Teton Valley Health Care
Teton Valley Health Care in Driggs, ID publishes cash prices for 230 common procedures listed here, from its own machine-readable price file updated Jul 21, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Idaho median for 112 of 230 procedures and above it for 106. By typical cash price it ranks #17 of 22 Idaho hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
120 E Howard St Driggs ID 83422 Collected Sep 27, 2026 Source price file (208) 354-2383
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 131313 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ultrasound study of arm and leg arteries | $544.80 | $681.00 | $10.22–$667.38 | 3% below | 20% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Ultrasound of both sides of head and neck blood flow | $791.20 | $989.00 | $33.06–$969.22 | 31% below | 20% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Ultrasound study of arm or leg veins with compression and maneuvers | $1,076.00 | $1,345.00 | $28.72–$1,318.10 | 12% above | 20% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function | $1,940.00 | $2,425.00 | $60.33–$2,376.50 | 7% above | 20% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Ultrasound of heart with continuous electrocardiogram (ECG) during rest, exercise and/or drug induced stress with review and report | $1,100.00 | $1,375.00 | $72.35–$1,347.50 | 42% below | 20% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Single contrast X-ray of upper digestive tract | $413.60 | $517.00 | $33.35–$506.66 | 24% below | 20% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Ultrasound study of one arm or leg veins with compression and maneuvers | $408.80 | $511.00 | $18.36–$500.78 | 29% below | 20% |
| X-ray of the abdomen, 1 view CPT 74018 X-ray of abdomen, 1 view | $172.80 | $216.00 | $7.65–$211.68 | 14% below | 20% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Liver enzyme (SGPT), level | $44.00 | $55.00 | $2.92–$53.35 | 66% above | 20% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Liver enzyme (SGOT), level | $43.20 | $54.00 | $2.80–$52.38 | 34% above | 20% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel | $193.60 | $242.00 | $42.87–$234.74 | 11% below | 20% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Measurement of antibody (IgE) to allergic substance, crude allergen extract, each | $40.00 | $50.00 | $2.61–$48.50 | 78% above | 20% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Measurement of antibody for rheumatoid arthritis assessment | $83.20 | $104.00 | $11.66–$100.88 | 34% above | 20% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Screening test for autoimmune disorder | $75.20 | $94.00 | $10.88–$91.18 | 39% above | 20% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide (heart and blood vessel protein) level | $188.00 | $235.00 | $35.33–$227.95 | 12% above | 20% |
| Basic metabolic panel (blood test) CPT 80048 Blood test, basic group of blood chemicals (Calcium, total) | $83.20 | $104.00 | $7.61–$100.88 | 98% above | 20% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology examination of tissue using a microscope, intermediate complexity | $380.00 | $475.00 | $32.23–$465.50 | 60% above | 20% |
| Blood culture for bacteria CPT 87040 Bacterial blood culture | $141.60 | $177.00 | $9.29–$171.69 | 31% above | 20% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insertion of needle into vein for collection of blood sample | $43.20 | $54.00 | $2.70–$52.92 | 92% above | 20% |
| Blood glucose (sugar) test CPT 82947 Blood glucose (sugar) level | $37.60 | $47.00 | $1.85–$45.59 | 48% above | 20% |
| Blood lead test CPT 83655 Lead level | $86.40 | $108.00 | $10.90–$104.76 | 56% above | 20% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin (reproductive hormone) analysis | $70.40 | $88.00 | $6.62–$85.36 | 53% above | 20% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood group typing (ABO) | $52.80 | $66.00 | $1.97–$64.02 | 13% above | 20% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Measurement C-reactive protein for detection of infection or inflammation | $96.80 | $121.00 | $4.66–$117.37 | 122% above | 20% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Detection test by nucleic acid for clostridium difficile, amplified probe technique | $190.40 | $238.00 | $33.54–$230.86 | 15% above | 20% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9 | $104.00 | $130.00 | $18.73–$126.10 | 8% above | 20% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunologic analysis for detection of tumor antigen, quantitative; CA 125 | $58.40 | $73.00 | $15.19–$70.81 | 38% below | 20% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen | $70.90 | $88.62 | $41.65–$85.96 | 24% below | 20% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | $110.40 | $138.00 | $31.58–$133.86 | 3% below | 20% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $78.40 | $98.00 | $12.05–$95.06 | 45% above | 20% |
| Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $66.40 | $83.00 | $6.45–$80.51 | 70% above | 20% |
| Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test | $59.20 | $74.00 | $4.79–$71.78 | 82% above | 20% |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals | $103.20 | $129.00 | $9.50–$125.13 | 83% above | 20% |
