South County Health
South County Health in Wakefield, RI publishes cash prices for 431 common procedures listed here, from its own machine-readable price file updated Jul 24, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Rhode Island median for 208 of 365 procedures and below it for 61. By typical cash price it ranks #7 of 7 Rhode Island hospitals and #11 of 11 hospitals in the Providence, RI area, cheapest first. Select a procedure to compare it with other hospitals nearby.
100 KENYON AVE WAKEFIELD RI 02879 Collected Sep 22, 2026 Source price file Check a bill from this hospital (401) 782-8000
Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 410008 · CMS hospital register NPI 1952366106
Financial assistance
Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply
South County Health is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.
You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.
Source: IRS, section 501(r) requirements for nonprofit hospitals.
CMS price transparency record
The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named South County Health in Wakefield, RI:
- May 16, 2023 Warning notice
- Aug 18, 2023 Case closed
- Mar 9, 2026 Warning notice
- Jun 12, 2026 Corrective action plan requested
Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Rhode Island | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections | $1,960.20 | $3,267.00 | $302.77 | 3% below | 40% |
| Abdominal X-ray, 2 views CPT 74019 Radiologic examination, abdomen; 2 views | $285.60 | $476.00 | $109.64 | at median | 40% |
| Ankle X-ray, complete, 3 or more views CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $285.60 | $476.00 | $101.59 | 35% above | 40% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial | $381.60 | $636.00 | $91.00 | — | 40% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 Computed tomography, upper extremity; without contrast material | $1,218.00 | $2,030.00 | $309.82 | 17% above | 40% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study | $569.40 | $949.00 | $242.10 | 28% above | 40% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone and/or joint imaging; whole body | $601.80 | $1,003.00 | $707.14 | at median | 40% |
| Breast ultrasound, complete, one breast one side CPT 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete | $177.00 | $295.00 | $104.22 | at median | 40% |
| Breast ultrasound, limited (one breast or one area) one side CPT 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited | $182.40 | $304.00 | $169.54 | at median | 40% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing | $1,227.00 | $2,045.00 | $490.94 | at median | 40% |
| CT angiography (CTA) of the head CPT 70496 Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing | $715.80 | $1,193.00 | $345.63 | at median | 40% |
| CT angiography (CTA) of the neck CPT 70498 Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing | $995.40 | $1,659.00 | $540.16 | at median | 40% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing | $995.40 | $1,659.00 | $345.63 | at median | 40% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Computed tomography, abdomen and pelvis; without contrast material | $1,650.00 | $2,750.00 | $376.84 | at median | 40% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) | $1,650.00 | $2,750.00 | $307.74 | 3% below | 40% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions | $1,650.00 | $2,750.00 | $369.36 | at median | 40% |
| CT scan of the abdomen with contrast CPT 74160 Computed tomography, abdomen; with contrast material(s) | $1,650.00 | $2,750.00 | $475.48 | at median | 40% |
| CT scan of the abdomen without contrast CPT 74150 Computed tomography, abdomen; without contrast material | $1,218.00 | $2,030.00 | $179.56 | 3% above | 40% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Computed tomography, maxillofacial area; without contrast material | $1,218.00 | $2,030.00 | $215.93 | 17% above | 40% |
| CT scan of the head or brain, no contrast dye CPT 70450 Computed tomography, head or brain; without contrast material | $1,218.00 | $2,030.00 | $109.64 | 11% above | 40% |
| CT scan of the head with contrast CPT 70460 Computed tomography, head or brain; with contrast material(s) | $1,650.00 | $2,750.00 | $307.84 | at median | 40% |
| CT scan of the head without and with contrast CPT 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections | $1,960.20 | $3,267.00 | $196.49 | at median | 40% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Computed tomography, lumbar spine; without contrast material | $1,218.00 | $2,030.00 | $652.88 | at median | 40% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Computed tomography, cervical spine; without contrast material | $1,218.00 | $2,030.00 | $652.88 | at median | 40% |
| CT scan of the pelvis, with contrast dye CPT 72193 Computed tomography, pelvis; with contrast material(s) | $1,650.00 | $2,750.00 | $831.21 | at median | 40% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex scan of extracranial arteries; complete bilateral study | $1,266.00 | $2,110.00 | $290.65 | — | 40% |
| Chest CT scan without and with contrast CPT 71270 Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections | $1,960.20 | $3,267.00 | $412.69 | at median | 40% |
| Chest X-ray, 2 views CPT 71046 Radiologic examination, chest; 2 views | $285.60 | $476.00 | $66.97 | 20% above | 40% |
| Chest X-ray, single view CPT 71045 Radiologic examination, chest; single view | $285.60 | $476.00 | $18.47 | 26% above | 40% |
| Collarbone (clavicle) X-ray, complete CPT 73000 Radiologic examination; clavicle, complete | $285.60 | $476.00 | $137.90 | 34% above | 40% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete | $614.40 | $1,024.00 | $219.05 | 35% above | 40% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) | $422.40 | $704.00 | $109.64 | 3% above | 40% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) | $422.40 | $704.00 | $59.50 | 91% above | 40% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation | $984.00 | $1,640.00 | $453.02 | 58% above | 40% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Computed tomography, thorax, diagnostic; without contrast material | $1,218.00 | $2,030.00 | $168.20 | at median | 40% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Computed tomography, thorax, diagnostic; with contrast material(s) | $1,650.00 | $2,750.00 | $884.66 | 13% above | 40% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral | $304.20 | $507.00 | $154.64 | — | 40% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $240.60 | $401.00 | $92.07 | at median | 40% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study | $1,810.80 | $3,018.00 | $1,015.86 | — | 40% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study | $984.00 | $1,640.00 | $495.83 | — | 40% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography | $1,158.00 | $1,930.00 | $727.22 | at median | 40% |
