Hospital Sioux Falls, SD-MN

Pioneer Memorial Hospital - Cah

Listed in its price file as “Pioneer Memorial Hospital and Health Services”.

Pioneer Memorial Hospital - Cah in Viborg, SD publishes cash prices for 278 common procedures listed here, from its own machine-readable price file updated Apr 30, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the South Dakota median for 146 of 272 procedures and below it for 122. By typical cash price it ranks #14 of 20 South Dakota hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

315 N. Washington Street, Viborg, SD 57070 Collected Sep 27, 2026 Source price file (605) 326-5161

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 431328 · CMS hospital register

The price file shows no self-pay discount

For 790 of the 790 prices listed here, the cash price in Pioneer Memorial Hospital - Cah's file equals its full list price (chargemaster), so the file publishes no self-pay discount. That is why it compares as expensive. Many hospitals still reduce bills for uninsured patients or offer financial assistance based on income: before a planned visit, ask the billing office for its self-pay rate and discount policy in writing.

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 Pioneer Memorial Hospital - Cah in Viborg, SD:

Mar 7, 2024 Warning notice
Jun 13, 2024 Corrective action plan requested
Sep 24, 2024 Case closed
Jul 8, 2025 Met requirements

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems. Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.

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 South Dakota	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 RADIOLOGIC EXAM ANKLE COMP 3+ VIEWS	$197.00	$197.00	$68.95–$189.12	32% below	—
Ankle X-ray, complete, 3 or more views CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$512.00	$512.00	$179.20–$491.52	77% above	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RADIOLOGIC EXAM ANKLE COMP 3+ VIEWS	$197.00	$197.00	$68.95–$189.12	—	—
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RAD EXAM ANKLE MIN 3 VWS	$512.00	$512.00	$179.20–$491.52	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$356.00	$356.00	$124.60–$341.76	—	—
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 LIMITED BILAT PHYSIOLOGIC STUDIES EXT ART 1-2 LVLS	$356.00	$356.00	$124.60–$341.76	—	—
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,876.00	$1,876.00	$656.60–$1,800.96	9% below	—
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE AND OR JNT IMG WHOLE BODY	$1,876.00	$1,876.00	$656.60–$1,800.96	—	—
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US UNILATERAL BREAST LIMITED	$536.00	$536.00	$187.60–$514.56	5% below	—
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US UNILATERAL BREAST LIMITED	$536.00	$536.00	$187.60–$514.56	—	—
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST WCONT +WO IF PERF	$4,821.00	$4,821.00	$1,687.35–$4,628.16	76% above	—
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST WCONT +WO IF PERF	$4,821.00	$4,821.00	$1,687.35–$4,628.16	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST	$4,414.00	$4,414.00	$1,544.90–$4,237.44	16% above	—
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST	$4,414.00	$4,414.00	$1,544.90–$4,237.44	—	—
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W CONTRAST	$5,296.00	$5,296.00	$1,853.60–$5,084.16	13% above	—
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W CONTRAST	$5,296.00	$5,296.00	$1,853.60–$5,084.16	—	—
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS WO THEN W CONT	$5,517.00	$5,517.00	$1,930.95–$5,296.32	10% above	—
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS WO THEN W CONT	$5,517.00	$5,517.00	$1,930.95–$5,296.32	—	—
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W CONTRAST	$3,373.00	$3,373.00	$1,180.55–$3,238.08	11% above	—
