SelfPayRates
Hospital

Heart of America Medical Center

Listed in its price file as “Good Samaritan Hospital Association”.

Heart of America Medical Center in Rugby, ND publishes cash prices for 272 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the North Dakota median for 132 of 270 procedures and above it for 127. By typical cash price it ranks #16 of 32 North Dakota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

2975 Highway 2 East, Rugby, ND 58368 Collected Sep 27, 2026 Source price file

Scans and imaging

ProcedureCash price List priceInsurers payvs North DakotaOff list
Abdominal CT scan without and with contrast CPT 74170 HC CT ABD W/WO DYE $2,097.75 $2,797.00 $995.69–$1,711.67 at median 25%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT ABD W/WO DYE $2,097.75 $2,797.00 $995.69–$1,711.67 — 25%
Abdominal X-ray, 2 views CPT 74019 HC XRAY ABDOMEN 2 VIEWS $131.25 $175.00 $58.08–$107.37 23% below 25%
Abdominal X-ray, 2 views inpatient CPT 74019 HC XRAY ABDOMEN 2 VIEWS $131.25 $175.00 $58.08–$107.37 — 25%
Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE MIN 3 VIEWS $138.00 $184.00 $58.79–$116.18 10% below 25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 HA TRINITY ANKLE COMPLETE RT $138.00 $184.00 $58.79–$116.18 10% below 25%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE MIN 3 VIEWS $138.00 $184.00 $58.79–$116.18 — 25%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 HA TRINITY ANKLE COMPLETE RT $138.00 $184.00 $58.79–$116.18 — 25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC EXTREMITY STUDY VASCULAR $340.50 $454.00 $151.62–$286.25 16% above 25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC EXTREMITY STUDY VASCULAR $340.50 $454.00 $151.62–$286.25 — 25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT UPPER EXTREM W/O DYE $1,347.75 $1,797.00 $572.05 7% above 25%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT UPPER EXTREM W/O DYE $1,347.75 $1,797.00 $572.05 — 25%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE WHOLE BODY/JOINT SCAN $1,509.00 $2,012.00 $1,233.51 32% above 25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE WHOLE BODY/JOINT SCAN $1,509.00 $2,012.00 $1,233.51 — 25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US BREAST UNILAT W/AXILLA LIMITED $301.50 $402.00 $135.08–$253.14 1% above 25%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 HC US BREAST UNILAT W/AXILLA LIMITED $301.50 $402.00 $135.08–$253.14 — 25%
CT angiography (CTA) of the neck CPT 70498 HC CTA NECK $2,160.00 $2,880.00 $950.26–$1,814.88 8% above 25%
CT angiography (CTA) of the neck inpatient CPT 70498 HC CTA NECK $2,160.00 $2,880.00 $950.26–$1,814.88 — 25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD/PELVIS W/O CONTRAST $1,179.75 $1,573.00 $523.47–$991.17 31% below 25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD/PELVIS W/O CONTRAST $1,179.75 $1,573.00 $523.47–$991.17 — 25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABD/PELVIS W/CONTRAST $2,380.50 $3,174.00 $1,051.96–$2,000.52 4% below 25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABD/PELVIS W/CONTRAST $2,380.50 $3,174.00 $1,051.96–$2,000.52 — 25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD/PELVIS W/O&W CONTRAST $2,720.25 $3,627.00 $1,187.28–$2,285.48 6% below 25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD/PELVIS W/O&W CONTRAST $2,720.25 $3,627.00 $1,187.28–$2,285.48 — 25%
CT scan of the abdomen with contrast CPT 74160 HC CT ABD W/DYE $1,828.50 $2,438.00 $819.93–$867.74 16% above 25%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABD W/DYE $1,828.50 $2,438.00 $819.93–$867.74 — 25%
CT scan of the abdomen without contrast CPT 74150 HA TRINITY CT ABD WO CONTRAST $937.50 $1,250.00 $412.76–$765.28 25% below 25%
CT scan of the abdomen without contrast CPT 74150 HC CT ABD W/O DYE $937.50 $1,250.00 $412.76–$765.28 25% below 25%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABD W/O DYE $937.50 $1,250.00 $412.76–$765.28 — 25%
CT scan of the abdomen without contrast inpatient CPT 74150 HA TRINITY CT ABD WO CONTRAST $937.50 $1,250.00 $412.76–$765.28 — 25%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT FACIAL BONES W/O CONTRAST $1,005.75 $1,341.00 $451.00–$820.46 6% below 25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT FACIAL BONES W/O CONTRAST $1,005.75 $1,341.00 $451.00–$820.46 — 25%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT BRAIN W/O CONTRAST $764.25 $1,019.00 $336.13–$641.95 29% below 25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT BRAIN W/O CONTRAST $764.25 $1,019.00 $336.13–$641.95 — 25%
CT scan of the head with contrast CPT 70460 HC CT BRAIN W/CONTRAST $1,114.50 $1,486.00 $529.00–$531.20 12% below 25%
CT scan of the head with contrast inpatient CPT 70460 HC CT BRAIN W/CONTRAST $1,114.50 $1,486.00 $529.00–$531.20 — 25%
CT scan of the head without and with contrast CPT 70470 HC CT BRAIN W/WO CONTRAST $1,333.50 $1,778.00 $632.75–$1,120.34 9% below 25%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT BRAIN W/WO CONTRAST $1,333.50 $1,778.00 $632.75–$1,120.34 — 25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT SPINE CERVICAL W/O DYE $1,362.75 $1,817.00 $601.72–$1,145.01 3% above 25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT SPINE CERVICAL W/O DYE $1,362.75 $1,817.00 $601.72–$1,145.01 — 25%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W/DYE $1,836.00 $2,448.00 $1,498.13 15% above 25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W/DYE $1,836.00 $2,448.00 $1,498.13 — 25%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC CAROTID DOPPLER $747.00 $996.00 $187.80–$610.75 7% above 25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC CAROTID DOPPLER $747.00 $996.00 $187.80–$610.75 — 25%
Chest CT scan without and with contrast CPT 71270 HC CT THORAX W+WO CONTRAST $1,710.75 $2,281.00 $752.80–$1,399.00 at median 25%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT THORAX W+WO CONTRAST $1,710.75 $2,281.00 $752.80–$1,399.00 — 25%
Collarbone (clavicle) X-ray, complete CPT 73000 HC CLAVICLE COMPLETE $117.00 $156.00 $51.32–$98.01 15% below 25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC CLAVICLE COMPLETE $117.00 $156.00 $51.32–$98.01 — 25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US RETROPERIT (RENAL LAAA) $428.25 $571.00 $188.59–$359.60 1% below 25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US RETROPERIT (RENAL LAAA) $428.25 $571.00 $188.59–$359.60 — 25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DEXASCAN $171.00 $228.00 $75.11–$139.55 36% below 25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DEXASCAN $171.00 $228.00 $75.11–$139.55 — 25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT THORAX WO CONTRAST $1,045.50 $1,394.00 $460.02–$878.23 14% below 25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT THORAX WO CONTRAST $1,045.50 $1,394.00 $460.02–$878.23 — 25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT THORAX W CONTRAST $1,400.25 $1,867.00 $616.17–$1,176.81 at median 25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT THORAX W CONTRAST $1,400.25 $1,867.00 $616.17–$1,176.81 — 25%
Diagnostic mammogram, both breasts both sides CPT 77066 HC DIAGNOSTIC MAMMO CAD BILATERAL $672.00 $896.00 $301.16–$564.71 — 25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DIAGNOSTIC MAMMO CAD BILATERAL $672.00 $896.00 $301.16–$564.71 — 25%
Diagnostic mammogram, one breast one side CPT 77065 HC DIAGNOSTIC MAMMO CAD UNILATERAL $524.25 $699.00 $230.76–$440.73 34% above 25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC DIAGNOSTIC MAMMO CAD UNILATERAL $524.25 $699.00 $230.76–$440.73 — 25%
Duplex ultrasound of the leg veins, both legs CPT 93970 HC VENOUS IMAGING $743.25 $991.00 $332.88–$606.25 4% above 25%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 HC VENOUS IMAGING $743.25 $991.00 $332.88–$606.25 — 25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/DOPPLER COMPLETE $739.50 $986.00 $306.76–$621.18 1% below 25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE W/DOPPLER COMPLETE $739.50 $986.00 $306.76–$621.18 — 25%
Elbow X-ray, 2 views CPT 73070 HC ELBOW 2 VIEWS $108.00 $144.00 $48.38–$88.27 20% below 25%
Elbow X-ray, 2 views inpatient CPT 73070 HC ELBOW 2 VIEWS $108.00 $144.00 $48.38–$88.27 — 25%
Elbow X-ray, complete, 3 or more views CPT 73080 HC ELBOW MIN 3 VIEWS $118.50 $158.00 $50.66–$99.32 26% below 25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC ELBOW MIN 3 VIEWS $118.50 $158.00 $50.66–$99.32 — 25%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT ORBITS/FOSSA/SELLA/IAC $1,762.50 $2,350.00 $1,481.24 26% above 25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT ORBITS/FOSSA/SELLA/IAC $1,762.50 $2,350.00 $1,481.24 — 25%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC FACIAL BONES MIN 3 VIEWS $171.00 $228.00 $75.64–$143.45 12% below 25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC FACIAL BONES MIN 3 VIEWS $171.00 $228.00 $75.64–$143.45 — 25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC FOREARM 2 VIEWS $111.00 $148.00 $48.94–$90.95 24% below 25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC FOREARM 2 VIEWS $111.00 $148.00 $48.94–$90.95 — 25%
Hand X-ray, 2 views CPT 73120 HC HAND 2 VIEWS $117.00 $156.00 $51.13–$98.01 17% below 25%
Hand X-ray, 2 views inpatient CPT 73120 HC HAND 2 VIEWS $117.00 $156.00 $51.13–$98.01 — 25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC HEEL MIN 2 VIEWS $108.00 $144.00 $45.92–$88.27 25% below 25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC HEEL MIN 2 VIEWS $108.00 $144.00 $45.92–$88.27 — 25%
Knee X-ray, 3 views both sides CPT 73562 HC KNEE MIN 3 VIEWS BILATERAL $157.50 $210.00 $68.79–$128.52 — 25%
Knee X-ray, 3 views CPT 73562 HC KNEE MIN 3 VIEWS $157.50 $210.00 $68.79–$128.52 12% below 25%
Knee X-ray, 3 views inpatient both sides CPT 73562 HC KNEE MIN 3 VIEWS BILATERAL $157.50 $210.00 $68.79–$128.52 — 25%
Knee X-ray, 3 views inpatient CPT 73562 HC KNEE MIN 3 VIEWS $157.50 $210.00 $68.79–$128.52 — 25%
Knee X-ray, complete, 4 or more views CPT 73564 HC KNEE 4 OR MORE VIEWS $171.00 $228.00 $143.46 12% below 25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC KNEE 4 OR MORE VIEWS $171.00 $228.00 $143.46 — 25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT LOWER EXTREM W/O DYE $1,353.00 $1,804.00 $606.56–$1,136.57 17% above 25%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT LOWER EXTREM W/O DYE $1,353.00 $1,804.00 $606.56–$1,136.57 — 25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US ECHO EXAM OF ABDOMEN $348.00 $464.00 $151.74–$292.09 9% below 25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US ECHO EXAM OF ABDOMEN $348.00 $464.00 $151.74–$292.09 — 25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US XTR NON-VASC LMTD $185.25 $247.00 $79.22–$155.78 14% below 25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US XTR NON-VASC LMTD $185.25 $247.00 $79.22–$155.78 — 25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC LDCT FOR LUNG CANCER SCREEN $738.00 $984.00 $308.88–$601.71 at median 25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC LDCT FOR LUNG CANCER SCREEN $738.00 $984.00 $308.88–$601.71 — 25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC TIBIA FIBULA 2 VIEW $121.50 $162.00 $52.94–$152.00 24% below 25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC TIBIA FIBULA 2 VIEW $121.50 $162.00 $52.94–$152.00 — 25%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRA HEAD W/O DYE $2,283.75 $3,045.00 $1,377.60–$1,862.91 4% above 25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRA HEAD W/O DYE $2,283.75 $3,045.00 $1,377.60–$1,862.91 — 25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI-LOWER EXT JOINT W/O DYE $1,724.25 $2,299.00 $768.52–$1,409.73 11% below 25%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI-LOWER EXT JOINT W/O DYE $1,724.25 $2,299.00 $768.52–$1,409.73 — 25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOWER EXT JOINT W/WO DYE $3,690.75 $4,921.00 $1,655.20–$3,101.39 22% above 25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOWER EXT JOINT W/WO DYE $3,690.75 $4,921.00 $1,655.20–$3,101.39 — 25%
