Hospital

Graham Regional Medical Center

Graham Regional Medical Center publishes cash prices for 326 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Click a procedure to compare it with other hospitals nearby.

Collected Sep 27, 2026 Source price file

The price file shows no self-pay discount

For 977 of the 977 prices listed here, the cash price in Graham Regional Medical Center's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing. Other US hospitals whose cash price is their full list price.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 * Ankle 3 Views	$97.00	$97.00	$29.00–$208.00	—
Ankle X-ray, complete, 3 or more views CPT 73610 * Ankle 3 Views	$97.00	$97.00	$29.00–$208.00	—
Ankle X-ray, complete, 3 or more views CPT 73610 Ankle3 Views	$146.00	$146.00	$44.00–$256.00	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle 3 Views Rt	$88.00	$88.00	$8.00–$79.00	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 **Ankle, Left 3 Views	$162.00	$162.00	$49.00–$284.00	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 **Ankle, Right 3 Views	$162.00	$162.00	$49.00–$284.00	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle, Left 3 Views	$332.00	$332.00	$100.00–$581.00	—
Ankle X-ray, complete, 3 or more views one side CPT 73610 Ankle, Right 3 Views	$332.00	$332.00	$100.00–$581.00	—
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Upr/l Xtremity Art 2 Levels	$500.00	$500.00	$150.00–$808.00	—
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Scan Whole Body	$1,415.00	$1,415.00	$425.00–$1,274.00	—
Breast ultrasound, complete, one breast both sides CPT 76641 Breast Ultrasound, Bilateral	$860.00	$860.00	$258.00–$1,505.00	—
Breast ultrasound, complete, one breast one side CPT 76641 Breast Ultrasound Left	$130.00	$130.00	$78.00–$117.00	—
Breast ultrasound, complete, one breast one side CPT 76641 Breast Ultrasound, Right	$430.00	$430.00	$129.00–$753.00	—
Breast ultrasound, complete, one breast one side CPT 76641 Breast Ultrasound, Left	$430.00	$430.00	$129.00–$753.00	—
Breast ultrasound, limited (one breast or one area) CPT 76642 Breast Ultra Sound Targeted	$473.00	$473.00	$142.00–$828.00	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 **Cta Chest	$1,100.00	$1,100.00	$330.00–$2,750.00	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Cta Chest	$1,390.00	$1,390.00	$417.00–$3,475.00	—
CT of the heart without contrast dye to measure coronary calcium CPT 75571 Cardiac Calcium Score	$304.00	$304.00	$91.00–$1,405.00	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 **Ct Abdomen/pelvis	$1,100.00	$1,100.00	$330.00–$2,750.00	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 Ct Abdomen/pelvis	$1,274.00	$1,274.00	$382.00–$3,185.00	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast	$1,676.00	$1,676.00	$503.00–$4,190.00	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 **Ct Abdomen/pelvis W/wo Cont	$1,500.00	$1,500.00	$450.00–$3,750.00	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Ct Abdomen/pelvis W/wo Contras	$1,737.00	$1,737.00	$521.00–$4,343.00	—
CT scan of the abdomen with contrast CPT 74160 **Ct Abdomen W/contrast	$1,122.00	$1,122.00	$337.00–$2,805.00	—
CT scan of the abdomen with contrast CPT 74160 Abd With Contrast	$1,265.00	$1,265.00	$380.00–$3,163.00	—
CT scan of the abdomen with contrast CPT 74160 Ct Abdomen W/contrast	$1,300.00	$1,300.00	$390.00–$3,250.00	—
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen	$424.00	$424.00	$54.00–$382.00	—
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen Without Contrast	$825.00	$825.00	$248.00–$2,063.00	—
CT scan of the abdomen without contrast CPT 74150 **Ct Abdomen	$1,054.00	$1,054.00	$316.00–$2,635.00	—
CT scan of the abdomen without contrast CPT 74150 Abd. Without Contrast	$1,054.00	$1,054.00	$316.00–$2,635.00	—
CT scan of the abdomen without contrast CPT 74150 Ct Abdomen W/o Contrast	$1,221.00	$1,221.00	$366.00–$3,053.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinuses	$394.00	$394.00	$39.00–$355.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Sinuses Without Contrast	$1,051.00	$1,051.00	$315.00–$2,628.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 **Ct Sinuses	$1,051.00	$1,051.00	$315.00–$2,628.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Facial Bones	$1,263.00	$1,263.00	$379.00–$3,158.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 **Ct Maxillofacial	$1,263.00	$1,263.00	$379.00–$3,158.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Facial W/o Contrast	$1,462.00	$1,462.00	$439.00–$3,655.00	—
CT scan of the face and sinuses, no contrast dye CPT 70486 Ct Sinuses W/o Contrast	$1,462.00	$1,462.00	$439.00–$3,655.00	—
CT scan of the head or brain, no contrast dye CPT 70450 CT scan	$1,220.00	$1,220.00	$366.00–$3,050.00	—
CT scan of the head with contrast CPT 70460 Ct Head With Contrast	$1,275.00	$1,275.00	$383.00–$3,188.00	—
CT scan of the head with contrast CPT 70460 **Ct Head W/contrast	$1,275.00	$1,275.00	$383.00–$3,188.00	—
CT scan of the head with contrast CPT 70460 Ct Head W/contrast	$1,477.00	$1,477.00	$443.00–$3,693.00	—
CT scan of the head without and with contrast CPT 70470 Ct Head With/without Contrast	$1,111.00	$1,111.00	$333.00–$2,778.00	—
CT scan of the head without and with contrast CPT 70470 **Ct Head W/wo Contrast	$1,311.00	$1,311.00	$393.00–$3,278.00	—
CT scan of the head without and with contrast CPT 70470 Ct Head W/wo Contrast	$1,518.00	$1,518.00	$455.00–$3,795.00	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 **Ct Lumbar Spine	$1,184.00	$1,184.00	$355.00–$2,960.00	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Spine 1 Section-lumbar	$1,184.00	$1,184.00	$355.00–$2,960.00	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 Ct Lumbar Spine W/o Contrast	$1,371.00	$1,371.00	$411.00–$3,428.00	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Cervical Spine W/o Contr.	$1,144.00	$1,144.00	$343.00–$2,860.00	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Spine 1 Section-cervical	$1,181.00	$1,181.00	$354.00–$2,953.00	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 **Ct Cervical Spine	$1,181.00	$1,181.00	$354.00–$2,953.00	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 Ct Cervical Spine W/o Contrast	$1,368.00	$1,368.00	$410.00–$3,420.00	—
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast	$1,462.00	$1,462.00	$439.00–$3,655.00	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 **Carotid Flow Ultrasound	$754.00	$754.00	$226.00–$808.00	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Carotid Flow Study	$754.00	$754.00	$226.00–$808.00	—
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Carotid Flow Ultrasound	$873.00	$873.00	$262.00–$808.00	—
Chest X-ray, 2 views CPT 71046 Chest 2 Views	$304.00	$304.00	$91.00–$532.00	—
Chest X-ray, single view CPT 71045 Chest 1 View	$304.00	$304.00	$91.00–$532.00	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Sonogram Renal Echogram Kidney	$295.00	$295.00	$89.00–$516.00	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Renal Artery Study	$321.00	$321.00	$34.00–$289.00	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Us Adbomen And Retroperitoneum	$667.00	$667.00	$200.00–$1,167.00	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 Bone Density (Dexa) Study	$116.00	$116.00	$9.00–$104.00	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 **Bone Density (Dexa) Study	$308.00	$308.00	$92.00–$539.00	—
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Ob Level 2 Ultrasound	$659.00	$659.00	$198.00–$1,153.00	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Thoracic W/o Contrast	$463.00	$463.00	$49.00–$417.00	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Thorax Without Contrast	$937.00	$937.00	$281.00–$2,343.00	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 **Ct Chest	$937.00	$937.00	$281.00–$2,343.00	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest Without Contrast	$1,078.00	$1,078.00	$323.00–$2,695.00	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest W/o Contrast	$1,085.00	$1,085.00	$326.00–$2,713.00	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 Ct Chest W/o Contrast Low Dose	$1,085.00	$1,085.00	$326.00–$2,713.00	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest With Contrast	$1,178.00	$1,178.00	$353.00–$2,945.00	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Thorax With Contrast	$1,181.00	$1,181.00	$354.00–$2,953.00	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 **Ct Chest W/contrast	$1,181.00	$1,181.00	$354.00–$2,953.00	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 Ct Chest W/contrast	$1,345.00	$1,345.00	$404.00–$3,363.00	—
Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts	$774.00	$774.00	$225.00–$1,355.00	—
Diagnostic mammogram, one breast CPT 77065 Mammography of one breast	$430.00	$430.00	$129.00–$753.00	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Extremity Lower Bilateral Art	$733.00	$733.00	$36.00–$660.00	—
Duplex ultrasound of the leg arteries, both legs CPT 93925 Lower Ext Arteries Bil	$754.00	$754.00	$226.00–$808.00	—
Duplex ultrasound of the leg arteries, both legs CPT 93925 **Extremity, Lower Bil Art	$754.00	$754.00	$226.00–$808.00	—
Duplex ultrasound of the leg arteries, both legs CPT 93925 Extremity, Lower Bil Art	$890.00	$890.00	$267.00–$808.00	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Venous Doppler Ext Bilateral	$1,040.00	$1,040.00	$312.00–$936.00	—
Duplex ultrasound of the leg veins, both legs CPT 93970 Upper Lower Venous Ext Bil	$556.00	$556.00	$32.00–$500.00	—
Duplex ultrasound of the leg veins, both legs CPT 93970 Upper/lower Venous Ext Bil	$760.00	$760.00	$228.00–$808.00	—
Duplex ultrasound of the leg veins, both legs CPT 93970 Extremity Veins Doppler	$815.00	$815.00	$245.00–$808.00	—
Duplex ultrasound of the leg veins, both legs CPT 93970 Lower Ext Venous Doppler Bil	$1,426.00	$1,426.00	$428.00–$1,283.00	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Comp W Spec Doppler & Col	$1,523.00	$1,523.00	$457.00–$1,910.00	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 **Hepatobiliary W/o Cck	$569.00	$569.00	$171.00–$832.00	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary W/o Cck	$1,297.00	$1,297.00	$389.00–$1,167.00	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep Study, Less Than 6 Hrs	$982.00	$982.00	$295.00–$884.00	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Cpap/split	$2,578.00	$2,578.00	$364.00–$2,320.00	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Split Night Npsg Titration	$3,364.00	$3,364.00	$832.00–$3,028.00	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Npsgsplit Titration	$3,895.00	$3,895.00	$832.00–$3,506.00	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Bipap Titration/ Re-titration	$3,895.00	$3,895.00	$832.00–$3,506.00	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Cpap Titration/ Re-titration	$3,895.00	$3,895.00	$832.00–$3,506.00	—
Knee X-ray, 3 views CPT 73562 * Knee 3 Views	$97.00	$97.00	$29.00–$208.00	—
Knee X-ray, 3 views CPT 73562 Kneemultiple Viewsleft	$145.00	$145.00	$44.00–$254.00	—
Knee X-ray, 3 views CPT 73562 Kneemultiple Viewsright	$145.00	$145.00	$44.00–$254.00	—
Knee X-ray, 3 views one side CPT 73562 **Knee, Right Complete	$194.00	$194.00	$58.00–$340.00	—
Knee X-ray, 3 views one side CPT 73562 **Knee, Left Complete	$194.00	$194.00	$58.00–$340.00	—
Knee X-ray, 3 views one side CPT 73562 Knee Complete, Left	$332.00	$332.00	$100.00–$581.00	—
Knee X-ray, 3 views one side CPT 73562 Knee Complete, Right	$332.00	$332.00	$100.00–$581.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 **Pancreas Ultrasound	$245.00	$245.00	$74.00–$429.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Pancreas Sonogram	$245.00	$245.00	$74.00–$429.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Soft Tissue Abdomen Us	$260.00	$260.00	$27.00–$234.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 **Liver Ultrasound	$305.00	$305.00	$92.00–$534.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Liver Sonogram	$305.00	$305.00	$92.00–$534.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 **Soft Tissue Abdomen Us	$308.00	$308.00	$92.00–$539.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Appendix Ultrasound	$320.00	$320.00	$96.00–$560.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Abdominal Limited Ultrasound	$325.00	$325.00	$98.00–$569.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Sonogram Gall Bladder	$326.00	$326.00	$98.00–$571.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 **Gallbladder Ultrasound	$326.00	$326.00	$98.00–$571.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 **Spleen Ultrasound	$326.00	$326.00	$98.00–$571.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasoun Soft Tissue Abdomen	$667.00	$667.00	$200.00–$1,167.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Liver	$667.00	$667.00	$200.00–$1,167.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Gallbladder	$667.00	$667.00	$200.00–$1,167.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Spleen	$667.00	$667.00	$200.00–$1,167.00	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Pancreas	$667.00	$667.00	$200.00–$1,167.00	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Ct Lung Low Dosecancer Screen	$883.00	$883.00	$265.00–$2,208.00	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint	$2,350.00	$2,350.00	$705.00–$5,875.00	—
