Humboldt County Memorial Hospital
Humboldt County Memorial Hospital in Humboldt, IA publishes cash prices for 167 common procedures listed here, from its own machine-readable price file updated Mar 30, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Iowa median for 130 of 162 procedures and above it for 31. By typical cash price it ranks #7 of 78 Iowa hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
1000 15th Street North, Humboldt, IA 50548 Collected Sep 27, 2026 Source price file (515) 332-4200
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 161334 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 HC ANKLE MIN 3 VIEWS | $145.35 | $161.50 | $113.00–$161.00 | 35% below | 10% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC ANKLE MIN 3 VIEWS | $145.35 | $161.50 | $113.00–$161.00 | — | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS | $302.85 | $336.50 | $235.00–$336.00 | 3% below | 10% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC UPR/L XTREMITY ART 2 LEVELS | $302.85 | $336.50 | $235.00–$336.00 | — | 10% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 HC ESOPHAGRAM SGL CONTRAST STUDY | $315.90 | $351.00 | $245.00–$351.00 | 12% below | 10% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC ESOPHAGRAM SGL CONTRAST STUDY | $315.90 | $351.00 | $245.00–$351.00 | — | 10% |
| Bone scan, whole body (nuclear medicine) CPT 78306 HC NM BONE IMAGING WHOLE BODY | $843.75 | $937.50 | $656.00–$937.00 | 30% below | 10% |
| Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM BONE IMAGING WHOLE BODY | $843.75 | $937.50 | $656.00–$937.00 | — | 10% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 HC US BREAST LIMITED | $225.00 | $250.00 | $175.00–$250.00 | 37% below | 10% |
| Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US BREAST LIMITED | $225.00 | $250.00 | $175.00–$250.00 | — | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT ANGIOGRAPHY CHEST W WO CONTRAST | $1,282.95 | $1,425.50 | $997.00–$1,425.00 | 39% below | 10% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT ANGIOGRAPHY CHEST W WO CONTRAST | $1,282.95 | $1,425.50 | $997.00–$1,425.00 | — | 10% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT HEART WO CONTRAST W CALCIUM SCORE | $144.00 | $160.00 | $112.00–$160.00 | 64% above | 10% |
| CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT HEART WO CONTRAST W CALCIUM SCORE | $144.00 | $160.00 | $112.00–$160.00 | — | 10% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $2,430.00 | $2,700.00 | $1,890.00–$2,700.00 | 10% below | 10% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT ABD & PELVIS WO CONTRAST | $2,430.00 | $2,700.00 | $1,890.00–$2,700.00 | — | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,700.00 | $3,000.00 | $2,100.00–$3,000.00 | 16% below | 10% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT ABDOMEN & PELVIS W CONTRAST | $2,700.00 | $3,000.00 | $2,100.00–$3,000.00 | — | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT ABD & PELVIS W WO CONTR 1+ REG/SEC | $3,150.00 | $3,500.00 | $2,450.00–$3,500.00 | 9% below | 10% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT ABD & PELVIS W WO CONTR 1+ REG/SEC | $3,150.00 | $3,500.00 | $2,450.00–$3,500.00 | — | 10% |
| CT scan of the abdomen with contrast CPT 74160 HC CT ABDOMEN W CONTRAST | $1,217.25 | $1,352.50 | $946.00–$1,352.00 | 27% below | 10% |
| CT scan of the abdomen with contrast inpatient CPT 74160 HC CT ABDOMEN W CONTRAST | $1,217.25 | $1,352.50 | $946.00–$1,352.00 | — | 10% |
| CT scan of the abdomen without contrast CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,030.95 | $1,145.50 | $801.00–$1,145.00 | 22% below | 10% |
| CT scan of the abdomen without contrast inpatient CPT 74150 HC CT ABDOMEN WO CONTRAST | $1,030.95 | $1,145.50 | $801.00–$1,145.00 | — | 10% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $934.20 | $1,038.00 | $726.00–$1,038.00 | 27% below | 10% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT MAXILLOFACIAL WO CONTRAST | $934.20 | $1,038.00 | $726.00–$1,038.00 | — | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT HEAD OR BRAIN WO CONTRAST | $941.85 | $1,046.50 | $732.00–$1,046.00 | 31% below | 10% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT HEAD OR BRAIN WO CONTRAST | $941.85 | $1,046.50 | $732.00–$1,046.00 | — | 10% |
| CT scan of the head with contrast CPT 70460 HC CT HEAD OR BRAIN W CONTRAST | $1,031.85 | $1,146.50 | $802.00–$1,146.00 | 32% below | 10% |
| CT scan of the head with contrast inpatient CPT 70460 HC CT HEAD OR BRAIN W CONTRAST | $1,031.85 | $1,146.50 | $802.00–$1,146.00 | — | 10% |
| CT scan of the head without and with contrast CPT 70470 HC CT HEAD OR BRAIN W WO CONTRAST | $1,116.90 | $1,241.00 | $868.00–$1,241.00 | 38% below | 10% |
| CT scan of the head without and with contrast inpatient CPT 70470 HC CT HEAD OR BRAIN W WO CONTRAST | $1,116.90 | $1,241.00 | $868.00–$1,241.00 | — | 10% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $1,002.15 | $1,113.50 | $779.00–$1,113.00 | 34% below | 10% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT LUMBAR SPINE WO CONTRAST | $1,002.15 | $1,113.50 | $779.00–$1,113.00 | — | 10% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT CERVICAL SPINE WO CONTRAST | $934.20 | $1,038.00 | $726.00–$1,038.00 | 38% below | 10% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT CERVICAL SPINE WO CONTRAST | $934.20 | $1,038.00 | $726.00–$1,038.00 | — | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT PELVIS W CONTRAST | $1,217.25 | $1,352.50 | $946.00–$1,352.00 | 30% below | 10% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT PELVIS W CONTRAST | $1,217.25 | $1,352.50 | $946.00–$1,352.00 | — | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC CAROTID DUPLEX SCAN; BILAT | $717.75 | $797.50 | $558.00–$797.00 | — | 10% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC CAROTID DUPLEX SCAN; BILAT | $717.75 | $797.50 | $558.00–$797.00 | — | 10% |