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W CONTRAST	$3,373.00	$3,373.00	$1,180.55–$3,238.08	—	—
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO CONTRAST	$2,814.00	$2,814.00	$984.90–$2,701.44	42% above	—
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN WO CONTRAST	$2,814.00	$2,814.00	$984.90–$2,701.44	—	—
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL WO CONT	$3,032.00	$3,032.00	$1,061.20–$2,910.72	55% above	—
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL WO CONT	$3,032.00	$3,032.00	$1,061.20–$2,910.72	—	—
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WO CONTRAST	$3,464.00	$3,464.00	$1,212.40–$3,325.44	75% above	—
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WO CONTRAST	$3,464.00	$3,464.00	$1,212.40–$3,325.44	—	—
CT scan of the head with contrast CPT 70460 CT HEAD W CONTRAST	$4,154.00	$4,154.00	$1,453.90–$3,987.84	81% above	—
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W CONTRAST	$4,154.00	$4,154.00	$1,453.90–$3,987.84	—	—
CT scan of the head without and with contrast CPT 70470 CT HEAD WO THEN W CONTRAST	$4,330.00	$4,330.00	$1,515.50–$4,156.80	54% above	—
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD WO THEN W CONTRAST	$4,330.00	$4,330.00	$1,515.50–$4,156.80	—	—
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE WO CONT	$3,970.00	$3,970.00	$1,389.50–$3,811.20	67% above	—
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE WO CONT	$3,970.00	$3,970.00	$1,389.50–$3,811.20	—	—
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CONTRAST	$4,210.00	$4,210.00	$1,473.50–$4,041.60	87% above	—
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE WO CONTRAST	$4,210.00	$4,210.00	$1,473.50–$4,041.60	—	—
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W CONTRAST	$3,874.00	$3,874.00	$1,355.90–$3,719.04	73% above	—
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W CONTRAST	$3,874.00	$3,874.00	$1,355.90–$3,719.04	—	—
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUP CAROTID BILAT	$1,509.00	$1,509.00	$528.15–$1,448.64	—	—
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUP CAROTID BILAT	$1,509.00	$1,509.00	$528.15–$1,448.64	—	—
Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAMINIATION, CHEST; 2 VIEWS	$187.00	$187.00	$65.45–$179.52	50% below	—
Chest X-ray, 2 views CPT 71046 RAD EXAM CHEST 2 VWS	$463.00	$463.00	$162.05–$444.48	24% above	—
Chest X-ray, 2 views inpatient CPT 71046 RADIOLOGIC EXAMINIATION, CHEST; 2 VIEWS	$187.00	$187.00	$65.45–$179.52	—	—
Chest X-ray, 2 views inpatient CPT 71046 RAD EXAM CHEST 2 VWS	$463.00	$463.00	$162.05–$444.48	—	—
Chest X-ray, single view CPT 71045 RAD EXAM CHEST SINGLE VW	$297.00	$297.00	$103.95–$285.12	3% below	—
Chest X-ray, single view inpatient CPT 71045 RAD EXAM CHEST SINGLE VW	$297.00	$297.00	$103.95–$285.12	—	—
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEUM	$1,167.00	$1,167.00	$408.45–$1,120.32	30% above	—
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEUM	$1,167.00	$1,167.00	$408.45–$1,120.32	—	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE 1+ AXIAL SKELETON	$127.00	$127.00	$44.45–$121.92	77% below	—
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$527.00	$527.00	$184.45–$505.92	4% below	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE 1+ AXIAL SKELETON	$127.00	$127.00	$44.45–$121.92	—	—
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BONE DENSITY DEXA AXIAL SKELET	$527.00	$527.00	$184.45–$505.92	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA APPEND SKELETON PERIPHERAL	$76.00	$76.00	$26.60–$72.96	58% below	—
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE DENSITY DEXA APPEND SKEL	$216.00	$216.00	$75.60–$207.36	19% above	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA APPEND SKELETON PERIPHERAL	$76.00	$76.00	$26.60–$72.96	—	—
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE DENSITY DEXA APPEND SKEL	$216.00	$216.00	$75.60–$207.36	—	—
