Plaistow Fser
Plaistow Fser in Plaistow, NH publishes cash prices for 324 common procedures listed here, from its own machine-readable price file updated Sep 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the New Hampshire median for 318 of 322 procedures and below it for 2. By typical cash price it ranks #20 of 20 New Hampshire hospitals and #27 of 27 hospitals in the Boston, MA area, cheapest first. Select a procedure to compare it with other hospitals nearby.
26 PLAISTOW RD, PLAISTOW, NH, 03865 Collected Oct 23, 2026 Source price file Check a bill from this hospital (603) 421-2100
Acute care hospital For-profit hospital Emergency department CMS star rating 4 of 5 CCN 300017 · CMS hospital register NPI 1174570683
The price file shows no self-pay discount
For 539 of the 539 prices listed here, the cash price in Plaistow Fser's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs New Hampshire | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT ABDOMEN W&WO CONT | $4,505.25 | $4,505.25 | $139.21–$4,279.99 | 110% above | — |
| Abdominal X-ray, 2 views CPT 74019 ABD XR 2V | $1,062.75 | $1,062.75 | $32.84–$1,009.61 | 305% above | — |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3 + V RT | $978.25 | $978.25 | $30.23–$929.34 | 256% above | — |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE 3 + V LT | $978.25 | $978.25 | $30.23–$929.34 | 256% above | — |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 DOP ART 1-2 LEVELS BIL | $1,676.75 | $1,676.75 | $51.81–$1,592.91 | 272% above | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UP EXTREM W/O CONT RT | $6,758.25 | $6,758.25 | $208.83–$6,420.34 | 386% above | — |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UP EXTREM W/O CONT LT | $8,772.50 | $8,772.50 | $271.07–$8,333.88 | 531% above | — |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS | $1,841.50 | $1,841.50 | $56.90–$1,749.42 | 204% above | — |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone and/or joint imaging; whole body | $3,348.50 | $3,348.50 | $1,406.10–$1,628.42 | 77% above | — |
| Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE WHOLE BODY | $3,348.50 | $3,348.50 | $103.47–$3,181.07 | 77% above | — |
| Breast ultrasound, complete, one breast one side CPT 76641 US BRST UNI LT W AX COMP | $939.25 | $939.25 | $29.02–$892.29 | 69% above | — |
| Breast ultrasound, complete, one breast one side CPT 76641 US BRST UNI RT W AX COMP | $939.25 | $939.25 | $29.02–$892.29 | 69% above | — |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BRST UNI RT W AX LTD | $906.00 | $906.00 | $28.00–$860.70 | 149% above | — |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BRST UNI LT W AX LTD | $906.00 | $906.00 | $28.00–$860.70 | 149% above | — |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD&PEL W CONT | $6,766.50 | $6,766.50 | $209.08–$6,428.18 | 156% above | — |
| CT angiography (CTA) of the head CPT 70496 CTA HEAD | $4,864.75 | $4,864.75 | $150.32–$4,621.51 | 134% above | — |
| CT angiography (CTA) of the head CPT 70496 CTA HEAD VIZ AI TECH | $7,589.25 | $7,589.25 | $234.51–$7,209.79 | 264% above | — |
| CT angiography (CTA) of the neck CPT 70498 CTA NECK | $6,758.25 | $6,758.25 | $208.83–$6,420.34 | 224% above | — |
| CT angiography (CTA) of the neck CPT 70498 CTA NECK VIZ AI TECH | $7,589.25 | $7,589.25 | $234.51–$7,209.79 | 264% above | — |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST | $6,983.75 | $6,983.75 | $215.80–$6,634.56 | 232% above | — |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT HEART W CN ART/GRAFTS | $12,264.50 | $12,264.50 | $378.97–$11,651.27 | 66% above | — |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART WO CN W QUAN CA | $6,579.75 | $6,579.75 | $203.31–$6,250.76 | 2395% above | — |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD&PELVIS W/O CONT | $6,813.50 | $6,813.50 | $210.54–$6,472.82 | 175% above | — |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD&PELVIS W/CONT | $7,011.00 | $7,011.00 | $216.64–$6,660.45 | 148% above | — |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PELVIS W&WO CONT | $6,802.00 | $6,802.00 | $210.18–$6,461.90 | 119% above | — |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONT | $7,048.00 | $7,048.00 | $217.78–$6,695.60 | 322% above | — |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONT | $6,750.00 | $6,750.00 | $208.57–$6,412.50 | 391% above | — |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXIFAC W/O CNT | $6,739.25 | $6,739.25 | $208.24–$6,402.29 | 328% above | — |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONT | $6,702.25 | $6,702.25 | $207.10–$6,367.14 | 408% above | — |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/CONT | $6,753.00 | $6,753.00 | $208.67–$6,415.35 | 339% above | — |
| CT scan of the head without and with contrast CPT 70470 CT HD/BR W&W/O CONT | $6,850.25 | $6,850.25 | $211.67–$6,507.74 | 251% above | — |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST | $6,816.00 | $6,816.00 | $210.61–$6,475.20 | 384% above | — |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST | $7,015.25 | $7,015.25 | $216.77–$6,664.49 | 384% above | — |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST | $6,749.00 | $6,749.00 | $208.54–$6,411.55 | 316% above | — |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 DUP EXTRACRANIAL BIL | $3,759.50 | $3,759.50 | $116.17–$3,571.53 | 6% above | — |
| Chest CT scan without and with contrast CPT 71270 CT CHEST W&W/O CONT | $7,179.75 | $7,179.75 | $221.85–$6,820.76 | 188% above | — |
| Chest X-ray, 2 views CPT 71046 CHEST XRAY 2 V | $881.50 | $881.50 | $27.24–$837.42 | 243% above | — |
| Chest X-ray, single view CPT 71045 CHEST XRAY 1 V | $549.00 | $549.00 | $16.96–$521.55 | 144% above | — |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE COMP RT | $947.75 | $947.75 | $29.29–$900.36 | 273% above | — |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 XR CLAVICLE COMP LT | $947.75 | $947.75 | $29.29–$900.36 | 273% above | — |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COM | $2,024.75 | $2,024.75 | $62.56–$1,923.51 | 227% above | — |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL | $1,824.75 | $1,824.75 | $56.38–$1,733.51 | 322% above | — |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY PERIPHL | $1,552.00 | $1,552.00 | $47.96–$1,474.40 | 198% above | — |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US PREG W/FTL AN EX SGL | $3,659.50 | $3,659.50 | $113.08–$3,476.53 | 243% above | — |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST | $7,218.25 | $7,218.25 | $223.04–$6,857.34 | 419% above | — |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CONTRAST | $6,791.25 | $6,791.25 | $209.85–$6,451.69 | 308% above | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO DIAG CAD BI | $1,339.75 | $1,339.75 | $41.40–$1,272.76 | — | — |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAG CAD UNI LT | $1,303.75 | $1,303.75 | $40.29–$1,238.56 | 114% above | — |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMO DIAG CAD UNI RT | $1,303.75 | $1,303.75 | $40.29–$1,238.56 | 114% above | — |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 DUP LE ART BIL | $4,826.25 | $4,826.25 | $149.13–$4,584.94 | 105% above | — |
| Duplex ultrasound of the leg veins, both legs CPT 93970 DUP VEIN BIL | $4,826.25 | $4,826.25 | $149.13–$4,584.94 | 13% above | — |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO2D COMP W CF DOP | $8,922.50 | $8,922.50 | $275.71–$8,476.38 | 470% above | — |
| Elbow X-ray, 2 views one side CPT 73070 XR ELBOW 2 VIEWS LT | $826.00 | $826.00 | $25.52–$784.70 | 206% above | — |
| Elbow X-ray, 2 views one side CPT 73070 XR ELBOW 2 VIEWS RT | $826.00 | $826.00 | $25.52–$784.70 | 206% above | — |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW 3 + V RT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 276% above | — |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 XR ELBOW 3 + V LT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 276% above | — |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/SELLA/IAC WO | $6,890.25 | $6,890.25 | $212.91–$6,545.74 | 368% above | — |
| Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL BONES 3 + V | $1,212.25 | $1,212.25 | $37.46–$1,151.64 | 229% above | — |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM 2 VIEWS LT | $831.25 | $831.25 | $25.69–$789.69 | 228% above | — |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR FOREARM 2 VIEWS RT | $831.25 | $831.25 | $25.69–$789.69 | 228% above | — |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging, including gallbladder when present; | $3,697.75 | $3,697.75 | $1,547.35–$1,792.00 | 101% above | — |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPA IMAG INCL GB | $3,697.75 | $3,697.75 | $114.26–$3,512.86 | 101% above | — |
| Hand X-ray, 2 views one side CPT 73120 XR HAND 2 V LT | $831.25 | $831.25 | $25.69–$789.69 | 208% above | — |
| Hand X-ray, 2 views one side CPT 73120 XR HAND 2 V RT | $831.25 | $831.25 | $25.69–$789.69 | 208% above | — |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR CALCANEUS 2 + V RT | $936.75 | $936.75 | $28.95–$889.91 | 282% above | — |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR CALCANEUS 2 + V LT | $936.75 | $936.75 | $28.95–$889.91 | 282% above | — |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP UA HR OS RSP AF/EF | $861.25 | $861.25 | $26.61–$818.19 | 24% above | — |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a Sleep Studies | $12,463.50 | $12,463.50 | $1,651.00–$3,646.67 | 147% above | — |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a EEG | $12,463.50 | $12,463.50 | $488.00–$1,075.86 | 147% above | — |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLY >4 PAR W/CPAP OR BV | $12,463.50 | $12,463.50 | $385.12–$11,840.33 | 147% above | — |
| Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 V LT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 215% above | — |
| Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 V RT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 215% above | — |
| Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE 4 + V LT | $1,333.00 | $1,333.00 | $41.19–$1,266.35 | 303% above | — |
| Knee X-ray, complete, 4 or more views one side CPT 73564 XR KNEE 4 + V RT | $1,333.00 | $1,333.00 | $41.19–$1,266.35 | 303% above | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXTRM W/O C LT | $6,750.00 | $6,750.00 | $208.57–$6,412.50 | 386% above | — |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LOWER EXTRM W/O C RT | $6,750.00 | $6,750.00 | $208.57–$6,412.50 | 386% above | — |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LTD | $1,667.00 | $1,667.00 | $51.51–$1,583.65 | 231% above | — |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US EXTREM NON VASC LTD | $710.75 | $710.75 | $21.96–$675.21 | 114% above | — |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LUNG CA SCREEN WO CON | $999.75 | $999.75 | $30.89–$949.76 | 34% above | — |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA/FIBULA 2 V LT | $831.25 | $831.25 | $25.69–$789.69 | 209% above | — |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA/FIBULA 2 V RT | $831.25 | $831.25 | $25.69–$789.69 | 209% above | — |
| MR angiography (MRA) of the head without contrast CPT 70544 MRA HD W/O CONT | $8,430.75 | $8,430.75 | $260.51–$8,009.21 | 326% above | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LW JNT W/O CONT RT | $8,431.75 | $8,431.75 | $260.54–$8,010.16 | 286% above | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LW JNT W/O CONT LT | $8,431.75 | $8,431.75 | $260.54–$8,010.16 | 286% above | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LW JNT W&WO CONT LT | $9,705.50 | $9,705.50 | $299.90–$9,220.23 | 148% above | — |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LW JNT W&WO CONT RT | $9,705.50 | $9,705.50 | $299.90–$9,220.23 | 148% above | — |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONT | $8,431.75 | $8,431.75 | $260.54–$8,010.16 | 241% above | — |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W&WO CONT | $10,413.25 | $10,413.25 | $321.77–$9,892.59 | 181% above | — |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST | $8,430.75 | $8,430.75 | $260.51–$8,009.21 | 268% above | — |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W&WO CONT | $12,631.75 | $12,631.75 | $390.32–$12,000.16 | 245% above | — |
| MRI of the lower back, no contrast dye CPT 72148 MRI L-SPINE W/O CONT | $8,430.75 | $8,430.75 | $260.51–$8,009.21 | 243% above | — |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI L-SPINE W&W/O CONT | $10,413.25 | $10,413.25 | $321.77–$9,892.59 | 170% above | — |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINE W/O CONT | $8,431.75 | $8,431.75 | $260.54–$8,010.16 | 238% above | — |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE W&W/O CONT | $10,416.00 | $10,416.00 | $321.85–$9,895.20 | 171% above | — |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE W/O CONT | $8,431.75 | $8,431.75 | $260.54–$8,010.16 | 243% above | — |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W&WO CONT | $10,413.25 | $10,413.25 | $321.77–$9,892.59 | 197% above | — |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONT | $8,430.75 | $8,430.75 | $260.51–$8,009.21 | 218% above | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP JNT W/O CONT LT | $9,705.50 | $9,705.50 | $299.90–$9,220.23 | 366% above | — |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UP JNT W/O CONT RT | $9,705.50 | $9,705.50 | $299.90–$9,220.23 | 366% above | — |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR C-SPINE 4-5 V | $1,498.00 | $1,498.00 | $46.29–$1,423.10 | 268% above | — |
| Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/CONTRAST | $6,963.00 | $6,963.00 | $215.16–$6,614.85 | 340% above | — |
| Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CONTRAST | $6,732.25 | $6,732.25 | $208.03–$6,395.64 | 381% above | — |
| Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUE | $839.75 | $839.75 | $25.95–$797.76 | 280% above | — |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCRD SPECT R/S MULT | $16,609.00 | $16,609.00 | $513.22–$15,778.55 | 479% above | — |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantificat | $16,609.00 | $16,609.00 | $2,319.58–$2,686.33 | 479% above | — |
| Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST | $7,803.25 | $7,803.25 | $241.12–$7,413.09 | 430% above | — |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LTD OR FU | $767.25 | $767.25 | $23.71–$728.89 | 109% above | — |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE | $1,974.50 | $1,974.50 | $61.01–$1,875.78 | 244% above | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG AFTER 1ST TRI | $2,747.75 | $2,747.75 | $84.91–$2,610.36 | 343% above | — |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG 1ST TRIMTR | $2,078.50 | $2,078.50 | $64.23–$1,974.58 | 248% above | — |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANCY LTD | $1,877.50 | $1,877.50 | $58.01–$1,783.63 | 347% above | — |
| Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS UNI 2 V LT | $1,087.50 | $1,087.50 | $33.60–$1,033.13 | 349% above | — |
| Rib X-ray, one side, 2 views one side CPT 71100 XR RIBS UNI 2 V RT | $1,087.50 | $1,087.50 | $33.60–$1,033.13 | 349% above | — |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS UNI W/CXR 3+V LT | $750.75 | $750.75 | $23.20–$713.21 | 110% above | — |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR RIBS UNI W/CXR 3+V RT | $750.75 | $750.75 | $23.20–$713.21 | 110% above | — |
| Screening mammogram, both breasts both sides CPT 77067 MAMMO SCR CAD BI | $1,058.50 | $1,058.50 | $32.71–$1,005.58 | — | — |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2 + V RT | $831.25 | $831.25 | $25.69–$789.69 | 201% above | — |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 2 + V LT | $831.25 | $831.25 | $25.69–$789.69 | 201% above | — |
| Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUSES 3 + V | $760.75 | $760.75 | $23.51–$722.71 | 115% above | — |
| Skull X-ray, fewer than 4 views CPT 70250 XR SKULL < 4 V | $968.75 | $968.75 | $29.93–$920.31 | 253% above | — |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY >4 PAR | $11,843.00 | $11,843.00 | $365.95–$11,250.85 | 277% above | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist Sleep Studies | $11,843.00 | $11,843.00 | $1,651.00–$3,646.67 | 277% above | — |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist EEG | $11,843.00 | $11,843.00 | $488.00–$1,075.86 | 277% above | — |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO STRESS W CONT ECG | $7,136.50 | $7,136.50 | $220.52–$6,779.68 | 258% above | — |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 XR SWLW FUNC W/C&V | $1,342.75 | $1,342.75 | $41.49–$1,275.61 | 104% above | — |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 XR FEMUR MIN 2 VIEWS | $526.50 | $526.50 | $16.27–$500.18 | 78% above | — |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT T-SPINE W/O CONTRAST | $6,816.00 | $6,816.00 | $210.61–$6,475.20 | 428% above | — |