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Hip With & W/o Contrast	$1,102.00	$1,102.00	$98.00–$992.00	—
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Mri Hip Right With & W/o	$1,737.00	$1,737.00	$521.00–$4,343.00	—
MRI of the abdomen without contrast CPT 74181 **Mri Abdomen W/o Contrast	$1,381.00	$1,381.00	$414.00–$3,453.00	—
MRI of the abdomen without contrast CPT 74181 **Mri Abdomen	$1,381.00	$1,381.00	$414.00–$3,453.00	—
MRI of the abdomen without contrast CPT 74181 Mri Abdomen	$1,600.00	$1,600.00	$480.00–$4,000.00	—
MRI of the abdomen, without and then with contrast dye CPT 74183 Mri Abdomen W/wo Contrast	$2,084.00	$2,084.00	$625.00–$5,210.00	—
MRI of the brain, no contrast dye CPT 70551 Mri Brain W/o Contrast	$647.00	$647.00	$67.00–$582.00	—
MRI of the brain, no contrast dye CPT 70551 Mri Head Without Contrast	$1,040.00	$1,040.00	$312.00–$2,600.00	—
MRI of the brain, no contrast dye CPT 70551 **Mri Brain W/o Contrast	$1,543.00	$1,543.00	$463.00–$3,858.00	—
MRI of the brain, with and without contrast dye CPT 70553 MRI Scan	$2,480.00	$2,480.00	$744.00–$6,200.00	—
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal	$1,792.00	$1,792.00	$538.00–$4,480.00	—
MRI of the lower back, without and then with contrast dye CPT 72158 **Mri Lumbar Spine W/wo Cont	$2,128.00	$2,128.00	$638.00–$5,320.00	—
MRI of the lower back, without and then with contrast dye CPT 72158 Mri Lumbar Spine W/wo Contrast	$2,464.00	$2,464.00	$739.00–$6,160.00	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Spine C&c Thor W/o	$629.00	$629.00	$67.00–$566.00	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 **Mri Spinal C&c Thor W/o	$1,381.00	$1,381.00	$414.00–$3,453.00	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 **Mri Thoracic Spine W/o Cont	$1,381.00	$1,381.00	$414.00–$3,453.00	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Mri Thoracic Spine W/o Contras	$1,600.00	$1,600.00	$480.00–$4,000.00	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri C-spine W/wo Contrast	$1,068.00	$1,068.00	$104.00–$961.00	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Cervical Spine W/wo Contr.	$1,500.00	$1,500.00	$450.00–$3,750.00	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 **Mri Cervical Spine W/wo Cont	$1,902.00	$1,902.00	$571.00–$4,755.00	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 **Mri C-spine W & W/o Contrast	$1,902.00	$1,902.00	$571.00–$4,755.00	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 **Mri C Spine W/wo Contrast	$1,902.00	$1,902.00	$571.00–$4,755.00	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 Mri Cervical Spine W/wo Contra	$2,203.00	$2,203.00	$661.00–$5,508.00	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 **Mri Cervical Spine	$1,546.00	$1,546.00	$464.00–$3,865.00	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 Mri Cervical Spine	$1,791.00	$1,791.00	$537.00–$4,478.00	—
MRI of the pelvis without and with contrast CPT 72197 **Mri Pelvis W/wo Contrast	$1,600.00	$1,600.00	$480.00–$4,000.00	—
MRI of the pelvis without and with contrast CPT 72197 Mri Pelvis W/wo Contrast	$1,853.00	$1,853.00	$556.00–$4,633.00	—
MRI of the pelvis, no contrast dye CPT 72195 **Mri Pelvis W/o Contrast	$1,380.00	$1,380.00	$414.00–$3,450.00	—
MRI of the pelvis, no contrast dye CPT 72195 Mri Pelvis W/o Contrast	$1,598.00	$1,598.00	$479.00–$3,995.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 **Mri Hand Bilateral	$2,030.00	$2,030.00	$609.00–$5,075.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 **Mri Shoulder Bilateral	$2,030.00	$2,030.00	$609.00–$5,075.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 **Mri Elbow Bilateral	$2,030.00	$2,030.00	$609.00–$5,075.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 Mri Hand Bilateral	$2,048.00	$2,048.00	$614.00–$5,120.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 Mri Elbow Bilateral	$2,048.00	$2,048.00	$614.00–$5,120.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye both sides CPT 73221 Mri Shoulder Bilateral	$2,048.00	$2,048.00	$614.00–$5,120.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Any Joint U Ext W/o	$662.00	$662.00	$62.00–$596.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Shoulder	$1,040.00	$1,040.00	$312.00–$2,600.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Mri Elbow	$1,040.00	$1,040.00	$312.00–$2,600.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 **Mri Anj Joint U Ext W/o	$1,381.00	$1,381.00	$414.00–$3,453.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 **Mri Any Joint U Ext W/o	$1,381.00	$1,381.00	$414.00–$3,453.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Hand Left	$662.00	$662.00	$397.00–$596.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Elbow Right	$662.00	$662.00	$397.00–$596.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Elbow Right	$1,015.00	$1,015.00	$305.00–$2,538.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Elbow Left	$1,015.00	$1,015.00	$305.00–$2,538.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Hand Left	$1,015.00	$1,015.00	$305.00–$2,538.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Hand Right	$1,015.00	$1,015.00	$305.00–$2,538.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Shoulder Left	$1,015.00	$1,015.00	$305.00–$2,538.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Shoulder Right	$1,015.00	$1,015.00	$305.00–$2,538.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Upper Ext Joint, Left W/o	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Shoulder Right	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Elbow Left	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Upper Ext Joint, Right W/o	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Hand Right	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mri Shoulder Left	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Mrh Hand Right	$1,024.00	$1,024.00	$307.00–$2,560.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Upper Ext Joint, Right	$1,550.00	$1,550.00	$465.00–$3,875.00	—
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 **Mri Upper Ext Joint, Left	$1,550.00	$1,550.00	$465.00–$3,875.00	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial Per Imaging Multipl	$2,050.00	$2,050.00	$615.00–$1,845.00	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Appendix Ultrasound	$135.00	$135.00	$23.00–$122.00	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 **Appendix Ultrasound	$216.00	$216.00	$65.00–$416.00	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 **Bladder Ultrasound	$216.00	$216.00	$65.00–$416.00	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Bladder Ultrasound	$320.00	$320.00	$96.00–$560.00	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Appendicile Ultrasound	$216.00	$216.00	$65.00–$416.00	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Pelvic Mass Determin Echo	$273.00	$273.00	$82.00–$478.00	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 **Pelvic Ultrasound Non Ob	$273.00	$273.00	$82.00–$478.00	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Pelvic Ultrasound Non Ob	$311.00	$311.00	$32.00–$280.00	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound Pelvic Non Ob	$667.00	$667.00	$200.00–$1,167.00	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound Pelvic Complete	$667.00	$667.00	$200.00–$1,167.00	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Abdomial ultrasound of pregnant uterus	$469.00	$469.00	$141.00–$821.00	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 **Ob Pregnancy 0-14 Wks	$306.00	$306.00	$92.00–$536.00	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Fetal Age Determin Echo	$152.00	$152.00	$46.00–$416.00	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Doppler, Obstetric	$242.00	$242.00	$30.00–$218.00	—
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ultrasound Limited Ob Limited	$667.00	$667.00	$200.00–$1,167.00	—
Screening mammogram, both breasts both sides CPT 77067 Mammography, screening, bilateral	$748.00	$748.00	$224.00–$1,309.00	—
Shoulder X-ray, complete, 2 or more views CPT 73030 * Shoulder 2 Views	$101.00	$101.00	$30.00–$208.00	—
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulderright	$150.00	$150.00	$45.00–$263.00	—
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulderleft	$150.00	$150.00	$45.00–$263.00	—
Shoulder X-ray, complete, 2 or more views CPT 73030 Shoulderbilateral	$300.00	$300.00	$90.00–$525.00	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 **Shoulder, Right 2 Views	$150.00	$150.00	$45.00–$263.00	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 **Shoulder, Left 2 Views	$150.00	$150.00	$45.00–$263.00	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Shoulder 2 Views, Right	$332.00	$332.00	$100.00–$581.00	—
Shoulder X-ray, complete, 2 or more views one side CPT 73030 Shoulder 2 Views, Left	$332.00	$332.00	$100.00–$581.00	—
Sleep study in a lab (polysomnography) CPT 95810 Sleep study	$3,895.00	$3,895.00	$832.00–$3,506.00	—
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Test Echo W/wo Color	$1,598.00	$1,598.00	$479.00–$1,910.00	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 **Modified Barium Swallow	$246.00	$246.00	$74.00–$431.00	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 Modified Barium Swallow	$728.00	$728.00	$208.00–$1,274.00	—
Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina	$524.00	$524.00	$157.00–$917.00	—
Transvaginal ultrasound during pregnancy CPT 76817 **Transvaginal Ob Pelvic Sono	$228.00	$228.00	$68.00–$416.00	—
Transvaginal ultrasound during pregnancy CPT 76817 Transvaginal Ob Pelvic Sono	$278.00	$278.00	$35.00–$250.00	—
Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen	$667.00	$667.00	$200.00–$1,167.00	—
Ultrasound of the scrotum and testicles CPT 76870 Testicular Ultrasound	$191.00	$191.00	$29.00–$172.00	—
Ultrasound of the scrotum and testicles CPT 76870 **Testicular Ultrasound	$304.00	$304.00	$91.00–$532.00	—
Ultrasound of the scrotum and testicles CPT 76870 Ultrasound Testicular	$667.00	$667.00	$200.00–$1,167.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Echo Real Time Scan Comp	$233.00	$233.00	$70.00–$416.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 **Soft Tissue Head Neck Us	$308.00	$308.00	$92.00–$539.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 **Parotid Ultrasound	$308.00	$308.00	$92.00–$539.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Us Soft Tissue Head Neck	$308.00	$308.00	$92.00–$539.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Soft Tissue Ultrasound	$308.00	$308.00	$92.00–$539.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Thyroid Sonogram	$317.00	$317.00	$95.00–$555.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 **Thyroid Ultrasound	$317.00	$317.00	$95.00–$555.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Soft Tissue Head Neck Us	$328.00	$328.00	$26.00–$295.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound Thyroid	$667.00	$667.00	$200.00–$1,167.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultra Sound Soft Tissue Head/n	$667.00	$667.00	$200.00–$1,167.00	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound Parotid	$667.00	$667.00	$200.00–$1,167.00	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 **Upper Gi Series	$301.00	$301.00	$90.00–$527.00	—