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$3,825.00	$3,825.00	$1,338.75–$3,672.00	84% above	—
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX DIAGNOSTIC WO CONTRAST	$3,825.00	$3,825.00	$1,338.75–$3,672.00	—	—
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$4,591.00	$4,591.00	$1,606.85–$4,407.36	72% above	—
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX DIAGNOSTIC WITH CONTRAST	$4,591.00	$4,591.00	$1,606.85–$4,407.36	—	—
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,033.00	$1,033.00	$361.55–$991.68	—	—
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LOWER EXT CMPL BILAT	$1,033.00	$1,033.00	$361.55–$991.68	—	—
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,293.00	$1,293.00	$452.55–$1,241.28	—	—
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT CMPL BILAT	$1,293.00	$1,293.00	$452.55–$1,241.28	—	—
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,429.00	$2,429.00	$850.15–$2,331.84	1% above	—
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO (2D) COMPLETE W DOPPLER & COLOR	$2,429.00	$2,429.00	$850.15–$2,331.84	—	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$2,025.00	$2,025.00	$708.75–$1,944.00	1% above	—
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY IMG INCL GALLBLADDER	$2,025.00	$2,025.00	$708.75–$1,944.00	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY SPLT NGHT 95811	$3,153.00	$3,153.00	$1,103.55–$3,026.88	33% below	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$3,153.00	$3,153.00	$1,103.55–$3,026.88	33% below	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 SLEEP STUDY SPLT NGHT 95811	$3,153.00	$3,153.00	$1,103.55–$3,026.88	—	—
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 PSG CPAP BIPAP 4+ PARAMETERS	$3,153.00	$3,153.00	$1,103.55–$3,026.88	—	—
Knee X-ray, 3 views CPT 73562 RADIOLOGIC EXAM KNEE 3 VIEWS	$224.00	$224.00	$78.40–$215.04	34% below	—
Knee X-ray, 3 views CPT 73562 RAD EXAM KNEE 3 VWS	$486.00	$486.00	$170.10–$466.56	43% above	—
Knee X-ray, 3 views inpatient CPT 73562 RADIOLOGIC EXAM KNEE 3 VIEWS	$224.00	$224.00	$78.40–$215.04	—	—
Knee X-ray, 3 views inpatient CPT 73562 RAD EXAM KNEE 3 VWS	$486.00	$486.00	$170.10–$466.56	—	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD LIMITED	$1,276.00	$1,276.00	$446.60–$1,224.96	50% above	—
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD LIMITED	$1,276.00	$1,276.00	$446.60–$1,224.96	—	—
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$2,175.00	$2,175.00	$761.25–$2,088.00	148% above	—
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LW DOSE LUNG CA SCR NO CONTRAST	$2,175.00	$2,175.00	$761.25–$2,088.00	—	—
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JT WO CONTRAST	$4,678.00	$4,678.00	$1,637.30–$4,490.88	48% above	—
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JT WO CONTRAST	$4,678.00	$4,678.00	$1,637.30–$4,490.88	—	—
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$4,780.00	$4,780.00	$1,673.00–$4,588.80	15% above	—
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT JT WO THEN W CONT	$4,780.00	$4,780.00	$1,673.00–$4,588.80	—	—
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN WO CONTRAST	$4,170.00	$4,170.00	$1,459.50–$4,003.20	27% above	—
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN WO CONTRAST	$4,170.00	$4,170.00	$1,459.50–$4,003.20	—	—
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN WO THEN W CONT	$4,460.00	$4,460.00	$1,561.00–$4,281.60	2% above	—
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN WO THEN W CONT	$4,460.00	$4,460.00	$1,561.00–$4,281.60	—	—
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST	$4,170.00	$4,170.00	$1,459.50–$4,003.20	33% above	—
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST	$4,170.00	$4,170.00	$1,459.50–$4,003.20	—	—
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN WO THEN W CONT	$3,070.00	$3,070.00	$1,074.50–$2,947.20	29% below	—