| Toe X-ray, 2 or more views one side CPT 73660 XR TOE(S) 2 + V LT | $831.25 | $831.25 | $25.69–$789.69 | 276% above | — |
| Toe X-ray, 2 or more views one side CPT 73660 XR TOE(S) 2 + V RT | $831.25 | $831.25 | $25.69–$789.69 | 276% above | — |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $1,391.00 | $1,391.00 | $42.98–$1,321.45 | 150% above | — |
| Transvaginal ultrasound during pregnancy CPT 76817 US PREG UT TRANSVAGINAL | $1,391.00 | $1,391.00 | $42.98–$1,321.45 | 213% above | — |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $2,472.00 | $2,472.00 | $76.38–$2,348.40 | 266% above | — |
| Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM AND CNTS | $1,745.75 | $1,745.75 | $53.94–$1,658.46 | 225% above | — |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD AND NECK | $1,905.50 | $1,905.50 | $58.88–$1,810.22 | 276% above | — |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI SNGL CONTRAST | $1,863.75 | $1,863.75 | $57.59–$1,770.56 | 157% above | — |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS 2 + V RT | $831.25 | $831.25 | $25.69–$789.69 | 206% above | — |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 XR HUMERUS 2 + V LT | $831.25 | $831.25 | $25.69–$789.69 | 206% above | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUP VEIN UNI/LTD | $3,219.75 | $3,219.75 | $99.49–$3,058.76 | 291% above | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP VEIN UNI LT | $3,219.75 | $3,219.75 | $99.49–$3,058.76 | 291% above | — |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP VEIN UNI RT | $3,219.75 | $3,219.75 | $99.49–$3,058.76 | 291% above | — |
| Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2 VIEWS LT | $831.25 | $831.25 | $25.69–$789.69 | 225% above | — |
| Wrist X-ray, 2 views one side CPT 73100 XR WRIST 2 VIEWS RT | $831.25 | $831.25 | $25.69–$789.69 | 225% above | — |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 + V RT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 290% above | — |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 + V LT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 290% above | — |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR HIP W PEL UN 2-3 VIEW | $526.50 | $526.50 | $16.27–$500.18 | 62% above | — |
| X-ray of the abdomen, 1 view CPT 74018 ABD XR 1V | $612.25 | $612.25 | $18.92–$581.64 | 160% above | — |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LT | $831.25 | $831.25 | $25.69–$789.69 | 243% above | — |
| X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RT | $831.25 | $831.25 | $25.69–$789.69 | 243% above | — |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER(S) 2 + V LT | $831.25 | $831.25 | $25.69–$789.69 | 299% above | — |
| X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER(S) 2 + V RT | $831.25 | $831.25 | $25.69–$789.69 | 299% above | — |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LT | $831.25 | $831.25 | $25.69–$789.69 | 259% above | — |
| X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RT | $831.25 | $831.25 | $25.69–$789.69 | 259% above | — |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3 + V LT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 245% above | — |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT 3 + V RT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 245% above | — |
| X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3 + V RT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 292% above | — |
| X-ray of the hand, 3 or more views one side CPT 73130 XR HAND 3 + V LT | $1,086.50 | $1,086.50 | $33.57–$1,032.17 | 292% above | — |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 V LT | $831.25 | $831.25 | $25.69–$789.69 | 222% above | — |
| X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 V RT | $831.25 | $831.25 | $25.69–$789.69 | 222% above | — |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR L-SPINE 2/3 VIEWS | $1,033.75 | $1,033.75 | $31.94–$982.06 | 241% above | — |
| X-ray of the lower back, 4 or more views CPT 72110 XR L-SPINE 4 + VIEWS | $1,099.00 | $1,099.00 | $33.96–$1,044.05 | 180% above | — |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR T-SPINE 2 VIEWS | $1,033.75 | $1,033.75 | $31.94–$982.06 | 256% above | — |
| X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES COMP | $763.25 | $763.25 | $23.58–$725.09 | 159% above | — |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR C-SPINE 2-3 VIEWS | $993.50 | $993.50 | $30.70–$943.83 | 260% above | — |
| X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1/2 VIEWS | $606.75 | $606.75 | $18.75–$576.41 | 133% above | — |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX 2 + V | $853.50 | $853.50 | $26.37–$810.83 | 246% above | — |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs New Hampshire | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 ACTH QN | $1,044.75 | $1,044.75 | $219.40–$992.51 | 305% above | — |
| ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) | $1,044.75 | $1,044.75 | $63.53–$157.02 | 305% above | — |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; alanine amino (ALT) (SGPT) | $213.00 | $213.00 | $8.72–$21.55 | 249% above | — |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT (SGPT) | $213.00 | $213.00 | $44.73–$202.35 | 249% above | — |
| AST (aspartate aminotransferase) enzyme test CPT 84450 AST (SGOT) | $237.00 | $237.00 | $49.77–$225.15 | 350% above | — |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase; aspartate amino (AST) (SGOT) | $237.00 | $237.00 | $8.52–$21.06 | 350% above | — |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $586.50 | $586.50 | $123.17–$557.17 | 65% above | — |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsA | $586.50 | $586.50 | $38.10–$1,410.41 | 65% above | — |
| Albumin blood test CPT 82040 Albumin; serum, plasma or whole blood | $164.50 | $164.50 | $8.14–$20.13 | 248% above | — |
| Albumin blood test CPT 82040 ALBUMIN SERUM QN | $164.50 | $164.50 | $34.55–$156.28 | 248% above | — |
| Aldosterone blood test CPT 82088 ALDOSTERONE UR QN | $1,381.50 | $1,381.50 | $290.12–$1,312.42 | 458% above | — |
| Aldosterone blood test CPT 82088 ALDOSTERONE QN | $1,778.00 | $1,778.00 | $373.38–$1,689.10 | 618% above | — |
| Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase, alkaline; | $489.25 | $489.25 | $4.14–$153.49 | 630% above | — |
| Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS (ALP) | $489.25 | $489.25 | $102.74–$464.79 | 630% above | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE EACH | $237.00 | $237.00 | $49.77–$225.15 | 618% above | — |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | $237.00 | $237.00 | $8.59–$21.22 | 618% above | — |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETOPROT SERUM | $802.00 | $802.00 | $168.42–$761.90 | 589% above | — |
| Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETOPROT SERUM MAT | $990.75 | $990.75 | $208.06–$941.21 | 752% above | — |
| Ammonia blood test CPT 82140 Ammonia | $451.50 | $451.50 | $23.97–$59.24 | 371% above | — |
| Ammonia blood test CPT 82140 AMMONIA | $451.50 | $451.50 | $94.81–$428.93 | 371% above | — |
| Amylase blood test CPT 82150 AMYLASE PANCREATIC | $152.25 | $152.25 | $31.97–$144.64 | 103% above | — |
| Amylase blood test CPT 82150 AMYLASE FL | $239.00 | $239.00 | $50.19–$227.05 | 218% above | — |
| Amylase blood test CPT 82150 AMYLASE BLD | $270.75 | $270.75 | $56.86–$257.21 | 260% above | — |
| Amylase blood test CPT 82150 AMYLASE | $270.75 | $270.75 | $56.86–$257.21 | 260% above | — |
