATERAL	$697.11	$1,161.85	$119.69–$2,986.68	—	40%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST(S)	$332.70	$554.50	$119.69–$2,986.68	—	40%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST COMPLETE UNILATER RT	$348.30	$580.50	$119.69–$2,986.68	—	40%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL COMPLETE LT	$348.57	$580.95	$119.69–$2,986.68	—	40%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST LIMITED BILATERAL	$546.54	$910.90	$119.69–$1,821.80	—	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNI LIMITED LT	$273.27	$455.45	$119.69–$1,821.80	43% below	40%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNILATERAL LIMITED RT	$273.27	$455.45	$119.69–$1,821.80	43% below	40%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US BREAST LIMITED BILATERAL	$546.54	$910.90	$119.69–$1,821.80	—	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNI LIMITED LT	$273.27	$455.45	$119.69–$1,821.80	—	40%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNILATERAL LIMITED RT	$273.27	$455.45	$119.69–$1,821.80	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W	$2,019.12	$3,365.20	$307.92–$3,365.20	5% above	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W	$2,019.12	$3,365.20	$307.92–$3,365.20	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST	$289.74	$482.90	$16.51–$482.90	169% above	40%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HRT W/O DYE W/CA TEST	$289.74	$482.90	$16.51–$482.90	—	40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS WO	$1,338.42	$2,230.70	$249.56–$2,230.70	53% below	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS WO	$1,338.42	$2,230.70	$249.56–$2,230.70	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W	$2,369.19	$3,948.65	$452.04–$3,948.65	18% below	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W	$2,369.19	$3,948.65	$452.04–$3,948.65	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD & PELVIS WO/W	$3,167.94	$5,279.90	$452.04–$5,279.90	8% above	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD & PELVIS WO/W	$3,167.94	$5,279.90	$452.04–$5,279.90	—	40%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W	$2,580.36	$4,300.60	$307.92–$4,300.60	41% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W	$2,580.36	$4,300.60	$307.92–$4,300.60	—	40%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO	$2,019.81	$3,366.35	$146.24–$3,366.35	28% above	40%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO	$2,019.81	$3,366.35	$146.24–$3,366.35	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO	$1,021.02	$1,701.70	$146.24–$3,403.40	32% below	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/CORON WO	$1,021.02	$1,701.70	$146.24–$3,403.40	32% below	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/CORON WO	$1,021.02	$1,701.70	$146.24–$3,403.40	—	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO	$1,021.02	$1,701.70	$146.24–$3,403.40	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO	$1,002.96	$1,671.60	$146.24–$1,671.60	20% below	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO	$1,002.96	$1,671.60	$146.24–$1,671.60	—	40%
CT scan of the head with contrast CPT 70460 CT HEAD W	$1,145.34	$1,908.90	$307.92–$1,908.90	17% below	40%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W	$1,145.34	$1,908.90	$307.92–$1,908.90	—	40%
CT scan of the head without and with contrast CPT 70470 CT HEAD WO / W	$1,422.48	$2,370.80	$307.92–$2,370.80	17% below	40%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO / W	$1,422.48	$2,370.80	$307.92–$2,370.80	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR WO	$1,257.87	$2,096.45	$146.24–$2,096.45	30% below	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR WO	$1,257.87	$2,096.45	$146.24–$2,096.45	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERV WO	$1,264.83	$2,108.05	$146.24–$2,108.05	33% below	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERV WO	$1,264.83	$2,108.05	$146.24–$2,108.05	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W	$1,298.13	$2,163.55	$307.92–$2,163.55	35% below	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W	$1,298.13	$2,163.55	$307.92–$2,163.55	—	40%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CARO DOP COMP BI	$847.38	$1,412.30	$663.78–$1,412.30	—	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CARO DOP COMP BI	$847.38	$1,412.30	$663.78–$1,412.30	—	40%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$214.62	$357.70	$80.74–$1,157.60	27% below	40%
Chest X-ray, 2 views CPT 71046 XR CXR 2V W/ FLUORO	$479.94	$799.90	$80.74–$1,157.60	64% above	40%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEWS	$214.62	$357.70	$80.74–$1,157.60	—	40%
Chest X-ray, 2 views inpatient CPT 71046 XR CXR 2V W/ FLUORO	$479.94	$799.90	$80.74–$1,157.60	—	40%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$200.73	$334.55	$80.74–$334.55	7% above	40%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW	$200.73	$334.55	$80.74–$334.55	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL	$457.71	$762.85	$199.65–$2,288.55	40% below	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL COMPLT	$457.71	$762.85	$199.65–$2,288.55	40% below	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITO COMPL	$457.71	$762.85	$199.65–$2,288.55	40% below	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL COMPLT	$457.71	$762.85	$199.65–$2,288.55	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITO COMPL	$457.71	$762.85	$199.65–$2,288.55	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL	$457.71	$762.85	$199.65–$2,288.55	—	40%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB SGL/FIRST GEST	$616.08	$1,026.80	$199.65–$1,026.80	20% below	40%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB SGL/FIRST GEST	$616.08	$1,026.80	$199.65–$1,026.80	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO	$1,180.77	$1,967.95	$146.24–$1,967.95	10% below	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST WO	$1,180.77	$1,967.95	$146.24–$1,967.95	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W	$1,305.12	$2,175.20	$307.92–$2,175.20	21% below	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W	$1,305.12	$2,175.20	$307.92–$2,175.20	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMO BILATERAL	$307.68	$512.80	$110.93–$585.68	—	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMO BILATERAL	$307.68	$512.80	$110.93–$585.68	—	40%
Diagnostic mammogram, one breast one side CPT 77065 DIAGNOSTIC DIGITAL MAMMO UNILATERAL RT	$241.68	$402.80	$85.70–$903.36	15% below	40%
Diagnostic mammogram, one breast one side CPT 77065 DIAGNOSTIC MAMMO UNILATERAL LT	$241.68	$402.80	$85.70–$903.36	15% below	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DIAGNOSTIC MAMMO UNILATERAL LT	$241.68	$402.80	$85.70–$903.36	—	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 DIAGNOSTIC DIGITAL MAMMO UNILATERAL RT	$241.68	$402.80	$85.70–$903.36	—	40%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US ARTERY EXT LOW BI	$1,005.72	$1,676.20	$787.81–$1,676.20	—	40%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US ARTERY EXT LOW BI	$1,005.72	$1,676.20	$787.81–$1,676.20	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VEIN EXT UP BI	$972.39	$1,620.65	$1,523.40–$3,241.30	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VEIN EXT LOW BI	$972.39	$1,620.65	$1,523.40–$3,241.30	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VEIN EXT UP BI	$972.39	$1,620.65	$1,523.40–$3,241.30	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VEIN EXT LOW BI	$972.39	$1,620.65	$1,523.40–$3,241.30	—	40%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HOME SLEEP TEST (HST)	$620.25	$1,033.75	$485.86–$1,033.75	29% above	40%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HOME SLEEP TEST (HST)	$620.25	$1,033.75	$485.86–$1,033.75	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 ATTENDED POLYSOMNOGRAPHY W/CPAP SHORT	$3,606.24	$6,010.40	$5,649.76–$12,020.80	11% below	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 ATTENDED POLYSOMNOGRAPHY WITH CPAP	$3,606.24	$6,010.40	$5,649.76–$12,020.80	11% below	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 ATTENDED POLYSOMNOGRAPHY WITH CPAP	$3,606.24	$6,010.40	$5,649.76–$12,020.80	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 ATTENDED POLYSOMNOGRAPHY W/CPAP SHORT	$3,606.24	$6,010.40	$5,649.76–$12,020.80	—	40%
Knee X-ray, 3 views both sides CPT 73562 XR KNEE 3 VIEW BI	$388.26	$647.10	$79.04–$1,360.10	—	40%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEW RT	$213.90	$356.50	$79.04–$1,360.10	40% below	40%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEW LT	$213.90	$356.50	$79.04–$1,360.10	40% below	40%