| Elbow X-ray, 2 views CPT 73070 Radiologic examination, elbow; 2 views | $285.60 | $476.00 | $93.30 | 27% above | 40% |
| Elbow X-ray, complete, 3 or more views CPT 73080 Radiologic examination, elbow; complete, minimum of 3 views | $285.60 | $476.00 | $141.12 | 34% above | 40% |
| Eye socket (orbit) CT scan without contrast CPT 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material | $1,218.00 | $2,030.00 | $268.45 | 17% above | 40% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 Radiologic examination, facial bones; complete, minimum of 3 views | $285.60 | $476.00 | $95.44 | at median | 40% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 Radiologic examination; forearm, 2 views | $285.60 | $476.00 | $129.54 | 34% above | 40% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging, including gallbladder when present | $621.60 | $1,036.00 | $525.77 | at median | 40% |
| Hand X-ray, 2 views CPT 73120 Radiologic examination, hand; 2 views | $285.60 | $476.00 | $109.64 | 9% above | 40% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Radiologic examination; calcaneus, minimum of 2 views | $285.60 | $476.00 | $93.30 | 34% above | 40% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement) | $900.00 | $1,500.00 | $754.00 | 62% above | 40% |
| Knee X-ray, 3 views CPT 73562 Radiologic examination, knee; 3 views | $285.60 | $476.00 | $82.17 | 34% above | 40% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 Computed tomography, lower extremity; without contrast material | $1,218.00 | $2,030.00 | $201.04 | 17% above | 40% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) | $614.40 | $1,024.00 | $299.22 | 35% above | 40% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation | $152.40 | $254.00 | $141.44 | 40% below | 40% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) | $154.20 | $257.00 | $284.20 | 59% below | 40% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Radiologic examination; tibia and fibula, 2 views | $285.60 | $476.00 | $63.16 | 32% above | 40% |
| MR angiography (MRA) of the head without contrast CPT 70544 Magnetic resonance angiography, head; without contrast material(s) | $2,250.00 | $3,750.00 | $500.45 | 16% above | 40% |
| MRI of both breasts, without and then with contrast dye both sides CPT 77049 Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral | $654.00 | $1,090.00 | $366.05 | — | 40% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $2,250.00 | $3,750.00 | $351.13 | 7% above | 40% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $3,257.40 | $5,429.00 | $827.48 | at median | 40% |
| MRI of the abdomen without contrast CPT 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) | $2,250.00 | $3,750.00 | $382.59 | 5% above | 40% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences | $3,257.40 | $5,429.00 | $1,645.79 | at median | 40% |
| MRI of the brain, no contrast dye CPT 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material | $2,250.00 | $3,750.00 | $410.13 | 5% above | 40% |
| MRI of the brain, with and without contrast dye CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences | $3,257.40 | $5,429.00 | $560.83 | at median | 40% |
| MRI of the lower back, no contrast dye CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material | $2,250.00 | $3,750.00 | $222.53 | at median | 40% |
| MRI of the lower back, without and then with contrast dye CPT 72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar | $3,257.40 | $5,429.00 | $672.73 | at median | 40% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material | $2,250.00 | $3,750.00 | $351.13 | at median | 40% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical | $3,257.40 | $5,429.00 | $674.79 | at median | 40% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material | $2,250.00 | $3,750.00 | $1,208.88 | 7% above | 40% |
| MRI of the pelvis without and with contrast CPT 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences | $3,257.40 | $5,429.00 | $659.98 | 4% above | 40% |
| MRI of the pelvis, no contrast dye CPT 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) | $2,250.00 | $3,750.00 | $351.13 | 18% above | 40% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $2,250.00 | $3,750.00 | $351.13 | 7% above | 40% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Radiologic examination, spine, cervical; 4 or 5 views | $483.60 | $806.00 | $179.01 | 60% above | 40% |
| Neck soft tissue CT scan with contrast CPT 70491 Computed tomography, soft tissue neck; with contrast material(s) | $1,650.00 | $2,750.00 | $831.33 | at median | 40% |
| Neck soft tissue CT scan without contrast CPT 70490 Computed tomography, soft tissue neck; without contrast material | $1,218.00 | $2,030.00 | $311.01 | 17% above | 40% |
| Neck soft tissue X-ray CPT 70360 Radiologic examination; neck, soft tissue | $285.60 | $476.00 | $93.30 | 34% above | 40% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or red | $2,557.80 | $4,263.00 | $1,815.15 | at median | 40% |
| Pelvic CT scan without contrast CPT 72192 Computed tomography, pelvis; without contrast material | $1,218.00 | $2,030.00 | $613.40 | at median | 40% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) | $388.80 | $648.00 | $177.07 | 25% above | 40% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | $614.40 | $1,024.00 | $281.16 | 3% above | 40% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation | $614.40 | $1,024.00 | $189.31 | 26% above | 40% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation | $614.40 | $1,024.00 | $281.16 | 35% above | 40% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses | $388.80 | $648.00 | $177.07 | at median | 40% |
| Rib X-ray, one side, 2 views one side CPT 71100 Radiologic examination, ribs, unilateral; 2 views | $285.60 | $476.00 | $93.30 | 35% above | 40% |
| Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views | $285.60 | $476.00 | $109.64 | at median | 40% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $246.60 | $411.00 | $124.89 | — | 40% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $285.60 | $476.00 | $129.55 | 34% above | 40% |
| Sinus X-ray, complete, 3 or more views CPT 70220 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views | $285.60 | $476.00 | $137.87 | 31% above | 40% |
| Skull X-ray, fewer than 4 views CPT 70250 Radiologic examination, skull; less than 4 views | $285.60 | $476.00 | $71.94 | 9% above | 40% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuo | $1,244.40 | $2,074.00 | $727.22 | 14% above | 40% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study | $569.40 | $949.00 | $260.81 | 28% above | 40% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 Radiologic examination, femur; minimum 2 views | $285.60 | $476.00 | $30.26 | 31% above | 40% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Computed tomography, thoracic spine; without contrast material | $1,218.00 | $2,030.00 | $109.64 | at median | 40% |
