Hospital Minneapolis-St. Paul-Bloomington, MN-WI

Mille Lacs Health System

Mille Lacs Health System in Onamia, MN publishes cash prices for 283 common procedures listed here, from its own machine-readable price file updated Aug 13, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Minnesota median for 186 of 281 procedures and above it for 92. By typical cash price it ranks #6 of 79 Minnesota hospitals and #3 of 23 hospitals in the Minneapolis, MN area, cheapest first. Click a procedure to compare it with other hospitals nearby.

200 NORTH ELM STREET,ONAMIA,MN,56359-0000 Collected Sep 27, 2026 Source price file (320) 532-3154

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 241356 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Mille Lacs Health System in Onamia, MN:

Feb 10, 2023 Warning notice
Jun 13, 2023 Case closed
Mar 30, 2026 Warning notice
Jul 7, 2026 Corrective action plan requested

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE	$37.80	$54.00	$37.28–$584.00	83% below	30%
Ankle X-ray, complete, 3 or more views CPT 73610 ANKLE 3 V	$37.80	$54.00	$37.28–$584.00	83% below	30%
Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY ANKLE 3V	$371.00	$530.00	$37.28–$584.00	69% above	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 ANKLE 3 V	$37.80	$54.00	$37.28–$584.00	—	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-RAY EXAM OF ANKLE	$37.80	$54.00	$37.28–$584.00	—	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-RAY ANKLE 3V	$371.00	$530.00	$37.28–$584.00	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ART W/ABI	$482.30	$689.00	$46.00–$735.00	30% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ART W/ABI	$482.30	$689.00	$46.00–$735.00	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST	$91.70	$131.00	$103.20–$778.00	69% below	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 ESOPHAGRAM	$91.70	$131.00	$103.20–$778.00	69% below	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 X-RAY ESOPHAGRAM	$452.90	$647.00	$103.20–$778.00	55% above	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY XM ESOPHAGUS 1CNTRST	$91.70	$131.00	$103.20–$778.00	—	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 ESOPHAGRAM	$91.70	$131.00	$103.20–$778.00	—	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 X-RAY ESOPHAGRAM	$452.90	$647.00	$103.20–$778.00	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE IMAGING WHOLE BODY	$171.50	$245.00	$245.00–$2,915.00	86% below	30%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE WHOLE BODY	$171.50	$245.00	$245.00–$2,915.00	86% below	30%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE WHOL BOD	$1,869.00	$2,670.00	$245.00–$2,915.00	53% above	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE WHOLE BODY	$171.50	$245.00	$245.00–$2,915.00	—	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE IMAGING WHOLE BODY	$171.50	$245.00	$245.00–$2,915.00	—	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE WHOL BOD	$1,869.00	$2,670.00	$245.00–$2,915.00	—	30%
Breast ultrasound, complete, one breast CPT 76641 ULTRASOUND BREAST COMPLETE	$86.10	$123.00	$108.80–$893.00	77% below	30%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILAT COM	$86.10	$123.00	$108.80–$893.00	77% below	30%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL COMPLETE	$539.00	$770.00	$108.80–$893.00	43% above	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 ULTRASOUND BREAST COMPLETE	$86.10	$123.00	$108.80–$893.00	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILAT COM	$86.10	$123.00	$108.80–$893.00	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL COMPLETE	$539.00	$770.00	$108.80–$893.00	—	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED	$136.50	$195.00	$89.38–$775.00	57% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNILAT LIM	$136.50	$195.00	$89.38–$775.00	57% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST UNILATERAL LIMITED	$406.00	$580.00	$89.38–$775.00	29% above	30%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LIMITED	$136.50	$195.00	$89.38–$775.00	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNILAT LIM	$136.50	$195.00	$89.38–$775.00	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BREAST UNILATERAL LIMITED	$406.00	$580.00	$89.38–$775.00	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST	$362.60	$518.00	$309.11–$4,666.00	78% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CHEST ANGIOGRAPHY	$2,903.60	$4,148.00	$309.11–$4,666.00	75% above	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST	$362.60	$518.00	$309.11–$4,666.00	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CHEST ANGIOGRAPHY	$2,903.60	$4,148.00	$309.11–$4,666.00	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST	$345.80	$494.00	$200.15–$5,666.00	82% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PELVIS W/O	$345.80	$494.00	$200.15–$5,666.00	82% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD/PEL W/O	$3,620.40	$5,172.00	$200.15–$5,666.00	90% above	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD & PELVIS W/O CONTRAST	$345.80	$494.00	$200.15–$5,666.00	—	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PELVIS W/O	$345.80	$494.00	$200.15–$5,666.00	—	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD/PEL W/O	$3,620.40	$5,172.00	$200.15–$5,666.00	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST	$367.50	$525.00	$340.21–$6,248.00	85% below	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS W/CON	$367.50	$525.00	$340.21–$6,248.00	85% below	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PEL W/CON	$4,006.10	$5,723.00	$340.21–$6,248.00	63% above	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS W/CON	$367.50	$525.00	$340.21–$6,248.00	—	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD & PELVIS W/CONTRAST	$367.50	$525.00	$340.21–$6,248.00	—	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PEL W/CON	$4,006.10	$5,723.00	$340.21–$6,248.00	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$399.00	$570.00	$381.83–$15,316.00	84% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PEL W & W/O	$399.00	$570.00	$381.83–$15,316.00	84% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PEL W&W/O	$5,161.10	$7,373.00	$381.83–$15,316.00	101% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ENTEROGRAPHY	$5,161.10	$7,373.00	$381.83–$15,316.00	101% above	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PEL W & W/O	$399.00	$570.00	$381.83–$15,316.00	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR	$399.00	$570.00	$381.83–$15,316.00	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PEL W&W/O	$5,161.10	$7,373.00	$381.83–$15,316.00	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ENTEROGRAPHY	$5,161.10	$7,373.00	$381.83–$15,316.00	—	30%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$255.50	$365.00	$259.61–$3,968.00	83% below	30%
CT scan of the abdomen with contrast CPT 74160 CT ABD W/CON	$2,522.10	$3,603.00	$259.61–$3,968.00	73% above	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$255.50	$365.00	$259.61–$3,968.00	—	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABD W/CON	$2,522.10	$3,603.00	$259.61–$3,968.00	—	30%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$238.70	$341.00	$150.07–$2,974.00	80% below	30%
CT scan of the abdomen without contrast CPT 74150 CT ABD W/O	$1,843.10	$2,633.00	$150.07–$2,974.00	56% above	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$238.70	$341.00	$150.07–$2,974.00	—	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD W/O	$1,843.10	$2,633.00	$150.07–$2,974.00	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE	$171.50	$245.00	$140.91–$5,240.00	86% below	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O	$1,729.70	$2,471.00	$140.91–$5,240.00	38% above	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFAC W/O	$1,766.80	$2,524.00	$140.91–$5,240.00	41% above	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O DYE	$171.50	$245.00	$140.91–$5,240.00	—	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS W/O	$1,729.70	$2,471.00	$140.91–$5,240.00	—	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFAC W/O	$1,766.80	$2,524.00	$140.91–$5,240.00	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE	$171.50	$245.00	$116.17–$2,726.00	86% below	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O	$1,736.70	$2,481.00	$116.17–$2,726.00	38% above	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE	$171.50	$245.00	$116.17–$2,726.00	—	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O	$1,736.70	$2,481.00	$116.17–$2,726.00	—	30%
CT scan of the head with contrast CPT 70460 CT HEAD W/CON	$208.60	$298.00	$163.53–$3,142.00	84% below	30%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE	$208.60	$298.00	$163.53–$3,142.00	84% below	30%
CT scan of the head with contrast CPT 70460 CT HEAD W/C	$1,990.80	$2,844.00	$163.53–$3,142.00	53% above	30%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/DYE	$208.60	$298.00	$163.53–$3,142.00	—	30%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/CON	$208.60	$298.00	$163.53–$3,142.00	—	30%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/C	$1,990.80	$2,844.00	$163.53–$3,142.00	—	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE	$255.50	$365.00	$192.45–$3,415.00	84% below	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD W & W/O	$2,135.00	$3,050.00	$192.45–$3,415.00	34% above	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/DYE	$255.50	$365.00	$192.45–$3,415.00	—	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W & W/O	$2,135.00	$3,050.00	$192.45–$3,415.00	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE	$199.50	$285.00	$142.38–$3,065.00	85% below	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L SPINE W/O	$1,946.00	$2,780.00	$142.38–$3,065.00	43% above	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O DYE	$199.50	$285.00	$142.38–$3,065.00	—	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L SPINE W/O	$1,946.00	$2,780.00	$142.38–$3,065.00	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE	$215.60	$308.00	$143.09–$3,331.00	84% below	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C SPINE W/O	$2,116.10	$3,023.00	$143.09–$3,331.00	56% above	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT NECK SPINE W/O DYE	$215.60	$308.00	$143.09–$3,331.00	—	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C SPINE W/O	$2,116.10	$3,023.00	$143.09–$3,331.00	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE	$231.00	$330.00	$255.06–$3,221.00	84% below	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CON	$2,023.70	$2,891.00	$255.06–$3,221.00	38% above	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE	$231.00	$330.00	$255.06–$3,221.00	—	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CON	$2,023.70	$2,891.00	$255.06–$3,221.00	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$159.60	$228.00	$228.00–$4,051.00	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID BILAT	$1,370.60	$1,958.00	$228.00–$4,051.00	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 EXTRACRANIAL BILAT STUDY	$159.60	$228.00	$228.00–$4,051.00	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILAT	$1,370.60	$1,958.00	$228.00–$4,051.00	—	30%
Chest X-ray, 2 views CPT 71046 CHEST 2V	$43.40	$62.00	$34.08–$572.00	81% below	30%
Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$43.40	$62.00	$34.08–$572.00	81% below	30%
Chest X-ray, 2 views CPT 71046 X-RAY CHEST 2V	$357.00	$510.00	$34.08–$572.00	54% above	30%
Chest X-ray, 2 views inpatient CPT 71046 X-RAY EXAM CHEST 2 VIEWS	$43.40	$62.00	$34.08–$572.00	—	30%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2V	$43.40	$62.00	$34.08–$572.00	—	30%
Chest X-ray, 2 views inpatient CPT 71046 X-RAY CHEST 2V	$357.00	$510.00	$34.08–$572.00	—	30%
Chest X-ray, single view CPT 71045 CHEST 1V	$37.80	$54.00	$25.97–$520.00	79% below	30%
Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW	$37.80	$54.00	$25.97–$520.00	79% below	30%
Chest X-ray, single view CPT 71045 X-RAY CHEST 1V	$326.20	$466.00	$25.97–$520.00	84% above	30%
Chest X-ray, single view inpatient CPT 71045 X-RAY EXAM CHEST 1 VIEW	$37.80	$54.00	$25.97–$520.00	—	30%
Chest X-ray, single view inpatient CPT 71045 CHEST 1V	$37.80	$54.00	$25.97–$520.00	—	30%
Chest X-ray, single view inpatient CPT 71045 X-RAY CHEST 1V	$326.20	$466.00	$25.97–$520.00	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP	$146.30	$209.00	$115.16–$1,388.00	72% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RENAL	$825.30	$1,179.00	$115.16–$1,388.00	58% above	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US EXAM ABDO BACK WALL COMP	$146.30	$209.00	$115.16–$1,388.00	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RENAL	$825.30	$1,179.00	$115.16–$1,388.00	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA SCAN SPINE & PE	$40.60	$58.00	$38.68–$1,030.00	87% below	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL	$40.60	$58.00	$38.68–$1,030.00	87% below	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA SPINE & PE	$680.40	$972.00	$38.68–$1,030.00	117% above	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL	$40.60	$58.00	$38.68–$1,030.00	—	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA SCAN SPINE & PE	$40.60	$58.00	$38.68–$1,030.00	—	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA SPINE & PE	$680.40	$972.00	$38.68–$1,030.00	—	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY APPENDICULR	$40.60	$58.00	$31.97–$476.00	79% below	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DEXA SCAN FOREARM	$292.60	$418.00	$31.97–$476.00	52% above	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY APPENDICULR	$40.60	$58.00	$31.97–$476.00	—	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DEXA SCAN FOREARM	$292.60	$418.00	$31.97–$476.00	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C-	$231.00	$330.00	$145.88–$2,897.00	82% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O	$1,796.90	$2,567.00	$145.88–$2,897.00	43% above	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DX C-	$231.00	$330.00	$145.88–$2,897.00	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O	$1,796.90	$2,567.00	$145.88–$2,897.00	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+	$248.50	$355.00	$185.08–$3,471.00	83% below	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/CON	$2,181.20	$3,116.00	$185.08–$3,471.00	46% above	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DX C+	$248.50	$355.00	$185.08–$3,471.00	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/CON	$2,181.20	$3,116.00	$185.08–$3,471.00	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI	$578.20	$826.00	$116.86–$2,716.00	—	30%
Diagnostic mammogram, both breasts CPT 77066 MAMMO DIAG BIL W CAD	$199.50	$285.00	$116.86–$2,716.00	38% below	30%
Diagnostic mammogram, both breasts CPT 77066 MAMMO SAGE DIAG BILA	$416.50	$595.00	$116.86–$2,716.00	30% above	30%
Diagnostic mammogram, both breasts CPT 77066 X-RAY MAM DIAG BIL	$578.20	$826.00	$116.86–$2,716.00	80% above	30%
Diagnostic mammogram, both breasts CPT 77066 EKLUNF MAMMO DIAGNOS	$707.00	$1,010.00	$116.86–$2,716.00	121% above	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX MAMMO INCL CAD BI	$578.20	$826.00	$116.86–$2,716.00	—	30%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO DIAG BIL W CAD	$199.50	$285.00	$116.86–$2,716.00	—	30%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMO SAGE DIAG BILA	$416.50	$595.00	$116.86–$2,716.00	—	30%