| Amylase blood test CPT 82150 AMYLASE UR | $380.00 | $380.00 | $79.80–$361.00 | 406% above | — |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANTI-CCP | $647.25 | $647.25 | $135.92–$614.89 | 541% above | — |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic citrullinated peptide (CCP), antibody | $647.25 | $647.25 | $21.30–$52.65 | 541% above | — |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA QUAL SCREEN | $358.25 | $358.25 | $75.23–$340.34 | 272% above | — |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINEURON NUC AB-3 FA | $431.25 | $431.25 | $90.56–$409.69 | 347% above | — |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINEURON NUC AB-2 FA | $431.25 | $431.25 | $90.56–$409.69 | 347% above | — |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINEURON NUC AB-1 FA | $431.25 | $431.25 | $90.56–$409.69 | 347% above | — |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE | $889.75 | $889.75 | $186.85–$845.26 | 350% above | — |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 PRO-BNP QT | $958.50 | $958.50 | $201.28–$910.58 | 385% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE SURGICAL SPEC | $270.75 | $270.75 | $56.86–$257.21 | 157% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULT THROAT | $270.75 | $270.75 | $56.86–$257.21 | 157% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE CATHETER TIP | $270.75 | $270.75 | $56.86–$257.21 | 157% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL | $280.50 | $280.50 | $58.91–$266.48 | 166% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULT NOSE | $280.50 | $280.50 | $58.91–$266.48 | 166% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE PLACENTA | $280.50 | $280.50 | $58.91–$266.48 | 166% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE RESPIRATORY | $280.50 | $280.50 | $58.91–$266.48 | 166% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE BODY FLUID | $299.25 | $299.25 | $62.84–$284.29 | 184% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE TISSUE | $299.25 | $299.25 | $62.84–$284.29 | 184% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE EAR | $365.25 | $365.25 | $76.70–$346.99 | 246% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE CSF | $365.25 | $365.25 | $76.70–$346.99 | 246% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE EYE | $365.25 | $365.25 | $76.70–$346.99 | 246% above | — |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE WOUND | $365.25 | $365.25 | $76.70–$346.99 | 246% above | — |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium | $339.75 | $339.75 | $13.92–$34.40 | 393% above | — |
| Basic metabolic panel (blood test) CPT 80048 BMP TOTAL CALCIUM | $339.75 | $339.75 | $71.35–$322.76 | 393% above | — |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOT BLD | $164.50 | $164.50 | $34.55–$156.28 | 323% above | — |
| Bilirubin blood test, total CPT 82247 BILIRUBIN TOT FL | $164.50 | $164.50 | $34.55–$156.28 | 323% above | — |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURG PATH LEVEL 4 | $4,286.50 | $4,286.50 | $900.16–$4,072.18 | 1529% above | — |
| Blood culture for bacteria CPT 87040 CULTURE BLOOD | $339.75 | $339.75 | $71.35–$322.76 | 142% above | — |
| Blood culture for bacteria CPT 87040 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | $339.75 | $339.75 | $16.98–$41.96 | 142% above | — |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE | $76.75 | $76.75 | $2.37–$72.91 | 362% above | — |
| Blood glucose (sugar) test CPT 82947 Glucose; quantitative, blood (except reagent strip) | $156.25 | $156.25 | $6.46–$15.98 | 349% above | — |
| Blood glucose (sugar) test CPT 82947 GLUCOSE BLD QN | $156.25 | $156.25 | $32.81–$148.44 | 349% above | — |
| Blood lead test CPT 83655 LEAD URINE | $498.75 | $498.75 | $104.74–$473.81 | 579% above | — |
| Blood lead test CPT 83655 LEAD BLOOD | $535.25 | $535.25 | $112.40–$508.49 | 629% above | — |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUALITATIVE SERUM | $272.50 | $272.50 | $57.23–$258.88 | 185% above | — |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin, chorionic (hCG); qualitative | $272.50 | $272.50 | $6.02–$222.75 | 185% above | — |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO TYPE | $179.25 | $179.25 | $37.64–$170.29 | 263% above | — |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing, serologic; ABO | $179.25 | $179.25 | $4.92–$12.16 | 263% above | — |
| Blood urea nitrogen (BUN) test CPT 84520 UREA NITROGEN OTHER | $21.25 | $21.25 | $4.46–$20.19 | 29% below | — |
| Blood urea nitrogen (BUN) test CPT 84520 BUN | $192.75 | $192.75 | $40.48–$183.11 | 548% above | — |
| C-peptide blood test CPT 84681 C-PEPTIDE | $917.00 | $917.00 | $192.57–$871.15 | 560% above | — |
| C-peptide blood test CPT 84681 C-peptide | $917.00 | $917.00 | $34.23–$84.61 | 560% above | — |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein; | $352.00 | $352.00 | $8.52–$21.06 | 417% above | — |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $352.00 | $352.00 | $73.92–$334.40 | 417% above | — |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOX GENE AMP PROB | $405.50 | $405.50 | $85.16–$385.23 | 95% above | — |
| C. difficile toxin gene test (stool PCR) CPT 87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique | $405.50 | $405.50 | $61.31–$151.53 | 95% above | — |
| CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 QN | $502.75 | $502.75 | $105.58–$477.61 | 252% above | — |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 | $502.75 | $502.75 | $34.23–$84.61 | 252% above | — |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 | $546.25 | $546.25 | $34.23–$84.61 | 264% above | — |
| CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QN | $546.25 | $546.25 | $114.71–$518.94 | 264% above | — |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease ºCOVID-19»), amplified probe technique | $269.50 | $269.50 | $84.40–$208.62 | 116% above | — |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 DNA/RNA AMP | $269.50 | $269.50 | $56.59–$256.02 | 116% above | — |
| Calcium blood test, total CPT 82310 CALCIUM UR RANDOM QN | $27.50 | $27.50 | $5.78–$26.13 | 18% below | — |
| Calcium blood test, total CPT 82310 CALCIUM TOTAL | $194.25 | $194.25 | $40.79–$184.54 | 478% above | — |
| Carcinoembryonic antigen (CEA) test CPT 82378 CEA | $901.50 | $901.50 | $189.31–$856.42 | 553% above | — |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen (CEA) | $901.50 | $901.50 | $31.19–$77.09 | 553% above | — |
| Chickenpox (varicella) immunity blood test CPT 86787 VARIC ZOSTER AB QUAL | $404.50 | $404.50 | $84.94–$384.27 | 287% above | — |
| Chickenpox (varicella) immunity blood test CPT 86787 VARIC ZOSTER IGG | $404.50 | $404.50 | $84.94–$384.27 | 287% above | — |
| Chickenpox (varicella) immunity blood test CPT 86787 VARIC ZOSTER IGM | $611.75 | $611.75 | $128.47–$581.16 | 485% above | — |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMP PROBE | $374.75 | $374.75 | $78.70–$356.01 | 118% above | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $371.75 | $371.75 | $78.07–$353.16 | 206% above | — |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) | $371.75 | $371.75 | $22.03–$54.44 | 206% above | — |
| Complete blood count (CBC), no differential CPT 85027 CBC AUTOMATED | $221.25 | $221.25 | $46.46–$210.19 | 324% above | — |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL | $358.25 | $358.25 | $75.23–$340.34 | 280% above | — |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (8 | $358.25 | $358.25 | $17.37–$42.93 | 280% above | — |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL 1 HR | $365.50 | $365.50 | $76.75–$347.23 | 204% above | — |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL BASELINE | $365.50 | $365.50 | $76.75–$347.23 | 204% above | — |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL SALIVARY | $623.00 | $623.00 | $130.83–$591.85 | 418% above | — |
| Cortisol blood test, total CPT 82533 CORTISOL TOTAL | $623.00 | $623.00 | $130.83–$591.85 | 418% above | — |
| Creatine kinase (CK) blood test, total CPT 82550 CREAT KINASE (CK) TOTAL | $346.50 | $346.50 | $72.77–$329.18 | 414% above | — |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (CK), (CPK); total | $346.50 | $346.50 | $10.71–$26.47 | 414% above | — |
| Creatinine blood test CPT 82565 Creatinine; blood | $182.00 | $182.00 | $8.42–$20.82 | 309% above | — |
| Creatinine blood test CPT 82565 CREATININE BLD | $182.00 | $182.00 | $38.22–$172.90 | 309% above | — |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV AB CSF | $315.75 | $315.75 | $66.31–$299.96 | 158% above | — |
| Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG QUAL | $749.50 | $749.50 | $157.40–$712.02 | 512% above | — |