| Toe X-ray, 2 or more views CPT 73660 Radiologic examination; toe(s), minimum of 2 views | $285.60 | $476.00 | $129.54 | 34% above | 40% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound, transvaginal | $614.40 | $1,024.00 | $242.48 | 37% above | 40% |
| Transvaginal ultrasound during pregnancy CPT 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal | $614.40 | $1,024.00 | $186.26 | 35% above | 40% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound, abdominal, real time with image documentation; complete | $614.40 | $1,024.00 | $281.16 | 35% above | 40% |
| Ultrasound of the scrotum and testicles CPT 76870 Ultrasound, scrotum and contents | $614.40 | $1,024.00 | $109.64 | 39% above | 40% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation | $421.80 | $703.00 | $226.72 | at median | 40% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study | $569.40 | $949.00 | $242.10 | 15% above | 40% |
| Upper arm X-ray (humerus), 2 views CPT 73060 Radiologic examination; humerus, minimum of 2 views | $285.60 | $476.00 | $194.03 | 34% above | 40% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study | $614.40 | $1,024.00 | $327.42 | at median | 40% |
| Wrist X-ray, 2 views CPT 73100 Radiologic examination, wrist; 2 views | $285.60 | $476.00 | $59.50 | 34% above | 40% |
| Wrist X-ray, complete, 3 or more views CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $285.60 | $476.00 | $82.22 | 34% above | 40% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views | $285.60 | $476.00 | $93.30 | 31% above | 40% |
| X-ray of the abdomen, 1 view CPT 74018 Radiologic examination, abdomen; 1 view | $285.60 | $476.00 | $59.50 | 29% above | 40% |
| X-ray of the ankle, 2 views CPT 73600 Radiologic examination, ankle; 2 views | $285.60 | $476.00 | $64.52 | 34% above | 40% |
| X-ray of the finger(s), 2 or more views CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $285.60 | $476.00 | $129.55 | 28% above | 40% |
| X-ray of the foot, 2 views CPT 73620 Radiologic examination, foot; 2 views | $285.60 | $476.00 | $59.50 | 34% above | 40% |
| X-ray of the foot, complete, 3 or more views CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $285.60 | $476.00 | $129.54 | 34% above | 40% |
| X-ray of the hand, 3 or more views CPT 73130 Radiologic examination, hand; minimum of 3 views | $285.60 | $476.00 | $101.59 | 34% above | 40% |
| X-ray of the knee, 1 or 2 views CPT 73560 Radiologic examination, knee; 1 or 2 views | $285.60 | $476.00 | $59.50 | 34% above | 40% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views | $285.60 | $476.00 | $137.87 | 4% above | 40% |
| X-ray of the lower back, 4 or more views CPT 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views | $483.60 | $806.00 | $109.64 | 60% above | 40% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Radiologic examination, spine; thoracic, 2 views | $285.60 | $476.00 | $155.06 | 9% above | 40% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Radiologic examination, nasal bones, complete, minimum of 3 views | $285.60 | $476.00 | $137.89 | 34% above | 40% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Radiologic examination, spine, cervical; 2 or 3 views | $285.60 | $476.00 | $59.50 | 26% above | 40% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Radiologic examination, pelvis; 1 or 2 views | $285.60 | $476.00 | $55.60 | 9% above | 40% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Radiologic examination, sacrum and coccyx, minimum of 2 views | $285.60 | $476.00 | $59.50 | 34% above | 40% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Rhode Island | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) | $360.00 | $600.00 | $164.55 | 17% above | 40% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; alanine amino (ALT) (SGPT) | $58.20 | $97.00 | $24.43 | 82% above | 40% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase; aspartate amino (AST) (SGOT) | $55.20 | $92.00 | $23.88 | 62% above | 40% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) | $343.20 | $572.00 | $27.15 | at median | 40% |
| Albumin blood test CPT 82040 Albumin; serum, plasma or whole blood | $50.40 | $84.00 | $5.23 | 114% above | 40% |
| Aldosterone blood test CPT 82088 Aldosterone | $412.20 | $687.00 | $43.09 | 27% above | 40% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase, alkaline | $55.20 | $92.00 | $2.95 | 67% above | 40% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | $83.40 | $139.00 | $31.97 | 81% above | 40% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein (AFP); serum | $161.40 | $269.00 | $25.99 | 20% above | 40% |
| Ammonia blood test CPT 82140 Ammonia | $142.20 | $237.00 | $8.30 | 23% above | 40% |
| Amylase blood test CPT 82150 Amylase | $70.80 | $118.00 | $6.85 | at median | 40% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic citrullinated peptide (CCP), antibody | $157.20 | $262.00 | $74.82 | 38% above | 40% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies (ANA) | $120.00 | $200.00 | $11.69 | 24% above | 40% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide | $201.00 | $335.00 | $52.56 | at median | 40% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | $88.80 | $148.00 | $40.34 | 29% above | 40% |
| Basic metabolic panel (blood test) CPT 80048 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | $88.20 | $147.00 | $40.25 | 155% above | 40% |
| Bilirubin blood test, total CPT 82247 Bilirubin; total | $54.60 | $91.00 | $5.31 | 76% above | 40% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronc | $89.40 | $149.00 | $103.91 | 20% below | 40% |
| Blood culture for bacteria CPT 87040 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | $102.00 | $170.00 | $15.99 | 23% above | 40% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection of venous blood by venipuncture | $18.00 | $30.00 | $2.13 | 36% above | 40% |
| Blood lead test CPT 83655 Lead | $54.60 | $91.00 | $12.81 | at median | 40% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin, chorionic (hCG); qualitative | $77.40 | $129.00 | $33.78 | 68% above | 40% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing, serologic; ABO | $50.40 | $84.00 | $62.15 | 66% below | 40% |
| Blood urea nitrogen (BUN) test CPT 84520 Urea nitrogen; quantitative | $50.40 | $84.00 | $4.18 | 111% above | 40% |
| C-peptide blood test CPT 84681 C-peptide | $198.00 | $330.00 | $32.24 | 20% above | 40% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein | $55.20 | $92.00 | $23.85 | 32% above | 40% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique | $104.40 | $174.00 | $21.24 | at median | 40% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 | $198.00 | $330.00 | $32.24 | 20% above | 40% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 | $198.00 | $330.00 | $32.24 | 20% above | 40% |