| D-dimer blood test (blood clot marker) CPT 85379 Coagulation function measurement, D-dimer; quantitative | $93.60 | $117.00 | $9.16–$113.49 | at median | 20% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone (DHEA-S) hormone level | $100.00 | $125.00 | $20.01–$121.25 | 6% above | 20% |
| Estradiol blood test CPT 82670 Measurement of total estradiol (hormone) | $140.00 | $175.00 | $25.15–$169.75 | 4% above | 20% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin, follicle stimulating (reproductive hormone) level | $128.80 | $161.00 | $16.72–$156.17 | 23% above | 20% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Stool calprotectin (protein) level | $215.20 | $269.00 | $17.67–$260.93 | 60% above | 20% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin (blood protein) level | $72.80 | $91.00 | $12.27–$88.27 | 7% above | 20% |
| Folate (folic acid) blood test CPT 82746 Folic acid level, serum | $91.20 | $114.00 | $13.23–$110.58 | 25% above | 20% |
| Free T3 thyroid hormone test CPT 84481 Thyroid hormone, T3 measurement, free | $86.40 | $108.00 | $15.25–$104.76 | 30% above | 20% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (thyroid chemical), free | $66.40 | $83.00 | $7.49–$80.51 | 54% above | 20% |
| Free testosterone test CPT 84402 Testosterone (hormone) level, free | $107.20 | $134.00 | $22.92–$129.98 | 25% above | 20% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel | $160.00 | $200.00 | $94.00–$196.00 | 13% below | 20% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Blood glucose (sugar) level after receiving dose of glucose | $40.80 | $51.00 | $2.42–$49.47 | 46% above | 20% |
| Glucose tolerance test, 3 samples CPT 82951 Blood glucose (sugar) tolerance test, 3 specimens | $84.00 | $105.00 | $11.58–$101.85 | 17% above | 20% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | $98.40 | $123.00 | $31.58–$119.31 | 6% below | 20% |
| H. pylori antibody blood test CPT 86677 Analysis for antibody to Helicobacter pylori (gastrointestinal bacteria) | $88.80 | $111.00 | $15.17–$107.67 | 13% below | 20% |
| H. pylori stool antigen test CPT 87338 Detection test by immunoassay technique for Helicobacter pylori (GI tract bacteria) in stool | $123.20 | $154.00 | $12.94–$149.38 | 44% above | 20% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Detection test by nucleic acid for HIV-1 virus, quantification | $71.20 | $89.00 | $41.83–$86.33 | 82% below | 20% |
| HIV-1 and HIV-2 antibody test CPT 86703 Analysis for antibody to HIV-1 and HIV-2 virus | $88.00 | $110.00 | $12.34–$106.70 | 17% below | 20% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Detection test by nucleic acid for Human Papillomavirus (HPV), high-risk types | $107.20 | $134.00 | $31.58–$129.98 | 19% above | 20% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C level | $55.20 | $69.00 | $6.70–$66.93 | 28% above | 20% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody measurement | $84.80 | $106.00 | $9.67–$102.82 | 69% above | 20% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Detection test by immunoassay technique for hepatitis B surface antigen | $66.40 | $83.00 | $8.57–$80.51 | 36% above | 20% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody measurement | $110.40 | $138.00 | $12.84–$133.86 | 65% above | 20% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Detection test by nucleic acid for Hepatitis C virus, quantification | $232.00 | $290.00 | $38.56–$281.30 | 6% above | 20% |
| Herpes blood test, HSV-1 antibody CPT 86695 Analysis for antibody to Herpes simplex virus, type 1 | $39.20 | $49.00 | $6.46–$47.53 | 2% below | 20% |
| Herpes blood test, HSV-2 antibody CPT 86696 Analysis for antibody to Herpes simplex virus, type 2 | $99.20 | $124.00 | $17.42–$120.28 | 47% above | 20% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 Measurement C-reactive protein for detection of infection or inflammation, high sensitivity | $83.20 | $104.00 | $11.66–$100.88 | 33% above | 20% |
| Homocysteine blood test CPT 83090 Homocysteine (amino acid) level | $84.00 | $105.00 | $16.13–$101.85 | 5% above | 20% |
| Insulin blood test CPT 83525 Insulin measurement, total | $70.40 | $88.00 | $10.06–$85.36 | 15% above | 20% |
| Iron blood test (serum iron) CPT 83540 Iron level | $44.00 | $55.00 | $3.56–$53.35 | 40% above | 20% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $43.20 | $54.00 | $4.72–$52.38 | 1% below | 20% |
| Kidney function blood test panel CPT 80069 Kidney function blood test panel | $77.60 | $97.00 | $7.81–$94.09 | 29% above | 20% |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin, luteinizing (reproductive hormone) level | $109.60 | $137.00 | $16.67–$132.89 | 34% above | 20% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase (fat enzyme) level | $69.60 | $87.00 | $5.99–$84.39 | 12% above | 20% |
| Liver function blood test panel CPT 80076 Liver function blood test panel | $72.80 | $91.00 | $7.35–$88.27 | 57% above | 20% |
| Lyme disease antibody test CPT 86618 Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria) | $122.40 | $153.00 | $15.33–$148.41 | 50% above | 20% |
| Magnesium blood test CPT 83735 Magnesium level | $51.20 | $64.00 | $4.29–$62.08 | 16% above | 20% |
