Hospital Spencer, IA

Spencer Municipal Hospital

Spencer Municipal Hospital in Spencer, IA publishes cash prices for 283 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 below the Iowa median for 184 of 281 procedures and above it for 96. By typical cash price it ranks #21 of 78 Iowa hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1200 1st Ave E, Spencer, IA, 51301 Collected Sep 27, 2026 Source price file (712) 264-6198

Acute care hospital Emergency department CMS star rating 4 of 5 CCN 160112 · 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 one side CPT 73610 X-Ray Ankle 3 Views LT	$209.25	$279.00	$82.85–$265.05	8% below	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 X-Ray Ankle 3 Views RT	$209.25	$279.00	$82.85–$265.05	8% below	25%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 X-Ray Ankle 3 Views LT	$209.25	$279.00	$74.57–$265.05	—	25%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 X-Ray Ankle 3 Views RT	$209.25	$279.00	$74.57–$265.05	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ankle Arm Screen	$461.25	$615.00	$121.29–$584.25	44% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 Ankle Arm Screen	$461.25	$615.00	$109.16–$584.25	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Contrast X-Ray Esophagus	$431.25	$575.00	$127.74–$546.25	18% above	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Contrast X-Ray Esophagus	$431.25	$575.00	$127.74–$546.25	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Scan Whole Body	$2,762.25	$3,683.00	$378.11–$3,498.85	125% above	25%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone Scan Whole Body	$2,762.25	$3,683.00	$340.30–$3,498.85	—	25%
Breast ultrasound, complete, one breast both sides CPT 76641 Ultrasound Breast Complete BI	$294.00	$392.00	$100.06–$372.40	—	25%
Breast ultrasound, complete, one breast one side CPT 76641 Ultrasound Breast Complete RT	$294.00	$392.00	$100.06–$372.40	19% below	25%
Breast ultrasound, complete, one breast one side CPT 76641 Ultrasound Breast Complete LT	$294.00	$392.00	$100.06–$372.40	19% below	25%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 Ultrasound Breast Complete BI	$294.00	$392.00	$90.06–$372.40	—	25%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Ultrasound Breast Complete RT	$294.00	$392.00	$90.06–$372.40	—	25%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 Ultrasound Breast Complete LT	$294.00	$392.00	$90.06–$372.40	—	25%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 Ultrasound Breast Limited BI	$588.00	$784.00	$82.85–$744.80	—	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Ultrasound Breast Limited RT	$294.00	$392.00	$82.85–$372.40	19% below	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Ultrasound Breast Limited LT	$294.00	$392.00	$82.85–$372.40	19% below	25%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 Ultrasound Breast Limited BI	$588.00	$784.00	$74.57–$744.80	—	25%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Ultrasound Breast Limited LT	$294.00	$392.00	$74.57–$372.40	—	25%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 Ultrasound Breast Limited RT	$294.00	$392.00	$74.57–$372.40	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest WWO Contrast	$1,649.25	$2,199.00	$167.51–$2,089.05	22% below	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest WWO Contrast	$1,649.25	$2,199.00	$150.76–$2,089.05	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd & Pelvis WO Contrast	$1,635.00	$2,180.00	$227.45–$2,071.00	42% below	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd & Pelvis WO Contrast	$1,635.00	$2,180.00	$204.70–$2,071.00	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd & Pelv W Contrast	$1,635.00	$2,180.00	$336.05–$2,071.00	49% below	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd & Pelv W Contrast	$1,635.00	$2,180.00	$302.44–$2,071.00	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abd & Pelv WWO Contrast	$2,224.50	$2,966.00	$336.05–$2,817.70	38% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abd & Pelv WWO Contrast	$2,224.50	$2,966.00	$302.44–$2,817.70	—	25%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W Dye	$1,287.75	$1,717.00	$167.51–$1,631.15	24% below	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W Dye	$1,287.75	$1,717.00	$150.76–$1,631.15	—	25%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen WO Dye	$1,051.50	$1,402.00	$100.06–$1,331.90	23% below	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen WO Dye	$1,051.50	$1,402.00	$90.06–$1,331.90	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial WO Contrast	$912.00	$1,216.00	$100.06–$1,155.20	29% below	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial WO Contrast	$912.00	$1,216.00	$90.06–$1,155.20	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head/Brain WO Contrast	$859.50	$1,146.00	$100.06–$1,088.70	37% below	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head/Brain WO Contrast	$859.50	$1,146.00	$90.06–$1,088.70	—	25%
CT scan of the head with contrast CPT 70460 CT Head/Brain W Contrast	$930.75	$1,241.00	$167.51–$1,178.95	39% below	25%
CT scan of the head with contrast inpatient CPT 70460 CT Head/Brain W Contrast	$930.75	$1,241.00	$150.76–$1,178.95	—	25%
CT scan of the head without and with contrast CPT 70470 CT Head/Brain WWO Contrast	$859.50	$1,146.00	$167.51–$1,088.70	52% below	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head/Brain WWO Contrast	$859.50	$1,146.00	$150.76–$1,088.70	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumbar Spine WO Contrast	$843.75	$1,125.00	$100.06–$1,068.75	44% below	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lumbar Spine WO Contrast	$843.75	$1,125.00	$90.06–$1,068.75	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cervical Spine WO Contrast	$843.75	$1,125.00	$100.06–$1,068.75	44% below	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Cervical Spine WO Contrast	$843.75	$1,125.00	$90.06–$1,068.75	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W Dye	$1,238.25	$1,651.00	$167.51–$1,568.45	29% below	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W Dye	$1,238.25	$1,651.00	$150.76–$1,568.45	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 Extracranial Bilat Study	$612.00	$816.00	$227.45–$775.20	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 Extracranial Bilat Study	$612.00	$816.00	$204.70–$775.20	—	25%
Chest X-ray, 2 views CPT 71046 X-Ray Chest 2V PA/Lateral	$149.25	$199.00	$82.85–$189.05	28% below	25%
Chest X-ray, 2 views inpatient CPT 71046 X-Ray Chest 2V PA/Lateral	$149.25	$199.00	$74.57–$189.05	—	25%
Chest X-ray, single view CPT 71045 X-Ray Chest 1 View	$149.25	$199.00	$82.85–$189.05	11% below	25%
Chest X-ray, single view inpatient CPT 71045 X-Ray Chest 1 View	$149.25	$199.00	$74.57–$189.05	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Ultrasound Abdo Back Wall Comp	$612.00	$816.00	$100.06–$775.20	at median	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Ultrasound Abdo Back Wall Comp	$612.00	$816.00	$90.06–$775.20	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA Scan	$390.75	$521.00	$100.06–$494.95	at median	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA Scan	$390.75	$521.00	$90.06–$494.95	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA Bone Density/Peripheral	$267.00	$356.00	$82.85–$338.20	7% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA Bone Density/Peripheral	$267.00	$356.00	$74.57–$338.20	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Thorax WO Contrast	$912.00	$1,216.00	$100.06–$1,155.20	35% below	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Thorax WO Contrast	$912.00	$1,216.00	$90.06–$1,155.20	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Thorax W Contrast	$912.00	$1,216.00	$167.51–$1,155.20	50% below	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Thorax W Contrast	$912.00	$1,216.00	$150.76–$1,155.20	—	25%
Diagnostic mammogram, both breasts both sides CPT 77066 Mammo Dx Digit Impl BI	$289.50	$386.00	$141.17–$366.70	—	25%
Diagnostic mammogram, both breasts CPT 77066 Mammography Diagnostic Digital	$289.50	$386.00	$141.17–$366.70	15% below	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Mammo Dx Digit Impl BI	$289.50	$386.00	$127.05–$366.70	—	25%
Diagnostic mammogram, both breasts inpatient CPT 77066 Mammography Diagnostic Digital	$289.50	$386.00	$127.05–$366.70	—	25%
Diagnostic mammogram, one breast one side CPT 77065 Mammography DX Digital RT	$234.75	$313.00	$111.89–$297.35	20% below	25%
Diagnostic mammogram, one breast one side CPT 77065 Mammo DX Digit Implant Uni LT	$234.75	$313.00	$111.89–$297.35	20% below	25%
Diagnostic mammogram, one breast one side CPT 77065 Mammography DX Digital LT	$234.75	$313.00	$111.89–$297.35	20% below	25%
Diagnostic mammogram, one breast one side CPT 77065 Mammo DX Digit Implant Uni RT	$234.75	$313.00	$111.89–$297.35	20% below	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo DX Digit Implant Uni RT	$234.75	$313.00	$100.70–$297.35	—	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammography DX Digital RT	$234.75	$313.00	$100.70–$297.35	—	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammo DX Digit Implant Uni LT	$234.75	$313.00	$100.70–$297.35	—	25%
Diagnostic mammogram, one breast inpatient one side CPT 77065 Mammography DX Digital LT	$234.75	$313.00	$100.70–$297.35	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Arterial Duplex LE BI	$863.25	$1,151.00	$227.45–$1,093.45	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Arterial Duplex LE BI	$863.25	$1,151.00	$204.70–$1,093.45	—	25%
Duplex ultrasound of the leg veins, both legs CPT 93970 Venous Duplex	$897.75	$1,197.00	$227.45–$1,137.15	at median	25%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 Venous Duplex	$897.75	$1,197.00	$204.70–$1,137.15	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W Doppler Complete	$1,823.25	$2,431.00	$515.93–$2,309.45	19% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 TTE W Doppler Complete	$1,823.25	$2,431.00	$464.34–$2,309.45	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary Scan w/o EF	$1,172.25	$1,563.00	$378.11–$1,484.85	1% below	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary Scan w/o EF	$1,172.25	$1,563.00	$340.30–$1,484.85	—	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Polysomnogram W CPap	$2,468.25	$3,291.00	$957.32–$3,126.45	22% below	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Polysomnogram W CPap	$2,468.25	$3,291.00	$861.59–$3,126.45	—	25%
Knee X-ray, 3 views one side CPT 73562 X-Ray Knee 3 Views LT	$149.25	$199.00	$82.85–$189.05	32% below	25%
Knee X-ray, 3 views one side CPT 73562 X-Ray Knee 3 Views RT	$149.25	$199.00	$82.85–$189.05	32% below	25%
Knee X-ray, 3 views inpatient one side CPT 73562 X-Ray Knee 3 Views RT	$149.25	$199.00	$74.57–$189.05	—	25%