MRI of the abdomen without contrast CPT 74181 HC MRI-ABDOMEN W/O DYE $1,787.25 $2,383.00 $763.67–$1,502.01 11% below 25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI-ABDOMEN W/O DYE $1,787.25 $2,383.00 $763.67–$1,502.01 — 25%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W/WO DYE $3,023.25 $4,031.00 $1,296.48–$2,466.58 6% below 25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W/WO DYE $3,023.25 $4,031.00 $1,296.48–$2,466.58 — 25%
MRI of the brain, no contrast dye CPT 70551 HC MRI-BRAIN/BRAIN STEM $1,590.75 $2,121.00 $709.25–$1,336.49 6% below 25%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI-BRAIN/BRAIN STEM $1,590.75 $2,121.00 $709.25–$1,336.49 — 25%
MRI of the lower back, no contrast dye CPT 72148 HC MRI-L-SPINE W/O DYE $1,530.75 $2,041.00 $668.33–$1,286.51 24% below 25%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI-L-SPINE W/O DYE $1,530.75 $2,041.00 $668.33–$1,286.51 — 25%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI L-SPINE W/WO DYE $2,700.75 $3,601.00 $1,201.40–$2,269.25 18% below 25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI L-SPINE W/WO DYE $2,700.75 $3,601.00 $1,201.40–$2,269.25 — 25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI-T-SPINE W/O DYE $1,530.75 $2,041.00 $668.33–$1,248.86 27% below 25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI-T-SPINE W/O DYE $1,530.75 $2,041.00 $668.33–$1,248.86 — 25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI-C-SPINE W/O DYE $1,527.00 $2,036.00 $672.18–$1,283.27 21% below 25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI-C-SPINE W/O DYE $1,527.00 $2,036.00 $672.18–$1,283.27 — 25%
MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W/WO DYE $3,020.25 $4,027.00 $1,333.37–$2,537.98 6% below 25%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W/WO DYE $3,020.25 $4,027.00 $1,333.37–$2,537.98 — 25%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO DYE $2,064.00 $2,752.00 $979.56–$1,687.63 5% below 25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO DYE $2,064.00 $2,752.00 $979.56–$1,687.63 — 25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI-UPPER EXT JOINT W/O DYE $1,724.25 $2,299.00 $752.63–$1,448.79 11% below 25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI-UPPER EXT JOINT W/O DYE $1,724.25 $2,299.00 $752.63–$1,448.79 — 25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC CERVICAL SPINE 4 OR 5 VIEWS $196.50 $262.00 $88.13–$164.87 9% below 25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC CERVICAL SPINE 4 OR 5 VIEWS $196.50 $262.00 $88.13–$164.87 — 25%
Neck soft tissue X-ray CPT 70360 HC SOFT TISSUE NECK $123.75 $165.00 $100.62 15% below 25%
Neck soft tissue X-ray inpatient CPT 70360 HC SOFT TISSUE NECK $123.75 $165.00 $100.62 — 25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM THALLIUM S/R $2,282.25 $3,043.00 $1,235.45–$2,347.14 at median 25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM HT MUSCLE IMAGE SPECT,MULTIPLE $2,793.00 $3,724.00 $1,235.45–$2,347.14 22% above 25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM THALLIUM S/R $2,282.25 $3,043.00 $1,235.45–$2,347.14 — 25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM HT MUSCLE IMAGE SPECT,MULTIPLE $2,793.00 $3,724.00 $1,235.45–$2,347.14 — 25%
Pelvic CT scan without contrast CPT 72192 HC CT PELVIS W/O DYE $950.25 $1,267.00 $426.56–$798.39 25% below 25%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT PELVIS W/O DYE $950.25 $1,267.00 $426.56–$798.39 — 25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US PELVIC LIMITED $135.00 $180.00 $57.40–$110.53 57% below 25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US PELVIC LIMITED $135.00 $180.00 $57.40–$110.53 — 25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US PELVIC COMPLETE $423.75 $565.00 $182.99–$356.35 1% below 25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US PELVIC COMPLETE $423.75 $565.00 $182.99–$356.35 — 25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US PREGNANCY >=14WKS SNGL FETUS $510.00 $680.00 $316.80–$428.40 3% above 25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US PREGNANCY >=14WKS SNGL FETUS $510.00 $680.00 $316.80–$428.40 — 25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB COMPLETE(<14 WKS) $410.25 $547.00 $254.88–$334.93 2% above 25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB COMPLETE(<14 WKS) $410.25 $547.00 $254.88–$334.93 — 25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US PREGNANCY LMTD $291.75 $389.00 $245.35 4% below 25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US PREGNANCY LMTD $291.75 $389.00 $245.35 — 25%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 HC RIBS UNILATERAL 2 V PA CHEST $144.75 $193.00 $63.85–$121.38 26% below 25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 HC RIBS UNILATERAL 2 V PA CHEST $144.75 $193.00 $63.85–$121.38 — 25%
Screening mammogram, both breasts both sides CPT 77067 HC SCREENING MAMMO CAD BILATERAL $555.75 $741.00 $87.65–$466.70 — 25%
Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCREENING MAMMO CAD BILATERAL $555.75 $741.00 $87.65–$466.70 — 25%
Shoulder X-ray, complete, 2 or more views CPT 73030 HA TRINITY XR SHOULDER COMPLETE $117.00 $156.00 $49.98–$95.41 33% below 25%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER MIN 2 VIEWS $117.00 $156.00 $49.98–$95.41 33% below 25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HA TRINITY XR SHOULDER COMPLETE $117.00 $156.00 $49.98–$95.41 — 25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER MIN 2 VIEWS $117.00 $156.00 $49.98–$95.41 — 25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-RAY EXAM FEMUR 2/> $136.50 $182.00 $59.68–$111.79 17% below 25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-RAY EXAM FEMUR 2/> $136.50 $182.00 $59.68–$111.79 — 25%
Toe X-ray, 2 or more views CPT 73660 HC TOE MIN 2 VIEWS $125.25 $167.00 $55.46–$102.31 2% below 25%
Toe X-ray, 2 or more views inpatient CPT 73660 HC TOE MIN 2 VIEWS $125.25 $167.00 $55.46–$102.31 — 25%
Transvaginal pelvic ultrasound CPT 76830 HC US TRANSVAGINAL $492.00 $656.00 $212.18–$413.47 4% above 25%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US TRANSVAGINAL $492.00 $656.00 $212.18–$413.47 — 25%
Transvaginal ultrasound during pregnancy CPT 76817 HC US TRANSVAGINAL(OB) $332.25 $443.00 $270.67 1% above 25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US TRANSVAGINAL(OB) $332.25 $443.00 $270.67 — 25%
Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE $459.00 $612.00 $203.97–$385.56 11% below 25%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE $459.00 $612.00 $203.97–$385.56 — 25%
Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM $414.75 $553.00 $185.89–$348.56 3% above 25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM $414.75 $553.00 $185.89–$348.56 — 25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM HEAD/NECK $492.00 $656.00 $212.18–$413.47 5% above 25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM HEAD/NECK $492.00 $656.00 $212.18–$413.47 — 25%
Upper arm X-ray (humerus), 2 views CPT 73060 HC HUMERUS 2 VIEWS $123.75 $165.00 $58.66–$103.85 12% below 25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC HUMERUS 2 VIEWS $123.75 $165.00 $58.66–$103.85 — 25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC UNILAT/LTD VENOUS $480.75 $641.00 $211.48–$392.05 13% below 25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC UNILAT/LTD VENOUS $480.75 $641.00 $211.48–$392.05 — 25%
Wrist X-ray, 2 views CPT 73100 HC WRIST 2 VIEWS $133.50 $178.00 $58.34–$112.30 15% below 25%
Wrist X-ray, 2 views inpatient CPT 73100 HC WRIST 2 VIEWS $133.50 $178.00 $58.34–$112.30 — 25%
Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST COMP MIN 3 VIEWS $157.50 $210.00 $69.36–$132.41 14% below 25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST COMP MIN 3 VIEWS $157.50 $210.00 $69.36–$132.41 — 25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VW $179.25 $239.00 $79.66–$150.59 12% below 25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VW $179.25 $239.00 $79.66–$150.59 — 25%
X-ray of the abdomen, 1 view CPT 74018 HC XRAY ABDOMEN 1 VIEW $109.50 $146.00 $47.88–$92.17 21% below 25%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC XRAY ABDOMEN 1 VIEW $109.50 $146.00 $47.88–$92.17 — 25%
X-ray of the ankle, 2 views CPT 73600 HC X-RAY ANKLE 2 VIEWS $127.50 $170.00 $60.49–$107.10 13% below 25%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-RAY ANKLE 2 VIEWS $127.50 $170.00 $60.49–$107.10 — 25%
X-ray of the finger(s), 2 or more views CPT 73140 HC FINGER MIN 2 VIEWS $151.50 $202.00 $66.91–$127.22 5% below 25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGER MIN 2 VIEWS $151.50 $202.00 $66.91–$127.22 — 25%
X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VIEWS $109.50 $146.00 $52.06–$92.17 22% below 25%
X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VIEWS $109.50 $146.00 $52.06–$92.17 — 25%
X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT MIN 3 VIEWS $129.00 $172.00 $57.15–$105.15 12% below 25%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT MIN 3 VIEWS $129.00 $172.00 $57.15–$105.15 — 25%
X-ray of the hand, 3 or more views CPT 73130 HC HAND MIN 3 VIEWS $138.00 $184.00 $61.14–$116.18 19% below 25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND MIN 3 VIEWS $138.00 $184.00 $61.14–$116.18 — 25%
X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 1 OR 2 VIEWS $135.00 $180.00 $59.48–$113.59 16% below 25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 1 OR 2 VIEWS $135.00 $180.00 $59.48–$113.59 — 25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBAR SPINE 2 VIEWS $143.25 $191.00 $60.70–$120.08 22% below 25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HA ST A'S LUMBAR SPINE 2OR3 $143.25 $191.00 $60.70–$120.08 22% below 25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBAR SPINE 2 VIEWS $143.25 $191.00 $60.70–$120.08 — 25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HA ST A'S LUMBAR SPINE 2OR3 $143.25 $191.00 $60.70–$120.08 — 25%
X-ray of the lower back, 4 or more views CPT 72110 HC LUMBAR SPINE COM $200.25 $267.00 $89.56–$168.11 15% below 25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBAR SPINE COM $200.25 $267.00 $89.56–$168.11 — 25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC SPINE THORACIC 2 VIEWS $129.00 $172.00 $57.80–$105.15 17% below 25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC THORACIC AP/LATERAL SPINE $129.00 $172.00 $57.80–$105.15 17% below 25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC THORACIC AP/LATERAL SPINE $129.00 $172.00 $57.80–$105.15 — 25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC SPINE THORACIC 2 VIEWS $129.00 $172.00 $57.80–$105.15 — 25%
X-ray of the nasal bones, 3 or more views CPT 70160 HC NOSE BONES MIN 3 VIEWS $144.75 $193.00 $121.39 10% below 25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NOSE BONES MIN 3 VIEWS $144.75 $193.00 $121.39 — 25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE 2/3 VIEWS $143.25 $191.00 $62.90–$120.08 11% below 25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE 2/3 VIEWS $143.25 $191.00 $62.90–$120.08 — 25%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS $136.50 $182.00 $60.15–$114.89 10% below 25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS $136.50 $182.00 $60.15–$114.89 — 25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUN COCCYX MIN 2 VIEWS $123.75 $165.00 $52.27–$103.85 15% below 25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUN COCCYX MIN 2 VIEWS $123.75 $165.00 $52.27–$103.85 — 25%