| Calcium blood test, total CPT 82310 Calcium; total | $58.20 | $97.00 | $25.48 | 66% above | 40% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen (CEA) | $180.60 | $301.00 | $29.37 | 19% above | 40% |
| Chickenpox (varicella) immunity blood test CPT 86787 Antibody; varicella-zoster | $125.40 | $209.00 | $56.08 | 7% above | 40% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | $99.60 | $166.00 | $37.10 | at median | 40% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) | $130.20 | $217.00 | $61.65 | 20% above | 40% |
| Complete blood count (CBC), no differential CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | $74.40 | $124.00 | $30.41 | 55% above | 40% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium | $105.00 | $175.00 | $11.17 | 142% above | 40% |
| Cortisol blood test, total CPT 82533 Cortisol; total | $156.60 | $261.00 | $9.29 | 10% above | 40% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (CK), (CPK); total | $70.80 | $118.00 | $6.29 | 54% above | 40% |
| Creatinine blood test CPT 82565 Creatinine; blood | $55.20 | $92.00 | $4.95 | 45% above | 40% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Antibody; cytomegalovirus (CMV) | $139.20 | $232.00 | $13.91 | 21% above | 40% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation products, D-dimer; quantitative | $73.80 | $123.00 | $10.76 | at median | 40% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-sulfate (DHEA-S) | $208.80 | $348.00 | $94.82 | 18% above | 40% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART | $148.80 | $248.00 | $35.42 | 98% above | 40% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) | $73.20 | $122.00 | $4.00 | 165% above | 40% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) | $172.80 | $288.00 | $77.93 | 52% above | 40% |
| Estradiol blood test CPT 82670 Estradiol; total | $262.20 | $437.00 | $126.99 | 17% above | 40% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; follicle stimulating hormone (FSH) | $176.40 | $294.00 | $79.54 | 19% above | 40% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, fecal | $48.00 | $80.00 | $20.76 | at median | 40% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $135.00 | $225.00 | $7.77 | 47% above | 40% |
| Fibrinogen blood test CPT 85384 Fibrinogen; activity | $88.20 | $147.00 | $13.16 | 55% above | 40% |
| Folate (folic acid) blood test CPT 82746 Folic acid; serum | $105.00 | $175.00 | $15.54 | 28% above | 40% |
| Free T3 thyroid hormone test CPT 84481 Triiodothyronine T3; free | $73.20 | $122.00 | $17.91 | at median | 40% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine; free | $91.80 | $153.00 | $8.71 | 28% above | 40% |
| Free testosterone test CPT 84402 Testosterone; free | $236.40 | $394.00 | $39.45 | 16% above | 40% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase, gamma (GGT) | $73.80 | $123.00 | $7.61 | 27% above | 40% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85 | $343.80 | $573.00 | $48.51 | 769% above | 40% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; post glucose dose (includes glucose) | $50.40 | $84.00 | $5.02 | 20% above | 40% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) | $125.40 | $209.00 | $56.08 | 4% above | 40% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | $99.60 | $166.00 | $33.91 | at median | 40% |
| H. pylori stool antigen test CPT 87338 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; Helicobacter pylori, stool | $154.20 | $257.00 | $68.50 | 54% above | 40% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed | $335.40 | $559.00 | $89.98 | at median | 40% |
| HIV-1 and HIV-2 antibody test CPT 86703 Antibody; HIV-1 and HIV-2, single result | $58.20 | $97.00 | $13.25 | at median | 40% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), pooled result | $210.60 | $351.00 | $62.51 | at median | 40% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin; glycosylated (A1C) | $90.60 | $151.00 | $41.64 | 46% above | 40% |
| Hemoglobin blood test CPT 85018 Blood count; hemoglobin (Hgb) | $50.40 | $84.00 | $21.23 | 144% above | 40% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B core antibody (HBcAb); total | $120.00 | $200.00 | $6.87 | 14% above | 40% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody (HBsAb) | $105.00 | $175.00 | $49.87 | 25% above | 40% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) | $102.00 | $170.00 | $5.89 | 12% above | 40% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody | $135.00 | $225.00 | $63.78 | 35% above | 40% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | $261.60 | $436.00 | $118.70 | at median | 40% |
| Herpes blood test, HSV-1 antibody CPT 86695 Antibody; herpes simplex, type 1 | $44.40 | $74.00 | $7.52 | at median | 40% |
| Herpes blood test, HSV-2 antibody CPT 86696 Antibody; herpes simplex, type 2 | $44.40 | $74.00 | $20.46 | 1% below | 40% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein; high sensitivity (hsCRP) | $237.60 | $396.00 | $12.51 | 128% above | 40% |
| Homocysteine blood test CPT 83090 Homocysteine | $161.40 | $269.00 | $10.21 | 20% above | 40% |
| Insulin blood test CPT 83525 Insulin; total | $110.40 | $184.00 | $52.19 | 21% above | 40% |
| Iron blood test (serum iron) CPT 83540 Iron | $286.80 | $478.00 | $29.36 | 552% above | 40% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $90.60 | $151.00 | $4.98 | 37% above | 40% |
| Kidney function blood test panel CPT 80069 Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | $88.80 | $148.00 | $41.16 | 159% above | 40% |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin; luteinizing hormone (LH) | $176.40 | $294.00 | $28.68 | 18% above | 40% |
| Lactate (lactic acid) blood test CPT 83605 Lactate (lactic acid) | $105.00 | $175.00 | $10.32 | 25% above | 40% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate dehydrogenase (LD), (LDH) | $66.00 | $110.00 | $3.44 | 38% above | 40% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $72.00 | $120.00 | $10.68 | 36% above | 40% |
| Liver function blood test panel CPT 80076 Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) | $83.40 | $139.00 | $7.90 | 148% above | 40% |
| Lyme disease antibody test CPT 86618 Antibody; Borrelia burgdorferi (Lyme disease) | $66.00 | $110.00 | $9.71 | at median | 40% |
| Magnesium blood test CPT 83735 Magnesium | $72.00 | $120.00 | $10.37 | 37% above | 40% |
| Measles (rubeola) antibody test CPT 86765 Antibody; rubeola | $125.40 | $209.00 | $13.62 | 11% above | 40% |