Knee X-ray, 3 views inpatient one side CPT 73562 X-Ray Knee 3 Views LT	$149.25	$199.00	$74.57–$189.05	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Gallbladder	$388.50	$518.00	$100.06–$492.10	21% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Liver	$388.50	$518.00	$100.06–$492.10	21% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Ultrasound Abdomen Limited	$388.50	$518.00	$100.06–$492.10	21% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Ultrasound Gallbladder	$388.50	$518.00	$90.06–$492.10	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Ultrasound Abdomen Limited	$388.50	$518.00	$90.06–$492.10	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Ultrasound Liver	$388.50	$518.00	$90.06–$492.10	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LDCT For Lung Cancer Screen	$541.50	$722.00	$100.06–$685.90	19% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LDCT For Lung Cancer Screen	$541.50	$722.00	$90.06–$685.90	—	25%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Joint LE WO Dye LT	$1,386.00	$1,848.00	$227.45–$1,755.60	40% below	25%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Joint LE WO Dye RT	$1,386.00	$1,848.00	$227.45–$1,755.60	40% below	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Joint LE WO Dye LT	$1,386.00	$1,848.00	$204.70–$1,755.60	—	25%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI Joint LE WO Dye RT	$1,386.00	$1,848.00	$204.70–$1,755.60	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Joint LE WWO Dye LT	$1,386.00	$1,848.00	$336.05–$1,755.60	56% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Joint LE WWO Dye RT	$1,386.00	$1,848.00	$336.05–$1,755.60	56% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Joint LE WWO Dye RT	$1,386.00	$1,848.00	$302.44–$1,755.60	—	25%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI Joint LE WWO Dye LT	$1,386.00	$1,848.00	$302.44–$1,755.60	—	25%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen WO Dye	$1,758.00	$2,344.00	$227.45–$2,226.80	15% below	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen WO Dye	$1,758.00	$2,344.00	$204.70–$2,226.80	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen WWO Dye	$2,778.75	$3,705.00	$336.05–$3,519.75	19% below	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen WWO Dye	$2,778.75	$3,705.00	$302.44–$3,519.75	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI Brain WO Contrast	$1,701.75	$2,269.00	$227.45–$2,155.55	26% below	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain WO Contrast	$1,701.75	$2,269.00	$204.70–$2,155.55	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain Pituitary WWO Cont	$1,701.75	$2,269.00	$336.05–$2,155.55	53% below	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain WWO Contrast	$1,701.75	$2,269.00	$336.05–$2,155.55	53% below	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain Pituitary WWO Cont	$1,701.75	$2,269.00	$302.44–$2,155.55	—	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain WWO Contrast	$1,701.75	$2,269.00	$302.44–$2,155.55	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI Lumbar Spine WO Dye	$1,234.50	$1,646.00	$227.45–$1,563.70	49% below	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Lumbar Spine WO Dye	$1,234.50	$1,646.00	$204.70–$1,563.70	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Lumbar Spine WWO Dye	$1,234.50	$1,646.00	$336.05–$1,563.70	65% below	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Lumbar Spine WWO Dye	$1,234.50	$1,646.00	$302.44–$1,563.70	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Chest Spine WO Dye	$1,234.50	$1,646.00	$227.45–$1,563.70	48% below	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Chest Spine WO Dye	$1,234.50	$1,646.00	$204.70–$1,563.70	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Neck Spine WWO Dye	$1,187.25	$1,583.00	$336.05–$1,503.85	65% below	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Neck Spine WWO Dye	$1,187.25	$1,583.00	$302.44–$1,503.85	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Neck Spine WO Dye	$1,234.50	$1,646.00	$227.45–$1,563.70	46% below	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Neck Spine WO Dye	$1,234.50	$1,646.00	$204.70–$1,563.70	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis WWO Dye	$2,562.75	$3,417.00	$336.05–$3,246.15	21% below	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis WWO Dye	$2,562.75	$3,417.00	$302.44–$3,246.15	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis WO Dye	$1,758.00	$2,344.00	$227.45–$2,226.80	15% below	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis WO Dye	$1,758.00	$2,344.00	$204.70–$2,226.80	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Joint UE WO Dye LT	$1,386.00	$1,848.00	$227.45–$1,755.60	39% below	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Joint UE WO Dye RT	$1,386.00	$1,848.00	$227.45–$1,755.60	39% below	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Joint UE WO Dye LT	$1,386.00	$1,848.00	$204.70–$1,755.60	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI Joint UE WO Dye RT	$1,386.00	$1,848.00	$204.70–$1,755.60	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocard Perf Spect Rest Stress	$2,322.00	$3,096.00	$1,228.40–$2,941.20	17% below	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocard Perf Spect Rest Stress	$2,322.00	$3,096.00	$1,105.56–$2,941.20	—	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT Skull To Mid Thigh Sub	$3,743.25	$4,991.00	$1,372.47–$4,741.45	12% below	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET CT Skull To Mid Thigh Init	$3,743.25	$4,991.00	$1,372.47–$4,741.45	12% below	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT Skull To Mid Thigh Sub	$3,743.25	$4,991.00	$1,235.23–$4,741.45	—	25%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET CT Skull To Mid Thigh Init	$3,743.25	$4,991.00	$1,235.23–$4,741.45	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Ultrasound Pelvic Limited	$294.00	$392.00	$100.06–$372.40	17% below	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Ultrasound Pelvic Limited	$294.00	$392.00	$90.06–$372.40	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Ultrasound Pelvic Complete	$492.75	$657.00	$100.06–$624.15	9% below	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Ultrasound Pelvic Complete	$492.75	$657.00	$90.06–$624.15	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >14 Wk TVTA Single Fetus	$534.75	$713.00	$100.06–$677.35	3% below	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >14 Wk TVTA Single Fetus	$534.75	$713.00	$90.06–$677.35	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 Wks Single Fetus	$534.75	$713.00	$100.06–$677.35	16% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 Wks Single Fetus	$534.75	$713.00	$90.06–$677.35	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US Limited Fetus(s)	$321.00	$428.00	$100.06–$406.60	6% below	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US Limited Fetus(s)	$321.00	$428.00	$90.06–$406.60	—	25%
Screening mammogram, both breasts both sides CPT 77067 Mammo Screen Implant BI	$234.75	$313.00	$114.31–$297.35	—	25%
Screening mammogram, both breasts CPT 77067 Mammography Screening Digital	$234.75	$313.00	$114.31–$297.35	24% below	25%
Screening mammogram, both breasts one side CPT 77067 Mammo Screen Implant LT	$234.75	$313.00	$114.31–$297.35	24% below	25%
Screening mammogram, both breasts one side CPT 77067 Mammo Screen Implant RT	$234.75	$313.00	$114.31–$297.35	24% below	25%
Screening mammogram, both breasts one side CPT 77067 Mammo Screen Unilat RT	$234.75	$313.00	$114.31–$297.35	24% below	25%
Screening mammogram, both breasts one side CPT 77067 Mammo Screen Unilat LT	$234.75	$313.00	$114.31–$297.35	24% below	25%
Screening mammogram, both breasts inpatient both sides CPT 77067 Mammo Screen Implant BI	$234.75	$313.00	$102.88–$297.35	—	25%
Screening mammogram, both breasts inpatient CPT 77067 Mammography Screening Digital	$234.75	$313.00	$102.88–$297.35	—	25%
Screening mammogram, both breasts inpatient one side CPT 77067 Mammo Screen Implant RT	$234.75	$313.00	$102.88–$297.35	—	25%
Screening mammogram, both breasts inpatient one side CPT 77067 Mammo Screen Unilat LT	$234.75	$313.00	$102.88–$297.35	—	25%
Screening mammogram, both breasts inpatient one side CPT 77067 Mammo Screen Unilat RT	$234.75	$313.00	$102.88–$297.35	—	25%
Screening mammogram, both breasts inpatient one side CPT 77067 Mammo Screen Implant LT	$234.75	$313.00	$102.88–$297.35	—	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 X-Ray Shoulder RT	$149.25	$199.00	$82.85–$189.05	37% below	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 X-Ray Shoulder LT	$149.25	$199.00	$82.85–$189.05	37% below	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 X-Ray Shoulder LT	$149.25	$199.00	$74.57–$189.05	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 X-Ray Shoulder RT	$149.25	$199.00	$74.57–$189.05	—	25%
Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram	$2,468.25	$3,291.00	$957.32–$3,126.45	14% below	25%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysomnogram	$2,468.25	$3,291.00	$861.59–$3,126.45	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Cine/Vid X-Ray Throat/Esoph	$513.00	$684.00	$167.51–$649.80	26% above	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Cine/Vid X-Ray Throat/Esoph	$513.00	$684.00	$150.76–$649.80	—	25%
Transvaginal pelvic ultrasound CPT 76830 Ultrasound Transvaginal	$402.00	$536.00	$100.06–$509.20	23% below	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 Ultrasound Transvaginal	$402.00	$536.00	$90.06–$509.20	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 Transvaginal US Obstetrical	$331.50	$442.00	$100.06–$419.90	27% below	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 Transvaginal US Obstetrical	$331.50	$442.00	$90.06–$419.90	—	25%
Ultrasound of the abdomen, complete CPT 76700 Ultrasound Abdomen Complete	$612.00	$816.00	$100.06–$775.20	12% below	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 Ultrasound Abdomen Complete	$612.00	$816.00	$90.06–$775.20	—	25%
Ultrasound of the scrotum and testicles CPT 76870 Ultrasound Scrotum	$361.50	$482.00	$100.06–$457.90	33% below	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 Ultrasound Scrotum	$361.50	$482.00	$90.06–$457.90	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound Head And Neck	$417.75	$557.00	$100.06–$529.15	10% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Ultrasound Head And Neck	$417.75	$557.00	$90.06–$529.15	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-Ray Upper GI Delay w/o air	$550.50	$734.00	$167.51–$697.30	28% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-Ray Upper GI Delay w/o air	$550.50	$734.00	$150.76–$697.30	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Vein Mapping Extremity RT	$255.00	$340.00	$100.06–$323.00	61% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Vein Mapping Extremity LT	$255.00	$340.00	$100.06–$323.00	61% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Extremity Study RT	$619.50	$826.00	$100.06–$784.70	5% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Extremity Study LT	$619.50	$826.00	$100.06–$784.70	5% below	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Vein Mapping Extremity LT	$255.00	$340.00	$90.06–$323.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Vein Mapping Extremity RT	$255.00	$340.00	$90.06–$323.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Extremity Study LT	$619.50	$826.00	$90.06–$784.70	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Extremity Study RT	$619.50	$826.00	$90.06–$784.70	—	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 X-Ray Wrist 3 Views LT	$172.50	$230.00	$82.85–$218.50	23% below	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 X-Ray Wrist 3 Views RT	$172.50	$230.00	$82.85–$218.50	23% below	25%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 X-Ray Wrist 3 Views RT	$172.50	$230.00	$74.57–$218.50	—	25%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 X-Ray Wrist 3 Views LT	$172.50	$230.00	$74.57–$218.50	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip Unilat W Pelvis 2 View LT	$149.25	$199.00	$82.85–$189.05	24% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-Ray Hip Uni 2-3 Views LT	$149.25	$199.00	$82.85–$189.05	24% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-Ray Hip Uni 2-3 Views RT	$149.25	$199.00	$82.85–$189.05	24% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 Hip Unilat W Pelvis 2 View RT	$149.25	$199.00	$82.85–$189.05	24% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-Ray Hip Uni 2-3 Views LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hip Unilat W Pelvis 2 View LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 Hip Unilat W Pelvis 2 View RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-Ray Hip Uni 2-3 Views RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the abdomen, 1 view CPT 74018 X-Ray Abdomen	$149.25	$199.00	$82.85–$189.05	17% below	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-Ray Abdomen	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the ankle, 2 views one side CPT 73600 X-Ray Ankle 2 Views LT	$149.25	$199.00	$82.85–$189.05	15% below	25%
X-ray of the ankle, 2 views one side CPT 73600 X-Ray Ankle 2 Views RT	$149.25	$199.00	$82.85–$189.05	15% below	25%
X-ray of the ankle, 2 views inpatient one side CPT 73600 X-Ray Ankle 2 Views RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the ankle, 2 views inpatient one side CPT 73600 X-Ray Ankle 2 Views LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 X-Ray Finger(s) LT	$149.25	$199.00	$82.85–$189.05	12% below	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 X-Ray Finger(s) RT	$149.25	$199.00	$82.85–$189.05	12% below	25%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 X-Ray Finger(s) LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 X-Ray Finger(s) RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the foot, 2 views one side CPT 73620 X-Ray Foot 2 Views RT	$149.25	$199.00	$82.85–$189.05	11% below	25%