| Chest X-ray, 2 views CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS | $155.70 | $173.00 | $121.00–$173.00 | 24% below | 10% |
| Chest X-ray, 2 views inpatient CPT 71046 HC X-RAY EXAM CHEST 2 VIEWS | $155.70 | $173.00 | $121.00–$173.00 | — | 10% |
| Chest X-ray, single view CPT 71045 HC X-RAY EXAM CHEST 1 VIEW | $131.85 | $146.50 | $102.00–$146.00 | 21% below | 10% |
| Chest X-ray, single view inpatient CPT 71045 HC X-RAY EXAM CHEST 1 VIEW | $131.85 | $146.50 | $102.00–$146.00 | — | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US EXAM RETROPERITONEAL COMPL | $475.20 | $528.00 | $369.00–$528.00 | 22% below | 10% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US EXAM RETROPERITONEAL COMPL | $475.20 | $528.00 | $369.00–$528.00 | — | 10% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC DXA BONE DENSITY AXIAL | $383.85 | $426.50 | $298.00–$426.00 | 2% below | 10% |
| DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC DXA BONE DENSITY AXIAL | $383.85 | $426.50 | $298.00–$426.00 | — | 10% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB DETAILED SNGL FETUS | $458.10 | $509.00 | $356.00–$509.00 | 26% below | 10% |
| Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US OB DETAILED SNGL FETUS | $458.10 | $509.00 | $356.00–$509.00 | — | 10% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT CHEST WO CONTRAST DIAG | $1,031.85 | $1,146.50 | $802.00–$1,146.00 | 25% below | 10% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT CHEST WO CONTRAST DIAG | $1,031.85 | $1,146.50 | $802.00–$1,146.00 | — | 10% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT CHEST W CONTRAST DIAG | $1,217.25 | $1,352.50 | $946.00–$1,352.00 | 32% below | 10% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT CHEST W CONTRAST DIAG | $1,217.25 | $1,352.50 | $946.00–$1,352.00 | — | 10% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC DX MAMMO INCL CAD BILAT | $233.55 | $259.50 | $181.00–$259.00 | — | 10% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC DX MAMMO INCL CAD BILAT | $233.55 | $259.50 | $181.00–$259.00 | — | 10% |
| Diagnostic mammogram, one breast CPT 77065 HC DX MAMMO INCL CAD UNIL | $193.95 | $215.50 | $150.00–$215.00 | 33% below | 10% |
| Diagnostic mammogram, one breast inpatient CPT 77065 HC DX MAMMO INCL CAD UNIL | $193.95 | $215.50 | $150.00–$215.00 | — | 10% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC DUPLEX LE ART/BPG; BILAT | $440.55 | $489.50 | $342.00–$489.00 | — | 10% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC DUPLEX LE ART/BPG; BILAT | $440.55 | $489.50 | $342.00–$489.00 | — | 10% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC DUPLEX EXT VEINS; BILAT | $590.40 | $656.00 | $459.00–$656.00 | — | 10% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC DUPLEX EXT VEINS; BILAT | $590.40 | $656.00 | $459.00–$656.00 | — | 10% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC TTE W/ DOPPLER COMPLETE | $734.40 | $816.00 | $571.00–$816.00 | 52% below | 10% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC TTE W/ DOPPLER COMPLETE | $734.40 | $816.00 | $571.00–$816.00 | — | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING | $927.00 | $1,030.00 | $721.00–$1,030.00 | 20% below | 10% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM HEPATOBILIARY SYSTEM IMAGING | $927.00 | $1,030.00 | $721.00–$1,030.00 | — | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC SLEEP STUDY UNATT & RESP EFFT | $540.00 | $600.00 | $420.00–$600.00 | 2% below | 10% |
| Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC SLEEP STUDY UNATT & RESP EFFT | $540.00 | $600.00 | $420.00–$600.00 | — | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC PSS W 4/> PARAM W CPAP/BIPAP 6+ YRS | $2,019.60 | $2,244.00 | $1,570.00–$2,244.00 | 36% below | 10% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC PSS W 4/> PARAM W CPAP/BIPAP 6+ YRS | $2,019.60 | $2,244.00 | $1,570.00–$2,244.00 | — | 10% |
| Knee X-ray, 3 views CPT 73562 HC KNEE 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | 37% below | 10% |
| Knee X-ray, 3 views inpatient CPT 73562 HC KNEE 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | — | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US EXAM ABDOMEN LIMITED | $292.05 | $324.50 | $227.00–$324.00 | 40% below | 10% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US EXAM ABDOMEN LIMITED | $292.05 | $324.50 | $227.00–$324.00 | — | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT THORAX LUNG CANCER SCREEN | $313.20 | $348.00 | $243.00–$348.00 | 27% below | 10% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT THORAX LUNG CANCER SCREEN | $313.20 | $348.00 | $243.00–$348.00 | — | 10% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI LOW EXTR ANY JOINT WO CONTRAST | $1,861.20 | $2,068.00 | $1,447.00–$2,068.00 | 17% below | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI LOW EXTR ANY JOINT WO CONTRAST | $1,861.20 | $2,068.00 | $1,447.00–$2,068.00 | — | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI LOW EXTR ANY JOINT W WO CONTR | $1,838.70 | $2,043.00 | $1,430.00–$2,043.00 | 42% below | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI LOW EXTR ANY JOINT W WO CONTR | $1,838.70 | $2,043.00 | $1,430.00–$2,043.00 | — | 10% |
| MRI of the abdomen without contrast CPT 74181 HC MRI ABDOMEN WO CONTRAST | $1,861.20 | $2,068.00 | $1,447.00–$2,068.00 | 10% below | 10% |