| D-dimer blood test (blood clot marker) CPT 85379 D-DIMER QUANT | $341.25 | $341.25 | $71.66–$324.19 | 210% above | — |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation products, D-dimer; quantitative | $341.25 | $341.25 | $16.75–$41.39 | 210% above | — |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S | $1,128.25 | $1,128.25 | $236.93–$1,071.84 | 676% above | — |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-sulfate (DHEA-S) | $1,128.25 | $1,128.25 | $36.57–$90.38 | 676% above | — |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay ºeg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA»), c | $663.00 | $663.00 | $102.22–$252.65 | 187% above | — |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCR ANY NBR PER DOS | $663.00 | $663.00 | $139.23–$629.85 | 187% above | — |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL | $509.50 | $509.50 | $107.00–$484.02 | 866% above | — |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) | $509.50 | $509.50 | $11.53–$28.50 | 866% above | — |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV CAPSID IGM QUAL | $385.75 | $385.75 | $81.01–$366.46 | 268% above | — |
| Epstein-Barr virus (EBV) antibody test CPT 86665 EBV CAPSID IGG QUAL | $385.75 | $385.75 | $81.01–$366.46 | 268% above | — |
| Estradiol blood test CPT 82670 ESTRADIOL TOTAL | $857.25 | $857.25 | $180.02–$814.39 | 437% above | — |
| Estradiol blood test CPT 82670 Estradiol; total | $857.25 | $857.25 | $45.96–$113.60 | 437% above | — |
| FSH (follicle-stimulating hormone) test CPT 83001 FSH | $935.50 | $935.50 | $196.46–$888.73 | 646% above | — |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; follicle stimulating hormone (FSH) | $935.50 | $935.50 | $30.56–$75.54 | 646% above | — |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, fecal | $338.25 | $338.25 | $32.29–$79.81 | 59% above | — |
| Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL | $338.25 | $338.25 | $71.03–$321.34 | 59% above | — |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $453.00 | $453.00 | $10.90–$403.65 | 321% above | — |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN | $453.00 | $453.00 | $95.13–$430.35 | 321% above | — |
| Fibrinogen blood test CPT 85384 Fibrinogen; activity | $252.25 | $252.25 | $15.99–$39.52 | 208% above | — |
| Fibrinogen blood test CPT 85384 FIBRINOGEN ACTIVITY | $252.25 | $252.25 | $52.97–$239.64 | 208% above | — |
| Folate (folic acid) blood test CPT 82746 FOLATE (FOLIC ACID) SER | $294.00 | $294.00 | $61.74–$279.30 | 233% above | — |
| Folate (folic acid) blood test CPT 82746 Folic acid; serum | $294.00 | $294.00 | $24.18–$59.77 | 233% above | — |
| Free T3 thyroid hormone test CPT 84481 Triiodothyronine T3; free | $590.25 | $590.25 | $27.87–$68.87 | 261% above | — |
| Free T3 thyroid hormone test CPT 84481 T3 FREE | $590.25 | $590.25 | $123.95–$560.74 | 261% above | — |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine; free | $357.25 | $357.25 | $14.84–$36.67 | 264% above | — |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE | $357.25 | $357.25 | $75.02–$339.39 | 264% above | — |
| Free testosterone test CPT 84402 Testosterone; free | $661.75 | $661.75 | $41.90–$103.56 | 368% above | — |
| Free testosterone test CPT 84402 TESTOSTERONE FREE | $661.75 | $661.75 | $138.97–$628.66 | 368% above | — |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase, gamma (GGT) | $315.75 | $315.75 | $11.84–$29.27 | 387% above | — |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT | $315.75 | $315.75 | $66.31–$299.96 | 387% above | — |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; post glucose dose (includes glucose) | $621.25 | $621.25 | $7.81–$19.31 | 1101% above | — |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1 HR W GLUCOLA | $621.25 | $621.25 | $130.46–$590.19 | 1101% above | — |
| Glucose tolerance test, 3 samples CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) | $621.25 | $621.25 | $21.17–$52.33 | 403% above | — |
| Glucose tolerance test, 3 samples CPT 82951 GTT 1ST 3 SPECIMENS | $621.25 | $621.25 | $130.46–$590.19 | 403% above | — |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC AMP PROBE | $374.75 | $374.75 | $78.70–$356.01 | 78% above | — |
| H. pylori antibody blood test CPT 86677 H PYLORI AB QL IGG | $374.75 | $374.75 | $78.70–$356.01 | 107% above | — |
| H. pylori antibody blood test CPT 86677 H PYLORI AB QL IGA | $407.25 | $407.25 | $85.52–$386.89 | 125% above | — |
| H. pylori antibody blood test CPT 86677 H PYLORI AB QL IGM | $687.50 | $687.50 | $144.38–$653.13 | 280% above | — |
| H. pylori stool antigen test CPT 87338 H PYLORI AG EIA STOOL | $982.50 | $982.50 | $206.32–$933.38 | 768% above | — |
| H. pylori stool antigen test CPT 87338 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC | $982.50 | $982.50 | $23.66–$58.47 | 768% above | — |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed | $1,947.50 | $1,947.50 | $139.99–$346.00 | 353% above | — |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QN | $1,947.50 | $1,947.50 | $408.98–$1,850.13 | 353% above | — |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC | $387.00 | $387.00 | $39.61–$97.90 | 204% above | — |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1AG HIV-1/2AB SINGLE | $387.00 | $387.00 | $81.27–$367.65 | 204% above | — |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result | $339.75 | $339.75 | $57.72–$142.67 | 73% above | — |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HIGH RISK TYPES POOL | $339.75 | $339.75 | $71.35–$322.76 | 73% above | — |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin; glycosylated (A1C) | $257.50 | $257.50 | $15.97–$39.48 | 265% above | — |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C | $257.50 | $257.50 | $54.08–$244.63 | 265% above | — |
| Hemoglobin blood test CPT 85018 HEMOGLOBIN | $182.00 | $182.00 | $38.22–$172.90 | 734% above | — |
| Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL | $254.50 | $254.50 | $53.45–$241.78 | 258% above | — |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B core antibody (HBcAb); total | $254.50 | $254.50 | $9.64–$356.67 | 258% above | — |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody (HBsAb) | $358.25 | $358.25 | $17.67–$43.67 | 393% above | — |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB QUAL | $358.25 | $358.25 | $75.23–$340.34 | 393% above | — |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC | $331.50 | $331.50 | $8.26–$305.71 | 314% above | — |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B S AG EIA QL | $331.50 | $331.50 | $69.61–$314.93 | 314% above | — |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB QUAL | $331.50 | $331.50 | $69.61–$314.93 | 112% above | — |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody; | $331.50 | $331.50 | $23.47–$58.02 | 112% above | — |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C RNA QN | $1,852.25 | $1,852.25 | $388.97–$1,759.64 | 285% above | — |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | $1,852.25 | $1,852.25 | $70.47–$174.18 | 285% above | — |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX 1 AB IGG | $352.00 | $352.00 | $73.92–$334.40 | 235% above | — |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX 1 AB QL | $660.50 | $660.50 | $138.71–$627.48 | 529% above | — |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB IGM | $352.00 | $352.00 | $73.92–$334.40 | 188% above | — |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX 2 AB IGG | $660.50 | $660.50 | $138.71–$627.48 | 440% above | — |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $516.50 | $516.50 | $108.47–$490.68 | 427% above | — |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein; high sensitivity (hsCRP) | $516.50 | $516.50 | $21.30–$52.65 | 427% above | — |
| Homocysteine blood test CPT 83090 Homocysteine | $1,292.75 | $1,292.75 | $29.48–$72.86 | 887% above | — |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE QN | $1,292.75 | $1,292.75 | $271.48–$1,228.11 | 887% above | — |
| Insulin blood test CPT 83525 Insulin; total | $405.50 | $405.50 | $18.80–$46.47 | 339% above | — |
| Insulin blood test CPT 83525 INSULIN TOTAL | $405.50 | $405.50 | $85.16–$385.23 | 339% above | — |
| Iron blood test (serum iron) CPT 83540 IRON | $223.50 | $223.50 | $46.94–$212.32 | 252% above | — |
| Iron blood test (serum iron) CPT 83540 Iron | $223.50 | $223.50 | $5.18–$191.77 | 252% above | — |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING | $230.50 | $230.50 | $48.41–$218.97 | 348% above | — |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $230.50 | $230.50 | $14.38–$35.54 | 348% above | — |