Lab tests

ProcedureCash price List priceInsurers payvs North DakotaOff list
ACTH blood test CPT 82024 HA ASSAY OF ACTH $273.75 $365.00 $120.31–$229.78 103% above 25%
ACTH blood test inpatient CPT 82024 HA ASSAY OF ACTH $273.75 $365.00 $120.31–$229.78 — 25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HA WELLNESS ALT $8.25 $11.00 $16.32–$31.15 79% below 25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HA SGPT (ALT) $36.75 $49.00 $16.32–$31.15 8% below 25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HA WELLNESS ALT $8.25 $11.00 $16.32–$31.15 — 25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HA SGPT (ALT) $36.75 $49.00 $16.32–$31.15 — 25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HA SGOT (AST) $36.00 $48.00 $15.97–$30.50 9% below 25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HA SGOT (AST) $36.00 $48.00 $15.97–$30.50 — 25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HA ACUTE HEPATITIS PANEL $337.50 $450.00 $203.52–$276.00 48% above 25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HA ACUTE HEPATITIS PANEL $337.50 $450.00 $203.52–$276.00 — 25%
Albumin blood test CPT 82040 HA ALBUMIN (G/DL) $34.50 $46.00 $15.30–$29.20 1% below 25%
Albumin blood test CPT 82040 HA ALBUMIN $34.50 $46.00 $15.30–$29.20 1% below 25%
Albumin blood test inpatient CPT 82040 HA ALBUMIN $34.50 $46.00 $15.30–$29.20 — 25%
Albumin blood test inpatient CPT 82040 HA ALBUMIN (G/DL) $34.50 $46.00 $15.30–$29.20 — 25%
Aldosterone blood test CPT 82088 HA ALDOSTERONE, SERUM $289.50 $386.00 $236.85 135% above 25%
Aldosterone blood test CPT 82088 HA ALDOSTERONE, URINE $289.50 $386.00 $236.85 135% above 25%
Aldosterone blood test inpatient CPT 82088 HA ALDOSTERONE, URINE $289.50 $386.00 $236.85 — 25%
Aldosterone blood test inpatient CPT 82088 HA ALDOSTERONE, SERUM $289.50 $386.00 $236.85 — 25%
Allergy blood test, specific IgE, per allergen CPT 86003 HA ALLERGAN SPECIFIC IGG $36.00 $48.00 $15.97–$30.50 76% above 25%
Allergy blood test, specific IgE, per allergen CPT 86003 HA ALLERGEN SPECIFIC IGE $36.00 $48.00 $15.97–$30.50 76% above 25%
Allergy blood test, specific IgE, per allergen CPT 86003 HA ALLERGAN SPECIFIC IGE $36.00 $48.00 $15.97–$30.50 76% above 25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HA ALLERGEN SPECIFIC IGE $36.00 $48.00 $15.97–$30.50 — 25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HA ALLERGAN SPECIFIC IGE $36.00 $48.00 $15.97–$30.50 — 25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HA ALLERGAN SPECIFIC IGG $36.00 $48.00 $15.97–$30.50 — 25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HA AFP $118.50 $158.00 $52.00–$99.31 23% above 25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HA ALPHA-FETOPROTEIN, SERUM $118.50 $158.00 $52.00–$99.31 23% above 25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HA ALPHA-FETOPROTEIN, SERUM $118.50 $158.00 $52.00–$99.31 — 25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HA AFP $118.50 $158.00 $52.00–$99.31 — 25%
Ammonia blood test CPT 82140 HA AMMONIA $104.25 $139.00 $44.98–$87.62 110% above 25%
Ammonia blood test inpatient CPT 82140 HA AMMONIA $104.25 $139.00 $44.98–$87.62 — 25%
Amylase blood test CPT 82150 HA AMYLASE; BODY FLUID $48.00 $64.00 $20.39–$40.24 7% above 25%
Amylase blood test CPT 82150 HA AMYLASE $48.00 $64.00 $20.39–$40.24 7% above 25%
Amylase blood test inpatient CPT 82150 HA AMYLASE $48.00 $64.00 $20.39–$40.24 — 25%
Amylase blood test inpatient CPT 82150 HA AMYLASE; BODY FLUID $48.00 $64.00 $20.39–$40.24 — 25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HA CCP ANTIBODY $91.50 $122.00 $42.79–$74.64 6% above 25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HA CCP ANTIBODY $91.50 $122.00 $42.79–$74.64 — 25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HA ANA WITH REFLEX $85.50 $114.00 $37.72–$72.05 34% above 25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HA ANA HEP-2 SUBSTRATE $85.50 $114.00 $37.72–$72.05 34% above 25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HA ANA FACTOR $85.50 $114.00 $37.72–$72.05 34% above 25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HA ANA WITH REFLEX $85.50 $114.00 $37.72–$72.05 — 25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HA ANA HEP-2 SUBSTRATE $85.50 $114.00 $37.72–$72.05 — 25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HA ANA FACTOR $85.50 $114.00 $37.72–$72.05 — 25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HA NATRIURETIC PEPTIDE $249.75 $333.00 $109.78–$204.00 6% above 25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HA NATRIURETIC PEPTIDE $249.75 $333.00 $109.78–$204.00 — 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HA BACTERIAL CULTURE - OTHR $60.00 $80.00 $31.60–$90.00 7% below 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HA CULTURE OTHER $60.00 $80.00 $31.60–$90.00 7% below 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HA CULTURE (SPUTUM)-AEROBIC $60.00 $80.00 $31.60–$90.00 7% below 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HA CULTURE-OTHER $72.00 $96.00 $31.60–$90.00 11% above 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HA CULTURE (SPUTUM)-AEROBIC $60.00 $80.00 $31.60–$90.00 — 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HA CULTURE OTHER $60.00 $80.00 $31.60–$90.00 — 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HA BACTERIAL CULTURE - OTHR $60.00 $80.00 $31.60–$90.00 — 25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HA CULTURE-OTHER $72.00 $96.00 $31.60–$90.00 — 25%
Basic metabolic panel (blood test) CPT 80048 HA BASIC METABOLIC PANEL $59.25 $79.00 $26.17–$49.98 20% below 25%
Basic metabolic panel (blood test) CPT 80048 HA METABOLIC PANEL TOTAL CA $59.25 $79.00 $26.17–$49.98 20% below 25%
Basic metabolic panel (blood test) inpatient CPT 80048 HA BASIC METABOLIC PANEL $59.25 $79.00 $26.17–$49.98 — 25%
Basic metabolic panel (blood test) inpatient CPT 80048 HA METABOLIC PANEL TOTAL CA $59.25 $79.00 $26.17–$49.98 — 25%
Bilirubin blood test, total CPT 82247 HA BILIRUBIN TOTAL $35.25 $47.00 $45.00 1% above 25%
Bilirubin blood test, total CPT 82247 HA BILIRUBIN, TOTAL $35.25 $47.00 $45.00 1% above 25%
Bilirubin blood test, total inpatient CPT 82247 HA BILIRUBIN, TOTAL $35.25 $47.00 $45.00 — 25%
Bilirubin blood test, total inpatient CPT 82247 HA BILIRUBIN TOTAL $35.25 $47.00 $45.00 — 25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HA TISSUE EXAM,LEVEL IV $114.75 $153.00 $50.64–$96.72 7% below 25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HA TISSUE EXAM,LEVEL IV $114.75 $153.00 $50.64–$96.72 — 25%
Blood culture for bacteria CPT 87040 HA BLOOD CULTURE AEROBIC $74.25 $99.00 $31.60–$62.31 8% below 25%
Blood culture for bacteria inpatient CPT 87040 HA BLOOD CULTURE AEROBIC $74.25 $99.00 $31.60–$62.31 — 25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HA D VENIPUNCTURE $18.75 $25.00 $8.16–$15.57 5% above 25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HA VENIPUNTURE/IV $18.75 $25.00 $8.16–$15.57 5% above 25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HA M VENIPUNCTURE $18.75 $25.00 $8.16–$15.57 5% above 25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HA VENIPUNCTURE $18.75 $25.00 $8.16–$15.57 5% above 25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE $19.50 $26.00 $8.16–$15.57 9% above 25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HA M VENIPUNCTURE $18.75 $25.00 $8.16–$15.57 — 25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HA VENIPUNCTURE $18.75 $25.00 $8.16–$15.57 — 25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HA VENIPUNTURE/IV $18.75 $25.00 $8.16–$15.57 — 25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HA D VENIPUNCTURE $18.75 $25.00 $8.16–$15.57 — 25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 PR COLLECTION VENOUS BLOOD VENIPUNCTURE $19.50 $26.00 $8.16–$15.57 — 25%
Blood glucose (sugar) test CPT 82947 HA GLUCOSE $28.50 $38.00 $12.33–$23.36 at median 25%
Blood glucose (sugar) test inpatient CPT 82947 HA GLUCOSE $28.50 $38.00 $12.33–$23.36 — 25%
Blood lead test CPT 83655 HA LEAD, FILTER PAPER $85.50 $114.00 $37.72–$72.05 87% above 25%
Blood lead test CPT 83655 HA LEAD, BLOOD CAPILLARY $85.50 $114.00 $37.72–$72.05 87% above 25%
Blood lead test CPT 83655 HA LEAD $85.50 $114.00 $37.72–$72.05 87% above 25%
Blood lead test inpatient CPT 83655 HA LEAD, FILTER PAPER $85.50 $114.00 $37.72–$72.05 — 25%
Blood lead test inpatient CPT 83655 HA LEAD, BLOOD CAPILLARY $85.50 $114.00 $37.72–$72.05 — 25%
Blood lead test inpatient CPT 83655 HA LEAD $85.50 $114.00 $37.72–$72.05 — 25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HA M PREG TEST URINE $54.00 $72.00 $33.60–$45.43 18% below 25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HA HCG, QUAL $54.00 $72.00 $33.60–$45.43 18% below 25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HA PREG.TEST URINE/SERUM QUA $54.00 $72.00 $33.60–$45.43 18% below 25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HA D PREG TEST URINE $54.00 $72.00 $33.60–$45.43 18% below 25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HA HCG, QUAL $54.00 $72.00 $33.60–$45.43 — 25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HA M PREG TEST URINE $54.00 $72.00 $33.60–$45.43 — 25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HA D PREG TEST URINE $54.00 $72.00 $33.60–$45.43 — 25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HA PREG.TEST URINE/SERUM QUA $54.00 $72.00 $33.60–$45.43 — 25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HA ABO TYPING $22.50 $30.00 $9.52–$18.17 42% below 25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HA ABO TYPING - UNIT $22.50 $30.00 $9.52–$18.17 42% below 25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HA BLOOD TYPING; ABO $22.50 $30.00 $9.52–$18.17 42% below 25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HA ABO TYPING - PRE $22.50 $30.00 $9.52–$18.17 42% below 25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HA A B O TYPE $22.50 $30.00 $9.52–$18.17 42% below 25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HA ABO TYPING $22.50 $30.00 $9.52–$18.17 — 25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HA ABO TYPING - UNIT $22.50 $30.00 $9.52–$18.17 — 25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HA A B O TYPE $22.50 $30.00 $9.52–$18.17 — 25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HA ABO TYPING - PRE $22.50 $30.00 $9.52–$18.17 — 25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HA BLOOD TYPING; ABO $22.50 $30.00 $9.52–$18.17 — 25%
Blood urea nitrogen (BUN) test CPT 84520 HA BUN $29.25 $39.00 $12.92–$24.01 19% below 25%
Blood urea nitrogen (BUN) test CPT 84520 HA BUN QUANTITATIVE $29.25 $39.00 $12.92–$24.01 19% below 25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HA BUN QUANTITATIVE $29.25 $39.00 $12.92–$24.01 — 25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HA BUN $29.25 $39.00 $12.92–$24.01 — 25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HA RCRP $36.00 $48.00 $15.97–$29.85 1% below 25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HA C-REACTIVE PROTEIN $36.00 $48.00 $15.97–$29.85 1% below 25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HA C-REATIVE PROTEIN $36.00 $48.00 $15.97–$29.85 1% below 25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HA C-REATIVE PROTEIN $36.00 $48.00 $15.97–$29.85 — 25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HA RCRP $36.00 $48.00 $15.97–$29.85 — 25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HA C-REACTIVE PROTEIN $36.00 $48.00 $15.97–$29.85 — 25%