| MRI of the abdomen without contrast inpatient CPT 74181 HC MRI ABDOMEN WO CONTRAST | $1,861.20 | $2,068.00 | $1,447.00–$2,068.00 | — | 10% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI ABDOMEN W WO CONTRAST | $2,920.95 | $3,245.50 | $2,271.00–$3,245.00 | 13% below | 10% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI ABDOMEN W WO CONTRAST | $2,920.95 | $3,245.50 | $2,271.00–$3,245.00 | — | 10% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI BRAIN WO CONTRAST | $1,861.20 | $2,068.00 | $1,447.00–$2,068.00 | 15% below | 10% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI BRAIN WO CONTRAST | $1,861.20 | $2,068.00 | $1,447.00–$2,068.00 | — | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI BRAIN W WO CONTRAST | $3,007.35 | $3,341.50 | $2,339.00–$3,341.00 | 15% below | 10% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI BRAIN W WO CONTRAST | $3,007.35 | $3,341.50 | $2,339.00–$3,341.00 | — | 10% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST | $1,718.55 | $1,909.50 | $1,336.00–$1,909.00 | 28% below | 10% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI SPINE LUMBAR WO CONTRAST | $1,718.55 | $1,909.50 | $1,336.00–$1,909.00 | — | 10% |
| MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI SPINE LUMBAR W WO CONTRAST | $2,960.10 | $3,289.00 | $2,302.00–$3,289.00 | 14% below | 10% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI SPINE LUMBAR W WO CONTRAST | $2,960.10 | $3,289.00 | $2,302.00–$3,289.00 | — | 10% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI SPINE THORACIC WO CONTRAST | $1,813.95 | $2,015.50 | $1,410.00–$2,015.00 | 22% below | 10% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI SPINE THORACIC WO CONTRAST | $1,813.95 | $2,015.50 | $1,410.00–$2,015.00 | — | 10% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI SPINE CERVICAL W WO CONTRAST | $2,960.10 | $3,289.00 | $2,302.00–$3,289.00 | 12% below | 10% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI SPINE CERVICAL W WO CONTRAST | $2,960.10 | $3,289.00 | $2,302.00–$3,289.00 | — | 10% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI SPINE CERVICAL WO CONTRAST | $1,718.55 | $1,909.50 | $1,336.00–$1,909.00 | 24% below | 10% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI SPINE CERVICAL WO CONTRAST | $1,718.55 | $1,909.50 | $1,336.00–$1,909.00 | — | 10% |
| MRI of the pelvis without and with contrast CPT 72197 HC MRI PELVIS W WO CONTRAST | $3,055.50 | $3,395.00 | $2,376.00–$3,395.00 | 5% below | 10% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI PELVIS W WO CONTRAST | $3,055.50 | $3,395.00 | $2,376.00–$3,395.00 | — | 10% |
| MRI of the pelvis, no contrast dye CPT 72195 HC MRI PELVIS WO CONTRAST | $1,909.80 | $2,122.00 | $1,485.00–$2,122.00 | 7% below | 10% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI PELVIS WO CONTRAST | $1,909.80 | $2,122.00 | $1,485.00–$2,122.00 | — | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI UP EXTR ANY JOINT WO CONTRAST | $1,813.95 | $2,015.50 | $1,410.00–$2,015.00 | 19% below | 10% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI UP EXTR ANY JOINT WO CONTRAST | $1,813.95 | $2,015.50 | $1,410.00–$2,015.00 | — | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US EXAM PELVIC LTD | $198.00 | $220.00 | $154.00–$220.00 | 44% below | 10% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US EXAM PELVIC LTD | $198.00 | $220.00 | $154.00–$220.00 | — | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US EXAM PELVIC COMP TRANSABDOMINAL | $341.10 | $379.00 | $265.00–$379.00 | 35% below | 10% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US EXAM PELVIC COMP TRANSABDOMINAL | $341.10 | $379.00 | $265.00–$379.00 | — | 10% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB COMPLETE SNGL FETUS | $389.25 | $432.50 | $302.00–$432.00 | 29% below | 10% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US OB COMPLETE SNGL FETUS | $389.25 | $432.50 | $302.00–$432.00 | — | 10% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB LESS THAN 14 WKS SNGL FETUS | $341.10 | $379.00 | $265.00–$379.00 | 24% below | 10% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC US OB LESS THAN 14 WKS SNGL FETUS | $341.10 | $379.00 | $265.00–$379.00 | — | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB LIMITED FETUS(S) | $341.10 | $379.00 | $265.00–$379.00 | 2% above | 10% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US OB LIMITED FETUS(S) | $341.10 | $379.00 | $265.00–$379.00 | — | 10% |
| Screening mammogram, both breasts both sides CPT 77067 HC SCR MAMMO INCL CAD BILAT | $220.50 | $245.00 | $171.00–$245.00 | — | 10% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC SCR MAMMO INCL CAD BILAT | $220.50 | $245.00 | $171.00–$245.00 | — | 10% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 HC SHOULDER MIN 2 VIEWS | $146.25 | $162.50 | $113.00–$162.00 | 38% below | 10% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC SHOULDER MIN 2 VIEWS | $146.25 | $162.50 | $113.00–$162.00 | — | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 HC PSS W 4/> PARAM W TECH 6+ YRS | $1,744.20 | $1,938.00 | $1,356.00–$1,938.00 | 39% below | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC PSS W 4/> PARAM W TECH 6+ YRS | $1,744.20 | $1,938.00 | $1,356.00–$1,938.00 | — | 10% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 HC SWALLOWING FUNCTION W CINE VIDEO | $292.05 | $324.50 | $227.00–$324.00 | 27% below | 10% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC SWALLOWING FUNCTION W CINE VIDEO | $292.05 | $324.50 | $227.00–$324.00 | — | 10% |
| Transvaginal pelvic ultrasound CPT 76830 HC US NON OB TRANSVAG | $341.10 | $379.00 | $265.00–$379.00 | 35% below | 10% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US NON OB TRANSVAG | $341.10 | $379.00 | $265.00–$379.00 | — | 10% |
| Transvaginal ultrasound during pregnancy CPT 76817 HC US OB TRANSVAGINAL | $292.05 | $324.50 | $227.00–$324.00 | 36% below | 10% |
| Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US OB TRANSVAGINAL | $292.05 | $324.50 | $227.00–$324.00 | — | 10% |
| Ultrasound of the abdomen, complete CPT 76700 HC US EXAM ABDOMEN COMPLETE | $389.25 | $432.50 | $302.00–$432.00 | 44% below | 10% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US EXAM ABDOMEN COMPLETE | $389.25 | $432.50 | $302.00–$432.00 | — | 10% |
