Palo Alto County Hospital
Palo Alto County Hospital in Emmetsburg, IA publishes cash prices for 325 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Iowa median for 217 of 320 procedures and below it for 99. By typical cash price it ranks #59 of 85 Iowa hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
3201 First Street, Emmetsburg, IA 50536-2516 Collected Sep 27, 2026 Source price file (712) 852-5500
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 161357 · CMS hospital register NPI 1790793651
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 3 actions for a hospital named Palo Alto County Hospital in Emmetsburg, IA:
- Jul 15, 2025 Warning notice
- Sep 30, 2025 Case closed
- Jul 23, 2026 Warning notice
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.
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 Iowa | 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 | $2,201.25 | $2,935.00 | $682.00–$2,788.00 | 13% above | 25% |
| Abdominal CT scan without and with contrast inpatient CPT 74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections | $2,201.25 | $2,935.00 | $1,995.00–$2,935.00 | — | 25% |
| Abdominal X-ray, 2 views CPT 74019 Radiologic examination, abdomen; 2 views | $292.50 | $390.00 | $90.00–$370.00 | 17% above | 25% |
| Abdominal X-ray, 2 views inpatient CPT 74019 Radiologic examination, abdomen; 2 views | $292.50 | $390.00 | $265.00–$390.00 | — | 25% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 1% below | 25% |
| Ankle X-ray, complete, 3 or more views one side CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 1% below | 25% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 Radiologic examination, ankle; complete, minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Limited bilateral noninvasive physiologic studies of upper o | $534.00 | $712.00 | $165.00–$676.00 | — | 25% |
| 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 | $534.00 | $712.00 | $165.00–$676.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Limited bilateral noninvasive physiologic studies of upper o | $534.00 | $712.00 | $484.00–$712.00 | — | 25% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient 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 | $534.00 | $712.00 | $484.00–$712.00 | — | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Computed tomography, upper extremity; without contrast material | $1,606.50 | $2,142.00 | $498.00–$2,034.00 | 33% above | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 Computed tomography, upper extremity; without contrast material | $1,606.50 | $2,142.00 | $498.00–$2,034.00 | 33% above | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Computed tomography, upper extremity; without contrast material | $1,606.50 | $2,142.00 | $1,456.00–$2,142.00 | — | 25% |
| Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 Computed tomography, upper extremity; without contrast material | $1,606.50 | $2,142.00 | $1,456.00–$2,142.00 | — | 25% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Radiologic examination, esophagus, including scout chest rad | $375.75 | $501.00 | $116.00–$475.00 | 4% above | 25% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Radiologic examination, esophagus, including scout chest rad | $375.75 | $501.00 | $340.00–$501.00 | — | 25% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Bone and/or joint imaging; whole body | $1,378.50 | $1,838.00 | $427.00–$1,746.00 | 12% above | 25% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone and/or joint imaging; whole body | $1,378.50 | $1,838.00 | $1,249.00–$1,838.00 | — | 25% |
| 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 | $450.00 | $600.00 | $139.00–$570.00 | 23% above | 25% |
| 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 | $450.00 | $600.00 | $139.00–$570.00 | 23% above | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited | $450.00 | $600.00 | $408.00–$600.00 | — | 25% |
| Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited | $450.00 | $600.00 | $408.00–$600.00 | — | 25% |
| 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 | $4,431.75 | $5,909.00 | $1,375.00–$5,613.00 | 49% above | 25% |
| CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing | $4,431.75 | $5,909.00 | $3,460.00–$5,909.00 | — | 25% |
| CT angiography (CTA) of the head CPT 70496 Computed tomographic angiography, head, with contrast materi | $2,388.75 | $3,185.00 | $741.00–$3,025.00 | 23% above | 25% |
| CT angiography (CTA) of the head inpatient CPT 70496 Computed tomographic angiography, head, with contrast materi | $2,388.75 | $3,185.00 | $2,165.00–$3,185.00 | — | 25% |
| CT angiography (CTA) of the neck CPT 70498 Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing | $2,635.50 | $3,514.00 | $817.00–$3,338.00 | 26% above | 25% |
| CT angiography (CTA) of the neck inpatient CPT 70498 Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing | $2,635.50 | $3,514.00 | $2,389.00–$3,514.00 | — | 25% |
| 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 | $2,856.75 | $3,809.00 | $886.00–$3,618.00 | 34% above | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing | $2,856.75 | $3,809.00 | $2,590.00–$3,809.00 | — | 25% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 Computed tomography, abdomen and pelvis; without contrast material | $3,135.75 | $4,181.00 | $972.00–$3,971.00 | 20% above | 25% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 Computed tomography, abdomen and pelvis; without contrast material | $3,135.75 | $4,181.00 | $2,843.00–$4,181.00 | — | 25% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) | $3,648.00 | $4,864.00 | $1,131.00–$4,620.00 | 14% above | 25% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) | $3,648.00 | $4,864.00 | $3,307.00–$4,864.00 | — | 25% |
| 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 | $4,268.25 | $5,691.00 | $1,324.00–$5,406.00 | 25% above | 25% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient 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 | $4,268.25 | $5,691.00 | $3,460.00–$5,691.00 | — | 25% |
| CT scan of the abdomen with contrast CPT 74160 Computed tomography, abdomen; with contrast material(s) | $1,835.25 | $2,447.00 | $569.00–$2,324.00 | 9% above | 25% |
| CT scan of the abdomen with contrast inpatient CPT 74160 Computed tomography, abdomen; with contrast material(s) | $1,835.25 | $2,447.00 | $1,663.00–$2,447.00 | — | 25% |
| CT scan of the abdomen without contrast CPT 74150 Computed tomography, abdomen; without contrast material | $1,504.50 | $2,006.00 | $466.00–$1,905.00 | 14% above | 25% |
| CT scan of the abdomen without contrast inpatient CPT 74150 Computed tomography, abdomen; without contrast material | $1,504.50 | $2,006.00 | $1,364.00–$2,006.00 | — | 25% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 Computed tomography, maxillofacial area; without contrast material | $1,568.25 | $2,091.00 | $486.00–$1,986.00 | 22% above | 25% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 Computed tomography, maxillofacial area; without contrast material | $1,568.25 | $2,091.00 | $1,421.00–$2,091.00 | — | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 Computed tomography, head or brain; without contrast material | $1,650.00 | $2,200.00 | $511.00–$2,090.00 | 23% above | 25% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Computed tomography, head or brain; without contrast material | $1,650.00 | $2,200.00 | $1,496.00–$2,200.00 | — | 25% |
| CT scan of the head with contrast CPT 70460 Computed tomography, head or brain; with contrast material(s) | $1,875.00 | $2,500.00 | $581.00–$2,375.00 | 24% above | 25% |
| CT scan of the head with contrast inpatient CPT 70460 Computed tomography, head or brain; with contrast material(s) | $1,875.00 | $2,500.00 | $1,700.00–$2,500.00 | — | 25% |
| 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 | $2,175.00 | $2,900.00 | $674.00–$2,755.00 | 21% above | 25% |
| CT scan of the head without and with contrast inpatient CPT 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections | $2,175.00 | $2,900.00 | $1,972.00–$2,900.00 | — | 25% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 Computed tomography, lumbar spine; without contrast material | $1,728.75 | $2,305.00 | $536.00–$2,189.00 | 14% above | 25% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 Computed tomography, lumbar spine; without contrast material | $1,728.75 | $2,305.00 | $1,567.00–$2,305.00 | — | 25% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 Computed tomography, cervical spine; without contrast material | $2,012.25 | $2,683.00 | $624.00–$2,548.00 | 34% above | 25% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 Computed tomography, cervical spine; without contrast material | $2,012.25 | $2,683.00 | $1,824.00–$2,683.00 | — | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 Computed tomography, pelvis; with contrast material(s) | $1,959.75 | $2,613.00 | $608.00–$2,482.00 | 13% above | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Computed tomography, pelvis; with contrast material(s) | $1,959.75 | $2,613.00 | $1,776.00–$2,613.00 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Duplex scan of extracranial arteries; complete bilateral study | $729.00 | $972.00 | $226.00–$923.00 | — | 25% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Duplex scan of extracranial arteries; complete bilateral study | $729.00 | $972.00 | $660.00–$972.00 | — | 25% |
| Chest CT scan without and with contrast CPT 71270 Computed tomography, thorax, diagnostic; without contrast ma | $2,148.00 | $2,864.00 | $666.00–$2,720.00 | 11% above | 25% |
| Chest CT scan without and with contrast inpatient CPT 71270 Computed tomography, thorax, diagnostic; without contrast ma | $2,148.00 | $2,864.00 | $1,947.00–$2,864.00 | — | 25% |
| Chest X-ray, 2 views CPT 71046 Radiologic examination, chest; 2 views | $270.00 | $360.00 | $83.00–$342.00 | 31% above | 25% |
| Chest X-ray, 2 views inpatient CPT 71046 Radiologic examination, chest; 2 views | $270.00 | $360.00 | $244.00–$360.00 | — | 25% |
| Chest X-ray, single view CPT 71045 Radiologic examination, chest; single view | $216.56 | $288.75 | $67.00–$274.00 | 29% above | 25% |
| Chest X-ray, single view inpatient CPT 71045 Radiologic examination, chest; single view | $216.56 | $288.75 | $196.00–$288.00 | — | 25% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Radiologic examination; clavicle, complete | $198.75 | $265.00 | $61.00–$251.00 | 6% above | 25% |
| Collarbone (clavicle) X-ray, complete one side CPT 73000 Radiologic examination; clavicle, complete | $198.75 | $265.00 | $61.00–$251.00 | 6% above | 25% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Radiologic examination; clavicle, complete | $198.75 | $265.00 | $180.00–$265.00 | — | 25% |
| Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 Radiologic examination; clavicle, complete | $198.75 | $265.00 | $180.00–$265.00 | — | 25% |
| 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 | $637.50 | $850.00 | $197.00–$807.00 | 4% above | 25% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete | $637.50 | $850.00 | $578.00–$850.00 | — | 25% |
| 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) | $582.00 | $776.00 | $180.00–$737.00 | 47% above | 25% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) | $582.00 | $776.00 | $527.00–$776.00 | — | 25% |
| 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) | $280.50 | $374.00 | $87.00–$355.00 | 12% above | 25% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) | $280.50 | $374.00 | $254.00–$374.00 | — | 25% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 Computed tomography, thorax, diagnostic; without contrast ma | $1,568.25 | $2,091.00 | $486.00–$1,986.00 | 14% above | 25% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 Computed tomography, thorax, diagnostic; without contrast ma | $1,568.25 | $2,091.00 | $1,421.00–$2,091.00 | — | 25% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 Computed tomography, thorax, diagnostic; with contrast mater | $2,001.75 | $2,669.00 | $621.00–$2,535.00 | 13% above | 25% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 Computed tomography, thorax, diagnostic; with contrast mater | $2,001.75 | $2,669.00 | $1,814.00–$2,669.00 | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral | $437.25 | $583.00 | $135.00–$553.00 | — | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral Diagnostic mammography, including computer-aided detection ( | $437.25 | $583.00 | $135.00–$553.00 | — | 25% |