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Ugi W/small Bowel X-ray	$525.00	$525.00	$158.00–$919.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 **Venous, Upper Ext, Right	$744.00	$744.00	$223.00–$808.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Upper Ext Venous Doppler Rt	$744.00	$744.00	$223.00–$808.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Lower Ext Venous Doppler Lt	$755.00	$755.00	$227.00–$808.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Lower Ext Venous Doppler Rt	$757.00	$757.00	$227.00–$808.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 **Venous, Lower Ext, Left	$815.00	$815.00	$245.00–$808.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 **Venous, Lower Ext, Right	$815.00	$815.00	$245.00–$808.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Upper Ext Venous Doppler Lt	$917.00	$917.00	$275.00–$825.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 **Venous, Upper Ext, Left	$917.00	$917.00	$275.00–$825.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Lower Ext, Left	$944.00	$944.00	$283.00–$850.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Upper Ext, Left	$944.00	$944.00	$283.00–$850.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Upper Ext, Right	$944.00	$944.00	$283.00–$850.00	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Venous Lower Ext, Right	$944.00	$944.00	$283.00–$850.00	—
Wrist X-ray, complete, 3 or more views CPT 73110 **Wrist 3 Views	$109.00	$109.00	$33.00–$208.00	—
Wrist X-ray, complete, 3 or more views CPT 73110 Wristright	$130.00	$130.00	$39.00–$228.00	—
Wrist X-ray, complete, 3 or more views CPT 73110 Wristleft	$130.00	$130.00	$39.00–$228.00	—
Wrist X-ray, complete, 3 or more views CPT 73110 Wristbilateral	$260.00	$260.00	$78.00–$455.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Wrist 3 Views, Right	$99.00	$99.00	$59.00–$89.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Navicular Series, Right	$99.00	$99.00	$9.00–$89.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 **Wrist, Right 3 Views	$123.00	$123.00	$37.00–$215.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 **Wrist, Left 3 Views	$123.00	$123.00	$37.00–$215.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 **Navicular Series, Right	$135.00	$135.00	$41.00–$236.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 **Navicular Series, Left	$135.00	$135.00	$41.00–$236.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Navicular Series, Left	$249.00	$249.00	$75.00–$436.00	—
Wrist X-ray, complete, 3 or more views one side CPT 73110 Wrist 3 Views, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip 2 Views, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip 2 Views, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of the abdomen, 1 view CPT 74018 Abdomen Lat/decubitus	$249.00	$249.00	$75.00–$436.00	—
X-ray of the abdomen, 1 view CPT 74018 Kub	$249.00	$249.00	$75.00–$436.00	—
X-ray of the abdomen, 1 view CPT 74018 Abdomen 1 View	$249.00	$249.00	$75.00–$436.00	—
X-ray of the ankle, 2 views one side CPT 73600 Ankle, Left 2 Views	$76.00	$76.00	$8.00–$68.00	—
X-ray of the ankle, 2 views one side CPT 73600 Ankle, Right 2 Views	$76.00	$76.00	$46.00–$68.00	—
X-ray of the ankle, 2 views one side CPT 73600 **Ankle, Left 2 Views	$162.00	$162.00	$49.00–$284.00	—
X-ray of the ankle, 2 views one side CPT 73600 **Ankle, Right 2 Views	$162.00	$162.00	$49.00–$284.00	—
X-ray of the ankle, 2 views one side CPT 73600 Ankle 2 Views, Left	$332.00	$332.00	$100.00–$581.00	—
X-ray of the ankle, 2 views one side CPT 73600 Ankle 2 Views, Right	$332.00	$332.00	$100.00–$581.00	—
X-ray of the finger(s), 2 or more views CPT 73140 **Finger 3 Views	$93.00	$93.00	$28.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Fingers, Left	$87.00	$87.00	$7.00–$78.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 **Thumb, Left	$104.00	$104.00	$31.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 **Thumb, Right	$104.00	$104.00	$31.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 **Fingers, Left	$104.00	$104.00	$31.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 **Fingers, Right	$104.00	$104.00	$31.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Finger(s)left Hand	$116.00	$116.00	$35.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Finger(s)right Hand	$116.00	$116.00	$35.00–$208.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Thumb, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Fingers, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of the finger(s), 2 or more views one side CPT 73140 Thumb, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of the foot, 2 views CPT 73620 * Foot 2 Views	$85.00	$85.00	$26.00–$208.00	—
X-ray of the foot, 2 views one side CPT 73620 **Foot 2 Views, Right	$118.00	$118.00	$35.00–$208.00	—
X-ray of the foot, 2 views one side CPT 73620 **Foot, Left 2 Views	$118.00	$118.00	$35.00–$208.00	—
X-ray of the foot, 2 views one side CPT 73620 Foot 2 Views, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of the foot, 2 views one side CPT 73620 Foot 2 Views, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of the foot, complete, 3 or more views CPT 73630 * Foot 3 Views	$92.00	$92.00	$28.00–$208.00	—
X-ray of the foot, complete, 3 or more views CPT 73630 Footright	$139.00	$139.00	$42.00–$243.00	—
X-ray of the foot, complete, 3 or more views CPT 73630 Footleft	$139.00	$139.00	$42.00–$243.00	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 **Foot, Left 3 Views	$153.00	$153.00	$46.00–$268.00	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 **Foot, Right 3 Views	$153.00	$153.00	$46.00–$268.00	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot 3 Views, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of the foot, complete, 3 or more views one side CPT 73630 Foot 3 Views, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of the hand, 3 or more views CPT 73130 * Hand 3 Views	$95.00	$95.00	$29.00–$208.00	—
X-ray of the hand, 3 or more views one side CPT 73130 **Hand, Right 3 Views	$135.00	$135.00	$41.00–$236.00	—
X-ray of the hand, 3 or more views one side CPT 73130 **Hand, Left 3 Views	$135.00	$135.00	$41.00–$236.00	—
X-ray of the hand, 3 or more views one side CPT 73130 Hand 3 Views, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of the hand, 3 or more views one side CPT 73130 Hand 3 Views, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of the knee, 1 or 2 views both sides CPT 73560 Knee 1 Or 2 Views Bilateral	$82.00	$82.00	$49.00–$74.00	—
X-ray of the knee, 1 or 2 views CPT 73560 * Knee 2 Views	$86.00	$86.00	$26.00–$208.00	—
X-ray of the knee, 1 or 2 views CPT 73560 **Knee 1 Or 2 Views Bil	$256.00	$256.00	$77.00–$448.00	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 2 Views, Right	$82.00	$82.00	$8.00–$74.00	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 2 Views, Left	$82.00	$82.00	$49.00–$74.00	—
X-ray of the knee, 1 or 2 views one side CPT 73560 **Knee, Left 2 Views	$128.00	$128.00	$38.00–$224.00	—
X-ray of the knee, 1 or 2 views one side CPT 73560 **Knee, Right 2 Views	$128.00	$128.00	$38.00–$224.00	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 1 Or 2 Views, Right	$249.00	$249.00	$75.00–$436.00	—
X-ray of the knee, 1 or 2 views one side CPT 73560 Knee 1 Or 2 Views, Left	$249.00	$249.00	$75.00–$436.00	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Lumbar Spine 3 Views	$98.00	$98.00	$10.00–$88.00	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 **Lumbar Spine, 3 Views	$135.00	$135.00	$41.00–$236.00	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 **Spine Lumbar 2 Or 3 Views	$153.00	$153.00	$46.00–$268.00	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Lumbar Spine 2 Or 3 Views	$332.00	$332.00	$100.00–$581.00	—
X-ray of the lower back, 4 or more views CPT 72110 X-Ray of lower back	$332.00	$332.00	$100.00–$581.00	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic Spine Ap & Lateral	$88.00	$88.00	$10.00–$79.00	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 **Spine Dorsel 2 Views	$125.00	$125.00	$38.00–$219.00	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 **Thoracic Spine, Ap & Lateral	$152.00	$152.00	$46.00–$266.00	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Thoracic Spine, Ap & Lateral	$332.00	$332.00	$100.00–$581.00	—
X-ray of the nasal bones, 3 or more views CPT 70160 **Nasal Bones	$119.00	$119.00	$36.00–$208.00	—
X-ray of the nasal bones, 3 or more views CPT 70160 Nasal Bones	$249.00	$249.00	$75.00–$436.00	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical Spine, 3 Views	$93.00	$93.00	$10.00–$84.00	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 **Cervical Spine, 3 Views	$141.00	$141.00	$42.00–$247.00	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Cervical Spine, 2-3 Views	$332.00	$332.00	$100.00–$581.00	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Upper Gi W/sbft	$332.00	$332.00	$100.00–$581.00	—
X-ray of the pelvis, 1 or 2 views CPT 72170 **Pelvis	$105.00	$105.00	$32.00–$208.00	—
X-ray of the pelvis, 1 or 2 views CPT 72170 Pelvis	$409.00	$409.00	$123.00–$716.00	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 **Sacrum & Coccyx	$121.00	$121.00	$36.00–$212.00	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 **Coccyx 2 Views	$121.00	$121.00	$36.00–$212.00	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum	$129.00	$129.00	$39.00–$226.00	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum And Coccyx	$150.00	$150.00	$45.00–$263.00	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Optic Foramina	$249.00	$249.00	$75.00–$436.00	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum & Coccyx	$249.00	$249.00	$75.00–$436.00	—

Lab tests

Procedure	Cash price	List price	Insurers pay	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alt/sgpt	$56.00	$56.00	$17.00–$90.00	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast/sgot	$25.00	$25.00	$8.00–$40.00	—
AST (aspartate aminotransferase) enzyme test CPT 84450 Transaminase Sgot	$25.00	$25.00	$8.00–$40.00	—
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Acute Panel	$482.00	$482.00	$145.00–$771.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Latex Allergen	$63.00	$63.00	$19.00–$101.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific Ige Quant	$144.00	$144.00	$43.00–$230.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy,child Food & Environ	$258.00	$258.00	$77.00–$413.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Penicillin Profile 2	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Casein Ige	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pediatric Allergy Panel 14	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Respiratory Allergy Region X	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Eval 10, Southwest	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Dander Allergen	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Latex Specific Ige Panel	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen, Specific	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel, Food	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Tomato Igg	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander (E5) Ige	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 11, Mold Group	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pineapple Ige	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Giant Ragweed (Tall) (W3) Ige	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Gluten Ige Test	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Pork Ige	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Allergy Panel 18, Nut Mix	$348.00	$348.00	$104.00–$557.00	—
Allergy blood test, specific IgE, per allergen CPT 86003 Almond (F20) Ige	$348.00	$348.00	$104.00–$557.00	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Ccp Ab	$184.00	$184.00	$55.00–$294.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 * Antinuclear Ab (Ana)	$31.00	$31.00	$9.00–$50.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies (Ana)	$32.00	$32.00	$10.00–$51.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Centromere Antibody	$32.00	$32.00	$10.00–$51.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana-csf	$32.00	$32.00	$10.00–$51.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies	$38.00	$38.00	$11.00–$61.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Titer	$45.00	$45.00	$14.00–$72.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Ana Profile I (So)	$47.00	$47.00	$14.00–$75.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies Ana	$47.00	$47.00	$14.00–$75.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti-nuclear Antibodies Scree	$58.00	$58.00	$17.00–$93.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Inflamatory Profile Ii	$58.00	$58.00	$17.00–$93.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Lupus Panel	$58.00	$58.00	$17.00–$93.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Anti-nuclear Ab, Screen	$61.00	$61.00	$18.00–$98.00	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 Lupus Panel 12	$136.00	$136.00	$41.00–$218.00	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Cardio Iq St2/nt-probnp	$188.00	$188.00	$56.00–$301.00	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro Bnp,n-terminal	$222.00	$222.00	$67.00–$355.00	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-type Natriuretic Peptide/bnp	$222.00	$222.00	$67.00–$355.00	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro Bnp N Terminal	$222.00	$222.00	$67.00–$355.00	—
Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel	$110.00	$110.00	$33.00–$176.00	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 **Lvliv Surg Path Gross/mic Tc	$191.00	$191.00	$57.00–$306.00	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Lvl Iv Surgical Path Gross/mic	$221.00	$221.00	$66.00–$354.00	—
Blood culture for bacteria CPT 87040 Blood Culture Aerobic Only	$70.00	$70.00	$21.00–$112.00	—
Blood culture for bacteria CPT 87040 Culture Blood	$70.00	$70.00	$21.00–$112.00	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Ycfcvenipuncture	$8.00	$8.00	$2.00–$1,910.00	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ***Jrhcvenipuncture	$10.00	$10.00	$3.00–$1,910.00	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Routine Venipuncture	$12.00	$12.00	$4.00–$19.00	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Tissue Send Out	$12.00	$12.00	$4.00–$19.00	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Lab Referral Fee	$21.00	$21.00	$6.00–$34.00	—
Blood glucose (sugar) test CPT 82947 Glucose, Whole Blood	$16.00	$16.00	$5.00–$26.00	—
Blood glucose (sugar) test CPT 82947 Istat Ec 6+ Panel	$20.00	$20.00	$6.00–$32.00	—
Blood glucose (sugar) test CPT 82947 Istat 6+ Panel	$20.00	$20.00	$6.00–$32.00	—
Blood glucose (sugar) test CPT 82947 Glucose, Urine Quant	$21.00	$21.00	$6.00–$34.00	—
Blood glucose (sugar) test CPT 82947 Glucose,1hr Pp	$29.00	$29.00	$9.00–$46.00	—
Blood glucose (sugar) test CPT 82947 Glucose, 1hr Pp	$34.00	$34.00	$10.00–$54.00	—
Blood glucose (sugar) test CPT 82947 Glucose, Quant Blood	$34.00	$34.00	$10.00–$54.00	—
Blood glucose (sugar) test CPT 82947 Glucose 2hr Pp	$34.00	$34.00	$10.00–$54.00	—
Blood glucose (sugar) test CPT 82947 Glucose, Random	$34.00	$34.00	$10.00–$54.00	—
Blood glucose (sugar) test CPT 82947 Glucose,quantitative; Blood	$34.00	$34.00	$10.00–$54.00	—
Blood glucose (sugar) test CPT 82947 Glucose, Peritoneal	$35.00	$35.00	$11.00–$56.00	—
Blood glucose (sugar) test CPT 82947 Glucose, 2 Hr Pp	$36.00	$36.00	$11.00–$58.00	—
Blood glucose (sugar) test CPT 82947 Glucose, Fasting	$36.00	$36.00	$11.00–$58.00	—
Blood lead test CPT 83655 Lead, Random Urine	$58.00	$58.00	$17.00–$93.00	—
Blood lead test CPT 83655 Lead, Blood	$58.00	$58.00	$17.00–$93.00	—
Blood lead test CPT 83655 Heavy Metals, Urine Screen	$58.00	$58.00	$17.00–$93.00	—
Blood lead test CPT 83655 Lead (Blood) Level	$58.00	$58.00	$17.00–$93.00	—
Blood lead test CPT 83655 Lead, Industrial Exposure Osha	$58.00	$58.00	$17.00–$93.00	—
Blood lead test CPT 83655 Heavy Metal Scr Whole Blood	$94.00	$94.00	$28.00–$150.00	—
Blood lead test CPT 83655 Lead	$107.00	$107.00	$32.00–$171.00	—
Blood lead test CPT 83655 Heavy Metal, Urine	$115.00	$115.00	$35.00–$184.00	—
Blood lead test CPT 83655 Heavy Metal Urine, 24 Hour	$128.00	$128.00	$38.00–$205.00	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Serum	$66.00	$66.00	$20.00–$106.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Component Retyping; Abo	$8.00	$8.00	$2.00–$104.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 **Blood Prod Repeat Type/rh	$9.00	$9.00	$3.00–$14.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 * Patient Blood Type Abo	$15.00	$15.00	$5.00–$104.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 **Blood Typing; Abo	$24.00	$24.00	$7.00–$38.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 * Blood Typing, Abo	$26.00	$26.00	$8.00–$42.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Patient Blood Type, Carters Bb	$266.00	$266.00	$14.00–$239.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Typing	$266.00	$266.00	$80.00–$426.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Abo Group Typing	$296.00	$296.00	$89.00–$474.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Patient Blood Type	$296.00	$296.00	$89.00–$474.00	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing-abo Discrepancy	$296.00	$296.00	$14.00–$266.00	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive Protein	$21.00	$21.00	$6.00–$34.00	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Inflammatory I	$22.00	$22.00	$7.00–$35.00	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Inflamatory Profile Ii	$55.00	$55.00	$17.00–$88.00	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein	$65.00	$65.00	$20.00–$104.00	—
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium Diff Toxin B Pcr	$203.00	$203.00	$61.00–$325.00	—
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Toxin By Pcr	$203.00	$203.00	$61.00–$325.00	—
CA 19-9 blood test (tumor marker) CPT 86301 Ca 19-9, Serum	$100.00	$100.00	$30.00–$160.00	—
CA-125 blood test (ovarian cancer marker) CPT 86304 Ca 125, Serum	$193.00	$193.00	$58.00–$309.00	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Infectious Detection Covid	$244.00	$244.00	$73.00–$390.00	—
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 Sars-cov-2 Rt-pcr	$244.00	$244.00	$73.00–$390.00	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis,amp Prob	$85.00	$85.00	$26.00–$136.00	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Gc/chlamydia Dna Probe, Urine	$167.00	$167.00	$50.00–$267.00	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Gc/chlamydia Rna/tma	$167.00	$167.00	$50.00–$267.00	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Gc Chlam, Sda Urine	$167.00	$167.00	$50.00–$267.00	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Dna Amp	$168.00	$168.00	$50.00–$269.00	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Gc/chlamydia Dna,sda	$168.00	$168.00	$50.00–$269.00	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids	$128.00	$128.00	$38.00–$205.00	—
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (CBC), with differential white blood cells, automated	$57.00	$57.00	$17.00–$91.00	—
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (CBC), automated	$55.00	$55.00	$17.00–$88.00	—
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals	$145.00	$145.00	$44.00–$232.00	—
D-dimer blood test (blood clot marker) CPT 85379 D-dimer, Quantitative	$45.00	$45.00	$14.00–$72.00	—
D-dimer blood test (blood clot marker) CPT 85379 Thrombotic Marker Panel 85379	$119.00	$119.00	$36.00–$190.00	—
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone Sulfate	$329.00	$329.00	$99.00–$526.00	—
Estradiol blood test CPT 82670 Estradiol	$290.00	$290.00	$87.00–$464.00	—
Estradiol blood test CPT 82670 Estradiol, Ultra Sensitive	$290.00	$290.00	$87.00–$464.00	—
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone	$155.00	$155.00	$47.00–$248.00	—
FSH (follicle-stimulating hormone) test CPT 83001 Fsh (Icma) Urine	$155.00	$155.00	$47.00–$248.00	—
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Stool	$224.00	$224.00	$67.00–$358.00	—
Ferritin blood test (iron stores) CPT 82728 Thalassemia & Hemo-comp	$51.00	$51.00	$15.00–$82.00	—
Ferritin blood test (iron stores) CPT 82728 Ferritin	$139.00	$139.00	$42.00–$222.00	—
Ferritin blood test (iron stores) CPT 82728 Gma Ferritin	$139.00	$139.00	$42.00–$222.00	—
Folate (folic acid) blood test CPT 82746 Folic Acid	$92.00	$92.00	$28.00–$147.00	—
Folate (folic acid) blood test CPT 82746 Folate, Serum	$145.00	$145.00	$44.00–$232.00	—
Free T3 thyroid hormone test CPT 84481 Free T3	$252.00	$252.00	$76.00–$403.00	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4,free,direct Analysis	$158.00	$158.00	$47.00–$253.00	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine; Free	$158.00	$158.00	$47.00–$253.00	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4	$158.00	$158.00	$47.00–$253.00	—
Free testosterone test CPT 84402 Testosterone, Total & Free	$122.00	$122.00	$37.00–$195.00	—
Free testosterone test CPT 84402 Testosterone; Free	$199.00	$199.00	$60.00–$318.00	—
Free testosterone test CPT 84402 Testosterone,free,lc/ms/ms	$314.00	$314.00	$94.00–$502.00	—
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Profile	$308.00	$308.00	$92.00–$493.00	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 82950, Exploding Charge	$33.00	$33.00	$10.00–$53.00	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose, 2 Hr	$79.00	$79.00	$24.00–$126.00	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Scrn 1 Hr	$79.00	$79.00	$24.00–$126.00	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Gestational Diabetes Scr Ii	$79.00	$79.00	$24.00–$126.00	—
Glucose tolerance test, 3 samples CPT 82951 Gtt 3 Specimens	$64.00	$64.00	$19.00–$102.00	—
Glucose tolerance test, 3 samples CPT 82951 Gtt 2 Hour	$79.00	$79.00	$24.00–$126.00	—
Glucose tolerance test, 3 samples CPT 82951 Gtt Three Specimens	$83.00	$83.00	$25.00–$133.00	—
Glucose tolerance test, 3 samples CPT 82951 Lactose Tolerance Test, 5 Spc	$85.00	$85.00	$26.00–$136.00	—
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance, 5 Hr	$91.00	$91.00	$27.00–$146.00	—
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance, 4 Hr	$102.00	$102.00	$31.00–$163.00	—
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance Test 6 Hour	$118.00	$118.00	$35.00–$189.00	—
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance, 3 Hr	$118.00	$118.00	$35.00–$189.00	—
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance, 1 Hour	$157.00	$157.00	$47.00–$251.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae Amp Prob	$85.00	$85.00	$26.00–$136.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Sureswab,chlamydia/gc Rna,tma	$160.00	$160.00	$48.00–$256.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc By Dna Amp	$167.00	$167.00	$50.00–$267.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc/chlamydia Dna Probe, Urine	$167.00	$167.00	$50.00–$267.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc Chlam, Sda Urine	$167.00	$167.00	$50.00–$267.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc/chlamydia Rna,tma	$167.00	$167.00	$50.00–$267.00	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Gc/chlamydia Dna,sda	$168.00	$168.00	$50.00–$269.00	—
H. pylori antibody blood test CPT 86677 H. Pylori, Igm Ab	$176.00	$176.00	$53.00–$282.00	—
H. pylori stool antigen test CPT 87338 H. Pylori Ag Stool	$221.00	$221.00	$66.00–$354.00	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Rna By Pcr Quantitative	$366.00	$366.00	$110.00–$586.00	—
HIV-1 and HIV-2 antibody test CPT 86703 Htlvi-ii Antibody	$70.00	$70.00	$21.00–$112.00	—
HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1,2	$121.00	$121.00	$36.00–$194.00	—
HIV-1 and HIV-2 antibody test CPT 86703 Hiv 1,2 Antibody Rapid Test	$123.00	$123.00	$37.00–$197.00	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High-risk Types	$492.00	$492.00	$148.00–$787.00	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin Aic	$60.00	$60.00	$18.00–$96.00	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c	$65.00	$65.00	$20.00–$104.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis Surface Antibody	$29.00	$29.00	$9.00–$46.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Antibody	$40.00	$40.00	$12.00–$64.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 3000419 Exploding Charge	$45.00	$45.00	$14.00–$72.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hbsag+absab+hepc	$51.00	$51.00	$15.00–$82.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Comprehensive Pro	$56.00	$56.00	$17.00–$90.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitus B Surface Ab	$59.00	$59.00	$18.00–$94.00	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab	$59.00	$59.00	$18.00–$94.00	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ab Hbsag	$32.00	$32.00	$10.00–$51.00	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antiben	$41.00	$41.00	$12.00–$66.00	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hbsag+absab+hepc	$50.00	$50.00	$15.00–$80.00	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Antigen	$56.00	$56.00	$17.00–$90.00	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surf Ag	$56.00	$56.00	$17.00–$90.00	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 Haa	$61.00	$61.00	$18.00–$98.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody (Hcv)	$56.00	$56.00	$17.00–$90.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Total Ab	$59.00	$59.00	$18.00–$94.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab	$68.00	$68.00	$20.00–$109.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hep C Ab Test	$68.00	$68.00	$20.00–$109.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab/rflx Hcv Riba	$68.00	$68.00	$20.00–$109.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hbsag+absab+hepc	$69.00	$69.00	$21.00–$110.00	—