| Ultrasound of the scrotum and testicles CPT 76870 HC US SCROTUM AND CONTENTS | $341.10 | $379.00 | $265.00–$379.00 | 37% below | 10% |
| Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US SCROTUM AND CONTENTS | $341.10 | $379.00 | $265.00–$379.00 | — | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US EXAM OF HEAD AND NECK | $315.90 | $351.00 | $245.00–$351.00 | 32% below | 10% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC US EXAM OF HEAD AND NECK | $315.90 | $351.00 | $245.00–$351.00 | — | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC DUPLEX EXT VEINS UNIL/LIMIT | $495.90 | $551.00 | $385.00–$551.00 | 23% below | 10% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC DUPLEX EXT VEINS UNIL/LIMIT | $495.90 | $551.00 | $385.00–$551.00 | — | 10% |
| Wrist X-ray, complete, 3 or more views CPT 73110 HC WRIST COMPL MIN 3 VIEWS | $145.35 | $161.50 | $113.00–$161.00 | 34% below | 10% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC WRIST COMPL MIN 3 VIEWS | $145.35 | $161.50 | $113.00–$161.00 | — | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | 29% below | 10% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-RAY EXAM HIP UNI 2-3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | — | 10% |
| X-ray of the abdomen, 1 view CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW | $131.94 | $146.60 | $102.00–$146.00 | 25% below | 10% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-RAY EXAM ABDOMEN 1 VIEW | $131.94 | $146.60 | $102.00–$146.00 | — | 10% |
| X-ray of the ankle, 2 views CPT 73600 HC ANKLE 2 VIEWS | $112.05 | $124.50 | $87.00–$124.00 | 35% below | 10% |
| X-ray of the ankle, 2 views inpatient CPT 73600 HC ANKLE 2 VIEWS | $112.05 | $124.50 | $87.00–$124.00 | — | 10% |
| X-ray of the finger(s), 2 or more views CPT 73140 HC FINGER OR FINGERS MIN 2 VIEWS | $112.05 | $124.50 | $87.00–$124.00 | 33% below | 10% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC FINGER OR FINGERS MIN 2 VIEWS | $112.05 | $124.50 | $87.00–$124.00 | — | 10% |
| X-ray of the foot, 2 views CPT 73620 HC FOOT 2 VIEWS | $121.50 | $135.00 | $94.00–$135.00 | 25% below | 10% |
| X-ray of the foot, 2 views inpatient CPT 73620 HC FOOT 2 VIEWS | $121.50 | $135.00 | $94.00–$135.00 | — | 10% |
| X-ray of the foot, complete, 3 or more views CPT 73630 HC FOOT MIN 3 VIEWS | $145.35 | $161.50 | $113.00–$161.00 | 34% below | 10% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC FOOT MIN 3 VIEWS | $145.35 | $161.50 | $113.00–$161.00 | — | 10% |
| X-ray of the hand, 3 or more views CPT 73130 HC HAND MIN 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | 34% below | 10% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 HC HAND MIN 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | — | 10% |
| X-ray of the knee, 1 or 2 views CPT 73560 HC KNEE 1 OR 2 VIEWS | $126.90 | $141.00 | $98.00–$141.00 | 36% below | 10% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC KNEE 1 OR 2 VIEWS | $126.90 | $141.00 | $98.00–$141.00 | — | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC LUMBOSACR SPINE 2 OR 3 VIEWS | $180.90 | $201.00 | $140.00–$201.00 | 37% below | 10% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC LUMBOSACR SPINE 2 OR 3 VIEWS | $180.90 | $201.00 | $140.00–$201.00 | — | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 HC LUMBOSACR SPINE MIN 4 VIEWS | $214.20 | $238.00 | $166.00–$238.00 | 39% below | 10% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC LUMBOSACR SPINE MIN 4 VIEWS | $214.20 | $238.00 | $166.00–$238.00 | — | 10% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC THORACIC SPINE 2 VIEWS | $146.25 | $162.50 | $113.00–$162.00 | 42% below | 10% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC THORACIC SPINE 2 VIEWS | $146.25 | $162.50 | $113.00–$162.00 | — | 10% |
| X-ray of the nasal bones, 3 or more views CPT 70160 HC NASAL BONES MIN 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | 31% below | 10% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC NASAL BONES MIN 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | — | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC CERVICAL SPINE 2 OR 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | 46% below | 10% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC CERVICAL SPINE 2 OR 3 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | — | 10% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 HC PELVIS 1 OR 2 VIEWS | $131.85 | $146.50 | $102.00–$146.00 | 33% below | 10% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC PELVIS 1 OR 2 VIEWS | $131.85 | $146.50 | $102.00–$146.00 | — | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC SACRUM COCCYX MIN 2 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | 38% below | 10% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC SACRUM COCCYX MIN 2 VIEWS | $136.35 | $151.50 | $106.00–$151.00 | — | 10% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC ROUTINE VENIPUNCTURE | $15.30 | $17.00 | $11.00–$17.00 | 23% below | 10% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC ROUTINE VENIPUNCTURE | $15.30 | $17.00 | $11.00–$17.00 | — | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC COVID-19 LAB TEST NON-CDC AMP PRB | $103.50 | $115.00 | $80.00–$115.00 | 10% below | 10% |
| COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC COVID-19 LAB TEST NON-CDC AMP PRB | $103.50 | $115.00 | $80.00–$115.00 | — | 10% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-REACTIVE PROTEIN, HS | $27.00 | $30.00 | $21.00–$30.00 | 65% below | 10% |