| Mumps immunity blood test CPT 86735 Antibody; mumps | $125.40 | $209.00 | $7.44 | 10% above | 40% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free | $175.80 | $293.00 | $28.49 | 20% above | 40% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate specific antigen (PSA); total | $184.20 | $307.00 | $10.48 | 60% above | 40% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision | $120.00 | $200.00 | $56.43 | at median | 40% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision | $120.00 | $200.00 | $53.31 | at median | 40% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) | $364.80 | $608.00 | $63.93 | 11% above | 40% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood | $66.00 | $110.00 | $9.31 | 40% above | 40% |
| Phosphorus (phosphate) blood test CPT 84100 Phosphorus inorganic (phosphate) | $50.40 | $84.00 | $2.70 | 30% above | 40% |
| Potassium blood test CPT 84132 Potassium; serum, plasma or whole blood | $50.40 | $84.00 | $2.71 | 71% above | 40% |
| Progesterone blood test CPT 84144 Progesterone | $198.00 | $330.00 | $22.06 | 19% above | 40% |
| Prolactin blood test CPT 84146 Prolactin | $183.00 | $305.00 | $88.15 | 18% above | 40% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time | $22.80 | $38.00 | $20.20 | at median | 40% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service | $34.20 | $57.00 | $16.88 | 4% above | 40% |
| Rapid flu test (influenza antigen) CPT 87804 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza | $31.20 | $52.00 | $9.43 | at median | 40% |
| Renin blood test CPT 84244 Renin | $207.00 | $345.00 | $93.73 | 18% above | 40% |
| Rh blood typing CPT 86901 Blood typing, serologic; Rh (D) | $66.00 | $110.00 | $41.10 | 5% above | 40% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor; quantitative | $91.80 | $153.00 | $3.23 | 104% above | 40% |
| Rubella antibody test (immunity check) CPT 86762 Antibody; rubella | $139.20 | $232.00 | $22.29 | 21% above | 40% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation rate, erythrocyte; automated | $50.40 | $84.00 | $2.61 | 153% above | 40% |
| Sodium blood test CPT 84295 Sodium; serum, plasma or whole blood | $50.40 | $84.00 | $2.74 | 58% above | 40% |
| Stool ova and parasites exam CPT 87177 Ova and parasites, direct smears, concentration and identification | $72.00 | $120.00 | $8.60 | 1% above | 40% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Antibody; Treponema pallidum | $127.80 | $213.00 | $20.49 | 21% above | 40% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) | $43.20 | $72.00 | $18.48 | 17% above | 40% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | $77.40 | $129.00 | $65.54 | 84% below | 40% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; total | $243.00 | $405.00 | $39.98 | 18% above | 40% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each | $142.20 | $237.00 | $63.18 | 11% above | 40% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone (TSH) | $161.40 | $269.00 | $72.63 | 51% above | 40% |
| Total IgE blood test CPT 82785 Gammaglobulin (immunoglobulin); IgE | $157.80 | $263.00 | $70.80 | 20% above | 40% |
| Total cholesterol blood test CPT 82465 Cholesterol, serum or whole blood, total | $50.40 | $84.00 | $4.60 | 74% above | 40% |
| Total thyroxine (T4) blood test CPT 84436 Thyroxine; total | $72.00 | $120.00 | $32.98 | 53% above | 40% |
| Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine T3; total (TT-3) | $136.20 | $227.00 | $8.08 | 38% above | 40% |
| Transferrin blood test CPT 84466 Transferrin | $124.80 | $208.00 | $59.15 | 22% above | 40% |
| Trichomonas test (NAAT) CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | $72.00 | $120.00 | $20.00 | 12% below | 40% |
| Triglycerides blood test CPT 84478 Triglycerides | $64.80 | $108.00 | $8.90 | 75% above | 40% |
| Troponin test, quantitative CPT 84484 Troponin, quantitative | $67.80 | $113.00 | $7.11 | at median | 40% |
| Uric acid blood test CPT 84550 Uric acid; blood | $50.40 | $84.00 | $7.01 | 38% above | 40% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy | $68.40 | $114.00 | $30.84 | 174% above | 40% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy | $50.40 | $84.00 | $3.48 | 87% above | 40% |
| Urine culture for bacteria, with colony count CPT 87086 Culture, bacterial; quantitative colony count, urine | $55.20 | $92.00 | $4.60 | 7% above | 40% |
| Urine microalbumin (albumin) test CPT 82043 Albumin; urine (eg, microalbumin), quantitative | $64.80 | $108.00 | $3.29 | 15% above | 40% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vitamin B-12) | $147.00 | $245.00 | $15.95 | 24% above | 40% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed | $274.20 | $457.00 | $45.85 | 89% above | 40% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed | $359.40 | $599.00 | $164.00 | 17% above | 40% |
| Zinc blood test CPT 84630 Zinc | $110.40 | $184.00 | $6.49 | 21% above | 40% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (hCG); quantitative | $147.00 | $245.00 | $14.55 | 11% above | 40% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Rhode Island | Off list |
|---|---|---|---|---|---|
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 | $14,873.42 | $24,789.04 | $19,583.00 | — | 40% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction | $2,469.81 | $4,116.36 | $1,112.00 | — | 40% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair | $2,352.74 | $3,921.24 | $6,964.00 | — | 40% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance | $1,557.24 | $2,595.40 | $959.00 | 16% below | 40% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation | $315.00 | $525.00 | $2,276.00 | 48% below | 40% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment of metatarsal fracture; without manipulation, each | $315.00 | $525.00 | $251.19 | at median | 40% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method | $4,989.41 | $8,315.69 | $1,112.00 | — | 40% |
| Bunion correction with removal of part of the big toe joint CPT 28292 Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method | $4,024.15 | $6,706.92 | $4,553.00 | — | 40% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | $6,475.20 | $10,792.00 | $2,152.61 | at median | 40% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external | $1,027.80 | $1,713.00 | $717.00 | at median | 40% |
| Carpal tunnel release, open surgery CPT 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel | $3,815.78 | $6,359.64 | $1,108.00 | — | 40% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age | $4,776.32 | $7,960.53 | $821.00 | — | 40% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block | $3,604.80 | $6,008.00 | $724.00 | 1580% above | 40% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation | $315.00 | $525.00 | $251.19 | at median | 40% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique | $3,182.39 | $5,303.98 | $3,214.00 | at median | 40% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy, flexible; with biopsy, single or multiple | $3,101.40 | $5,169.00 | $971.00 | at median | 40% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | $3,102.47 | $5,170.79 | $821.00 | at median | 40% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix | $2,061.78 | $3,436.30 | $923.58 | 36% above | 40% |