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody	$106.00	$106.00	$32.00–$170.00	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C By Pcr	$134.00	$134.00	$40.00–$214.00	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Rna Pcr Quant	$444.00	$444.00	$133.00–$710.00	—
Hepatitis C viral load (HCV RNA) test CPT 87522 Heptimax (R) Hcv Rna	$444.00	$444.00	$133.00–$710.00	—
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1,2 Igm Ab, Ifa	$79.00	$79.00	$24.00–$126.00	—
Herpes blood test, HSV-1 antibody CPT 86695 Herpes, Simplex Type 1	$84.00	$84.00	$25.00–$134.00	—
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Type I	$108.00	$108.00	$32.00–$173.00	—
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1 Igg Herpeselect Sp Ab	$108.00	$108.00	$32.00–$173.00	—
Herpes blood test, HSV-1 antibody CPT 86695 Hsv 1,2 Igg & Igm Ab	$120.00	$120.00	$36.00–$192.00	—
Herpes blood test, HSV-2 antibody CPT 86696 Herpes, Simplex Type 2	$84.00	$84.00	$25.00–$134.00	—
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 1,2 Igm Ab, Ifa	$93.00	$93.00	$28.00–$149.00	—
Herpes blood test, HSV-2 antibody CPT 86696 Hsv 1,2 Igg & Igm Ab	$120.00	$120.00	$36.00–$192.00	—
High-sensitivity CRP (hs-CRP) test CPT 86141 Crp, Ultra Sensitive	$83.00	$83.00	$25.00–$133.00	—
Homocysteine blood test CPT 83090 Homocysteine, Cardiovascular	$204.00	$204.00	$61.00–$326.00	—
Homocysteine blood test CPT 83090 Homocysteine,nutrition/congeni	$204.00	$204.00	$61.00–$326.00	—
Insulin blood test CPT 83525 Insulin, 2 Hour	$131.00	$131.00	$39.00–$210.00	—
Insulin blood test CPT 83525 Insulin	$131.00	$131.00	$39.00–$210.00	—
Insulin blood test CPT 83525 Insulin; Total	$131.00	$131.00	$39.00–$210.00	—
Insulin blood test CPT 83525 Insulin, Serum 4 Samples	$131.00	$131.00	$39.00–$210.00	—
Iron blood test (serum iron) CPT 83540 Iron Send Out	$39.00	$39.00	$12.00–$62.00	—
Iron blood test (serum iron) CPT 83540 Fe & Tibc Send Out	$49.00	$49.00	$15.00–$78.00	—
Iron blood test (serum iron) CPT 83540 Serum Iron	$65.00	$65.00	$20.00–$104.00	—
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Send Out	$39.00	$39.00	$12.00–$62.00	—
Iron-binding capacity (TIBC) test CPT 83550 Fe & Tibc Send Out	$49.00	$49.00	$15.00–$78.00	—
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$101.00	$101.00	$30.00–$162.00	—
Kidney function blood test panel CPT 80069 Kidney function panel test	$196.00	$196.00	$59.00–$314.00	—
LH (luteinizing hormone) test CPT 83002 Lh (Icma) Urine	$162.00	$162.00	$49.00–$259.00	—
LH (luteinizing hormone) test CPT 83002 Lutenizing Hormone	$162.00	$162.00	$49.00–$259.00	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Jp Drainage	$78.00	$78.00	$23.00–$125.00	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, Perfitoneal Fluid	$78.00	$78.00	$23.00–$125.00	—
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$78.00	$78.00	$23.00–$125.00	—
Liver function blood test panel CPT 80076 Liver function blood test	$80.00	$80.00	$24.00–$128.00	—
Lyme disease antibody test CPT 86618 Lyme Antibody, Csf (Ifa)	$200.00	$200.00	$60.00–$320.00	—
Lyme disease antibody test CPT 86618 Borrelia Burgdorferi (Lyme Dis	$200.00	$200.00	$60.00–$320.00	—
Lyme disease antibody test CPT 86618 Lyme Disease Ab	$200.00	$200.00	$60.00–$320.00	—
Lyme disease antibody test CPT 86618 Lyme Disease Ab Index Cns	$210.00	$210.00	$63.00–$336.00	—
Magnesium blood test CPT 83735 Mg 24 Hr Ur W/o Creatinine	$56.00	$56.00	$17.00–$90.00	—
Magnesium blood test CPT 83735 Rbc Magnesium	$56.00	$56.00	$17.00–$90.00	—
Magnesium blood test CPT 83735 Magnesium	$56.00	$56.00	$17.00–$90.00	—
Magnesium blood test CPT 83735 Magnesium,24 Hour Urine	$56.00	$56.00	$17.00–$90.00	—
Measles (rubeola) antibody test CPT 86765 Rubeola Virus Pcr	$98.00	$98.00	$29.00–$157.00	—
Measles (rubeola) antibody test CPT 86765 Measles Ab Igg	$122.00	$122.00	$37.00–$195.00	—
Measles (rubeola) antibody test CPT 86765 Rubeola Igg Antibody	$122.00	$122.00	$37.00–$195.00	—
Measles (rubeola) antibody test CPT 86765 Measles Ab Igg/igm	$122.00	$122.00	$37.00–$195.00	—
Mono test (heterophile antibody, Monospot) CPT 86308 Heterophile,mono Screen	$41.00	$41.00	$12.00–$66.00	—
Obstetric blood test panel CPT 80055 Obstetric blood test panel	$283.00	$283.00	$85.00–$453.00	—
PSA (prostate-specific antigen) blood test, free CPT 84154 Total prostate-specific antigen (PSA) test	$116.00	$116.00	$35.00–$186.00	—
PSA (prostate-specific antigen) blood test, total CPT 84153 Total prostate-specific antigen (PSA) test	$187.00	$187.00	$56.00–$299.00	—
Parathyroid hormone (PTH) blood test CPT 83970 Pth,intact With Calcium	$196.00	$196.00	$59.00–$314.00	—
Parathyroid hormone (PTH) blood test CPT 83970 Pth, N-terminal	$196.00	$196.00	$59.00–$314.00	—
Parathyroid hormone (PTH) blood test CPT 83970 Pth With Calcium	$196.00	$196.00	$59.00–$314.00	—
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Whlmol Se	$196.00	$196.00	$59.00–$314.00	—
Parathyroid hormone (PTH) blood test CPT 83970 Pth, Intact (Irma)	$196.00	$196.00	$59.00–$314.00	—
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test	$247.00	$247.00	$74.00–$395.00	—
Progesterone blood test CPT 84144 Progesterone	$165.00	$165.00	$50.00–$264.00	—
Prolactin blood test CPT 84146 Prolactin	$143.00	$143.00	$43.00–$229.00	—
Prolactin blood test CPT 84146 Prolactin, Diluted	$143.00	$143.00	$43.00–$229.00	—
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time	$125.00	$125.00	$38.00–$200.00	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Opiate,pain Management/confirm	$95.00	$95.00	$29.00–$152.00	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen W/confirm,serum	$152.00	$152.00	$46.00–$243.00	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen,9 Panel,serum	$287.00	$287.00	$86.00–$459.00	—
Rapid flu test (influenza antigen) CPT 87804 Influenza Assay W/optic	$45.00	$45.00	$14.00–$72.00	—
Rapid flu test (influenza antigen) CPT 87804 Influenza A & B Antigen	$92.00	$92.00	$28.00–$147.00	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Ycfcstrep Test	$30.00	$30.00	$9.00–$206.00	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Grp A Strep Screen, Rapid	$61.00	$61.00	$18.00–$98.00	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Dna Amp Probe	$129.00	$129.00	$39.00–$206.00	—
Rheumatoid factor (RF) test CPT 86431 Quanitative	$21.00	$21.00	$6.00–$34.00	—
Rheumatoid factor (RF) test CPT 86431 Inflammatory I	$24.00	$24.00	$7.00–$38.00	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quantitative	$29.00	$29.00	$9.00–$46.00	—
Rheumatoid factor (RF) test CPT 86431 Lupus Panel	$42.00	$42.00	$13.00–$67.00	—
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor, Quantitativ	$50.00	$50.00	$15.00–$80.00	—
Rheumatoid factor (RF) test CPT 86431 Inflamatory Profile Ii	$55.00	$55.00	$17.00–$88.00	—
Rheumatoid factor (RF) test CPT 86431 Lupus Panel 12	$136.00	$136.00	$41.00–$218.00	—
Rubella antibody test (immunity check) CPT 86762 Rubella Igg Antibody	$107.00	$107.00	$32.00–$171.00	—
Stool ova and parasites exam CPT 87177 Ova And Parasites	$42.00	$42.00	$13.00–$67.00	—
Stool ova and parasites exam CPT 87177 Ova & Parasites, Direct, Co	$50.00	$50.00	$15.00–$80.00	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Hemacult	$20.00	$20.00	$6.00–$1,910.00	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool Occult Blood	$20.00	$20.00	$6.00–$32.00	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Ycfchemoccult	$20.00	$20.00	$6.00–$1,910.00	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood, Mcr Screening	$33.00	$33.00	$10.00–$53.00	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 Blood Occult Feces 1-3 De	$33.00	$33.00	$10.00–$53.00	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl, Csf	$47.00	$47.00	$14.00–$75.00	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rpr	$47.00	$47.00	$14.00–$75.00	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl	$47.00	$47.00	$14.00–$75.00	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin	$47.00	$47.00	$14.00–$75.00	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl,csf	$85.00	$85.00	$26.00–$136.00	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb Gold	$361.00	$361.00	$108.00–$578.00	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Quantiferon Tb Gold-incubated	$361.00	$361.00	$108.00–$578.00	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total & Free	$124.00	$124.00	$37.00–$198.00	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Free,bioavail,to	$124.00	$124.00	$37.00–$198.00	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; Total	$199.00	$199.00	$60.00–$318.00	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone,total (Fe & Pedi)	$223.00	$223.00	$67.00–$357.00	—
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total	$223.00	$223.00	$67.00–$357.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Antibodies	$35.00	$35.00	$11.00–$56.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Lupus Panel	$70.00	$70.00	$21.00–$112.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Ab Each	$98.00	$98.00	$29.00–$157.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 3000132 Exploding Charge	$107.00	$107.00	$32.00–$171.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Autoantibody Panel	$120.00	$120.00	$36.00–$192.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase	$127.00	$127.00	$38.00–$203.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver Kidney Microsome Lmk1 Ab	$127.00	$127.00	$38.00–$203.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Anti-microsomal Antibody	$127.00	$127.00	$38.00–$203.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Ab Group, Serum	$130.00	$130.00	$39.00–$208.00	—
Thyroid peroxidase (TPO) antibody test CPT 86376 Lupus Panel 12	$136.00	$136.00	$41.00–$218.00	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH)	$123.00	$123.00	$37.00–$197.00	—
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis,amplifie	$136.00	$136.00	$41.00–$218.00	—
Uric acid blood test CPT 84550 Inflammatory I	$21.00	$21.00	$6.00–$34.00	—
Uric acid blood test CPT 84550 Inflamatory Profile Ii	$55.00	$55.00	$17.00–$88.00	—
Uric acid blood test CPT 84550 Uric Acid; Blood	$56.00	$56.00	$17.00–$90.00	—
Uric acid blood test CPT 84550 Uric Acid, Blood	$56.00	$56.00	$17.00–$90.00	—
Urinalysis with microscope exam, automated CPT 81001 Urinalysis test using microscope	$50.00	$50.00	$15.00–$80.00	—
Urinalysis with microscope exam, manual CPT 81000 Urinalysis test using microscope	$63.00	$63.00	$19.00–$101.00	—
Urinalysis without microscope exam, automated CPT 81003 Urinalysis test	$21.00	$21.00	$6.00–$34.00	—
Urinalysis without microscope exam, manual CPT 81002 Urinalysis test	$62.00	$62.00	$19.00–$99.00	—
Urine culture for bacteria, with colony count CPT 87086 Culture,bacterial Quan Count	$60.00	$60.00	$18.00–$96.00	—
Urine culture for bacteria, with colony count CPT 87086 Urine Culture	$60.00	$60.00	$18.00–$96.00	—
Urine pregnancy test, read by color change CPT 81025 Ycfcpregnancy Test	$40.00	$40.00	$12.00–$104.00	—
Urine pregnancy test, read by color change CPT 81025 Hcg,qualitative Urine	$65.00	$65.00	$20.00–$104.00	—
Vitamin B12 (cobalamin) blood test CPT 82607 B-12	$145.00	$145.00	$44.00–$232.00	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Calcifediol (25 Oh Vit D-3)	$179.00	$179.00	$54.00–$286.00	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vit D, 25-hydroxy	$212.00	$212.00	$64.00–$339.00	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D Panel	$220.00	$220.00	$66.00–$352.00	—
Zinc blood test CPT 84630 Zinc, Plasma	$109.00	$109.00	$33.00–$174.00	—