Knee X-ray, 3 views inpatient both sides CPT 73562 XR KNEE 3 VIEW BI	$388.26	$647.10	$79.04–$1,360.10	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEW LT	$213.90	$356.50	$79.04–$1,360.10	—	40%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEW RT	$213.90	$356.50	$79.04–$1,360.10	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS	$457.71	$762.85	$199.65–$3,814.25	34% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALLBLADDER	$457.71	$762.85	$199.65–$3,814.25	34% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED	$457.71	$762.85	$199.65–$3,814.25	34% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SPLEEN ONLY	$457.71	$762.85	$199.65–$3,814.25	34% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US LIVER ONLY	$457.71	$762.85	$199.65–$3,814.25	34% below	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US LIVER ONLY	$457.71	$762.85	$199.65–$3,814.25	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS	$457.71	$762.85	$199.65–$3,814.25	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US SPLEEN ONLY	$457.71	$762.85	$199.65–$3,814.25	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED	$457.71	$762.85	$199.65–$3,814.25	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALLBLADDER	$457.71	$762.85	$199.65–$3,814.25	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LOW DOSE CHEST W/O	$815.43	$1,359.05	$105.17–$1,359.05	114% above	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT LOW DOSE CHEST W/O	$815.43	$1,359.05	$105.17–$1,359.05	—	40%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MR EXT LOW JNT BI WO	$3,051.96	$5,086.60	$355.60–$10,504.30	—	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR EXT LOW JNT RT WO	$1,625.31	$2,708.85	$355.60–$10,504.30	33% below	40%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR EXT LOW JNT LT WO	$1,625.31	$2,708.85	$355.60–$10,504.30	33% below	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MR EXT LOW JNT BI WO	$3,051.96	$5,086.60	$355.60–$10,504.30	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR EXT LOW JNT RT WO	$1,625.31	$2,708.85	$355.60–$10,504.30	—	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR EXT LOW JNT LT WO	$1,625.31	$2,708.85	$355.60–$10,504.30	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MR EXT LOW JNT BI WW	$4,293.87	$7,156.45	$590.62–$14,643.95	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR EXT LOW JNT RT WW	$2,246.25	$3,743.75	$590.62–$14,643.95	27% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR EXT LOW JNT LT WW	$2,246.25	$3,743.75	$590.62–$14,643.95	27% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MR EXT LOW JNT BI WW	$4,293.87	$7,156.45	$590.62–$14,643.95	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR EXT LOW JNT LT WW	$2,246.25	$3,743.75	$590.62–$14,643.95	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR EXT LOW JNT RT WW	$2,246.25	$3,743.75	$590.62–$14,643.95	—	40%
MRI of the abdomen without contrast CPT 74181 MR ABDOMEN WO	$2,696.34	$4,493.90	$355.60–$4,493.90	8% above	40%
MRI of the abdomen without contrast inpatient CPT 74181 MR ABDOMEN WO	$2,696.34	$4,493.90	$355.60–$4,493.90	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR ABDOMEN WO / W	$3,641.64	$6,069.40	$590.62–$6,069.40	at median	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR ABDOMEN WO / W	$3,641.64	$6,069.40	$590.62–$6,069.40	—	40%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN WO	$2,265.69	$3,776.15	$355.60–$3,776.15	10% above	40%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN WO	$2,265.69	$3,776.15	$355.60–$3,776.15	—	40%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN WO / W	$3,360.36	$5,600.60	$590.62–$11,201.20	13% above	40%
MRI of the brain, with and without contrast dye CPT 70553 MR IAC WO/W	$3,360.36	$5,600.60	$590.62–$11,201.20	13% above	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN WO / W	$3,360.36	$5,600.60	$590.62–$11,201.20	—	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR IAC WO/W	$3,360.36	$5,600.60	$590.62–$11,201.20	—	40%
MRI of the lower back, no contrast dye CPT 72148 MR SPINE LUMBAR WO	$2,404.62	$4,007.70	$355.60–$4,007.70	21% above	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR SPINE LUMBAR WO	$2,404.62	$4,007.70	$355.60–$4,007.70	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 MR SPINE LUMBAR W/W	$3,426.36	$5,710.60	$590.62–$5,710.60	35% above	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR SPINE LUMBAR W/W	$3,426.36	$5,710.60	$590.62–$5,710.60	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR SPINE THOR WO	$2,498.40	$4,164.00	$355.60–$4,164.00	43% above	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR SPINE THOR WO	$2,498.40	$4,164.00	$355.60–$4,164.00	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR SPINE CERV WO/W	$3,279.09	$5,465.15	$590.62–$5,465.15	33% above	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR SPINE CERV WO/W	$3,279.09	$5,465.15	$590.62–$5,465.15	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR SPINE CERV WO	$2,315.73	$3,859.55	$355.60–$3,859.55	21% above	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR SPINE CERV WO	$2,315.73	$3,859.55	$355.60–$3,859.55	—	40%
MRI of the pelvis without and with contrast CPT 72197 MR PELVIS WO / W	$3,344.37	$5,573.95	$590.62–$5,573.95	25% above	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS WO / W	$3,344.37	$5,573.95	$590.62–$5,573.95	—	40%
MRI of the pelvis, no contrast dye CPT 72195 MR PELVIS WO	$2,335.17	$3,891.95	$355.60–$3,891.95	30% above	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR PELVIS WO	$2,335.17	$3,891.95	$355.60–$3,891.95	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 MR EXT UP JNT BI WO	$2,911.68	$4,852.80	$355.60–$10,034.30	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR EXT UP JNT RT WO	$1,554.45	$2,590.75	$355.60–$10,034.30	33% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR EXT UP JNT LT WO	$1,554.45	$2,590.75	$355.60–$10,034.30	33% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient both sides CPT 73221 MR EXT UP JNT BI WO	$2,911.68	$4,852.80	$355.60–$10,034.30	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR EXT UP JNT RT WO	$1,554.45	$2,590.75	$355.60–$10,034.30	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR EXT UP JNT LT WO	$1,554.45	$2,590.75	$355.60–$10,034.30	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELV NON-OB LIMTD	$332.70	$554.50	$119.69–$1,109.00	1% above	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER	$332.70	$554.50	$119.69–$1,109.00	1% above	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER	$332.70	$554.50	$119.69–$1,109.00	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELV NON-OB LIMTD	$332.70	$554.50	$119.69–$1,109.00	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELV NON-OB COMP	$457.71	$762.85	$199.65–$762.85	46% below	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELV NON-OB COMP	$457.71	$762.85	$199.65–$762.85	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >14 WK 1/1 GEST	$457.71	$762.85	$199.65–$762.85	34% below	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >14 WK 1/1 GEST	$457.71	$762.85	$199.65–$762.85	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB <14 WK 1/1 GES	$457.71	$762.85	$199.65–$762.85	20% below	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB <14 WK 1/1 GES	$457.71	$762.85	$199.65–$762.85	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$457.71	$762.85	$199.65–$762.85	2% above	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$457.71	$762.85	$199.65–$762.85	—	40%
Screening mammogram, both breasts both sides CPT 77067 SCREENING DIGITAL MAM BILAT	$247.35	$412.25	$91.55–$824.50	—	40%
Screening mammogram, both breasts one side CPT 77067 SCREENING DIGITAL MAMMO UNILATERAL	$247.35	$412.25	$91.55–$824.50	20% below	40%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING DIGITAL MAM BILAT	$247.35	$412.25	$91.55–$824.50	—	40%
Screening mammogram, both breasts inpatient one side CPT 77067 SCREENING DIGITAL MAMMO UNILATERAL	$247.35	$412.25	$91.55–$824.50	—	40%
Shoulder X-ray, complete, 2 or more views both sides CPT 73030 XR SHOULDER 2+ V BI	$409.08	$681.80	$79.04–$1,429.60	—	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ V RT	$224.34	$373.90	$79.04–$1,429.60	32% below	40%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2+ V LT	$224.34	$373.90	$79.04–$1,429.60	32% below	40%
Shoulder X-ray, complete, 2 or more views inpatient both sides CPT 73030 XR SHOULDER 2+ V BI	$409.08	$681.80	$79.04–$1,429.60	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ V RT	$224.34	$373.90	$79.04–$1,429.60	—	40%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 2+ V LT	$224.34	$373.90	$79.04–$1,429.60	—	40%
Sleep study in a lab (polysomnography) CPT 95810 ATTENDED POLYSOMNOGRAPHY	$3,278.40	$5,464.00	$5,136.16–$10,928.00	10% below	40%