| High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-REACTIVE PROTEIN, HS | $27.00 | $30.00 | $21.00–$30.00 | — | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC VITAMIN D, 25 HYDROXY | $58.50 | $65.00 | $45.00–$65.00 | 53% below | 10% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC VITAMIN D, 25 HYDROXY | $58.50 | $65.00 | $45.00–$65.00 | — | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine CPT 64615 HC CHEMODENERV MUSC MIGRAINE | $616.50 | $685.00 | $479.00–$685.00 | 57% above | 10% |
| Botox injections for chronic migraine inpatient CPT 64615 HC CHEMODENERV MUSC MIGRAINE | $616.50 | $685.00 | $479.00–$685.00 | — | 10% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 HC CARDIOVERSION | $370.80 | $412.00 | $288.00–$412.00 | 54% below | 10% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC CARDIOVERSION | $370.80 | $412.00 | $288.00–$412.00 | — | 10% |
| Colonoscopy with polyp removal CPT 45385 HC COLONOSCOPY W/LESION REMOVAL BY SNARE | $1,872.90 | $2,081.00 | $1,456.00–$2,081.00 | 31% above | 10% |
| Colonoscopy with polyp removal inpatient CPT 45385 HC COLONOSCOPY W/LESION REMOVAL BY SNARE | $1,872.90 | $2,081.00 | $1,456.00–$2,081.00 | — | 10% |
| Colonoscopy with tissue sample CPT 45380 HC COLONOSCOPY AND BIOPSY | $1,813.50 | $2,015.00 | $1,410.00–$2,015.00 | 31% above | 10% |
| Colonoscopy with tissue sample inpatient CPT 45380 HC COLONOSCOPY AND BIOPSY | $1,813.50 | $2,015.00 | $1,410.00–$2,015.00 | — | 10% |
| Colonoscopy, diagnostic CPT 45378 HC DIAGNOSTIC COLONOSCOPY | $1,813.50 | $2,015.00 | $1,410.00–$2,015.00 | 67% above | 10% |
| Colonoscopy, diagnostic inpatient CPT 45378 HC DIAGNOSTIC COLONOSCOPY | $1,813.50 | $2,015.00 | $1,410.00–$2,015.00 | — | 10% |
| Earwax removal with instruments, one ear CPT 69210 HC REMOVAL IMPACTED CERUMEN (EARWAX) | $69.75 | $77.50 | $54.00–$77.00 | 33% below | 10% |
| Earwax removal with instruments, one ear inpatient CPT 69210 HC REMOVAL IMPACTED CERUMEN (EARWAX) | $69.75 | $77.50 | $54.00–$77.00 | — | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC INJ INTERLAM C/T W IMG | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 10% below | 10% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC INJ INTERLAM C/T W IMG | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $2,043.00 | $2,270.00 | $1,589.00–$2,270.00 | 62% above | 10% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC INJ PARAVERT F JNT L/S 1 LEV | $2,043.00 | $2,270.00 | $1,589.00–$2,270.00 | — | 10% |
| Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D ABSC SMPL OR SGL | $88.20 | $98.00 | $68.00–$98.00 | 64% below | 10% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D ABSC SMPL OR SGL | $88.20 | $98.00 | $68.00–$98.00 | — | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC INJ SGL TENDON SHTH OR LIGAMENT | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 349% above | 10% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC INJ SGL TENDON SHTH OR LIGAMENT | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC DRAIN/INJ MAJOR JNT/BURSA | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 213% above | 10% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC DRAIN/INJ MAJOR JNT/BURSA | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC DRAIN/INJ INTERM JNT/BURSA | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 275% above | 10% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC DRAIN/INJ INTERM JNT/BURSA | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC DRAIN/INJ JOINT/BURSA W/O US | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 295% above | 10% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC DRAIN/INJ JOINT/BURSA W/O US | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC INT REP S/A/T/EX 2.5 CM/< | $611.10 | $679.00 | $475.00–$679.00 | 72% above | 10% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC INT REP S/A/T/EX 2.5 CM/< | $611.10 | $679.00 | $475.00–$679.00 | — | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC INJ INTERLAM L/S W IMG | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 6% below | 10% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC INJ INTERLAM L/S W IMG | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | 18% below | 10% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC INJ(S) FORAMEN EPIDURAL L/S SGL LEV | $1,075.50 | $1,195.00 | $836.00–$1,195.00 | — | 10% |
| Nail removal (partial or complete), one nail CPT 11730 HC SPL AVULSE NP SGL | $45.00 | $50.00 | $35.00–$50.00 | 79% below | 10% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 HC SPL AVULSE NP SGL | $45.00 | $50.00 | $35.00–$50.00 | — | 10% |
| Occipital nerve block (injection for headaches) CPT 64405 HC INJ ANESTH/STER GREATER OCCIPITAL NERVE | $616.50 | $685.00 | $479.00–$685.00 | 53% above | 10% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 HC INJ ANESTH/STER GREATER OCCIPITAL NERVE | $616.50 | $685.00 | $479.00–$685.00 | — | 10% |
| Paracentesis with imaging guidance CPT 49083 HC ABD PARACENTESIS W/IMAGING | $526.50 | $585.00 | $409.00–$585.00 | 53% below | 10% |
| Paracentesis with imaging guidance inpatient CPT 49083 HC ABD PARACENTESIS W/IMAGING | $526.50 | $585.00 | $409.00–$585.00 | — | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC DESTROY LUMB/SAC FACET JNT UNIL | $3,010.50 | $3,345.00 | $2,341.00–$3,345.00 | 46% above | 10% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 HC DESTROY LUMB/SAC FACET JNT UNIL | $3,010.50 | $3,345.00 | $2,341.00–$3,345.00 | — | 10% |
| Short arm splint (forearm and hand) CPT 29125 HC APPLY SHORT ARM SPLINT STATIC | $76.05 | $84.50 | $59.00–$84.00 | 57% below | 10% |
| Short arm splint (forearm and hand) inpatient CPT 29125 HC APPLY SHORT ARM SPLINT STATIC | $76.05 | $84.50 | $59.00–$84.00 | — | 10% |
| Short leg splint (calf to foot) CPT 29515 HC APPLY SHORT LEG SPLINT | $31.50 | $35.00 | $24.00–$35.00 | 81% below | 10% |