| Measles (rubeola) antibody test CPT 86765 Analysis for antibody to Rubeola (measles virus) | $112.00 | $140.00 | $11.59–$135.80 | 94% above | 20% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Screening test for mononucleosis (mono) | $58.40 | $73.00 | $3.78–$70.81 | 27% above | 20% |
| Obstetric blood test panel CPT 80055 Obstetric blood test panel | $196.00 | $245.00 | $43.03–$237.65 | 12% below | 20% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free | $99.20 | $124.00 | $16.55–$120.28 | 21% above | 20% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total | $103.20 | $129.00 | $16.55–$125.13 | 15% above | 20% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap test, automated thin layer preparation; automated system and manual rescreening | $96.80 | $121.00 | $23.95–$117.37 | 10% below | 20% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap test, manual screening | $88.00 | $110.00 | $18.23–$106.70 | 2% below | 20% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) level | $76.00 | $95.00 | $37.15–$92.15 | 59% below | 20% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood | $64.00 | $80.00 | $4.81–$77.60 | 34% above | 20% |
| Progesterone blood test CPT 84144 Progesterone (reproductive hormone) level | $127.20 | $159.00 | $18.77–$154.23 | 27% above | 20% |
| Prolactin blood test CPT 84146 Prolactin (milk producing hormone) level | $47.20 | $59.00 | $11.43–$57.23 | 39% below | 20% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $40.80 | $51.00 | $2.19–$49.47 | 62% above | 20% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Testing for presence of drug, read by direct observation | $63.20 | $79.00 | $9.95–$76.63 | 5% above | 20% |
| Rapid flu test (influenza antigen) CPT 87804 Detection test by immunoassay with direct visual observation for influenza virus | $64.00 | $80.00 | $13.24–$77.60 | at median | 20% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Detection test by immunoassay with direct visual observation for Streptococcus, group A (strep) | $32.80 | $41.00 | $6.78–$39.77 | 47% below | 20% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor level | $112.00 | $140.00 | $5.10–$135.80 | 275% above | 20% |
| Rubella antibody test (immunity check) CPT 86762 Analysis for antibody to Rubella (German measles virus) | $73.60 | $92.00 | $12.95–$89.24 | 42% above | 20% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen evaluation volume, sperm count, motility and analysis | $20.80 | $26.00 | $3.20–$25.22 | 78% below | 20% |
| Stool ova and parasites exam CPT 87177 Smear for parasites | $60.00 | $75.00 | $6.68–$72.75 | 35% above | 20% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool analysis for blood to screen for colon tumors | $28.00 | $35.00 | $1.53–$33.95 | 47% above | 20% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Stool analysis for blood, by fecal hemoglobin determination by immunoassay | $79.20 | $99.00 | $14.33–$96.03 | 12% above | 20% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis detection test | $140.80 | $176.00 | $3.84–$170.72 | 401% above | 20% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, gamma interferon | $80.80 | $101.00 | $47.47–$97.97 | 65% below | 20% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone (hormone) level, total | $119.20 | $149.00 | $23.23–$144.53 | 4% above | 20% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (autoantibody) measurement | $89.60 | $112.00 | $13.10–$108.64 | 26% above | 20% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $88.00 | $110.00 | $15.12–$106.70 | 15% above | 20% |
| Trichomonas test (NAAT) CPT 87661 Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique | $151.20 | $189.00 | $31.58–$183.33 | 29% above | 20% |
| Uric acid blood test CPT 84550 Uric acid level, blood | $38.40 | $48.00 | $2.17–$46.56 | 55% above | 20% |
| Urinalysis with microscope exam, automated CPT 81001 Manual urinalysis test with examination using microscope, automated | $41.60 | $52.00 | $1.65–$50.44 | 164% above | 20% |
| Urinalysis with microscope exam, manual CPT 81000 Manual urinalysis test with examination using microscope, non-automated | $36.80 | $46.00 | $1.85–$44.62 | 26% above | 20% |
| Urinalysis without microscope exam, automated CPT 81003 Automated urinalysis test | $14.40 | $18.00 | $0.41–$17.46 | 13% above | 20% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, manual test | $26.40 | $33.00 | $1.15–$32.01 | 56% above | 20% |
| Urine culture for bacteria, with colony count CPT 87086 Bacterial colony count, urine | $61.60 | $77.00 | $6.21–$74.69 | 17% above | 20% |
| Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test | $50.40 | $63.00 | $5.42–$61.11 | 33% above | 20% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (vitamin B-12) level | $88.80 | $111.00 | $13.57–$107.67 | 21% above | 20% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D-3 level | $160.80 | $201.00 | $26.64–$194.97 | 92% above | 20% |
| Zinc blood test CPT 84630 Zinc level | $73.60 | $92.00 | $10.25–$89.24 | 9% above | 20% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (reproductive hormone) level | $104.00 | $130.00 | $13.55–$126.10 | 27% above | 20% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| Appendectomy, open surgery CPT 44950 Removal of appendix | $1,155.20 | $1,444.00 | $487.95–$1,723.16 | 54% below | 20% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Repair of anterior cruciate ligament of knee using an endoscope | $1,784.00 | $2,230.00 | $753.80–$2,408.62 | 85% below | 20% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Repair of shoulder rotator cuff using an endoscope | $1,954.40 | $2,443.00 | $826.20–$2,628.90 | 84% below | 20% |