Sleep study in a lab (polysomnography) CPT 95810 ATTENDED POLYSOMNOGRAPHY SHORTENED	$3,278.40	$5,464.00	$5,136.16–$10,928.00	10% below	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 ATTENDED POLYSOMNOGRAPHY	$3,278.40	$5,464.00	$5,136.16–$10,928.00	—	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 ATTENDED POLYSOMNOGRAPHY SHORTENED	$3,278.40	$5,464.00	$5,136.16–$10,928.00	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR BA SWALLOW SPEECH	$370.23	$617.05	$130.90–$617.05	20% below	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR BA SWALLOW SPEECH	$370.23	$617.05	$130.90–$617.05	—	40%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$457.71	$762.85	$199.65–$3,605.90	23% below	40%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL/LIMITED	$790.41	$1,317.35	$199.65–$3,605.90	33% above	40%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAG/PELVIS COMBO	$915.42	$1,525.70	$199.65–$3,605.90	54% above	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$457.71	$762.85	$199.65–$3,605.90	—	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL/LIMITED	$790.41	$1,317.35	$199.65–$3,605.90	—	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAG/PELVIS COMBO	$915.42	$1,525.70	$199.65–$3,605.90	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$457.71	$762.85	$199.65–$762.85	6% below	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB TRANSVAGINAL	$457.71	$762.85	$199.65–$762.85	—	40%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$457.71	$762.85	$199.65–$762.85	55% below	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$457.71	$762.85	$199.65–$762.85	—	40%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICLES	$457.71	$762.85	$199.65–$762.85	8% below	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICLES	$457.71	$762.85	$199.65–$762.85	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD/NECK	$457.71	$762.85	$199.65–$762.85	33% below	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD/NECK	$457.71	$762.85	$199.65–$762.85	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UP GI W/KUB	$464.64	$774.40	$130.90–$1,548.80	12% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UP GI WO/KUB	$464.64	$774.40	$130.90–$1,548.80	12% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UP GI W/KUB	$464.64	$774.40	$130.90–$1,548.80	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UP GI WO/KUB	$464.64	$774.40	$130.90–$1,548.80	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN EXT LOW RT	$526.50	$877.50	$1,649.68–$3,510.00	30% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN EXT LOW LT	$526.50	$877.50	$1,649.68–$3,510.00	30% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN EXT UP LT	$526.50	$877.50	$1,649.68–$3,510.00	30% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VEIN EXT UP RT	$526.50	$877.50	$1,649.68–$3,510.00	30% below	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN EXT UP RT	$526.50	$877.50	$1,649.68–$3,510.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN EXT LOW LT	$526.50	$877.50	$1,649.68–$3,510.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN EXT UP LT	$526.50	$877.50	$1,649.68–$3,510.00	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VEIN EXT LOW RT	$526.50	$877.50	$1,649.68–$3,510.00	—	40%
Wrist X-ray, complete, 3 or more views both sides CPT 73110 XR WRIST 3+ VIEW BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3+ VIEW RT	$200.73	$334.55	$79.04–$1,272.20	29% below	40%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3+ VIEW LT	$200.73	$334.55	$79.04–$1,272.20	29% below	40%
Wrist X-ray, complete, 3 or more views inpatient both sides CPT 73110 XR WRIST 3+ VIEW BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3+ VIEW LT	$200.73	$334.55	$79.04–$1,272.20	—	40%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3+ VIEW RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP UNI WITH PELVIS 2-3VW LT	$208.38	$347.30	$79.04–$1,415.38	21% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XRAY HIP UNI WITH PELVIS 2-3 VIEW RT	$208.38	$347.30	$79.04–$1,415.38	21% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP AP/LAT RIGHT	$215.31	$358.85	$79.04–$1,415.38	19% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP AP/LAT LEFT	$215.31	$358.85	$79.04–$1,415.38	19% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP UNI WITH PELVIS 2-3VW LT	$208.38	$347.30	$79.04–$1,415.38	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XRAY HIP UNI WITH PELVIS 2-3 VIEW RT	$208.38	$347.30	$79.04–$1,415.38	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP AP/LAT LEFT	$215.31	$358.85	$79.04–$1,415.38	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP AP/LAT RIGHT	$215.31	$358.85	$79.04–$1,415.38	—	40%
X-ray of the abdomen, 1 view CPT 74018 XR ABD/KUB 1 VIEW	$225.03	$375.05	$80.74–$375.05	4% below	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABD/KUB 1 VIEW	$225.03	$375.05	$80.74–$375.05	—	40%
X-ray of the ankle, 2 views both sides CPT 73600 XR ANKLE 2 VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	19% below	40%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	19% below	40%
X-ray of the ankle, 2 views inpatient both sides CPT 73600 XR ANKLE 2 VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE 2 VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT LITTLE	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT THUMB	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT INDEX	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT MIDDLE	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RIGHT RING	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LEFT THUMB	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER RT LITTLE	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LEFT INDEX	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT MIDDLE	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER LT RING	$200.73	$334.55	$79.04–$3,345.50	at median	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LEFT INDEX	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT RING	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT INDEX	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT MIDDLE	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RIGHT RING	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT LITTLE	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT LITTLE	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LT MIDDLE	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER RT THUMB	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER LEFT THUMB	$200.73	$334.55	$79.04–$3,345.50	—	40%
X-ray of the foot, 2 views both sides CPT 73620 XR FOOT 2 VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	5% below	40%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LEFT	$200.73	$334.55	$79.04–$1,272.20	5% below	40%
X-ray of the foot, 2 views inpatient both sides CPT 73620 XR FOOT 2 VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS LEFT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT 2 VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the foot, complete, 3 or more views both sides CPT 73630 XR FOOT 3+ VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3+ VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	42% below	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3+ VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	42% below	40%
X-ray of the foot, complete, 3 or more views inpatient both sides CPT 73630 XR FOOT 3+ VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3+ VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT 3+ VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the hand, 3 or more views both sides CPT 73130 XR HAND 3+ VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3+ VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	21% below	40%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3+ VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	21% below	40%
X-ray of the hand, 3 or more views inpatient both sides CPT 73130 XR HAND 3+ VIEWS BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3+ VIEWS RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND 3+ VIEWS LT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the knee, 1 or 2 views both sides CPT 73560 XR KNEE 1-2 VIEW BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1-2 VIEW RT	$200.73	$334.55	$79.04–$1,272.20	38% below	40%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1-2 VIEW LT	$200.73	$334.55	$79.04–$1,272.20	38% below	40%