| Diagnostic mammogram, both breasts CPT 77066 Diagnostic mammography, including computer-aided detection ( | $437.25 | $583.00 | $135.00–$553.00 | 22% above | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral Diagnostic mammography, including computer-aided detection ( | $437.25 | $583.00 | $396.00–$583.00 | — | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral | $437.25 | $583.00 | $396.00–$583.00 | — | 25% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Diagnostic mammography, including computer-aided detection ( | $437.25 | $583.00 | $396.00–$583.00 | — | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $348.00 | $464.00 | $107.00–$440.00 | 19% above | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $348.00 | $464.00 | $107.00–$440.00 | 19% above | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection ( | $360.00 | $480.00 | $111.00–$456.00 | 23% above | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography, including computer-aided detection ( | $360.00 | $480.00 | $111.00–$456.00 | 23% above | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $348.00 | $464.00 | $315.00–$464.00 | — | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral | $348.00 | $464.00 | $315.00–$464.00 | — | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Diagnostic mammography, including computer-aided detection ( | $360.00 | $480.00 | $326.00–$480.00 | — | 25% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 Diagnostic mammography, including computer-aided detection ( | $360.00 | $480.00 | $326.00–$480.00 | — | 25% |
| 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 | $1,050.00 | $1,400.00 | $325.00–$1,330.00 | — | 25% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study | $1,050.00 | $1,400.00 | $952.00–$1,400.00 | — | 25% |
| 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 | $1,200.00 | $1,600.00 | $372.00–$1,520.00 | — | 25% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study | $1,200.00 | $1,600.00 | $1,088.00–$1,600.00 | — | 25% |
| 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 echo | $1,684.50 | $2,246.00 | $522.00–$2,133.00 | 10% above | 25% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient 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 echo | $1,684.50 | $2,246.00 | $1,527.00–$2,246.00 | — | 25% |
| Elbow X-ray, 2 views one side CPT 73070 Radiologic examination, elbow; 2 views | $207.00 | $276.00 | $64.00–$262.00 | 31% above | 25% |
| Elbow X-ray, 2 views one side CPT 73070 Radiologic examination, elbow; 2 views | $207.00 | $276.00 | $64.00–$262.00 | 31% above | 25% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Radiologic examination, elbow; 2 views | $207.00 | $276.00 | $187.00–$276.00 | — | 25% |
| Elbow X-ray, 2 views inpatient one side CPT 73070 Radiologic examination, elbow; 2 views | $207.00 | $276.00 | $187.00–$276.00 | — | 25% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Radiologic examination, elbow; complete, minimum of 3 views | $243.75 | $325.00 | $75.00–$308.00 | 12% above | 25% |
| Elbow X-ray, complete, 3 or more views one side CPT 73080 Radiologic examination, elbow; complete, minimum of 3 views | $244.50 | $326.00 | $75.00–$309.00 | 13% above | 25% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Radiologic examination, elbow; complete, minimum of 3 views | $243.75 | $325.00 | $221.00–$325.00 | — | 25% |
| Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 Radiologic examination, elbow; complete, minimum of 3 views | $244.50 | $326.00 | $221.00–$326.00 | — | 25% |
| 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 | $1,504.50 | $2,006.00 | $466.00–$1,905.00 | 16% above | 25% |
| Eye socket (orbit) CT scan without contrast inpatient CPT 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material | $1,504.50 | $2,006.00 | $1,364.00–$2,006.00 | — | 25% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 Radiologic examination, facial bones; complete, minimum of 3 views | $270.75 | $361.00 | $84.00–$342.00 | 1% above | 25% |
| Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Radiologic examination, facial bones; complete, minimum of 3 views | $270.75 | $361.00 | $245.00–$361.00 | — | 25% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Radiologic examination; forearm, 2 views | $183.00 | $244.00 | $56.00–$231.00 | 6% below | 25% |
| Forearm X-ray (radius and ulna), 2 views one side CPT 73090 Radiologic examination; forearm, 2 views | $183.00 | $244.00 | $56.00–$231.00 | 6% below | 25% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Radiologic examination; forearm, 2 views | $183.00 | $244.00 | $165.00–$244.00 | — | 25% |
| Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 Radiologic examination; forearm, 2 views | $183.00 | $244.00 | $165.00–$244.00 | — | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary system imaging, including gallbladder when present; | $1,291.50 | $1,722.00 | $400.00–$1,635.00 | 7% above | 25% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary system imaging, including gallbladder when present; | $1,291.50 | $1,722.00 | $1,170.00–$1,722.00 | — | 25% |
| Hand X-ray, 2 views one side CPT 73120 Radiologic examination, hand; 2 views | $168.75 | $225.00 | $52.00–$213.00 | 4% above | 25% |
| Hand X-ray, 2 views one side CPT 73120 Radiologic examination, hand; 2 views | $168.75 | $225.00 | $52.00–$213.00 | 4% above | 25% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Radiologic examination, hand; 2 views | $168.75 | $225.00 | $153.00–$225.00 | — | 25% |
| Hand X-ray, 2 views inpatient one side CPT 73120 Radiologic examination, hand; 2 views | $168.75 | $225.00 | $153.00–$225.00 | — | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Radiologic examination; calcaneus, minimum of 2 views | $228.75 | $305.00 | $70.00–$289.00 | 38% above | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 Radiologic examination; calcaneus, minimum of 2 views | $228.75 | $305.00 | $70.00–$289.00 | 38% above | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Radiologic examination; calcaneus, minimum of 2 views | $228.75 | $305.00 | $207.00–$305.00 | — | 25% |
| Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 Radiologic examination; calcaneus, minimum of 2 views | $228.75 | $305.00 | $207.00–$305.00 | — | 25% |
| 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) | $699.00 | $932.00 | $216.00–$885.00 | 26% above | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement) | $699.00 | $932.00 | $633.00–$932.00 | — | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 | $3,749.25 | $4,999.00 | $1,163.00–$4,749.00 | 19% above | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnography; age 6 years or older, sleep staging with 4 | $3,749.25 | $4,999.00 | $3,399.00–$4,999.00 | — | 25% |
| Knee X-ray, 3 views one side CPT 73562 Radiologic examination, knee; 3 views | $267.00 | $356.00 | $82.00–$338.00 | 25% above | 25% |
| Knee X-ray, 3 views one side CPT 73562 Radiologic examination, knee; 3 views | $267.00 | $356.00 | $82.00–$338.00 | 25% above | 25% |
| Knee X-ray, 3 views inpatient one side CPT 73562 Radiologic examination, knee; 3 views | $267.00 | $356.00 | $242.00–$356.00 | — | 25% |
| Knee X-ray, 3 views inpatient one side CPT 73562 Radiologic examination, knee; 3 views | $267.00 | $356.00 | $242.00–$356.00 | — | 25% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Radiologic examination, knee; complete, 4 or more views | $309.75 | $413.00 | $96.00–$392.00 | 13% above | 25% |
| Knee X-ray, complete, 4 or more views one side CPT 73564 Radiologic examination, knee; complete, 4 or more views | $309.75 | $413.00 | $96.00–$392.00 | 13% above | 25% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Radiologic examination, knee; complete, 4 or more views | $309.75 | $413.00 | $280.00–$413.00 | — | 25% |
| Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 Radiologic examination, knee; complete, 4 or more views | $309.75 | $413.00 | $280.00–$413.00 | — | 25% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Computed tomography, lower extremity; without contrast material | $1,703.25 | $2,271.00 | $528.00–$2,157.00 | 28% above | 25% |
| Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 Computed tomography, lower extremity; without contrast material | $1,703.25 | $2,271.00 | $528.00–$2,157.00 | 28% above | 25% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Computed tomography, lower extremity; without contrast material | $1,703.25 | $2,271.00 | $1,544.00–$2,271.00 | — | 25% |
| Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 Computed tomography, lower extremity; without contrast material | $1,703.25 | $2,271.00 | $1,544.00–$2,271.00 | — | 25% |
| 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) | $481.50 | $642.00 | $149.00–$609.00 | at median | 25% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) | $481.50 | $642.00 | $436.00–$642.00 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Ultrasound, limited, joint or focal evaluation of other nonv | $337.50 | $450.00 | $104.00–$427.00 | 4% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Ultrasound, limited, joint or focal evaluation of other nonv | $315.00 | $420.00 | $97.00–$399.00 | 10% below | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Ultrasound, limited, joint or focal evaluation of other nonv | $337.50 | $450.00 | $306.00–$450.00 | — | 25% |
| Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 Ultrasound, limited, joint or focal evaluation of other nonv | $315.00 | $420.00 | $285.00–$420.00 | — | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Computed tomography, thorax, low dose for lung cancer screen | $278.25 | $371.00 | $86.00–$352.00 | 36% below | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Computed tomography, thorax, low dose for lung cancer screen | $278.25 | $371.00 | $252.00–$371.00 | — | 25% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Radiologic examination; tibia and fibula, 2 views | $274.50 | $366.00 | $85.00–$347.00 | 43% above | 25% |
| Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 Radiologic examination; tibia and fibula, 2 views | $274.50 | $366.00 | $85.00–$347.00 | 43% above | 25% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Radiologic examination; tibia and fibula, 2 views | $274.50 | $366.00 | $248.00–$366.00 | — | 25% |
| Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 Radiologic examination; tibia and fibula, 2 views | $274.50 | $366.00 | $248.00–$366.00 | — | 25% |
| MR angiography (MRA) of the head without contrast CPT 70544 Magnetic resonance angiography, head; without contrast material(s) | $2,256.00 | $3,008.00 | $699.00–$2,857.00 | at median | 25% |
| MR angiography (MRA) of the head without contrast inpatient CPT 70544 Magnetic resonance angiography, head; without contrast material(s) | $2,256.00 | $3,008.00 | $2,045.00–$3,008.00 | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $2,270.25 | $3,027.00 | $704.00–$2,875.00 | 1% above | 25% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $2,270.25 | $3,027.00 | $704.00–$2,875.00 | 1% above | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $2,270.25 | $3,027.00 | $2,058.00–$3,027.00 | — | 25% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material | $2,270.25 | $3,027.00 | $2,058.00–$3,027.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $3,198.00 | $4,264.00 | $992.00–$4,050.00 | 1% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower | $3,198.00 | $4,264.00 | $992.00–$4,050.00 | 1% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower | $3,198.00 | $4,264.00 | $992.00–$4,050.00 | 1% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $3,198.00 | $4,264.00 | $992.00–$4,050.00 | 1% above | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower | $3,198.00 | $4,264.00 | $2,899.00–$4,264.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $3,198.00 | $4,264.00 | $2,899.00–$4,264.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower | $3,198.00 | $4,264.00 | $2,899.00–$4,264.00 | — | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences | $3,198.00 | $4,264.00 | $2,899.00–$4,264.00 | — | 25% |
| MRI of the abdomen without contrast CPT 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) | $2,256.00 | $3,008.00 | $699.00–$2,857.00 | 9% above | 25% |
| MRI of the abdomen without contrast inpatient CPT 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) | $2,256.00 | $3,008.00 | $2,045.00–$3,008.00 | — | 25% |
| 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 | $3,281.25 | $4,375.00 | $1,018.00–$4,156.00 | 3% below | 25% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences | $3,281.25 | $4,375.00 | $2,975.00–$4,375.00 | — | 25% |
| MRI of the brain, no contrast dye CPT 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material | $2,545.50 | $3,394.00 | $789.00–$3,224.00 | 11% above | 25% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material | $2,545.50 | $3,394.00 | $2,307.00–$3,394.00 | — | 25% |
| 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 | $4,350.00 | $5,800.00 | $1,349.00–$5,510.00 | 23% above | 25% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences | $4,350.00 | $5,800.00 | $3,460.00–$5,800.00 | — | 25% |
| MRI of the lower back, no contrast dye CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material | $2,129.25 | $2,839.00 | $660.00–$2,697.00 | 11% below | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material | $2,129.25 | $2,839.00 | $1,930.00–$2,839.00 | — | 25% |