Diagnostic mammogram, both breasts inpatient CPT 77066 X-RAY MAM DIAG BIL	$578.20	$826.00	$116.86–$2,716.00	—	30%
Diagnostic mammogram, both breasts inpatient CPT 77066 EKLUNF MAMMO DIAGNOS	$707.00	$1,010.00	$116.86–$2,716.00	—	30%
Diagnostic mammogram, one breast CPT 77065 MAMMO DIAG UNI W CAD	$163.10	$233.00	$91.62–$2,775.00	48% below	30%
Diagnostic mammogram, one breast CPT 77065 X-RAY MAM UNI X VS	$324.80	$464.00	$91.62–$2,775.00	4% above	30%
Diagnostic mammogram, one breast CPT 77065 MAMMO EKLUND EXTRA VIEWS	$401.80	$574.00	$91.62–$2,775.00	29% above	30%
Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI	$488.60	$698.00	$91.62–$2,775.00	57% above	30%
Diagnostic mammogram, one breast CPT 77065 X-RAY MAM DIAG UNI	$488.60	$698.00	$91.62–$2,775.00	57% above	30%
Diagnostic mammogram, one breast CPT 77065 EKLUND MAMMO UNILATE	$564.20	$806.00	$91.62–$2,775.00	82% above	30%
Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO DIAG UNI W CAD	$163.10	$233.00	$91.62–$2,775.00	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 X-RAY MAM UNI X VS	$324.80	$464.00	$91.62–$2,775.00	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 MAMMO EKLUND EXTRA VIEWS	$401.80	$574.00	$91.62–$2,775.00	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 X-RAY MAM DIAG UNI	$488.60	$698.00	$91.62–$2,775.00	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 DX MAMMO INCL CAD UNI	$488.60	$698.00	$91.62–$2,775.00	—	30%
Diagnostic mammogram, one breast inpatient CPT 77065 EKLUND MAMMO UNILATE	$564.20	$806.00	$91.62–$2,775.00	—	30%
Duplex ultrasound of the leg arteries, both legs CPT 93925 LOWER EXTREMITY STUDY	$156.80	$224.00	$224.00–$2,040.00	81% below	30%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US LOWER EXT SCAN	$1,271.20	$1,816.00	$224.00–$2,040.00	58% above	30%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 LOWER EXTREMITY STUDY	$156.80	$224.00	$224.00–$2,040.00	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US LOWER EXT SCAN	$1,271.20	$1,816.00	$224.00–$2,040.00	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS BILAT	$1,056.30	$1,509.00	$195.00–$3,141.00	—	30%
Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY	$136.50	$195.00	$195.00–$3,141.00	85% below	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS BILAT	$1,056.30	$1,509.00	$195.00–$3,141.00	—	30%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 EXTREMITY STUDY	$136.50	$195.00	$195.00–$3,141.00	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHO W/BUBBLE	$1,913.10	$2,733.00	$2,157.20–$10,786.00	52% above	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHO COMPLETE	$1,913.10	$2,733.00	$2,157.20–$10,786.00	52% above	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHO W/BUBBLE	$1,913.10	$2,733.00	$2,157.20–$10,786.00	—	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHO COMPLETE	$1,913.10	$2,733.00	$2,157.20–$10,786.00	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HIDA	$1,572.20	$2,246.00	$473.80–$2,369.00	17% above	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HIDA	$1,572.20	$2,246.00	$473.80–$2,369.00	—	30%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATTEND	$739.20	$1,056.00	$211.20–$1,056.00	21% above	30%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY UNATTEND	$739.20	$1,056.00	$211.20–$1,056.00	—	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOMNOGRAPHY W/	$956.90	$1,367.00	$1,374.20–$6,871.00	72% below	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SPLIT NHGT SLEEP W/C	$3,852.80	$5,504.00	$1,374.20–$6,871.00	11% above	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOMNOGRAPHY W/	$956.90	$1,367.00	$1,374.20–$6,871.00	—	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SPLIT NHGT SLEEP W/C	$3,852.80	$5,504.00	$1,374.20–$6,871.00	—	30%
Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3	$40.60	$58.00	$41.17–$588.00	83% below	30%
Knee X-ray, 3 views CPT 73562 KNEE 3V	$40.60	$58.00	$41.17–$588.00	83% below	30%
Knee X-ray, 3 views CPT 73562 X-RAY KNEE 3V	$371.00	$530.00	$41.17–$588.00	60% above	30%
Knee X-ray, 3 views inpatient CPT 73562 X-RAY EXAM OF KNEE 3	$40.60	$58.00	$41.17–$588.00	—	30%
Knee X-ray, 3 views inpatient CPT 73562 KNEE 3V	$40.60	$58.00	$41.17–$588.00	—	30%
Knee X-ray, 3 views inpatient CPT 73562 X-RAY KNEE 3V	$371.00	$530.00	$41.17–$588.00	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN	$86.10	$123.00	$92.96–$2,297.00	79% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL LIMITED	$86.10	$123.00	$92.96–$2,297.00	79% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN B SCAN	$350.70	$501.00	$92.96–$2,297.00	16% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US FAST/BILARY	$435.40	$622.00	$92.96–$2,297.00	4% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LTD	$616.00	$880.00	$92.96–$2,297.00	47% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL LIMITED	$86.10	$123.00	$92.96–$2,297.00	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ECHO EXAM OF ABDOMEN	$86.10	$123.00	$92.96–$2,297.00	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN B SCAN	$350.70	$501.00	$92.96–$2,297.00	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US FAST/BILARY	$435.40	$622.00	$92.96–$2,297.00	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LTD	$616.00	$880.00	$92.96–$2,297.00	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C-	$203.00	$290.00	$150.83–$2,857.00	65% below	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE LUNG CT	$1,796.90	$2,567.00	$150.83–$2,857.00	211% above	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCR C-	$203.00	$290.00	$150.83–$2,857.00	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LOW DOSE LUNG CT	$1,796.90	$2,567.00	$150.83–$2,857.00	—	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JNT OF LWR EXTRE W/O DYE	$189.70	$271.00	$228.71–$4,920.00	89% below	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JT W/O	$3,254.30	$4,649.00	$228.71–$4,920.00	83% above	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI JNT OF LWR EXTRE W/O DYE	$189.70	$271.00	$228.71–$4,920.00	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOW EXT JT W/O	$3,254.30	$4,649.00	$228.71–$4,920.00	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LO EXT JT W&W/O	$5,240.90	$7,487.00	$356.00–$7,843.00	104% above	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LO EXT JT W&W/O	$5,240.90	$7,487.00	$356.00–$7,843.00	—	30%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$291.90	$417.00	$223.59–$4,520.00	87% below	30%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O	$2,872.10	$4,103.00	$223.59–$4,520.00	32% above	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$291.90	$417.00	$223.59–$4,520.00	—	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O	$2,872.10	$4,103.00	$223.59–$4,520.00	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABD W/O CNTR FLWD CNTR	$439.60	$628.00	$391.06–$6,900.00	85% below	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W&W/O	$439.60	$628.00	$391.06–$6,900.00	85% below	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W & W/O	$4,390.40	$6,272.00	$391.06–$6,900.00	49% above	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W&W/O	$439.60	$628.00	$391.06–$6,900.00	—	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABD W/O CNTR FLWD CNTR	$439.60	$628.00	$391.06–$6,900.00	—	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W & W/O	$4,390.40	$6,272.00	$391.06–$6,900.00	—	30%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN STEM W/O DYE	$206.50	$295.00	$220.88–$4,040.00	90% below	30%
MRI of the brain, no contrast dye CPT 70551 MRI HEAD W/O	$2,621.50	$3,745.00	$220.88–$4,040.00	29% above	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN STEM W/O DYE	$206.50	$295.00	$220.88–$4,040.00	—	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI HEAD W/O	$2,621.50	$3,745.00	$220.88–$4,040.00	—	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE	$455.00	$650.00	$363.22–$7,599.00	83% below	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI HEAD W & W/O	$4,864.30	$6,949.00	$363.22–$7,599.00	80% above	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN STEM W/O & W/DYE	$455.00	$650.00	$363.22–$7,599.00	—	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI HEAD W & W/O	$4,864.30	$6,949.00	$363.22–$7,599.00	—	30%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O DYE	$208.60	$298.00	$216.51–$4,322.00	90% below	30%
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE W/O	$2,816.80	$4,024.00	$216.51–$4,322.00	35% above	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O DYE	$208.60	$298.00	$216.51–$4,322.00	—	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE W/O	$2,816.80	$4,024.00	$216.51–$4,322.00	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPINE W/O & W/DYE	$455.00	$650.00	$366.05–$7,215.00	82% below	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE W & W/O	$4,595.50	$6,565.00	$366.05–$7,215.00	79% above	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMBAR SPINE W/O & W/DYE	$455.00	$650.00	$366.05–$7,215.00	—	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE W & W/O	$4,595.50	$6,565.00	$366.05–$7,215.00	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI CHEST SPINE W/O DYE	$264.60	$378.00	$216.16–$4,123.00	88% below	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE W/O	$2,621.50	$3,745.00	$216.16–$4,123.00	23% above	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI CHEST SPINE W/O DYE	$264.60	$378.00	$216.16–$4,123.00	—	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE W/O	$2,621.50	$3,745.00	$216.16–$4,123.00	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI NECK SPINE W/O & W/DYE	$291.90	$417.00	$366.75–$6,982.00	88% below	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE W & W/O	$4,595.50	$6,565.00	$366.75–$6,982.00	84% above	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI NECK SPINE W/O & W/DYE	$291.90	$417.00	$366.75–$6,982.00	—	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE W & W/O	$4,595.50	$6,565.00	$366.75–$6,982.00	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI NECK SPINE W/O DYE	$206.50	$295.00	$216.16–$4,368.00	90% below	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE W/O	$2,851.10	$4,073.00	$216.16–$4,368.00	35% above	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI NECK SPINE W/O DYE	$206.50	$295.00	$216.16–$4,368.00	—	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE W/O	$2,851.10	$4,073.00	$216.16–$4,368.00	—	30%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE	$439.60	$628.00	$390.35–$7,193.00	83% below	30%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W & W/O	$4,595.50	$6,565.00	$390.35–$7,193.00	73% above	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/DYE	$439.60	$628.00	$390.35–$7,193.00	—	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W & W/O	$4,595.50	$6,565.00	$390.35–$7,193.00	—	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O	$2,872.10	$4,103.00	$241.00–$4,344.00	36% above	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O	$2,872.10	$4,103.00	$241.00–$4,344.00	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXTREM W/O DYE	$270.90	$387.00	$229.42–$5,068.00	87% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT W/O	$270.90	$387.00	$229.42–$5,068.00	87% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPE EXT JT W/O	$3,276.70	$4,681.00	$229.42–$5,068.00	54% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT W/O	$270.90	$387.00	$229.42–$5,068.00	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI JOINT UPR EXTREM W/O DYE	$270.90	$387.00	$229.42–$5,068.00	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPE EXT JT W/O	$3,276.70	$4,681.00	$229.42–$5,068.00	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIO STRESS MULT	$4,293.10	$6,133.00	$1,279.40–$6,397.00	51% above	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIO STRESS MULT	$4,293.10	$6,133.00	$1,279.40–$6,397.00	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED	$56.00	$80.00	$48.57–$2,234.00	82% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 NON OBSTETRIC US-LIM	$56.00	$80.00	$48.57–$2,234.00	82% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS/BLADDER	$366.10	$523.00	$48.57–$2,234.00	20% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS LIMITED	$518.70	$741.00	$48.57–$2,234.00	70% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US BLADDER PRE AND POST VOIDING	$522.90	$747.00	$48.57–$2,234.00	71% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US EXAM PELVIC LIMITED	$56.00	$80.00	$48.57–$2,234.00	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 NON OBSTETRIC US-LIM	$56.00	$80.00	$48.57–$2,234.00	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS/BLADDER	$366.10	$523.00	$48.57–$2,234.00	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS LIMITED	$518.70	$741.00	$48.57–$2,234.00	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US BLADDER PRE AND POST VOIDING	$522.90	$747.00	$48.57–$2,234.00	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE	$136.50	$195.00	$112.35–$1,241.00	71% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS NON-OB	$732.20	$1,046.00	$112.35–$1,241.00	56% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US EXAM PELVIC COMPLETE	$136.50	$195.00	$112.35–$1,241.00	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS NON-OB	$732.20	$1,046.00	$112.35–$1,241.00	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >/= 14 WKS SNGL FETUS	$199.50	$285.00	$143.32–$1,331.00	58% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB>14 WEEKS	$199.50	$285.00	$143.32–$1,331.00	58% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >14 WEEKS	$732.20	$1,046.00	$143.32–$1,331.00	53% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB>14 WEEKS	$199.50	$285.00	$143.32–$1,331.00	—	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US >/= 14 WKS SNGL FETUS	$199.50	$285.00	$143.32–$1,331.00	—	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >14 WEEKS	$732.20	$1,046.00	$143.32–$1,331.00	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS	$199.50	$285.00	$124.23–$2,340.00	52% below	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB <14 WEEKS	$641.20	$916.00	$124.23–$2,340.00	53% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB <14 WEEKS TWIN	$797.30	$1,139.00	$124.23–$2,340.00	91% above	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US < 14 WKS SINGLE FETUS	$199.50	$285.00	$124.23–$2,340.00	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB <14 WEEKS	$641.20	$916.00	$124.23–$2,340.00	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB <14 WEEKS TWIN	$797.30	$1,139.00	$124.23–$2,340.00	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$131.60	$188.00	$85.86–$1,891.00	59% below	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANT UTERUS	$453.60	$648.00	$85.86–$1,891.00	41% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$642.60	$918.00	$85.86–$1,891.00	100% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S)	$131.60	$188.00	$85.86–$1,891.00	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANT UTERUS	$453.60	$648.00	$85.86–$1,891.00	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB LIMITED	$642.60	$918.00	$85.86–$1,891.00	—	30%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT	$152.60	$218.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts both sides CPT 77067 MAM SCREEN BILATERAL	$401.80	$574.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD	$578.20	$826.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts CPT 77067 MAMMO SCR BIL W CAD	$152.60	$218.00	$96.53–$3,178.00	55% below	30%