Zinc blood test CPT 84630 Zinc, Rbc	$109.00	$109.00	$33.00–$174.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin Chorionic Hcg Qt	$36.00	$36.00	$11.00–$58.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Alpha-fetoprotein Quad Marker	$97.00	$97.00	$29.00–$155.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg, Quantitative, Serum	$103.00	$103.00	$31.00–$165.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Alpha-fetoprotein, Penta	$105.00	$105.00	$32.00–$168.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta Hcg Tumor Marker	$162.00	$162.00	$49.00–$259.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg,total With Hama Treatment	$162.00	$162.00	$49.00–$259.00	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta-hcg, Quant	$162.00	$162.00	$49.00–$259.00	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	Off list
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthrs Aid Acl Rpr/agmntj	$31,406.00	$31,406.00	$9,422.00–$94,218.00	—
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscopy Shoulder W Rotator	$21,432.00	$21,432.00	$6,430.00–$64,296.00	—
Botox injections for chronic migraine CPT 64615 Chemus Migraine Botox Inj	$450.00	$450.00	$135.00–$1,350.00	—
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx Breast 1st Lesion Strtctc	$5,181.00	$5,181.00	$1,554.00–$15,543.00	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Clsd Tr Of Distal Fib Fx	$1,032.00	$1,032.00	$310.00–$1,910.00	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed Tx Fracture Metatarsal	$603.00	$603.00	$181.00–$1,910.00	—
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction Of Bunion Meta	$14,372.00	$14,372.00	$4,312.00–$43,116.00	—
Bunion correction with removal of part of the big toe joint CPT 28292 Correct Bunion Sasamoidect	$14,372.00	$14,372.00	$4,312.00–$43,116.00	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 **Cardioversion	$250.00	$250.00	$93.00–$225.00	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 **Er Cardioversion	$1,199.00	$1,199.00	$360.00–$1,910.00	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$2,028.00	$2,028.00	$608.00–$1,910.00	—
Carpal tunnel release, open surgery both sides CPT 64721 Bilat Carpal Tunnel	$10,200.00	$10,200.00	$3,060.00–$30,600.00	—
Carpal tunnel release, open surgery CPT 64721 Carpal Tunnel Release	$7,532.00	$7,532.00	$2,260.00–$22,596.00	—
Cataract surgery with lens implant CPT 66984 Removal of cataract with insertion of lens	$8,908.00	$8,908.00	$2,672.00–$26,724.00	—
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision, Using Clamp	$7,681.00	$7,681.00	$2,304.00–$23,043.00	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed Tx Distal Radial Fx	$603.00	$603.00	$181.00–$1,910.00	—
Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope	$4,164.00	$4,164.00	$1,249.00–$12,492.00	—
Colonoscopy with tissue sample CPT 45380 Biopsy exam of large bowel using an endoscope	$4,166.00	$4,166.00	$1,250.00–$12,498.00	—
Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using an endoscope	$2,940.00	$2,940.00	$882.00–$8,820.00	—
Complex cataract surgery with lens implant CPT 66982 Cataract Surgery Complex	$8,908.00	$8,908.00	$2,672.00–$26,724.00	—
Earwax removal by irrigation (rinsing), one ear CPT 69209 Removal Impacted Cerumen	$196.00	$196.00	$59.00–$1,910.00	—
Earwax removal with instruments, one ear CPT 69210 Ycfccerumen Removal/irrig	$20.00	$20.00	$6.00–$1,910.00	—
Earwax removal with instruments, one ear CPT 69210 **Jrhccerumen Removal/irrig	$30.00	$30.00	$9.00–$1,910.00	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endometrial Biopsy	$158.00	$158.00	$47.00–$1,910.00	—
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Esi Thor L/s W Image	$2,434.00	$2,434.00	$730.00–$7,302.00	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Bil Nerve Block Single L/s Lv	$4,200.00	$4,200.00	$1,260.00–$12,600.00	—
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Nerve Block L/s Single Level	$4,200.00	$4,200.00	$1,260.00–$12,600.00	—
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Ventral Hernia	$18,992.00	$18,992.00	$5,698.00–$56,976.00	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy W Collect	$2,735.00	$2,735.00	$821.00–$8,205.00	—
Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope	$20,475.00	$20,475.00	$6,143.00–$61,425.00	—
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Lap Cholecy W/cholangiography	$20,475.00	$20,475.00	$6,143.00–$61,425.00	—
Hammertoe correction surgery CPT 28285 Repair Of Hammertoe	$9,734.00	$9,734.00	$2,920.00–$29,202.00	—
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy	$750.00	$750.00	$225.00–$2,250.00	—
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy,rubberband In	$1,915.00	$1,915.00	$575.00–$5,745.00	—
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorroidect I&e Sgl Col Grp	$5,759.00	$5,759.00	$1,728.00–$17,277.00	—
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 Total Hip Arthroplasty	$8,230.00	$8,230.00	$2,469.00–$24,690.00	—
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 **Hsg Hysterosalpingogram	$365.00	$365.00	$110.00–$639.00	—
Incision and drainage of a simple or single skin abscess CPT 10060 ***Jrhc Abcess I&d	$65.00	$65.00	$20.00–$2,202.00	—
Incision and drainage of a simple or single skin abscess CPT 10060 I & D Abcess	$536.00	$536.00	$161.00–$2,202.00	—
Incision and drainage of a simple or single skin abscess CPT 10060 Drainage Of Skin Abscess	$734.00	$734.00	$220.00–$2,202.00	—
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia patient age 5 years or older	$11,550.00	$11,550.00	$3,465.00–$34,650.00	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tend Sheath/lig Trgr Pnts	$635.00	$635.00	$191.00–$1,910.00	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Trigger Inj Tend Sheath/lig Tr	$635.00	$635.00	$191.00–$1,910.00	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 **Jrhc-aspiration/inj Lg Joint	$65.00	$65.00	$20.00–$3,201.00	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain/inj Joint/bursa W/o Us	$1,067.00	$1,067.00	$320.00–$3,201.00	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis Asipiration/inj	$1,067.00	$1,067.00	$320.00–$3,201.00	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Intro/removal Major Jnt/bursa	$1,600.00	$1,600.00	$480.00–$3,201.00	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Drain Joint/bursa W/o Us	$1,600.00	$1,600.00	$480.00–$4,800.00	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 **Ycfcaspiration Joint Med	$45.00	$45.00	$14.00–$3,201.00	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Jrhcaspiration Joint Medium	$55.00	$55.00	$17.00–$1,910.00	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/inj Joint/bursa W/o Us	$1,067.00	$1,067.00	$320.00–$3,201.00	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis Aspir&/injectio	$1,131.00	$1,131.00	$339.00–$3,393.00	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Introduction/removal Int Joint	$1,131.00	$1,131.00	$339.00–$3,201.00	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Carpometacarpal Jt Inj	$1,121.00	$1,121.00	$336.00–$3,363.00	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis-small Joint	$1,121.00	$1,121.00	$336.00–$3,363.00	—
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthrs Kne Srg Mnisc Rpr M/l	$13,189.00	$13,189.00	$3,957.00–$39,567.00	—
Knee arthroscopy with meniscus trim CPT 29881 Removal of one knee cartilage using an endoscope	$10,133.00	$10,133.00	$3,040.00–$30,399.00	—
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Meniscectomy Knee	$14,372.00	$14,372.00	$4,312.00–$43,116.00	—
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthrs Knee Surg Dbrdmt/shvg	$9,734.00	$9,734.00	$2,920.00–$29,202.00	—
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopic Appendectomy	$21,705.00	$21,705.00	$6,512.00–$65,115.00	—
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Removal of recurring cataract in lens capsule using laser	$2,159.00	$2,159.00	$648.00–$6,477.00	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair-intermediate 2.5cm/less	$1,006.00	$1,006.00	$302.00–$1,910.00	—
Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s) of therapeutic substance	$2,438.00	$2,438.00	$731.00–$7,314.00	—
Lower-back epidural injection, without imaging guidance CPT 62322 Injection(s) of therapeutic substance	$3,201.00	$3,201.00	$960.00–$9,603.00	—
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s) of anesthetic into lower spine using imaging guidance	$3,363.00	$3,363.00	$1,009.00–$10,089.00	—
Lumbar discectomy or laminotomy to free a nerve root, one level one side CPT 63030 Lamot Dcmprn Nrv Rt 1 Lmbr	$31,406.00	$31,406.00	$9,422.00–$94,218.00	—
Lumbar interbody fusion (PLIF or TLIF), one level CPT 22630 Arthrd Pst Tq 1ntrspc Lum	$43,838.00	$43,838.00	$13,151.00–$131,514.00	—
Lumbar laminectomy (spinal decompression), one level CPT 63047 Lam Facetec & Foramot Lumbar	$31,406.00	$31,406.00	$9,422.00–$94,218.00	—
Lumbar spinal fusion (posterior), one level CPT 22612 Arthrd Pst Tq 1ntrspc Lumbar	$43,838.00	$43,838.00	$13,151.00–$131,514.00	—
Lumpectomy (partial mastectomy) CPT 19301 Mastectomy, Partial	$11,445.00	$11,445.00	$3,434.00–$34,335.00	—
Miscarriage treatment with D&C, first trimester CPT 59820 Treat Missed Abortion	$315.00	$315.00	$95.00–$1,910.00	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 **Jrhc-removal Skin Lesion 0.5	$125.00	$125.00	$38.00–$1,910.00	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc B9+marg 0.5cm Or Less	$1,846.00	$1,846.00	$554.00–$1,910.00	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excision, Other Benign Lesion	$417.00	$417.00	$125.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 Nail Avulsion Ta	$201.00	$201.00	$60.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F3	$368.00	$368.00	$110.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T8	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F7	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F6	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F5	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F4	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F2	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F8	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T6	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T7	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T9	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion F9	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion Fa	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ****Nail Avulsion T1	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T2	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion Ta	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T3	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T4	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 ***Nail Avulsion T5	$442.00	$442.00	$133.00–$1,910.00	—
Nail removal (partial or complete), one nail CPT 11730 Nail Avulsion Simple	$512.00	$512.00	$154.00–$2,202.00	—
Nail removal (partial or complete), one nail CPT 11730 Avulsion Of Nail Plate Prt Com	$624.00	$624.00	$187.00–$2,202.00	—
Nail removal (partial or complete), one nail CPT 11730 Removal Of Nail Plate	$734.00	$734.00	$220.00–$2,202.00	—
Occipital nerve block (injection for headaches) CPT 64405 Injection Occiptal Nerve	$400.00	$400.00	$120.00–$1,200.00	—
Paracentesis with imaging guidance CPT 49083 Paracentesis, Abd W/guidence	$3,037.00	$3,037.00	$911.00–$5,315.00	—
Paracentesis with imaging guidance CPT 49083 Paracentesis	$3,037.00	$3,037.00	$416.00–$5,315.00	—
Partial knee replacement (one compartment) CPT 27446 Arthrp Knee Condyle&plateau Me	$43,838.00	$43,838.00	$13,151.00–$131,514.00	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 **Jrhc-removal Ingrown Toenail	$75.00	$75.00	$23.00–$3,018.00	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Nail Excision Partial/complete	$1,006.00	$1,006.00	$302.00–$3,018.00	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Of Nail & Nail Matrix	$1,006.00	$1,006.00	$302.00–$3,018.00	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Of Nail	$1,169.00	$1,169.00	$351.00–$1,910.00	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Nail&nail Matrix Prtl	$1,199.00	$1,199.00	$360.00–$3,597.00	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Removal Of Nail Bed	$1,412.00	$1,412.00	$424.00–$4,236.00	—
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Lumb/sac Facet Rfa	$6,815.00	$6,815.00	$2,045.00–$20,445.00	—
Removal of a breast lump, open surgery CPT 19120 Removal of one or more breast growth, open procedure	$13,545.00	$13,545.00	$4,064.00–$40,635.00	—
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal Fb	$1,006.00	$1,006.00	$302.00–$1,910.00	—
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Medic Screening Colonoscopy	$3,221.00	$3,221.00	$966.00–$9,663.00	—