C. difficile toxin gene test (stool PCR) CPT 87493 HA CLOSTRIDIUM DIFFICELE PCR $248.25 $331.00 $106.96–$208.36 29% above 25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HA CLOSTRIDIUM DIFFICELE PCR $248.25 $331.00 $106.96–$208.36 — 25%
CA 19-9 blood test (tumor marker) CPT 86301 HA CA 19-9 $147.75 $197.00 $65.27–$123.97 40% above 25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HA CA 19-9 $147.75 $197.00 $65.27–$123.97 — 25%
CA-125 blood test (ovarian cancer marker) CPT 86304 HA CA-125 $147.75 $197.00 $64.92–$123.97 12% above 25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HA CA-125 $147.75 $197.00 $64.92–$123.97 — 25%
Calcium blood test, total CPT 82310 HA ASSAY CALCIUM $36.00 $48.00 $15.33–$30.50 4% above 25%
Calcium blood test, total CPT 82310 HA CALCIUM TOTAL $36.00 $48.00 $15.33–$30.50 4% above 25%
Calcium blood test, total inpatient CPT 82310 HA ASSAY CALCIUM $36.00 $48.00 $15.33–$30.50 — 25%
Calcium blood test, total inpatient CPT 82310 HA CALCIUM TOTAL $36.00 $48.00 $15.33–$30.50 — 25%
Carcinoembryonic antigen (CEA) test CPT 82378 HA CEA(CARCINOEMBRYONIC ANTI $135.00 $180.00 $59.48–$113.59 9% above 25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HA CEA(CARCINOEMBRYONIC ANTI $135.00 $180.00 $59.48–$113.59 — 25%
Chickenpox (varicella) immunity blood test CPT 86787 HA ANTIBODY,VANCELLA-ZOSTER $24.75 $33.00 $74.52 55% below 25%
Chickenpox (varicella) immunity blood test CPT 86787 HA EMPLOYEE-VZV AB $33.75 $45.00 $74.52 38% below 25%
Chickenpox (varicella) immunity blood test CPT 86787 HA VARICELLA ZOSTER AB, IGM $91.50 $122.00 $74.52 68% above 25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HA ANTIBODY,VANCELLA-ZOSTER $24.75 $33.00 $74.52 — 25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HA EMPLOYEE-VZV AB $33.75 $45.00 $74.52 — 25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HA VARICELLA ZOSTER AB, IGM $91.50 $122.00 $74.52 — 25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HA CHLAMYDIA $248.25 $331.00 $154.08–$208.36 68% above 25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HA CHLAMYDIA URINE LCR $248.25 $331.00 $154.08–$208.36 68% above 25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HA CHLAMYDIA $248.25 $331.00 $154.08–$208.36 — 25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HA CHLAMYDIA URINE LCR $248.25 $331.00 $154.08–$208.36 — 25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HA WELLNESS LIPID $9.75 $13.00 $41.46–$79.19 87% below 25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HA LIPID PANEL $94.50 $126.00 $41.46–$79.19 22% above 25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HA WELLNESS LIPID $9.75 $13.00 $41.46–$79.19 — 25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HA LIPID PANEL $94.50 $126.00 $41.46–$79.19 — 25%
Complete blood count (CBC) with differential CPT 85025 HA CBC/AUTO DIFF $55.50 $74.00 $24.47–$46.73 9% below 25%
Complete blood count (CBC) with differential CPT 85025 HA CBC / PLTS / AUTO DIFF $55.50 $74.00 $24.47–$46.73 9% below 25%
Complete blood count (CBC) with differential inpatient CPT 85025 HA CBC / PLTS / AUTO DIFF $55.50 $74.00 $24.47–$46.73 — 25%
Complete blood count (CBC) with differential inpatient CPT 85025 HA CBC/AUTO DIFF $55.50 $74.00 $24.47–$46.73 — 25%
Complete blood count (CBC), no differential CPT 85027 HA WELLNESS CBC $9.75 $13.00 $21.07–$40.24 79% below 25%
Complete blood count (CBC), no differential CPT 85027 HA CBC $48.00 $64.00 $21.07–$40.24 2% above 25%
Complete blood count (CBC), no differential CPT 85027 HA CBC / PLATELETS $48.00 $64.00 $21.07–$40.24 2% above 25%
Complete blood count (CBC), no differential inpatient CPT 85027 HA WELLNESS CBC $9.75 $13.00 $21.07–$40.24 — 25%
Complete blood count (CBC), no differential inpatient CPT 85027 HA CBC / PLATELETS $48.00 $64.00 $21.07–$40.24 — 25%
Complete blood count (CBC), no differential inpatient CPT 85027 HA CBC $48.00 $64.00 $21.07–$40.24 — 25%
Comprehensive metabolic panel (blood test) CPT 80053 HA COMPREHEN METABOLIC PANEL $76.50 $102.00 $33.64–$64.26 17% below 25%
Comprehensive metabolic panel (blood test) CPT 80053 HA CMP $76.50 $102.00 $33.64–$64.26 17% below 25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HA COMPREHEN METABOLIC PANEL $76.50 $102.00 $33.64–$64.26 — 25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HA CMP $76.50 $102.00 $33.64–$64.26 — 25%
Cortisol blood test, total CPT 82533 HA CORITSOL LEVEL TOTAL $114.75 $153.00 $50.64–$94.11 120% above 25%
Cortisol blood test, total CPT 82533 HA CORTISOL $114.75 $153.00 $50.64–$94.11 120% above 25%
Cortisol blood test, total inpatient CPT 82533 HA CORTISOL $114.75 $153.00 $50.64–$94.11 — 25%
Cortisol blood test, total inpatient CPT 82533 HA CORITSOL LEVEL TOTAL $114.75 $153.00 $50.64–$94.11 — 25%
Creatine kinase (CK) blood test, total CPT 82550 HA C.K. I $48.00 $64.00 $19.99–$38.94 4% above 25%
Creatine kinase (CK) blood test, total CPT 82550 HA C.K. TOTAL $48.00 $64.00 $19.99–$38.94 4% above 25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HA C.K. TOTAL $48.00 $64.00 $19.99–$38.94 — 25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HA C.K. I $48.00 $64.00 $19.99–$38.94 — 25%
Creatinine blood test CPT 82565 HA CREATININE BLOOD $35.25 $47.00 $15.30–$29.20 11% below 25%
Creatinine blood test CPT 82565 HA CREATININE; BLOOD $35.25 $47.00 $15.30–$29.20 11% below 25%
Creatinine blood test inpatient CPT 82565 HA CREATININE BLOOD $35.25 $47.00 $15.30–$29.20 — 25%
Creatinine blood test inpatient CPT 82565 HA CREATININE; BLOOD $35.25 $47.00 $15.30–$29.20 — 25%
D-dimer blood test (blood clot marker) CPT 85379 HA D-DIMER QUAN $73.50 $98.00 $32.29–$60.00 at median 25%
D-dimer blood test (blood clot marker) CPT 85379 HA D-DIMER; QUANTITATIVE $73.50 $98.00 $32.29–$60.00 at median 25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HA D-DIMER; QUANTITATIVE $73.50 $98.00 $32.29–$60.00 — 25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HA D-DIMER QUAN $73.50 $98.00 $32.29–$60.00 — 25%
DHEA sulfate (DHEA-S) blood test CPT 82627 HA DHEAS $159.00 $212.00 $74.70–$133.71 62% above 25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HA DHEAS $159.00 $212.00 $74.70–$133.71 — 25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HA LYTES(K,NA,CL,CO2)PANELS $51.00 $68.00 $42.84 12% below 25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HA LYTES(K,NA,CL,CO2)PANELS $51.00 $68.00 $42.84 — 25%
Estradiol blood test CPT 82670 HA ESTRADIOL $199.50 $266.00 $93.55–$167.46 74% above 25%
Estradiol blood test inpatient CPT 82670 HA ESTRADIOL $199.50 $266.00 $93.55–$167.46 — 25%
FSH (follicle-stimulating hormone) test CPT 83001 HA FSH $132.00 $176.00 $62.00–$110.99 29% above 25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HA FSH $132.00 $176.00 $62.00–$110.99 — 25%
Fecal calprotectin (stool inflammation test) CPT 83993 HA CALPROTECIN FECAL $279.00 $372.00 $123.78–$227.18 76% above 25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HA CALPROTECIN FECAL $279.00 $372.00 $123.78–$227.18 — 25%
Ferritin blood test (iron stores) CPT 82728 HA FERRITIN $96.75 $129.00 $42.48–$81.13 21% above 25%
Ferritin blood test (iron stores) CPT 82728 HA FERRITIN (TRANS) $96.75 $129.00 $42.48–$81.13 21% above 25%
Ferritin blood test (iron stores) inpatient CPT 82728 HA FERRITIN (TRANS) $96.75 $129.00 $42.48–$81.13 — 25%
Ferritin blood test (iron stores) inpatient CPT 82728 HA FERRITIN $96.75 $129.00 $42.48–$81.13 — 25%
Folate (folic acid) blood test CPT 82746 HA FOLIC ACID SERUM $105.00 $140.00 $46.22–$88.27 14% above 25%
Folate (folic acid) blood test CPT 82746 HA FOLATE $105.00 $140.00 $46.22–$88.27 14% above 25%
Folate (folic acid) blood test inpatient CPT 82746 HA FOLATE $105.00 $140.00 $46.22–$88.27 — 25%
Folate (folic acid) blood test inpatient CPT 82746 HA FOLIC ACID SERUM $105.00 $140.00 $46.22–$88.27 — 25%
Free T3 thyroid hormone test CPT 84481 HA T3-FREE $120.00 $160.00 $52.67–$100.61 19% above 25%
Free T3 thyroid hormone test CPT 84481 HA FREE T3 $120.00 $160.00 $52.67–$100.61 19% above 25%
Free T3 thyroid hormone test inpatient CPT 84481 HA FREE T3 $120.00 $160.00 $52.67–$100.61 — 25%
Free T3 thyroid hormone test inpatient CPT 84481 HA T3-FREE $120.00 $160.00 $52.67–$100.61 — 25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HA FREE T4 $62.25 $83.00 $27.53–$52.57 at median 25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HA FREE T4 $62.25 $83.00 $27.53–$52.57 — 25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HA GGT $51.75 $69.00 $24.29–$43.48 12% above 25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HA GGT $51.75 $69.00 $24.29–$43.48 — 25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HA GENERAL HEALTH PANEL $338.25 $451.00 $148.92–$284.30 43% above 25%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HA GENERAL HEALTH PANEL $338.25 $451.00 $148.92–$284.30 — 25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HA GLUCOSE, POST TEST $33.75 $45.00 $21.12–$28.56 9% below 25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HA GLUCOSE, POST TEST $33.75 $45.00 $21.12–$28.56 — 25%
Glucose tolerance test, 3 samples CPT 82951 HA GLUCOSE TOL(3 SPECIMENS) $90.75 $121.00 $75.94 at median 25%
Glucose tolerance test, 3 samples inpatient CPT 82951 HA GLUCOSE TOL(3 SPECIMENS) $90.75 $121.00 $75.94 — 25%
H. pylori stool antigen test CPT 87338 HA HELICOBACTER PYLORI STOOL $102.75 $137.00 $45.20–$86.33 2% above 25%
H. pylori stool antigen test inpatient CPT 87338 HA HELICOBACTER PYLORI STOOL $102.75 $137.00 $45.20–$86.33 — 25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HA HIV-1 RNA QUANT. $601.50 $802.00 $505.64 130% above 25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HA HIV-1 RNA QUANT. $601.50 $802.00 $505.64 — 25%
HIV-1 and HIV-2 antibody test CPT 86703 HA HIV 1&2, SINGLE ASSAY $97.50 $130.00 $60.48–$126.00 23% above 25%
HIV-1 and HIV-2 antibody test CPT 86703 HA HIV-1 $97.50 $130.00 $60.48–$126.00 23% above 25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HA HIV-1 $97.50 $130.00 $60.48–$126.00 — 25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HA HIV 1&2, SINGLE ASSAY $97.50 $130.00 $60.48–$126.00 — 25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HA GLYCOHEMOGLOBIN - AIC $69.75 $93.00 $30.59–$58.41 at median 25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HA GLYCOSYLATED HEMOGLOBIN T $69.75 $93.00 $30.59–$58.41 at median 25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HA GLYCOHEMOGLOBIN - AIC $69.75 $93.00 $30.59–$58.41 — 25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HA GLYCOSYLATED HEMOGLOBIN T $69.75 $93.00 $30.59–$58.41 — 25%
Hemoglobin blood test CPT 85018 HA HEMOGLOBIN $18.00 $24.00 $8.34–$14.92 22% below 25%
Hemoglobin blood test inpatient CPT 85018 HA HEMOGLOBIN $18.00 $24.00 $8.34–$14.92 — 25%
Hepatitis B core antibody test (total) CPT 86704 HA HEPATITIS A AB TOTAL $85.50 $114.00 $70.10 29% above 25%