| 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 | $4,038.75 | $5,385.00 | $1,253.00–$5,115.00 | 18% above | 25% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar | $4,038.75 | $5,385.00 | $3,460.00–$5,385.00 | — | 25% |
| 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 | $2,320.50 | $3,094.00 | $719.00–$2,939.00 | at median | 25% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material | $2,320.50 | $3,094.00 | $2,103.00–$3,094.00 | — | 25% |
| 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 | $4,267.50 | $5,690.00 | $1,324.00–$5,405.00 | 30% above | 25% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical | $4,267.50 | $5,690.00 | $3,460.00–$5,690.00 | — | 25% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material | $2,256.00 | $3,008.00 | $699.00–$2,857.00 | at median | 25% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material | $2,256.00 | $3,008.00 | $2,045.00–$3,008.00 | — | 25% |
| 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 | $4,038.75 | $5,385.00 | $1,253.00–$5,115.00 | 25% above | 25% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences | $4,038.75 | $5,385.00 | $3,460.00–$5,385.00 | — | 25% |
| MRI of the pelvis, no contrast dye CPT 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) | $2,129.25 | $2,839.00 | $660.00–$2,697.00 | 3% above | 25% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) | $2,129.25 | $2,839.00 | $1,930.00–$2,839.00 | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $2,270.25 | $3,027.00 | $704.00–$2,875.00 | 3% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $2,270.25 | $3,027.00 | $704.00–$2,875.00 | 3% above | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $2,270.25 | $3,027.00 | $2,058.00–$3,027.00 | — | 25% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) | $2,270.25 | $3,027.00 | $2,058.00–$3,027.00 | — | 25% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Radiologic examination, spine, cervical; 4 or 5 views | $297.00 | $396.00 | $92.00–$376.00 | 9% below | 25% |
| Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Radiologic examination, spine, cervical; 4 or 5 views | $297.00 | $396.00 | $269.00–$396.00 | — | 25% |
| Neck soft tissue CT scan with contrast CPT 70491 Computed tomography, soft tissue neck; with contrast material(s) | $1,835.25 | $2,447.00 | $569.00–$2,324.00 | 14% above | 25% |
| Neck soft tissue CT scan with contrast inpatient CPT 70491 Computed tomography, soft tissue neck; with contrast material(s) | $1,835.25 | $2,447.00 | $1,663.00–$2,447.00 | — | 25% |
| Neck soft tissue CT scan without contrast CPT 70490 Computed tomography, soft tissue neck; without contrast material | $1,504.50 | $2,006.00 | $466.00–$1,905.00 | 19% above | 25% |
| Neck soft tissue CT scan without contrast inpatient CPT 70490 Computed tomography, soft tissue neck; without contrast material | $1,504.50 | $2,006.00 | $1,364.00–$2,006.00 | — | 25% |
| Neck soft tissue X-ray CPT 70360 Radiologic examination; neck, soft tissue | $177.75 | $237.00 | $55.00–$225.00 | 1% above | 25% |
| Neck soft tissue X-ray inpatient CPT 70360 Radiologic examination; neck, soft tissue | $177.75 | $237.00 | $161.00–$237.00 | — | 25% |
| 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 quantifica | $4,110.00 | $5,480.00 | $1,275.00–$5,206.00 | 47% above | 25% |
| Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantifica | $4,110.00 | $5,480.00 | $3,460.00–$5,480.00 | — | 25% |
| Pelvic CT scan without contrast CPT 72192 Computed tomography, pelvis; without contrast material | $1,631.25 | $2,175.00 | $506.00–$2,066.00 | 26% above | 25% |
| Pelvic CT scan without contrast inpatient CPT 72192 Computed tomography, pelvis; without contrast material | $1,631.25 | $2,175.00 | $1,479.00–$2,175.00 | — | 25% |
| 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) | $481.50 | $642.00 | $149.00–$609.00 | 37% above | 25% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) | $481.50 | $642.00 | $436.00–$642.00 | — | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | $600.00 | $800.00 | $186.00–$760.00 | 11% above | 25% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | $600.00 | $800.00 | $544.00–$800.00 | — | 25% |
| 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 | $712.50 | $950.00 | $221.00–$902.00 | 29% above | 25% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient 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 | $712.50 | $950.00 | $646.00–$950.00 | — | 25% |
| 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 | $507.75 | $677.00 | $157.00–$643.00 | 10% above | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient 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 | $507.75 | $677.00 | $460.00–$677.00 | — | 25% |
| 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 | $631.50 | $842.00 | $195.00–$799.00 | 86% above | 25% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient 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 | $631.50 | $842.00 | $572.00–$842.00 | — | 25% |
| Rib X-ray, one side, 2 views one side CPT 71100 Radiologic examination, ribs, unilateral; 2 views | $270.75 | $361.00 | $84.00–$342.00 | 28% above | 25% |
| Rib X-ray, one side, 2 views one side CPT 71100 Radiologic examination, ribs, unilateral; 2 views | $270.75 | $361.00 | $84.00–$342.00 | 28% above | 25% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Radiologic examination, ribs, unilateral; 2 views | $270.75 | $361.00 | $245.00–$361.00 | — | 25% |
| Rib X-ray, one side, 2 views inpatient one side CPT 71100 Radiologic examination, ribs, unilateral; 2 views | $270.75 | $361.00 | $245.00–$361.00 | — | 25% |
| 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 | $311.25 | $415.00 | $96.00–$394.00 | 8% above | 25% |
| 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 | $311.25 | $415.00 | $96.00–$394.00 | 8% above | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views | $311.25 | $415.00 | $282.00–$415.00 | — | 25% |
| Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views | $311.25 | $415.00 | $282.00–$415.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breas | $273.75 | $365.00 | $84.00–$346.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $273.75 | $365.00 | $84.00–$346.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breas | $273.75 | $365.00 | $84.00–$346.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $273.75 | $365.00 | $84.00–$346.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breas | $299.25 | $399.00 | $92.00–$379.00 | — | 25% |
| Screening mammogram, both breasts both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $299.25 | $399.00 | $92.00–$379.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening mammography, bilateral (2-view study of each breas | $273.75 | $365.00 | $248.00–$365.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $273.75 | $365.00 | $248.00–$365.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $273.75 | $365.00 | $248.00–$365.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening mammography, bilateral (2-view study of each breas | $273.75 | $365.00 | $248.00–$365.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed | $299.25 | $399.00 | $271.00–$399.00 | — | 25% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Screening mammography, bilateral (2-view study of each breas | $299.25 | $399.00 | $271.00–$399.00 | — | 25% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $303.00 | $404.00 | $94.00–$383.00 | 31% above | 25% |
| Shoulder X-ray, complete, 2 or more views one side CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $303.00 | $404.00 | $94.00–$383.00 | 31% above | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $303.00 | $404.00 | $274.00–$404.00 | — | 25% |
| Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 Radiologic examination, shoulder; complete, minimum of 2 views | $303.00 | $404.00 | $274.00–$404.00 | — | 25% |
| Sinus X-ray, complete, 3 or more views CPT 70220 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views | $288.00 | $384.00 | $89.00–$364.00 | 18% above | 25% |
| Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views | $288.00 | $384.00 | $261.00–$384.00 | — | 25% |
| Skull X-ray, fewer than 4 views CPT 70250 Radiologic examination, skull; less than 4 views | $288.00 | $384.00 | $89.00–$364.00 | 41% above | 25% |
| Skull X-ray, fewer than 4 views inpatient CPT 70250 Radiologic examination, skull; less than 4 views | $288.00 | $384.00 | $261.00–$384.00 | — | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist | $3,369.00 | $4,492.00 | $1,045.00–$4,267.00 | 17% above | 25% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist | $3,369.00 | $4,492.00 | $3,054.00–$4,492.00 | — | 25% |
| 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/o | $965.25 | $1,287.00 | $299.00–$1,222.00 | 36% below | 25% |
| Stress echocardiogram, complete, including the stress test and supervision inpatient 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/o | $965.25 | $1,287.00 | $875.00–$1,287.00 | — | 25% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Radiologic examination, swallowing function, with cineradiog | $375.00 | $500.00 | $116.00–$475.00 | 9% below | 25% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Radiologic examination, swallowing function, with cineradiog | $375.00 | $500.00 | $340.00–$500.00 | — | 25% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Radiologic examination, femur; minimum 2 views | $255.75 | $341.00 | $79.00–$323.00 | 31% above | 25% |
| Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 Radiologic examination, femur; minimum 2 views | $255.75 | $341.00 | $79.00–$323.00 | 31% above | 25% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Radiologic examination, femur; minimum 2 views | $255.75 | $341.00 | $231.00–$341.00 | — | 25% |
| Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 Radiologic examination, femur; minimum 2 views | $255.75 | $341.00 | $231.00–$341.00 | — | 25% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 Computed tomography, thoracic spine; without contrast material | $1,728.75 | $2,305.00 | $536.00–$2,189.00 | 25% above | 25% |
| Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 Computed tomography, thoracic spine; without contrast material | $1,728.75 | $2,305.00 | $1,567.00–$2,305.00 | — | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 Radiologic examination; toe(s), minimum of 2 views | $168.75 | $225.00 | $52.00–$213.00 | 2% below | 25% |
| Toe X-ray, 2 or more views one side CPT 73660 Radiologic examination; toe(s), minimum of 2 views | $168.75 | $225.00 | $52.00–$213.00 | 2% below | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 Radiologic examination; toe(s), minimum of 2 views | $168.75 | $225.00 | $153.00–$225.00 | — | 25% |
| Toe X-ray, 2 or more views inpatient one side CPT 73660 Radiologic examination; toe(s), minimum of 2 views | $168.75 | $225.00 | $153.00–$225.00 | — | 25% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound, transvaginal | $577.50 | $770.00 | $179.00–$731.00 | 13% above | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Ultrasound, transvaginal | $577.50 | $770.00 | $523.00–$770.00 | — | 25% |
| Transvaginal ultrasound during pregnancy CPT 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal | $577.50 | $770.00 | $179.00–$731.00 | 27% above | 25% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal | $577.50 | $770.00 | $523.00–$770.00 | — | 25% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound, abdominal, real time with image documentation; complete | $573.75 | $765.00 | $178.00–$726.00 | 17% below | 25% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Ultrasound, abdominal, real time with image documentation; complete | $573.75 | $765.00 | $520.00–$765.00 | — | 25% |
| Ultrasound of the scrotum and testicles CPT 76870 Ultrasound, scrotum and contents | $584.25 | $779.00 | $181.00–$740.00 | 8% above | 25% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 Ultrasound, scrotum and contents | $584.25 | $779.00 | $529.00–$779.00 | — | 25% |
| 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 | $577.50 | $770.00 | $179.00–$731.00 | 24% above | 25% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation | $577.50 | $770.00 | $523.00–$770.00 | — | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Radiologic examination, upper gastrointestinal tract, includ | $450.00 | $600.00 | $139.00–$570.00 | 4% above | 25% |
| Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Radiologic examination, upper gastrointestinal tract, includ | $450.00 | $600.00 | $408.00–$600.00 | — | 25% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Radiologic examination; humerus, minimum of 2 views | $258.75 | $345.00 | $80.00–$327.00 | 39% above | 25% |
| Upper arm X-ray (humerus), 2 views one side CPT 73060 Radiologic examination; humerus, minimum of 2 views | $258.75 | $345.00 | $80.00–$327.00 | 39% above | 25% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Radiologic examination; humerus, minimum of 2 views | $258.75 | $345.00 | $234.00–$345.00 | — | 25% |
| Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 Radiologic examination; humerus, minimum of 2 views | $258.75 | $345.00 | $234.00–$345.00 | — | 25% |
| 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 | $758.25 | $1,011.00 | $235.00–$960.00 | 17% above | 25% |
| 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 | $759.00 | $1,012.00 | $235.00–$961.00 | 17% above | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study | $758.25 | $1,011.00 | $687.00–$1,011.00 | — | 25% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study | $759.00 | $1,012.00 | $688.00–$1,012.00 | — | 25% |
| Wrist X-ray, 2 views one side CPT 73100 Radiologic examination, wrist; 2 views | $177.75 | $237.00 | $55.00–$225.00 | 3% below | 25% |
| Wrist X-ray, 2 views one side CPT 73100 Radiologic examination, wrist; 2 views | $177.75 | $237.00 | $55.00–$225.00 | 3% below | 25% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Radiologic examination, wrist; 2 views | $177.75 | $237.00 | $161.00–$237.00 | — | 25% |
| Wrist X-ray, 2 views inpatient one side CPT 73100 Radiologic examination, wrist; 2 views | $177.75 | $237.00 | $161.00–$237.00 | — | 25% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 1% below | 25% |
| Wrist X-ray, complete, 3 or more views one side CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 1% below | 25% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 Radiologic examination, wrist; complete, minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| 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 | $256.50 | $342.00 | $79.00–$324.00 | 23% above | 25% |
| 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 | $256.50 | $342.00 | $79.00–$324.00 | 23% above | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views | $256.50 | $342.00 | $232.00–$342.00 | — | 25% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views | $256.50 | $342.00 | $232.00–$342.00 | — | 25% |
| X-ray of the abdomen, 1 view CPT 74018 Radiologic examination, abdomen; 1 view | $228.37 | $304.50 | $70.00–$289.00 | 29% above | 25% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 Radiologic examination, abdomen; 1 view | $228.37 | $304.50 | $207.00–$304.00 | — | 25% |
| X-ray of the ankle, 2 views one side CPT 73600 Radiologic examination, ankle; 2 views | $159.75 | $213.00 | $49.00–$202.00 | 5% below | 25% |
| X-ray of the ankle, 2 views one side CPT 73600 Radiologic examination, ankle; 2 views | $159.75 | $213.00 | $49.00–$202.00 | 5% below | 25% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Radiologic examination, ankle; 2 views | $159.75 | $213.00 | $144.00–$213.00 | — | 25% |
| X-ray of the ankle, 2 views inpatient one side CPT 73600 Radiologic examination, ankle; 2 views | $159.75 | $213.00 | $144.00–$213.00 | — | 25% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $168.75 | $225.00 | $52.00–$213.00 | at median | 25% |
| X-ray of the finger(s), 2 or more views one side CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $168.75 | $225.00 | $52.00–$213.00 | at median | 25% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $168.75 | $225.00 | $153.00–$225.00 | — | 25% |
| X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 Radiologic examination, finger(s), minimum of 2 views | $168.75 | $225.00 | $153.00–$225.00 | — | 25% |
| X-ray of the foot, 2 views one side CPT 73620 Radiologic examination, foot; 2 views | $176.25 | $235.00 | $54.00–$223.00 | 9% above | 25% |
| X-ray of the foot, 2 views one side CPT 73620 Radiologic examination, foot; 2 views | $176.25 | $235.00 | $54.00–$223.00 | 9% above | 25% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Radiologic examination, foot; 2 views | $176.25 | $235.00 | $159.00–$235.00 | — | 25% |
| X-ray of the foot, 2 views inpatient one side CPT 73620 Radiologic examination, foot; 2 views | $176.25 | $235.00 | $159.00–$235.00 | — | 25% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 1% above | 25% |
| X-ray of the foot, complete, 3 or more views one side CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 1% above | 25% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 Radiologic examination, foot; complete, minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| X-ray of the hand, 3 or more views one side CPT 73130 Radiologic examination, hand; minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 8% above | 25% |
| X-ray of the hand, 3 or more views one side CPT 73130 Radiologic examination, hand; minimum of 3 views | $219.00 | $292.00 | $67.00–$277.00 | 8% above | 25% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 Radiologic examination, hand; minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| X-ray of the hand, 3 or more views inpatient one side CPT 73130 Radiologic examination, hand; minimum of 3 views | $219.00 | $292.00 | $198.00–$292.00 | — | 25% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Radiologic examination, knee; 1 or 2 views | $226.50 | $302.00 | $70.00–$286.00 | 16% above | 25% |
| X-ray of the knee, 1 or 2 views one side CPT 73560 Radiologic examination, knee; 1 or 2 views | $226.50 | $302.00 | $70.00–$286.00 | 16% above | 25% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Radiologic examination, knee; 1 or 2 views | $226.50 | $302.00 | $205.00–$302.00 | — | 25% |
| X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 Radiologic examination, knee; 1 or 2 views | $226.50 | $302.00 | $205.00–$302.00 | — | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views | $288.00 | $384.00 | $89.00–$364.00 | 1% above | 25% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views | $288.00 | $384.00 | $261.00–$384.00 | — | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views | $397.50 | $530.00 | $123.00–$503.00 | 13% above | 25% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views | $397.50 | $530.00 | $360.00–$530.00 | — | 25% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 Radiologic examination, spine; thoracic, 2 views | $240.75 | $321.00 | $74.00–$304.00 | 3% below | 25% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Radiologic examination, spine; thoracic, 2 views | $240.75 | $321.00 | $218.00–$321.00 | — | 25% |
| X-ray of the nasal bones, 3 or more views CPT 70160 Radiologic examination, nasal bones, complete, minimum of 3 views | $228.75 | $305.00 | $70.00–$289.00 | 16% above | 25% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Radiologic examination, nasal bones, complete, minimum of 3 views | $228.75 | $305.00 | $207.00–$305.00 | — | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Radiologic examination, spine, cervical; 2 or 3 views | $240.00 | $320.00 | $74.00–$304.00 | 3% below | 25% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Radiologic examination, spine, cervical; 2 or 3 views | $240.00 | $320.00 | $217.00–$320.00 | — | 25% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 Radiologic examination, pelvis; 1 or 2 views | $198.00 | $264.00 | $61.00–$250.00 | 1% above | 25% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Radiologic examination, pelvis; 1 or 2 views | $198.00 | $264.00 | $179.00–$264.00 | — | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Radiologic examination, sacrum and coccyx, minimum of 2 views | $277.50 | $370.00 | $86.00–$351.00 | 27% above | 25% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Radiologic examination, sacrum and coccyx, minimum of 2 views | $277.50 | $370.00 | $251.00–$370.00 | — | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) | $93.75 | $125.00 | $29.00–$118.00 | 44% below | 25% |
| ACTH blood test inpatient CPT 82024 Adrenocorticotropic hormone (ACTH) | $93.75 | $125.00 | $85.00–$125.00 | — | 25% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; alanine amino (ALT) (SGPT) | $50.25 | $67.00 | $15.00–$63.00 | 15% above | 25% |
| ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Transferase; alanine amino (ALT) (SGPT) | $50.25 | $67.00 | $45.00–$67.00 | — | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Transferase; aspartate amino (AST) (SGOT) | $49.50 | $66.00 | $15.00–$62.00 | 23% above | 25% |
| AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Transferase; aspartate amino (AST) (SGOT) | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| 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 (HBs | $210.75 | $281.00 | $65.00–$266.00 | 10% below | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsA | $221.25 | $295.00 | $68.00–$280.00 | 6% below | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient 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 (HBs | $210.75 | $281.00 | $191.00–$281.00 | — | 25% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsA | $221.25 | $295.00 | $200.00–$295.00 | — | 25% |
| Albumin blood test CPT 82040 Albumin; serum, plasma or whole blood | $49.50 | $66.00 | $15.00–$62.00 | 38% above | 25% |
| Albumin blood test inpatient CPT 82040 Albumin; serum, plasma or whole blood | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Aldosterone blood test CPT 82088 Aldosterone | $116.25 | $155.00 | $36.00–$147.00 | 34% below | 25% |
| Aldosterone blood test inpatient CPT 82088 Aldosterone | $116.25 | $155.00 | $105.00–$155.00 | — | 25% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase, alkaline; | $50.25 | $67.00 | $15.00–$63.00 | 23% above | 25% |
| Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Phosphatase, alkaline; | $50.25 | $67.00 | $45.00–$67.00 | — | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | $24.00 | $32.00 | $7.00–$30.00 | 38% below | 25% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | $24.00 | $32.00 | $21.00–$32.00 | — | 25% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein (AFP); serum | $81.00 | $108.00 | $25.00–$102.00 | 10% below | 25% |
| Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-fetoprotein (AFP); serum | $81.00 | $108.00 | $73.00–$108.00 | — | 25% |
| Ammonia blood test CPT 82140 Ammonia | $138.00 | $184.00 | $42.00–$174.00 | 57% above | 25% |
| Ammonia blood test inpatient CPT 82140 Ammonia | $138.00 | $184.00 | $125.00–$184.00 | — | 25% |
| Amylase blood test CPT 82150 Amylase | $58.50 | $78.00 | $18.00–$74.00 | 10% above | 25% |
| Amylase blood test inpatient CPT 82150 Amylase | $58.50 | $78.00 | $53.00–$78.00 | — | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic citrullinated peptide (CCP), antibody | $110.25 | $147.00 | $34.00–$139.00 | 39% above | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic citrullinated peptide (CCP), antibody | $110.25 | $147.00 | $99.00–$147.00 | — | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear antibodies (ANA); | $79.50 | $106.00 | $24.00–$100.00 | 9% above | 25% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear antibodies (ANA); | $79.50 | $106.00 | $72.00–$106.00 | — | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide | $147.75 | $197.00 | $45.00–$187.00 | 6% below | 25% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Natriuretic peptide | $147.75 | $197.00 | $133.00–$197.00 | — | 25% |
| 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 | $69.75 | $93.00 | $21.00–$88.00 | 16% above | 25% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | $69.75 | $93.00 | $63.00–$93.00 | — | 25% |
| 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 | $101.25 | $135.00 | $31.00–$128.00 | 17% above | 25% |
| Basic metabolic panel (blood test) inpatient 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 | $101.25 | $135.00 | $91.00–$135.00 | — | 25% |
| Bilirubin blood test, total CPT 82247 Bilirubin; total | $49.50 | $66.00 | $15.00–$62.00 | 8% above | 25% |
| Bilirubin blood test, total inpatient CPT 82247 Bilirubin; total | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| 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, | $171.00 | $228.00 | $53.00–$216.00 | 4% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) inpatient 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, | $171.00 | $228.00 | $155.00–$228.00 | — | 25% |
| Blood culture for bacteria CPT 87040 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | $91.50 | $122.00 | $28.00–$115.00 | at median | 25% |
| Blood culture for bacteria inpatient CPT 87040 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | $91.50 | $122.00 | $82.00–$122.00 | — | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection of venous blood by venipuncture | $28.50 | $38.00 | $8.00–$36.00 | 35% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Collection of venous blood by venipuncture | $28.50 | $38.00 | $25.00–$38.00 | — | 25% |
| Blood glucose (sugar) test CPT 82947 Glucose; quantitative, blood (except reagent strip) | $49.50 | $66.00 | $15.00–$62.00 | 47% above | 25% |
| Blood glucose (sugar) test inpatient CPT 82947 Glucose; quantitative, blood (except reagent strip) | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Blood lead test CPT 83655 Lead | $71.25 | $95.00 | $22.00–$90.00 | 32% above | 25% |
| Blood lead test inpatient CPT 83655 Lead | $71.25 | $95.00 | $64.00–$95.00 | — | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood typing, serologic; ABO | $45.00 | $60.00 | $13.00–$57.00 | 21% below | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood typing, serologic; ABO | $45.00 | $60.00 | $40.00–$60.00 | — | 25% |