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Screening Colonoscopy High Ris	$4,195.00	$4,195.00	$1,259.00–$12,585.00	—
Short arm cast (elbow to hand) CPT 29075 Casts Elbow To Finger Shortarm	$657.00	$657.00	$197.00–$1,910.00	—
Short arm splint (forearm and hand) CPT 29125 **Jrhc-short Arm Splint	$50.00	$50.00	$15.00–$1,910.00	—
Short arm splint (forearm and hand) CPT 29125 Ot App Forearm Splint -Static	$459.00	$459.00	$138.00–$803.00	—
Short arm splint (forearm and hand) CPT 29125 Application Short Arm Splint	$459.00	$459.00	$138.00–$1,910.00	—
Short leg cast (below the knee) CPT 29405 **Jrhc-short Leg Cast	$70.00	$70.00	$21.00–$1,910.00	—
Short leg splint (calf to foot) CPT 29515 **Jrhc-appl Short Leg Splint	$60.00	$60.00	$18.00–$1,910.00	—
Short leg splint (calf to foot) CPT 29515 Application Short Leg Splint	$445.00	$445.00	$134.00–$1,910.00	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Distal Clavical Arthroscopy Sh	$10,763.00	$10,763.00	$3,229.00–$32,289.00	—
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Distal Clavical Sh Arthroscopy	$10,763.00	$10,763.00	$3,229.00–$32,289.00	—
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of shoulder bone using endoscope	$5,011.00	$5,011.00	$1,503.00–$15,033.00	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair-simple 2.5 Cm Or Less	$624.00	$624.00	$187.00–$1,910.00	—
Skin tag removal, up to 15 tags CPT 11200 Removal Skin Tags	$624.00	$624.00	$187.00–$1,910.00	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Puncture,lumbar Diagn	$2,541.00	$2,541.00	$762.00–$2,287.00	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Repair-simple 2.6-7.5 Cm	$624.00	$624.00	$187.00–$1,910.00	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Repair-simple 2.5cm Or Less	$624.00	$624.00	$187.00–$1,910.00	—
Thoracentesis with imaging guidance CPT 32555 Thoracentesis, Needle Or Cathe	$2,251.00	$2,251.00	$675.00–$5,794.00	—
Thoracentesis with imaging guidance CPT 32555 Thoracentesis Procedure	$3,311.00	$3,311.00	$416.00–$5,794.00	—
Total hip replacement CPT 27130 Hip Replacement, Procedure	$39,669.00	$39,669.00	$11,901.00–$119,007.00	—
Total hip replacement CPT 27130 Hip Replacement, Total	$43,838.00	$43,838.00	$13,151.00–$131,514.00	—
Total knee replacement CPT 27447 Knee Replacement, Procedure	$43,838.00	$43,838.00	$13,151.00–$131,514.00	—
Total knee replacement CPT 27447 Knee Replacement, Total	$43,838.00	$43,838.00	$13,151.00–$131,514.00	—
Total shoulder replacement CPT 23472 Total Shoulder Arthroplasty	$39,669.00	$39,669.00	$11,901.00–$119,007.00	—
Total shoulder replacement CPT 23472 Shoulder Arthroplasty Replacem	$52,892.00	$52,892.00	$15,868.00–$158,676.00	—
Trigger finger release surgery CPT 26055 Tendon Sheath Incision	$5,975.00	$5,975.00	$1,793.00–$17,925.00	—
Trigger finger release surgery CPT 26055 Trigger Finger Release	$5,975.00	$5,975.00	$1,793.00–$17,925.00	—
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Single/multi Trigger Pnts	$653.00	$653.00	$196.00–$1,959.00	—
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Tubal Ligation	$17,256.00	$17,256.00	$5,177.00–$51,768.00	—
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx Breast 1st Lesion Us Imag	$5,281.00	$5,281.00	$1,584.00–$15,843.00	—
Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy exam of esophagus, stomach or small bowel using an endoscope	$3,192.00	$3,192.00	$958.00–$9,576.00	—
Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach or small bowel using an endoscope	$2,813.00	$2,813.00	$844.00–$8,439.00	—
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Vasectomy	$7,681.00	$7,681.00	$2,304.00–$23,043.00	—
Wart removal, up to 14 warts CPT 17110 **Jrhc-wart Destruction	$55.00	$55.00	$17.00–$1,910.00	—
Wart removal, up to 14 warts CPT 17110 ***Ycfcwart Destruction	$143.00	$143.00	$43.00–$1,910.00	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement Skin/subcut Tissue	$1,141.00	$1,141.00	$342.00–$3,423.00	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	Off list
Blood transfusion (giving blood or blood components) CPT 36430 * Blood Administration/hour	$70.00	$70.00	$21.00–$104.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Adm 0-1 Hr (Ob)	$159.00	$159.00	$48.00–$143.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Adm 1-2 Hr (Ob)	$212.00	$212.00	$64.00–$191.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 1-2 Hour	$212.00	$212.00	$64.00–$191.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Crna Transfusion Bld/bld Prod	$234.00	$234.00	$70.00–$211.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 2-4 Hr (Ob)	$265.00	$265.00	$80.00–$239.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 2-4 Hour	$265.00	$265.00	$80.00–$239.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 4-6 Hour	$318.00	$318.00	$95.00–$286.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 4-6 Hr (Ob)	$318.00	$318.00	$95.00–$286.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 6-8 Hr (Ob)	$371.00	$371.00	$104.00–$334.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin 6-8 Hour	$371.00	$371.00	$104.00–$334.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Admin > 8 Hour	$477.00	$477.00	$104.00–$429.00	—
Blood transfusion (giving blood or blood components) CPT 36430 **Blood Transfusioned	$781.00	$781.00	$234.00–$1,910.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood/blood Comp Transfusion	$943.00	$943.00	$104.00–$849.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration	$943.00	$943.00	$104.00–$849.00	—
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration Ob	$943.00	$943.00	$104.00–$849.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ycfcinhalation Treatment	$44.00	$44.00	$13.00–$260.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Updraft Treatment(nebulizer)	$195.00	$195.00	$59.00–$260.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhal Txinitl Same Day	$572.00	$572.00	$172.00–$515.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ippb Treatment	$572.00	$572.00	$172.00–$515.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Metered Dose Inhaler Subsq	$572.00	$572.00	$172.00–$515.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Sputum Collection	$572.00	$572.00	$172.00–$515.00	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhal Txsubseq Same Day	$572.00	$572.00	$172.00–$515.00	—
Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy Admin 1st Hour	$223.00	$223.00	$67.00–$562.00	—
Critical care, first 30 to 74 minutes CPT 99291 Critical Care Min 30 Minutes	$786.00	$786.00	$196.00–$707.00	—
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 30-74 Min	$2,893.00	$2,893.00	$868.00–$5,400.00	—
Critical care, first 30 to 74 minutes CPT 99291 Emerg Room Critical Care 30-74	$2,893.00	$2,893.00	$868.00–$5,400.00	—
Critical care, first 30 to 74 minutes CPT 99291 Trauma Team W/o Ntc W/cc	$6,590.00	$6,590.00	$1,910.00–$5,931.00	—
EEG (brain wave test), awake and drowsy, routine CPT 95816 Electroencephalgram	$288.00	$288.00	$86.00–$364.00	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ycfcekg	$65.00	$65.00	$20.00–$208.00	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ***Jrhcekg	$70.00	$70.00	$21.00–$208.00	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg	$274.00	$274.00	$82.00–$247.00	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Room Level 1 W/mod	$182.00	$182.00	$55.00–$1,910.00	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Room Level 1	$258.00	$258.00	$77.00–$1,910.00	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Room Level 2 W/mod	$339.00	$339.00	$102.00–$1,910.00	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Room Level 2	$476.00	$476.00	$143.00–$1,910.00	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Established Pt-intermed	$168.00	$168.00	$68.00–$151.00	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Room Level 3 W/mod	$596.00	$596.00	$179.00–$1,910.00	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Room Level 3	$851.00	$851.00	$255.00–$1,910.00	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Trauma Team W/o Ntc Ed Level 3	$4,548.00	$4,548.00	$1,100.00–$4,093.00	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Trauma Team W/o Ntc Ed Level 4	$5,117.00	$5,117.00	$1,535.00–$4,605.00	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Room Level 5	$2,110.00	$2,110.00	$633.00–$4,850.00	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Trauma Team W/o Ntc Ed Level 5	$5,807.00	$5,807.00	$1,742.00–$5,226.00	—
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular Stress Test	$2,938.00	$2,938.00	$881.00–$2,644.00	—
Family therapy with the patient, 50 minutes CPT 90847 Family psychotherapy, including patient, 50 min	$386.00	$386.00	$116.00–$347.00	—
Group psychotherapy session CPT 90853 Group psychotherapy	$231.00	$231.00	$69.00–$208.00	—
Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 Holter Monitor	$111.00	$111.00	$33.00–$260.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Inf Hydration Up 1 Hr -As	$113.00	$113.00	$34.00–$233.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Inf,hydration Up 1 Hr Nb	$125.00	$125.00	$38.00–$233.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Inf Hydration Up 1 Hr Obs	$125.00	$125.00	$38.00–$233.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initl Avs-ss	$325.00	$325.00	$98.00–$293.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initl Avs-er	$325.00	$325.00	$98.00–$293.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initl 1vs-obs	$325.00	$325.00	$98.00–$293.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initl 1vs-er	$325.00	$325.00	$98.00–$293.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initl Avs-obs	$325.00	$325.00	$98.00–$293.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initl 1vs-ob	$325.00	$325.00	$98.00–$293.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 1st Hr	$377.00	$377.00	$113.00–$339.00	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Iv Hydra 31-90 Initial	$547.00	$547.00	$164.00–$492.00	—
IV infusion of a medicine, first hour CPT 96365 I V Start Up	$67.00	$67.00	$40.00–$86.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Infusioninitial Hr -Nurs	$125.00	$125.00	$38.00–$233.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Infusion Therapy 1 Hour	$167.00	$167.00	$50.00–$233.00	—
IV infusion of a medicine, first hour CPT 96365 Infusion Therapy Initial	$212.00	$212.00	$64.00–$233.00	—
IV infusion of a medicine, first hour CPT 96365 Infusion Therapy Initial (Ob)	$225.00	$225.00	$68.00–$233.00	—
IV infusion of a medicine, first hour CPT 96365 Infusion Therapy Init (Nursery	$250.00	$250.00	$75.00–$233.00	—
IV infusion of a medicine, first hour CPT 96365 **Er Iv Infusion 2nd Line 1s	$439.00	$439.00	$132.00–$1,910.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Iniavs-er	$521.00	$521.00	$156.00–$469.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Ini 1vs-ss	$521.00	$521.00	$156.00–$469.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Iniavs-ss	$521.00	$521.00	$156.00–$469.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Ini 1vs-er	$521.00	$521.00	$156.00–$469.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Iniavs-obs	$521.00	$521.00	$156.00–$469.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Ini 1vs-obs	$521.00	$521.00	$156.00–$469.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-60 Iniavs	$768.00	$768.00	$230.00–$691.00	—
IV infusion of a medicine, first hour CPT 96365 Iv Inf 1stmed16-90 Iniavs	$768.00	$768.00	$230.00–$691.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ***Im/subq Injection	$45.00	$45.00	$14.00–$1,910.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Antiboticnursing	$70.00	$70.00	$21.00–$1,910.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ***Im/sub-q Injection	$117.00	$117.00	$35.00–$1,910.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 **Er Im Inj Each	$117.00	$117.00	$35.00–$1,910.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject Im/sq Only-obs	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject-im/sq Dur Inf-obs	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject-im/sq Dur Infus-er	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject-im/sq Only-ob	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject-im/sq Dur Inf-ss	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject-im/sq Dur Infus-ob	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject-im/sq Only-er	$161.00	$161.00	$48.00–$233.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inject Im/sq Only	$300.00	$300.00	$90.00–$270.00	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Im/sq Injection	$300.00	$300.00	$90.00–$270.00	—