Hepatitis B core antibody test (total) inpatient CPT 86704 HA HEPATITIS A AB TOTAL $85.50 $114.00 $70.10 — 25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HA EMPLOYEE-ANTI-HBS $22.50 $30.00 $15.59–$27.26 57% below 25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HA HEPATITIS B SURFACE ANTIB $33.00 $44.00 $15.59–$27.26 38% below 25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HA EMPLOYEE-ANTI-HBS $22.50 $30.00 $15.59–$27.26 — 25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HA HEPATITIS B SURFACE ANTIB $33.00 $44.00 $15.59–$27.26 — 25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HA HEPATITIS BS AG $74.25 $99.00 $34.81–$60.36 38% above 25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC PRENATAL HEP B S AG $74.25 $99.00 $34.81–$60.36 38% above 25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HA HEPATITIS BS AG $74.25 $99.00 $34.81–$60.36 — 25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC PRENATAL HEP B S AG $74.25 $99.00 $34.81–$60.36 — 25%
Hepatitis C antibody blood test (screening) CPT 86803 HA HEPTITIS C A-B TEST $101.25 $135.00 $42.32–$82.43 43% above 25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HA HEPTITIS C A-B TEST $101.25 $135.00 $42.32–$82.43 — 25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HA HEPATITIS C, RNA QUANT $303.00 $404.00 $130.61–$254.45 131% above 25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HA HEPATITIS C, QUANTITATIVE $459.00 $612.00 $130.61–$254.45 250% above 25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HA HEPATITIS C, RNA QUANT $303.00 $404.00 $130.61–$254.45 — 25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HA HEPATITIS C, QUANTITATIVE $459.00 $612.00 $130.61–$254.45 — 25%
Herpes blood test, HSV-1 antibody CPT 86695 HA HERPES SIMPLEX TYPE 1 $93.75 $125.00 $58.08 97% above 25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HA HERPES SIMPLEX TYPE 1 $93.75 $125.00 $58.08 — 25%
Herpes blood test, HSV-2 antibody CPT 86696 HA HERPES SIMPLEX TYPE 2 $137.25 $183.00 $85.44 113% above 25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HA HERPES SIMPLEX TYPE 2 $137.25 $183.00 $85.44 — 25%
High-sensitivity CRP (hs-CRP) test CPT 86141 HA C-REACTIVE PROTEIN HS $91.50 $122.00 $42.79–$76.59 18% above 25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HA C-REACTIVE PROTEIN HS $91.50 $122.00 $42.79–$76.59 — 25%
Homocysteine blood test CPT 83090 HA HEMOCYSTINE $120.00 $160.00 $56.20–$100.61 24% above 25%
Homocysteine blood test inpatient CPT 83090 HA HEMOCYSTINE $120.00 $160.00 $56.20–$100.61 — 25%
Insulin blood test CPT 83525 HA INSULIN; TOTAL $81.00 $108.00 $68.15 41% above 25%
Insulin blood test inpatient CPT 83525 HA INSULIN; TOTAL $81.00 $108.00 $68.15 — 25%
Iron blood test (serum iron) CPT 83540 HA IRON $48.00 $64.00 $21.07–$40.24 25% above 25%
Iron blood test (serum iron) inpatient CPT 83540 HA IRON $48.00 $64.00 $21.07–$40.24 — 25%
Iron-binding capacity (TIBC) test CPT 83550 HA IRON BINDING CAPACITY $60.75 $81.00 $26.85–$51.27 17% above 25%
Iron-binding capacity (TIBC) test CPT 83550 HA IRON BINDING TEST $60.75 $81.00 $26.85–$51.27 17% above 25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HA IRON BINDING TEST $60.75 $81.00 $26.85–$51.27 — 25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HA IRON BINDING CAPACITY $60.75 $81.00 $26.85–$51.27 — 25%
Kidney function blood test panel CPT 80069 HA RENAL FUNCTION PANEL $60.00 $80.00 $26.51–$50.62 12% below 25%
Kidney function blood test panel inpatient CPT 80069 HA RENAL FUNCTION PANEL $60.00 $80.00 $26.51–$50.62 — 25%
LH (luteinizing hormone) test CPT 83002 HA LH $131.25 $175.00 $107.37–$110.34 26% above 25%
LH (luteinizing hormone) test inpatient CPT 83002 HA LH $131.25 $175.00 $107.37–$110.34 — 25%
Lactate (lactic acid) blood test CPT 83605 HA LACTIC ACID $77.25 $103.00 $33.99–$64.91 1% below 25%
Lactate (lactic acid) blood test inpatient CPT 83605 HA LACTIC ACID $77.25 $103.00 $33.99–$64.91 — 25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HA LDH; BODY FLUID $43.50 $58.00 $20.31–$35.36 1% above 25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HA LDH $43.50 $58.00 $20.31–$35.36 1% above 25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HA LDH; BODY FLUID $43.50 $58.00 $20.31–$35.36 — 25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HA LDH $43.50 $58.00 $20.31–$35.36 — 25%
Lipase blood test (pancreas enzyme) CPT 83690 HA LIPASE $50.25 $67.00 $21.41–$42.19 6% below 25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HA LIPASE $50.25 $67.00 $21.41–$42.19 — 25%
Liver function blood test panel CPT 80076 HA HEPATIC FUNCTION PANEL $57.75 $77.00 $24.32–$47.37 20% below 25%
Liver function blood test panel inpatient CPT 80076 HA HEPATIC FUNCTION PANEL $57.75 $77.00 $24.32–$47.37 — 25%
Lyme disease antibody test CPT 86618 HA LYME DISEASE $121.50 $162.00 $56.93–$101.90 121% above 25%
Lyme disease antibody test inpatient CPT 86618 HA LYME DISEASE $121.50 $162.00 $56.93–$101.90 — 25%
Magnesium blood test CPT 83735 HA MAGNESIUM $48.75 $65.00 $21.41–$40.89 64% above 25%
Magnesium blood test inpatient CPT 83735 HA MAGNESIUM $48.75 $65.00 $21.41–$40.89 — 25%
Measles (rubeola) antibody test CPT 86765 HA ANTIBODY, RUBEOLA $24.75 $33.00 $20.77 56% below 25%
Measles (rubeola) antibody test CPT 86765 HA EMPLOYEE-RUBEOLA AB $26.25 $35.00 $20.77 54% below 25%
Measles (rubeola) antibody test CPT 86765 HA RUBEOLA AB, IGM $90.75 $121.00 $20.77 60% above 25%
Measles (rubeola) antibody test inpatient CPT 86765 HA ANTIBODY, RUBEOLA $24.75 $33.00 $20.77 — 25%
Measles (rubeola) antibody test inpatient CPT 86765 HA EMPLOYEE-RUBEOLA AB $26.25 $35.00 $20.77 — 25%
Measles (rubeola) antibody test inpatient CPT 86765 HA RUBEOLA AB, IGM $90.75 $121.00 $20.77 — 25%
Mono test (heterophile antibody, Monospot) CPT 86308 HA MONO HETEROPHILE AB $36.00 $48.00 $17.04–$30.50 14% below 25%
Mono test (heterophile antibody, Monospot) CPT 86308 HA MONO TEST HELEROPHILE ANT $36.00 $48.00 $17.04–$30.50 14% below 25%
Mono test (heterophile antibody, Monospot) CPT 86308 HA M MONO TEST $36.00 $48.00 $17.04–$30.50 14% below 25%
Mono test (heterophile antibody, Monospot) CPT 86308 HA D MONO TEST $36.00 $48.00 $17.04–$30.50 14% below 25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HA MONO TEST HELEROPHILE ANT $36.00 $48.00 $17.04–$30.50 — 25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HA MONO HETEROPHILE AB $36.00 $48.00 $17.04–$30.50 — 25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HA D MONO TEST $36.00 $48.00 $17.04–$30.50 — 25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HA M MONO TEST $36.00 $48.00 $17.04–$30.50 — 25%
PSA (prostate-specific antigen) blood test, free CPT 84154 HA PSA FREE $130.50 $174.00 $55.74–$109.69 101% above 25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HA PSA FREE $130.50 $174.00 $55.74–$109.69 — 25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HA WELLNESS PSA $22.50 $30.00 $57.44–$109.69 75% below 25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HA PSA TOTAL $130.50 $174.00 $57.44–$109.69 46% above 25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HA WELLNESS PSA $22.50 $30.00 $57.44–$109.69 — 25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HA PSA TOTAL $130.50 $174.00 $57.44–$109.69 — 25%
Pap test (liquid-based, automated screening with review) CPT 88175 HA CYTOPATH C/V AUTO FLUID R $187.50 $250.00 $82.62–$88.11 41% above 25%
Pap test (liquid-based, automated screening with review) CPT 88175 HA CYTOPATHOLOGY W/SCREENING $187.50 $250.00 $82.62–$88.11 41% above 25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HA CYTOPATH C/V AUTO FLUID R $187.50 $250.00 $82.62–$88.11 — 25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HA CYTOPATHOLOGY W/SCREENING $187.50 $250.00 $82.62–$88.11 — 25%
Parathyroid hormone (PTH) blood test CPT 83970 HA PARATHORMONE(PARATHYROID $292.50 $390.00 $129.83–$246.00 40% above 25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HA PARATHORMONE(PARATHYROID $292.50 $390.00 $129.83–$246.00 — 25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HA APTT $43.50 $58.00 $19.03–$36.34 33% above 25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HA APTT $43.50 $58.00 $19.03–$36.34 — 25%
Phosphorus (phosphate) blood test CPT 84100 HA PHOSPHORUS $33.75 $45.00 $14.95–$27.91 1% below 25%
Phosphorus (phosphate) blood test inpatient CPT 84100 HA PHOSPHORUS $33.75 $45.00 $14.95–$27.91 — 25%
Potassium blood test CPT 84132 HA POTASSIUM (K) SERUM $32.25 $43.00 $14.57–$27.26 21% below 25%
Potassium blood test inpatient CPT 84132 HA POTASSIUM (K) SERUM $32.25 $43.00 $14.57–$27.26 — 25%
Progesterone blood test CPT 84144 HA PROGESTERONE SERUM $147.75 $197.00 $69.26–$120.63 23% above 25%
Progesterone blood test inpatient CPT 84144 HA PROGESTERONE SERUM $147.75 $197.00 $69.26–$120.63 — 25%
Prolactin blood test CPT 84146 HA PROLACTIN $137.25 $183.00 $59.31–$115.53 39% above 25%
Prolactin blood test inpatient CPT 84146 HA PROLACTIN $137.25 $183.00 $59.31–$115.53 — 25%
Prothrombin time (PT/INR) clotting test CPT 85610 HA PROTHROMBIN TIME $32.25 $43.00 $12.57–$24.01 30% above 25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HA PROTHROMBIN TIME $32.25 $43.00 $12.57–$24.01 — 25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN-PAIN MGT $81.00 $108.00 $33.99–$68.16 6% below 25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HA D DRUG SCREEN-PAIN MANAGE $81.00 $108.00 $33.99–$68.16 6% below 25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HA DRUG SCREEN $81.00 $108.00 $33.99–$68.16 6% below 25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HA BUPRENORPHINE DIPSTICK TEST $81.00 $108.00 $33.99–$68.16 6% below 25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HA D DRUG SCREEN-PAIN MGMT $81.00 $108.00 $33.99–$68.16 6% below 25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HA M DRUG SCREEN-PAIN M GMT $81.00 $108.00 $33.99–$68.16 6% below 25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN-PAIN MGT $81.00 $108.00 $33.99–$68.16 — 25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HA BUPRENORPHINE DIPSTICK TEST $81.00 $108.00 $33.99–$68.16 — 25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HA D DRUG SCREEN-PAIN MGMT $81.00 $108.00 $33.99–$68.16 — 25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HA M DRUG SCREEN-PAIN M GMT $81.00 $108.00 $33.99–$68.16 — 25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HA DRUG SCREEN $81.00 $108.00 $33.99–$68.16 — 25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HA D DRUG SCREEN-PAIN MANAGE $81.00 $108.00 $33.99–$68.16 — 25%
Rapid flu test (influenza antigen) CPT 87804 HA M INFLUENZA A&B,RAPID $106.50 $142.00 $44.65–$89.58 27% above 25%
Rapid flu test (influenza antigen) CPT 87804 HA INFLUENZA A & B, RAPID $106.50 $142.00 $44.65–$89.58 27% above 25%
Rapid flu test (influenza antigen) CPT 87804 HA INFLUENZAE A&B RAPID (POC) $106.50 $142.00 $44.65–$89.58 27% above 25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HA INFLUENZA A & B, RAPID $106.50 $142.00 $44.65–$89.58 — 25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HA M INFLUENZA A&B,RAPID $106.50 $142.00 $44.65–$89.58 — 25%
Rapid flu test (influenza antigen) inpatient CPT 87804 HA INFLUENZAE A&B RAPID (POC) $106.50 $142.00 $44.65–$89.58 — 25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HA QUICK STREP $106.50 $142.00 $50.04–$89.57 30% above 25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HA M QUICK STREP $106.50 $142.00 $50.04–$89.57 30% above 25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HA D QUICK STREP $106.50 $142.00 $50.04–$89.57 30% above 25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HA D QUICK STREP $106.50 $142.00 $50.04–$89.57 — 25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HA QUICK STREP $106.50 $142.00 $50.04–$89.57 — 25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HA M QUICK STREP $106.50 $142.00 $50.04–$89.57 — 25%