| Botox injections for chronic migraine CPT 64615 Injection of chemical for paralysis of facial and neck nerve muscles on both sides of face | $349.60 | $437.00 | $123.85–$423.89 | 45% below | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed treatment of broken outside lower leg bone at ankle | $331.24 | $414.05 | $190.46–$2,120.00 | 12% below | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed treatment of broken outside lower leg bone at ankle | $544.80 | $681.00 | $251.61–$685.21 | 45% above | 20% |
| Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 Closed treatment of broken outside lower leg bone at ankle | $331.24 | $414.05 | $190.46–$2,120.00 | — | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment of broken bone in forefoot or midfoot | $220.04 | $275.05 | $126.52–$2,120.00 | 38% below | 20% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment of broken bone in forefoot or midfoot | $389.60 | $487.00 | $174.54–$487.00 | 9% above | 20% |
| Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 Closed treatment of broken bone in forefoot or midfoot | $220.04 | $275.05 | $126.52–$2,120.00 | — | 20% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction of bunion with alignment correction of midfoot bone toward toe area | $966.40 | $1,208.00 | $454.81–$1,990.99 | 84% below | 20% |
| Bunion correction with removal of part of the big toe joint CPT 28292 Correction of bunion | $913.60 | $1,142.00 | $430.86–$1,588.68 | 87% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat | $240.00 | $300.00 | $90.24–$300.00 | 84% below | 20% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat | $1,589.60 | $1,987.00 | $131.30–$2,120.00 | 8% above | 20% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 External shock to heart to regulate heart beat | $1,589.60 | $1,987.00 | $131.30–$2,120.00 | — | 20% |
| Carpal tunnel release, open surgery CPT 64721 Release and/or relocation of hand nerve | $808.80 | $1,011.00 | $348.58–$1,011.00 | 70% below | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation | $351.20 | $439.00 | $201.94–$2,120.00 | 4% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation | $616.00 | $770.00 | $273.71–$770.00 | 83% above | 20% |
| Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation | $351.20 | $439.00 | $201.94–$2,120.00 | — | 20% |
| Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical snare | $464.00 | $580.00 | $209.88–$925.54 | 81% below | 20% |
| Colonoscopy with tissue sample CPT 45380 Biopsy of large bowel using a flexible endoscope | $366.40 | $458.00 | $166.48–$886.10 | 86% below | 20% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using a flexible endoscope | $336.80 | $421.00 | $153.87–$688.13 | 87% below | 20% |
| Earwax removal with instruments, one ear CPT 69210 Removal of impacted ear wax | $60.00 | $75.00 | $25.42–$95.00 | 25% below | 20% |
| Earwax removal with instruments, one ear CPT 69210 Removal of impacted ear wax | $62.40 | $78.00 | $35.88–$2,120.00 | 22% below | 20% |
| Earwax removal with instruments, one ear inpatient CPT 69210 Removal of impacted ear wax | $62.40 | $78.00 | $35.88–$2,120.00 | — | 20% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection of substance into middle or upper spine canal using imaging guidance | $796.80 | $996.00 | $220.93–$966.12 | 54% below | 20% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection of lower or sacral spine facet joint using imaging guidance, single level | $1,032.80 | $1,291.00 | $146.39–$1,252.27 | at median | 20% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Initial repair of sliding hernia of abdomen, 3-10 cm in length | $1,023.20 | $1,279.00 | $432.27–$1,279.00 | 91% below | 20% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 Initial repair of sliding hernia of abdomen, more than 10 cm in length | $1,377.60 | $1,722.00 | $583.37–$1,722.00 | 91% below | 20% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Initial repair of sliding hernia of abdomen, less than 3 cm in length | $612.00 | $765.00 | $258.59–$765.00 | 93% below | 20% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic exam of lower portion of large bowel using a flexible endoscope | $1,050.40 | $1,313.00 | $156.51–$1,286.74 | 4% above | 20% |
| Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope | $1,189.60 | $1,487.00 | $503.24–$1,765.48 | 90% below | 20% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Removal of gallbladder with X-ray study of bile ducts using an endoscope | $1,292.80 | $1,616.00 | $546.84–$1,921.88 | 86% below | 20% |