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psychiatric Assessment	$453.00	$453.00	$136.00–$408.00	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuro Re-ed, 2 Units	$145.00	$145.00	$44.00–$254.00	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuro Re-ed 15 Min Ca	$145.00	$145.00	$44.00–$254.00	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuro Re-ed, 3 Units	$145.00	$145.00	$44.00–$254.00	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuro Re-ed, 4 Units	$145.00	$145.00	$44.00–$254.00	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuro Re-ed, 5 Units	$145.00	$145.00	$44.00–$254.00	—
Neuromuscular re-education, 15 minutes CPT 97112 Neuro Re-ed, 6 Units	$145.00	$145.00	$44.00–$254.00	—
Neuromuscular re-education, 15 minutes CPT 97112 O T Neuromuscular Reeducation	$145.00	$145.00	$44.00–$254.00	—
New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit, 30 min	$338.00	$338.00	$101.00–$1,910.00	—
New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit, 45 min	$571.00	$571.00	$171.00–$1,910.00	—
New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit, 60 min	$742.00	$742.00	$223.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Cbe 20 Min New Patient	$74.00	$74.00	$22.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Treatment Room New Pt (Ob)	$90.00	$90.00	$27.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 ***Jrhcov/new Pt Expanded	$97.00	$97.00	$29.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 ***Ycfcov/new Pt Expanded	$103.00	$103.00	$31.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Treatment Roomnew Pt (As)	$221.00	$221.00	$66.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit-new Patient 10min	$221.00	$221.00	$66.00–$1,910.00	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office Visit-new Patient 20min	$221.00	$221.00	$66.00–$1,910.00	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Nutrition Thrpy Inital 15min	$116.00	$116.00	$35.00–$104.00	—
Occupational therapy evaluation, low complexity CPT 97165 Occupational Therapy Evaluatio	$312.00	$312.00	$94.00–$546.00	—
Occupational therapy evaluation, low complexity CPT 97165 Ot Evaluation	$312.00	$312.00	$94.00–$546.00	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval High Complex 45 Min	$383.00	$383.00	$115.00–$670.00	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical Therapy Evaluation	$383.00	$383.00	$115.00–$670.00	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Mod Complex 30 Min	$383.00	$383.00	$115.00–$670.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy	$97.00	$97.00	$29.00–$170.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Myofascial Release 15 Min	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 15 Minutes	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Myofascial Release, 4 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Myofascial Release, 3 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Myofascial Release, 2 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Traction, 2 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Joint Mobilization, 4 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Joint Mobilization, 3 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Joint Mobilization, 2 Units	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Traction 15 Minutes	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Joint Mobilization 15 Min	$120.00	$120.00	$36.00–$210.00	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical therapy, therapeutic exercise	$290.00	$290.00	$87.00–$508.00	—
Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventative medicine evaluation (18-39 years)	$80.00	$80.00	$24.00–$1,910.00	—
Preventive checkup, returning patient aged 18–39 CPT 99395 Ycfcest Patient (18-20 Yrs)	$70.00	$70.00	$21.00–$63.00	—
Preventive checkup, returning patient aged 18–39 CPT 99395 Jrhcest Patient (18-20 Yrs)	$80.00	$80.00	$24.00–$72.00	—
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 min	$457.00	$457.00	$104.00–$411.00	—
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 min	$493.00	$493.00	$148.00–$444.00	—
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 min	$551.00	$551.00	$165.00–$496.00	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 ***Smokin Cessation 3-10 Min	$67.00	$67.00	$20.00–$104.00	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation 3-10 Minutes	$92.00	$92.00	$28.00–$104.00	—
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation 3 To 10 Mins	$92.00	$92.00	$28.00–$104.00	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 **Ycfcov/est/comp	$100.00	$100.00	$30.00–$1,910.00	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ***Jrhcov/est/comp	$125.00	$125.00	$38.00–$1,910.00	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Ycfcextended Physical Exam	$145.00	$145.00	$44.00–$1,910.00	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 *Jrhcextended Physical Exam	$145.00	$145.00	$44.00–$1,910.00	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office Visit-existing Pt 40min	$487.00	$487.00	$146.00–$1,910.00	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Jrhcpre Employment Physical	$65.00	$65.00	$20.00–$1,910.00	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Jrhcov/est/expanded	$87.00	$87.00	$26.00–$1,910.00	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ***Ycfcov/est/expanded	$221.00	$221.00	$66.00–$1,910.00	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Visit-existing Pt 15min	$224.00	$224.00	$67.00–$1,910.00	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Ycfcnursing/sports Physical	$50.00	$50.00	$15.00–$1,910.00	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 **Ycfcov/est/detailed	$90.00	$90.00	$27.00–$1,910.00	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ***Jrhcov/est/detailed	$100.00	$100.00	$30.00–$1,910.00	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office Visit-existing Pt 25min	$344.00	$344.00	$103.00–$1,910.00	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 **Jrhcsports Physical	$25.00	$25.00	$8.00–$1,910.00	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Jrhcsports/camp Physical	$25.00	$25.00	$8.00–$1,910.00	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 **Jrhcov/est/strightforward	$50.00	$50.00	$15.00–$1,910.00	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Ycfcov/est/straightfwd-limi	$50.00	$50.00	$15.00–$1,910.00	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office Visit-existing 10 Min	$70.00	$70.00	$21.00–$1,910.00	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office/outpatient Visit, Est	$100.00	$100.00	$30.00–$104.00	—
Speech and language evaluation CPT 92523 Eval Language Comprehension	$725.00	$725.00	$156.00–$1,269.00	—
Speech therapy session, individual CPT 92507 Speech/language/voice Therapy	$325.00	$325.00	$98.00–$569.00	—
Speech therapy session, individual CPT 92507 Speech Treatment Short Session	$325.00	$325.00	$98.00–$569.00	—
Spirometry (breathing test) CPT 94010 Pulmonary Function W/abg	$212.00	$212.00	$64.00–$260.00	—
Spirometry (breathing test) CPT 94010 Pulmonary Function Screen	$561.00	$561.00	$168.00–$1,910.00	—
Spirometry before and after a bronchodilator CPT 94060 Pulmonary Function Pre/post	$824.00	$824.00	$247.00–$1,910.00	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therap Exe Func Training, 2 Un	$145.00	$145.00	$44.00–$254.00	—
Therapeutic activities (functional training), 15 minutes CPT 97530 O T Therapeutic Activities	$145.00	$145.00	$44.00–$254.00	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therap Exe Funct Training, 4 U	$145.00	$145.00	$44.00–$254.00	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Ther Ex Funct Training 15 Min	$145.00	$145.00	$44.00–$254.00	—
Therapeutic activities (functional training), 15 minutes CPT 97530 Therap Exe Funct Training,3u	$145.00	$145.00	$44.00–$254.00	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$424.00	$424.00	$124.00–$382.00	—

Vaccines

Procedure	Cash price	List price	Insurers pay	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Ycfcvaricella	$198.00	$198.00	$59.00–$178.00	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Ycfcinfluenza Vaccine Adult	$25.00	$25.00	$8.00–$23.00	—
Hepatitis A vaccine, adult dose CPT 90632 Ycfchep A	$66.00	$66.00	$20.00–$59.00	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 Ycfcmmr	$106.00	$106.00	$32.00–$95.00	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Jrhcpneumococcal Vacine	$45.00	$45.00	$14.00–$1,910.00	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Ycfcpneumococcal Vaccine	$45.00	$45.00	$14.00–$1,910.00	—
Rabies vaccine, one dose CPT 90675 Rabies Vaccine Im	$953.00	$953.00	$286.00–$1,910.00	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Ycfcdtap	$75.00	$75.00	$23.00–$2,442.00	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix (Tet,dip,pertus Vacci	$407.00	$407.00	$122.00–$2,442.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Furosemide 40mg Tab	$2.00	$2.00	$1.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Docusate Na 100mg Cap (Colace)	$2.00	$2.00	$1.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Buspirone Hcl 5mg Po	$5.00	$5.00	$2.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 **Ycfcimmunization Admin 1	$5.00	$5.00	$2.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 **Jrhc-immunization Admin 1	$5.00	$5.00	$2.00–$5.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Metformin Hcl 500mg Tab	$5.00	$5.00	$2.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Flagyl *Er 500mg Tab X4	$5.00	$5.00	$2.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Atenolol 25mg Tab Po	$5.00	$5.00	$2.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Famotidine 20mg Tab	$6.00	$6.00	$2.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Nitrofurantoin Macroc 100mg Po	$11.00	$11.00	$3.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Keppra 250mg Tab	$16.00	$16.00	$5.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Colchicine 0.6mg Po	$21.00	$21.00	$6.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Imm/adm/im/subq Vac/tox Single	$56.00	$56.00	$17.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine/toxoid Admin Single	$60.00	$60.00	$18.00–$936.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine-administered	$187.00	$187.00	$24.00–$168.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Vaccine-pneumococcal Admin	$187.00	$187.00	$24.00–$168.00	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Im/subq Inj Tetanussingle	$187.00	$187.00	$24.00–$168.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Folic Acid 1mg Tab	$1.00	$1.00	$1.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Benztropine Mesylate 1mg Po	$2.00	$2.00	$1.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Senna 187mg Tab	$2.00	$2.00	$1.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Demadex 20mg Tab	$3.00	$3.00	$1.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Megace (Megestrol) 40mg Tab	$5.00	$5.00	$2.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Potassium Chl 10meq Tab	$5.00	$5.00	$2.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 *Ycfcimmunization Admin Add	$5.00	$5.00	$2.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 *Jrhcimmunization Admin Add	$5.00	$5.00	$2.00–$5.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Carbidopa/levodopa 25/100 Po	$6.00	$6.00	$2.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Dexamethasone 4mg Tab	$7.00	$7.00	$2.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Diltiazem Hcl 180mg Cap	$10.00	$10.00	$3.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Clonazepam 0.5mg Po	$10.00	$10.00	$3.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Ciprofloxacin 500mg Tab	$18.00	$18.00	$5.00–$42.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine/toxoid Admin Adtl	$60.00	$60.00	$18.00–$54.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 **Im/subq Inj Tetanus -Mul	$81.00	$81.00	$24.00–$73.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Im/subq Inj Vacc/toxoids Multi	$84.00	$84.00	$24.00–$76.00	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Vaccine Each Addtl Admin	$94.00	$94.00	$24.00–$85.00	—

Source file: https://secure.claraprice.net/price-transparency/JXVV-1691592288793/machine-readable/752597537_graham-regional-medical-center_standardcharges.json