Screening mammogram, both breasts CPT 77067 X-RAY MAM MBCCCP	$416.50	$595.00	$96.53–$3,178.00	23% above	30%
Screening mammogram, both breasts CPT 77067 MAM SCREEN EKLUN	$522.90	$747.00	$96.53–$3,178.00	55% above	30%
Screening mammogram, both breasts CPT 77067 X-RAY MAM SCRE BIL	$578.20	$826.00	$96.53–$3,178.00	71% above	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT	$152.60	$218.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAM SCREEN BILATERAL	$401.80	$574.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCR MAMMO BI INCL CAD	$578.20	$826.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SCR BIL W CAD	$152.60	$218.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts inpatient CPT 77067 X-RAY MAM MBCCCP	$416.50	$595.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts inpatient CPT 77067 MAM SCREEN EKLUN	$522.90	$747.00	$96.53–$3,178.00	—	30%
Screening mammogram, both breasts inpatient CPT 77067 X-RAY MAM SCRE BIL	$578.20	$826.00	$96.53–$3,178.00	—	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER	$40.60	$58.00	$34.80–$560.00	82% below	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 SHOULDER 2V	$40.60	$58.00	$34.80–$560.00	82% below	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY SHOULDER 2V	$351.40	$502.00	$34.80–$560.00	56% above	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY EXAM OF SHOULDER	$40.60	$58.00	$34.80–$560.00	—	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 SHOULDER 2V	$40.60	$58.00	$34.80–$560.00	—	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-RAY SHOULDER 2V	$351.40	$502.00	$34.80–$560.00	—	30%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY 4	$956.90	$1,367.00	$1,294.80–$6,474.00	69% below	30%
Sleep study in a lab (polysomnography) CPT 95810 STD OVERNGHT SLEEP S	$3,574.90	$5,107.00	$1,294.80–$6,474.00	16% above	30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY 4	$956.90	$1,367.00	$1,294.80–$6,474.00	—	30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 STD OVERNGHT SLEEP S	$3,574.90	$5,107.00	$1,294.80–$6,474.00	—	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 VIDEO SWALLOW	$74.20	$106.00	$136.81–$960.00	75% below	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY XM SWLNG FUNCJ C+	$74.20	$106.00	$136.81–$960.00	75% below	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 X-RAY VIDEO SWALL	$597.80	$854.00	$136.81–$960.00	101% above	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-RAY XM SWLNG FUNCJ C+	$74.20	$106.00	$136.81–$960.00	—	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 VIDEO SWALLOW	$74.20	$106.00	$136.81–$960.00	—	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 X-RAY VIDEO SWALL	$597.80	$854.00	$136.81–$960.00	—	30%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB	$152.60	$218.00	$127.20–$1,457.00	61% below	30%
Transvaginal pelvic ultrasound CPT 76830 US PELVIS ENDOVAG	$867.30	$1,239.00	$127.20–$1,457.00	124% above	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL US NON-OB	$152.60	$218.00	$127.20–$1,457.00	—	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIS ENDOVAG	$867.30	$1,239.00	$127.20–$1,457.00	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC	$152.60	$218.00	$98.19–$1,631.00	54% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 US OB ENDOVAGINAL	$152.60	$218.00	$98.19–$1,631.00	54% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 US OB ENDOVAGINA	$989.10	$1,413.00	$98.19–$1,631.00	196% above	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 TRANSVAGINAL US OBSTETRIC	$152.60	$218.00	$98.19–$1,631.00	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB ENDOVAGINAL	$152.60	$218.00	$98.19–$1,631.00	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB ENDOVAGINA	$989.10	$1,413.00	$98.19–$1,631.00	—	30%
Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE	$163.10	$233.00	$124.67–$1,279.00	72% below	30%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPL	$732.20	$1,046.00	$124.67–$1,279.00	25% above	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US EXAM ABDOM COMPLETE	$163.10	$233.00	$124.67–$1,279.00	—	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPL	$732.20	$1,046.00	$124.67–$1,279.00	—	30%
Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM	$88.20	$126.00	$107.43–$1,612.00	81% below	30%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$453.60	$648.00	$107.43–$1,612.00	1% below	30%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICULAR	$458.50	$655.00	$107.43–$1,612.00	at median	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US EXAM SCROTUM	$88.20	$126.00	$107.43–$1,612.00	—	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$453.60	$648.00	$107.43–$1,612.00	—	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICULAR	$458.50	$655.00	$107.43–$1,612.00	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK	$112.70	$161.00	$119.48–$1,039.00	75% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US THYROID/ST NECK	$614.60	$878.00	$119.48–$1,039.00	35% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US EXAM OF HEAD AND NECK	$112.70	$161.00	$119.48–$1,039.00	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US THYROID/ST NECK	$614.60	$878.00	$119.48–$1,039.00	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$140.00	$200.00	$40.00–$200.00	56% below	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI	$140.00	$200.00	$40.00–$200.00	56% below	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 X-RAY XM UPR GI TRC 1CNTRST	$140.00	$200.00	$40.00–$200.00	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI	$140.00	$200.00	$40.00–$200.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VENOUD LTD	$87.50	$125.00	$45.00–$3,039.00	84% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US PERIPHERAL VASCULAR ACCESS	$302.40	$432.00	$45.00–$3,039.00	45% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VENOUS LTD	$833.00	$1,190.00	$45.00–$3,039.00	52% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VEN LIMIT	$872.90	$1,247.00	$45.00–$3,039.00	59% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VENOUD LTD	$87.50	$125.00	$45.00–$3,039.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US PERIPHERAL VASCULAR ACCESS	$302.40	$432.00	$45.00–$3,039.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VENOUS LTD	$833.00	$1,190.00	$45.00–$3,039.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VEN LIMIT	$872.90	$1,247.00	$45.00–$3,039.00	—	30%
Wrist X-ray, complete, 3 or more views CPT 73110 WRIST 3V	$42.00	$60.00	$41.17–$590.00	81% below	30%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST	$42.00	$60.00	$41.17–$590.00	81% below	30%
Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY WRIST 3V	$371.00	$530.00	$41.17–$590.00	70% above	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY EXAM OF WRIST	$42.00	$60.00	$41.17–$590.00	—	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 WRIST 3V	$42.00	$60.00	$41.17–$590.00	—	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-RAY WRIST 3V	$371.00	$530.00	$41.17–$590.00	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS	$43.40	$62.00	$47.51–$1,264.00	84% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP UNI 2-3V	$43.40	$62.00	$47.51–$1,264.00	84% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR HIP UNI 2-3 VIEW	$351.40	$502.00	$47.51–$1,264.00	27% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 XR HIP 2V W PELVIS	$490.00	$700.00	$47.51–$1,264.00	77% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIP UNI 2-3V	$43.40	$62.00	$47.51–$1,264.00	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS	$43.40	$62.00	$47.51–$1,264.00	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XR HIP UNI 2-3 VIEW	$351.40	$502.00	$47.51–$1,264.00	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XR HIP 2V W PELVIS	$490.00	$700.00	$47.51–$1,264.00	—	30%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1V	$37.80	$54.00	$30.21–$495.00	82% below	30%
X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW	$37.80	$54.00	$30.21–$495.00	82% below	30%
X-ray of the abdomen, 1 view CPT 74018 X-RAY ABDOMEN 1V	$308.70	$441.00	$30.21–$495.00	47% above	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1V	$37.80	$54.00	$30.21–$495.00	—	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 RADEX ABDOMEN 1 VIEW	$37.80	$54.00	$30.21–$495.00	—	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-RAY ABDOMEN 1V	$308.70	$441.00	$30.21–$495.00	—	30%
X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE	$32.20	$46.00	$33.05–$499.00	80% below	30%
X-ray of the ankle, 2 views CPT 73600 ANKLE 1-2V	$32.20	$46.00	$33.05–$499.00	80% below	30%
X-ray of the ankle, 2 views CPT 73600 X-RAY ANKLE 1-2V	$317.10	$453.00	$33.05–$499.00	95% above	30%
X-ray of the ankle, 2 views inpatient CPT 73600 ANKLE 1-2V	$32.20	$46.00	$33.05–$499.00	—	30%
X-ray of the ankle, 2 views inpatient CPT 73600 X-RAY EXAM OF ANKLE	$32.20	$46.00	$33.05–$499.00	—	30%
X-ray of the ankle, 2 views inpatient CPT 73600 X-RAY ANKLE 1-2V	$317.10	$453.00	$33.05–$499.00	—	30%
X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S)	$27.30	$39.00	$38.01–$421.00	86% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 FINGER 3V	$27.30	$39.00	$38.01–$421.00	86% below	30%
X-ray of the finger(s), 2 or more views CPT 73140 X-RAY FINGER 3V	$267.40	$382.00	$38.01–$421.00	38% above	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-RAY EXAM OF FINGER(S)	$27.30	$39.00	$38.01–$421.00	—	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 FINGER 3V	$27.30	$39.00	$38.01–$421.00	—	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-RAY FINGER 3V	$267.40	$382.00	$38.01–$421.00	—	30%
X-ray of the foot, 2 views CPT 73620 FOOT 1-2V	$31.50	$45.00	$28.80–$547.00	81% below	30%
X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT	$31.50	$45.00	$28.80–$547.00	81% below	30%
X-ray of the foot, 2 views CPT 73620 X-RAY FOOT 1-2V	$351.40	$502.00	$28.80–$547.00	111% above	30%
X-ray of the foot, 2 views inpatient CPT 73620 X-RAY EXAM OF FOOT	$31.50	$45.00	$28.80–$547.00	—	30%
X-ray of the foot, 2 views inpatient CPT 73620 FOOT 1-2V	$31.50	$45.00	$28.80–$547.00	—	30%
X-ray of the foot, 2 views inpatient CPT 73620 X-RAY FOOT 1-2V	$351.40	$502.00	$28.80–$547.00	—	30%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT	$32.20	$46.00	$34.81–$576.00	85% below	30%
X-ray of the foot, complete, 3 or more views CPT 73630 FOOT 3V	$32.20	$46.00	$34.81–$576.00	85% below	30%
X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY FOOT 3V	$371.00	$530.00	$34.81–$576.00	78% above	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-RAY EXAM OF FOOT	$32.20	$46.00	$34.81–$576.00	—	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 FOOT 3V	$32.20	$46.00	$34.81–$576.00	—	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-RAY FOOT 3V	$371.00	$530.00	$34.81–$576.00	—	30%
X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND	$37.80	$54.00	$36.93–$565.00	82% below	30%
X-ray of the hand, 3 or more views CPT 73130 HAND 3V	$37.80	$54.00	$36.93–$565.00	82% below	30%
X-ray of the hand, 3 or more views CPT 73130 X-RAY HAND 3V	$357.70	$511.00	$36.93–$565.00	66% above	30%
X-ray of the hand, 3 or more views inpatient CPT 73130 X-RAY EXAM OF HAND	$37.80	$54.00	$36.93–$565.00	—	30%
X-ray of the hand, 3 or more views inpatient CPT 73130 HAND 3V	$37.80	$54.00	$36.93–$565.00	—	30%
X-ray of the hand, 3 or more views inpatient CPT 73130 X-RAY HAND 3V	$357.70	$511.00	$36.93–$565.00	—	30%
X-ray of the knee, 1 or 2 views CPT 73560 KNEE 1 OR 2V	$32.20	$46.00	$34.81–$900.00	83% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2	$32.20	$46.00	$34.81–$900.00	83% below	30%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY KNEE 1V	$246.40	$352.00	$34.81–$900.00	31% above	30%
X-ray of the knee, 1 or 2 views CPT 73560 X-RAY KNEE 2V	$351.40	$502.00	$34.81–$900.00	87% above	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 KNEE 1 OR 2V	$32.20	$46.00	$34.81–$900.00	—	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY EXAM OF KNEE 1 OR 2	$32.20	$46.00	$34.81–$900.00	—	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY KNEE 1V	$246.40	$352.00	$34.81–$900.00	—	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-RAY KNEE 2V	$351.40	$502.00	$34.81–$900.00	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$43.40	$62.00	$40.44–$608.00	83% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 L SPINE 2-3V	$43.40	$62.00	$40.44–$608.00	83% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY L SPINE 2-3V	$382.20	$546.00	$40.44–$608.00	45% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 L SPINE 2-3V	$43.40	$62.00	$40.44–$608.00	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS	$43.40	$62.00	$40.44–$608.00	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-RAY L SPINE 2-3V	$382.20	$546.00	$40.44–$608.00	—	30%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY L SPINE 4 +	$433.30	$619.00	$51.73–$1,478.00	27% above	30%
X-ray of the lower back, 4 or more views CPT 72110 X-RAY L SPINE 4V	$562.80	$804.00	$51.73–$1,478.00	64% above	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY L SPINE 4 +	$433.30	$619.00	$51.73–$1,478.00	—	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY L SPINE 4V	$562.80	$804.00	$51.73–$1,478.00	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 T SPINE 2V	$43.40	$62.00	$33.03–$505.00	82% below	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS	$43.40	$62.00	$33.03–$505.00	82% below	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY T SPINE 2V	$310.10	$443.00	$33.03–$505.00	26% above	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 T SPINE 2V	$43.40	$62.00	$33.03–$505.00	—	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-RAY EXAM THORAC SPINE 2VWS	$43.40	$62.00	$33.03–$505.00	—	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-RAY T SPINE 2V	$310.10	$443.00	$33.03–$505.00	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES	$36.40	$52.00	$38.70–$446.00	83% below	30%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONE	$36.40	$52.00	$38.70–$446.00	83% below	30%