| Blood urea nitrogen (BUN) test CPT 84520 Urea nitrogen; quantitative | $49.50 | $66.00 | $15.00–$62.00 | 47% above | 25% |
| Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea nitrogen; quantitative | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| C-peptide blood test CPT 84681 C-peptide | $87.75 | $117.00 | $27.00–$111.00 | 17% below | 25% |
| C-peptide blood test inpatient CPT 84681 C-peptide | $87.75 | $117.00 | $79.00–$117.00 | — | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-reactive protein; | $56.25 | $75.00 | $17.00–$71.00 | 4% below | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-reactive protein; | $56.25 | $75.00 | $51.00–$75.00 | — | 25% |
| 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 | $139.50 | $186.00 | $43.00–$176.00 | 29% above | 25% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique | $139.50 | $186.00 | $126.00–$186.00 | — | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 | $134.25 | $179.00 | $41.00–$170.00 | 38% above | 25% |
| CA 19-9 blood test (tumor marker) inpatient CPT 86301 Immunoassay for tumor antigen, quantitative; CA 19-9 | $134.25 | $179.00 | $121.00–$179.00 | — | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 | $128.25 | $171.00 | $39.00–$162.00 | 12% above | 25% |
| CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Immunoassay for tumor antigen, quantitative; CA 125 | $128.25 | $171.00 | $116.00–$171.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now) | $90.00 | $120.00 | $27.00–$114.00 | 24% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Infectious agent detection by nucleic acid (DNA or RNA); sev | $130.50 | $174.00 | $40.00–$165.00 | 10% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) RNA (ID Now) | $90.00 | $120.00 | $81.00–$120.00 | — | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Infectious agent detection by nucleic acid (DNA or RNA); sev | $130.50 | $174.00 | $118.00–$174.00 | — | 25% |
| Calcium blood test, total CPT 82310 Calcium; total | $45.75 | $61.00 | $14.00–$57.00 | 14% above | 25% |
| Calcium blood test, total inpatient CPT 82310 Calcium; total | $45.75 | $61.00 | $41.00–$61.00 | — | 25% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen (CEA) | $108.00 | $144.00 | $33.00–$136.00 | 2% above | 25% |
| Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic antigen (CEA) | $108.00 | $144.00 | $97.00–$144.00 | — | 25% |
| Chickenpox (varicella) immunity blood test CPT 86787 Antibody; varicella-zoster | $66.75 | $89.00 | $20.00–$84.00 | 4% above | 25% |
| Chickenpox (varicella) immunity blood test inpatient CPT 86787 Antibody; varicella-zoster | $66.75 | $89.00 | $60.00–$89.00 | — | 25% |
| 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 | $105.00 | $140.00 | $32.00–$133.00 | 6% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | $105.00 | $140.00 | $95.00–$140.00 | — | 25% |
| 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) | $99.00 | $132.00 | $30.00–$125.00 | 14% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient 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) | $99.00 | $132.00 | $89.00–$132.00 | — | 25% |
| Complete blood count (CBC) with differential CPT 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | $81.00 | $108.00 | $25.00–$102.00 | 29% above | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | $81.00 | $108.00 | $73.00–$108.00 | — | 25% |
| Complete blood count (CBC), no differential CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | $69.75 | $93.00 | $21.00–$88.00 | 52% above | 25% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | $69.75 | $93.00 | $63.00–$93.00 | — | 25% |
| 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 ( | $117.00 | $156.00 | $36.00–$148.00 | 5% below | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (8 | $123.00 | $164.00 | $38.00–$155.00 | at median | 25% |
| Comprehensive metabolic panel (blood test) inpatient 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 ( | $117.00 | $156.00 | $106.00–$156.00 | — | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (8 | $123.00 | $164.00 | $111.00–$164.00 | — | 25% |
| Cortisol blood test, total CPT 82533 Cortisol; total | $105.00 | $140.00 | $32.00–$133.00 | 5% above | 25% |
| Cortisol blood test, total inpatient CPT 82533 Cortisol; total | $105.00 | $140.00 | $95.00–$140.00 | — | 25% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (CK), (CPK); total | $58.50 | $78.00 | $18.00–$74.00 | 20% above | 25% |
| Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine kinase (CK), (CPK); total | $58.50 | $78.00 | $53.00–$78.00 | — | 25% |
| Creatinine blood test CPT 82565 Creatinine; blood | $49.50 | $66.00 | $15.00–$62.00 | 38% above | 25% |
| Creatinine blood test inpatient CPT 82565 Creatinine; blood | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Antibody; cytomegalovirus (CMV) | $80.25 | $107.00 | $24.00–$101.00 | 18% above | 25% |
| Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Antibody; cytomegalovirus (CMV) | $80.25 | $107.00 | $72.00–$107.00 | — | 25% |
| D-dimer blood test (blood clot marker) CPT 85379 Fibrin degradation products, D-dimer; quantitative | $102.75 | $137.00 | $31.00–$130.00 | 21% above | 25% |
| D-dimer blood test (blood clot marker) inpatient CPT 85379 Fibrin degradation products, D-dimer; quantitative | $102.75 | $137.00 | $93.00–$137.00 | — | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-sulfate (DHEA-S) | $84.75 | $113.00 | $26.00–$107.00 | 27% below | 25% |
| DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone-sulfate (DHEA-S) | $84.75 | $113.00 | $76.00–$113.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Cord Drug Screen | $121.50 | $162.00 | $37.00–$153.00 | 4% below | 25% |
| 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]), | $129.00 | $172.00 | $40.00–$163.00 | 2% above | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Cord Drug Screen | $121.50 | $162.00 | $110.00–$162.00 | — | 25% |
| Drug screen by lab instrument (any number of drug classes) inpatient 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]), | $129.00 | $172.00 | $116.00–$172.00 | — | 25% |
| 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) | $80.25 | $107.00 | $24.00–$101.00 | 17% above | 25% |
| Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) | $80.25 | $107.00 | $72.00–$107.00 | — | 25% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) | $36.75 | $49.00 | $11.00–$46.00 | 49% below | 25% |
| Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) | $36.75 | $49.00 | $33.00–$49.00 | — | 25% |
| Estradiol blood test CPT 82670 Estradiol; total | $105.75 | $141.00 | $32.00–$133.00 | 18% below | 25% |
| Estradiol blood test inpatient CPT 82670 Estradiol; total | $105.75 | $141.00 | $95.00–$141.00 | — | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; follicle stimulating hormone (FSH) | $92.25 | $123.00 | $28.00–$116.00 | 10% below | 25% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Gonadotropin; follicle stimulating hormone (FSH) | $92.25 | $123.00 | $83.00–$123.00 | — | 25% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin | $93.75 | $125.00 | $29.00–$118.00 | 5% above | 25% |
| Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin | $93.75 | $125.00 | $85.00–$125.00 | — | 25% |
| Fibrinogen blood test CPT 85384 Fibrinogen; activity | $84.00 | $112.00 | $26.00–$106.00 | 27% above | 25% |
| Fibrinogen blood test inpatient CPT 85384 Fibrinogen; activity | $84.00 | $112.00 | $76.00–$112.00 | — | 25% |
| Folate (folic acid) blood test CPT 82746 Folic acid; serum | $100.50 | $134.00 | $31.00–$127.00 | 14% above | 25% |
| Folate (folic acid) blood test inpatient CPT 82746 Folic acid; serum | $100.50 | $134.00 | $91.00–$134.00 | — | 25% |
| Free T3 thyroid hormone test CPT 84481 Triiodothyronine T3; free | $100.50 | $134.00 | $31.00–$127.00 | 7% below | 25% |
| Free T3 thyroid hormone test inpatient CPT 84481 Triiodothyronine T3; free | $100.50 | $134.00 | $91.00–$134.00 | — | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine; free | $71.25 | $95.00 | $22.00–$90.00 | 9% above | 25% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine; free | $71.25 | $95.00 | $64.00–$95.00 | — | 25% |
| Free testosterone test CPT 84402 Testosterone; free | $75.75 | $101.00 | $23.00–$95.00 | 27% below | 25% |
| Free testosterone test inpatient CPT 84402 Testosterone; free | $75.75 | $101.00 | $68.00–$101.00 | — | 25% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase, gamma (GGT) | $58.50 | $78.00 | $18.00–$74.00 | 15% above | 25% |
| Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Glutamyltransferase, gamma (GGT) | $58.50 | $78.00 | $53.00–$78.00 | — | 25% |
| 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 | $293.25 | $391.00 | $90.00–$371.00 | 83% above | 25% |
| General health panel: metabolic panel, blood count and TSH in one order inpatient 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 | $293.25 | $391.00 | $265.00–$391.00 | — | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; post glucose dose (includes glucose) | $54.00 | $72.00 | $16.00–$68.00 | 35% above | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose; post glucose dose (includes glucose) | $54.00 | $72.00 | $48.00–$72.00 | — | 25% |
| Glucose tolerance test, 3 samples CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) | $96.00 | $128.00 | $29.00–$121.00 | 10% above | 25% |
| Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) | $96.00 | $128.00 | $87.00–$128.00 | — | 25% |
| 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 | $105.00 | $140.00 | $32.00–$133.00 | 13% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | $105.00 | $140.00 | $95.00–$140.00 | — | 25% |
| H. pylori stool antigen test CPT 87338 Infectious agent antigen detection by immunoassay technique | $117.00 | $156.00 | $36.00–$148.00 | 4% above | 25% |
| 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 [IMC | $123.00 | $164.00 | $38.00–$155.00 | 10% above | 25% |
| H. pylori stool antigen test inpatient CPT 87338 Infectious agent antigen detection by immunoassay technique | $117.00 | $156.00 | $106.00–$156.00 | — | 25% |
| H. pylori stool antigen test inpatient CPT 87338 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMC | $123.00 | $164.00 | $111.00–$164.00 | — | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Infectious agent antigen detection by immunoassay technique | $75.00 | $100.00 | $23.00–$95.00 | 2% below | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Infectious agent antigen detection by immunoassay technique | $75.00 | $100.00 | $68.00–$100.00 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Hum High Risk HPV Laboratory | $104.25 | $139.00 | $32.00–$132.00 | 10% above | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Hum HPV laboratory | $105.75 | $141.00 | $32.00–$133.00 | 12% above | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Hum High Risk HPV Laboratory | $104.25 | $139.00 | $94.00–$139.00 | — | 25% |
| HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Infectious agent detection by nucleic acid (DNA or RNA); Hum HPV laboratory | $105.75 | $141.00 | $95.00–$141.00 | — | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin; glycosylated (A1C) | $77.25 | $103.00 | $23.00–$97.00 | 19% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin; glycosylated (A1C) | $77.25 | $103.00 | $70.00–$103.00 | — | 25% |
| Hemoglobin blood test CPT 85018 Blood count; hemoglobin (Hgb) | $30.75 | $41.00 | $9.00–$38.00 | 8% above | 25% |
| Hemoglobin blood test inpatient CPT 85018 Blood count; hemoglobin (Hgb) | $30.75 | $41.00 | $27.00–$41.00 | — | 25% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B core antibody (HBcAb); total | $120.75 | $161.00 | $37.00–$152.00 | 69% above | 25% |
| Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B core antibody (HBcAb); total | $120.75 | $161.00 | $109.00–$161.00 | — | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody (HBsAb) | $64.50 | $86.00 | $20.00–$81.00 | 6% below | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B surface antibody (HBsAb) | $64.50 | $86.00 | $58.00–$86.00 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Infectious agent antigen detection by immunoassay technique | $71.25 | $95.00 | $22.00–$90.00 | 2% above | 25% |
| 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 [IMC | $75.00 | $100.00 | $23.00–$95.00 | 7% above | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Infectious agent antigen detection by immunoassay technique | $71.25 | $95.00 | $64.00–$95.00 | — | 25% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMC | $75.00 | $100.00 | $68.00–$100.00 | — | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody; | $67.50 | $90.00 | $20.00–$85.00 | 15% below | 25% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C antibody; | $67.50 | $90.00 | $61.00–$90.00 | — | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hep | $319.50 | $426.00 | $99.00–$404.00 | 21% above | 25% |