| Hammertoe correction surgery CPT 28285 Correction of toe joint deformity | $725.60 | $907.00 | $346.48–$1,177.25 | 73% below | 20% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Removal of external hemorrhoids by rubber banding | $701.60 | $877.00 | $239.34–$859.46 | at median | 20% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Removal of single external and internal hemorrhoid group | $650.40 | $813.00 | $322.00–$1,086.98 | 77% below | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Simple or single drainage of skin abscess | $224.80 | $281.00 | $103.74–$2,120.00 | at median | 20% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Simple or single drainage of skin abscess | $224.80 | $281.00 | $103.74–$272.57 | at median | 20% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Simple or single drainage of skin abscess | $224.80 | $281.00 | $103.74–$2,120.00 | — | 20% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia (5 years or older) | $942.28 | $1,177.85 | $400.10–$1,395.64 | 85% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection into tendon or ligament | $82.40 | $103.00 | $47.38–$99.91 | 62% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection into tendon or ligament | $91.20 | $114.00 | $47.87–$2,120.00 | 58% below | 20% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection into tendon or ligament | $91.20 | $114.00 | $47.87–$2,120.00 | — | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspiration and/or injection of fluid from large joint | $474.40 | $593.00 | $53.75–$2,120.00 | 56% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspiration and/or injection of fluid from large joint | $474.40 | $593.00 | $53.75–$575.21 | 56% above | 20% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Aspiration and/or injection of fluid from large joint | $474.40 | $593.00 | $53.75–$2,120.00 | — | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium joint | $278.40 | $348.00 | $45.57–$337.56 | 17% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium joint | $278.40 | $348.00 | $45.57–$2,120.00 | 17% below | 20% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Aspiration and/or injection of fluid from medium joint | $278.40 | $348.00 | $45.57–$2,120.00 | — | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration and/or injection of fluid from small joint | $288.80 | $361.00 | $44.12–$2,120.00 | at median | 20% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration and/or injection of fluid from small joint | $288.80 | $361.00 | $44.12–$350.17 | at median | 20% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Aspiration and/or injection of fluid from small joint | $288.80 | $361.00 | $44.12–$2,120.00 | — | 20% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Repair of inside or outside knee joint cartilage using an endoscope | $1,267.20 | $1,584.00 | $536.25–$1,699.30 | 82% below | 20% |
| Knee arthroscopy with meniscus trim CPT 29881 Removal of knee cartilage using an endoscope | $999.20 | $1,249.00 | $422.98–$1,326.78 | 85% below | 20% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Removal of both knee cartilages using an endoscope | $1,036.00 | $1,295.00 | $438.62–$1,376.96 | 85% below | 20% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Removal or shaving of knee joint cartilage using an endoscope | $923.20 | $1,154.00 | $484.52–$1,523.25 | 87% below | 20% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Removal of appendix using an endoscope | $1,089.24 | $1,361.55 | $459.57–$1,609.08 | 83% below | 20% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Repair of groin hernia using an endoscope | $784.00 | $980.00 | $331.97–$1,150.00 | 94% below | 20% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Repair of recurrent groin hernia using an endoscope | $1,023.20 | $1,279.00 | $432.55–$1,497.76 | 93% below | 20% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Removal of ovaries and/or tubes using an endoscope | $1,200.00 | $1,500.00 | $503.96–$1,500.00 | 85% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less | $279.20 | $349.00 | $124.38–$424.82 | 13% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less | $308.00 | $385.00 | $177.10–$2,120.00 | 4% below | 20% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less | $308.00 | $385.00 | $177.10–$2,120.00 | — | 20% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection of substance into lower spine canal using imaging guidance | $796.80 | $996.00 | $217.49–$966.12 | 37% below | 20% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection of substance into lower spine canal | $796.80 | $996.00 | $117.11–$966.12 | 31% below | 20% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | $1,064.00 | $1,330.00 | $207.77–$1,290.10 | 39% below | 20% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment | $838.40 | $1,048.00 | $482.08–$1,027.04 | 94% below | 20% |
| Lumpectomy (partial mastectomy) CPT 19301 Partial removal of breast | $1,190.40 | $1,488.00 | $502.46–$1,488.00 | 81% below | 20% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less | $532.00 | $665.00 | $106.21–$645.05 | 83% above | 20% |
| Nail removal (partial or complete), one nail CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail | $195.20 | $244.00 | $96.42–$2,120.00 | at median | 20% |
| Nail removal (partial or complete), one nail CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail | $239.20 | $299.00 | $96.42–$293.02 | 23% above | 20% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail | $195.20 | $244.00 | $96.42–$2,120.00 | — | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $382.40 | $478.00 | $61.77–$463.66 | at median | 20% |