X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY NASAL BONE	$275.80	$394.00	$38.70–$446.00	26% above	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONE	$36.40	$52.00	$38.70–$446.00	—	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-RAY EXAM OF NASAL BONES	$36.40	$52.00	$38.70–$446.00	—	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-RAY NASAL BONE	$275.80	$394.00	$38.70–$446.00	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 C SPINE 3V OR LESS	$43.40	$62.00	$40.09–$592.00	83% below	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$43.40	$62.00	$40.09–$592.00	83% below	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY C SPINE 3 VIEW OR LESS	$371.00	$530.00	$40.09–$592.00	49% above	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW	$43.40	$62.00	$40.09–$592.00	—	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 C SPINE 3V OR LESS	$43.40	$62.00	$40.09–$592.00	—	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-RAY C SPINE 3 VIEW OR LESS	$371.00	$530.00	$40.09–$592.00	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS	$37.80	$54.00	$28.09–$556.00	81% below	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1V	$37.80	$54.00	$28.09–$556.00	81% below	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY PELVIS 1V	$351.40	$502.00	$28.09–$556.00	76% above	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1V	$37.80	$54.00	$28.09–$556.00	—	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY EXAM OF PELVIS	$37.80	$54.00	$28.09–$556.00	—	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-RAY PELVIS 1V	$351.40	$502.00	$28.09–$556.00	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE	$37.80	$54.00	$32.69–$468.00	83% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACR/COCCYX	$37.80	$54.00	$32.69–$468.00	83% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY SACR/COCCYX	$289.80	$414.00	$32.69–$468.00	28% above	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-RAY EXAM SACRUM TAILBONE	$37.80	$54.00	$32.69–$468.00	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACR/COCCYX	$37.80	$54.00	$32.69–$468.00	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-RAY SACR/COCCYX	$289.80	$414.00	$32.69–$468.00	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 NIS SGPT	$26.60	$38.00	$30.60–$153.00	41% below	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT SEND OUT	$80.50	$115.00	$30.60–$153.00	78% above	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 NIS SGPT	$26.60	$38.00	$30.60–$153.00	—	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT SEND OUT	$80.50	$115.00	$30.60–$153.00	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 NIS SGOT	$26.60	$38.00	$62.00–$310.00	41% below	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST SEND OUT	$93.10	$133.00	$62.00–$310.00	108% above	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 CASH SGOT	$97.30	$139.00	$62.00–$310.00	117% above	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 NIS SGOT	$26.60	$38.00	$62.00–$310.00	—	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST SEND OUT	$93.10	$133.00	$62.00–$310.00	—	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 CASH SGOT	$97.30	$139.00	$62.00–$310.00	—	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANE	$506.80	$724.00	$144.80–$724.00	117% above	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANE	$506.80	$724.00	$144.80–$724.00	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN GRASS	$19.60	$28.00	$94.60–$473.00	29% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN TX & OK	$22.40	$32.00	$94.60–$473.00	47% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD IGE	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPECIFIC	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MI,MN,WI	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, TREE	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, MOLD	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MITE	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ADULT FOOD IGE SPECIFIC	$41.30	$59.00	$94.60–$473.00	172% above	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN GRASS	$19.60	$28.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN TX & OK	$22.40	$32.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, MOLD	$41.30	$59.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN FOOD IGE	$41.30	$59.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MI,MN,WI	$41.30	$59.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ADULT FOOD IGE SPECIFIC	$41.30	$59.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, TREE	$41.30	$59.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MITE	$41.30	$59.00	$94.60–$473.00	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPECIFIC	$41.30	$59.00	$94.60–$473.00	—	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEPTIDE	$140.70	$201.00	$40.20–$201.00	236% above	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITR PEPTIDE	$140.70	$201.00	$40.20–$201.00	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 LAB FANA	$112.70	$161.00	$67.00–$335.00	150% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 CENTROMERE AB	$121.80	$174.00	$67.00–$335.00	171% above	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 LAB FANA	$112.70	$161.00	$67.00–$335.00	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 CENTROMERE AB	$121.80	$174.00	$67.00–$335.00	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NIS BNP	$26.60	$38.00	$7.60–$38.00	80% below	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NIS BNP	$26.60	$38.00	$7.60–$38.00	—	30%
Basic metabolic panel (blood test) CPT 80048 NIS BASIC MET PANEL	$26.60	$38.00	$82.60–$413.00	70% below	30%
Basic metabolic panel (blood test) CPT 80048 CASH BMP	$262.50	$375.00	$82.60–$413.00	194% above	30%
Basic metabolic panel (blood test) inpatient CPT 80048 NIS BASIC MET PANEL	$26.60	$38.00	$82.60–$413.00	—	30%
Basic metabolic panel (blood test) inpatient CPT 80048 CASH BMP	$262.50	$375.00	$82.60–$413.00	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST	$85.40	$122.00	$71.66–$1,414.00	18% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV G&M	$85.40	$122.00	$71.66–$1,414.00	18% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LAB TISSUE LEVEL IV	$301.00	$430.00	$71.66–$1,414.00	188% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LAB BONE MARROW CORE	$301.70	$431.00	$71.66–$1,414.00	188% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LAB CELL BLOCK BF	$301.70	$431.00	$71.66–$1,414.00	188% above	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV G&M	$85.40	$122.00	$71.66–$1,414.00	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 TISSUE EXAM BY PATHOLOGIST	$85.40	$122.00	$71.66–$1,414.00	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LAB TISSUE LEVEL IV	$301.00	$430.00	$71.66–$1,414.00	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LAB CELL BLOCK BF	$301.70	$431.00	$71.66–$1,414.00	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LAB BONE MARROW CORE	$301.70	$431.00	$71.66–$1,414.00	—	30%
Blood culture for bacteria CPT 87040 NIS CULTURE BLOOD	$18.20	$26.00	$5.20–$26.00	83% below	30%
Blood culture for bacteria inpatient CPT 87040 NIS CULTURE BLOOD	$18.20	$26.00	$5.20–$26.00	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 LAB DRAW	$105.70	$151.00	$30.20–$151.00	408% above	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 LAB DRAW	$105.70	$151.00	$30.20–$151.00	—	30%
Blood glucose (sugar) test CPT 82947 NIS GLUCOSE	$26.60	$38.00	$63.60–$318.00	40% below	30%
Blood glucose (sugar) test CPT 82947 NIS GTT FAST	$26.60	$38.00	$63.60–$318.00	40% below	30%
Blood glucose (sugar) test CPT 82947 NIS CLINITEST	$26.60	$38.00	$63.60–$318.00	40% below	30%
Blood glucose (sugar) test CPT 82947 GLUCOSE SEND OUT	$69.30	$99.00	$63.60–$318.00	56% above	30%
Blood glucose (sugar) test CPT 82947 CASH GLUCOSE	$73.50	$105.00	$63.60–$318.00	66% above	30%
Blood glucose (sugar) test inpatient CPT 82947 NIS GTT FAST	$26.60	$38.00	$63.60–$318.00	—	30%
Blood glucose (sugar) test inpatient CPT 82947 NIS GLUCOSE	$26.60	$38.00	$63.60–$318.00	—	30%
Blood glucose (sugar) test inpatient CPT 82947 NIS CLINITEST	$26.60	$38.00	$63.60–$318.00	—	30%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE SEND OUT	$69.30	$99.00	$63.60–$318.00	—	30%
Blood glucose (sugar) test inpatient CPT 82947 CASH GLUCOSE	$73.50	$105.00	$63.60–$318.00	—	30%
Blood lead test CPT 83655 LAB LEAD LEVEL	$86.10	$123.00	$50.40–$252.00	176% above	30%
Blood lead test CPT 83655 HEAVY METALS LEAD	$90.30	$129.00	$50.40–$252.00	189% above	30%
Blood lead test inpatient CPT 83655 LAB LEAD LEVEL	$86.10	$123.00	$50.40–$252.00	—	30%
Blood lead test inpatient CPT 83655 HEAVY METALS LEAD	$90.30	$129.00	$50.40–$252.00	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 SERUM PREGNANCY QUAL	$73.50	$105.00	$21.00–$105.00	6% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 SERUM PREGNANCY QUAL	$73.50	$105.00	$21.00–$105.00	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 LAB BLOOD TYPE ABO F	$67.20	$96.00	$19.20–$96.00	27% above	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 LAB BLOOD TYPE ABO F	$67.20	$96.00	$19.20–$96.00	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 NIS CRP	$26.60	$38.00	$50.40–$252.00	51% below	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 LAB CRP	$59.50	$85.00	$50.40–$252.00	9% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP INFLAMMATION	$90.30	$129.00	$50.40–$252.00	66% above	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 NIS CRP	$26.60	$38.00	$50.40–$252.00	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 LAB CRP	$59.50	$85.00	$50.40–$252.00	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP INFLAMMATION	$90.30	$129.00	$50.40–$252.00	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF TOX AMP PROBE	$184.10	$263.00	$52.60–$263.00	39% above	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFF TOX AMP PROBE	$184.10	$263.00	$52.60–$263.00	—	30%
CA 19-9 blood test (tumor marker) CPT 86301 LAB CA 19.9	$163.10	$233.00	$46.60–$233.00	61% above	30%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 LAB CA 19.9	$163.10	$233.00	$46.60–$233.00	—	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 LAB CA 125	$190.40	$272.00	$54.40–$272.00	87% above	30%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 LAB CA 125	$190.40	$272.00	$54.40–$272.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19	$63.70	$91.00	$52.23–$837.00	47% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$63.70	$91.00	$52.23–$837.00	47% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID19 (ABBOTT)	$93.80	$134.00	$52.23–$837.00	22% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID 19 ABBOTT	$93.80	$134.00	$52.23–$837.00	22% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID BY PCR	$98.70	$141.00	$52.23–$837.00	18% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 XPERT COVID	$98.70	$141.00	$52.23–$837.00	18% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID PCR MHEALTH	$137.20	$196.00	$52.23–$837.00	14% above	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$63.70	$91.00	$52.23–$837.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19	$63.70	$91.00	$52.23–$837.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID 19 ABBOTT	$93.80	$134.00	$52.23–$837.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID19 (ABBOTT)	$93.80	$134.00	$52.23–$837.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 XPERT COVID	$98.70	$141.00	$52.23–$837.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID BY PCR	$98.70	$141.00	$52.23–$837.00	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID PCR MHEALTH	$137.20	$196.00	$52.23–$837.00	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 LAB CHLAMYDIA/AMPLIF	$59.50	$85.00	$85.00–$425.00	37% below	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 XPERT CHLAMYDIA	$119.00	$170.00	$85.00–$425.00	27% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 XPERT GONORRHEA	$119.00	$170.00	$85.00–$425.00	27% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 LAB CHLAMYDIA/AMPLIF	$59.50	$85.00	$85.00–$425.00	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 XPERT GONORRHEA	$119.00	$170.00	$85.00–$425.00	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 XPERT CHLAMYDIA	$119.00	$170.00	$85.00–$425.00	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 NIS LIPID PANEL	$26.60	$38.00	$60.40–$302.00	71% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 CASH LIPID	$184.80	$264.00	$60.40–$302.00	100% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 NIS LIPID PANEL	$26.60	$38.00	$60.40–$302.00	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 CASH LIPID	$184.80	$264.00	$60.40–$302.00	—	30%
Complete blood count (CBC) with differential CPT 85025 NIS CBC AUTO DIFF	$18.20	$26.00	$58.00–$290.00	78% below	30%
Complete blood count (CBC) with differential CPT 85025 CASH CBC	$184.80	$264.00	$58.00–$290.00	122% above	30%
Complete blood count (CBC) with differential inpatient CPT 85025 NIS CBC AUTO DIFF	$18.20	$26.00	$58.00–$290.00	—	30%
Complete blood count (CBC) with differential inpatient CPT 85025 CASH CBC	$184.80	$264.00	$58.00–$290.00	—	30%
Complete blood count (CBC), no differential CPT 85027 NIS HEMOGRAM	$18.20	$26.00	$30.60–$153.00	72% below	30%
Complete blood count (CBC), no differential CPT 85027 LAB HEMOGRAM	$88.90	$127.00	$30.60–$153.00	36% above	30%
Complete blood count (CBC), no differential inpatient CPT 85027 NIS HEMOGRAM	$18.20	$26.00	$30.60–$153.00	—	30%
Complete blood count (CBC), no differential inpatient CPT 85027 LAB HEMOGRAM	$88.90	$127.00	$30.60–$153.00	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 NIS CHEM 14 PANEL	$26.60	$38.00	$7.60–$38.00	72% below	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 NIS CHEM 14 PANEL	$26.60	$38.00	$7.60–$38.00	—	30%
D-dimer blood test (blood clot marker) CPT 85379 NIS D DIMER	$18.20	$26.00	$5.20–$26.00	82% below	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 NIS D DIMER	$18.20	$26.00	$5.20–$26.00	—	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 CL DHEA-S	$172.90	$247.00	$49.40–$247.00	199% above	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 CL DHEA-S	$172.90	$247.00	$49.40–$247.00	—	30%
Estradiol blood test CPT 82670 ESTRADIOL FREE	$169.40	$242.00	$145.20–$726.00	156% above	30%
Estradiol blood test CPT 82670 CL ESTRADIOL	$169.40	$242.00	$145.20–$726.00	156% above	30%
Estradiol blood test CPT 82670 ESTRADIOL LC/MS/MS	$169.40	$242.00	$145.20–$726.00	156% above	30%
Estradiol blood test inpatient CPT 82670 ESTRADIOL LC/MS/MS	$169.40	$242.00	$145.20–$726.00	—	30%
Estradiol blood test inpatient CPT 82670 CL ESTRADIOL	$169.40	$242.00	$145.20–$726.00	—	30%
Estradiol blood test inpatient CPT 82670 ESTRADIOL FREE	$169.40	$242.00	$145.20–$726.00	—	30%
FSH (follicle-stimulating hormone) test CPT 83001 LAB FSH	$139.30	$199.00	$39.80–$199.00	97% above	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 LAB FSH	$139.30	$199.00	$39.80–$199.00	—	30%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, STOOL	$364.00	$520.00	$104.00–$520.00	333% above	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, STOOL	$364.00	$520.00	$104.00–$520.00	—	30%
Ferritin blood test (iron stores) CPT 82728 NIS FERRITIN	$26.60	$38.00	$7.60–$38.00	70% below	30%
Ferritin blood test (iron stores) inpatient CPT 82728 NIS FERRITIN	$26.60	$38.00	$7.60–$38.00	—	30%
Folate (folic acid) blood test CPT 82746 NIS FOLATE	$26.60	$38.00	$48.00–$240.00	67% below	30%
Folate (folic acid) blood test CPT 82746 FOLATE SERUM	$141.40	$202.00	$48.00–$240.00	77% above	30%
Folate (folic acid) blood test inpatient CPT 82746 NIS FOLATE	$26.60	$38.00	$48.00–$240.00	—	30%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE SERUM	$141.40	$202.00	$48.00–$240.00	—	30%
Free T3 thyroid hormone test CPT 84481 NIS FREE T3	$26.60	$38.00	$7.60–$38.00	74% below	30%
Free T3 thyroid hormone test inpatient CPT 84481 NIS FREE T3	$26.60	$38.00	$7.60–$38.00	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 NIS FREE T4	$26.60	$38.00	$7.60–$38.00	61% below	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 NIS FREE T4	$26.60	$38.00	$7.60–$38.00	—	30%
Free testosterone test CPT 84402 TESTOSTERONE-FREE	$137.90	$197.00	$39.40–$197.00	121% above	30%
Free testosterone test inpatient CPT 84402 TESTOSTERONE-FREE	$137.90	$197.00	$39.40–$197.00	—	30%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GEN HEALTH PANEL	$575.40	$822.00	$164.40–$822.00	132% above	30%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GEN HEALTH PANEL	$575.40	$822.00	$164.40–$822.00	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 NIS GTT 1ST HOUR	$26.60	$38.00	$15.20–$76.00	37% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 NIS GLUC/C GLU	$26.60	$38.00	$15.20–$76.00	37% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 NIS GLUC/C GLU	$26.60	$38.00	$15.20–$76.00	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 NIS GTT 1ST HOUR	$26.60	$38.00	$15.20–$76.00	—	30%