Renin blood test CPT 84244 HA RENIN ACTIVITY $156.75 $209.00 $128.21 107% above 25%
Renin blood test inpatient CPT 84244 HA RENIN ACTIVITY $156.75 $209.00 $128.21 — 25%
Rh blood typing CPT 86901 HA RH TYPING $22.50 $30.00 $9.52–$18.17 41% below 25%
Rh blood typing CPT 86901 HA RH TYPING - UNIT $22.50 $30.00 $9.52–$18.17 41% below 25%
Rh blood typing CPT 86901 HA RH D $22.50 $30.00 $9.52–$18.17 41% below 25%
Rh blood typing CPT 86901 HA RH TYPING - POST $22.50 $30.00 $9.52–$18.17 41% below 25%
Rh blood typing CPT 86901 HA RH TYPING - PRE $22.50 $30.00 $9.52–$18.17 41% below 25%
Rh blood typing inpatient CPT 86901 HA RH TYPING $22.50 $30.00 $9.52–$18.17 — 25%
Rh blood typing inpatient CPT 86901 HA RH TYPING - UNIT $22.50 $30.00 $9.52–$18.17 — 25%
Rh blood typing inpatient CPT 86901 HA RH TYPING - POST $22.50 $30.00 $9.52–$18.17 — 25%
Rh blood typing inpatient CPT 86901 HA RH TYPING - PRE $22.50 $30.00 $9.52–$18.17 — 25%
Rh blood typing inpatient CPT 86901 HA RH D $22.50 $30.00 $9.52–$18.17 — 25%
Rheumatoid factor (RF) test CPT 86431 HA RHEUMATOID FACTOR QUANT $40.50 $54.00 $17.67–$33.75 11% above 25%
Rheumatoid factor (RF) test inpatient CPT 86431 HA RHEUMATOID FACTOR QUANT $40.50 $54.00 $17.67–$33.75 — 25%
Rubella antibody test (immunity check) CPT 86762 HA EMPLOYEE - RUBELLA IMMUNE $26.25 $35.00 $63.84–$83.73 57% below 25%
Rubella antibody test (immunity check) CPT 86762 HA ANTIBODY,RUBELLA $102.75 $137.00 $63.84–$83.73 67% above 25%
Rubella antibody test (immunity check) inpatient CPT 86762 HA EMPLOYEE - RUBELLA IMMUNE $26.25 $35.00 $63.84–$83.73 — 25%
Rubella antibody test (immunity check) inpatient CPT 86762 HA ANTIBODY,RUBELLA $102.75 $137.00 $63.84–$83.73 — 25%
Sodium blood test CPT 84295 HA SODIUM SERUM $33.75 $45.00 $15.17–$27.91 14% below 25%
Sodium blood test inpatient CPT 84295 HA SODIUM SERUM $33.75 $45.00 $15.17–$27.91 — 25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HA D OCCULT BLOOD / SCREEN $28.50 $38.00 $12.70–$24.01 at median 25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HA OCCULT BLOOD / FECES $28.50 $38.00 $12.70–$24.01 at median 25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HA R OCCULT BLOOD SCREEN $28.50 $38.00 $12.70–$24.01 at median 25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HA M OCCULT BLOOD / SCREEN $28.50 $38.00 $12.70–$24.01 at median 25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HA D OCCULT BLOOD / SCREEN $28.50 $38.00 $12.70–$24.01 — 25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HA M OCCULT BLOOD / SCREEN $28.50 $38.00 $12.70–$24.01 — 25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HA OCCULT BLOOD / FECES $28.50 $38.00 $12.70–$24.01 — 25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HA R OCCULT BLOOD SCREEN $28.50 $38.00 $12.70–$24.01 — 25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HA FIT - FECAL BLOOD SCRN $114.75 $153.00 $50.65–$94.76 35% above 25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HA FIT - FECAL BLOOD SCRN $114.75 $153.00 $50.65–$94.76 — 25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HA AB; TREPONEMA PALLIDUM $93.75 $125.00 $58.08 120% above 25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HA AB; TREPONEMA PALLIDUM $93.75 $125.00 $58.08 — 25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HA VDRL, CSF $30.75 $41.00 $19.20–$25.96 5% above 25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HA RPR SYPHILIS TEST, QUAL $30.75 $41.00 $19.20–$25.96 5% above 25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HA VDRL, CSF $30.75 $41.00 $19.20–$25.96 — 25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HA RPR SYPHILIS TEST, QUAL $30.75 $41.00 $19.20–$25.96 — 25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HA EMPLOYEE -QUANTIFERON $34.50 $46.00 $80.97–$162.27 70% below 25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HA TUBERCULOSIS TEST $193.50 $258.00 $80.97–$162.27 69% above 25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HA EMPLOYEE -QUANTIFERON $34.50 $46.00 $80.97–$162.27 — 25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HA TUBERCULOSIS TEST $193.50 $258.00 $80.97–$162.27 — 25%
Testosterone blood test, total (not free testosterone) CPT 84403 HA TESTOSTERONE TOTAL $183.75 $245.00 $79.31–$154.48 126% above 25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HA TESTOSTERONE TOTAL $183.75 $245.00 $79.31–$154.48 — 25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HA MICROSONAL $104.25 $139.00 $48.95–$87.62 63% above 25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HA MICROSOMAL AB (TPO) $104.25 $139.00 $48.95–$87.62 63% above 25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HA MICROSONAL $104.25 $139.00 $48.95–$87.62 — 25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HA MICROSOMAL AB (TPO) $104.25 $139.00 $48.95–$87.62 — 25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HA WELLNESS TSH $22.50 $30.00 $52.00–$99.31 78% below 25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HA TSH $118.50 $158.00 $52.00–$99.31 16% above 25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HA WELLNESS TSH $22.50 $30.00 $52.00–$99.31 — 25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HA TSH $118.50 $158.00 $52.00–$99.31 — 25%
Total IgE blood test CPT 82785 HA IGE $117.00 $156.00 $51.32–$95.38 38% above 25%
Total IgE blood test inpatient CPT 82785 HA IGE $117.00 $156.00 $51.32–$95.38 — 25%
Total cholesterol blood test CPT 82465 HA CHOLESTEROL $31.50 $42.00 $14.87 1% below 25%
Total cholesterol blood test inpatient CPT 82465 HA CHOLESTEROL $31.50 $42.00 $14.87 — 25%
Total thyroxine (T4) blood test CPT 84436 HA TT4 $50.25 $67.00 $42.19 18% above 25%
Total thyroxine (T4) blood test inpatient CPT 84436 HA TT4 $50.25 $67.00 $42.19 — 25%
Total triiodothyronine (T3) blood test CPT 84480 HA T 3 $100.50 $134.00 $62.40–$84.38 5% above 25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HA T 3 $100.50 $134.00 $62.40–$84.38 — 25%
Transferrin blood test CPT 84466 HA TRANSFERRIN $89.25 $119.00 $42.06–$73.26 16% above 25%
Transferrin blood test inpatient CPT 84466 HA TRANSFERRIN $89.25 $119.00 $42.06–$73.26 — 25%
Trichomonas test (NAAT) CPT 87661 HA TRICHOMONS VAGINALIS AMP $169.50 $226.00 $142.16 65% above 25%
Trichomonas test (NAAT) inpatient CPT 87661 HA TRICHOMONS VAGINALIS AMP $169.50 $226.00 $142.16 — 25%
Troponin test, quantitative CPT 84484 HA TROPONIN 1 $80.25 $107.00 $35.35–$67.50 at median 25%
Troponin test, quantitative CPT 84484 HA TROPONIN 1 (LOCI) $80.25 $107.00 $35.35–$67.50 at median 25%
Troponin test, quantitative CPT 84484 HA TROPONIN I, HS $80.25 $107.00 $35.35–$67.50 at median 25%
Troponin test, quantitative inpatient CPT 84484 HA TROPONIN I, HS $80.25 $107.00 $35.35–$67.50 — 25%
Troponin test, quantitative inpatient CPT 84484 HA TROPONIN 1 $80.25 $107.00 $35.35–$67.50 — 25%
Troponin test, quantitative inpatient CPT 84484 HA TROPONIN 1 (LOCI) $80.25 $107.00 $35.35–$67.50 — 25%
Uric acid blood test CPT 84550 HA URIC ACID BLOOD $32.25 $43.00 $14.28–$27.26 17% below 25%
Uric acid blood test inpatient CPT 84550 HA URIC ACID BLOOD $32.25 $43.00 $14.28–$27.26 — 25%
Urinalysis with microscope exam, automated CPT 81001 HA UA AUTO W/MICRO $24.00 $32.00 $10.53–$20.12 33% below 25%
Urinalysis with microscope exam, automated inpatient CPT 81001 HA UA AUTO W/MICRO $24.00 $32.00 $10.53–$20.12 — 25%
Urinalysis with microscope exam, manual CPT 81000 HA N-AUTOM URINE DIP W MICRO $24.00 $32.00 $11.24–$20.12 9% below 25%
Urinalysis with microscope exam, manual CPT 81000 HA M URINE MIDSTREAM $24.00 $32.00 $11.24–$20.12 9% below 25%
Urinalysis with microscope exam, manual CPT 81000 HA D URINE MIDSTREAM $24.00 $32.00 $11.24–$20.12 9% below 25%
Urinalysis with microscope exam, manual inpatient CPT 81000 HA M URINE MIDSTREAM $24.00 $32.00 $11.24–$20.12 — 25%
Urinalysis with microscope exam, manual inpatient CPT 81000 HA D URINE MIDSTREAM $24.00 $32.00 $11.24–$20.12 — 25%
Urinalysis with microscope exam, manual inpatient CPT 81000 HA N-AUTOM URINE DIP W MICRO $24.00 $32.00 $11.24–$20.12 — 25%
Urinalysis without microscope exam, automated CPT 81003 HA UA AUTO W/O MICRO $18.00 $24.00 $7.66–$14.92 1% above 25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HA UA AUTO W/O MICRO $18.00 $24.00 $7.66–$14.92 — 25%
Urinalysis without microscope exam, manual CPT 81002 HA M URINE DIPSTICK $19.50 $26.00 $8.47–$16.22 6% below 25%
Urinalysis without microscope exam, manual CPT 81002 HA ROUTINE URINE NON AUTOMAT $19.50 $26.00 $8.47–$16.22 6% below 25%
Urinalysis without microscope exam, manual CPT 81002 HA D URINE DIPSTICK $19.50 $26.00 $8.47–$16.22 6% below 25%
Urinalysis without microscope exam, manual inpatient CPT 81002 HA D URINE DIPSTICK $19.50 $26.00 $8.47–$16.22 — 25%
Urinalysis without microscope exam, manual inpatient CPT 81002 HA M URINE DIPSTICK $19.50 $26.00 $8.47–$16.22 — 25%
Urinalysis without microscope exam, manual inpatient CPT 81002 HA ROUTINE URINE NON AUTOMAT $19.50 $26.00 $8.47–$16.22 — 25%
Urine culture for bacteria, with colony count CPT 87086 HA BACT CULTURE - URINE; QUA $57.00 $76.00 $25.15–$46.73 9% below 25%
Urine culture for bacteria, with colony count inpatient CPT 87086 HA BACT CULTURE - URINE; QUA $57.00 $76.00 $25.15–$46.73 — 25%
Vitamin B12 (cobalamin) blood test CPT 82607 HA VITAMIN B12 $108.00 $144.00 $47.58–$90.87 22% above 25%
Vitamin B12 (cobalamin) blood test CPT 82607 HA B 12 $108.00 $144.00 $47.58–$90.87 22% above 25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HA B 12 $108.00 $144.00 $47.58–$90.87 — 25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HA VITAMIN B12 $108.00 $144.00 $47.58–$90.87 — 25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HA WELLNESS VIT D $26.25 $35.00 $92.10–$175.90 84% below 25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HA VITAMIN D; 25 HYDROXY $209.25 $279.00 $92.10–$175.90 30% above 25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HA VITAMIN D $209.25 $279.00 $92.10–$175.90 30% above 25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HA WELLNESS VIT D $26.25 $35.00 $92.10–$175.90 — 25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HA VITAMIN D $209.25 $279.00 $92.10–$175.90 — 25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HA VITAMIN D; 25 HYDROXY $209.25 $279.00 $92.10–$175.90 — 25%
Zinc blood test CPT 84630 HA ZINC $81.00 $108.00 $38.07–$68.15 72% above 25%
Zinc blood test inpatient CPT 84630 HA ZINC $81.00 $108.00 $38.07–$68.15 — 25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HA HCG,QUANTATIVE $108.00 $144.00 $73.44–$90.87 36% above 25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HA HCG $108.00 $144.00 $73.44–$90.87 36% above 25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HA GONADOTROPIN, CHORIONIC ( $108.00 $144.00 $73.44–$90.87 36% above 25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HA B-HCG, TUMOR MARKER $108.00 $144.00 $73.44–$90.87 36% above 25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HA B-HCG, TUMOR MARKER $108.00 $144.00 $73.44–$90.87 — 25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HA GONADOTROPIN, CHORIONIC ( $108.00 $144.00 $73.44–$90.87 — 25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HA HCG $108.00 $144.00 $73.44–$90.87 — 25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HA HCG,QUANTATIVE $108.00 $144.00 $73.44–$90.87 — 25%