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN WO THEN W CONT	$3,070.00	$3,070.00	$1,074.50–$2,947.20	—	—
MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST	$4,584.00	$4,584.00	$1,604.40–$4,400.64	40% above	—
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST	$4,584.00	$4,584.00	$1,604.40–$4,400.64	—	—
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L SPINE WO THEN W CONT	$4,780.00	$4,780.00	$1,673.00–$4,588.80	8% above	—
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L SPINE WO THEN W CONT	$4,780.00	$4,780.00	$1,673.00–$4,588.80	—	—
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T SPINE WO CONTRAST	$4,584.00	$4,584.00	$1,604.40–$4,400.64	40% above	—
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T SPINE WO CONTRAST	$4,584.00	$4,584.00	$1,604.40–$4,400.64	—	—
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C SPINE WO THEN W CONT	$4,780.00	$4,780.00	$1,673.00–$4,588.80	11% above	—
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C SPINE WO THEN W CONT	$4,780.00	$4,780.00	$1,673.00–$4,588.80	—	—
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C SPINE WO CONTRAST	$4,584.00	$4,584.00	$1,604.40–$4,400.64	40% above	—
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C SPINE WO CONTRAST	$4,584.00	$4,584.00	$1,604.40–$4,400.64	—	—
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS WO CONTRAST	$4,170.00	$4,170.00	$1,459.50–$4,003.20	16% above	—
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS WO CONTRAST	$4,170.00	$4,170.00	$1,459.50–$4,003.20	—	—
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JT WO CONTRAST	$4,678.00	$4,678.00	$1,637.30–$4,490.88	43% above	—
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JT WO CONTRAST	$4,678.00	$4,678.00	$1,637.30–$4,490.88	—	—
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$3,814.00	$3,814.00	$1,334.90–$3,661.44	11% below	—
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL SPECT MULT STDY	$3,814.00	$3,814.00	$1,334.90–$3,661.44	—	—
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC LIMITED	$596.00	$596.00	$208.60–$572.16	21% above	—
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC LIMITED	$596.00	$596.00	$208.60–$572.16	—	—
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC COMPLETE	$1,013.00	$1,013.00	$354.55–$972.48	1% above	—
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC COMPLETE	$1,013.00	$1,013.00	$354.55–$972.48	—	—
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PG UTR 2-3TRI SGL 1ST	$794.00	$794.00	$277.90–$762.24	at median	—
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PG UTR 2-3TRI SGL 1ST	$794.00	$794.00	$277.90–$762.24	—	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREG UTER 1ST TRI SGL	$794.00	$794.00	$277.90–$762.24	9% above	—
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREG UTER 1ST TRI SGL	$794.00	$794.00	$277.90–$762.24	—	—
Screening mammogram, both breasts both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$437.00	$437.00	$152.95–$419.52	—	—
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SCREEN BILAT INCL CAD	$437.00	$437.00	$152.95–$419.52	—	—
Shoulder X-ray, complete, 2 or more views CPT 73030 RADIOLOGIC EXAM SHLDR COMP 2+ VIEWS	$173.00	$173.00	$60.55–$166.08	49% below	—
Shoulder X-ray, complete, 2 or more views CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$540.00	$540.00	$189.00–$518.40	58% above	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RADIOLOGIC EXAM SHLDR COMP 2+ VIEWS	$173.00	$173.00	$60.55–$166.08	—	—
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RAD EXAM SHOULDER COMPL MIN 2 VWS	$540.00	$540.00	$189.00–$518.40	—	—
Sleep study in a lab (polysomnography) CPT 95810 PSG 4+ PARAMETERS	$3,153.00	$3,153.00	$1,103.55–$3,026.88	28% below	—
Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4+ PARAMETERS	$3,153.00	$3,153.00	$1,103.55–$3,026.88	—	—