Glucose tolerance test, 3 samples CPT 82951 NIS GTT 2ND HOUR	$26.60	$38.00	$15.20–$76.00	72% below	30%
Glucose tolerance test, 3 samples CPT 82951 NIS 3 HR GLUCOSE TOL	$26.60	$38.00	$15.20–$76.00	72% below	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 NIS GTT 2ND HOUR	$26.60	$38.00	$15.20–$76.00	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 NIS 3 HR GLUCOSE TOL	$26.60	$38.00	$15.20–$76.00	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 LAB GC/AMPLIFIED DNA	$59.50	$85.00	$17.00–$85.00	30% below	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 LAB GC/AMPLIFIED DNA	$59.50	$85.00	$17.00–$85.00	—	30%
H. pylori antibody blood test CPT 86677 LAB H PYLORI ABY-IgG	$38.50	$55.00	$74.20–$371.00	67% below	30%
H. pylori antibody blood test CPT 86677 LAB H PYLORI ABY-IgM	$38.50	$55.00	$74.20–$371.00	67% below	30%
H. pylori antibody blood test CPT 86677 LAB HPYLORI ABY IgA	$38.50	$55.00	$74.20–$371.00	67% below	30%
H. pylori antibody blood test CPT 86677 H PYLORI IGM	$144.20	$206.00	$74.20–$371.00	23% above	30%
H. pylori antibody blood test inpatient CPT 86677 LAB H PYLORI ABY-IgM	$38.50	$55.00	$74.20–$371.00	—	30%
H. pylori antibody blood test inpatient CPT 86677 LAB H PYLORI ABY-IgG	$38.50	$55.00	$74.20–$371.00	—	30%
H. pylori antibody blood test inpatient CPT 86677 LAB HPYLORI ABY IgA	$38.50	$55.00	$74.20–$371.00	—	30%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGM	$144.20	$206.00	$74.20–$371.00	—	30%
H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL	$80.50	$115.00	$23.00–$115.00	26% below	30%
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG STOOL	$80.50	$115.00	$23.00–$115.00	—	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA QN PCR<400	$469.70	$671.00	$268.40–$1,342.00	309% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 ULTRA RNA QN PCR <50	$469.70	$671.00	$268.40–$1,342.00	309% above	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 ULTRA RNA QN PCR <50	$469.70	$671.00	$268.40–$1,342.00	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA QN PCR<400	$469.70	$671.00	$268.40–$1,342.00	—	30%
HIV-1 and HIV-2 antibody test CPT 86703 LAB HIV	$67.20	$96.00	$19.20–$96.00	1% above	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 LAB HIV	$67.20	$96.00	$19.20–$96.00	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV	$116.20	$166.00	$33.20–$166.00	84% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV	$116.20	$166.00	$33.20–$166.00	—	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 LAB HPV SCREEN	$116.20	$166.00	$33.20–$166.00	10% below	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 LAB HPV SCREEN	$116.20	$166.00	$33.20–$166.00	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 NIS GLYCOSULATED HBA	$18.20	$26.00	$78.80–$394.00	68% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 NIS HGB A1C	$26.60	$38.00	$78.80–$394.00	54% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HBA1C	$115.50	$165.00	$78.80–$394.00	100% above	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 CASH HGB A1C	$115.50	$165.00	$78.80–$394.00	100% above	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 NIS GLYCOSULATED HBA	$18.20	$26.00	$78.80–$394.00	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 NIS HGB A1C	$26.60	$38.00	$78.80–$394.00	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HBA1C	$115.50	$165.00	$78.80–$394.00	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 CASH HGB A1C	$115.50	$165.00	$78.80–$394.00	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 LAB HEPBS ABY	$120.40	$172.00	$34.40–$172.00	83% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 LAB HEPBS ABY	$120.40	$172.00	$34.40–$172.00	—	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 LAB HepBSAG	$116.20	$166.00	$33.20–$166.00	118% above	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 LAB HepBSAG	$116.20	$166.00	$33.20–$166.00	—	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 LAB HEP C QUANT PCR	$416.50	$595.00	$119.00–$595.00	236% above	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 LAB HEP C QUANT PCR	$416.50	$595.00	$119.00–$595.00	—	30%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX VIRUS	$93.10	$133.00	$26.60–$133.00	101% above	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX VIRUS	$93.10	$133.00	$26.60–$133.00	—	30%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX VIRUS	$107.10	$153.00	$30.60–$153.00	86% above	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SIMPLEX VIRUS	$107.10	$153.00	$30.60–$153.00	—	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 LAB CRP-CARDIO	$120.40	$172.00	$34.40–$172.00	70% above	30%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 LAB CRP-CARDIO	$120.40	$172.00	$34.40–$172.00	—	30%
Homocysteine blood test CPT 83090 LAB HOMOCYSTEINE-NUT	$185.50	$265.00	$106.00–$530.00	107% above	30%
Homocysteine blood test CPT 83090 LAB HOMOCYSTEINE-CAR	$185.50	$265.00	$106.00–$530.00	107% above	30%
Homocysteine blood test inpatient CPT 83090 LAB HOMOCYSTEINE-CAR	$185.50	$265.00	$106.00–$530.00	—	30%
Homocysteine blood test inpatient CPT 83090 LAB HOMOCYSTEINE-NUT	$185.50	$265.00	$106.00–$530.00	—	30%
Insulin blood test CPT 83525 LAB INSULIN, SERUM	$104.30	$149.00	$29.80–$149.00	90% above	30%
Insulin blood test inpatient CPT 83525 LAB INSULIN, SERUM	$104.30	$149.00	$29.80–$149.00	—	30%
Iron blood test (serum iron) CPT 83540 NIS SERUM FE	$26.60	$38.00	$7.60–$38.00	48% below	30%
Iron blood test (serum iron) inpatient CPT 83540 NIS SERUM FE	$26.60	$38.00	$7.60–$38.00	—	30%
Iron-binding capacity (TIBC) test CPT 83550 NIS TIBC	$26.60	$38.00	$7.60–$38.00	59% below	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 NIS TIBC	$26.60	$38.00	$7.60–$38.00	—	30%
Kidney function blood test panel CPT 80069 NIS RENAL PROFILE	$26.60	$38.00	$7.60–$38.00	75% below	30%
Kidney function blood test panel inpatient CPT 80069 NIS RENAL PROFILE	$26.60	$38.00	$7.60–$38.00	—	30%
LH (luteinizing hormone) test CPT 83002 LAB LUTENIZING HORMO	$139.30	$199.00	$39.80–$199.00	71% above	30%
LH (luteinizing hormone) test inpatient CPT 83002 LAB LUTENIZING HORMO	$139.30	$199.00	$39.80–$199.00	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 NIS LIPASE	$26.60	$38.00	$7.60–$38.00	55% below	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 NIS LIPASE	$26.60	$38.00	$7.60–$38.00	—	30%
Liver function blood test panel CPT 80076 CASH LIVER PANEL	$21.00	$30.00	$13.60–$68.00	79% below	30%
Liver function blood test panel CPT 80076 NIS LIVER PROFILE	$26.60	$38.00	$13.60–$68.00	74% below	30%
Liver function blood test panel inpatient CPT 80076 CASH LIVER PANEL	$21.00	$30.00	$13.60–$68.00	—	30%
Liver function blood test panel inpatient CPT 80076 NIS LIVER PROFILE	$26.60	$38.00	$13.60–$68.00	—	30%
Lyme disease antibody test CPT 86618 NIS LYME TITER	$26.60	$38.00	$54.00–$270.00	59% below	30%
Lyme disease antibody test CPT 86618 LYME SCREEN IGG	$81.20	$116.00	$54.00–$270.00	26% above	30%
Lyme disease antibody test CPT 86618 LAB LYME TITER	$81.20	$116.00	$54.00–$270.00	26% above	30%
Lyme disease antibody test inpatient CPT 86618 NIS LYME TITER	$26.60	$38.00	$54.00–$270.00	—	30%
Lyme disease antibody test inpatient CPT 86618 LAB LYME TITER	$81.20	$116.00	$54.00–$270.00	—	30%
Lyme disease antibody test inpatient CPT 86618 LYME SCREEN IGG	$81.20	$116.00	$54.00–$270.00	—	30%
Magnesium blood test CPT 83735 NIS MAGNESIUM	$26.60	$38.00	$45.80–$229.00	15% below	30%
Magnesium blood test CPT 83735 URINE MAGNESIUM RANDOM	$41.30	$59.00	$45.80–$229.00	32% above	30%
Magnesium blood test CPT 83735 STONE FORMER PANEL URINE MAGNESIUM	$92.40	$132.00	$45.80–$229.00	196% above	30%
Magnesium blood test inpatient CPT 83735 NIS MAGNESIUM	$26.60	$38.00	$45.80–$229.00	—	30%
Magnesium blood test inpatient CPT 83735 URINE MAGNESIUM RANDOM	$41.30	$59.00	$45.80–$229.00	—	30%
Magnesium blood test inpatient CPT 83735 STONE FORMER PANEL URINE MAGNESIUM	$92.40	$132.00	$45.80–$229.00	—	30%
Measles (rubeola) antibody test CPT 86765 RUBEOLA ABY IGM	$30.80	$44.00	$37.00–$185.00	16% below	30%
Measles (rubeola) antibody test CPT 86765 CL ANTIBODY RUBEOLA	$98.70	$141.00	$37.00–$185.00	170% above	30%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA ABY IGM	$30.80	$44.00	$37.00–$185.00	—	30%
Measles (rubeola) antibody test inpatient CPT 86765 CL ANTIBODY RUBEOLA	$98.70	$141.00	$37.00–$185.00	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 NIS MONO TEST	$26.60	$38.00	$69.00–$345.00	48% below	30%
Mono test (heterophile antibody, Monospot) CPT 86308 LAB HETEROPHIL	$37.10	$53.00	$69.00–$345.00	28% below	30%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO TEST	$84.00	$120.00	$69.00–$345.00	64% above	30%
Mono test (heterophile antibody, Monospot) CPT 86308 LAB MONO TEST	$93.80	$134.00	$69.00–$345.00	83% above	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 NIS MONO TEST	$26.60	$38.00	$69.00–$345.00	—	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 LAB HETEROPHIL	$37.10	$53.00	$69.00–$345.00	—	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO TEST	$84.00	$120.00	$69.00–$345.00	—	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 LAB MONO TEST	$93.80	$134.00	$69.00–$345.00	—	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$40.60	$58.00	$11.60–$58.00	13% above	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$40.60	$58.00	$11.60–$58.00	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 NIS PSA DIAGNOSTIC	$26.60	$38.00	$92.00–$460.00	67% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 NIS PSA TOTAL	$26.60	$38.00	$92.00–$460.00	67% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 CASH PSA	$134.40	$192.00	$92.00–$460.00	66% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL	$134.40	$192.00	$92.00–$460.00	66% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 NIS PSA DIAGNOSTIC	$26.60	$38.00	$92.00–$460.00	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 NIS PSA TOTAL	$26.60	$38.00	$92.00–$460.00	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA TOTAL	$134.40	$192.00	$92.00–$460.00	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CASH PSA	$134.40	$192.00	$92.00–$460.00	—	30%
Pap test (liquid-based, automated screening with review) CPT 88175 THIN LAYER IMAGED DIAGNOSIC	$85.40	$122.00	$24.40–$122.00	at median	30%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THIN LAYER IMAGED DIAGNOSIC	$85.40	$122.00	$24.40–$122.00	—	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 LAB THIN PREP PAP DI	$121.80	$174.00	$34.80–$174.00	58% above	30%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 LAB THIN PREP PAP DI	$121.80	$174.00	$34.80–$174.00	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 LAB PTH	$280.70	$401.00	$80.20–$401.00	139% above	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 LAB PTH	$280.70	$401.00	$80.20–$401.00	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 NIS PTT	$18.20	$26.00	$21.60–$108.00	69% below	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT SEND OUT	$57.40	$82.00	$21.60–$108.00	2% below	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 NIS PTT	$18.20	$26.00	$21.60–$108.00	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT SEND OUT	$57.40	$82.00	$21.60–$108.00	—	30%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 QNATAL ADVANCED	$2,357.60	$3,368.00	$673.60–$3,368.00	71% above	30%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 QNATAL ADVANCED	$2,357.60	$3,368.00	$673.60–$3,368.00	—	30%
Prolactin blood test CPT 84146 LAB PROLACTIN	$189.70	$271.00	$54.20–$271.00	191% above	30%
Prolactin blood test inpatient CPT 84146 LAB PROLACTIN	$189.70	$271.00	$54.20–$271.00	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 NIS PROTIME	$18.20	$26.00	$67.20–$336.00	40% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/INR METER	$69.30	$99.00	$67.20–$336.00	129% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 CASH PROTIME	$80.50	$115.00	$67.20–$336.00	166% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 NIS PROTIME	$18.20	$26.00	$67.20–$336.00	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT/INR METER	$69.30	$99.00	$67.20–$336.00	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 CASH PROTIME	$80.50	$115.00	$67.20–$336.00	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 LAB RDS/COCAINE	$30.80	$44.00	$76.00–$380.00	47% below	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 RAPID DRUG CUP	$235.20	$336.00	$76.00–$380.00	303% above	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 LAB RDS/COCAINE	$30.80	$44.00	$76.00–$380.00	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 RAPID DRUG CUP	$235.20	$336.00	$76.00–$380.00	—	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA VIRUS	$66.50	$95.00	$152.20–$761.00	19% above	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA B VIRUS	$111.30	$159.00	$152.20–$761.00	99% above	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A VIRUS	$111.30	$159.00	$152.20–$761.00	99% above	30%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A/B	$121.80	$174.00	$152.20–$761.00	118% above	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA VIRUS	$66.50	$95.00	$152.20–$761.00	—	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA B VIRUS	$111.30	$159.00	$152.20–$761.00	—	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A VIRUS	$111.30	$159.00	$152.20–$761.00	—	30%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A/B	$121.80	$174.00	$152.20–$761.00	—	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 NIS STREP SCRN RAPID	$18.20	$26.00	$49.80–$249.00	66% below	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP SCREEN RAPID	$59.50	$85.00	$49.80–$249.00	11% above	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 LAB STREP SCREEN RAP	$96.60	$138.00	$49.80–$249.00	81% above	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 NIS STREP SCRN RAPID	$18.20	$26.00	$49.80–$249.00	—	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP SCREEN RAPID	$59.50	$85.00	$49.80–$249.00	—	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 LAB STREP SCREEN RAP	$96.60	$138.00	$49.80–$249.00	—	30%
Rheumatoid factor (RF) test CPT 86431 RA, BODY FLUID	$116.20	$166.00	$33.20–$166.00	140% above	30%
Rheumatoid factor (RF) test inpatient CPT 86431 RA, BODY FLUID	$116.20	$166.00	$33.20–$166.00	—	30%
Rubella antibody test (immunity check) CPT 86762 TORCH IGG RUBELLA	$23.80	$34.00	$52.20–$261.00	50% below	30%
Rubella antibody test (immunity check) CPT 86762 NIS RUBELLA	$26.60	$38.00	$52.20–$261.00	44% below	30%
Rubella antibody test (immunity check) CPT 86762 TORCH ABY IGM RUBELLA	$32.20	$46.00	$52.20–$261.00	32% below	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IMMUNE TITER	$100.10	$143.00	$52.20–$261.00	112% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 TORCH IGG RUBELLA	$23.80	$34.00	$52.20–$261.00	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 NIS RUBELLA	$26.60	$38.00	$52.20–$261.00	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 TORCH ABY IGM RUBELLA	$32.20	$46.00	$52.20–$261.00	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IMMUNE TITER	$100.10	$143.00	$52.20–$261.00	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 NIS SED RATE	$18.20	$26.00	$5.20–$26.00	52% below	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 NIS SED RATE	$18.20	$26.00	$5.20–$26.00	—	30%