X-ray of the foot, 2 views one side CPT 73620 X-Ray Foot 2 Views LT	$149.25	$199.00	$82.85–$189.05	11% below	25%
X-ray of the foot, 2 views inpatient one side CPT 73620 X-Ray Foot 2 Views RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the foot, 2 views inpatient one side CPT 73620 X-Ray Foot 2 Views LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 X-Ray Foot 3 Views LT	$184.50	$246.00	$82.85–$233.70	16% below	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 X-Ray Foot 3 Views RT	$184.50	$246.00	$82.85–$233.70	16% below	25%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 X-Ray Foot 3 Views RT	$184.50	$246.00	$74.57–$233.70	—	25%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 X-Ray Foot 3 Views LT	$184.50	$246.00	$74.57–$233.70	—	25%
X-ray of the hand, 3 or more views one side CPT 73130 X-Ray Hand RT	$149.25	$199.00	$82.85–$189.05	27% below	25%
X-ray of the hand, 3 or more views one side CPT 73130 X-Ray Hand LT	$149.25	$199.00	$82.85–$189.05	27% below	25%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 X-Ray Hand LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 X-Ray Hand RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 X-Ray Knee 1-2 Views RT	$149.25	$199.00	$82.85–$189.05	26% below	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 X-Ray Knee 1-2 Views LT	$149.25	$199.00	$82.85–$189.05	26% below	25%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 X-Ray Knee 1-2 Views LT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 X-Ray Knee 1-2 Views RT	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-Ray Lumbosacral 2-3 Views	$222.75	$297.00	$100.06–$282.15	22% below	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-Ray Lumbosacral 2-3 Views	$222.75	$297.00	$90.06–$282.15	—	25%
X-ray of the lower back, 4 or more views CPT 72110 X-Ray Lumbosacral 4 Views	$222.75	$297.00	$100.06–$282.15	37% below	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-Ray Lumbosacral 4 Views	$222.75	$297.00	$90.06–$282.15	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-Ray Spine Thoracic 2 Views	$286.50	$382.00	$100.06–$362.90	13% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-Ray Spine Thoracic 2 Views	$286.50	$382.00	$90.06–$362.90	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 X-Ray Facial Bones 3 Views	$143.25	$191.00	$82.85–$181.45	30% below	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-Ray Facial Bones 3 Views	$143.25	$191.00	$74.57–$181.45	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-Ray Spine Cervical 2-3 Views	$358.50	$478.00	$82.85–$454.10	43% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-Ray Spine Cervical 2-3 Views	$358.50	$478.00	$74.57–$454.10	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-Ray Pelvis 1-2 Views	$222.75	$297.00	$100.06–$282.15	12% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-Ray Pelvis 1-2 Views	$222.75	$297.00	$90.06–$282.15	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-Ray Sacrum Tailbone	$149.25	$199.00	$82.85–$189.05	33% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Sacrum or Coccyx Min 2 View	$149.25	$199.00	$82.85–$189.05	33% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Sacrum or Coccyx Min 2 View	$149.25	$199.00	$74.57–$189.05	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-Ray Sacrum Tailbone	$149.25	$199.00	$74.57–$189.05	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT SGpT	$62.25	$83.00	$5.30–$78.85	48% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT SGpT	$62.25	$83.00	$4.77–$78.85	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST SGoT	$33.00	$44.00	$5.18–$41.80	16% below	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST SGoT	$33.00	$44.00	$4.66–$41.80	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel	$160.50	$214.00	$47.63–$203.30	30% below	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel	$160.50	$214.00	$42.87–$203.30	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Farmer Lung Allergen	$53.25	$71.00	$5.22–$67.45	37% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Spec Ige	$53.25	$71.00	$5.22–$67.45	37% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Farmer Lung Allergen	$53.25	$71.00	$4.70–$67.45	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Spec Ige	$53.25	$71.00	$4.70–$67.45	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Citrulline Antibody	$82.50	$110.00	$12.95–$104.50	19% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Citrulline Antibody	$82.50	$110.00	$11.66–$104.50	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B Type Natriuretic Peptide	$135.75	$181.00	$39.26–$171.95	13% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro-B Type Natriuretic Peptide	$135.75	$181.00	$39.26–$171.95	13% below	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Pro-B Type Natriuretic Peptide	$135.75	$181.00	$35.33–$171.95	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B Type Natriuretic Peptide	$135.75	$181.00	$35.33–$171.95	—	25%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$82.50	$110.00	$8.46–$104.50	at median	25%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$82.50	$110.00	$7.61–$104.50	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Surg Path L4	$120.00	$160.00	$50.28–$152.00	33% below	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Surg Path L4	$120.00	$160.00	$45.25–$152.00	—	25%
Blood culture for bacteria CPT 87040 Culture Blood	$168.00	$224.00	$10.32–$212.80	94% above	25%
Blood culture for bacteria inpatient CPT 87040 Culture Blood	$168.00	$224.00	$9.29–$212.80	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Draw & Process Specimen	$30.75	$41.00	$9.34–$38.95	55% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$30.75	$41.00	$9.34–$38.95	55% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Draw & Process Specimen	$30.75	$41.00	$8.41–$38.95	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$30.75	$41.00	$8.41–$38.95	—	25%
Blood glucose (sugar) test CPT 82947 Glucose Blood	$62.25	$83.00	$3.93–$78.85	85% above	25%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Blood	$62.25	$83.00	$3.54–$78.85	—	25%
Blood lead test CPT 83655 Lead Blood Ref	$72.00	$96.00	$12.11–$91.20	37% above	25%
Blood lead test CPT 83655 Lead Urine	$72.00	$96.00	$12.11–$91.20	37% above	25%
Blood lead test inpatient CPT 83655 Lead Urine	$72.00	$96.00	$10.90–$91.20	—	25%
Blood lead test inpatient CPT 83655 Lead Blood Ref	$72.00	$96.00	$10.90–$91.20	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg Beta Qual	$85.50	$114.00	$7.52–$108.30	39% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hcg Beta Qual	$85.50	$114.00	$6.77–$108.30	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 OB Blood Typing Abo	$102.75	$137.00	$47.06–$157.68	80% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Typing Abo	$102.75	$137.00	$47.06–$157.68	80% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 OB Blood Typing Abo	$102.75	$137.00	$47.06–$130.15	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Typing Abo	$102.75	$137.00	$47.06–$130.15	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$68.25	$91.00	$5.18–$86.45	18% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$68.25	$91.00	$4.66–$86.45	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff By PCR	$89.25	$119.00	$37.27–$113.05	17% below	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff By PCR	$89.25	$119.00	$33.54–$113.05	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$168.00	$224.00	$20.81–$212.80	75% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$168.00	$224.00	$18.73–$212.80	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$168.00	$224.00	$20.81–$212.80	47% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$168.00	$224.00	$18.73–$212.80	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 Amp Probe	$89.25	$119.00	$51.31–$113.05	22% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 Amp Prb Hi Thrp	$89.25	$119.00	$51.31–$113.05	22% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 Amp Prb Hi Thrp	$89.25	$119.00	$46.18–$113.05	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 Amp Probe	$89.25	$119.00	$46.18–$113.05	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia DNA Amp Probe	$89.25	$119.00	$35.09–$113.05	10% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia DNA Amp Probe	$89.25	$119.00	$31.58–$113.05	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$88.50	$118.00	$13.39–$112.10	4% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$88.50	$118.00	$12.05–$112.10	—	25%
Complete blood count (CBC) with differential CPT 85025 OB CBC W/Auto Diff	$30.00	$40.00	$7.77–$38.00	51% below	25%
Complete blood count (CBC) with differential CPT 85025 CBC W Auto Diff	$79.50	$106.00	$7.77–$100.70	29% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 OB CBC W/Auto Diff	$30.00	$40.00	$6.99–$38.00	—	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W Auto Diff	$79.50	$106.00	$6.99–$100.70	—	25%
Complete blood count (CBC), no differential CPT 85027 CBC WO Auto Diff	$48.75	$65.00	$6.47–$61.75	9% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC WO Auto Diff	$48.75	$65.00	$5.82–$61.75	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$105.00	$140.00	$10.56–$133.00	12% below	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$105.00	$140.00	$9.50–$133.00	—	25%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer Quant	$138.00	$184.00	$10.18–$174.80	63% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer Quant	$138.00	$184.00	$9.16–$174.80	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dheas	$71.25	$95.00	$22.23–$90.25	36% below	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dheas	$71.25	$95.00	$20.01–$90.25	—	25%
Estradiol blood test CPT 82670 Estradiol Ref Total	$135.75	$181.00	$27.94–$171.95	4% above	25%
Estradiol blood test CPT 82670 Estradiol Total	$135.75	$181.00	$27.94–$171.95	4% above	25%
Estradiol blood test inpatient CPT 82670 Estradiol Total	$135.75	$181.00	$25.15–$171.95	—	25%
Estradiol blood test inpatient CPT 82670 Estradiol Ref Total	$135.75	$181.00	$25.15–$171.95	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 Fsh	$135.75	$181.00	$18.58–$171.95	34% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Fsh	$135.75	$181.00	$16.72–$171.95	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin	$138.75	$185.00	$19.63–$175.75	14% below	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin	$138.75	$185.00	$17.67–$175.75	—	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$89.25	$119.00	$13.63–$113.05	1% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$89.25	$119.00	$12.27–$113.05	—	25%
Folate (folic acid) blood test CPT 82746 Folic Acid Blood	$94.50	$126.00	$14.70–$119.70	7% above	25%
Folate (folic acid) blood test inpatient CPT 82746 Folic Acid Blood	$94.50	$126.00	$13.23–$119.70	—	25%
Free T3 thyroid hormone test CPT 84481 T3 Free	$111.00	$148.00	$16.94–$140.60	4% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$111.00	$148.00	$15.25–$140.60	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free By Dialysis	$51.00	$68.00	$9.02–$64.60	21% below	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Free	$75.75	$101.00	$9.02–$95.95	17% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free By Dialysis	$51.00	$68.00	$8.12–$64.60	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Free	$75.75	$101.00	$8.12–$95.95	—	25%
Free testosterone test CPT 84402 Testosterone Fre Female/Child	$130.50	$174.00	$25.47–$165.30	23% above	25%
Free testosterone test CPT 84402 Testosterone Free	$130.50	$174.00	$25.47–$165.30	23% above	25%
Free testosterone test inpatient CPT 84402 Testosterone Fre Female/Child	$130.50	$174.00	$22.92–$165.30	—	25%