| Cystoscopy with ureteral stent placement CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) | $4,725.33 | $7,875.55 | $2,232.42 | 9% above | 40% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Cystourethroscopy (separate procedure) | $4,202.05 | $7,003.42 | $2,276.00 | 57% above | 40% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) | $4,903.14 | $8,171.90 | $3,750.00 | 107% above | 40% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion | $145.80 | $243.00 | $134.00 | 24% below | 40% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia | $4,512.01 | $7,520.01 | $821.00 | — | 40% |
| Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia | $4,209.63 | $7,016.05 | $1,184.00 | — | 40% |
| Earwax removal with instruments, one ear one side CPT 69210 Removal impacted cerumen requiring instrumentation, unilateral | $121.80 | $203.00 | $1,184.00 | at median | 40% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy | $1,081.78 | $1,802.97 | $3,750.00 | — | 40% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level | $1,372.80 | $2,288.00 | $1,184.00 | 49% below | 40% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible | $8,704.83 | $14,508.05 | $1,184.00 | — | 40% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible | $6,135.62 | $10,226.04 | $1,365.00 | — | 40% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | $2,331.60 | $3,886.00 | $1,184.00 | at median | 40% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopy, surgical; cholecystectomy | $14,839.32 | $24,732.21 | $1,184.00 | — | 40% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laparoscopy, surgical; cholecystectomy with cholangiography | $14,334.59 | $23,890.98 | $6,964.00 | — | 40% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 Cholecystectomy | $18,516.64 | $30,861.07 | $11,296.00 | — | 40% |
| Hammertoe correction surgery CPT 28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) | $3,815.60 | $6,359.33 | $3,750.00 | 25% above | 40% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy, internal, by rubber band ligation(s) | $5,201.83 | $8,669.71 | $1,184.00 | 180% above | 40% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy, internal and external, single column/group | $8,972.12 | $14,953.54 | $3,750.00 | — | 40% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft | $6,320.73 | $10,534.56 | $7,898.00 | — | 40% |
| Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation) | $8,356.44 | $13,927.40 | $1,365.00 | — | 40% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C | $4,647.00 | $7,745.00 | $1,108.00 | 95% above | 40% |
| IUD insertion (the device itself billed separately) CPT 58300 Insertion of intrauterine device (IUD) | $3,894.78 | $6,491.30 | $251.19 | 1215% above | 40% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single | $427.80 | $713.00 | $2,276.00 | at median | 40% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair initial inguinal hernia, age 5 years or older; reducible | $8,994.43 | $14,990.71 | $1,371.00 | — | 40% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia) | $611.40 | $1,019.00 | $3,349.00 | 15% below | 40% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | $1,557.00 | $2,595.00 | $251.19 | 3% above | 40% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance | $419.40 | $699.00 | $251.19 | 72% below | 40% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance | $410.40 | $684.00 | $2,276.00 | 56% below | 40% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) | $6,491.90 | $10,819.83 | $1,365.00 | — | 40% |
| Knee arthroscopy with meniscus trim CPT 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed | $5,841.25 | $9,735.42 | $821.00 | — | 40% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed | $5,742.81 | $9,571.35 | $4,553.00 | — | 40% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) | $5,613.32 | $9,355.54 | $1,365.00 | — | 40% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopy, surgical, appendectomy | $12,148.12 | $20,246.87 | $3,275.77 | — | 40% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less | $8,907.86 | $14,846.44 | $6,964.00 | — | 40% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | $14,237.87 | $23,729.79 | $4,423.96 | — | 40% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Laparoscopy, surgical; repair initial inguinal hernia | $12,787.12 | $21,311.87 | $1,371.00 | — | 40% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Laparoscopy, surgical; repair recurrent inguinal hernia | $13,252.10 | $22,086.83 | $4,423.96 | — | 40% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) | $8,260.34 | $13,767.23 | $1,564.00 | — | 40% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less | $531.00 | $885.00 | $1,184.00 | 20% below | 40% |
| Left heart catheterization, diagnostic one side CPT 93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed | $6,766.80 | $11,278.00 | $1,876.41 | at median | 40% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluorosc | $928.20 | $1,547.00 | $717.00 | 65% below | 40% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance | $1,372.80 | $2,288.00 | $717.00 | 49% below | 40% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level | $1,372.80 | $2,288.00 | $724.00 | at median | 40% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar | $10,402.88 | $17,338.13 | $4,770.09 | — | 40% |
| Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar | $29,311.52 | $48,852.53 | $11,312.00 | — | 40% |
| Lumbar interbody fusion (PLIF or TLIF), one level CPT 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar | $4,955.14 | $8,258.57 | $3,349.00 | — | 40% |
| Lumbar laminectomy (spinal decompression), one level both sides CPT 63047 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar | $11,978.58 | $19,964.30 | $4,770.09 | — | 40% |
| Lumbar spinal fusion (posterior), one level CPT 22612 Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) | $5,828.86 | $9,714.77 | $1,184.00 | — | 40% |
| Lumpectomy (partial mastectomy) CPT 19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) | $6,449.50 | $10,749.17 | $3,750.00 | 78% above | 40% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Treatment of missed abortion, completed surgically; first trimester | $5,882.98 | $9,804.96 | $3,750.00 | 158% above | 40% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less | $821.40 | $1,369.00 | $2,276.00 | 2% above | 40% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less | $1,029.17 | $1,715.29 | $1,184.00 | at median | 40% |