Stool ova and parasites exam CPT 87177 OVA & PARA CONCEN	$104.30	$149.00	$29.80–$149.00	196% above	30%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARA CONCEN	$104.30	$149.00	$29.80–$149.00	—	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD TRI	$70.70	$101.00	$20.20–$101.00	100% above	30%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD TRI	$70.70	$101.00	$20.20–$101.00	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 NIS FECAL OCCULT BLD	$26.60	$38.00	$7.60–$38.00	54% below	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 NIS FECAL OCCULT BLD	$26.60	$38.00	$7.60–$38.00	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 NIS RPR	$26.60	$38.00	$36.80–$184.00	10% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR QL W/REFLEX REF	$39.20	$56.00	$36.80–$184.00	32% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 LAB VDRL-CSF	$63.00	$90.00	$36.80–$184.00	113% above	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 NIS RPR	$26.60	$38.00	$36.80–$184.00	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR QL W/REFLEX REF	$39.20	$56.00	$36.80–$184.00	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 LAB VDRL-CSF	$63.00	$90.00	$36.80–$184.00	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON	$98.00	$140.00	$28.00–$140.00	21% below	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON	$98.00	$140.00	$28.00–$140.00	—	30%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE WOMEN &	$58.80	$84.00	$71.40–$357.00	6% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 LAB TESTOSTERONE TOT	$191.10	$273.00	$71.40–$357.00	205% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE WOMEN &	$58.80	$84.00	$71.40–$357.00	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 LAB TESTOSTERONE TOT	$191.10	$273.00	$71.40–$357.00	—	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 LAB THYROID PEROXIDA	$116.20	$166.00	$66.40–$332.00	120% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER CYTOSOLIC AG	$116.20	$166.00	$66.40–$332.00	120% above	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LAB THYROID PEROXIDA	$116.20	$166.00	$66.40–$332.00	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER CYTOSOLIC AG	$116.20	$166.00	$66.40–$332.00	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 NIS TSH	$26.60	$38.00	$106.60–$533.00	72% below	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 LAB PKU-TSH	$167.30	$239.00	$106.60–$533.00	79% above	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 CASH TSH	$179.20	$256.00	$106.60–$533.00	91% above	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 NIS TSH	$26.60	$38.00	$106.60–$533.00	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 LAB PKU-TSH	$167.30	$239.00	$106.60–$533.00	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 CASH TSH	$179.20	$256.00	$106.60–$533.00	—	30%
Uric acid blood test CPT 84550 NIS URIC ACID	$26.60	$38.00	$7.60–$38.00	39% below	30%
Uric acid blood test inpatient CPT 84550 NIS URIC ACID	$26.60	$38.00	$7.60–$38.00	—	30%
Urinalysis with microscope exam, automated CPT 81001 NIS URINALYSIS	$26.60	$38.00	$58.80–$294.00	46% below	30%
Urinalysis with microscope exam, automated CPT 81001 ISLE URINALYSIS	$84.00	$120.00	$58.80–$294.00	69% above	30%
Urinalysis with microscope exam, automated CPT 81001 LAB URINALYSIS	$95.20	$136.00	$58.80–$294.00	92% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 NIS URINALYSIS	$26.60	$38.00	$58.80–$294.00	—	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 ISLE URINALYSIS	$84.00	$120.00	$58.80–$294.00	—	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 LAB URINALYSIS	$95.20	$136.00	$58.80–$294.00	—	30%
Urinalysis without microscope exam, automated CPT 81003 NIS UA W/O MICRO	$26.60	$38.00	$18.20–$91.00	4% above	30%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITYFUMC	$37.10	$53.00	$18.20–$91.00	45% above	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 NIS UA W/O MICRO	$26.60	$38.00	$18.20–$91.00	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITYFUMC	$37.10	$53.00	$18.20–$91.00	—	30%
Urinalysis without microscope exam, manual CPT 81002 NIS ICTOTEST	$26.60	$38.00	$19.40–$97.00	20% above	30%
Urinalysis without microscope exam, manual CPT 81002 UA DIP MANUAL	$41.30	$59.00	$19.40–$97.00	86% above	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 NIS ICTOTEST	$26.60	$38.00	$19.40–$97.00	—	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA DIP MANUAL	$41.30	$59.00	$19.40–$97.00	—	30%
Urine culture for bacteria, with colony count CPT 87086 NIS CULTURE URINE	$18.20	$26.00	$39.00–$195.00	67% below	30%
Urine culture for bacteria, with colony count CPT 87086 LAB CULTURE-URINE	$118.30	$169.00	$39.00–$195.00	115% above	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 NIS CULTURE URINE	$18.20	$26.00	$39.00–$195.00	—	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 LAB CULTURE-URINE	$118.30	$169.00	$39.00–$195.00	—	30%
Urine pregnancy test, read by color change CPT 81025 CASH PREGNANCY TEST	$23.10	$33.00	$32.40–$162.00	41% below	30%
Urine pregnancy test, read by color change CPT 81025 NIS PREGNANCY TEST	$26.60	$38.00	$32.40–$162.00	32% below	30%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST	$63.70	$91.00	$32.40–$162.00	64% above	30%
Urine pregnancy test, read by color change inpatient CPT 81025 CASH PREGNANCY TEST	$23.10	$33.00	$32.40–$162.00	—	30%
Urine pregnancy test, read by color change inpatient CPT 81025 NIS PREGNANCY TEST	$26.60	$38.00	$32.40–$162.00	—	30%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST	$63.70	$91.00	$32.40–$162.00	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 NIS B12	$26.60	$38.00	$7.60–$38.00	70% below	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 NIS B12	$26.60	$38.00	$7.60–$38.00	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL	$202.30	$289.00	$116.00–$580.00	108% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CASH VITAMIN D	$203.70	$291.00	$116.00–$580.00	110% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL	$202.30	$289.00	$116.00–$580.00	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CASH VITAMIN D	$203.70	$291.00	$116.00–$580.00	—	30%
Zinc blood test CPT 84630 LAB ZINC	$96.60	$138.00	$27.60–$138.00	221% above	30%
Zinc blood test inpatient CPT 84630 LAB ZINC	$96.60	$138.00	$27.60–$138.00	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG TUMOR MARKER	$198.80	$284.00	$113.60–$568.00	115% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 LAB HCG-MAT SCREEN	$198.80	$284.00	$113.60–$568.00	115% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG TUMOR MARKER	$198.80	$284.00	$113.60–$568.00	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 LAB HCG-MAT SCREEN	$198.80	$284.00	$113.60–$568.00	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Botox injections for chronic migraine CPT 64615 CHEMODENERV MUSC MIG	$267.40	$382.00	$76.40–$382.00	56% below	30%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODENERV MUSC MIG	$267.40	$382.00	$76.40–$382.00	—	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MAMMO BREAST NDL COR	$386.40	$552.00	$110.40–$552.00	77% below	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 MAMMO BREAST NDL COR	$386.40	$552.00	$110.40–$552.00	—	30%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY	$1,187.20	$1,696.00	$200.14–$1,696.00	2% below	30%
Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,187.20	$1,696.00	$200.14–$1,696.00	2% below	30%
Colonoscopy, diagnostic inpatient CPT 45378 DIAGNOSTIC COLONOSCOPY	$1,187.20	$1,696.00	$200.14–$1,696.00	—	30%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY	$1,187.20	$1,696.00	$200.14–$1,696.00	—	30%
Cystoscopy with ureteral stent placement CPT 52332 CYSTO WITH INDWELLING URETRAL STENT	$1,288.00	$1,840.00	$368.00–$1,840.00	62% below	30%
Cystoscopy with ureteral stent placement inpatient CPT 52332 CYSTO WITH INDWELLING URETRAL STENT	$1,288.00	$1,840.00	$368.00–$1,840.00	—	30%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$368.20	$526.00	$105.20–$526.00	51% below	30%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOSCOPY	$368.20	$526.00	$105.20–$526.00	51% below	30%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOSCOPY	$368.20	$526.00	$105.20–$526.00	—	30%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY	$368.20	$526.00	$105.20–$526.00	—	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALG LESION	$97.30	$139.00	$27.80–$139.00	46% below	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DEST PREMALG LESION	$97.30	$139.00	$27.80–$139.00	46% below	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DEST PREMALG LESION	$97.30	$139.00	$27.80–$139.00	—	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALG LESION	$97.30	$139.00	$27.80–$139.00	—	30%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 TYMPANOSTOMY LOCAL OR TOPICAL ANESTH	$683.20	$976.00	$195.20–$976.00	60% above	30%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 TYMPANOSTOMY LOCAL OR TOPICAL ANESTH	$683.20	$976.00	$195.20–$976.00	—	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EAR WAX UNI	$40.60	$58.00	$11.60–$58.00	48% below	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMV IMPACT EAR UNIL	$40.60	$58.00	$11.60–$58.00	48% below	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EAR WAX UNI	$40.60	$58.00	$11.60–$58.00	—	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMV IMPACT EAR UNIL	$40.60	$58.00	$11.60–$58.00	—	30%
Earwax removal with instruments, one ear CPT 69210 RMVL IMPACTD CERUMEN	$122.50	$175.00	$35.00–$175.00	1% below	30%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI	$122.50	$175.00	$35.00–$175.00	1% below	30%
Earwax removal with instruments, one ear inpatient CPT 69210 RMVL IMPACTD CERUMEN	$122.50	$175.00	$35.00–$175.00	—	30%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX UNI	$122.50	$175.00	$35.00–$175.00	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAM CRV/THR	$469.70	$671.00	$869.40–$4,347.00	53% below	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 XR EPIDURAL SPINE	$2,573.20	$3,676.00	$869.40–$4,347.00	160% above	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 NJX INTERLAM CRV/THR	$469.70	$671.00	$869.40–$4,347.00	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 XR EPIDURAL SPINE	$2,573.20	$3,676.00	$869.40–$4,347.00	—	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARA F JNT L/S 1	$315.00	$450.00	$90.00–$450.00	77% below	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$315.00	$450.00	$90.00–$450.00	77% below	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARA F JNT L/S 1	$315.00	$450.00	$90.00–$450.00	—	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$315.00	$450.00	$90.00–$450.00	—	30%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 PRR AA HRN 3-10 RDC	$1,603.00	$2,290.00	$458.00–$2,290.00	3% above	30%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 PRR AA HRN 3-10 RDC	$1,603.00	$2,290.00	$458.00–$2,290.00	—	30%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN <3 CM	$961.80	$1,374.00	$274.80–$1,374.00	37% below	30%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 RPR AA HRN <3 CM	$961.80	$1,374.00	$274.80–$1,374.00	—	30%
Hammertoe correction surgery CPT 28285 CORRECTION HAMMERTOE	$1,113.70	$1,591.00	$318.20–$1,591.00	53% below	30%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION HAMMERTOE	$1,113.70	$1,591.00	$318.20–$1,591.00	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 XRAY CATH & SALINE I	$491.40	$702.00	$140.40–$702.00	62% above	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 XRAY CATH & SALINE I	$491.40	$702.00	$140.40–$702.00	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$180.60	$258.00	$51.60–$258.00	37% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 DRN SKIN ABSCESS SIM	$180.60	$258.00	$51.60–$258.00	37% below	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSCESS SIMPLE/SINGLE	$180.60	$258.00	$51.60–$258.00	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRN SKIN ABSCESS SIM	$180.60	$258.00	$51.60–$258.00	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJECT MAJOR JOINT	$245.70	$351.00	$183.40–$917.00	32% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$245.70	$351.00	$183.40–$917.00	32% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ ASP MAJOR JT	$396.20	$566.00	$183.40–$917.00	9% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJECT MAJOR JOINT	$245.70	$351.00	$183.40–$917.00	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ JOINT/BURSA W/O US	$245.70	$351.00	$183.40–$917.00	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ ASP MAJOR JT	$396.20	$566.00	$183.40–$917.00	—	30%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG IMPLANT DEVICE	$200.20	$286.00	$57.20–$286.00	27% below	30%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEVICE	$200.20	$286.00	$57.20–$286.00	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JNT W/O US	$148.40	$212.00	$102.40–$512.00	51% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$210.00	$300.00	$102.40–$512.00	31% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHOCENTESIS INTERMEDIATE JOINT	$210.00	$300.00	$102.40–$512.00	31% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JNT W/O US	$148.40	$212.00	$102.40–$512.00	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRAIN/INJ JOINT/BURSA W/O US	$210.00	$300.00	$102.40–$512.00	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHOCENTESIS INTERMEDIATE JOINT	$210.00	$300.00	$102.40–$512.00	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$189.70	$271.00	$54.20–$271.00	41% below	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMALL JOINT	$189.70	$271.00	$54.20–$271.00	41% below	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMALL JOINT	$189.70	$271.00	$54.20–$271.00	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRAIN/INJ JOINT/BURSA W/O US	$189.70	$271.00	$54.20–$271.00	—	30%
Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 LAP GAS BYPASS ROUX-EN-Y	$8,355.90	$11,937.00	$2,387.40–$11,937.00	—	30%
Laparoscopic Roux-en-Y gastric bypass, standard limb length inpatient CPT 43644 LAP GAS BYPASS ROUX-EN-Y	$8,355.90	$11,937.00	$2,387.40–$11,937.00	—	30%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP REPAIR INITIAL ING HERNIA	$2,311.40	$3,302.00	$660.40–$3,302.00	94% above	30%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAP REPAIR INITIAL ING HERNIA	$2,311.40	$3,302.00	$660.40–$3,302.00	—	30%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAI	$1,414.00	$2,020.00	$404.00–$2,020.00	at median	30%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAP ING HERNIA REPAI	$1,414.00	$2,020.00	$404.00–$2,020.00	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTM RPR S/A/T 2.5<	$272.30	$389.00	$77.80–$389.00	40% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTM RPR S/A/T 2.5<	$272.30	$389.00	$77.80–$389.00	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC	$528.50	$755.00	$151.00–$755.00	44% below	30%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ DRAIN ASP SPINE	$528.50	$755.00	$151.00–$755.00	44% below	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 NJX INTERLAMINAR LMBR/SAC	$528.50	$755.00	$151.00–$755.00	—	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DRAIN ASP SPINE	$528.50	$755.00	$151.00–$755.00	—	30%
Lower-back epidural injection, without imaging guidance CPT 62322 LUMBAR, SACRAL INJEC	$406.70	$581.00	$663.80–$3,319.00	58% below	30%