| Short leg splint (calf to foot) inpatient CPT 29515 HC APPLY SHORT LEG SPLINT | $31.50 | $35.00 | $24.00–$35.00 | — | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC SREP S/N/A/G/TR/E 2.5 CM/< | $108.00 | $120.00 | $84.00–$120.00 | 52% below | 10% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC SREP S/N/A/G/TR/E 2.5 CM/< | $108.00 | $120.00 | $84.00–$120.00 | — | 10% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAG | $324.45 | $360.50 | $252.00–$360.00 | 33% below | 10% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC SPINAL PUNCTURE LUMBAR DIAG | $324.45 | $360.50 | $252.00–$360.00 | — | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC SREP S/N/A/G/TR/E 2.6-7.5 CM | $108.00 | $120.00 | $84.00–$120.00 | 56% below | 10% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC SREP S/N/A/G/TR/E 2.6-7.5 CM | $108.00 | $120.00 | $84.00–$120.00 | — | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC SREP F/E/N/L/MM 2.5 CM/< | $108.00 | $120.00 | $84.00–$120.00 | 56% below | 10% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC SREP F/E/N/L/MM 2.5 CM/< | $108.00 | $120.00 | $84.00–$120.00 | — | 10% |
| Trigger point injections, 1 or 2 muscles CPT 20552 HC INJ TRIGGER POINT 1/2 MUSCL | $95.40 | $106.00 | $74.00–$106.00 | 61% below | 10% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC INJ TRIGGER POINT 1/2 MUSCL | $95.40 | $106.00 | $74.00–$106.00 | — | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC BX BREAST 1ST LESION US IMAG | $1,266.58 | $1,407.32 | $985.00–$1,407.00 | 39% below | 10% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC BX BREAST 1ST LESION US IMAG | $1,266.58 | $1,407.32 | $985.00–$1,407.00 | — | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC UGI BALLOON DIL ESOPH < 30 MM DIA | $1,819.80 | $2,022.00 | $1,415.00–$2,022.00 | 14% below | 10% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 HC UGI BALLOON DIL ESOPH < 30 MM DIA | $1,819.80 | $2,022.00 | $1,415.00–$2,022.00 | — | 10% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC UGI W BX SGL/MULTIPLE | $1,903.50 | $2,115.00 | $1,480.00–$2,115.00 | 51% above | 10% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC UGI W BX SGL/MULTIPLE | $1,903.50 | $2,115.00 | $1,480.00–$2,115.00 | — | 10% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 HC UPPR GI SCOPE W/SUBMUC INJ | $1,894.50 | $2,105.00 | $1,473.00–$2,105.00 | 104% above | 10% |
| Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 HC UPPR GI SCOPE W/SUBMUC INJ | $1,894.50 | $2,105.00 | $1,473.00–$2,105.00 | — | 10% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC EGD REMOVE LESION SNARE | $2,126.70 | $2,363.00 | $1,654.00–$2,363.00 | 82% above | 10% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 HC EGD REMOVE LESION SNARE | $2,126.70 | $2,363.00 | $1,654.00–$2,363.00 | — | 10% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC UGI DIAGNOSTIC | $1,874.70 | $2,083.00 | $1,458.00–$2,083.00 | 92% above | 10% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 HC UGI DIAGNOSTIC | $1,874.70 | $2,083.00 | $1,458.00–$2,083.00 | — | 10% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 HC TRANSFUSION BLOOD OR COMPONENT PER UNIT | $459.00 | $510.00 | $357.00–$510.00 | 16% below | 10% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC TRANSFUSION BLOOD OR COMPONENT PER UNIT | $459.00 | $510.00 | $357.00–$510.00 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT SUBQ | $59.85 | $66.50 | $46.00–$66.00 | 46% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI AIRWAY INHALATION TX SUBQ | $90.00 | $100.00 | $70.00–$100.00 | 18% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC AIRWAY INHALATION TREATMENT INITIAL | $93.60 | $104.00 | $72.00–$104.00 | 15% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC MDI AIRWAY INHALATION TX INITIAL | $99.00 | $110.00 | $77.00–$110.00 | 10% below | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT SUBQ | $59.85 | $66.50 | $46.00–$66.00 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI AIRWAY INHALATION TX SUBQ | $90.00 | $100.00 | $70.00–$100.00 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC AIRWAY INHALATION TREATMENT INITIAL | $93.60 | $104.00 | $72.00–$104.00 | — | 10% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC MDI AIRWAY INHALATION TX INITIAL | $99.00 | $110.00 | $77.00–$110.00 | — | 10% |
| Chemotherapy IV infusion, first hour CPT 96413 HC CHEMO, IV INFUSION, 1 HR | $185.40 | $206.00 | $144.00–$206.00 | 66% below | 10% |
| Chemotherapy IV infusion, first hour inpatient CPT 96413 HC CHEMO, IV INFUSION, 1 HR | $185.40 | $206.00 | $144.00–$206.00 | — | 10% |
| Critical care, first 30 to 74 minutes CPT 99291 HC CRITICAL CARE 30-74 MIN | $572.85 | $636.50 | $445.00–$636.00 | 35% below | 10% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 HC CRITICAL CARE 30-74 MIN | $572.85 | $636.50 | $445.00–$636.00 | — | 10% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 HC EEG AWAKE & DROWSY | $793.80 | $882.00 | $617.00–$882.00 | 25% above | 10% |
| EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 HC EEG AWAKE & DROWSY | $793.80 | $882.00 | $617.00–$882.00 | — | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC 12 LEAD EKG; TRACING ONLY | $165.15 | $183.50 | $128.00–$183.00 | 4% above | 10% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC 12 LEAD EKG; TRACING ONLY | $165.15 | $183.50 | $128.00–$183.00 | — | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED LEVEL 1 VISIT | $99.00 | $110.00 | $77.00–$110.00 | 47% above | 10% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ED LEVEL 1 VISIT | $99.00 | $110.00 | $77.00–$110.00 | — | 10% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED LEVEL 2 VISIT | $175.50 | $195.00 | $136.00–$195.00 | 22% above | 10% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ED LEVEL 2 VISIT | $175.50 | $195.00 | $136.00–$195.00 | — | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED LEVEL 3 VISIT | $297.00 | $330.00 | $231.00–$330.00 | 6% above | 10% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ED LEVEL 3 VISIT | $297.00 | $330.00 | $231.00–$330.00 | — | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED LEVEL 4 VISIT | $490.50 | $545.00 | $381.00–$545.00 | 6% below | 10% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ED LEVEL 4 VISIT | $490.50 | $545.00 | $381.00–$545.00 | — | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED LEVEL 5 VISIT | $747.00 | $830.00 | $581.00–$830.00 | 2% below | 10% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ED LEVEL 5 VISIT | $747.00 | $830.00 | $581.00–$830.00 | — | 10% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 HC CVSLR STRESS TEST; TRACING | $490.05 | $544.50 | $381.00–$544.00 | 27% below | 10% |
| Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC CVSLR STRESS TEST; TRACING | $490.05 | $544.50 | $381.00–$544.00 | — | 10% |
| Group psychotherapy session CPT 90853 HC PROCESS EDUCATION GROUP | $126.00 | $140.00 | $98.00–$140.00 | 43% below | 10% |
| Group psychotherapy session inpatient CPT 90853 HC PROCESS EDUCATION GROUP | $126.00 | $140.00 | $98.00–$140.00 | — | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC HYDRATION IV INFUSION INIT 31-60 MIN | $92.70 | $103.00 | $72.00–$103.00 | 67% below | 10% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC HYDRATION IV INFUSION INIT 31-60 MIN | $92.70 | $103.00 | $72.00–$103.00 | — | 10% |
| IV infusion of a medicine, first hour CPT 96365 HC THER/PROPH/DX IV INF INIT UP TO 1HR | $129.60 | $144.00 | $100.00–$144.00 | 59% below | 10% |
| IV infusion of a medicine, first hour inpatient CPT 96365 HC THER/PROPH/DX IV INF INIT UP TO 1HR | $129.60 | $144.00 | $100.00–$144.00 | — | 10% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC THER/PROPH/DIAG INJ SC/IM | $46.35 | $51.50 | $36.00–$51.00 | 46% below | 10% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC THER/PROPH/DIAG INJ SC/IM | $46.35 | $51.50 | $36.00–$51.00 | — | 10% |
| Neuromuscular re-education, 15 minutes CPT 97112 HC NEUROMUSCLE RE-EDUC EA 15M | $54.90 | $61.00 | $42.00–$61.00 | 40% below | 10% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC NEUROMUSCLE RE-EDUC EA 15M | $54.90 | $61.00 | $42.00–$61.00 | — | 10% |
| New patient office visit, about 30 minutes CPT 99203 HC O/P VISIT NEW LEVEL 3 | $163.80 | $182.00 | $127.00–$182.00 | at median | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC O/P VISIT NEW LEVEL 3 | $163.80 | $182.00 | $127.00–$182.00 | — | 10% |
| New patient office visit, about 45 minutes CPT 99204 HC O/P VISIT NEW LEVEL 4 | $279.00 | $310.00 | $217.00–$310.00 | 13% above | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC O/P VISIT NEW LEVEL 4 | $279.00 | $310.00 | $217.00–$310.00 | — | 10% |
| New patient office visit, about 60 minutes CPT 99205 HC O/P VISIT NEW LEVEL 5 | $363.60 | $404.00 | $282.00–$404.00 | 13% above | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC O/P VISIT NEW LEVEL 5 | $363.60 | $404.00 | $282.00–$404.00 | — | 10% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC O/P VISIT NEW LEVEL 2 | $90.00 | $100.00 | $70.00–$100.00 | 11% below | 10% |
| New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC O/P VISIT NEW LEVEL 2 | $90.00 | $100.00 | $70.00–$100.00 | — | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC INIT NUTRITION THERAPY; EACH 15M | $31.50 | $35.00 | $24.00–$35.00 | 26% below | 10% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC INIT NUTRITION THERAPY; EACH 15M | $31.50 | $35.00 | $24.00–$35.00 | — | 10% |
| Occupational therapy evaluation, low complexity CPT 97165 HC OT EVAL LOW COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | 39% below | 10% |
| Occupational therapy evaluation, low complexity inpatient CPT 97165 HC OT EVAL LOW COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | — | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC PT EVAL HIGH COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | 49% below | 10% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC PT EVAL HIGH COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | — | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC PT EVAL LOW COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | 43% below | 10% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC PT EVAL LOW COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | — | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC PT EVAL MOD COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | 45% below | 10% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC PT EVAL MOD COMPLEX | $110.25 | $122.50 | $85.00–$122.00 | — | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC MANUAL THERAPY EA 15M | $59.85 | $66.50 | $46.00–$66.00 | 38% below | 10% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC MANUAL THERAPY EA 15M | $59.85 | $66.50 | $46.00–$66.00 | — | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC THERAP EXERCISE ROM EA 15M | $59.85 | $66.50 | $46.00–$66.00 | 34% below | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC THERAP EXERCISE ROM EA 15M | $59.85 | $66.50 | $46.00–$66.00 | — | 10% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC O/P VISIT EST LEVEL 5 (40-54 MIN) | $240.30 | $267.00 | $186.00–$267.00 | 2% above | 10% |
| Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC O/P VISIT EST LEVEL 5 (40-54 MIN) | $240.30 | $267.00 | $186.00–$267.00 | — | 10% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC O/P VISIT EST LEVEL 3 (20-29 MIN) | $111.15 | $123.50 | $86.00–$123.00 | 6% below | 10% |
| Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC O/P VISIT EST LEVEL 3 (20-29 MIN) | $111.15 | $123.50 | $86.00–$123.00 | — | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC O/P VISIT EST LEVEL 4 (30-39 MIN) | $170.10 | $189.00 | $132.00–$189.00 | 2% above | 10% |
| Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC O/P VISIT EST LEVEL 4 (30-39 MIN) | $170.10 | $189.00 | $132.00–$189.00 | — | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC O/P VISIT EST LEVEL 2 (10-19 MIN) | $90.00 | $100.00 | $70.00–$100.00 | 13% above | 10% |
| Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC O/P VISIT EST LEVEL 2 (10-19 MIN) | $90.00 | $100.00 | $70.00–$100.00 | — | 10% |
| Speech and language evaluation CPT 92523 HC EVAL SPEECH SOUND LANG COMPREHEN | $202.50 | $225.00 | $157.00–$225.00 | 33% below | 10% |
| Speech and language evaluation inpatient CPT 92523 HC EVAL SPEECH SOUND LANG COMPREHEN | $202.50 | $225.00 | $157.00–$225.00 | — | 10% |
| Speech therapy session, individual CPT 92507 HC SPEECH/HEARING THERAPY | $151.65 | $168.50 | $117.00–$168.00 | 30% below | 10% |
| Speech therapy session, individual inpatient CPT 92507 HC SPEECH/HEARING THERAPY | $151.65 | $168.50 | $117.00–$168.00 | — | 10% |
| Spirometry (breathing test) CPT 94010 HC SPIROMETRY | $27.00 | $30.00 | $21.00–$30.00 | 85% below | 10% |
| Spirometry (breathing test) inpatient CPT 94010 HC SPIROMETRY | $27.00 | $30.00 | $21.00–$30.00 | — | 10% |
| Spirometry before and after a bronchodilator CPT 94060 HC BRONCHOSPASM PRE & POST BD | $82.80 | $92.00 | $64.00–$92.00 | 79% below | 10% |
| Spirometry before and after a bronchodilator inpatient CPT 94060 HC BRONCHOSPASM PRE & POST BD | $82.80 | $92.00 | $64.00–$92.00 | — | 10% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 HC THERAPEUTIC ACTIVITY DIR EA 15M | $59.85 | $66.50 | $46.00–$66.00 | 41% below | 10% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC THERAPEUTIC ACTIVITY DIR EA 15M | $59.85 | $66.50 | $46.00–$66.00 | — | 10% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC PHLEBOTOMY, THERAPEUTIC | $48.15 | $53.50 | $37.00–$53.00 | 76% below | 10% |
| Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC PHLEBOTOMY, THERAPEUTIC | $48.15 | $53.50 | $37.00–$53.00 | — | 10% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Iowa | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 HC IIV ADJUVANT VACCINE IM | $67.50 | $75.00 | $52.00–$75.00 | 19% above | 10% |
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 HC IIV ADJUVANT VACCINE IM | $67.50 | $75.00 | $52.00–$75.00 | — | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 HC IIV3 VACC NO PRSV 0.5 ML IM | $27.00 | $30.00 | $21.00–$30.00 | 25% above | 10% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 HC IIV3 VACC NO PRSV 0.5 ML IM | $27.00 | $30.00 | $21.00–$30.00 | — | 10% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 HC FLU VACC PRSV FREE INC ANTIG IM | $67.50 | $75.00 | $52.00–$75.00 | 15% below | 10% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 HC FLU VACC PRSV FREE INC ANTIG IM | $67.50 | $75.00 | $52.00–$75.00 | — | 10% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 HC MENACWY-D MENACWY-CRM VACCINE IM | $101.25 | $112.50 | $78.00–$112.00 | 57% below | 10% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 HC MENACWY-D MENACWY-CRM VACCINE IM | $101.25 | $112.50 | $78.00–$112.00 | — | 10% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $610.65 | $610.65 | $427.00–$610.00 | 22% above | — |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY | $610.65 | $610.65 | $427.00–$610.00 | — | — |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 HC TD VACCINE NO PRSRV >= 7 IM | $39.37 | $43.75 | $30.00–$43.00 | 34% below | 10% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 HC TD VACCINE NO PRSRV >= 7 IM | $39.37 | $43.75 | $30.00–$43.00 | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 HC TDAP VACCINE >7 IM | $37.12 | $41.25 | $28.00–$41.00 | 56% below | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TAKE HOME CEPHALEXIN 250 MG/5ML SUSP | $181.95 | $181.95 | $127.00–$181.00 | 117% above | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 INFLUENZA VAC RECOMB HA (PF) 0.5 ML IM SOSY | $182.02 | $182.02 | $127.00–$182.00 | 117% above | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 HC TDAP VACCINE >7 IM | $37.12 | $41.25 | $28.00–$41.00 | — | 10% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TAKE HOME CEPHALEXIN 250 MG/5ML SUSP | $181.95 | $181.95 | $127.00–$181.00 | — | — |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 INFLUENZA VAC RECOMB HA (PF) 0.5 ML IM SOSY | $182.02 | $182.02 | $127.00–$182.00 | — | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC IMMUNIZATION ADM 1 VACCINE | $13.50 | $15.00 | $10.00–$15.00 | 61% below | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN INFLUENZA VIRUS VACCINE | $13.50 | $15.00 | $10.00–$15.00 | 61% below | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC ADMIN PNEUMONIA VACCINE | $13.95 | $15.50 | $10.00–$15.00 | 60% below | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY | $15.50 | $15.50 | $10.00–$15.00 | 56% below | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 INFLUENZA VAC TISS-CULT SUBUNT 0.5 ML IM SUSY | $15.50 | $15.50 | $10.00–$15.00 | 56% below | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN INFLUENZA VIRUS VACCINE | $13.50 | $15.00 | $10.00–$15.00 | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC IMMUNIZATION ADM 1 VACCINE | $13.50 | $15.00 | $10.00–$15.00 | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC ADMIN PNEUMONIA VACCINE | $13.95 | $15.50 | $10.00–$15.00 | — | 10% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY | $15.50 | $15.50 | $10.00–$15.00 | — | — |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 INFLUENZA VAC TISS-CULT SUBUNT 0.5 ML IM SUSY | $15.50 | $15.50 | $10.00–$15.00 | — | — |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC IMMUNIZATION ADM EA ADDTL VACCINE | $9.00 | $10.00 | $7.00–$10.00 | 69% below | 10% |
| Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC IMMUNIZATION ADM EA ADDTL VACCINE | $9.00 | $10.00 | $7.00–$10.00 | — | 10% |