| 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 | $335.25 | $447.00 | $104.00–$424.00 | 27% above | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hep | $319.50 | $426.00 | $289.00–$426.00 | — | 25% |
| Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | $335.25 | $447.00 | $303.00–$447.00 | — | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 Antibody; herpes simplex, non-specific type test | $103.50 | $138.00 | $32.00–$131.00 | 54% above | 25% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Antibody; herpes simplex, non-specific type test | $103.50 | $138.00 | $93.00–$138.00 | — | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 Antibody; herpes simplex, type 2 | $103.50 | $138.00 | $32.00–$131.00 | 79% above | 25% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Antibody; herpes simplex, type 2 | $103.50 | $138.00 | $93.00–$138.00 | — | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive protein; high sensitivity (hsCRP) | $80.25 | $107.00 | $24.00–$101.00 | at median | 25% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-reactive protein; high sensitivity (hsCRP) | $80.25 | $107.00 | $72.00–$107.00 | — | 25% |
| Homocysteine blood test CPT 83090 Homocysteine | $94.50 | $126.00 | $29.00–$119.00 | 2% below | 25% |
| Homocysteine blood test inpatient CPT 83090 Homocysteine | $94.50 | $126.00 | $85.00–$126.00 | — | 25% |
| Insulin blood test CPT 83525 Insulin; total | $83.25 | $111.00 | $25.00–$105.00 | 9% above | 25% |
| Insulin blood test inpatient CPT 83525 Insulin; total | $83.25 | $111.00 | $75.00–$111.00 | — | 25% |
| Iron blood test (serum iron) CPT 83540 Iron | $50.25 | $67.00 | $15.00–$63.00 | 20% above | 25% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron | $50.25 | $67.00 | $45.00–$67.00 | — | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $48.75 | $65.00 | $15.00–$61.00 | at median | 25% |
| Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron binding capacity | $48.75 | $65.00 | $44.00–$65.00 | — | 25% |
| 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 | $101.25 | $135.00 | $31.00–$128.00 | 7% above | 25% |
| Kidney function blood test panel inpatient 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 | $101.25 | $135.00 | $91.00–$135.00 | — | 25% |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin; luteinizing hormone (LH) | $84.75 | $113.00 | $26.00–$107.00 | 7% below | 25% |
| LH (luteinizing hormone) test inpatient CPT 83002 Gonadotropin; luteinizing hormone (LH) | $84.75 | $113.00 | $76.00–$113.00 | — | 25% |
| Lactate (lactic acid) blood test CPT 83605 Lactate (lactic acid) | $72.75 | $97.00 | $22.00–$92.00 | 4% below | 25% |
| Lactate (lactic acid) blood test inpatient CPT 83605 Lactate (lactic acid) | $72.75 | $97.00 | $65.00–$97.00 | — | 25% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate dehydrogenase (LD), (LDH); | $53.25 | $71.00 | $16.00–$67.00 | 23% above | 25% |
| Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate dehydrogenase (LD), (LDH); | $53.25 | $71.00 | $48.00–$71.00 | — | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase | $64.50 | $86.00 | $20.00–$81.00 | 2% below | 25% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase | $64.50 | $86.00 | $58.00–$86.00 | — | 25% |
| 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, alan | $114.75 | $153.00 | $35.00–$145.00 | 29% above | 25% |
| Liver function blood test panel inpatient 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, alan | $114.75 | $153.00 | $104.00–$153.00 | — | 25% |
| Lyme disease antibody test CPT 86618 Antibody; Borrelia burgdorferi (Lyme disease) | $82.50 | $110.00 | $25.00–$104.00 | 5% below | 25% |
| Lyme disease antibody test inpatient CPT 86618 Antibody; Borrelia burgdorferi (Lyme disease) | $82.50 | $110.00 | $74.00–$110.00 | — | 25% |
| Magnesium blood test CPT 83735 Magnesium | $53.25 | $71.00 | $16.00–$67.00 | 9% above | 25% |
| Magnesium blood test inpatient CPT 83735 Magnesium | $53.25 | $71.00 | $48.00–$71.00 | — | 25% |
| Measles (rubeola) antibody test CPT 86765 Antibody; rubeola | $81.00 | $108.00 | $25.00–$102.00 | 42% above | 25% |
| Measles (rubeola) antibody test inpatient CPT 86765 Antibody; rubeola | $81.00 | $108.00 | $73.00–$108.00 | — | 25% |
| Mumps immunity blood test CPT 86735 Antibody; mumps | $88.50 | $118.00 | $27.00–$112.00 | 69% above | 25% |
| Mumps immunity blood test inpatient CPT 86735 Antibody; mumps | $88.50 | $118.00 | $80.00–$118.00 | — | 25% |
| Obstetric blood test panel CPT 80055 Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated | $228.75 | $305.00 | $70.00–$289.00 | 103% above | 25% |
| Obstetric blood test panel inpatient CPT 80055 Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated | $228.75 | $305.00 | $207.00–$305.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate specific antigen (PSA); free | $110.25 | $147.00 | $34.00–$139.00 | 13% above | 25% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate specific antigen (PSA); free | $110.25 | $147.00 | $99.00–$147.00 | — | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate specific antigen (PSA); total | $114.00 | $152.00 | $35.00–$144.00 | 17% above | 25% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate specific antigen (PSA); total | $114.00 | $152.00 | $103.00–$152.00 | — | 25% |
| 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, unde | $81.75 | $109.00 | $25.00–$103.00 | 4% above | 25% |
| 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 | $85.50 | $114.00 | $26.00–$108.00 | 8% above | 25% |
| Pap test (liquid-based, automated screening with review) inpatient 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, unde | $81.75 | $109.00 | $74.00–$109.00 | — | 25% |
| Pap test (liquid-based, automated screening with review) inpatient 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 | $85.50 | $114.00 | $77.00–$114.00 | — | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) | $147.75 | $197.00 | $45.00–$187.00 | 17% below | 25% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathormone (parathyroid hormone) | $147.75 | $197.00 | $133.00–$197.00 | — | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood | $55.50 | $74.00 | $17.00–$70.00 | 20% above | 25% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplastin time, partial (PTT); plasma or whole blood | $55.50 | $74.00 | $50.00–$74.00 | — | 25% |
| Phosphorus (phosphate) blood test CPT 84100 Phosphorus inorganic (phosphate); | $49.50 | $66.00 | $15.00–$62.00 | 39% above | 25% |
| Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus inorganic (phosphate); | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Potassium blood test CPT 84132 Potassium; serum, plasma or whole blood | $49.50 | $66.00 | $15.00–$62.00 | 44% above | 25% |
| Potassium blood test inpatient CPT 84132 Potassium; serum, plasma or whole blood | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Progesterone blood test CPT 84144 Progesterone | $108.75 | $145.00 | $33.00–$137.00 | 9% above | 25% |
| Progesterone blood test inpatient CPT 84144 Progesterone | $108.75 | $145.00 | $98.00–$145.00 | — | 25% |
| Prolactin blood test CPT 84146 Prolactin | $132.75 | $177.00 | $41.00–$168.00 | 29% above | 25% |
| Prolactin blood test inpatient CPT 84146 Prolactin | $132.75 | $177.00 | $120.00–$177.00 | — | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin time; | $40.50 | $54.00 | $12.00–$51.00 | 23% above | 25% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin time; | $40.50 | $54.00 | $36.00–$54.00 | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug test(s), presumptive, any number of drug classes, any n | $83.25 | $111.00 | $25.00–$105.00 | 14% above | 25% |
| 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, c | $171.75 | $229.00 | $53.00–$217.00 | 136% above | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug test(s), presumptive, any number of drug classes, any n | $83.25 | $111.00 | $75.00–$111.00 | — | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day inpatient 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, c | $171.75 | $229.00 | $155.00–$229.00 | — | 25% |
| Renin blood test CPT 84244 Renin | $87.00 | $116.00 | $26.00–$110.00 | 20% below | 25% |
| Renin blood test inpatient CPT 84244 Renin | $87.00 | $116.00 | $78.00–$116.00 | — | 25% |
| Rh blood typing CPT 86901 Blood typing, serologic; Rh (D) | $42.75 | $57.00 | $13.00–$54.00 | 5% below | 25% |
| Rh blood typing inpatient CPT 86901 Blood typing, serologic; Rh (D) | $42.75 | $57.00 | $38.00–$57.00 | — | 25% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor; quantitative | $71.25 | $95.00 | $22.00–$90.00 | 47% above | 25% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid factor; quantitative | $71.25 | $95.00 | $64.00–$95.00 | — | 25% |
| Rubella antibody test (immunity check) CPT 86762 Antibody; rubella | $58.50 | $78.00 | $18.00–$74.00 | 9% below | 25% |
| Rubella antibody test (immunity check) inpatient CPT 86762 Antibody; rubella | $58.50 | $78.00 | $53.00–$78.00 | — | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation rate, erythrocyte; automated | $37.50 | $50.00 | $11.00–$47.00 | 8% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation rate, erythrocyte; automated | $37.50 | $50.00 | $34.00–$50.00 | — | 25% |
| Sodium blood test CPT 84295 Sodium; serum, plasma or whole blood | $49.50 | $66.00 | $15.00–$62.00 | 47% above | 25% |
| Sodium blood test inpatient CPT 84295 Sodium; serum, plasma or whole blood | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards | $31.50 | $42.00 | $9.00–$39.00 | 5% below | 25% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards | $31.50 | $42.00 | $28.00–$42.00 | — | 25% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | $45.75 | $61.00 | $14.00–$57.00 | 21% below | 25% |
| Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | $45.75 | $61.00 | $41.00–$61.00 | — | 25% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Antibody; Treponema pallidum | $176.25 | $235.00 | $54.00–$223.00 | 226% above | 25% |
| Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Antibody; Treponema pallidum | $176.25 | $235.00 | $159.00–$235.00 | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, cell mediated immunity antigen response m | $202.50 | $270.00 | $62.00–$256.00 | 34% above | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | $213.00 | $284.00 | $66.00–$269.00 | 41% above | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Tuberculosis test, cell mediated immunity antigen response m | $202.50 | $270.00 | $183.00–$270.00 | — | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | $213.00 | $284.00 | $193.00–$284.00 | — | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; total | $92.25 | $123.00 | $28.00–$116.00 | 10% below | 25% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone; total | $92.25 | $123.00 | $83.00–$123.00 | — | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each | $98.25 | $131.00 | $30.00–$124.00 | 23% above | 25% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal antibodies (eg, thyroid or liver-kidney), each | $98.25 | $131.00 | $89.00–$131.00 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone (TSH) Newborn metabolic screening | $36.75 | $49.00 | $11.00–$46.00 | 63% below | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid stimulating hormone (TSH) | $102.75 | $137.00 | $31.00–$130.00 | 3% above | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid stimulating hormone (TSH) Newborn metabolic screening | $36.75 | $49.00 | $33.00–$49.00 | — | 25% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid stimulating hormone (TSH) | $102.75 | $137.00 | $93.00–$137.00 | — | 25% |
| Total IgE blood test CPT 82785 Gammaglobulin (immunoglobulin); IgE | $72.00 | $96.00 | $22.00–$91.00 | 5% below | 25% |
| Total IgE blood test inpatient CPT 82785 Gammaglobulin (immunoglobulin); IgE | $72.00 | $96.00 | $65.00–$96.00 | — | 25% |
| Total cholesterol blood test CPT 82465 Cholesterol, serum or whole blood, total | $49.50 | $66.00 | $15.00–$62.00 | 41% above | 25% |
| Total cholesterol blood test inpatient CPT 82465 Cholesterol, serum or whole blood, total | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Total thyroxine (T4) blood test CPT 84436 Thyroxine; total | $82.50 | $110.00 | $25.00–$104.00 | 56% above | 25% |
| Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine; total | $82.50 | $110.00 | $74.00–$110.00 | — | 25% |
| Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine T3; total (TT-3) | $84.00 | $112.00 | $26.00–$106.00 | 8% above | 25% |
| Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine T3; total (TT-3) | $84.00 | $112.00 | $76.00–$112.00 | — | 25% |
| Transferrin blood test CPT 84466 Transferrin | $72.75 | $97.00 | $22.00–$92.00 | 7% above | 25% |
| Transferrin blood test inpatient CPT 84466 Transferrin | $72.75 | $97.00 | $65.00–$97.00 | — | 25% |
| Trichomonas test (NAAT) CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | $90.00 | $120.00 | $27.00–$114.00 | 6% below | 25% |