Lower-back epidural injection, without imaging guidance CPT 62322 INTRATHECAL INJ PAIN MNGMNT	$958.30	$1,369.00	$663.80–$3,319.00	at median	30%
Lower-back epidural injection, without imaging guidance CPT 62322 EPIDURAL STEROID INJ	$958.30	$1,369.00	$663.80–$3,319.00	at median	30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 LUMBAR, SACRAL INJEC	$406.70	$581.00	$663.80–$3,319.00	—	30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INTRATHECAL INJ PAIN MNGMNT	$958.30	$1,369.00	$663.80–$3,319.00	—	30%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 EPIDURAL STEROID INJ	$958.30	$1,369.00	$663.80–$3,319.00	—	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPID L/S	$429.10	$613.00	$122.60–$613.00	67% below	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPID L/S	$429.10	$613.00	$122.60–$613.00	—	30%
Lumpectomy (partial mastectomy) CPT 19301 MASTECTOMY, PARTIAL	$1,473.50	$2,105.00	$421.00–$2,105.00	at median	30%
Lumpectomy (partial mastectomy) inpatient CPT 19301 MASTECTOMY, PARTIAL	$1,473.50	$2,105.00	$421.00–$2,105.00	—	30%
Mastectomy (total removal of the breast) CPT 19303 SIMPLE MASTECTOMY CO	$2,668.40	$3,812.00	$762.40–$3,812.00	at median	30%
Mastectomy (total removal of the breast) inpatient CPT 19303 SIMPLE MASTECTOMY CO	$2,668.40	$3,812.00	$762.40–$3,812.00	—	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT MARG .5/<	$147.00	$210.00	$42.00–$210.00	64% below	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TR-EXT MARG .5/<	$147.00	$210.00	$42.00–$210.00	—	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE MARG .5<	$186.20	$266.00	$53.20–$266.00	65% below	30%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC FACE MARG .5<	$186.20	$266.00	$53.20–$266.00	—	30%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS W IMAG	$889.70	$1,271.00	$254.20–$1,271.00	2% above	30%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS W IMAG	$889.70	$1,271.00	$254.20–$1,271.00	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DEST LUMB/SAC FAC JT	$750.40	$1,072.00	$323.40–$1,617.00	64% below	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST LUMB/SAC FAC JT	$750.40	$1,072.00	$323.40–$1,617.00	—	30%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONSCOPY NOT HGH R	$984.20	$1,406.00	$205.64–$1,406.00	10% below	30%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$984.20	$1,406.00	$205.64–$1,406.00	10% below	30%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLONSCOPY NOT HGH R	$984.20	$1,406.00	$205.64–$1,406.00	—	30%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLON CA SCRN NOT HI RSK IND	$984.20	$1,406.00	$205.64–$1,406.00	—	30%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY HIGH RSK	$1,176.00	$1,680.00	$205.51–$1,680.00	at median	30%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$1,176.00	$1,680.00	$205.51–$1,680.00	at median	30%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLORECTAL SCRN; HI RISK IND	$1,176.00	$1,680.00	$205.51–$1,680.00	—	30%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLONOSCOPY HIGH RSK	$1,176.00	$1,680.00	$205.51–$1,680.00	—	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHROTRIPSY	$2,534.00	$3,620.00	$724.00–$3,620.00	39% below	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHROTRIPSY	$2,534.00	$3,620.00	$724.00–$3,620.00	—	30%
Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST	$239.40	$342.00	$68.40–$342.00	12% below	30%
Short leg cast (below the knee) inpatient CPT 29405 APPLY SHORT LEG CAST	$239.40	$342.00	$68.40–$342.00	—	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SINGL LES	$95.20	$136.00	$27.20–$136.00	67% below	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$95.20	$136.00	$27.20–$136.00	67% below	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$95.20	$136.00	$27.20–$136.00	—	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SINGL LES	$95.20	$136.00	$27.20–$136.00	—	30%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MARG .5<	$214.90	$307.00	$61.40–$307.00	56% below	30%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC TR-EXT MARG .5<	$214.90	$307.00	$61.40–$307.00	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$536.20	$766.00	$328.80–$1,644.00	26% below	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$536.20	$766.00	$328.80–$1,644.00	—	30%
TURP (transurethral resection of the prostate) CPT 52601 TRANSURETHRAL RESECTION OF PROSTRATE	$3,270.40	$4,672.00	$934.40–$4,672.00	1% above	30%
TURP (transurethral resection of the prostate) inpatient CPT 52601 TRANSURETHRAL RESECTION OF PROSTRATE	$3,270.40	$4,672.00	$934.40–$4,672.00	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANG BX SKN SNGL LES	$69.30	$99.00	$41.20–$206.00	72% below	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BX SKIN	$74.90	$107.00	$41.20–$206.00	69% below	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$74.90	$107.00	$41.20–$206.00	69% below	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANG BX SKN SNGL LES	$69.30	$99.00	$41.20–$206.00	—	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BX SKIN	$74.90	$107.00	$41.20–$206.00	—	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$74.90	$107.00	$41.20–$206.00	—	30%
Thoracentesis with imaging guidance CPT 32555 ER THORACENT W IMAGE	$259.00	$370.00	$590.60–$2,953.00	71% below	30%
Thoracentesis with imaging guidance CPT 32555 NRS SERV THORACENTES	$360.50	$515.00	$590.60–$2,953.00	60% below	30%
Thoracentesis with imaging guidance CPT 32555 US THORANCEN PUNC	$418.60	$598.00	$590.60–$2,953.00	53% below	30%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$578.20	$826.00	$590.60–$2,953.00	35% below	30%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS INIT OR SUBSQ	$578.20	$826.00	$590.60–$2,953.00	35% below	30%
Thoracentesis with imaging guidance inpatient CPT 32555 ER THORACENT W IMAGE	$259.00	$370.00	$590.60–$2,953.00	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 NRS SERV THORACENTES	$360.50	$515.00	$590.60–$2,953.00	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 US THORANCEN PUNC	$418.60	$598.00	$590.60–$2,953.00	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$578.20	$826.00	$590.60–$2,953.00	—	30%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS INIT OR SUBSQ	$578.20	$826.00	$590.60–$2,953.00	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER PN	$140.00	$200.00	$40.00–$200.00	55% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$140.00	$200.00	$40.00–$200.00	55% below	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NJX 1/MLT TRIGGER PN	$140.00	$200.00	$40.00–$200.00	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 NJX 1/MLT TRIGGER POINT 1/2	$140.00	$200.00	$40.00–$200.00	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 MAM CLIP PLACEMENT	$301.00	$430.00	$596.80–$2,984.00	82% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST 1ST LESION	$317.80	$454.00	$596.80–$2,984.00	81% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST BX W/CLIP	$648.20	$926.00	$596.80–$2,984.00	60% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST BX W/CLIP PLACEMENT	$821.80	$1,174.00	$596.80–$2,984.00	50% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 MAM CLIP PLACEMENT	$301.00	$430.00	$596.80–$2,984.00	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION	$317.80	$454.00	$596.80–$2,984.00	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BREAST BX W/CLIP	$648.20	$926.00	$596.80–$2,984.00	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 US BREAST BX W/CLIP PLACEMENT	$821.80	$1,174.00	$596.80–$2,984.00	—	30%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN	$543.90	$777.00	$155.40–$777.00	86% below	30%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF 1ST VEIN	$543.90	$777.00	$155.40–$777.00	—	30%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION B9 LES UP TO 14	$121.80	$174.00	$34.80–$174.00	38% below	30%
Wart removal, up to 14 warts CPT 17110 DEST B9 LESION 1-14	$121.80	$174.00	$34.80–$174.00	38% below	30%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION B9 LES UP TO 14	$121.80	$174.00	$34.80–$174.00	—	30%
Wart removal, up to 14 warts inpatient CPT 17110 DEST B9 LESION 1-14	$121.80	$174.00	$34.80–$174.00	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB TREATMENT	$58.80	$84.00	$16.80–$84.00	50% below	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB TREATMENT	$58.80	$84.00	$16.80–$84.00	—	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE MNGMNT	$553.70	$791.00	$158.20–$791.00	64% below	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE MNGMNT	$553.70	$791.00	$158.20–$791.00	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG TRACING ONLY	$63.70	$91.00	$90.00–$450.00	63% below	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$203.70	$291.00	$90.00–$450.00	18% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG TRACING ONLY	$63.70	$91.00	$90.00–$450.00	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$203.70	$291.00	$90.00–$450.00	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LEVEL 2	$256.20	$366.00	$73.20–$366.00	3% above	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ER LEVEL 2	$256.20	$366.00	$73.20–$366.00	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS-DOT	$651.00	$930.00	$186.00–$930.00	10% below	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS-DOT	$651.00	$930.00	$186.00–$930.00	—	30%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTX W/PT 50 MIN	$116.90	$167.00	$33.40–$167.00	40% below	30%
Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYTH W/PT	$116.90	$167.00	$33.40–$167.00	40% below	30%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYTX W/PT 50 MIN	$116.90	$167.00	$33.40–$167.00	—	30%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYTH W/PT	$116.90	$167.00	$33.40–$167.00	—	30%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTH W/O PT	$138.60	$198.00	$39.60–$198.00	24% below	30%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN	$138.60	$198.00	$39.60–$198.00	24% below	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTH W/O PT	$138.60	$198.00	$39.60–$198.00	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN	$138.60	$198.00	$39.60–$198.00	—	30%
Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY	$63.70	$91.00	$58.20–$291.00	18% below	30%
Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY	$63.70	$91.00	$58.20–$291.00	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER IV INF HYDRATN IN	$276.50	$395.00	$262.20–$1,311.00	1% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INF INITIAL	$276.50	$395.00	$262.20–$1,311.00	1% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INF HYDRATION INI	$364.70	$521.00	$262.20–$1,311.00	34% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INF INITIAL	$276.50	$395.00	$262.20–$1,311.00	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ER IV INF HYDRATN IN	$276.50	$395.00	$262.20–$1,311.00	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV INF HYDRATION INI	$364.70	$521.00	$262.20–$1,311.00	—	30%
IV infusion of a medicine, first hour CPT 96365 ER IV INF FOR THER I	$338.10	$483.00	$456.80–$2,284.00	3% above	30%
IV infusion of a medicine, first hour CPT 96365 UC IV INF 1ST HOUR	$338.10	$483.00	$456.80–$2,284.00	3% above	30%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION UP TO 1	$443.80	$634.00	$456.80–$2,284.00	35% above	30%
IV infusion of a medicine, first hour CPT 96365 IV INF FOR THER INIT	$478.80	$684.00	$456.80–$2,284.00	46% above	30%
IV infusion of a medicine, first hour inpatient CPT 96365 ER IV INF FOR THER I	$338.10	$483.00	$456.80–$2,284.00	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 UC IV INF 1ST HOUR	$338.10	$483.00	$456.80–$2,284.00	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION UP TO 1	$443.80	$634.00	$456.80–$2,284.00	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF FOR THER INIT	$478.80	$684.00	$456.80–$2,284.00	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM	$15.40	$22.00	$22.00–$407.00	80% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM	$22.40	$32.00	$22.00–$407.00	71% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER INJ THER/PROPH SC	$57.40	$82.00	$22.00–$407.00	26% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 UC IM/SQ INJECTION	$57.40	$82.00	$22.00–$407.00	26% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER INJ/ANTIBIOTIC	$57.40	$82.00	$22.00–$407.00	26% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THER/PROPH SC OR	$74.90	$107.00	$22.00–$407.00	3% below	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM	$15.40	$22.00	$22.00–$407.00	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM	$22.40	$32.00	$22.00–$407.00	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 UC IM/SQ INJECTION	$57.40	$82.00	$22.00–$407.00	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER INJ THER/PROPH SC	$57.40	$82.00	$22.00–$407.00	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER INJ/ANTIBIOTIC	$57.40	$82.00	$22.00–$407.00	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THER/PROPH SC OR	$74.90	$107.00	$22.00–$407.00	—	30%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC DIAG INT	$277.90	$397.00	$79.40–$397.00	8% above	30%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC DIAG INT	$277.90	$397.00	$79.40–$397.00	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 97112 NEURO RE-ED	$109.90	$157.00	$63.00–$315.00	52% above	30%
Neuromuscular re-education, 15 minutes CPT 97112 97112 OT NEURO RE-ED	$110.60	$158.00	$63.00–$315.00	53% above	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 NEURO RE-ED	$109.90	$157.00	$63.00–$315.00	—	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 97112 OT NEURO RE-ED	$110.60	$158.00	$63.00–$315.00	—	30%
New patient office visit, about 30 minutes CPT 99203 OFFICE VST NEW LVL 3	$77.70	$111.00	$111.00–$782.00	33% below	30%
New patient office visit, about 30 minutes CPT 99203 OFFIC VST NEW PT III	$219.80	$314.00	$111.00–$782.00	88% above	30%
New patient office visit, about 30 minutes CPT 99203 OFFICE VISIT NEW III	$249.90	$357.00	$111.00–$782.00	114% above	30%
New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN	$249.90	$357.00	$111.00–$782.00	114% above	30%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VST NEW LVL 3	$77.70	$111.00	$111.00–$782.00	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFIC VST NEW PT III	$219.80	$314.00	$111.00–$782.00	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT NEW III	$249.90	$357.00	$111.00–$782.00	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE O/P NEW LOW 30 MIN	$249.90	$357.00	$111.00–$782.00	—	30%
New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN	$110.60	$158.00	$158.00–$1,113.00	36% below	30%
New patient office visit, about 45 minutes CPT 99204 OFFICE VISIT NEW IV	$110.60	$158.00	$158.00–$1,113.00	36% below	30%
New patient office visit, about 45 minutes CPT 99204 OFFIC VST NEW PT IV	$313.60	$448.00	$158.00–$1,113.00	83% above	30%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE O/P NEW MOD 45 MIN	$110.60	$158.00	$158.00–$1,113.00	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT NEW IV	$110.60	$158.00	$158.00–$1,113.00	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFIC VST NEW PT IV	$313.60	$448.00	$158.00–$1,113.00	—	30%
New patient office visit, about 60 minutes CPT 99205 OFFIC VST NEW PT V	$422.10	$603.00	$243.40–$1,217.00	79% above	30%