| Nail removal (partial or complete), one nail CPT 11730 Avulsion of nail plate, partial or complete, simple; single | $191.40 | $319.00 | $2,276.00 | 15% below | 40% |
| Pacemaker implant (dual chamber) CPT 33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | $24,322.20 | $40,537.00 | $9,101.90 | 13% above | 40% |
| Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance | $1,855.80 | $3,093.00 | $923.58 | at median | 40% |
| Partial knee replacement (one compartment) CPT 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment | $13,738.67 | $22,897.79 | $6,140.00 | — | 40% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal | $3,733.82 | $6,223.03 | $2,276.00 | 145% above | 40% |
| Prostate biopsy CPT 55700 Biopsy, prostate; needle or punch, single or multiple, any approach | $3,343.77 | $5,572.95 | $821.00 | — | 40% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; | $10,148.83 | $16,914.72 | $9,012.00 | — | 40% |
| Removal of a breast lump, open surgery CPT 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions | $3,895.51 | $6,492.51 | $1,112.00 | 54% above | 40% |
| Removal of a foreign object under the skin, simple CPT 10120 Incision and removal of foreign body, subcutaneous tissues; simple | $489.00 | $815.00 | $251.19 | at median | 40% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal cancer screening; colonoscopy on individual at high risk | $3,043.94 | $5,073.24 | $717.00 | 14% above | 40% |
| Septoplasty to straighten the nasal septum CPT 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft | $1,081.78 | $1,802.97 | $3,750.00 | — | 40% |
| Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Lithotripsy, extracorporeal shock wave | $5,559.27 | $9,265.45 | $4,956.00 | — | 40% |
| Short arm cast (elbow to hand) CPT 29075 Application, cast; elbow to finger (short arm) | $405.00 | $675.00 | $350.60 | at median | 40% |
| Short arm splint (forearm and hand) CPT 29125 Application of short arm splint (forearm to hand); static | $179.40 | $299.00 | $3,349.00 | at median | 40% |
| Short leg cast (below the knee) CPT 29405 Application of short leg cast (below knee to toes) | $405.00 | $675.00 | $1,184.00 | at median | 40% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint (calf to foot) | $199.20 | $332.00 | $1,184.00 | 11% below | 40% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) | $1,911.61 | $3,186.01 | $1,552.00 | — | 40% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) | $2,371.80 | $3,953.01 | $1,112.00 | — | 40% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less | $280.80 | $468.00 | $2,276.00 | at median | 40% |
| Skin biopsy, punch, one lesion CPT 11104 Punch biopsy of skin (including simple closure, when performed); single lesion | $299.40 | $499.00 | $3,349.00 | 34% below | 40% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less | $820.80 | $1,368.00 | $923.58 | at median | 40% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions | $355.40 | $592.33 | $1,184.00 | at median | 40% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal puncture, lumbar, diagnostic | $592.80 | $988.00 | $181.00 | 46% below | 40% |
| 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 superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm | $305.40 | $509.00 | $1,184.00 | at median | 40% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | $299.40 | $499.00 | $1,184.00 | 32% below | 40% |
| TURP (transurethral resection of the prostate) CPT 52601 Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included) | $10,345.46 | $17,242.44 | $1,371.00 | — | 40% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion | $299.40 | $499.00 | $3,349.00 | 34% below | 40% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance | $918.60 | $1,531.00 | $1,184.00 | 46% below | 40% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy, primary or secondary; age 12 or over | $2,372.63 | $3,954.38 | $3,275.77 | — | 40% |
| Total hip replacement CPT 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft | $12,870.72 | $21,451.20 | $19,034.40 | — | 40% |
| Total knee replacement CPT 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) | $13,600.26 | $22,667.11 | $6,140.00 | — | 40% |
| Total shoulder replacement CPT 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) | $12,941.80 | $21,569.67 | $11,296.00 | — | 40% |
| Trigger finger release surgery CPT 26055 Tendon sheath incision (eg, for trigger finger) | $3,735.85 | $6,226.42 | $971.00 | 46% above | 40% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) | $388.80 | $648.00 | $1,184.00 | at median | 40% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) | $8,269.47 | $13,782.45 | $3,275.77 | — | 40% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance | $2,451.24 | $4,085.40 | $959.00 | at median | 40% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) | $3,047.64 | $5,079.40 | $3,214.00 | at median | 40% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | $3,101.40 | $5,169.00 | $971.00 | at median | 40% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance | $1,587.54 | $2,645.90 | $971.00 | at median | 40% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique | $3,792.75 | $6,321.25 | $959.00 | at median | 40% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire | $3,033.63 | $5,056.05 | $2,232.42 | at median | 40% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | $3,101.40 | $5,169.00 | $724.00 | at median | 40% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) | $9,128.49 | $15,214.15 | $4,553.00 | — | 40% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) | $6,948.16 | $11,580.27 | $1,553.00 | — | 40% |
| Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) | $4,396.08 | $7,326.80 | $971.00 | — | 40% |
| Vein ablation, radiofrequency, first vein CPT 36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated | $4,039.20 | $6,732.00 | $4,553.00 | 61% below | 40% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less | $1,396.20 | $2,327.00 | $821.00 | at median | 40% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation | $7,671.63 | $12,786.05 | $6,964.00 | — | 40% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Rhode Island | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion, blood or blood components | $1,000.80 | $1,668.00 | $134.00 | at median | 40% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device | $149.40 | $249.00 | $77.03 | 32% below | 40% |
| Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | $444.60 | $741.00 | $191.02 | 15% below | 40% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | $1,654.80 | $2,758.00 | $1,139.00 | 5% below | 40% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | $87.60 | $146.00 | $61.00 | — | 40% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | $156.00 | $260.00 | $12.18 | at median | 40% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | $314.40 | $524.00 | $230.00 | at median | 40% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | $501.00 | $835.00 | $188.05 | at median | 40% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | $947.40 | $1,579.00 | $1,654.51 | at median | 40% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | $1,119.60 | $1,866.00 | $1,139.00 | at median | 40% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | $1,405.20 | $2,342.00 | $710.25 | at median | 40% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report | $406.80 | $678.00 | $70.73 | at median | 40% |
| Holter monitor, heart rhythm recording up to 48 hours, with report CPT 93224 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional | $366.60 | $611.00 | $289.03 | — | 40% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour | $324.60 | $541.00 | $125.00 | at median | 40% |
| IV infusion of a medicine, first hour CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | $324.60 | $541.00 | $125.00 | at median | 40% |
| IV push of a medicine, first drug CPT 96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug | $186.60 | $311.00 | $217.02 | 21% below | 40% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | $87.60 | $146.00 | $87.18 | 12% below | 40% |
| Neuromuscular re-education, 15 minutes CPT 97112 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities | $156.00 | $260.00 | $49.30 | 225% above | 40% |
| New patient office visit, about 30 minutes CPT 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | $224.40 | $374.00 | $28.20 | 14% below | 40% |
| New patient office visit, about 45 minutes CPT 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or excee | $316.80 | $528.00 | $155.49 | 10% below | 40% |
| New patient office visit, about 60 minutes CPT 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | $449.40 | $749.00 | $28.20 | 6% below | 40% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceede | $202.20 | $337.00 | $28.20 | 6% below | 40% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | $36.60 | $61.00 | $51.00 | 28% below | 40% |
| Occupational therapy evaluation, low complexity CPT 97165 Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance | $141.60 | $236.00 | $100.96 | 51% above | 40% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from | $145.80 | $243.00 | $104.23 | 4% above | 40% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and | $145.80 | $243.00 | $107.47 | 37% above | 40% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements fro | $145.80 | $243.00 | $118.00 | 37% above | 40% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | $148.80 | $248.00 | $43.24 | 185% above | 40% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years | $166.20 | $277.00 | $28.20 | 56% below | 40% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 | $143.40 | $239.00 | $28.20 | 53% below | 40% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | $71.40 | $119.00 | $51.00 | 35% above | 40% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or | $448.20 | $747.00 | $28.20 | 4% below | 40% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or e | $224.40 | $374.00 | $28.20 | 18% below | 40% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met | $295.80 | $493.00 | $28.20 | 15% below | 40% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met o | $202.20 | $337.00 | $106.08 | 8% below | 40% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | $231.00 | $385.00 | $28.20 | — | 40% |
| Speech and language evaluation CPT 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) | $363.60 | $606.00 | $204.00 | 82% above | 40% |
| Speech therapy session, individual CPT 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | $276.00 | $460.00 | $118.00 | 185% above | 40% |
| Spirometry (breathing test) CPT 94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation | $62.40 | $104.00 | $186.00 | 74% below | 40% |
| Spirometry before and after a bronchodilator CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration | $100.80 | $168.00 | $372.56 | 77% below | 40% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | $142.80 | $238.00 | $58.22 | 163% above | 40% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, therapeutic (separate procedure) | $343.80 | $573.00 | $149.80 | 132% above | 40% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Rhode Island | Off list |
|---|---|---|---|---|---|
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella virus vaccine (VAR), live, for subcutaneous use | $288.99 | $481.65 | $122.13 | 11% below | 40% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use | $209.44 | $349.06 | $132.86 | 53% below | 40% |
| Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A vaccine (HepA), adult dosage, for intramuscular use | $145.61 | $242.68 | $0.50 | 39% below | 40% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use | $116.50 | $194.17 | $70.19 | 3% below | 40% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use | $23.74 | $39.56 | $13.54 | 4% above | 40% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use | $32.40 | $54.00 | $0.50 | 58% below | 40% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use | $161.93 | $269.89 | $99.11 | 71% above | 40% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use | $101.40 | $169.00 | $0.50 | 79% below | 40% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), for intramuscular use | $337.02 | $561.70 | $229.33 | — | 40% |
| Nasal spray flu vaccine, live (FluMist) CPT 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use | $13.80 | $23.00 | $23.46 | — | 40% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use | $140.16 | $233.60 | $160.96 | 53% below | 40% |
| Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use | $72.29 | $120.49 | $0.50 | 31% below | 40% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine, for intramuscular use | $732.53 | $1,220.88 | $432.11 | at median | 40% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use | $352.12 | $586.86 | $195.59 | 18% above | 40% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use | $67.32 | $112.20 | $33.70 | 1% below | 40% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use | $78.33 | $130.55 | $42.97 | 34% below | 40% |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use | $52.80 | $88.00 | $149.15 | — | 40% |
| Typhoid vaccine, oral capsules (Vivotif) CPT 90690 Typhoid vaccine, live, oral | $56.40 | $94.00 | $107.73 | — | 40% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | $143.40 | $239.00 | $87.18 | at median | 40% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | $74.40 | $124.00 | $37.20–$111.60 | 18% below | 40% |
| Yellow fever vaccine, live CPT 90717 Yellow fever vaccine, live, for subcutaneous use | $105.00 | $175.00 | $160.35 | — | 40% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.