X-ray of the knee, 1 or 2 views inpatient both sides CPT 73560 XR KNEE 1-2 VIEW BI	$361.86	$603.10	$79.04–$1,272.20	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1-2 VIEW LT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE 1-2 VIEW RT	$200.73	$334.55	$79.04–$1,272.20	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR SPN LUMB 2-3 VIEW	$241.71	$402.85	$130.90–$402.85	21% below	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR SPN LUMB 2-3 VIEW	$241.71	$402.85	$130.90–$402.85	—	40%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMB 4+ V	$332.70	$554.50	$130.90–$554.50	38% below	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMB 4+ V	$332.70	$554.50	$130.90–$554.50	—	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR SPINE THOR 2 VS	$238.23	$397.05	$130.90–$397.05	34% below	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR SPINE THOR 2 VS	$238.23	$397.05	$130.90–$397.05	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NOSE/NASAL BONES	$200.73	$334.55	$79.04–$368.73	24% below	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NOSE/NASAL BONES	$200.73	$334.55	$79.04–$368.73	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERV 2-3 V	$230.61	$384.35	$130.90–$384.35	35% below	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR SPINE CERV 2-3 V	$230.61	$384.35	$130.90–$384.35	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1-2 VIEWS	$200.73	$334.55	$130.90–$342.73	19% below	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1-2 VIEWS	$200.73	$334.55	$130.90–$342.73	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX	$200.73	$334.55	$79.04–$334.55	23% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM/COCCYX	$200.73	$334.55	$79.04–$334.55	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Wyoming	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT)	$23.76	$39.60	$5.30–$39.60	15% below	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALANINE AMINO (ALT) (SGPT)	$23.76	$39.60	$5.30–$39.60	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT)	$23.76	$39.60	$5.18–$39.60	23% below	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 TRANSFERASE (AST) (SGOT)	$23.76	$39.60	$5.18–$39.60	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$458.55	$764.25	$47.63–$764.25	70% above	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$458.55	$764.25	$47.63–$764.25	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC IGE	$22.68	$37.80	$5.22–$37.80	39% below	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC IGE	$22.68	$37.80	$5.22–$37.80	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY	$86.61	$144.35	$12.95–$144.35	22% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP ANTIBODY	$86.61	$144.35	$12.95–$144.35	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES	$72.21	$120.35	$12.09–$120.35	2% above	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODIES	$72.21	$120.35	$12.09–$120.35	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$129.48	$215.80	$39.26–$215.80	3% below	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 ASSAY OF NATRIURETIC PEPTIDE	$129.48	$215.80	$39.26–$215.80	—	40%
Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA	$64.68	$107.80	$8.46–$107.80	12% below	40%
Basic metabolic panel (blood test) inpatient CPT 80048 METABOLIC PANEL TOTAL CA	$64.68	$107.80	$8.46–$107.80	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$112.53	$187.55	$42.98–$187.55	9% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST	$112.53	$187.55	$42.98–$187.55	—	40%
Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA	$49.23	$82.05	$10.32–$82.05	54% below	40%
Blood culture for bacteria inpatient CPT 87040 BLOOD CULTURE FOR BACTERIA	$49.23	$82.05	$10.32–$82.05	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$16.41	$27.35	$2.70–$136.15	31% below	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE-NURSING	$32.64	$54.40	$2.70–$136.15	37% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$16.41	$27.35	$2.70–$136.15	—	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE-NURSING	$32.64	$54.40	$2.70–$136.15	—	40%
Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$28.02	$46.70	$3.93–$46.70	26% below	40%
Blood glucose (sugar) test inpatient CPT 82947 ASSAY GLUCOSE BLOOD QUANT	$28.02	$46.70	$3.93–$46.70	—	40%
Blood lead test CPT 83655 ASSAY OF LEAD	$53.94	$89.90	$12.11–$89.90	at median	40%
Blood lead test inpatient CPT 83655 ASSAY OF LEAD	$53.94	$89.90	$12.11–$89.90	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$49.65	$82.75	$7.52–$82.75	1% below	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 CHORIONIC GONADOTROPIN ASSAY	$49.65	$82.75	$7.52–$82.75	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING ABO	$34.02	$56.70	$2.99–$56.70	57% below	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING ABO	$34.02	$56.70	$2.99–$56.70	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$41.22	$68.70	$5.18–$68.70	51% below	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$41.22	$68.70	$5.18–$68.70	—	40%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE	$138.99	$231.65	$37.27–$231.65	6% below	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF AMPLIFIED PROBE	$138.99	$231.65	$37.27–$231.65	—	40%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$99.03	$165.05	$20.81–$165.05	1% above	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSAY TUMOR CA 19-9	$99.03	$165.05	$20.81–$165.05	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125	$103.14	$171.90	$20.81–$171.90	at median	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSAY TUMOR CA 125	$103.14	$171.90	$20.81–$171.90	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 RAPID TEST	$138.90	$231.50	$46.18–$561.40	28% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CORONA VIRUS TEST	$197.94	$329.90	$46.18–$561.40	83% above	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 RAPID TEST	$138.90	$231.50	$46.18–$561.40	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CORONA VIRUS TEST	$197.94	$329.90	$46.18–$561.40	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHYLMD TRACH DNA AMP PROBE	$132.99	$221.65	$35.09–$221.65	40% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHYLMD TRACH DNA AMP PROBE	$132.99	$221.65	$35.09–$221.65	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$86.22	$143.70	$13.39–$143.70	28% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$86.22	$143.70	$13.39–$143.70	—	40%
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$54.36	$90.60	$7.77–$90.60	19% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$54.36	$90.60	$7.77–$90.60	—	40%
Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED	$51.45	$85.75	$6.47–$85.75	6% above	40%
Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED	$51.45	$85.75	$6.47–$85.75	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL	$75.45	$125.75	$10.56–$125.75	17% below	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHEN METABOLIC PANEL	$75.45	$125.75	$10.56–$125.75	—	40%
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION QUANT	$102.84	$171.40	$10.18–$171.40	at median	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION QUANT	$102.84	$171.40	$10.18–$171.40	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE	$129.48	$215.80	$22.23–$215.80	at median	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DEHYDROEPIANDROSTERONE	$129.48	$215.80	$22.23–$215.80	—	40%
Estradiol blood test CPT 82670 ASSAY OF ESTRADIOL	$105.90	$176.50	$27.94–$176.50	5% below	40%
Estradiol blood test inpatient CPT 82670 ASSAY OF ESTRADIOL	$105.90	$176.50	$27.94–$176.50	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$107.88	$179.80	$18.58–$179.80	12% below	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 ASSAY OF GONADOTROPIN (FSH)	$107.88	$179.80	$18.58–$179.80	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$116.52	$194.20	$19.63–$194.20	42% below	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$116.52	$194.20	$19.63–$194.20	—	40%
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN	$79.86	$133.10	$13.63–$133.10	at median	40%
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN	$79.86	$133.10	$13.63–$133.10	—	40%
Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM	$88.47	$147.45	$14.70–$147.45	at median	40%
Folate (folic acid) blood test inpatient CPT 82746 ASSAY OF FOLIC ACID SERUM	$88.47	$147.45	$14.70–$147.45	—	40%
Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3)	$114.36	$190.60	$16.94–$190.60	14% above	40%
Free T3 thyroid hormone test inpatient CPT 84481 FREE ASSAY (FT-3)	$114.36	$190.60	$16.94–$190.60	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE	$60.42	$100.70	$9.02–$100.70	2% below	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE	$60.42	$100.70	$9.02–$100.70	—	40%
Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE	$120.87	$201.45	$25.47–$201.45	7% above	40%