Free testosterone test inpatient CPT 84402 Testosterone Free	$130.50	$174.00	$22.92–$165.30	—	25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$160.50	$214.00	$56.77–$203.30	16% below	25%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$160.50	$214.00	$56.77–$203.30	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Post Dose	$60.00	$80.00	$4.75–$76.00	67% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose Post Dose	$60.00	$80.00	$4.28–$76.00	—	25%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tol 1st 3 Specimens	$122.25	$163.00	$12.87–$154.85	45% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose Tol 1st 3 Specimens	$122.25	$163.00	$11.58–$154.85	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N Gonorrhoeae DNA Amp Probe	$89.25	$119.00	$35.09–$113.05	2% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 N Gonorrhoeae DNA Amp Probe	$89.25	$119.00	$31.58–$113.05	—	25%
H. pylori stool antigen test CPT 87338 H Pylori Antigen Stool	$102.75	$137.00	$14.38–$130.15	8% below	25%
H. pylori stool antigen test inpatient CPT 87338 H Pylori Antigen Stool	$102.75	$137.00	$12.94–$130.15	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 Na Quan	$216.00	$288.00	$85.10–$273.60	20% below	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 Na Quan	$216.00	$288.00	$76.59–$273.60	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 OB HIV1Ag/HIV12Ab Sng Rslt	$34.50	$46.00	$24.08–$43.70	54% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV1Ag/HIV12Ab Sng Result	$56.25	$75.00	$24.08–$71.25	25% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 OB HIV1Ag/HIV12Ab Sng Rslt	$34.50	$46.00	$21.67–$43.70	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV1Ag/HIV12Ab Sng Result	$56.25	$75.00	$21.67–$71.25	—	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA Probe	$89.25	$119.00	$35.09–$113.05	6% below	25%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA Probe	$89.25	$119.00	$31.58–$113.05	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C	$72.75	$97.00	$9.71–$92.15	20% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C	$72.75	$97.00	$8.74–$92.15	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Antibody	$51.75	$69.00	$10.74–$65.55	24% below	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Antibody	$51.75	$69.00	$9.67–$65.55	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 OB Hep B Surface Agn	$34.50	$46.00	$10.33–$43.70	47% below	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surface Agn	$67.50	$90.00	$10.33–$85.50	3% above	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 OB Hep B Surface Agn	$34.50	$46.00	$9.30–$43.70	—	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surface Agn	$67.50	$90.00	$9.30–$85.50	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 OB HCV Antibody	$44.25	$59.00	$14.27–$56.05	43% below	25%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody	$91.50	$122.00	$14.27–$115.90	17% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 OB HCV Antibody	$44.25	$59.00	$12.84–$56.05	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody	$91.50	$122.00	$12.84–$115.90	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep C Rna Pcr Quant	$320.25	$427.00	$42.84–$405.65	24% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hep C Rna Pcr Quant	$320.25	$427.00	$38.56–$405.65	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex I IgG	$78.00	$104.00	$13.19–$98.80	16% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex I IgG	$78.00	$104.00	$11.87–$98.80	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex II IgG	$51.75	$69.00	$19.35–$65.55	11% below	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex II IgG	$51.75	$69.00	$17.42–$65.55	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sens	$59.25	$79.00	$12.95–$75.05	24% below	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sens	$59.25	$79.00	$11.66–$75.05	—	25%
Homocysteine blood test CPT 83090 Homocystine	$68.25	$91.00	$17.92–$86.45	28% below	25%
Homocysteine blood test inpatient CPT 83090 Homocystine	$68.25	$91.00	$16.13–$86.45	—	25%
Insulin blood test CPT 83525 Insulin	$74.25	$99.00	$11.43–$94.05	3% below	25%
Insulin blood test inpatient CPT 83525 Insulin	$74.25	$99.00	$10.29–$94.05	—	25%
Iron blood test (serum iron) CPT 83540 Iron Serum	$42.00	$56.00	$6.47–$53.20	3% above	25%
Iron blood test (serum iron) inpatient CPT 83540 Iron Serum	$42.00	$56.00	$5.82–$53.20	—	25%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$72.75	$97.00	$8.74–$92.15	49% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$72.75	$97.00	$7.87–$92.15	—	25%
Kidney function blood test panel CPT 80069 Renal Function Panel	$87.00	$116.00	$8.68–$110.20	1% below	25%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$87.00	$116.00	$7.81–$110.20	—	25%
LH (luteinizing hormone) test CPT 83002 Lh	$135.75	$181.00	$18.52–$171.95	47% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 Lh	$135.75	$181.00	$16.67–$171.95	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase	$62.25	$83.00	$6.89–$78.85	4% below	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase	$62.25	$83.00	$6.20–$78.85	—	25%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$80.25	$107.00	$8.17–$101.65	5% below	25%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$80.25	$107.00	$7.35–$101.65	—	25%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody	$114.00	$152.00	$17.03–$144.40	29% above	25%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Antibody	$114.00	$152.00	$15.33–$144.40	—	25%
Magnesium blood test CPT 83735 Magnesium Fluid	$7.50	$10.00	$6.70–$35.30	85% below	25%
Magnesium blood test CPT 83735 Magnesium RBC	$27.75	$37.00	$6.70–$35.30	43% below	25%
Magnesium blood test CPT 83735 Magnesium 24 Hr Urine	$47.25	$63.00	$6.70–$59.85	2% below	25%
Magnesium blood test CPT 83735 Magnesium	$47.25	$63.00	$6.70–$59.85	2% below	25%
Magnesium blood test inpatient CPT 83735 Magnesium Fluid	$7.50	$10.00	$6.03–$35.30	—	25%
Magnesium blood test inpatient CPT 83735 Magnesium RBC	$27.75	$37.00	$6.03–$35.30	—	25%
Magnesium blood test inpatient CPT 83735 Magnesium 24 Hr Urine	$47.25	$63.00	$6.03–$59.85	—	25%
Magnesium blood test inpatient CPT 83735 Magnesium	$47.25	$63.00	$6.03–$59.85	—	25%
Measles (rubeola) antibody test CPT 86765 Rubeola Antibody	$82.50	$110.00	$12.88–$104.50	51% above	25%
Measles (rubeola) antibody test CPT 86765 Rubeola IgG Antibody	$82.50	$110.00	$12.88–$104.50	51% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola IgG Antibody	$82.50	$110.00	$11.59–$104.50	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola Antibody	$82.50	$110.00	$11.59–$104.50	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free	$87.75	$117.00	$18.39–$111.15	10% below	25%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA Free	$87.75	$117.00	$16.55–$111.15	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total	$72.75	$97.00	$18.39–$92.15	24% below	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total	$72.75	$97.00	$16.55–$92.15	—	25%
Pap test (liquid-based, automated screening with review) CPT 88175 Cytopath Pap C/V Auto Fld Redo	$53.25	$71.00	$26.61–$67.45	32% below	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Cytopath Pap C/V Auto Fld Redo	$53.25	$71.00	$23.95–$67.45	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 Pth	$135.75	$181.00	$41.28–$171.95	23% below	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Pth	$135.75	$181.00	$37.15–$171.95	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Aptt Ref	$30.00	$40.00	$6.01–$38.00	33% below	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Aptt	$30.00	$40.00	$6.01–$38.00	33% below	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Aptt	$30.00	$40.00	$5.41–$38.00	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Aptt Ref	$30.00	$40.00	$5.41–$38.00	—	25%
Progesterone blood test CPT 84144 Progesterone	$56.25	$75.00	$20.86–$71.25	42% below	25%
Progesterone blood test inpatient CPT 84144 Progesterone	$56.25	$75.00	$18.77–$71.25	—	25%
Prolactin blood test CPT 84146 Prolactin	$135.75	$181.00	$19.38–$171.95	36% above	25%
Prolactin blood test inpatient CPT 84146 Prolactin	$135.75	$181.00	$17.44–$171.95	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$30.00	$40.00	$4.29–$38.00	9% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Ref	$30.00	$40.00	$4.29–$38.00	9% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time PoCT	$30.00	$40.00	$4.29–$38.00	9% below	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time PoCT	$30.00	$40.00	$3.86–$38.00	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time Ref	$30.00	$40.00	$3.86–$38.00	—	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time	$30.00	$40.00	$3.86–$38.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen Urine Direct Obv	$72.75	$97.00	$12.60–$92.15	1% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Screen Urine Direct Obv	$72.75	$97.00	$11.34–$92.15	—	25%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant	$51.75	$69.00	$5.67–$65.55	7% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quant	$51.75	$69.00	$5.10–$65.55	—	25%
Rubella antibody test (immunity check) CPT 86762 OB Rubella IgG	$42.75	$57.00	$14.39–$54.15	27% below	25%
Rubella antibody test (immunity check) CPT 86762 Rubella IgM	$46.50	$62.00	$14.39–$58.90	21% below	25%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG	$46.50	$62.00	$14.39–$58.90	21% below	25%
Rubella antibody test (immunity check) inpatient CPT 86762 OB Rubella IgG	$42.75	$57.00	$12.95–$54.15	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgM	$46.50	$62.00	$12.95–$58.90	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG	$46.50	$62.00	$12.95–$58.90	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sedimentation Rate Automated	$39.00	$52.00	$2.70–$49.40	16% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sedimentation Rate Automated	$39.00	$52.00	$2.43–$49.40	—	25%
Stool ova and parasites exam CPT 87177 Ova And Parasites Smears	$66.75	$89.00	$8.90–$84.55	37% above	25%
Stool ova and parasites exam inpatient CPT 87177 Ova And Parasites Smears	$66.75	$89.00	$8.01–$84.55	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Bld Colorectal Scr	$30.75	$41.00	$4.38–$38.95	7% below	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Bld Colorectal Scr	$30.75	$41.00	$3.94–$38.95	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 IFOB	$72.75	$97.00	$15.92–$92.15	26% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 IFOB Screen	$72.75	$97.00	$15.92–$92.15	26% above	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 IFOB Screen	$72.75	$97.00	$14.33–$92.15	—	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 IFOB	$72.75	$97.00	$14.33–$92.15	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR	$51.75	$69.00	$4.27–$65.55	7% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Serum	$51.75	$69.00	$4.27–$65.55	7% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Vdrl Csf	$51.75	$69.00	$4.27–$65.55	7% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Vdrl Csf	$51.75	$69.00	$3.84–$65.55	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Vdrl Serum	$51.75	$69.00	$3.84–$65.55	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR	$51.75	$69.00	$3.84–$65.55	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tbint Quantiferon	$154.50	$206.00	$61.98–$195.70	2% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Tbint Quantiferon	$154.50	$206.00	$55.78–$195.70	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone By Lc/Ms	$135.75	$181.00	$25.81–$171.95	32% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total	$135.75	$181.00	$25.81–$171.95	32% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total Ref	$135.75	$181.00	$25.81–$171.95	32% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total	$135.75	$181.00	$23.23–$171.95	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone By Lc/Ms	$135.75	$181.00	$23.23–$171.95	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total Ref	$135.75	$181.00	$23.23–$171.95	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase Antibody	$60.75	$81.00	$14.55–$76.95	20% below	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase Antibody	$60.75	$81.00	$13.10–$76.95	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$111.00	$148.00	$16.80–$140.60	14% above	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Neonatal	$111.00	$148.00	$16.80–$140.60	14% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$111.00	$148.00	$15.12–$140.60	—	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Neonatal	$111.00	$148.00	$15.12–$140.60	—	25%
Uric acid blood test CPT 84550 Uric Acid Blood	$62.25	$83.00	$4.52–$78.85	72% above	25%