Swallow study (modified barium swallow, video X-ray) CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$575.00	$575.00	$201.25–$552.00	21% below	—
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RAD SWALLOWING FUNC W CINERAD OR VIDEORAD	$575.00	$575.00	$201.25–$552.00	—	—
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$1,009.00	$1,009.00	$353.15–$968.64	46% above	—
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$1,009.00	$1,009.00	$353.15–$968.64	—	—
Transvaginal ultrasound during pregnancy CPT 76817 US PG UTR TRANSVAG	$830.00	$830.00	$290.50–$796.80	35% above	—
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PG UTR TRANSVAG	$830.00	$830.00	$290.50–$796.80	—	—
Ultrasound of the abdomen, complete CPT 76700 US ABD COMPLETE	$1,364.00	$1,364.00	$477.40–$1,309.44	19% above	—
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABD COMPLETE	$1,364.00	$1,364.00	$477.40–$1,309.44	—	—
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$1,167.00	$1,167.00	$408.45–$1,120.32	28% above	—
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$1,167.00	$1,167.00	$408.45–$1,120.32	—	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD NECK	$571.00	$571.00	$199.85–$548.16	31% below	—
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD NECK	$571.00	$571.00	$199.85–$548.16	—	—
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$957.00	$957.00	$334.95–$918.72	2% below	—
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT LTD UNILAT	$957.00	$957.00	$334.95–$918.72	—	—
Wrist X-ray, complete, 3 or more views CPT 73110 RADIOLOGIC EXAM WRIST COMP 3+ VIEWS	$229.00	$229.00	$80.15–$219.84	23% below	—
Wrist X-ray, complete, 3 or more views CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$427.00	$427.00	$149.45–$409.92	43% above	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RADIOLOGIC EXAM WRIST COMP 3+ VIEWS	$229.00	$229.00	$80.15–$219.84	—	—
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RAD EXAM WRIST COMPL MIN 3 VWS	$427.00	$427.00	$149.45–$409.92	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-RAY EXAM, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 2-3 VIEWS	$217.00	$217.00	$75.95–$208.32	30% below	—
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS	$520.00	$520.00	$182.00–$499.20	68% above	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 X-RAY EXAM, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 2-3 VIEWS	$217.00	$217.00	$75.95–$208.32	—	—
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS	$520.00	$520.00	$182.00–$499.20	—	—
X-ray of the abdomen, 1 view CPT 74018 RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW	$218.00	$218.00	$76.30–$209.28	33% below	—
X-ray of the abdomen, 1 view CPT 74018 RAD EXAM ABDOMEN 1 VW	$427.00	$427.00	$149.45–$409.92	31% above	—
X-ray of the abdomen, 1 view inpatient CPT 74018 RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW	$218.00	$218.00	$76.30–$209.28	—	—
X-ray of the abdomen, 1 view inpatient CPT 74018 RAD EXAM ABDOMEN 1 VW	$427.00	$427.00	$149.45–$409.92	—	—
X-ray of the ankle, 2 views CPT 73600 RADIOLOGIC EXAM ANKLE 2 VIEWS	$166.00	$166.00	$58.10–$159.36	42% below	—
X-ray of the ankle, 2 views CPT 73600 RAD EXAM ANKLE 2 VWS	$311.00	$311.00	$108.85–$298.56	9% above	—
X-ray of the ankle, 2 views inpatient CPT 73600 RADIOLOGIC EXAM ANKLE 2 VIEWS	$166.00	$166.00	$58.10–$159.36	—	—
X-ray of the ankle, 2 views inpatient CPT 73600 RAD EXAM ANKLE 2 VWS	$311.00	$311.00	$108.85–$298.56	—	—
X-ray of the finger(s), 2 or more views CPT 73140 RADIOLOGIC EXAM FINGER(S) 2+ VIEWS	$203.00	$203.00	$71.05–$194.88	14% below	—
X-ray of the finger(s), 2 or more views CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$370.00	$370.00	$129.50–$355.20	57% above	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RADIOLOGIC EXAM FINGER(S) 2+ VIEWS	$203.00	$203.00	$71.05–$194.88	—	—