Surgery and procedures

ProcedureCash price List priceInsurers payvs North DakotaOff list
Carpal tunnel release, open surgery CPT 64721 HC CARPAL TUNNEL MEDIDAN NERVE $3,626.25 $4,835.00 $1,538.58–$1,625.94 at median 25%
Carpal tunnel release, open surgery inpatient CPT 64721 HC CARPAL TUNNEL MEDIDAN NERVE $3,626.25 $4,835.00 $1,538.58–$1,625.94 — 25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 HC RPR AA HERNIA 1ST 3-10 CM REDUCIBLE $5,164.50 $6,886.00 $2,272.90 9% above 25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 HC RPR AA HERNIA 1ST 3-10 CM REDUCIBLE $5,164.50 $6,886.00 $2,272.90 — 25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 HC RPR AA HERNIA 1ST < 3 CM REDUCIBLE $5,736.75 $7,649.00 $2,722.37–$4,820.21 22% above 25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 HC RPR AA HERNIA 1ST < 3 CM REDUCIBLE $5,736.75 $7,649.00 $2,722.37–$4,820.21 — 25%
Gallbladder removal, laparoscopic CPT 47562 HC LAPAROSCOPIC CHOLECYSTECTOMY $9,230.25 $12,307.00 $4,029.20–$7,530.20 19% above 25%
Gallbladder removal, laparoscopic inpatient CPT 47562 HC LAPAROSCOPIC CHOLECYSTECTOMY $9,230.25 $12,307.00 $4,029.20–$7,530.20 — 25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 HC LAPARO CHOLECYSTECTOMY/GRAPH $9,230.25 $12,307.00 $7,756.09 18% above 25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 HC LAPARO CHOLECYSTECTOMY/GRAPH $9,230.25 $12,307.00 $7,756.09 — 25%
Incision and drainage of a simple or single skin abscess CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE $316.50 $422.00 $292.24 1% above 25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE $316.50 $422.00 $292.24 — 25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC RPR INITIAL HERNIA >5 YRS REDUC $5,919.75 $7,893.00 $2,583.96–$5,274.00 1% above 25%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 HC RPR INITIAL HERNIA >5 YRS REDUC $5,919.75 $7,893.00 $2,583.96–$5,274.00 — 25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US $147.00 $196.00 $109.26–$311.98 54% below 25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US $147.00 $196.00 $109.26–$311.98 — 25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 PR EXCISION NAIL&NAIL MATRIX PRTL/COMPL PERM RMVL $607.50 $810.00 $162.19–$425.58 at median 25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 PR EXCISION NAIL&NAIL MATRIX PRTL/COMPL PERM RMVL $607.50 $810.00 $162.19–$425.58 — 25%
Skin biopsy, punch, one lesion CPT 11104 HC PUNCH BX SNGL SKIN LESION $594.75 $793.00 $446.12 75% above 25%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC PUNCH BX SNGL SKIN LESION $594.75 $793.00 $446.12 — 25%
Skin tag removal, up to 15 tags CPT 11200 PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15 $240.75 $321.00 $230.12–$285.58 4% above 25%
Skin tag removal, up to 15 tags inpatient CPT 11200 PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15 $240.75 $321.00 $230.12–$285.58 — 25%
Trigger point injections, 1 or 2 muscles CPT 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES $134.25 $179.00 $308.78 63% below 25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES $134.25 $179.00 $308.78 — 25%
Wart removal, up to 14 warts CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 $306.75 $409.00 $242.04–$350.64 19% above 25%
Wart removal, up to 14 warts inpatient CPT 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 $306.75 $409.00 $242.04–$350.64 — 25%