| Kidney function blood test panel CPT 80069 Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus i | $621.25 | $621.25 | $6.94–$256.91 | 771% above | — |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $621.25 | $621.25 | $130.46–$590.19 | 771% above | — |
| LH (luteinizing hormone) test CPT 83002 LH | $566.00 | $566.00 | $118.86–$537.70 | 329% above | — |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin; luteinizing hormone (LH) | $566.00 | $566.00 | $30.47–$75.30 | 329% above | — |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID BODY FL | $218.50 | $218.50 | $45.88–$207.57 | 104% above | — |
| Lactate (lactic acid) blood test CPT 83605 LACTIC ACID | $392.25 | $392.25 | $82.37–$372.64 | 266% above | — |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH (LD) | $210.25 | $210.25 | $44.15–$199.74 | 323% above | — |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH (LD) CSF | $439.50 | $439.50 | $92.30–$417.52 | 785% above | — |
| Lactate dehydrogenase (LDH) blood test CPT 83615 LDH (LD) BODY FLUID | $439.50 | $439.50 | $92.30–$417.52 | 785% above | — |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $249.25 | $249.25 | $11.33–$28.01 | 233% above | — |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE | $249.25 | $249.25 | $52.34–$236.79 | 233% above | — |
| Liver function blood test panel CPT 80076 Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alani | $241.00 | $241.00 | $6.54–$241.92 | 256% above | — |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $241.00 | $241.00 | $50.61–$228.95 | 256% above | — |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB IGM QL | $114.50 | $114.50 | $24.05–$108.78 | 9% above | — |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB QL | $811.50 | $811.50 | $170.41–$770.92 | 675% above | — |
| Lyme disease antibody test CPT 86618 LYME DISEASE AB IGG QL | $811.50 | $811.50 | $170.41–$770.92 | 675% above | — |
| Magnesium blood test CPT 83735 MAGNESIUM BLD | $194.25 | $194.25 | $40.79–$184.54 | 269% above | — |
| Magnesium blood test CPT 83735 MAGNESIUM URINE | $239.00 | $239.00 | $50.19–$227.05 | 354% above | — |
| Magnesium blood test CPT 83735 MAGNESIUM RBC | $365.25 | $365.25 | $76.70–$346.99 | 593% above | — |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGG | $250.75 | $250.75 | $52.66–$238.21 | 170% above | — |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM | $250.75 | $250.75 | $52.66–$238.21 | 170% above | — |
| Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile antibodies; screening | $366.75 | $366.75 | $8.52–$21.06 | 488% above | — |
| Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCR (HETEROPHILE) | $366.75 | $366.75 | $77.02–$348.41 | 488% above | — |
| Mumps immunity blood test CPT 86735 MUMPS IGG QUAL | $493.25 | $493.25 | $103.58–$468.59 | 411% above | — |
| Mumps immunity blood test CPT 86735 MUMPS IGM QUAL | $671.25 | $671.25 | $140.96–$637.69 | 595% above | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PROS SPEC AG FREE | $748.25 | $748.25 | $157.13–$710.84 | 577% above | — |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free | $748.25 | $748.25 | $14.71–$544.39 | 577% above | — |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROS SPEC AG (PSA) TOTAL | $401.50 | $401.50 | $84.31–$381.43 | 283% above | — |
| Pap test (liquid-based, automated screening with review) CPT 88175 PAP AUTO W MAN RESCN TLP | $411.25 | $411.25 | $86.36–$390.69 | 244% above | — |
| Pap test (liquid-based, automated screening with review) CPT 88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under | $411.25 | $411.25 | $43.77–$108.19 | 244% above | — |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAPDX TCSC NORSC TH | $241.00 | $241.00 | $50.61–$228.95 | 125% above | — |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision | $241.00 | $241.00 | $33.33–$82.37 | 125% above | — |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PTH) | $689.00 | $689.00 | $144.69–$654.55 | 180% above | — |
| Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT | $689.00 | $689.00 | $144.69–$654.55 | 180% above | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PTT | $347.75 | $347.75 | $73.03–$330.36 | 466% above | — |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood | $347.75 | $347.75 | $9.89–$24.44 | 466% above | — |
| Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS BLD | $205.00 | $205.00 | $43.05–$194.75 | 221% above | — |
| Phosphorus (phosphate) blood test CPT 84100 Phosphorus inorganic (phosphate); | $205.00 | $205.00 | $7.80–$19.27 | 221% above | — |
| Potassium blood test CPT 84132 Potassium; serum, plasma or whole blood | $164.50 | $164.50 | $7.83–$19.35 | 206% above | — |
| Potassium blood test CPT 84132 POTASSIUM BLD | $164.50 | $164.50 | $34.55–$156.28 | 206% above | — |
| Progesterone blood test CPT 84144 PROGESTERONE | $887.00 | $887.00 | $186.27–$842.65 | 481% above | — |
| Progesterone blood test CPT 84144 Progesterone | $887.00 | $887.00 | $34.31–$84.81 | 481% above | — |
| Prolactin blood test CPT 84146 PROLACTIN | $524.25 | $524.25 | $110.09–$498.04 | 269% above | — |
| Prolactin blood test CPT 84146 Prolactin | $524.25 | $524.25 | $31.88–$78.80 | 269% above | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME | $156.25 | $156.25 | $32.81–$148.44 | 246% above | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time; | $156.25 | $156.25 | $7.06–$17.44 | 246% above | — |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS B AG OIA | $165.50 | $165.50 | $34.76–$157.22 | 26% above | — |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS A AG OIA | $165.50 | $165.50 | $34.76–$157.22 | 26% above | — |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A OPTICAL IA | $292.50 | $292.50 | $61.42–$277.88 | 275% above | — |
| Renin blood test CPT 84244 Renin | $891.00 | $891.00 | $17.59–$650.97 | 479% above | — |
| Renin blood test CPT 84244 RENIN | $891.00 | $891.00 | $187.11–$846.45 | 479% above | — |
| Rh blood typing CPT 86901 RH TYPE | $160.50 | $160.50 | $33.70–$152.47 | 187% above | — |
| Rh blood typing CPT 86901 Blood typing, serologic; Rh (D) | $160.50 | $160.50 | $4.92–$12.16 | 187% above | — |
| Rheumatoid factor (RF) test CPT 86431 RA QN | $168.50 | $168.50 | $35.38–$160.07 | 224% above | — |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor; quantitative | $168.50 | $168.50 | $9.33–$23.05 | 224% above | — |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA AB QUAL | $469.00 | $469.00 | $98.49–$445.55 | 510% above | — |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG | $614.00 | $614.00 | $128.94–$583.30 | 699% above | — |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM | $663.00 | $663.00 | $139.23–$629.85 | 763% above | — |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE AUTO | $144.25 | $144.25 | $30.29–$137.04 | 298% above | — |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation rate, erythrocyte; automated | $144.25 | $144.25 | $4.44–$10.98 | 298% above | — |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen analysis; volume, count, motility, and differential | $407.25 | $407.25 | $9.85–$364.43 | 4% above | — |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANALYSIS COMPLETE | $407.25 | $407.25 | $85.52–$386.89 | 4% above | — |
| Sodium blood test CPT 84295 SODIUM BLD | $205.00 | $205.00 | $43.05–$194.75 | 502% above | — |
| Sodium blood test CPT 84295 Sodium; serum, plasma or whole blood | $205.00 | $205.00 | $7.91–$19.56 | 502% above | — |
| Stool ova and parasites exam CPT 87177 Ova and parasites, direct smears, concentration and identification | $575.75 | $575.75 | $14.64–$36.19 | 419% above | — |
| Stool ova and parasites exam CPT 87177 O&P SMEAR CONC ID | $575.75 | $575.75 | $120.91–$546.96 | 419% above | — |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLD SCN 3 SPEC | $133.75 | $133.75 | $28.09–$127.06 | 262% above | — |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | $445.00 | $445.00 | $26.19–$64.73 | 352% above | — |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLD CRC IA | $445.00 | $445.00 | $93.45–$422.75 | 352% above | — |
| Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMA PALLIDUM AB | $230.75 | $230.75 | $48.46–$219.21 | 101% above | — |