New patient office visit, about 60 minutes CPT 99205 OFFICE VISIT NEW V	$429.80	$614.00	$243.40–$1,217.00	83% above	30%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFIC VST NEW PT V	$422.10	$603.00	$243.40–$1,217.00	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT NEW V	$429.80	$614.00	$243.40–$1,217.00	—	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VST NEW LVL 2	$55.30	$79.00	$79.00–$434.00	27% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN	$55.30	$79.00	$79.00–$434.00	27% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 UC NEW PT LEVEL 1	$57.40	$82.00	$79.00–$434.00	25% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE VISIT NEW II	$191.10	$273.00	$79.00–$434.00	151% above	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VST NEW LVL 2	$55.30	$79.00	$79.00–$434.00	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE O/P NEW SF 15 MIN	$55.30	$79.00	$79.00–$434.00	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 UC NEW PT LEVEL 1	$57.40	$82.00	$79.00–$434.00	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VISIT NEW II	$191.10	$273.00	$79.00–$434.00	—	30%
Occupational therapy evaluation, low complexity CPT 97165 97165 OT EVAL LOW CO	$233.80	$334.00	$66.80–$334.00	38% above	30%
Occupational therapy evaluation, low complexity inpatient CPT 97165 97165 OT EVAL LOW CO	$233.80	$334.00	$66.80–$334.00	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 97163 EVAL HIGH COMP	$226.10	$323.00	$64.60–$323.00	13% above	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 97163 EVAL HIGH COMP	$226.10	$323.00	$64.60–$323.00	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 97161 EVAL LOW COMP	$226.10	$323.00	$64.60–$323.00	34% above	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 97161 EVAL LOW COMP	$226.10	$323.00	$64.60–$323.00	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 97162 EVAL MOD COMP	$226.10	$323.00	$64.60–$323.00	22% above	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 97162 EVAL MOD COMP	$226.10	$323.00	$64.60–$323.00	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MUSCLE TRIG POINT ST	$18.20	$26.00	$68.20–$341.00	78% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 MANUAL TECH	$109.90	$157.00	$68.20–$341.00	33% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 97140 OT MAN THER 15	$110.60	$158.00	$68.20–$341.00	34% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MUSCLE TRIG POINT ST	$18.20	$26.00	$68.20–$341.00	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 MANUAL TECH	$109.90	$157.00	$68.20–$341.00	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 97140 OT MAN THER 15	$110.60	$158.00	$68.20–$341.00	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC PROC 15M	$15.40	$22.00	$93.20–$466.00	83% below	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 CARDIAC REHAB,PHASE1	$90.30	$129.00	$93.20–$466.00	at median	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 THERAPEUTIC EXERCISE	$109.90	$157.00	$93.20–$466.00	22% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 97110 OT THER EX 15	$110.60	$158.00	$93.20–$466.00	22% above	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC PROC 15M	$15.40	$22.00	$93.20–$466.00	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 CARDIAC REHAB,PHASE1	$90.30	$129.00	$93.20–$466.00	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 THERAPEUTIC EXERCISE	$109.90	$157.00	$93.20–$466.00	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 97110 OT THER EX 15	$110.60	$158.00	$93.20–$466.00	—	30%
Psychiatric evaluation with medical services CPT 90792 PSYCH EVAL W/ MED	$320.60	$458.00	$91.60–$458.00	61% above	30%
Psychiatric evaluation with medical services CPT 90792 PSYCH DIAG EVAL W/MED SRVCS	$320.60	$458.00	$91.60–$458.00	61% above	30%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH EVAL W/ MED	$320.60	$458.00	$91.60–$458.00	—	30%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCH DIAG EVAL W/MED SRVCS	$320.60	$458.00	$91.60–$458.00	—	30%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 PSYCL TST EVAL PHYS/QHP 1ST	$155.40	$222.00	$44.40–$222.00	6% below	30%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 PSYCL TST EVL 1ST HR	$155.40	$222.00	$44.40–$222.00	6% below	30%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 PSYCL TST EVAL PHYS/QHP 1ST	$155.40	$222.00	$44.40–$222.00	—	30%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 PSYCL TST EVL 1ST HR	$155.40	$222.00	$44.40–$222.00	—	30%
Psychotherapy session, 30 minutes CPT 90832 INDIV PSYTH 30 MIN	$123.90	$177.00	$35.40–$177.00	9% above	30%
Psychotherapy session, 30 minutes CPT 90832 PSYTX W PT 30 MINUTES	$123.90	$177.00	$35.40–$177.00	9% above	30%
Psychotherapy session, 30 minutes inpatient CPT 90832 INDIV PSYTH 30 MIN	$123.90	$177.00	$35.40–$177.00	—	30%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYTX W PT 30 MINUTES	$123.90	$177.00	$35.40–$177.00	—	30%
Psychotherapy session, 45 minutes CPT 90834 INDIV PSYTH 45 MIN	$194.60	$278.00	$55.60–$278.00	30% above	30%
Psychotherapy session, 45 minutes CPT 90834 PSYTX W PT 45 MINUTES	$194.60	$278.00	$55.60–$278.00	30% above	30%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYTX W PT 45 MINUTES	$194.60	$278.00	$55.60–$278.00	—	30%
Psychotherapy session, 45 minutes inpatient CPT 90834 INDIV PSYTH 45 MIN	$194.60	$278.00	$55.60–$278.00	—	30%
Psychotherapy session, 60 minutes CPT 90837 INDIVIDUAL PSYCHOTHERAPY 60 MIN	$317.10	$453.00	$90.60–$453.00	75% above	30%
Psychotherapy session, 60 minutes inpatient CPT 90837 INDIVIDUAL PSYCHOTHERAPY 60 MIN	$317.10	$453.00	$90.60–$453.00	—	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$8.40	$12.00	$2.40–$12.00	75% below	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING USE CESSATION COUNSELING >3 MIN	$8.40	$12.00	$2.40–$12.00	75% below	30%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$8.40	$12.00	$2.40–$12.00	—	30%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING USE CESSATION COUNSELING >3 MIN	$8.40	$12.00	$2.40–$12.00	—	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE VISIT EST V	$298.20	$426.00	$184.60–$923.00	76% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN	$298.20	$426.00	$184.60–$923.00	76% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFIC VST EST PT V	$347.90	$497.00	$184.60–$923.00	106% above	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT EST V	$298.20	$426.00	$184.60–$923.00	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE O/P EST HI 40 MIN	$298.20	$426.00	$184.60–$923.00	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFIC VST EST PT V	$347.90	$497.00	$184.60–$923.00	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN	$58.10	$83.00	$83.00–$557.00	38% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VST EST LVL 3	$58.10	$83.00	$83.00–$557.00	38% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFIC VST EST PT III	$151.90	$217.00	$83.00–$557.00	61% above	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE VISIT EST III	$179.90	$257.00	$83.00–$557.00	91% above	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VST EST LVL 3	$58.10	$83.00	$83.00–$557.00	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE O/P EST LOW 20 MIN	$58.10	$83.00	$83.00–$557.00	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFIC VST EST PT III	$151.90	$217.00	$83.00–$557.00	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT EST III	$179.90	$257.00	$83.00–$557.00	—	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VST EST IV	$81.90	$117.00	$117.00–$833.00	32% below	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFIC VST EST PT IV	$228.20	$326.00	$117.00–$833.00	90% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN	$273.00	$390.00	$117.00–$833.00	127% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE VISIT EST IV	$273.00	$390.00	$117.00–$833.00	127% above	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VST EST IV	$81.90	$117.00	$117.00–$833.00	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFIC VST EST PT IV	$228.20	$326.00	$117.00–$833.00	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT EST IV	$273.00	$390.00	$117.00–$833.00	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE O/P EST MOD 30 MIN	$273.00	$390.00	$117.00–$833.00	—	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VST EST LVL 2	$51.80	$74.00	$74.00–$466.00	37% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN	$51.80	$74.00	$74.00–$466.00	37% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 DAC ASSESSMENT	$133.00	$190.00	$74.00–$466.00	63% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE VISIT EST II	$141.40	$202.00	$74.00–$466.00	73% above	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VST EST LVL 2	$51.80	$74.00	$74.00–$466.00	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE O/P EST SF 10 MIN	$51.80	$74.00	$74.00–$466.00	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 DAC ASSESSMENT	$133.00	$190.00	$74.00–$466.00	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT EST II	$141.40	$202.00	$74.00–$466.00	—	30%
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE CONSULT III	$297.50	$425.00	$85.00–$425.00	63% above	30%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE CONSULT III	$297.50	$425.00	$85.00–$425.00	—	30%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE CONSULT IV	$423.50	$605.00	$121.00–$605.00	105% above	30%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE CONSULT IV	$423.50	$605.00	$121.00–$605.00	—	30%
Speech and language evaluation CPT 92523 EVAL LANG COMP/EXP	$368.90	$527.00	$105.40–$527.00	15% above	30%
Speech and language evaluation inpatient CPT 92523 EVAL LANG COMP/EXP	$368.90	$527.00	$105.40–$527.00	—	30%
Speech therapy session, individual CPT 92507 SPEECH/LANG/HEAR 15	$109.20	$156.00	$263.20–$1,316.00	48% below	30%
Speech therapy session, individual CPT 92507 SPEECH/LANG/HEAR 30	$207.20	$296.00	$263.20–$1,316.00	2% below	30%
Speech therapy session, individual CPT 92507 SPEECH/LANG/HEAR 45	$292.60	$418.00	$263.20–$1,316.00	39% above	30%
Speech therapy session, individual CPT 92507 SPEECH/LANG/HEAR 60	$312.20	$446.00	$263.20–$1,316.00	48% above	30%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG/HEAR 15	$109.20	$156.00	$263.20–$1,316.00	—	30%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG/HEAR 30	$207.20	$296.00	$263.20–$1,316.00	—	30%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG/HEAR 45	$292.60	$418.00	$263.20–$1,316.00	—	30%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANG/HEAR 60	$312.20	$446.00	$263.20–$1,316.00	—	30%
Spirometry (breathing test) CPT 94010 SPIROMETRY	$135.80	$194.00	$38.80–$194.00	14% below	30%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY	$135.80	$194.00	$38.80–$194.00	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 THER ACT	$111.30	$159.00	$63.80–$319.00	44% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 97530 OT THER ACTIV	$112.00	$160.00	$63.80–$319.00	45% above	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 THER ACT	$111.30	$159.00	$63.80–$319.00	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 97530 OT THER ACTIV	$112.00	$160.00	$63.80–$319.00	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Minnesota	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SPIKEVAX 25/26	$554.40	$792.00	$158.40–$792.01	202% above	30%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 SPIKEVAX 25/26	$554.40	$792.00	$158.40–$792.01	—	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COMIRNATY 12YUP	$447.30	$639.00	$315.60–$1,578.00	158% above	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COMIRNATY 25/26	$657.30	$939.00	$315.60–$1,578.00	280% above	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COMIRNATY 12YUP	$447.30	$639.00	$315.60–$1,578.00	—	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COMIRNATY 25/26	$657.30	$939.00	$315.60–$1,578.00	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE 25/26	$35.00	$50.00	$23.00–$115.00	58% above	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE 0.5ML 24/25	$45.50	$65.00	$23.00–$115.00	105% above	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE 25/26	$35.00	$50.00	$23.00–$115.00	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE 0.5ML 24/25	$45.50	$65.00	$23.00–$115.00	—	30%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9 VACCINE	$1,280.30	$1,829.00	$365.80–$1,829.01	238% above	30%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9 VACCINE	$1,280.30	$1,829.00	$365.80–$1,829.01	—	30%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITS A (ADULT)	$642.60	$918.00	$183.60–$918.00	515% above	30%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITS A (ADULT)	$642.60	$918.00	$183.60–$918.00	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B ADULT	$487.90	$697.00	$139.40–$697.00	335% above	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B ADULT	$487.90	$697.00	$139.40–$697.00	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU HD 0.7ML PFS	$44.80	$64.00	$68.40–$342.01	40% below	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HD 0.7ML	$61.60	$88.00	$68.40–$342.01	18% below	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HD 25/26	$63.00	$90.00	$68.40–$342.01	16% below	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HD 24/25	$70.00	$100.00	$68.40–$342.01	7% below	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU HD 0.7ML PFS	$44.80	$64.00	$68.40–$342.01	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HD 0.7ML	$61.60	$88.00	$68.40–$342.01	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HD 25/26	$63.00	$90.00	$68.40–$342.01	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HD 24/25	$70.00	$100.00	$68.40–$342.01	—	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 PRIORIX	$403.90	$577.00	$115.40–$577.02	224% above	30%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 PRIORIX	$403.90	$577.00	$115.40–$577.02	—	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B	$955.50	$1,365.00	$273.00–$1,365.00	217% above	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B	$955.50	$1,365.00	$273.00–$1,365.00	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 0.5ML	$1,131.20	$1,616.00	$323.20–$1,616.00	181% above	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 0.5ML	$1,131.20	$1,616.00	$323.20–$1,616.00	—	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL INJ	$477.40	$682.00	$136.40–$682.00	262% above	30%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL INJ	$477.40	$682.00	$136.40–$682.00	—	30%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 AREXVY 120MCG/0.5ML	$1,194.20	$1,706.00	$341.20–$1,706.00	806% above	30%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 AREXVY 120MCG/0.5ML	$1,194.20	$1,706.00	$341.20–$1,706.00	—	30%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGRIX 50MCG/0.5ML	$850.50	$1,215.00	$243.00–$1,215.00	271% above	30%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 SHINGRIX 50MCG/0.5ML	$850.50	$1,215.00	$243.00–$1,215.00	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA T	$206.50	$295.00	$59.00–$295.00	231% above	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA T	$206.50	$295.00	$59.00–$295.00	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX VACCINE	$222.60	$318.00	$63.60–$318.01	184% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX VACCINE	$222.60	$318.00	$63.60–$318.01	—	30%

Source file: https://www.mlhealth.org/sites/default/files/410785161_MILLE-LACS-HEALTH-SYSTEM_standardcharges.csv