| Occipital nerve block (injection for headaches) CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $382.40 | $478.00 | $61.77–$2,120.00 | at median | 20% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $382.40 | $478.00 | $61.77–$2,120.00 | — | 20% |
| Paracentesis with imaging guidance CPT 49083 Drainage of fluid from abdominal cavity using imaging guidance | $2,000.00 | $2,500.00 | $249.95–$2,425.00 | 50% above | 20% |
| Partial knee replacement (one compartment) CPT 27446 Replacement of knee joint on side of knee | $2,091.20 | $2,614.00 | $885.56–$2,679.20 | 87% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent removal fingernail or toenail | $190.40 | $238.00 | $88.68–$263.66 | 44% below | 20% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent removal fingernail or toenail | $376.80 | $471.00 | $134.35–$2,120.00 | 12% above | 20% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent removal fingernail or toenail | $376.80 | $471.00 | $134.35–$2,120.00 | — | 20% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint | $4,455.20 | $5,569.00 | $373.59–$5,457.62 | 15% above | 20% |
| Removal of a breast lump, open surgery CPT 19120 Removal of growth and tissue of breast, duct, or nipple | $757.60 | $947.00 | $368.97–$1,014.22 | 75% below | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple | $917.60 | $1,147.00 | $124.78–$2,120.00 | 162% above | 20% |
| Removal of a foreign object under the skin, simple CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple | $917.60 | $1,147.00 | $124.78–$1,112.59 | 162% above | 20% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple | $917.60 | $1,147.00 | $124.78–$2,120.00 | — | 20% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK | $337.60 | $422.00 | $70.00–$422.00 | 87% below | 20% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK | $336.80 | $421.00 | $70.00–$421.00 | 87% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 Application of elbow to finger cast | $110.40 | $138.00 | $63.48–$2,120.00 | 49% below | 20% |
| Short arm cast (elbow to hand) CPT 29075 Application of elbow to finger cast | $114.40 | $143.00 | $54.00–$184.80 | 48% below | 20% |
| Short arm cast (elbow to hand) inpatient CPT 29075 Application of elbow to finger cast | $110.40 | $138.00 | $63.48–$2,120.00 | — | 20% |
| Short arm splint (forearm and hand) CPT 29125 Application of nonmoveable forearm to hand splint | $74.40 | $93.00 | $37.76–$138.41 | 55% below | 20% |
| Short arm splint (forearm and hand) CPT 29125 Application of nonmoveable forearm to hand splint | $308.80 | $386.00 | $53.06–$2,120.00 | 88% above | 20% |
| Short arm splint (forearm and hand) inpatient CPT 29125 Application of nonmoveable forearm to hand splint | $308.80 | $386.00 | $53.06–$2,120.00 | — | 20% |
| Short leg cast (below the knee) CPT 29405 Application of short leg cast | $451.44 | $564.30 | $64.99–$2,120.00 | 146% above | 20% |
| Short leg cast (below the knee) inpatient CPT 29405 Application of short leg cast | $451.44 | $564.30 | $64.99–$2,120.00 | — | 20% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint from calf to foot | $92.00 | $115.00 | $45.89–$152.86 | 43% below | 20% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint from calf to foot | $335.20 | $419.00 | $58.03–$2,120.00 | 108% above | 20% |
| Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint from calf to foot | $335.20 | $419.00 | $58.03–$2,120.00 | — | 20% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Partial removal of collar bone at shoulder using an endoscope | $1,247.20 | $1,559.00 | $528.04–$1,655.07 | 82% below | 20% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of part of shoulder bone and repair of ligament using an endoscope | $309.60 | $387.00 | $131.03–$429.50 | 89% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | $81.60 | $102.00 | $40.07–$152.87 | 63% below | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | $326.40 | $408.00 | $77.26–$2,120.00 | 49% above | 20% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | $326.40 | $408.00 | $77.26–$2,120.00 | — | 20% |
| Skin biopsy, punch, one lesion CPT 11104 Punch biopsy, first skin growth | $424.80 | $531.00 | $105.41–$515.07 | 114% above | 20% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of skin tag, 1-15 skin tags | $141.60 | $177.00 | $64.55–$177.00 | at median | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $837.60 | $1,047.00 | $104.78–$1,015.59 | 2% above | 20% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $837.60 | $1,047.00 | $104.78–$2,120.00 | 2% above | 20% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $837.60 | $1,047.00 | $104.78–$2,120.00 | — | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm | $107.20 | $134.00 | $52.24–$187.23 | 51% below | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm | $354.40 | $443.00 | $93.26–$2,120.00 | 63% above | 20% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm | $354.40 | $443.00 | $93.26–$2,120.00 | — | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less | $100.80 | $126.00 | $49.43–$186.64 | 60% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less | $248.00 | $310.00 | $92.59–$2,120.00 | 2% below | 20% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less | $248.00 | $310.00 | $92.59–$2,120.00 | — | 20% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Biopsy of related skin growth, first growth | $220.80 | $276.00 | $84.83–$267.72 | 16% above | 20% |