Uric acid blood test inpatient CPT 84550 Uric Acid Blood	$62.25	$83.00	$4.07–$78.85	—	25%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto W Micro	$51.75	$69.00	$3.17–$65.55	24% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto W Micro	$51.75	$69.00	$2.85–$65.55	—	25%
Urinalysis without microscope exam, automated CPT 81003 Ketone Urine Auto	$26.25	$35.00	$2.25–$33.25	2% above	25%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Auto WO Scope	$29.25	$39.00	$2.25–$37.05	14% above	25%
Urinalysis without microscope exam, automated CPT 81003 Protein Urine Auto	$39.75	$53.00	$2.25–$50.35	55% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Ketone Urine Auto	$26.25	$35.00	$2.03–$33.25	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Auto WO Scope	$29.25	$39.00	$2.03–$37.05	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Protein Urine Auto	$39.75	$53.00	$2.03–$50.35	—	25%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine W Col Count	$56.25	$75.00	$8.07–$71.25	4% below	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture Urine W Col Count	$56.25	$75.00	$7.26–$71.25	—	25%
Urine pregnancy test, read by color change CPT 81025 Hcg Beta Qual Urine	$54.00	$72.00	$8.61–$68.40	29% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 Hcg Beta Qual Urine	$54.00	$72.00	$7.75–$68.40	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 B12	$111.00	$148.00	$15.08–$140.60	33% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 B12	$111.00	$148.00	$13.57–$140.60	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25 Hydvit D2 And D3	$125.25	$167.00	$29.60–$158.65	at median	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Oh	$125.25	$167.00	$29.60–$158.65	at median	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25 Hydvit D2 And D3	$125.25	$167.00	$26.64–$158.65	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Oh	$125.25	$167.00	$26.64–$158.65	—	25%
Zinc blood test CPT 84630 Zinc	$69.00	$92.00	$11.39–$87.40	31% above	25%
Zinc blood test CPT 84630 Zinc Urine	$69.00	$92.00	$11.39–$87.40	31% above	25%
Zinc blood test inpatient CPT 84630 Zinc	$69.00	$92.00	$10.25–$87.40	—	25%
Zinc blood test inpatient CPT 84630 Zinc Urine	$69.00	$92.00	$10.25–$87.40	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Beta Quan Serum	$56.25	$75.00	$15.05–$71.25	37% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg Tumor Marker	$63.00	$84.00	$15.05–$79.80	29% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg Beta Quan Serum	$56.25	$75.00	$13.55–$71.25	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg Tumor Marker	$63.00	$84.00	$13.55–$79.80	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Biopsy Breast 1st Lesion LT	$5,091.00	$6,788.00	$1,524.58–$6,448.60	75% above	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 Biopsy Breast 1st Lesion RT	$5,091.00	$6,788.00	$1,524.58–$6,448.60	75% above	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 Biopsy Breast 1st Lesion RT	$5,091.00	$6,788.00	$1,372.12–$6,448.60	—	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 Biopsy Breast 1st Lesion LT	$5,091.00	$6,788.00	$1,372.12–$6,448.60	—	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Electric Ext	$398.25	$531.00	$424.80–$800.47	52% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion	$1,404.00	$1,872.00	$615.75–$1,778.40	69% above	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Electric Ext	$398.25	$531.00	$424.80–$800.47	—	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion	$1,404.00	$1,872.00	$554.17–$1,778.40	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Bx/Curette Cervix W Scope	$205.50	$274.00	$219.20–$839.06	40% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 Bx/Curette Cervix W Scope	$205.50	$274.00	$219.20–$839.06	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destroy Premal Lesion 1st	$74.25	$99.00	$79.20–$323.47	50% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 Destroy Premal Lesion 1st	$74.25	$99.00	$79.20–$323.47	—	25%
Earwax removal by irrigation (rinsing), one ear both sides CPT 69209 Remove Impacted Cerumen BI	$18.00	$24.00	$19.20–$72.66	—	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Remove Impacted Cerumen LT	$15.75	$21.00	$16.80–$72.66	77% below	25%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 Remove Impacted Cerumen RT	$15.75	$21.00	$16.80–$72.66	77% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient both sides CPT 69209 Remove Impacted Cerumen BI	$18.00	$24.00	$19.20–$56.82	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Remove Impacted Cerumen RT	$15.75	$21.00	$16.80–$56.82	—	25%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 Remove Impacted Cerumen LT	$15.75	$21.00	$16.80–$56.82	—	25%
Earwax removal with instruments, one ear one side CPT 69210 Remove Impacted Cerumen LT	$45.00	$60.00	$48.00–$72.66	57% below	25%
Earwax removal with instruments, one ear one side CPT 69210 Remove Impacted Cerumen RT	$45.00	$60.00	$48.00–$72.66	57% below	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Remove Impacted Cerumen LT	$45.00	$60.00	$48.00–$57.00	—	25%
Earwax removal with instruments, one ear inpatient one side CPT 69210 Remove Impacted Cerumen RT	$45.00	$60.00	$48.00–$57.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Endometrial Biopsy	$118.50	$158.00	$126.40–$839.06	54% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 Endometrial Biopsy	$118.50	$158.00	$126.40–$839.06	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Inj Epidural C/T W Guide	$1,573.50	$2,098.00	$651.63–$1,993.10	28% above	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Inj Epidural C/T W Guide	$1,573.50	$2,098.00	$586.47–$1,993.10	—	25%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 Inj Paravert F Jnt L/S 1 Lv BI	$2,361.00	$3,148.00	$837.73–$2,990.60	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Inj Paravert F Jnt L/S 1 Lev R	$1,306.50	$1,742.00	$837.73–$1,654.90	2% above	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 Inj Paravert F Jnt L/S 1 Lv BI	$2,361.00	$3,148.00	$753.95–$2,990.60	—	25%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Inj Paravert F Jnt L/S 1 Lev R	$1,306.50	$1,742.00	$753.95–$1,654.90	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Catheter For Hysterography	$512.25	$683.00	$51.03–$648.85	53% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Catheter For Hysterography	$512.25	$683.00	$45.93–$648.85	—	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Biopsy	$1,424.25	$1,899.00	$1,519.20–$6,198.55	60% below	25%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 Hysteroscopy Biopsy	$1,424.25	$1,899.00	$1,519.20–$6,198.55	—	25%
IUD insertion (the device itself billed separately) CPT 58300 Female	$174.00	$232.00	$185.60–$273.39	34% below	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 Female	$174.00	$232.00	$185.60–$273.39	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Simple/Single	$124.50	$166.00	$132.80–$323.47	50% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess Simple/Single	$215.25	$287.00	$186.97–$272.65	13% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Abscess or Cyst	$924.00	$1,232.00	$186.97–$1,170.40	272% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Simple/Single	$124.50	$166.00	$132.80–$323.47	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess Simple/Single	$215.25	$287.00	$186.97–$272.65	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Abscess or Cyst	$924.00	$1,232.00	$168.27–$1,170.40	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) both sides CPT 20550 Inject Single Tendon Sheath BI	$174.00	$232.00	$185.60–$794.73	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 Inject Single Tendon Sheath RT	$87.00	$116.00	$92.80–$794.73	65% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) one side CPT 20550 Inject Single Tendon Sheath LT	$96.00	$128.00	$102.40–$794.73	61% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient both sides CPT 20550 Inject Single Tendon Sheath BI	$174.00	$232.00	$185.60–$794.73	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 Inject Single Tendon Sheath RT	$87.00	$116.00	$92.80–$794.73	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient one side CPT 20550 Inject Single Tendon Sheath LT	$96.00	$128.00	$102.40–$794.73	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 Asp/Inj Large Joint BI	$176.25	$235.00	$188.00–$794.73	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Asp/Inj Large Joint RT	$98.25	$131.00	$104.80–$794.73	72% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Asp/Inj Large Joint LT	$157.50	$210.00	$168.00–$361.09	56% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Asp/Inj Large Joint RT	$157.50	$210.00	$168.00–$361.09	56% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Asp/Inj Major Joint LT	$733.50	$978.00	$277.76–$929.10	107% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Asp/Inj Large Joint LT	$733.50	$978.00	$277.76–$929.10	107% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Asp/Inj Major Joint RT	$733.50	$978.00	$277.76–$929.10	107% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 Asp/Inj Large Joint BI	$176.25	$235.00	$188.00–$794.73	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Asp/Inj Large Joint RT	$98.25	$131.00	$104.80–$794.73	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Asp/Inj Large Joint LT	$157.50	$210.00	$168.00–$361.09	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Asp/Inj Large Joint RT	$157.50	$210.00	$168.00–$361.09	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Asp/Inj Major Joint LT	$733.50	$978.00	$249.99–$929.10	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Asp/Inj Major Joint RT	$733.50	$978.00	$249.99–$929.10	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient one side CPT 20610 Asp/Inj Large Joint LT	$733.50	$978.00	$249.99–$929.10	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 Asp/Inj Intermediate Joint BI	$195.00	$260.00	$208.00–$794.73	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Asp/Inj Intermediate Joint LT	$96.00	$128.00	$102.40–$794.73	69% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Asp/Inj Intermediate Joint RT	$128.25	$171.00	$136.80–$361.09	58% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Asp/Inj Intermediate Joint LT	$128.25	$171.00	$136.80–$361.09	58% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) one side CPT 20605 Asp/Inj Intermediate Joint RT	$733.50	$978.00	$277.76–$929.10	139% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 Asp/Inj Intermediate Joint BI	$195.00	$260.00	$208.00–$794.73	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Asp/Inj Intermediate Joint LT	$96.00	$128.00	$102.40–$794.73	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Asp/Inj Intermediate Joint LT	$128.25	$171.00	$136.80–$361.09	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Asp/Inj Intermediate Joint RT	$128.25	$171.00	$136.80–$361.09	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient one side CPT 20605 Asp/Inj Intermediate Joint RT	$733.50	$978.00	$249.99–$929.10	—	25%
Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 Asp/Inj Small Joint BI	$148.50	$198.00	$158.40–$794.73	—	25%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Asp/Inj Small Joint LT	$85.50	$114.00	$91.20–$794.73	69% below	25%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Asp/Inj Small Joint RT	$85.50	$114.00	$91.20–$794.73	69% below	25%
Joint injection or drainage, small joint (fingers, toes) one side CPT 20600 Asp/Inj Small Joint RT	$132.00	$176.00	$140.80–$361.09	52% below	25%
Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 Asp/Inj Small Joint BI	$148.50	$198.00	$158.40–$794.73	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Asp/Inj Small Joint LT	$85.50	$114.00	$91.20–$794.73	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Asp/Inj Small Joint RT	$85.50	$114.00	$91.20–$794.73	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient one side CPT 20600 Asp/Inj Small Joint RT	$132.00	$176.00	$140.80–$361.09	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair Lac Intermed <2.5 CM	$210.00	$280.00	$224.00–$1,225.75	41% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Repair Lac Intermed <2.5 CM	$360.75	$481.00	$375.94–$488.72	1% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Repair Lac Intermed <2.5 CM	$210.00	$280.00	$224.00–$1,225.75	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Repair Lac Intermed <2.5 CM	$360.75	$481.00	$375.94–$488.72	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 Inj Epidural L/S W Guide	$1,573.50	$2,098.00	$651.63–$1,993.10	32% above	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj Epidural L/S W Guide	$1,573.50	$2,098.00	$586.47–$1,993.10	—	25%
Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 Inj Foramen Epidural L/S BI	$1,960.50	$2,614.00	$837.73–$2,483.30	—	25%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Inj Foramen Epidural L/S RT	$1,306.50	$1,742.00	$837.73–$1,654.90	at median	25%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 Inj Foramen Epidural L/S LT	$1,306.50	$1,742.00	$837.73–$1,654.90	at median	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 Inj Foramen Epidural L/S BI	$1,960.50	$2,614.00	$753.95–$2,483.30	—	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Inj Foramen Epidural L/S RT	$1,306.50	$1,742.00	$753.95–$1,654.90	—	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 Inj Foramen Epidural L/S LT	$1,306.50	$1,742.00	$753.95–$1,654.90	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Exc Ben Lesion <0.5 Trunk Limb	$106.50	$142.00	$113.60–$860.67	62% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Exc Ben Lesion <0.5 Trunk Limb	$106.50	$142.00	$113.60–$798.01	—	25%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Simp Singl	$152.25	$203.00	$162.40–$380.12	29% below	25%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Simp Singl	$195.00	$260.00	$186.97–$247.00	8% below	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate Simp Singl	$152.25	$203.00	$162.40–$380.12	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 Avulsion Nail Plate Simp Singl	$195.00	$260.00	$186.97–$247.00	—	25%
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W Imaging	$1,555.50	$2,074.00	$882.21–$1,970.30	37% above	25%
Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W Imaging	$1,555.50	$2,074.00	$793.99–$1,970.30	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail Matrix Part/Complete	$333.75	$445.00	$356.00–$798.01	23% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Exc Nail Matrix Part/Complete	$340.50	$454.00	$363.20–$488.72	21% below	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Exc Nail Matrix Part/Complete	$333.75	$445.00	$338.35–$798.01	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Exc Nail Matrix Part/Complete	$340.50	$454.00	$363.20–$488.72	—	25%
Prostate removal (prostatectomy), laparoscopic CPT 55866 Prostatectomy, Retropubic Lapa	$2,466.00	$3,288.00	$2,630.40–$12,735.50	42% below	25%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Prostatectomy, Retropubic Lapa	$2,466.00	$3,288.00	$2,630.40–$12,735.50	—	25%
Removal of a foreign object under the skin, simple CPT 10120 I&R Foreign Body Simple	$132.00	$176.00	$140.80–$488.72	57% below	25%
Removal of a foreign object under the skin, simple CPT 10120 I&R Foreign Body Simple	$213.75	$285.00	$228.00–$488.72	31% below	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R Foreign Body Simple	$132.00	$176.00	$140.80–$382.24	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 I&R Foreign Body Simple	$213.75	$285.00	$228.00–$488.72	—	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 ESWL	$11,362.50	$15,150.00	$3,245.34–$14,392.50	239% above	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 ESWL	$11,362.50	$15,150.00	$2,920.81–$14,392.50	—	25%
Short arm cast (elbow to hand) one side CPT 29075 Apply Short Arm Cast RT	$143.25	$191.00	$152.80–$470.43	37% below	25%
Short arm cast (elbow to hand) one side CPT 29075 Apply Short Arm Cast LT	$147.75	$197.00	$157.60–$470.43	35% below	25%
Short arm cast (elbow to hand) one side CPT 29075 Apply Short Arm Cast LT	$162.00	$216.00	$172.80–$324.87	29% below	25%
Short arm cast (elbow to hand) inpatient one side CPT 29075 Apply Short Arm Cast RT	$143.25	$191.00	$152.80–$470.43	—	25%
Short arm cast (elbow to hand) inpatient one side CPT 29075 Apply Short Arm Cast LT	$147.75	$197.00	$157.60–$470.43	—	25%
Short arm cast (elbow to hand) inpatient one side CPT 29075 Apply Short Arm Cast LT	$162.00	$216.00	$172.80–$324.87	—	25%
Short arm splint (forearm and hand) one side CPT 29125 Apply Short Arm Splint LT	$57.00	$76.00	$60.80–$157.68	68% below	25%
Short arm splint (forearm and hand) one side CPT 29125 Apply Short Arm Splint RT	$127.50	$170.00	$121.29–$161.50	29% below	25%
Short arm splint (forearm and hand) one side CPT 29125 Apply Short Arm Splint LT	$127.50	$170.00	$121.29–$161.50	29% below	25%
Short arm splint (forearm and hand) inpatient one side CPT 29125 Apply Short Arm Splint LT	$57.00	$76.00	$60.80–$123.32	—	25%
Short arm splint (forearm and hand) inpatient one side CPT 29125 Apply Short Arm Splint RT	$127.50	$170.00	$121.29–$161.50	—	25%
Short arm splint (forearm and hand) inpatient one side CPT 29125 Apply Short Arm Splint LT	$127.50	$170.00	$121.29–$161.50	—	25%
Short leg cast (below the knee) one side CPT 29405 Apply Short Leg Cast RT	$162.75	$217.00	$173.60–$324.87	32% below	25%
Short leg cast (below the knee) inpatient one side CPT 29405 Apply Short Leg Cast RT	$162.75	$217.00	$173.60–$324.87	—	25%
Short leg splint (calf to foot) one side CPT 29515 Apply Short Leg Splint LT	$103.50	$138.00	$110.40–$193.02	38% below	25%
Short leg splint (calf to foot) one side CPT 29515 Apply Short Leg Splint RT	$103.50	$138.00	$110.40–$193.02	38% below	25%
Short leg splint (calf to foot) one side CPT 29515 Apply Short Leg Splint RT	$118.50	$158.00	$112.05–$193.02	29% below	25%
Short leg splint (calf to foot) inpatient one side CPT 29515 Apply Short Leg Splint LT	$103.50	$138.00	$110.40–$193.02	—	25%
Short leg splint (calf to foot) inpatient one side CPT 29515 Apply Short Leg Splint RT	$103.50	$138.00	$110.40–$193.02	—	25%
Short leg splint (calf to foot) inpatient one side CPT 29515 Apply Short Leg Splint RT	$118.50	$158.00	$112.05–$150.96	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Lac Simple <2.5 CM	$150.75	$201.00	$160.80–$688.82	34% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair Lac Simple <2.5 CM	$282.75	$377.00	$186.97–$358.15	23% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Repair Lac Simple <2.5 CM	$150.75	$201.00	$160.80–$688.82	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Repair Lac Simple <2.5 CM	$282.75	$377.00	$186.97–$358.15	—	25%
Skin biopsy, punch, one lesion CPT 11104 Punch Biopsy 1st Lesion	$107.25	$143.00	$114.40–$798.01	59% below	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 Punch Biopsy 1st Lesion	$107.25	$143.00	$114.40–$798.01	—	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Exc Mal Lesion <0.5 Trunk Limb	$159.75	$213.00	$170.40–$860.67	60% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 Exc Mal Lesion <0.5 Trunk Limb	$159.75	$213.00	$170.40–$798.01	—	25%
Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tags Up To 15	$89.25	$119.00	$95.20–$323.47	48% below	25%
Skin tag removal, up to 15 tags CPT 11200 Remove Skin Tags Up To 15	$154.50	$206.00	$164.80–$243.06	10% below	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 Remove Skin Tags Up To 15	$89.25	$119.00	$95.20–$323.47	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 Remove Skin Tags Up To 15	$154.50	$206.00	$164.80–$243.06	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Fluid Tap Diagnostic	$1,573.50	$2,098.00	$651.63–$1,993.10	224% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture Dx w/o Gde	$1,573.50	$2,098.00	$651.63–$1,993.10	224% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Fluid Tap Diagnostic	$1,573.50	$2,098.00	$586.47–$1,993.10	—	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture Dx w/o Gde	$1,573.50	$2,098.00	$586.47–$1,993.10	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Repair Lac Simple 2.6-7.5 CM	$172.50	$230.00	$184.00–$688.82	30% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Repair Lac Simple 2.6-7.5 CM	$365.25	$487.00	$186.97–$462.65	49% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Repair Lac Simple 2.6-7.5 CM	$172.50	$230.00	$168.27–$688.82	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Repair Lac Simple 2.6-7.5 CM	$365.25	$487.00	$186.97–$462.65	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Repair Lac Simple <2.5 CM	$292.50	$390.00	$186.97–$370.50	17% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Repair Lac Simple <2.5 CM	$292.50	$390.00	$186.97–$370.50	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Tangential Biopsy 1st Lesion	$85.50	$114.00	$91.20–$798.01	59% below	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential Biopsy 1st Lesion	$85.50	$114.00	$91.20–$798.01	—	25%
Thoracentesis with imaging guidance one side CPT 32555 Aspirate Pleura W Imaging LT	$1,538.25	$2,051.00	$581.76–$1,948.45	65% above	25%
Thoracentesis with imaging guidance one side CPT 32555 Aspirate Pleura W Imaging RT	$1,538.25	$2,051.00	$581.76–$1,948.45	65% above	25%
Thoracentesis with imaging guidance inpatient one side CPT 32555 Aspirate Pleura W Imaging RT	$1,538.25	$2,051.00	$523.58–$1,948.45	—	25%
Thoracentesis with imaging guidance inpatient one side CPT 32555 Aspirate Pleura W Imaging LT	$1,538.25	$2,051.00	$523.58–$1,948.45	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Inject Trigger Points 1-2 Mus	$93.75	$125.00	$100.00–$361.09	69% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Inject Trigger Points 1-2 Mus	$733.50	$978.00	$277.76–$929.10	144% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inject Trigger Points 1-2 Mus	$93.75	$125.00	$100.00–$361.09	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inject Trigger Points 1-2 Mus	$733.50	$978.00	$249.99–$929.10	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Biopsy Breast 1st Lesion RT	$4,585.50	$6,114.00	$1,524.58–$5,808.30	120% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Biopsy Breast 1st Lesion LT	$4,585.50	$6,114.00	$1,524.58–$5,808.30	120% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 Biopsy Breast 1st Lesion LT	$4,585.50	$6,114.00	$1,372.12–$5,808.30	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 Biopsy Breast 1st Lesion RT	$4,585.50	$6,114.00	$1,372.12–$5,808.30	—	25%
Wart removal, up to 14 warts CPT 17110 Destroy Benign Lesions 1-14	$109.50	$146.00	$116.80–$323.47	46% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 Destroy Benign Lesions 1-14	$109.50	$146.00	$116.80–$323.47	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin Subq 20 CM	$121.50	$162.00	$129.60–$488.72	71% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Skin Subq 20 CM	$1,266.00	$1,688.00	$375.94–$1,603.60	197% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin Subq 20 CM	$121.50	$162.00	$129.60–$488.72	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Skin Subq 20 CM	$1,266.00	$1,688.00	$338.35–$1,603.60	—	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 Blood Administration	$445.50	$594.00	$377.24–$564.30	22% below	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Administration	$445.50	$594.00	$370.23–$564.30	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation Treatment	$28.50	$38.00	$30.40–$248.80	75% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Treatment Subsequent	$296.25	$395.00	$191.38–$375.25	158% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Treatment	$296.25	$395.00	$191.38–$375.25	158% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation Treat Acute Initial	$296.25	$395.00	$191.38–$375.25	158% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation Treat Acute Subseq	$296.25	$395.00	$191.38–$375.25	158% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation Treatment	$28.50	$38.00	$30.40–$231.52	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Treatment	$296.25	$395.00	$172.24–$375.25	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation Treat Acute Initial	$296.25	$395.00	$172.24–$375.25	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Treatment Subsequent	$296.25	$395.00	$172.24–$375.25	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation Treat Acute Subseq	$296.25	$395.00	$172.24–$375.25	—	25%
Chemotherapy IV infusion, first hour CPT 96413 Chemotherapy Inf Initial	$560.25	$747.00	$108.59–$709.65	3% above	25%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemotherapy Inf Initial	$560.25	$747.00	$97.73–$709.65	—	25%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 1st 30-74 Min	$747.75	$997.00	$792.86–$1,030.72	15% below	25%