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RAD EXAM FINGER(S) MIN 2 VWS	$370.00	$370.00	$129.50–$355.20	—	—
X-ray of the foot, 2 views CPT 73620 RADIOLOGIC EXAM FOOT 2 VIEWS	$158.00	$158.00	$55.30–$151.68	44% below	—
X-ray of the foot, 2 views CPT 73620 RAD EXAM FOOT 2 VWS	$311.00	$311.00	$108.85–$298.56	10% above	—
X-ray of the foot, 2 views inpatient CPT 73620 RADIOLOGIC EXAM FOOT 2 VIEWS	$158.00	$158.00	$55.30–$151.68	—	—
X-ray of the foot, 2 views inpatient CPT 73620 RAD EXAM FOOT 2 VWS	$311.00	$311.00	$108.85–$298.56	—	—
X-ray of the foot, complete, 3 or more views CPT 73630 RADIOLOGIC EXAM FOOT COMP 3+ VIEWS	$274.00	$274.00	$95.90–$263.04	11% below	—
X-ray of the foot, complete, 3 or more views CPT 73630 RAD EXAM FOOT MIN 3 VWS	$468.00	$468.00	$163.80–$449.28	53% above	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RADIOLOGIC EXAM FOOT COMP 3+ VIEWS	$274.00	$274.00	$95.90–$263.04	—	—
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RAD EXAM FOOT MIN 3 VWS	$468.00	$468.00	$163.80–$449.28	—	—
X-ray of the hand, 3 or more views CPT 73130 RADIOLOGIC EXAM HAND 3+ VIEWS	$285.00	$285.00	$99.75–$273.60	5% below	—
X-ray of the hand, 3 or more views CPT 73130 RAD EXAM HAND MIN 3 VWS	$495.00	$495.00	$173.25–$475.20	64% above	—
X-ray of the hand, 3 or more views inpatient CPT 73130 RADIOLOGIC EXAM HAND 3+ VIEWS	$285.00	$285.00	$99.75–$273.60	—	—
X-ray of the hand, 3 or more views inpatient CPT 73130 RAD EXAM HAND MIN 3 VWS	$495.00	$495.00	$173.25–$475.20	—	—
X-ray of the knee, 1 or 2 views CPT 73560 RADIOLOGIC EXAM KNEE 1 2 VIEWS	$173.00	$173.00	$60.55–$166.08	39% below	—
X-ray of the knee, 1 or 2 views CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$527.00	$527.00	$184.45–$505.92	85% above	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RADIOLOGIC EXAM KNEE 1 2 VIEWS	$173.00	$173.00	$60.55–$166.08	—	—
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RAD EXAM KNEE 1 OR 2 VWS	$527.00	$527.00	$184.45–$505.92	—	—
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$617.00	$617.00	$215.95–$592.32	45% above	—
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RAD EXAM SPINE LUMB 2 OR 3 VWS	$617.00	$617.00	$215.95–$592.32	—	—
X-ray of the lower back, 4 or more views CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$566.00	$566.00	$198.10–$543.36	3% below	—
X-ray of the lower back, 4 or more views inpatient CPT 72110 RAD EXAM SPINE LUMB MIN 4 VWS	$566.00	$566.00	$198.10–$543.36	—	—
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RAD EXAM SPINE THOR 2 VWS	$492.00	$492.00	$172.20–$472.32	36% above	—
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RAD EXAM SPINE THOR 2 VWS	$492.00	$492.00	$172.20–$472.32	—	—
X-ray of the nasal bones, 3 or more views CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$311.00	$311.00	$108.85–$298.56	1% below	—
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RAD EXAM NASAL BONES COMPL MIN 3 VWS	$311.00	$311.00	$108.85–$298.56	—	—
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$566.00	$566.00	$198.10–$543.36	53% above	—
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RAD EXAM SPINE CERV 2 OR 3 VWS	$566.00	$566.00	$198.10–$543.36	—	—
X-ray of the pelvis, 1 or 2 views CPT 72170 RADIOLOGIC EXAM PELVIS 1 OR 2 VIEWS	$161.00	$161.00	$56.35–$154.56	49% below	—
X-ray of the pelvis, 1 or 2 views CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$426.00	$426.00	$149.10–$408.96	34% above	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RADIOLOGIC EXAM PELVIS 1 OR 2 VIEWS	$161.00	$161.00	$56.35–$154.56	—	—
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RAD EXAM PELVIS 1 OR 2 VWS	$426.00	$426.00	$149.10–$408.96	—	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$330.00	$330.00	$115.50–$316.80	9% above	—
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RAD EXAM SACRUM COCCYX MIN 2 VWS	$330.00	$330.00	$115.50–$316.80	—	—