Free testosterone test inpatient CPT 84402 ASSAY OF FREE TESTOSTERONE	$120.87	$201.45	$25.47–$201.45	—	40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$147.96	$246.60	$40.92–$246.60	53% below	40%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GENERAL HEALTH PANEL	$147.96	$246.60	$40.92–$246.60	—	40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST	$36.66	$61.10	$4.75–$61.10	14% below	40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TEST	$36.66	$61.10	$4.75–$61.10	—	40%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$77.67	$129.45	$12.87–$129.45	8% below	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST (GTT)	$77.67	$129.45	$12.87–$129.45	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB	$140.73	$234.55	$35.09–$234.55	57% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N.GONORRHOEAE DNA AMP PROB	$140.73	$234.55	$35.09–$234.55	—	40%
H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY	$103.14	$171.90	$16.85–$171.90	at median	40%
H. pylori antibody blood test inpatient CPT 86677 HELICOBACTER PYLORI ANTIBODY	$103.14	$171.90	$16.85–$171.90	—	40%
H. pylori stool antigen test CPT 87338 HPYLORI STOOL EIA	$56.28	$93.80	$14.38–$93.80	42% below	40%
H. pylori stool antigen test inpatient CPT 87338 HPYLORI STOOL EIA	$56.28	$93.80	$14.38–$93.80	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$322.50	$537.50	$85.10–$537.50	29% above	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 QUANT&REVRSE TRNSCRPJ	$322.50	$537.50	$85.10–$537.50	—	40%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY	$82.53	$137.55	$13.71–$137.55	25% above	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY	$82.53	$137.55	$13.71–$137.55	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB	$101.40	$169.00	$24.08–$169.00	22% above	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG W/HIV-1 & HIV-2 AB	$101.40	$169.00	$24.08–$169.00	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST	$58.26	$97.10	$9.71–$97.10	21% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN TEST	$58.26	$97.10	$9.71–$97.10	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY	$63.93	$106.55	$10.74–$106.55	16% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY	$63.93	$106.55	$10.74–$106.55	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG EIA	$56.28	$93.80	$10.33–$93.80	at median	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG EIA	$56.28	$93.80	$10.33–$93.80	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST	$101.07	$168.45	$14.27–$168.45	41% above	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C AB TEST	$101.07	$168.45	$14.27–$168.45	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$197.07	$328.45	$42.84–$328.45	10% below	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C REVRS TRNSCRPJ	$197.07	$328.45	$42.84–$328.45	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$90.75	$151.25	$13.19–$151.25	48% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 TEST	$90.75	$151.25	$13.19–$151.25	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$90.75	$151.25	$19.35–$151.25	16% above	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX TYPE 2 TEST	$90.75	$151.25	$19.35–$151.25	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS	$53.64	$89.40	$12.95–$89.40	18% below	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HS	$53.64	$89.40	$12.95–$89.40	—	40%
Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTINE	$81.99	$136.65	$17.92–$136.65	1% above	40%
Homocysteine blood test inpatient CPT 83090 ASSAY OF HOMOCYSTINE	$81.99	$136.65	$17.92–$136.65	—	40%
Insulin blood test CPT 83525 ASSAY OF INSULIN	$81.99	$136.65	$11.43–$136.65	6% above	40%
Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN	$81.99	$136.65	$11.43–$136.65	—	40%
Iron blood test (serum iron) CPT 83540 ASSAY OF IRON	$24.54	$40.90	$6.47–$40.90	at median	40%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON	$24.54	$40.90	$6.47–$40.90	—	40%
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST	$36.66	$61.10	$8.74–$61.10	4% below	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING TEST	$36.66	$61.10	$8.74–$61.10	—	40%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$80.82	$134.70	$8.68–$134.70	16% below	40%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$80.82	$134.70	$8.68–$134.70	—	40%
LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH)	$107.88	$179.80	$18.52–$179.80	at median	40%
LH (luteinizing hormone) test inpatient CPT 83002 ASSAY OF GONADOTROPIN (LH)	$107.88	$179.80	$18.52–$179.80	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE	$47.46	$79.10	$6.89–$79.10	32% below	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 ASSAY OF LIPASE	$47.46	$79.10	$6.89–$79.10	—	40%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$67.35	$112.25	$8.17–$112.25	9% below	40%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$67.35	$112.25	$8.17–$112.25	—	40%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY	$103.14	$171.90	$17.03–$171.90	19% above	40%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODY	$103.14	$171.90	$17.03–$171.90	—	40%
Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM	$34.53	$57.55	$6.70–$57.55	12% below	40%
Magnesium blood test inpatient CPT 83735 ASSAY OF MAGNESIUM	$34.53	$57.55	$6.70–$57.55	—	40%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY	$86.61	$144.35	$12.88–$144.35	87% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ANTIBODY	$86.61	$144.35	$12.88–$144.35	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN	$37.14	$61.90	$5.18–$61.90	33% below	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODY SCREEN	$37.14	$61.90	$5.18–$61.90	—	40%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$215.31	$358.85	$47.81–$358.85	24% below	40%
Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL	$215.31	$358.85	$47.81–$358.85	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE	$86.31	$143.85	$18.39–$143.85	at median	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 ASSAY OF PSA FREE	$86.31	$143.85	$18.39–$143.85	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL	$103.59	$172.65	$18.39–$172.65	20% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL	$103.59	$172.65	$18.39–$172.65	—	40%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$100.41	$167.35	$26.61–$167.35	1% below	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTOPATH C/V AUTO FLUID REDO	$100.41	$167.35	$26.61–$167.35	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE	$196.38	$327.30	$41.28–$327.30	9% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 ASSAY OF PARATHORMONE	$196.38	$327.30	$41.28–$327.30	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL	$49.92	$83.20	$6.01–$83.20	12% above	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL	$49.92	$83.20	$6.01–$83.20	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 NIPT-FETAL CHRMOML ANEUPLOIDY	$1,216.17	$2,026.95	$722.10–$2,026.95	6% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 NIPT-FETAL CHRMOML ANEUPLOIDY	$1,216.17	$2,026.95	$722.10–$2,026.95	—	40%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE	$107.88	$179.80	$20.86–$372.20	11% above	40%
Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE 20-	$115.44	$192.40	$20.86–$372.20	18% above	40%
Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE	$107.88	$179.80	$20.86–$372.20	—	40%
Progesterone blood test inpatient CPT 84144 ASSAY OF PROGESTERONE 20-	$115.44	$192.40	$20.86–$372.20	—	40%
Prolactin blood test CPT 84146 ASSAY OF PROLACTIN	$107.88	$179.80	$19.38–$179.80	17% above	40%
Prolactin blood test inpatient CPT 84146 ASSAY OF PROLACTIN	$107.88	$179.80	$19.38–$179.80	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$35.25	$58.75	$4.29–$58.75	8% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME	$35.25	$58.75	$4.29–$58.75	—	40%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC	$61.59	$102.65	$14.70–$102.65	5% below	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA ASSAY W/OPTIC	$61.59	$102.65	$14.70–$102.65	—	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A ASSAY W/OPTIC	$61.59	$102.65	$14.70–$102.65	23% above	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A ASSAY W/OPTIC	$61.59	$102.65	$14.70–$102.65	—	40%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$41.22	$68.70	$5.67–$68.70	at median	40%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT	$41.22	$68.70	$5.67–$68.70	—	40%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY	$54.57	$90.95	$14.39–$90.95	14% below	40%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA ANTIBODY	$54.57	$90.95	$14.39–$90.95	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED	$35.25	$58.75	$2.70–$58.75	11% above	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 RBC SED RATE AUTOMATED	$35.25	$58.75	$2.70–$58.75	—	40%
Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS	$47.49	$79.15	$8.90–$79.15	5% below	40%