Critical care, first 30 to 74 minutes CPT 99291 Critical Care 1st 30-74 Min	$1,461.00	$1,948.00	$792.86–$1,850.60	66% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care 1st 30-74 Min	$747.75	$997.00	$792.86–$1,030.72	—	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical Care 1st 30-74 Min	$1,461.00	$1,948.00	$713.58–$1,850.60	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Routine	$681.00	$908.00	$293.01–$862.60	6% above	25%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG Routine	$681.00	$908.00	$263.71–$862.60	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Tracing	$206.25	$275.00	$55.89–$261.25	30% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Tracing	$206.25	$275.00	$50.30–$261.25	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Room Visit Level 1	$170.25	$227.00	$82.85–$215.65	140% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Sane Exam	$228.75	$305.00	$82.85–$289.75	223% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency Room Visit Level 1	$170.25	$227.00	$74.57–$215.65	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Sane Exam	$228.75	$305.00	$74.57–$289.75	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Room Visit Level 2	$164.25	$219.00	$149.01–$208.05	5% above	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Room Visit Level 2	$257.25	$343.00	$149.01–$325.85	64% above	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency Room Visit Level 2	$164.25	$219.00	$149.01–$208.05	—	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency Room Visit Level 2	$257.25	$343.00	$134.11–$325.85	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Room Visit Level 3	$243.75	$325.00	$260.00–$338.71	18% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Room Visit Level 3	$403.50	$538.00	$260.54–$511.10	36% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Room Visit Level 3	$243.75	$325.00	$260.00–$338.71	—	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Room Visit Level 3	$403.50	$538.00	$234.49–$511.10	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Room Visit Level 4	$362.25	$483.00	$386.40–$520.88	36% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Room Visit Level 4	$609.00	$812.00	$400.68–$771.40	8% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Room Visit Level 4	$362.25	$483.00	$386.40–$520.88	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Room Visit Level 4	$609.00	$812.00	$360.61–$771.40	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Room Visit Level 5	$546.75	$729.00	$576.90–$749.97	37% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Room Visit Level 5	$912.00	$1,216.00	$576.90–$1,155.20	6% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency Room Visit Level 5	$546.75	$729.00	$576.90–$749.97	—	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency Room Visit Level 5	$912.00	$1,216.00	$519.21–$1,155.20	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiovascular Stress Test	$835.50	$1,114.00	$293.01–$1,058.30	24% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiovascular Stress Test	$835.50	$1,114.00	$263.71–$1,058.30	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Infusion 31-60 Min	$63.75	$85.00	$27.62–$471.25	77% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Inf Therapy Hyd Initial	$560.25	$747.00	$27.62–$709.65	99% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Inf Therapy Hydration Initial	$560.25	$747.00	$27.62–$709.65	99% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Infusion 31-60 Min	$63.75	$85.00	$24.86–$471.25	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Inf Therapy Hyd Initial	$560.25	$747.00	$24.86–$709.65	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Inf Therapy Hydration Initial	$560.25	$747.00	$24.86–$709.65	—	25%
IV infusion of a medicine, first hour CPT 96365 Inf Therapy Med Initial	$560.25	$747.00	$52.65–$709.65	77% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 Inf Therapy Med Initial	$560.25	$747.00	$47.39–$709.65	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Subq IM Injection	$107.25	$143.00	$12.85–$135.85	19% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Subq IM Injection	$107.25	$143.00	$11.57–$135.85	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Evaluation	$186.75	$249.00	$151.18–$236.55	27% below	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Evaluation	$186.75	$249.00	$136.07–$236.55	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Re-Educ OT	$124.50	$166.00	$29.98–$196.22	36% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Re-Educ PT	$124.50	$166.00	$29.98–$196.22	36% above	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Re-Educ OT	$124.50	$166.00	$26.98–$196.22	—	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Re-Educ PT	$124.50	$166.00	$26.98–$196.22	—	25%
New patient office visit, about 30 minutes CPT 99203 New Patient Level 3 Low Comp	$112.50	$150.00	$72.84–$142.50	30% below	25%
New patient office visit, about 30 minutes CPT 99203 New Patient Level 3 Low Comp	$134.25	$179.00	$72.84–$170.05	16% below	25%
New patient office visit, about 30 minutes CPT 99203 New Patient Level 3	$168.75	$225.00	$72.84–$213.75	5% above	25%
New patient office visit, about 30 minutes CPT 99203 New Patient Level 3 Wound Care	$168.75	$225.00	$72.84–$213.75	5% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 New Patient Level 3 Low Comp	$112.50	$150.00	$65.56–$142.50	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 New Patient Level 3 Low Comp	$134.25	$179.00	$72.84–$170.05	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 New Patient Level 3 Wound Care	$168.75	$225.00	$65.56–$213.75	—	25%
New patient office visit, about 30 minutes inpatient CPT 99203 New Patient Level 3	$168.75	$225.00	$65.56–$213.75	—	25%
New patient office visit, about 45 minutes CPT 99204 New Patient Level 4 Mod Comp	$144.00	$192.00	$118.92–$182.40	41% below	25%
New patient office visit, about 45 minutes CPT 99204 New Patient Level 4 Wound Care	$168.75	$225.00	$118.92–$213.75	31% below	25%
New patient office visit, about 45 minutes CPT 99204 New Patient Level 4 Mod Comp	$204.00	$272.00	$118.92–$258.40	16% below	25%
New patient office visit, about 45 minutes inpatient CPT 99204 New Patient Level 4 Mod Comp	$144.00	$192.00	$107.03–$182.40	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 New Patient Level 4 Wound Care	$168.75	$225.00	$107.03–$213.75	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 New Patient Level 4 Mod Comp	$204.00	$272.00	$118.92–$258.40	—	25%
New patient office visit, about 60 minutes CPT 99205 New Patient Level 5 High Comp	$104.25	$139.00	$111.20–$210.04	67% below	25%
New patient office visit, about 60 minutes CPT 99205 New Patient Level 5 High Comp	$246.75	$329.00	$161.57–$312.55	22% below	25%
New patient office visit, about 60 minutes inpatient CPT 99205 New Patient Level 5 High Comp	$104.25	$139.00	$111.20–$163.19	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 New Patient Level 5 High Comp	$246.75	$329.00	$161.57–$312.55	—	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Patient Level 2 SF Comp	$61.50	$82.00	$41.97–$77.90	38% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Patient Level 2 SF Comp	$82.50	$110.00	$41.97–$104.50	17% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Patient Level 2 Wound Care	$168.75	$225.00	$41.97–$213.75	69% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Patient Level 2	$168.75	$225.00	$41.97–$213.75	69% above	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Patient Level 2 SF Comp	$61.50	$82.00	$37.77–$77.90	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Patient Level 2 SF Comp	$82.50	$110.00	$41.97–$104.50	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Patient Level 2	$168.75	$225.00	$37.77–$213.75	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 New Patient Level 2 Wound Care	$168.75	$225.00	$37.77–$213.75	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT Indiv Initial Ea 15 Min	$59.25	$79.00	$29.44–$144.50	39% above	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT Indiv Initial Ea 15 Min	$59.25	$79.00	$26.50–$144.50	—	25%
Occupational therapy evaluation, low complexity CPT 97165 OT Eval Low Complexity	$213.00	$284.00	$94.00–$269.80	19% above	25%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Eval Low Complexity	$213.00	$284.00	$84.60–$269.80	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Eval High Complexity	$195.00	$260.00	$91.63–$248.76	9% below	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT Eval High Complexity	$195.00	$260.00	$82.47–$248.76	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Eval Low Complexity	$195.00	$260.00	$91.63–$248.76	at median	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Eval Low Complexity	$195.00	$260.00	$82.47–$248.76	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Eval Mod Complexity	$195.00	$260.00	$91.63–$248.76	2% below	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Eval Mod Complexity	$195.00	$260.00	$82.47–$248.76	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy PT Each 15 Min	$124.50	$166.00	$25.42–$196.22	29% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy OT Each 15 Min	$124.50	$166.00	$25.42–$196.22	29% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy PT Each 15 Min	$124.50	$166.00	$22.88–$196.22	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy OT Each 15 Min	$124.50	$166.00	$22.88–$196.22	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exer OT	$124.50	$166.00	$26.94–$196.22	33% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exer PT	$124.50	$166.00	$26.94–$196.22	33% above	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exer PT	$124.50	$166.00	$24.25–$196.22	—	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exer OT	$124.50	$166.00	$24.25–$196.22	—	25%
Preventive checkup, new patient aged 18–39 CPT 99385 Preventive Exam 18-39 Year New	$100.50	$134.00	$107.20–$127.30	49% below	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Preventive Exam 18-39 Year New	$100.50	$134.00	$107.20–$127.30	—	25%
Preventive checkup, new patient aged 40–64 CPT 99386 Preventive Exam 40-64 Year New	$116.25	$155.00	$124.00–$147.25	44% below	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Preventive Exam 40-64 Year New	$116.25	$155.00	$124.00–$147.25	—	25%