| Syphilis antibody test (Treponema pallidum) CPT 86780 FTA AB CONFIRM | $280.50 | $280.50 | $58.91–$266.48 | 144% above | — |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR QUAL | $109.25 | $109.25 | $22.94–$103.79 | 192% above | — |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL CSF QUAL | $187.00 | $187.00 | $39.27–$177.65 | 400% above | — |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | $963.75 | $963.75 | $101.96–$252.00 | 338% above | — |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB GAMMA INTERFERON RESP | $963.75 | $963.75 | $202.39–$915.56 | 338% above | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL | $436.75 | $436.75 | $91.72–$414.91 | 176% above | — |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; total | $436.75 | $436.75 | $42.46–$104.94 | 176% above | — |
| Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB | $315.75 | $315.75 | $66.31–$299.96 | 151% above | — |
| Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER-KIDNEY MICRO AB | $598.25 | $598.25 | $125.63–$568.34 | 375% above | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone (TSH) | $371.75 | $371.75 | $27.64–$68.31 | 213% above | — |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $371.75 | $371.75 | $78.07–$353.16 | 213% above | — |
| Total IgE blood test CPT 82785 IGE | $726.25 | $726.25 | $152.51–$689.94 | 654% above | — |
| Total IgE blood test CPT 82785 Gammaglobulin (immunoglobulin); IgE | $726.25 | $726.25 | $27.08–$66.92 | 654% above | — |
| Total cholesterol blood test CPT 82465 Cholesterol, serum or whole blood, total | $205.00 | $205.00 | $7.16–$17.69 | 399% above | — |
| Total cholesterol blood test CPT 82465 CHOLESTEROL BLD | $205.00 | $205.00 | $43.05–$194.75 | 399% above | — |
| Total thyroxine (T4) blood test CPT 84436 THYROXINE T4 TOTAL | $280.50 | $280.50 | $58.91–$266.48 | 312% above | — |
| Total thyroxine (T4) blood test CPT 84436 Thyroxine; total | $280.50 | $280.50 | $5.50–$203.65 | 312% above | — |
| Total triiodothyronine (T3) blood test CPT 84480 T3 TOTAL | $524.25 | $524.25 | $110.09–$498.04 | 394% above | — |
| Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine T3; total (TT-3) | $524.25 | $524.25 | $23.33–$57.65 | 394% above | — |
| Transferrin blood test CPT 84466 Transferrin | $341.25 | $341.25 | $20.99–$51.88 | 114% above | — |
| Transferrin blood test CPT 84466 TRANSFERRIN | $341.25 | $341.25 | $71.66–$324.19 | 114% above | — |
| Trichomonas test (NAAT) CPT 87661 TRICH VAGINALIS AMP PRBE | $262.75 | $262.75 | $55.18–$249.61 | 50% above | — |
| Trichomonas test (NAAT) CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | $262.75 | $262.75 | $57.72–$142.67 | 50% above | — |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES | $291.00 | $291.00 | $61.11–$276.45 | 380% above | — |
| Triglycerides blood test CPT 84478 TRIGLYCERIDES OTHER | $291.00 | $291.00 | $61.11–$276.45 | 380% above | — |
| Troponin test, quantitative CPT 84484 TROPONIN QUANT | $543.25 | $543.25 | $114.08–$516.09 | 334% above | — |
| Troponin test, quantitative CPT 84484 Troponin, quantitative | $543.25 | $543.25 | $20.51–$50.70 | 334% above | — |
| Uric acid blood test CPT 84550 Uric acid; blood | $194.25 | $194.25 | $7.44–$18.38 | 234% above | — |
| Uric acid blood test CPT 84550 URIC ACID BLD | $194.25 | $194.25 | $40.79–$184.54 | 234% above | — |
| Urinalysis with microscope exam, automated CPT 81001 UA W MICRO AUTO | $218.50 | $218.50 | $45.88–$207.57 | 335% above | — |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, w | $218.50 | $218.50 | $5.21–$12.89 | 335% above | — |
| Urinalysis without microscope exam, automated CPT 81003 UA W O MICRO AUTO | $144.25 | $144.25 | $30.29–$137.04 | 467% above | — |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, w | $144.25 | $144.25 | $3.70–$9.15 | 467% above | — |
| Urinalysis without microscope exam, manual CPT 81002 SPEC GRAV UR MANUAL | $48.50 | $48.50 | $10.19–$46.08 | 157% above | — |
| Urinalysis without microscope exam, manual CPT 81002 PROTEIN UR QUAL MAN | $48.50 | $48.50 | $10.19–$46.08 | 157% above | — |
| Urinalysis without microscope exam, manual CPT 81002 ACETONE UA MANUAL | $124.00 | $124.00 | $26.04–$117.80 | 557% above | — |
| Urinalysis without microscope exam, manual CPT 81002 UA W O MICRO MANUAL | $141.75 | $141.75 | $29.77–$134.66 | 651% above | — |
| Urine culture for bacteria, with colony count CPT 87086 CULT COLONY COUNT UR | $239.00 | $239.00 | $50.19–$227.05 | 190% above | — |
| Urine culture for bacteria, with colony count CPT 87086 Culture, bacterial; quantitative colony count, urine | $239.00 | $239.00 | $13.28–$32.81 | 190% above | — |
| Urine microalbumin (albumin) test CPT 82043 Albumin; urine (eg, microalbumin), quantitative | $254.50 | $254.50 | $9.51–$23.50 | 200% above | — |
| Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN QN | $254.50 | $254.50 | $53.45–$241.78 | 200% above | — |
| Urine pregnancy test, read by color change CPT 81025 PREG URINE QUAL BY DOO | $91.75 | $91.75 | $19.27–$87.16 | 149% above | — |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vitamin B-12); | $412.50 | $412.50 | $24.81–$61.31 | 317% above | — |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 | $412.50 | $412.50 | $86.63–$391.88 | 317% above | — |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed | $1,625.75 | $1,625.75 | $48.69–$120.35 | 721% above | — |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D3 25-OH | $1,625.75 | $1,625.75 | $341.41–$1,544.46 | 721% above | — |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 VITAMIN D 1-25 W/WO FRAC | $1,345.25 | $1,345.25 | $282.50–$1,277.99 | 322% above | — |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed | $1,345.25 | $1,345.25 | $63.33–$156.53 | 322% above | — |
| Zinc blood test CPT 84630 ZINC BLOOD | $292.50 | $292.50 | $61.42–$277.88 | 211% above | — |
| Zinc blood test CPT 84630 ZINC URINE | $524.25 | $524.25 | $110.09–$498.04 | 458% above | — |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA QUANTITATIVE | $633.50 | $633.50 | $133.03–$601.83 | 382% above | — |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (hCG); quantitative | $633.50 | $633.50 | $24.76–$61.19 | 382% above | — |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs New Hampshire | Off list |
|---|---|---|---|---|---|
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION EXTERNAL | $3,559.25 | $3,559.25 | $109.98–$3,381.29 | 223% above | — |
| Catheter ablation for atrial fibrillation CPT 93656 COM EP REPO CTH TX AFIB | $113,337.50 | $113,337.50 | $3,502.13–$107,670.63 | 41% above | — |
| Catheter ablation for atrial fibrillation CPT 93656 Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including | $113,337.50 | $113,337.50 | $29,614.00–$54,090.10 | 41% above | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs New Hampshire | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION | $4,873.50 | $4,873.50 | $150.59–$4,629.82 | 497% above | — |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 INH TX AC AWY OBST | $671.25 | $671.25 | $20.74–$637.69 | 418% above | — |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV SING/IN DR 1 HR | $1,320.50 | $1,320.50 | $40.80–$1,254.47 | 132% above | — |
| Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE 1ST 30-74 MINS | $16,022.25 | $16,022.25 | $495.09–$15,221.14 | 665% above | — |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG REC AW & DROWSY | $2,918.25 | $2,918.25 | $90.17–$2,772.34 | 254% above | — |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY | $828.25 | $828.25 | $25.59–$786.84 | 438% above | — |
| Electroconvulsive therapy (ECT), one session CPT 90870 ECT WITH MONITORING | $2,595.50 | $2,595.50 | $80.20–$2,465.72 | at median | — |
| Electroconvulsive therapy (ECT), one session CPT 90870 Electroconvulsive therapy (includes necessary monitoring) | $2,595.50 | $2,595.50 | $1,441.04–$1,441.05 | at median | — |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 LVL 1 EMER DEPT | $202.00 | $202.00 | $6.24–$191.90 | 5% above | — |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 LVL 2 EMER DEPT | $2,162.00 | $2,162.00 | $66.81–$2,053.90 | 651% above | — |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 LVL 3 EMER DEPT | $5,252.75 | $5,252.75 | $162.31–$4,990.11 | 887% above | — |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 LVL 4 EMER DEPT | $7,540.25 | $7,540.25 | $232.99–$7,163.24 | 712% above | — |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 LVL 5 EMER DEPT | $10,475.50 | $10,475.50 | $323.69–$9,951.73 | 704% above | — |
| Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST | $3,525.75 | $3,525.75 | $108.95–$3,349.46 | 317% above | — |
| Family therapy with the patient, 50 minutes CPT 90847 FAM W PT 50 MIN | $1,095.25 | $1,095.25 | $33.84–$1,040.49 | 2% above | — |
| Family therapy without the patient, 50 minutes CPT 90846 FAM WO PT 50 MIN | $1,095.25 | $1,095.25 | $33.84–$1,040.49 | 2% above | — |
| Group psychotherapy session CPT 90853 IOP PSY GRP (NOT FAMILY) | $960.00 | $960.00 | $29.66–$912.00 | 94% above | — |
| Group psychotherapy session CPT 90853 IOP CD GRP (NOT FAMILY) | $960.00 | $960.00 | $29.66–$912.00 | 94% above | — |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INIT UP TO 1HR | $564.50 | $564.50 | $17.44–$536.27 | 69% above | — |
| IV infusion of a medicine, first hour CPT 96365 IV INITIAL UP TO 1 HOUR | $907.25 | $907.25 | $28.03–$861.89 | 169% above | — |
| IV push of a medicine, first drug CPT 96374 IVP SINGLE/INITIAL DRUG | $513.00 | $513.00 | $15.85–$487.35 | 165% above | — |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM OR SQ | $354.00 | $354.00 | $10.94–$336.30 | 314% above | — |
| Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSY DX EVAL | $770.50 | $770.50 | $23.81–$731.98 | 52% above | — |
| New patient office visit, about 30 minutes CPT 99203 OP VISIT LEVEL 3 NP | $826.00 | $826.00 | $25.52–$826.00 | 433% above | — |
| New patient office visit, about 45 minutes CPT 99204 OP VISIT LEVEL 4 NP | $955.25 | $955.25 | $29.52–$955.25 | 347% above | — |
| New patient office visit, about 60 minutes CPT 99205 OP VISIT LEVEL 5 NP | $1,088.25 | $1,088.25 | $33.63–$1,088.25 | 300% above | — |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 BASIC CARE NP | $564.50 | $564.50 | $17.44–$564.50 | 374% above | — |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP VISIT LEVEL 2 NP | $647.50 | $647.50 | $20.01–$647.50 | 444% above | — |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INIT ASSESS EA 15MIN | $78.75 | $78.75 | $2.43–$74.81 | 32% above | — |
| Occupational therapy evaluation, low complexity CPT 97165 Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or | $798.50 | $798.50 | $81.99–$182.72 | 235% above | — |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination | $798.50 | $798.50 | $79.77–$177.76 | 193% above | — |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using st | $798.50 | $798.50 | $79.77–$177.76 | 253% above | — |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination o | $798.50 | $798.50 | $79.77–$177.76 | 230% above | — |
| Psychiatric evaluation with medical services CPT 90792 PSY DX EVAL W/ MED SVC | $1,188.75 | $1,188.75 | $36.73–$1,129.31 | 623% above | — |
| Psychotherapy session, 30 minutes CPT 90832 INDIV SESSION 30MIN | $689.00 | $689.00 | $21.29–$654.55 | 104% above | — |
| Psychotherapy session, 45 minutes CPT 90834 INDIV SESSION 45MIN | $1,029.00 | $1,029.00 | $31.80–$977.55 | 14% above | — |
| Psychotherapy session, 60 minutes CPT 90837 INDIV SESSION 60MIN | $1,332.75 | $1,332.75 | $41.18–$1,266.11 | 98% above | — |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKECESS 3-10 MIN | $86.75 | $86.75 | $2.68–$82.41 | 141% above | — |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP VISIT LEVEL 5 EST | $1,057.25 | $1,057.25 | $32.67–$1,057.25 | 392% above | — |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP VISIT LEVEL 3 EST | $795.75 | $795.75 | $24.59–$795.75 | 760% above | — |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP VISIT LEVEL 4 EST | $929.25 | $929.25 | $28.71–$929.25 | 566% above | — |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP VISIT LEVEL 2 EST | $598.50 | $598.50 | $18.49–$598.50 | 556% above | — |
| Speech and language evaluation CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) | $932.00 | $932.00 | $184.34–$410.81 | 165% above | — |
| Spirometry (breathing test) CPT 94010 SPIROMETRY | $672.75 | $672.75 | $20.79–$639.11 | 242% above | — |
| Spirometry before and after a bronchodilator CPT 94060 BRONCH EV SPIR PRE/POST | $1,184.75 | $1,184.75 | $36.61–$1,125.51 | 248% above | — |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEB | $468.50 | $468.50 | $14.48–$445.07 | 92% above | — |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs New Hampshire | Off list |
|---|---|---|---|---|---|
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella virus vaccine (VAR), live, for subcutaneous use | $1,580.75 | $1,580.75 | $197.14–$594.51 | 230% above | — |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARIVAX LIVE VAC SQ | $1,580.75 | $1,580.75 | $48.85–$1,580.75 | 230% above | — |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 FLUBLOK TRI PF IM | $269.00 | $269.00 | $8.31–$255.55 | 224% above | — |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use | $269.00 | $269.00 | $95.22–$266.85 | 224% above | — |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE TRI 0.5 ML PF IM | $290.50 | $290.50 | $8.98–$275.98 | 991% above | — |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 ENGERIX-B ADULT 20MCG IM | $1,289.50 | $1,289.50 | $39.85–$1,225.03 | 639% above | — |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 RECOMBIVAX ADLT 10MCG IM | $1,289.50 | $1,289.50 | $39.85–$1,225.03 | 639% above | — |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPLISAV-B ADULT IM | $926.75 | $926.75 | $28.64–$880.41 | 173% above | — |
| Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 Hepatitis B vaccine (HepB), CpG-adjuvanted, adult dosage, 2 dose or 4 dose schedule, for intramuscular use | $926.75 | $926.75 | $172.23–$481.98 | 173% above | — |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 ENGERIX-B PED 10MCG IM | $376.50 | $376.50 | $11.63–$357.68 | 143% above | — |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use | $376.50 | $376.50 | $32.20–$90.52 | 143% above | — |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PEDVAXHIB 3 DOSE VAC IM | $417.25 | $417.25 | $12.89–$417.25 | at median | — |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use | $417.25 | $417.25 | $31.59–$97.40 | at median | — |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use | $663.00 | $663.00 | $95.22–$266.85 | 497% above | — |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HD PF IM | $663.00 | $663.00 | $20.49–$629.85 | 497% above | — |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use | $621.75 | $621.75 | $99.45–$294.59 | 472% above | — |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VAC LIVE SQ | $621.75 | $621.75 | $19.21–$621.75 | 472% above | — |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR-13 VAC IM | $2,306.00 | $2,306.00 | $71.26–$2,190.70 | 265% above | — |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use | $2,306.00 | $2,306.00 | $281.36–$700.70 | 265% above | — |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use | $1,169.75 | $1,169.75 | $129.47–$362.31 | 426% above | — |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOVAX 23 VAC IMSQ | $1,169.75 | $1,169.75 | $36.15–$1,111.26 | 426% above | — |
| Rabies vaccine, one dose CPT 90675 IMOVAX 1 ML VAC IM | $1,620.50 | $1,620.50 | $50.07–$1,539.47 | 159% above | — |
| Rabies vaccine, one dose CPT 90675 RABAVERT 1 ML VAC IM | $3,098.50 | $3,098.50 | $95.74–$2,943.57 | 395% above | — |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use | $1,774.25 | $1,774.25 | $221.59–$666.91 | 830% above | — |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGRIX VAC IM | $1,774.25 | $1,774.25 | $54.82–$1,774.25 | 830% above | — |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TENIVAC VAC >= 7 YRS IM | $430.50 | $430.50 | $13.30–$430.50 | 478% above | — |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use | $430.50 | $430.50 | $37.59–$142.07 | 478% above | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX VAC >= 7 YRS IM | $907.25 | $907.25 | $28.03–$907.25 | 1502% above | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL VAC >= 7 YRS IM | $907.25 | $907.25 | $28.03–$907.25 | 1502% above | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZ ADMIN SGL | $85.00 | $85.00 | $2.63–$80.75 | 170% above | — |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZ ADMIN EA ADDTL | $141.75 | $141.75 | $4.38–$141.75 | 336% above | — |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.