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES SMEARS	$47.49	$79.15	$8.90–$79.15	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES	$21.57	$35.95	$3.99–$35.95	9% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD FECES	$21.57	$35.95	$3.99–$35.95	—	40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL	$75.54	$125.90	$15.92–$125.90	53% above	40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ASSAY TEST FOR BLOOD FECAL	$75.54	$125.90	$15.92–$125.90	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL	$28.89	$48.15	$4.27–$48.15	32% below	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREP QUAL	$28.89	$48.15	$4.27–$48.15	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE	$234.93	$391.55	$61.98–$391.55	63% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL IMMUN MEASURE	$234.93	$391.55	$61.98–$391.55	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$97.83	$163.05	$25.81–$163.05	3% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TOTAL TESTOSTERONE	$97.83	$163.05	$25.81–$163.05	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH	$82.53	$137.55	$14.55–$137.55	21% above	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODY EACH	$82.53	$137.55	$14.55–$137.55	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE	$86.31	$143.85	$16.80–$143.85	21% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE	$86.31	$143.85	$16.80–$143.85	—	40%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$132.63	$221.05	$35.09–$221.05	at median	40%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$132.63	$221.05	$35.09–$221.05	—	40%
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID	$23.76	$39.60	$4.52–$39.60	20% below	40%
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID	$23.76	$39.60	$4.52–$39.60	—	40%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$30.18	$50.30	$3.17–$50.30	33% below	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$30.18	$50.30	$3.17–$50.30	—	40%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE	$30.18	$50.30	$3.89–$50.30	3% above	40%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS NONAUTO W/SCOPE	$30.18	$50.30	$3.89–$50.30	—	40%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O SCOPE	$24.90	$41.50	$2.25–$41.50	34% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O SCOPE	$24.90	$41.50	$2.25–$41.50	—	40%
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$23.61	$39.35	$3.13–$39.35	10% above	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE	$23.61	$39.35	$3.13–$39.35	—	40%
Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT	$43.98	$73.30	$8.07–$73.30	39% below	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE CULTURE/COLONY COUNT	$43.98	$73.30	$8.07–$73.30	—	40%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$44.58	$74.30	$7.75–$74.30	1% below	40%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$44.58	$74.30	$7.75–$74.30	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12	$86.31	$143.85	$15.08–$143.85	at median	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12	$86.31	$143.85	$15.08–$143.85	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$161.88	$269.80	$29.60–$269.80	33% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$161.88	$269.80	$29.60–$269.80	—	40%
Zinc blood test CPT 84630 ASSAY OF ZINC	$81.99	$136.65	$11.39–$136.65	48% above	40%
Zinc blood test inpatient CPT 84630 ASSAY OF ZINC	$81.99	$136.65	$11.39–$136.65	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST	$81.99	$136.65	$15.05–$136.65	at median	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 CHORIONIC GONADOTROPIN TEST	$81.99	$136.65	$15.05–$136.65	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Wyoming	Off list
Carpal tunnel release, open surgery both sides CPT 64721 BILATERAL CARPAL TUNNEL SNX	$7,640.31	$12,733.85	$2,607.00–$19,100.80	—	40%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SNX	$3,820.17	$6,366.95	$2,607.00–$19,100.80	29% above	40%
Carpal tunnel release, open surgery inpatient both sides CPT 64721 BILATERAL CARPAL TUNNEL SNX	$7,640.31	$12,733.85	$2,607.00–$19,100.80	—	40%
Carpal tunnel release, open surgery inpatient CPT 64721 CARPAL TUNNEL SNX	$3,820.17	$6,366.95	$2,607.00–$19,100.80	—	40%
Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY W/ENDOSCOPE US	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY W/ENDOSCOPE US	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Colonoscopy with polyp removal CPT 45385 LESION REMOVAL COLONOSCOPY	$1,423.86	$2,373.10	$1,115.35–$2,373.10	26% below	40%
Colonoscopy with polyp removal inpatient CPT 45385 LESION REMOVAL COLONOSCOPY	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY	$1,423.86	$2,373.10	$1,115.35–$2,373.10	26% below	40%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY AND BIOPSY	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,423.86	$2,373.10	$1,115.35–$2,373.10	20% below	40%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Epidural steroid injection, neck or mid back, with imaging guidance both sides CPT 62321 NJX DX/THER SBST INTRLMNR CRV/THRC BILAT	$1,859.46	$3,099.10	$788.00–$7,749.25	—	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ INTERLAM CRV/THRC	$930.03	$1,550.05	$788.00–$7,749.25	12% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC	$930.03	$1,550.05	$788.00–$7,749.25	12% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient both sides CPT 62321 NJX DX/THER SBST INTRLMNR CRV/THRC BILAT	$1,859.46	$3,099.10	$788.00–$7,749.25	—	40%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ INTERLAM CRV/THRC	$930.03	$1,550.05	$788.00–$7,749.25	—	40%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAMINAR CRV/THRC	$930.03	$1,550.05	$788.00–$7,749.25	—	40%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 INJ L/S JNT 1 LEV BILATERAL	$2,598.39	$4,330.65	$788.00–$19,590.45	—	40%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 INJ PARAVERT F JNG L/S 1 LEV BILATERAL	$2,598.39	$4,330.65	$788.00–$19,590.45	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ L/S PV JNT 1 LEV	$1,319.70	$2,199.50	$788.00–$19,590.45	18% below	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNG L/S 1 LEV	$1,319.70	$2,199.50	$788.00–$19,590.45	18% below	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ L/S JNT 1 LEV	$1,319.70	$2,199.50	$788.00–$19,590.45	18% below	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 INJ L/S JNT 1 LEV BILATERAL	$2,598.39	$4,330.65	$788.00–$19,590.45	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 INJ PARAVERT F JNG L/S 1 LEV BILATERAL	$2,598.39	$4,330.65	$788.00–$19,590.45	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ L/S PV JNT 1 LEV	$1,319.70	$2,199.50	$788.00–$19,590.45	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ L/S JNT 1 LEV	$1,319.70	$2,199.50	$788.00–$19,590.45	—	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNG L/S 1 LEV	$1,319.70	$2,199.50	$788.00–$19,590.45	—	40%
Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S)	$1,423.86	$2,373.10	$788.00–$2,373.10	44% above	40%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 LIGATION OF HEMORRHOID(S)	$1,423.86	$2,373.10	$788.00–$2,373.10	—	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$290.19	$483.65	$293.00–$1,348.35	39% below	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$518.82	$864.70	$293.00–$1,348.35	9% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY	$290.19	$483.65	$293.00–$1,348.35	—	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY	$518.82	$864.70	$293.00–$1,348.35	—	40%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAIN SKIN ABCESS	$364.65	$607.75	$285.64–$607.75	73% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAIN SKIN ABCESS	$364.65	$607.75	$285.64–$607.75	—	40%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$547.05	$911.75	$293.00–$911.75	180% above	40%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$547.05	$911.75	$293.00–$911.75	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 XR DRN/INJ JT/BUR BI	$1,389.15	$2,315.25	$293.00–$4,237.85	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$459.00	$765.00	$293.00–$4,237.85	30% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA	$694.56	$1,157.60	$293.00–$4,237.85	96% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 XR DRN/INJ JT/BUR BI	$1,389.15	$2,315.25	$293.00–$4,237.85	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$459.00	$765.00	$293.00–$4,237.85	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA	$694.56	$1,157.60	$293.00–$4,237.85	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS	$694.56	$1,157.60	$293.00–$4,612.00	166% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$694.56	$1,157.60	$293.00–$4,612.00	166% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 DRN/INJ JOINT LT	$344.52	$574.20	$293.00–$4,612.00	32% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 DRAIN/INJ JNT RT	$344.52	$574.20	$293.00–$4,612.00	32% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS	$694.56	$1,157.60	$293.00–$4,612.00	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$694.56	$1,157.60	$293.00–$4,612.00	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 DRN/INJ JOINT LT	$344.52	$574.20	$293.00–$4,612.00	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 DRAIN/INJ JNT RT	$344.52	$574.20	$293.00–$4,612.00	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O ULTRASOUND	$765.42	$1,275.70	$293.00–$1,500.42	320% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O ULTRASOUND	$765.42	$1,275.70	$293.00–$1,500.42	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$917.52	$1,529.20	$788.00–$4,587.60	51% above	40%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ LUMB/SAC	$917.52	$1,529.20	$788.00–$4,587.60	51% above	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ LUMB/SAC	$917.52	$1,529.20	$788.00–$4,587.60	—	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$917.52	$1,529.20	$788.00–$4,587.60	—	40%
Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC	$764.76	$1,274.60	$599.06–$1,274.60	at median	40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 NJX INTERLAMINAR LMBR/SAC	$764.76	$1,274.60	$599.06–$1,274.60	—	40%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 INJ FORAMEN EPIDURAL L/S BILATERAL	$1,830.21	$3,050.35	$788.00–$14,543.73	—	40%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 INJ EPI L/S BI	$2,495.10	$4,158.50	$788.00–$14,543.73	—	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S	$936.27	$1,560.45	$788.00–$14,543.73	31% above	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ EPI L/S	$1,247.55	$2,079.25	$788.00–$14,543.73	75% above	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ EPI L/S BILATERA	$1,830.21	$3,050.35	$788.00–$14,543.73	157% above	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 INJ FORAMEN EPIDURAL L/S BILATERAL	$1,830.21	$3,050.35	$788.00–$14,543.73	—	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 INJ EPI L/S BI	$2,495.10	$4,158.50	$788.00–$14,543.73	—	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S	$936.27	$1,560.45	$788.00–$14,543.73	—	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ EPI L/S	$1,247.55	$2,079.25	$788.00–$14,543.73	—	40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ EPI L/S BILATERA	$1,830.21	$3,050.35	$788.00–$14,543.73	—	40%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE	$634.17	$1,056.95	$293.00–$1,056.95	293% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE	$634.17	$1,056.95	$293.00–$1,056.95	—	40%
Occipital nerve block (injection for headaches) CPT 64405 NJX AA&/STRD GR OCPL NRV	$496.96	$828.27	$293.00–$2,484.81	at median	40%
Occipital nerve block (injection for headaches) inpatient CPT 64405 NJX AA&/STRD GR OCPL NRV	$496.96	$828.27	$293.00–$2,484.81	—	40%
Paracentesis with imaging guidance CPT 49083 US ABDM PARACENTESIS	$1,156.47	$1,927.45	$905.90–$1,927.45	26% above	40%
Paracentesis with imaging guidance inpatient CPT 49083 US ABDM PARACENTESIS	$1,156.47	$1,927.45	$905.90–$1,927.45	—	40%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT	$2,095.62	$3,492.70	$2,607.00–$24,448.95	12% below	40%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST LUMB/SAC FAC JN	$2,095.62	$3,492.70	$2,607.00–$24,448.95	12% below	40%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST LUMB/SAC FAC JN	$2,095.62	$3,492.70	$2,607.00–$24,448.95	—	40%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT	$2,095.62	$3,492.70	$2,607.00–$24,448.95	—	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR OF WOUND <2.5 CM	$341.01	$568.35	$267.12–$568.35	40% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR OF WOUND <2.5 CM	$341.01	$568.35	$267.12–$568.35	—	40%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$1,423.86	$2,373.10	$293.00–$2,373.10	399% above	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$1,423.86	$2,373.10	$293.00–$2,373.10	—	40%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS UPW/15	$954.36	$1,590.60	$293.00–$1,590.60	387% above	40%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS UPW/15	$954.36	$1,590.60	$293.00–$1,590.60	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$825.84	$1,376.40	$646.90–$1,770.84	40% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$825.84	$1,376.40	$646.90–$1,770.84	—	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 BX SKIN SUBCUTANEOUS&/MUCOUS MEMB 1 LES	$863.34	$1,438.90	$293.00–$1,438.90	210% above	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 BX SKIN SUBCUTANEOUS&/MUCOUS MEMB 1 LES	$863.34	$1,438.90	$293.00–$1,438.90	—	40%
Thoracentesis with imaging guidance CPT 32555 US THORACENTESIS	$1,124.01	$1,873.35	$788.00–$1,873.35	12% above	40%
Thoracentesis with imaging guidance inpatient CPT 32555 US THORACENTESIS	$1,124.01	$1,873.35	$788.00–$1,873.35	—	40%
Trigger finger release surgery CPT 26055 TENDON SHEATH INCISION	$1,962.45	$3,270.75	$1,275.00–$3,270.75	48% above	40%
Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION	$1,962.45	$3,270.75	$1,275.00–$3,270.75	—	40%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$377.85	$629.75	$293.00–$1,490.70	100% above	40%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJECTION 1-2 MUSCLES	$377.85	$629.75	$293.00–$1,490.70	100% above	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER POINT INJECTION 1-2 MUSCLES	$377.85	$629.75	$293.00–$1,490.70	—	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$377.85	$629.75	$293.00–$1,490.70	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BX BREAST LEFT	$1,929.18	$3,215.30	$850.00–$6,430.60	13% below	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 BX BREAST RIGHT	$1,929.18	$3,215.30	$850.00–$6,430.60	13% below	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 BX BREAST LEFT	$1,929.18	$3,215.30	$850.00–$6,430.60	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 BX BREAST RIGHT	$1,929.18	$3,215.30	$850.00–$6,430.60	—	40%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM	$2,604.63	$4,341.05	$1,275.00–$4,341.05	134% above	40%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 ESOPH EGD DILATION <30 MM	$2,604.63	$4,341.05	$1,275.00–$4,341.05	—	40%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$1,423.86	$2,373.10	$1,115.35–$2,373.10	14% below	40%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD BIOPSY SINGLE/MULTIPLE	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE	$2,604.63	$4,341.05	$1,275.00–$4,341.05	49% above	40%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 EGD REMOVE LESION SNARE	$2,604.63	$4,341.05	$1,275.00–$4,341.05	—	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 EGD GUIDE WIRE INSERTION	$1,423.86	$2,373.10	$1,115.35–$2,373.10	5% below	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 EGD GUIDE WIRE INSERTION	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$1,423.86	$2,373.10	$1,115.35–$2,373.10	3% above	40%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$1,423.86	$2,373.10	$1,115.35–$2,373.10	—	40%
Upper endoscopy with drainage of a pseudocyst through the stomach wall CPT 43240 EGD W/TRANSMURAL DRAIN CYST	$2,604.63	$4,341.05	$2,040.29–$4,341.05	—	40%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 EGD W/TRANSMURAL DRAIN CYST	$2,604.63	$4,341.05	$2,040.29–$4,341.05	—	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Wyoming	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION	$727.20	$1,212.00	$293.00–$2,424.00	3% above	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION	$727.20	$1,212.00	$293.00–$2,424.00	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPPB TX	$109.74	$182.90	$515.76–$1,097.40	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 SPUTUM IND/AEROSTAR CART	$109.74	$182.90	$515.76–$1,097.40	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 UABD TX	$109.74	$182.90	$515.76–$1,097.40	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI TX	$109.74	$182.90	$515.76–$1,097.40	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INTRAPULMONIC PERC VENT	$109.74	$182.90	$515.76–$1,097.40	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HM/CM TX	$109.74	$182.90	$515.76–$1,097.40	at median	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 UABD TX	$109.74	$182.90	$515.76–$1,097.40	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HM/CM TX	$109.74	$182.90	$515.76–$1,097.40	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 IPPB TX	$109.74	$182.90	$515.76–$1,097.40	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 SPUTUM IND/AEROSTAR CART	$109.74	$182.90	$515.76–$1,097.40	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI TX	$109.74	$182.90	$515.76–$1,097.40	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INTRAPULMONIC PERC VENT	$109.74	$182.90	$515.76–$1,097.40	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE EKG NURSING	$165.30	$275.50	$129.48–$275.50	8% below	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ROUTINE EKG NURSING	$165.30	$275.50	$129.48–$275.50	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER LEVEL 1	$260.46	$434.10	$204.02–$434.10	18% above	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ER LEVEL 1	$260.46	$434.10	$204.02–$434.10	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2	$347.28	$578.80	$272.03–$578.80	4% above	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2	$347.28	$578.80	$272.03–$578.80	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER LEVEL 3	$468.15	$780.25	$366.71–$780.25	26% below	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ER LEVEL 3	$468.15	$780.25	$366.71–$780.25	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER LEVEL 4	$825.84	$1,376.40	$646.90–$1,376.40	20% below	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ER LEVEL 4	$825.84	$1,376.40	$646.90–$1,376.40	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER LEVEL 5	$1,282.17	$2,136.95	$1,004.36–$2,136.95	5% below	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ER LEVEL 5	$1,282.17	$2,136.95	$1,004.36–$2,136.95	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 BASIC HYDRATION	$42.00	$70.00	$831.05–$1,910.92	84% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 NAUSEA SUPPORT	$96.00	$160.00	$831.05–$1,910.92	64% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 LIQUID LIFT	$102.00	$170.00	$831.05–$1,910.92	62% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 PAINEZZ	$102.00	$170.00	$831.05–$1,910.92	62% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 REBOOT	$102.00	$170.00	$831.05–$1,910.92	62% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 MIGRAINE MELT	$102.00	$170.00	$831.05–$1,910.92	62% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUS HYDRATION INITIAL 31 MIN-1 HR	$256.98	$428.30	$831.05–$1,910.92	4% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYDRA INTITIAL 31 MIN-1 HOUR	$256.98	$428.30	$831.05–$1,910.92	4% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 BASIC HYDRATION	$42.00	$70.00	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 NAUSEA SUPPORT	$96.00	$160.00	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 PAINEZZ	$102.00	$170.00	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 REBOOT	$102.00	$170.00	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 MIGRAINE MELT	$102.00	$170.00	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 LIQUID LIFT	$102.00	$170.00	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUS HYDRATION INITIAL 31 MIN-1 HR	$256.98	$428.30	$831.05–$1,910.92	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INFUSION HYDRA INTITIAL 31 MIN-1 HOUR	$256.98	$428.30	$831.05–$1,910.92	—	40%
IV infusion of a medicine, first hour CPT 96365 ALLERGY RELIEF	$42.00	$70.00	$819.90–$1,744.50	88% below	40%
IV infusion of a medicine, first hour CPT 96365 PAIN RELIEF	$42.00	$70.00	$819.90–$1,744.50	88% below	40%
IV infusion of a medicine, first hour CPT 96365 IV THERAPY INITIAL UP TO 1 HOUR	$481.35	$802.25	$819.90–$1,744.50	32% above	40%
IV infusion of a medicine, first hour inpatient CPT 96365 PAIN RELIEF	$42.00	$70.00	$819.90–$1,744.50	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 ALLERGY RELIEF	$42.00	$70.00	$819.90–$1,744.50	—	40%
IV infusion of a medicine, first hour inpatient CPT 96365 IV THERAPY INITIAL UP TO 1 HOUR	$481.35	$802.25	$819.90–$1,744.50	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION/THER/PROPH/DIAG SC	$126.42	$210.70	$99.02–$210.70	26% above	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION/THER/PROPH/DIAG SC	$126.42	$210.70	$99.02–$210.70	—	40%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$382.50	$637.50	$898.87–$1,912.50	1% below	40%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 NRV CNDJ TEST 7-8 STUDIES	$382.50	$637.50	$898.87–$1,912.50	—	40%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR	$59.97	$99.95	$32.81–$199.90	44% below	40%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REDUCTION 15 MIN	$59.97	$99.95	$32.81–$199.90	44% below	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR REDUCTION 15 MIN	$59.97	$99.95	$32.81–$199.90	—	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR	$59.97	$99.95	$32.81–$199.90	—	40%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION LOW COMPLEXITY	$166.20	$277.00	$100.95–$277.00	20% below	40%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION LOW COMPLEXITY	$166.20	$277.00	$100.95–$277.00	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION HIGH COMPLEXITY	$166.20	$277.00	$98.27–$277.00	44% below	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION HIGH COMPLEXITY	$166.20	$277.00	$98.27–$277.00	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION LOW COMPLEXITY	$166.20	$277.00	$98.27–$277.00	13% below	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION LOW COMPLEXITY	$166.20	$277.00	$98.27–$277.00	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION MODERATE COMPLEXITY	$166.20	$277.00	$98.27–$277.00	33% below	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION MODERATE COMPLEXITY	$166.20	$277.00	$98.27–$277.00	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY EA 15 MIN	$46.26	$77.10	$27.77–$154.20	59% below	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY	$46.26	$77.10	$27.77–$154.20	59% below	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY	$46.26	$77.10	$27.77–$154.20	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY EA 15 MIN	$46.26	$77.10	$27.77–$154.20	—	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PROCEDURE EA 15 MIN	$59.97	$99.95	$29.12–$199.90	44% below	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE EA 15 MIN	$59.97	$99.95	$29.12–$199.90	44% below	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE EA 15 MIN	$59.97	$99.95	$29.12–$199.90	—	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PROCEDURE EA 15 MIN	$59.97	$99.95	$29.12–$199.90	—	40%
Spirometry (breathing test) CPT 94010 SPIROMETRY SINGLE	$187.14	$311.90	$293.18–$623.80	9% below	40%
Spirometry (breathing test) CPT 94010 INCENTIVE SPIROMETER INITIAL	$187.14	$311.90	$293.18–$623.80	9% below	40%
Spirometry (breathing test) inpatient CPT 94010 INCENTIVE SPIROMETER INITIAL	$187.14	$311.90	$293.18–$623.80	—	40%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY SINGLE	$187.14	$311.90	$293.18–$623.80	—	40%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY PRE/POST W/MVV	$245.88	$409.80	$577.80–$1,229.40	37% below	40%
Spirometry before and after a bronchodilator CPT 94060 INCENTIVE SPIROMETER SUBSEQU	$245.88	$409.80	$577.80–$1,229.40	37% below	40%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY PRE/POST BRONCHO	$245.88	$409.80	$577.80–$1,229.40	37% below	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY PRE/POST W/MVV	$245.88	$409.80	$577.80–$1,229.40	—	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY PRE/POST BRONCHO	$245.88	$409.80	$577.80–$1,229.40	—	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 INCENTIVE SPIROMETER SUBSEQU	$245.88	$409.80	$577.80–$1,229.40	—	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES -FUNCTIONAL TRAIN	$59.97	$99.95	$35.16–$199.90	40% below	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY EA 15 MIN	$59.97	$99.95	$35.16–$199.90	40% below	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITIES -FUNCTIONAL TRAIN	$59.97	$99.95	$35.16–$199.90	—	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY EA 15 MIN	$59.97	$99.95	$35.16–$199.90	—	40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$200.01	$333.35	$156.67–$333.35	16% above	40%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$200.01	$333.35	$156.67–$333.35	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Wyoming	Off list
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE	$164.22	$273.70	$128.63–$273.70	1% above	40%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE	$164.22	$273.70	$128.63–$273.70	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE	$226.74	$377.90	$177.61–$377.90	32% above	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR VACCINE	$226.74	$377.90	$177.61–$377.90	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE	$872.82	$1,454.70	$683.70–$1,454.70	98% above	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE	$872.82	$1,454.70	$683.70–$1,454.70	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP	$127.98	$213.30	$100.25–$213.30	32% above	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP	$127.98	$213.30	$100.25–$213.30	—	40%

Source file: https://s3.amazonaws.com/ycubaa-production-marlin-1-charge-management-public/facilities/6ce7fdc6-0418-49e7-bcc6-8530004867be/462887963_ASPEN-MOUNTAIN-MEDICAL_standardcharges.zip