| Thoracentesis with imaging guidance CPT 32555 Aspiration of fluid from chest cavity using imaging guidance | $1,736.80 | $2,171.00 | $269.69–$2,127.58 | 50% above | 20% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Aspiration of fluid from chest cavity using imaging guidance | $1,736.80 | $2,171.00 | $269.69–$2,127.58 | — | 20% |
| Total hip replacement CPT 27130 Replacement of thigh bone and hip joint with prosthesis | $2,335.20 | $2,919.00 | $988.44–$3,136.80 | 85% below | 20% |
| Total knee replacement CPT 27447 Replacement of knee joint, both sides of knee | $2,332.00 | $2,915.00 | $987.30–$3,132.80 | 85% below | 20% |
| Total shoulder replacement CPT 23472 Prosthetic repair of shoulder joint, total shoulder | $2,268.58 | $2,835.72 | $1,112.64–$3,358.40 | 87% below | 20% |
| Trigger finger release surgery CPT 26055 Incision of tendon covering of finger | $544.00 | $680.00 | $264.01–$1,187.90 | 69% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection of trigger points, 1-2 muscles | $78.40 | $98.00 | $44.67–$2,120.00 | 48% below | 20% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection of trigger points, 1-2 muscles | $362.40 | $453.00 | $44.67–$443.94 | 139% above | 20% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection of trigger points, 1-2 muscles | $78.40 | $98.00 | $44.67–$2,120.00 | — | 20% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Biopsy of breast and placement of locating device using ultrasound, first growth | $2,324.00 | $2,905.00 | $431.48–$2,846.90 | 7% below | 20% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm | $2,332.00 | $2,915.00 | $937.34–$2,856.70 | 17% below | 20% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $253.60 | $317.00 | $115.89–$776.52 | 88% below | 20% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $224.80 | $281.00 | $103.58–$582.94 | 89% below | 20% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal of sperm duct | $1,030.40 | $1,288.00 | $280.58–$1,249.36 | 42% below | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Removal of skin and tissue, 20.0 sq cm or less | $433.60 | $542.00 | $107.86–$2,120.00 | 30% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Removal of skin and tissue, 20.0 sq cm or less | $476.00 | $595.00 | $107.86–$577.15 | 43% above | 20% |
| Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Removal of skin and tissue, 20.0 sq cm or less | $433.60 | $542.00 | $107.86–$2,120.00 | — | 20% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treatment of broken forearm bone on thumb side of wrist, above wrist, with placement of stabilizing device | $1,368.80 | $1,711.00 | $581.33–$1,711.00 | 86% below | 20% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion of blood or blood products | $801.60 | $1,002.00 | $30.58–$981.96 | 19% below | 20% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment for airway obstruction or sputum production | $195.20 | $244.00 | $8.87–$239.12 | 9% below | 20% |
| Chemotherapy IV infusion, first hour CPT 96413 Administration of chemotherapy into vein, 1 hour or less | $490.40 | $613.00 | $110.40–$594.61 | 28% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, first 30-74 minutes | $476.00 | $595.00 | $188.30–$595.00 | 79% below | 20% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, first 30-74 minutes | $1,836.00 | $2,295.00 | $234.24–$2,249.10 | 20% below | 20% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care, first 30-74 minutes | $1,836.00 | $2,295.00 | $234.24–$2,249.10 | — | 20% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 Measurement of brain wave activity (EEG), awake and drowsy | $845.95 | $1,057.44 | $48.76–$1,036.29 | 30% below | 20% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | $203.20 | $254.00 | $4.77–$248.92 | 17% above | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for problem that may not require health care professional | $56.00 | $70.00 | $8.90–$70.00 | 72% below | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for problem that may not require health care professional | $57.60 | $72.00 | $18.60–$2,120.00 | 71% below | 20% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency department visit for problem that may not require health care professional | $57.60 | $72.00 | $18.60–$2,120.00 | — | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit with straightforward medical decision making | $93.60 | $117.00 | $32.86–$117.00 | 74% below | 20% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit with straightforward medical decision making | $424.80 | $531.00 | $36.00–$2,120.00 | 20% above | 20% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency department visit with straightforward medical decision making | $424.80 | $531.00 | $36.00–$2,120.00 | — | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit with low level of medical decision making | $158.40 | $198.00 | $55.66–$198.00 | 74% below | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit with low level of medical decision making | $740.00 | $925.00 | $61.18–$2,120.00 | 21% above | 20% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency department visit with low level of medical decision making | $740.00 | $925.00 | $61.18–$2,120.00 | — | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit with moderate level of medical decision making | $270.40 | $338.00 | $94.78–$338.00 | 73% below | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit with moderate level of medical decision making | $1,232.80 | $1,541.00 | $103.72–$2,120.00 | 23% above | 20% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency department visit with moderate level of medical decision making | $1,232.80 | $1,541.00 | $103.72–$2,120.00 | — | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit with high level of medical decision making | $392.00 | $490.00 | $137.38–$490.00 | 73% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit with high level of medical decision making | $1,360.80 | $1,701.00 | $150.51–$2,120.00 | 6% below | 20% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency department visit with high level of medical decision making | $1,360.80 | $1,701.00 | $150.51–$2,120.00 | — | 20% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Exercise or drug-induced heart stress test with electrocardiogram (ECG) | $895.20 | $1,119.00 | $28.12–$1,096.62 | 18% above | 20% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion into a vein for hydration, 31-60 minutes | $376.80 | $471.00 | $27.95–$456.87 | 9% above | 20% |
| IV infusion of a medicine, first hour CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | $490.40 | $613.00 | $54.86–$594.61 | 2% above | 20% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle | $94.40 | $118.00 | $11.98–$114.46 | 17% below | 20% |
| Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nerve conduction, 7-8 studies | $406.40 | $508.00 | $91.31–$492.76 | at median | 20% |
| New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $101.60 | $127.00 | $58.42–$123.19 | 36% below | 20% |
| New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $160.80 | $201.00 | $92.46–$194.97 | 36% below | 20% |
| New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | $218.40 | $273.00 | $125.58–$264.81 | 31% below | 20% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more | $58.40 | $73.00 | $33.58–$70.81 | 55% below | 20% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Therapy procedure for nutrition management, each 15 minutes | $44.80 | $56.00 | $25.76–$54.88 | 26% below | 20% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use intermediate counseling, 3-10 minutes | $20.44 | $25.55 | $11.75–$25.04 | 42% below | 20% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | $173.60 | $217.00 | $99.82–$210.49 | 36% below | 20% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more | $44.00 | $55.00 | $25.30–$84.67 | 68% below | 20% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $44.00 | $55.00 | $25.30–$120.07 | 78% below | 20% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $44.00 | $55.00 | $25.30–$53.35 | 50% below | 20% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office or other outpatient consultation with low level of medical decision making, if using time, 30 minutes or more | $205.60 | $257.00 | $113.08–$257.00 | at median | 20% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office or other outpatient consultation with moderate level of medical decision making, if using time, 40 minutes or more | $300.00 | $375.00 | $165.00–$375.00 | at median | 20% |
| Spirometry (breathing test) CPT 94010 Test to measure expiratory airflow and volume | $256.00 | $320.00 | $7.07–$313.60 | 6% above | 20% |
| Spirometry before and after a bronchodilator CPT 94060 Test to measure expiratory airflow and volume changes before and after medication administration | $427.20 | $534.00 | $8.89–$523.32 | 17% below | 20% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Drawing of blood for a medical problem | $175.20 | $219.00 | $81.22–$214.62 | 29% below | 20% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 Exercise or drug-induced heart stress test with electrocardiogram (ECG) with supervision and review by physician | $1,020.00 | $1,275.00 | $59.25–$1,249.50 | 659% above | 20% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | $315.07 | $393.84 | $185.10–$385.96 | 30% above | 20% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza vaccine split virus, preservative free | $156.91 | $196.14 | $58.73–$192.22 | 8% above | 20% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal vaccine, 23-valent | $165.65 | $207.06 | $95.25–$202.92 | 11% above | 20% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine for injection into muscle | $740.20 | $925.25 | $307.75–$906.75 | 77% above | 20% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older) | $157.32 | $196.65 | $32.55–$192.72 | 110% above | 20% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration of vaccine | $58.40 | $73.00 | $13.90–$71.54 | 1% above | 20% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration of vaccine, each additional vaccine | $36.00 | $45.00 | $10.54–$44.10 | at median | 20% |
Source file: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbTetonValley&type=CDMWithoutLabel&fileType=CSV