| Trichomonas test (NAAT) inpatient CPT 87661 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | $90.00 | $120.00 | $81.00–$120.00 | — | 25% |
| Triglycerides blood test CPT 84478 Triglycerides | $49.50 | $66.00 | $15.00–$62.00 | 18% above | 25% |
| Triglycerides blood test inpatient CPT 84478 Triglycerides | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| Troponin test, quantitative CPT 84484 Troponin, quantitative | $110.25 | $147.00 | $34.00–$139.00 | 5% below | 25% |
| Troponin test, quantitative inpatient CPT 84484 Troponin, quantitative | $110.25 | $147.00 | $99.00–$147.00 | — | 25% |
| Uric acid blood test CPT 84550 Uric acid; blood | $49.50 | $66.00 | $15.00–$62.00 | 29% above | 25% |
| Uric acid blood test inpatient CPT 84550 Uric acid; blood | $49.50 | $66.00 | $44.00–$66.00 | — | 25% |
| 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, | $50.25 | $67.00 | $15.00–$63.00 | 17% above | 25% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, gl | $50.25 | $67.00 | $15.00–$63.00 | 17% above | 25% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis, by dip stick or tablet reagent for bilirubin, gl | $50.25 | $67.00 | $45.00–$67.00 | — | 25% |
| Urinalysis with microscope exam, automated inpatient 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, | $50.25 | $67.00 | $45.00–$67.00 | — | 25% |
| 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, | $27.00 | $36.00 | $8.00–$34.00 | 3% above | 25% |
| Urinalysis without microscope exam, automated inpatient 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, | $27.00 | $36.00 | $24.00–$36.00 | — | 25% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automat | $28.50 | $38.00 | $8.00–$36.00 | 23% above | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automat | $28.50 | $38.00 | $25.00–$38.00 | — | 25% |
| Urine culture for bacteria, with colony count CPT 87086 Culture, bacterial; quantitative colony count, urine | $59.25 | $79.00 | $18.00–$75.00 | 1% above | 25% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Culture, bacterial; quantitative colony count, urine | $59.25 | $79.00 | $53.00–$79.00 | — | 25% |
| Urine microalbumin (albumin) test CPT 82043 Albumin; urine (eg, microalbumin), quantitative | $69.00 | $92.00 | $21.00–$87.00 | 26% above | 25% |
| Urine microalbumin (albumin) test inpatient CPT 82043 Albumin; urine (eg, microalbumin), quantitative | $69.00 | $92.00 | $62.00–$92.00 | — | 25% |
| Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test, by visual color comparison methods | $42.75 | $57.00 | $13.00–$54.00 | 1% above | 25% |
| Urine pregnancy test, read by color change inpatient CPT 81025 Urine pregnancy test, by visual color comparison methods | $42.75 | $57.00 | $38.00–$57.00 | — | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vitamin B-12); | $92.25 | $123.00 | $28.00–$116.00 | 6% above | 25% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Cyanocobalamin (Vitamin B-12); | $92.25 | $123.00 | $83.00–$123.00 | — | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed | $110.25 | $147.00 | $34.00–$139.00 | 15% below | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed | $110.25 | $147.00 | $99.00–$147.00 | — | 25% |
| Zinc blood test CPT 84630 Zinc | $81.75 | $109.00 | $25.00–$103.00 | 56% above | 25% |
| Zinc blood test inpatient CPT 84630 Zinc | $81.75 | $109.00 | $74.00–$109.00 | — | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (hCG); quantitative | $96.00 | $128.00 | $29.00–$121.00 | 7% above | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Gonadotropin, chorionic (hCG); quantitative | $96.00 | $128.00 | $87.00–$128.00 | — | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external | $801.00 | $1,068.00 | $248.00–$1,014.00 | 3% below | 25% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external | $801.00 | $1,068.00 | $726.00–$1,068.00 | — | 25% |
| 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 | $546.00 | $728.00 | $169.00–$691.00 | 49% below | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Circumcision, using clamp or other device with regional dorsal penile or ring block | $546.00 | $728.00 | $495.00–$728.00 | — | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, | $1,200.75 | $1,601.00 | $372.00–$1,520.00 | 2% below | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, | $1,200.75 | $1,601.00 | $1,088.00–$1,601.00 | — | 25% |
| 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 | $1,348.50 | $1,798.00 | $418.00–$1,708.00 | 4% above | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral | $1,348.50 | $1,798.00 | $418.00–$1,708.00 | 4% above | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Injection(s), diagnostic or therapeutic agent, paravertebral | $1,348.50 | $1,798.00 | $1,222.00–$1,798.00 | — | 25% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient 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 | $1,348.50 | $1,798.00 | $1,222.00–$1,798.00 | — | 25% |
| 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 | $289.50 | $386.00 | $89.00–$366.00 | 13% above | 25% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single | $289.50 | $386.00 | $262.00–$386.00 | — | 25% |
| 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, | $1,419.00 | $1,892.00 | $440.00–$1,797.00 | 17% above | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, | $1,419.00 | $1,892.00 | $440.00–$1,797.00 | 17% above | 25% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, | $1,419.00 | $1,892.00 | $1,286.00–$1,892.00 | — | 25% |
| Lower-back epidural injection, with imaging guidance inpatient 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, | $1,419.00 | $1,892.00 | $1,286.00–$1,892.00 | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforam | $882.75 | $1,177.00 | $273.00–$1,118.00 | 33% below | 25% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforam | $882.75 | $1,177.00 | $273.00–$1,118.00 | 33% below | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforam | $882.75 | $1,177.00 | $800.00–$1,177.00 | — | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Injection(s), anesthetic agent(s) and/or steroid; transforam | $882.75 | $1,177.00 | $800.00–$1,177.00 | — | 25% |
| Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance | $1,575.75 | $2,101.00 | $488.00–$1,995.00 | 43% above | 25% |
| Paracentesis with imaging guidance CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with ima | $1,577.25 | $2,103.00 | $489.00–$1,997.00 | 43% above | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance | $1,575.75 | $2,101.00 | $1,428.00–$2,101.00 | — | 25% |
| Paracentesis with imaging guidance inpatient CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with ima | $1,577.25 | $2,103.00 | $1,430.00–$2,103.00 | — | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destruction by neurolytic agent, paravertebral facet joint n | $2,625.00 | $3,500.00 | $814.00–$3,325.00 | 20% above | 25% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destruction by neurolytic agent, paravertebral facet joint n | $2,625.00 | $3,500.00 | $2,380.00–$3,500.00 | — | 25% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint (calf to foot) | $162.75 | $217.00 | $50.00–$206.00 | 5% below | 25% |
| Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint (calf to foot) | $162.75 | $217.00 | $147.00–$217.00 | — | 25% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions | $217.50 | $290.00 | $67.00–$275.00 | 26% above | 25% |
| Skin tag removal, up to 15 tags inpatient CPT 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions | $217.50 | $290.00 | $197.00–$290.00 | — | 25% |
| Thoracentesis with imaging guidance CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural | $2,127.00 | $2,836.00 | $659.00–$2,694.00 | 124% above | 25% |
| Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis, needle or catheter, aspiration of the pleural | $2,127.00 | $2,836.00 | $1,928.00–$2,836.00 | — | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion, blood or blood components | $267.75 | $357.00 | $83.00–$339.00 | 54% below | 25% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion, blood or blood components | $267.75 | $357.00 | $242.00–$357.00 | — | 25% |
| 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, | $114.75 | $153.00 | $35.00–$145.00 | 1% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressurized or nonpressurized inhalation treatment for acute | $117.00 | $156.00 | $36.00–$148.00 | 1% above | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient 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, | $114.75 | $153.00 | $104.00–$153.00 | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Pressurized or nonpressurized inhalation treatment for acute | $117.00 | $156.00 | $106.00–$156.00 | — | 25% |
| 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 | $960.00 | $1,280.00 | $297.00–$1,216.00 | 4% below | 25% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | $960.00 | $1,280.00 | $870.00–$1,280.00 | — | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 Electroencephalogram (EEG); including recording awake and dr | $640.50 | $854.00 | $198.00–$811.00 | 1% below | 25% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Electroencephalogram (EEG); including recording awake and dr | $640.50 | $854.00 | $580.00–$854.00 | — | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | $155.25 | $207.00 | $48.00–$196.00 | 3% below | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | $155.25 | $207.00 | $140.00–$207.00 | — | 25% |
| 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 | $124.50 | $166.00 | $38.00–$157.00 | 19% below | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency department visit for the evaluation and management | $124.50 | $166.00 | $112.00–$166.00 | — | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit for the evaluation and management | $207.00 | $276.00 | $64.00–$262.00 | 21% below | 25% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency department visit for the evaluation and management | $207.00 | $276.00 | $187.00–$276.00 | — | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit for the evaluation and management | $384.75 | $513.00 | $119.00–$487.00 | 8% below | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency department visit for the evaluation and management | $384.75 | $513.00 | $348.00–$513.00 | — | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit for the evaluation and management | $562.50 | $750.00 | $174.00–$712.00 | 13% below | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency department visit for the evaluation and management | $562.50 | $750.00 | $510.00–$750.00 | — | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit for the evaluation and management | $676.50 | $902.00 | $209.00–$856.00 | 31% below | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency department visit for the evaluation and management | $676.50 | $902.00 | $613.00–$902.00 | — | 25% |
| 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 a | $902.25 | $1,203.00 | $279.00–$1,142.00 | 34% above | 25% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation a | $902.25 | $1,203.00 | $818.00–$1,203.00 | — | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour | $178.50 | $238.00 | $55.00–$226.00 | 36% below | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour | $178.50 | $238.00 | $161.00–$238.00 | — | 25% |
| 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 | $208.50 | $278.00 | $64.00–$264.00 | 34% below | 25% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | $208.50 | $278.00 | $189.00–$278.00 | — | 25% |
| 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 | $104.25 | $139.00 | $32.00–$132.00 | 45% below | 25% |
| IV push of a medicine, first drug inpatient CPT 96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug | $104.25 | $139.00 | $94.00–$139.00 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify Injection, ertapenem sodium, 500 mg | $63.75 | $85.00 | $19.00–$80.00 | 30% below | 25% |
| 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 | $63.75 | $85.00 | $19.00–$80.00 | 30% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify Injection, ertapenem sodium, 500 mg | $63.75 | $85.00 | $57.00–$85.00 | — | 25% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | $63.75 | $85.00 | $57.00–$85.00 | — | 25% |
| 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 | $32.25 | $43.00 | $10.00–$40.00 | 27% below | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | $32.25 | $43.00 | $29.00–$43.00 | — | 25% |
| Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes with patient | $151.50 | $202.00 | $47.00–$191.00 | 10% below | 25% |
| Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes with patient | $234.75 | $313.00 | $72.00–$297.00 | 6% above | 25% |
| Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 60 minutes with patient | $264.75 | $353.00 | $82.00–$335.00 | 3% below | 25% |
| Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use cessation counseling visit; intermed | $27.00 | $36.00 | $8.00–$34.00 | 27% below | 25% |
| Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking and tobacco use cessation counseling visit; intermed | $27.00 | $36.00 | $24.00–$36.00 | — | 25% |
| Spirometry (breathing test) CPT 94010 Spirometry, including graphic record, total and timed vital | $241.50 | $322.00 | $74.00–$305.00 | 23% above | 25% |
| Spirometry (breathing test) inpatient CPT 94010 Spirometry, including graphic record, total and timed vital | $241.50 | $322.00 | $218.00–$322.00 | — | 25% |
| Spirometry before and after a bronchodilator CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration | $476.25 | $635.00 | $147.00–$603.00 | 21% above | 25% |
| Spirometry before and after a bronchodilator CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- | $476.25 | $635.00 | $147.00–$603.00 | 21% above | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration | $476.25 | $635.00 | $431.00–$635.00 | — | 25% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- | $476.25 | $635.00 | $431.00–$635.00 | — | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, therapeutic (separate procedure) | $93.75 | $125.00 | $29.00–$118.00 | 51% below | 25% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy, therapeutic (separate procedure) | $93.75 | $125.00 | $85.00–$125.00 | — | 25% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | $107.25 | $143.00 | $33.00–$135.00 | 59% below | 25% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | $107.25 | $143.00 | $97.00–$143.00 | — | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella virus vaccine (VAR), live, for subcutaneous use | $174.75 | $233.00 | $54.00–$221.00 | 7% above | 25% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella virus vaccine (VAR), live, for subcutaneous use | $174.75 | $233.00 | $158.00–$233.00 | — | 25% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use | $126.75 | $169.00 | $39.00–$160.00 | 51% above | 25% |
| DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use | $126.75 | $169.00 | $114.00–$169.00 | — | 25% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use | $53.25 | $71.00 | $16.00–$67.00 | 20% above | 25% |
| DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use | $53.25 | $71.00 | $48.00–$71.00 | — | 25% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use | $110.25 | $147.00 | $34.00–$139.00 | 4% below | 25% |
| DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use | $110.25 | $147.00 | $99.00–$147.00 | — | 25% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use | $142.50 | $190.00 | $44.00–$180.00 | 33% above | 25% |
| DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use | $142.50 | $190.00 | $129.00–$190.00 | — | 25% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, in | $154.50 | $206.00 | $47.00–$195.00 | 9% above | 25% |
| DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) inpatient CPT 90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, in | $154.50 | $206.00 | $140.00–$206.00 | — | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza virus vaccine, trivalent (IIV3), split virus, pres | $18.00 | $24.00 | $5.00–$22.00 | 20% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza virus vaccine, trivalent (IIV3), split virus, pres | $18.00 | $24.00 | $16.00–$24.00 | — | 25% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use | $294.00 | $392.00 | $91.00–$372.00 | 6% below | 25% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use | $294.00 | $392.00 | $266.00–$392.00 | — | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use | $153.00 | $204.00 | $47.00–$193.00 | 23% above | 25% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use | $153.00 | $204.00 | $138.00–$204.00 | — | 25% |
| Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A vaccine (HepA), adult dosage, for intramuscular use | $138.75 | $185.00 | $43.00–$175.00 | 12% above | 25% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A vaccine (HepA), adult dosage, for intramuscular use | $138.75 | $185.00 | $125.00–$185.00 | — | 25% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use | $81.00 | $108.00 | $25.00–$102.00 | 66% above | 25% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use | $81.00 | $108.00 | $73.00–$108.00 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use | $138.75 | $185.00 | $43.00–$175.00 | 27% above | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 00006-4995-41 - Hepatitis B Vaccine 10 mcg/mL Inj 1 mL (Recombivax-HB GEq) [PA] | $186.20 | $186.20 | $43.00–$176.00 | 70% above | — |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use | $138.75 | $185.00 | $125.00–$185.00 | — | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 00006-4995-41 - Hepatitis B Vaccine 10 mcg/mL Inj 1 mL (Recombivax-HB GEq) [PA] | $186.20 | $186.20 | $126.00–$186.00 | — | — |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use | $98.25 | $131.00 | $30.00–$124.00 | 68% above | 25% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 58160-0820-52 - hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus | $202.55 | $202.55 | $47.00–$192.00 | 246% above | — |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use | $98.25 | $131.00 | $89.00–$131.00 | — | 25% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 58160-0820-52 - hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus | $202.55 | $202.55 | $137.00–$202.00 | — | — |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjuga | $65.25 | $87.00 | $20.00–$82.00 | 49% above | 25% |
| Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjuga | $65.25 | $87.00 | $59.00–$87.00 | — | 25% |
| 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 | $58.50 | $78.00 | $18.00–$74.00 | 58% above | 25% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use | $58.50 | $78.00 | $53.00–$78.00 | — | 25% |
| 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 | $72.00 | $96.00 | $22.00–$91.00 | 7% below | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use | $72.00 | $96.00 | $65.00–$96.00 | — | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use | $101.25 | $135.00 | $31.00–$128.00 | 17% below | 25% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use | $101.25 | $135.00 | $91.00–$135.00 | — | 25% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use | $289.50 | $386.00 | $89.00–$366.00 | 22% below | 25% |
| MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use | $289.50 | $386.00 | $262.00–$386.00 | — | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quad | $162.75 | $217.00 | $50.00–$206.00 | 28% below | 25% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quad | $162.75 | $217.00 | $147.00–$217.00 | — | 25% |
| Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quad | $169.50 | $226.00 | $52.00–$214.00 | 13% above | 25% |
| Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quad | $169.50 | $226.00 | $153.00–$226.00 | — | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal recombinant protein and outer membrane vesicle | $219.75 | $293.00 | $68.00–$278.00 | 10% below | 25% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Meningococcal recombinant protein and outer membrane vesicle | $219.75 | $293.00 | $199.00–$293.00 | — | 25% |
| Meningococcal B vaccine (Trumenba) CPT 90621 Trumenba | $183.75 | $245.00 | $57.00–$232.00 | 9% above | 25% |
| Meningococcal B vaccine (Trumenba) inpatient CPT 90621 Trumenba | $183.75 | $245.00 | $166.00–$245.00 | — | 25% |
| Nasal spray flu vaccine, live (FluMist) CPT 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use | $30.75 | $41.00 | $9.00–$38.00 | at median | 25% |
| Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use | $30.75 | $41.00 | $27.00–$41.00 | — | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use | $247.50 | $330.00 | $76.00–$313.00 | 40% below | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 00005-1971-02 - pneumococcal 13-valent conjugate vaccine 0.5ml [PA] | $742.00 | $742.00 | $172.00–$704.00 | 80% above | — |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use | $247.50 | $330.00 | $224.00–$330.00 | — | 25% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 00005-1971-02 - pneumococcal 13-valent conjugate vaccine 0.5ml [PA] | $742.00 | $742.00 | $504.00–$742.00 | — | — |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intra | $247.50 | $330.00 | $76.00–$313.00 | 48% below | 25% |
| Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intra | $247.50 | $330.00 | $224.00–$330.00 | — | 25% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 Pneumococcal conjugate vaccine, 21 valent (PCV21), for intra | $339.75 | $453.00 | $105.00–$430.00 | 36% below | 25% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 Pneumococcal conjugate vaccine, 21 valent (PCV21), for intra | $339.75 | $453.00 | $308.00–$453.00 | — | 25% |
| 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 | $136.50 | $182.00 | $42.00–$172.00 | 37% below | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient 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 | $136.50 | $182.00 | $123.00–$182.00 | — | 25% |
| Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use | $60.00 | $80.00 | $18.00–$76.00 | 19% above | 25% |
| Polio vaccine, inactivated (IPV) inpatient CPT 90713 Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use | $60.00 | $80.00 | $54.00–$80.00 | — | 25% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Respiratory syncytial virus, monoclonal antibody, seasonal d | $376.50 | $502.00 | $116.00–$476.00 | 35% below | 25% |
| RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Respiratory syncytial virus, monoclonal antibody, seasonal d | $376.50 | $502.00 | $341.00–$502.00 | — | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV (Abrysvo) Vaccine | $224.25 | $299.00 | $69.00–$284.00 | 29% below | 25% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV (Abrysvo) Vaccine | $224.25 | $299.00 | $203.00–$299.00 | — | 25% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine, for intramuscular use | $381.00 | $508.00 | $118.00–$482.00 | 47% below | 25% |
| Rabies vaccine, one dose CPT 90675 58160-0964-12 - Rabies Vaccine (Chicken Embryo) Vial (RabAvert) [PA] | $1,204.80 | $1,204.80 | $280.00–$1,144.00 | 69% above | — |
| Rabies vaccine, one dose inpatient CPT 90675 Rabies vaccine, for intramuscular use | $381.00 | $508.00 | $345.00–$508.00 | — | 25% |
| Rabies vaccine, one dose inpatient CPT 90675 58160-0964-12 - Rabies Vaccine (Chicken Embryo) Vial (RabAvert) [PA] | $1,204.80 | $1,204.80 | $819.00–$1,204.00 | — | — |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use | $188.25 | $251.00 | $58.00–$238.00 | 8% above | 25% |
| Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use | $188.25 | $251.00 | $170.00–$251.00 | — | 25% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use | $120.75 | $161.00 | $37.00–$152.00 | 13% above | 25% |
| Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use | $120.75 | $161.00 | $109.00–$161.00 | — | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use | $264.00 | $352.00 | $81.00–$334.00 | 21% above | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use | $264.00 | $352.00 | $239.00–$352.00 | — | 25% |
| 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 | $51.75 | $69.00 | $16.00–$65.00 | 13% below | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 49281-0215-15 - Diphtheria/Tetanus Toxoid Adsorbed Adult 0.5 mL (Td Adult GEq) [PA] | $68.25 | $68.25 | $15.00–$64.00 | 14% above | — |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use | $51.75 | $69.00 | $46.00–$69.00 | — | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 49281-0215-15 - Diphtheria/Tetanus Toxoid Adsorbed Adult 0.5 mL (Td Adult GEq) [PA] | $68.25 | $68.25 | $46.00–$68.00 | — | — |
| 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 | $69.75 | $93.00 | $21.00–$88.00 | 18% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 49281-0400-20 - Diphtheria(Reduced)/Pertussis/Tetanus Vaccine 0.5 mL (Adacel GEq) [PA] | $208.65 | $208.65 | $48.00–$198.00 | 146% above | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use | $69.75 | $93.00 | $63.00–$93.00 | — | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 49281-0400-20 - Diphtheria(Reduced)/Pertussis/Tetanus Vaccine 0.5 mL (Adacel GEq) [PA] | $208.65 | $208.65 | $141.00–$208.00 | — | — |
| Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use | $144.00 | $192.00 | $44.00–$182.00 | 20% above | 25% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use | $144.00 | $192.00 | $130.00–$192.00 | — | 25% |
| 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) | $56.25 | $75.00 | $17.00–$71.00 | 61% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | $56.25 | $75.00 | $51.00–$75.00 | — | 25% |
| 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 additio | $54.00 | $72.00 | $16.00–$68.00 | 88% above | 25% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in additio | $54.00 | $72.00 | $48.00–$72.00 | — | 25% |
Source file: https://pachs.com/wp-content/uploads/420455510_Palo-Alto-County-Hospital_StandardCharges.csv