Doctor visits and therapy

ProcedureCash price List priceInsurers payvs North DakotaOff list
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 1HR $564.00 $752.00 $258.04–$568.44 26% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 2HRS $600.75 $801.00 $258.04–$568.44 21% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HC BLOOD ADMIN 2+ HRS $600.75 $801.00 $258.04–$568.44 21% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 3HRS $620.25 $827.00 $258.04–$568.44 19% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 4HRS $657.75 $877.00 $258.04–$568.44 14% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 5HRS $695.25 $927.00 $258.04–$568.44 9% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 6HRS $732.75 $977.00 $258.04–$568.44 4% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 7HRS $750.00 $1,000.00 $258.04–$568.44 1% below 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 8HRS $807.00 $1,076.00 $258.04–$568.44 6% above 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 9HRS $845.25 $1,127.00 $258.04–$568.44 11% above 25%
Blood transfusion (giving blood or blood components) CPT 36430 HA BLOOD ADMINISTRATION 10HRS $880.50 $1,174.00 $258.04–$568.44 16% above 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 1HR $564.00 $752.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC BLOOD ADMIN 2+ HRS $600.75 $801.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 2HRS $600.75 $801.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 3HRS $620.25 $827.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 4HRS $657.75 $877.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 5HRS $695.25 $927.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 6HRS $732.75 $977.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 7HRS $750.00 $1,000.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 8HRS $807.00 $1,076.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 9HRS $845.25 $1,127.00 $258.04–$568.44 — 25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HA BLOOD ADMINISTRATION 10HRS $880.50 $1,174.00 $258.04–$568.44 — 25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HA EZ PAP $26.25 $35.00 $30.69–$57.12 78% below 25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TRMT $70.50 $94.00 $30.69–$57.12 41% below 25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HA EZ PAP $26.25 $35.00 $30.69–$57.12 — 25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TRMT $70.50 $94.00 $30.69–$57.12 — 25%
Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO,IV INFUSION,1 HR $780.75 $1,041.00 $343.60–$637.41 10% above 25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO,IV INFUSION,1 HR $780.75 $1,041.00 $343.60–$637.41 — 25%
Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 1ST HOUR $1,776.00 $2,368.00 $842.81 4% above 25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 1ST HOUR $1,776.00 $2,368.00 $842.81 — 25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC ROUTINE EKG $39.00 $52.00 $16.99–$32.45 68% below 25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC ROUTINE EKG $39.00 $52.00 $16.99–$32.45 — 25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED LEVEL I $129.75 $173.00 $78.24–$163.00 28% below 25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED LEVEL I $129.75 $173.00 $78.24–$163.00 — 25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED LEVEL II $235.50 $314.00 $104.71–$197.97 20% below 25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED LEVEL II $235.50 $314.00 $104.71–$197.97 — 25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED LEVEL III $414.75 $553.00 $182.51–$338.18 6% below 25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED LEVEL III $414.75 $553.00 $182.51–$338.18 — 25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED LEVEL IV $866.25 $1,155.00 $383.18–$727.64 8% above 25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED LEVEL IV $866.25 $1,155.00 $383.18–$727.64 — 25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED LEVEL V $1,225.50 $1,634.00 $550.02–$1,001.71 at median 25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED LEVEL V $1,225.50 $1,634.00 $550.02–$1,001.71 — 25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC STRESS TEST $157.50 $210.00 $69.33–$132.41 53% below 25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC STRESS TEST $157.50 $210.00 $69.33–$132.41 — 25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRATION IV INFUSION,INIT $405.75 $541.00 $181.76–$331.04 15% above 25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRATION IV INFUSION,INIT $405.75 $541.00 $181.76–$331.04 — 25%
IV infusion of a medicine, first hour CPT 96365 HC THER/PROPH/DIAG IV INF,INIT $491.25 $655.00 $218.35–$412.82 16% above 25%
IV infusion of a medicine, first hour inpatient CPT 96365 HC THER/PROPH/DIAG IV INF,INIT $491.25 $655.00 $218.35–$412.82 — 25%
IV push of a medicine, first drug CPT 96374 HC THER/PROPH/DIAG INJ,IV PUSH $405.75 $541.00 $177.03–$331.59 37% above 25%
IV push of a medicine, first drug inpatient CPT 96374 HC THER/PROPH/DIAG INJ,IV PUSH $405.75 $541.00 $177.03–$331.59 — 25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPH/DIAG INJ,SC/IM $123.75 $165.00 $55.24–$101.05 41% above 25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPH/DIAG INJ,SC/IM $123.75 $165.00 $55.24–$101.05 — 25%
Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSC RE-ED 15MIN $109.50 $146.00 $52.06–$89.58 3% below 25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSC RE-ED 15MIN $109.50 $146.00 $52.06–$89.58 — 25%
New patient office visit, about 30 minutes CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES $289.50 $386.00 $233.25–$298.18 18% above 25%
New patient office visit, about 30 minutes inpatient CPT 99203 PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES $289.50 $386.00 $233.25–$298.18 — 25%
New patient office visit, about 45 minutes CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES $441.75 $589.00 $242.04–$337.58 21% above 25%
New patient office visit, about 45 minutes inpatient CPT 99204 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES $441.75 $589.00 $242.04–$337.58 — 25%
New patient office visit, about 60 minutes CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES $546.00 $728.00 $233.16–$364.58 34% above 25%
New patient office visit, about 60 minutes inpatient CPT 99205 PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES $546.00 $728.00 $233.16–$364.58 — 25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES $200.25 $267.00 $222.59–$331.18 20% above 25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES $200.25 $267.00 $222.59–$331.18 — 25%
Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN $282.75 $377.00 $124.44–$230.43 4% above 25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX 30 MIN $282.75 $377.00 $124.44–$230.43 — 25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN $425.25 $567.00 $180.06–$357.00 36% above 25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX 45 MIN $425.25 $567.00 $180.06–$357.00 — 25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN $376.50 $502.00 $165.58–$307.02 41% above 25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX 20 MIN $376.50 $502.00 $165.58–$307.02 — 25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN $327.75 $437.00 $144.16–$275.21 14% above 25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX 30 MIN $327.75 $437.00 $144.16–$275.21 — 25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY 15MIN $97.50 $130.00 $42.84–$79.19 9% below 25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY 15MIN $97.50 $130.00 $42.84–$79.19 — 25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAP EX 15MIN $105.00 $140.00 $46.24–$85.68 4% below 25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAP EX 15MIN $105.00 $140.00 $46.24–$85.68 — 25%
Preventive checkup, returning patient aged 40–64 CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS $335.25 $447.00 $233.16 42% above 25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS $335.25 $447.00 $233.16 — 25%
Preventive checkup, returning patient aged 65 or older CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER $360.75 $481.00 $314.71 45% above 25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER $360.75 $481.00 $314.71 — 25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN $383.25 $511.00 $233.25–$322.38 at median 25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN $383.25 $511.00 $233.25–$322.38 — 25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN $195.00 $260.00 $231.87–$242.04 at median 25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN $195.00 $260.00 $231.87–$242.04 — 25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN $285.75 $381.00 $233.25–$370.00 at median 25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN $285.75 $381.00 $233.25–$370.00 — 25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HA SPORTS PHYSICAL $80.25 $107.00 $145.08–$354.78 at median 25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN $117.75 $157.00 $145.08–$354.78 46% above 25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HA SPORTS PHYSICAL $80.25 $107.00 $145.08–$354.78 — 25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN $117.75 $157.00 $145.08–$354.78 — 25%
Speech and language evaluation CPT 92523 HC EVAL OF SPEECH SOUND LANG COMPREHEN $729.75 $973.00 $613.39 28% above 25%
Speech and language evaluation inpatient CPT 92523 HC EVAL OF SPEECH SOUND LANG COMPREHEN $729.75 $973.00 $613.39 — 25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAP ACTIVITY 15MIN $130.50 $174.00 $57.44–$109.70 10% above 25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAP ACTIVITY 15MIN $130.50 $174.00 $57.44–$109.70 — 25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HA PHLEBOTOMY, THERAPEUTIC $290.25 $387.00 $137.84 at median 25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HA PHLEBOTOMY, THERAPEUTIC $290.25 $387.00 $137.84 — 25%

Vaccines

ProcedureCash price List priceInsurers payvs North DakotaOff list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE $24.75 $33.00 $25.96 23% below 25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY $33.75 $45.00 $25.96 5% above 25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE $24.75 $33.00 $25.96 — 25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY $33.75 $45.00 $25.96 — 25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY $71.25 $95.00 $31.75 5% below 25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM $73.50 $98.00 $31.75 2% below 25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY $71.25 $95.00 $31.75 — 25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM $73.50 $98.00 $31.75 — 25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE $271.50 $362.00 $261.10 18% below 25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PR PCV20 VACCINE FOR INTRAMUSCULAR USE $271.50 $362.00 $261.10 — 25%
Rabies vaccine, one dose CPT 90675 PR RABIES VACCINE INTRAMUSCULAR $471.75 $629.00 $325.36–$501.25 25% below 25%
Rabies vaccine, one dose inpatient CPT 90675 PR RABIES VACCINE INTRAMUSCULAR $471.75 $629.00 $325.36–$501.25 — 25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY $22.13 $29.50 $10.23–$19.14 68% below 25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 PR TDAP VACCINE 7 YRS/> IM $53.25 $71.00 $10.23–$19.14 23% below 25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY $22.13 $29.50 $10.23–$19.14 — 25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 PR TDAP VACCINE 7 YRS/> IM $53.25 $71.00 $10.23–$19.14 — 25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADMINISTRATION $60.75 $81.00 $27.40–$51.27 23% above 25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADMINISTRATION $60.75 $81.00 $27.40–$51.27 — 25%

Source file: https://hospitalpricetransparencyfiles.com/good-samaritan-hospital-association/450226419_Good-Samaritan-Hospital-Association_standardcharges.csv