Preventive checkup, new patient aged 65 or older CPT 99387 Preventive Exam 65 Year New	$122.25	$163.00	$130.40–$154.85	51% below	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 Preventive Exam 65 Year New	$122.25	$163.00	$130.40–$154.85	—	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 Preventive Exam 18-39 Year Est	$59.25	$79.00	$63.20–$75.05	64% below	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 Preventive Exam 18-39 Year Est	$59.25	$79.00	$63.20–$75.05	—	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 Preventive Exam 40-64 Year Est	$60.75	$81.00	$64.80–$76.95	67% below	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 Preventive Exam 40-64 Year Est	$60.75	$81.00	$64.80–$76.95	—	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 Preventive Exam 65 Year Est	$62.25	$83.00	$66.40–$78.85	71% below	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 Preventive Exam 65 Year Est	$62.25	$83.00	$66.40–$78.85	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation 3-10 Min	$5.25	$7.00	$5.60–$115.76	86% below	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking Cessation 3-10 Min	$22.50	$30.00	$24.00–$36.44	39% below	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking Cessation 3-10 Min	$5.25	$7.00	$5.60–$115.76	—	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Smoking Cessation 3-10 Min	$22.50	$30.00	$24.00–$36.44	—	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Patient Level 5 High Comp	$68.25	$91.00	$72.80–$167.15	71% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Patient Level 5 Wound Care	$168.75	$225.00	$128.58–$213.75	28% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OB Outpatient Visit B	$168.75	$225.00	$128.58–$213.75	28% below	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Est Patient Level 5 High Comp	$191.25	$255.00	$128.58–$242.25	19% below	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Patient Level 5 High Comp	$68.25	$91.00	$72.80–$129.87	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Patient Level 5 Wound Care	$168.75	$225.00	$115.72–$213.75	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OB Outpatient Visit B	$168.75	$225.00	$115.72–$213.75	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Est Patient Level 5 High Comp	$191.25	$255.00	$128.58–$242.25	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Office Visit Level 3	$47.25	$63.00	$50.40–$76.73	60% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Patient Level 3 Low Comp	$101.25	$135.00	$59.02–$128.25	14% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Patient Level 3	$168.75	$225.00	$59.02–$213.75	43% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Monitoring of Self Injections	$168.75	$225.00	$59.02–$213.75	43% above	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Est Patient Level 3 Wound Care	$168.75	$225.00	$59.02–$213.75	43% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Office Visit Level 3	$47.25	$63.00	$50.40–$59.85	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Patient Level 3 Low Comp	$101.25	$135.00	$59.02–$128.25	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Patient Level 3 Wound Care	$168.75	$225.00	$53.12–$213.75	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Monitoring of Self Injections	$168.75	$225.00	$53.12–$213.75	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Est Patient Level 3	$168.75	$225.00	$53.12–$213.75	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Patient Level 4 Mod Comp	$51.75	$69.00	$55.20–$112.91	68% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Patient Level 4 Mod Comp	$157.50	$210.00	$86.85–$199.50	4% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OB Outpatient Visit A	$168.75	$225.00	$86.85–$213.75	3% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Est Patient Level 4 Wound Care	$168.75	$225.00	$86.85–$213.75	3% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Patient Level 4 Mod Comp	$51.75	$69.00	$55.20–$87.72	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Patient Level 4 Mod Comp	$157.50	$210.00	$86.85–$199.50	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OB Outpatient Visit A	$168.75	$225.00	$78.17–$213.75	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Est Patient Level 4 Wound Care	$168.75	$225.00	$78.17–$213.75	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Patient Level 2 SF Comp	$29.25	$39.00	$31.20–$40.98	63% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Patient Level 2 SF Comp	$63.75	$85.00	$31.52–$80.75	19% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Patient Level 2 Wound Care	$168.75	$225.00	$31.52–$213.75	115% above	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Est Patient Level 2	$168.75	$225.00	$31.52–$213.75	115% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Patient Level 2 SF Comp	$29.25	$39.00	$28.37–$37.05	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Patient Level 2 SF Comp	$63.75	$85.00	$31.52–$80.75	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Patient Level 2 Wound Care	$168.75	$225.00	$28.37–$213.75	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Est Patient Level 2	$168.75	$225.00	$28.37–$213.75	—	25%
Speech and language evaluation CPT 92523 Speech Sound Lang Comprehen	$273.75	$365.00	$209.43–$346.75	10% below	25%
Speech and language evaluation CPT 92523 Speech Sound Lang Comp or Expr	$273.75	$365.00	$209.43–$346.75	10% below	25%
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comp or Expr	$273.75	$365.00	$188.49–$346.75	—	25%
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comprehen	$273.75	$365.00	$188.49–$346.75	—	25%
Speech therapy session, individual CPT 92507 Speech Therapy Trmt	$214.50	$286.00	$70.39–$271.70	2% below	25%
Speech therapy session, individual inpatient CPT 92507 Speech Therapy Trmt	$214.50	$286.00	$63.35–$271.70	—	25%
Spirometry (breathing test) CPT 94010 PFT Screen Spirometry	$207.00	$276.00	$147.22–$262.20	3% above	25%
Spirometry (breathing test) inpatient CPT 94010 PFT Screen Spirometry	$207.00	$276.00	$132.50–$262.20	—	25%
Spirometry before and after a bronchodilator CPT 94060 PFT Pre & Post Screen Spirome	$402.75	$537.00	$293.01–$510.15	2% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT Pre & Post Screen Spirome	$402.75	$537.00	$263.71–$510.15	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activity PT	$124.50	$166.00	$32.23–$196.22	22% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activity OT	$124.50	$166.00	$32.23–$196.22	22% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activity OT	$124.50	$166.00	$29.01–$196.22	—	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activity PT	$124.50	$166.00	$29.01–$196.22	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy Therapeutic	$430.50	$574.00	$121.29–$545.30	119% above	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy Therapeutic	$430.50	$574.00	$109.16–$545.30	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Iowa	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Covid Vax Moderna 50 Mcg/.5Ml	$261.75	$349.00	$161.65–$331.55	2% below	25%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARS-CoV-2 Vaccine 50mcg/.5mL	$373.50	$498.00	$161.65–$473.10	39% above	25%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Covid Vax Moderna 50 Mcg/.5Ml	$261.75	$349.00	$145.49–$331.55	—	25%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SARS-CoV-2 Vaccine 50mcg/.5mL	$373.50	$498.00	$145.49–$473.10	—	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella SubQ	$265.50	$354.00	$283.20–$336.30	66% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella SubQ	$265.50	$354.00	$283.20–$336.30	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza (IIV3) Split PF 0.5	$36.75	$49.00	$23.22–$74.71	70% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza Vax(6 Mo+)V3 Pf .5Ml	$38.25	$51.00	$23.22–$74.71	76% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza (IIV3) Split PF 0.5	$36.75	$49.00	$20.89–$74.71	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Influenza Vax(6 Mo+)V3 Pf .5Ml	$38.25	$51.00	$20.89–$74.71	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9vHPV 3 dose	$388.50	$518.00	$300.29–$492.10	29% above	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 9vHPV 3 dose	$388.50	$518.00	$300.29–$492.10	—	25%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HepA-HepB Adult IM	$169.50	$226.00	$180.80–$330.04	36% above	25%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HepA-HepB Adult IM	$169.50	$226.00	$180.80–$330.04	—	25%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine Adult IM	$116.25	$155.00	$67.98–$147.25	9% below	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine Adult IM	$116.25	$155.00	$66.19–$147.25	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HepB Adult 3 dose IM	$95.25	$127.00	$67.98–$120.65	14% below	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HepB Adult 3 dose IM	$95.25	$127.00	$67.63–$120.65	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Vax HD .7 Ml Fluzone	$51.75	$69.00	$55.20–$127.61	35% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza Vx Hd(65Yr+)V3 Pf .5	$128.25	$171.00	$67.98–$162.45	61% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza (IIV) Split PF IM	$156.00	$208.00	$67.98–$197.60	96% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Vax HD .7 Ml Fluzone	$51.75	$69.00	$55.20–$99.14	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza Vx Hd(65Yr+)V3 Pf .5	$128.25	$171.00	$67.98–$162.45	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza (IIV) Split PF IM	$156.00	$208.00	$67.98–$197.60	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR SubQ	$148.50	$198.00	$67.98–$188.10	42% above	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Meas/Mump/Rubel Vac 0.5ML Vial	$173.25	$231.00	$67.98–$219.45	65% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR SubQ	$148.50	$198.00	$67.98–$188.10	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Meas/Mump/Rubel Vac 0.5ML Vial	$173.25	$231.00	$67.98–$219.45	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Mcv4 or MenACWY IM	$183.00	$244.00	$195.20–$330.04	21% below	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Mcv4 or MenACWY IM	$183.00	$244.00	$195.20–$330.04	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MenB 2 dose IM	$260.25	$347.00	$277.60–$330.04	6% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MenB 2 dose IM	$260.25	$347.00	$277.60–$330.04	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumo Conjugate Vaccine 20 Va	$212.25	$283.00	$226.40–$406.77	58% below	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumo 20 Valent Vacc 0.5 Ml	$500.25	$667.00	$300.29–$633.65	at median	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumo Conjugate Vaccine 20 Va	$212.25	$283.00	$226.40–$330.04	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumo 20 Valent Vacc 0.5 Ml	$500.25	$667.00	$281.61–$633.65	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RSV Vaccine Bivalent	$282.75	$377.00	$67.98–$358.15	6% below	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV Vaccine Bivalent	$282.75	$377.00	$67.98–$358.15	—	25%
Rabies vaccine, one dose CPT 90675 Rabies Vacc Chx Pre-Exposure	$636.75	$849.00	$300.29–$806.55	9% below	25%
Rabies vaccine, one dose CPT 90675 Rabies Vacc Chx Post-Ex Immun	$636.75	$849.00	$300.29–$806.55	9% below	25%
Rabies vaccine, one dose CPT 90675 Rabies Vax Pcec/Pf 2.5Unit Vl	$637.50	$850.00	$300.29–$807.50	9% below	25%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vacc Chx Post-Ex Immun	$636.75	$849.00	$277.59–$806.55	—	25%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vacc Chx Pre-Exposure	$636.75	$849.00	$277.59–$806.55	—	25%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vax Pcec/Pf 2.5Unit Vl	$637.50	$850.00	$277.59–$807.50	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster (HZV) IM	$262.50	$350.00	$280.00–$332.50	11% above	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster (HZV) IM	$262.50	$350.00	$280.00–$332.50	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Td PF 7 years+ old IM	$82.50	$110.00	$38.97–$104.50	38% above	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Td PF 7 years+ old IM	$82.50	$110.00	$35.07–$104.50	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Dip/Tet/Acel Pertus 0.5ML	$78.00	$104.00	$39.69–$98.80	7% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tdap >7 years old IM	$82.50	$110.00	$39.69–$104.50	2% below	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Dip/Tet/Acel Pertus 0.5ML	$78.00	$104.00	$35.72–$98.80	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap >7 years old IM	$82.50	$110.00	$35.72–$104.50	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin Hepatitis	$14.25	$19.00	$15.20–$87.06	59% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Influenza Vaccine	$27.00	$36.00	$28.80–$87.06	23% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin 1st	$27.00	$36.00	$28.80–$87.06	23% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin Influenza	$107.25	$143.00	$38.84–$135.85	206% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Administration	$107.25	$143.00	$38.84–$135.85	206% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin Pneumo	$107.25	$143.00	$38.84–$135.85	206% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin Hepatitis	$14.25	$19.00	$15.20–$68.09	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin 1st	$27.00	$36.00	$28.80–$68.09	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Admin Influenza Vaccine	$27.00	$36.00	$28.80–$68.09	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin Pneumo	$107.25	$143.00	$38.84–$135.85	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin Influenza	$107.25	$143.00	$38.84–$135.85	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Administration	$107.25	$143.00	$38.84–$135.85	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin Each Addl	$107.25	$143.00	$13.11–$135.85	272% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin Each Addl	$107.25	$143.00	$11.80–$135.85	—	25%

Source file: https://www.spencerhospital.org/webres/File/Pricing/426005883_spencer-municipal-hospital_standardcharges.csv