Lab tests

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$109.00	$109.00	$38.15–$104.64	50% above	—
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 TRANSFERASE ALANINE AMINO ALT SGPT 84460	$109.00	$109.00	$38.15–$104.64	—	—
AST (aspartate aminotransferase) enzyme test CPT 84450 AST 84450	$85.00	$85.00	$29.75–$81.60	17% above	—
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST 84450	$85.00	$85.00	$29.75–$81.60	—	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN ON PANEL 86003	$42.00	$42.00	$14.70–$40.32	22% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$54.00	$54.00	$18.90–$51.84	57% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG MACADAMIA NUT SO 86003.926	$54.00	$54.00	$18.90–$51.84	57% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALERGEN SPEC IGE QNT SO 86003	$64.00	$64.00	$22.40–$61.44	86% above	—
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERG RED DYE CARMINE SO 86003.938	$72.00	$72.00	$25.20–$69.12	109% above	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN ON PANEL 86003	$42.00	$42.00	$14.70–$40.32	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG MACADAMIA NUT SO 86003.926	$54.00	$54.00	$18.90–$51.84	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH 86003	$54.00	$54.00	$18.90–$51.84	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALERGEN SPEC IGE QNT SO 86003	$64.00	$64.00	$22.40–$61.44	—	—
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERG RED DYE CARMINE SO 86003.938	$72.00	$72.00	$25.20–$69.12	—	—
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$265.00	$265.00	$92.75–$254.40	125% above	—
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITR PEP AB(CCP) 86200	$265.00	$265.00	$92.75–$254.40	—	—
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$193.00	$193.00	$67.55–$185.28	138% above	—
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR ANTIBODY SCRE86038	$193.00	$193.00	$67.55–$185.28	—	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO B-TYPE NATRIURETIC PEPTIDE 83880.900	$264.00	$264.00	$92.40–$253.44	40% above	—
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE 83880	$264.00	$264.00	$92.40–$253.44	40% above	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE 83880	$264.00	$264.00	$92.40–$253.44	—	—
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PRO B-TYPE NATRIURETIC PEPTIDE 83880.900	$264.00	$264.00	$92.40–$253.44	—	—
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL 80048	$149.00	$149.00	$52.15–$143.04	4% above	—
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL 80048	$149.00	$149.00	$52.15–$143.04	—	—
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH LEVEL IV 88305	$312.00	$312.00	$109.20–$299.52	94% above	—
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH LEVEL IV 88305	$312.00	$312.00	$109.20–$299.52	—	—
Blood culture for bacteria CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$272.00	$272.00	$95.20–$261.12	50% above	—
Blood culture for bacteria inpatient CPT 87040 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES 87040	$272.00	$272.00	$95.20–$261.12	—	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE	$14.00	$14.00	$4.90–$13.44	45% below	—
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE 36415	$37.00	$37.00	$12.95–$35.52	45% above	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION VENOUS BLOOD VENIPUNCTURE	$14.00	$14.00	$4.90–$13.44	—	—
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE 36415	$37.00	$37.00	$12.95–$35.52	—	—
Blood glucose (sugar) test CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$74.00	$74.00	$25.90–$71.04	26% above	—
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE QUANT BLOOD (EXCEPT REAGENT STRIP) 82947	$74.00	$74.00	$25.90–$71.04	—	—
Blood lead test CPT 83655 LEAD BLOOD 83655.900	$25.00	$25.00	$8.75–$24.00	44% below	—
Blood lead test CPT 83655 LEAD BLOOD VENOUS 83655.904	$28.00	$28.00	$9.80–$26.88	38% below	—
Blood lead test CPT 83655 LEAD BLOOD CAPILLARY 83655.905	$28.00	$28.00	$9.80–$26.88	38% below	—
Blood lead test CPT 83655 LEAD 83655	$205.00	$205.00	$71.75–$196.80	356% above	—
Blood lead test inpatient CPT 83655 LEAD BLOOD 83655.900	$25.00	$25.00	$8.75–$24.00	—	—
Blood lead test inpatient CPT 83655 LEAD BLOOD CAPILLARY 83655.905	$28.00	$28.00	$9.80–$26.88	—	—
Blood lead test inpatient CPT 83655 LEAD BLOOD VENOUS 83655.904	$28.00	$28.00	$9.80–$26.88	—	—
Blood lead test inpatient CPT 83655 LEAD 83655	$205.00	$205.00	$71.75–$196.80	—	—
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUAL 84703	$188.00	$188.00	$65.80–$180.48	60% above	—
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUAL 84703	$188.00	$188.00	$65.80–$180.48	—	—
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$51.00	$51.00	$17.85–$48.96	at median	—
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING SEROLOGIC ABO 86900	$51.00	$51.00	$17.85–$48.96	—	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C REACTIVE PROTEIN QUANT 86140	$111.00	$111.00	$38.85–$106.56	33% above	—
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C REACTIVE PROTEIN QUANT 86140	$111.00	$111.00	$38.85–$106.56	—	—
C. difficile toxin gene test (stool PCR) CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$208.00	$208.00	$72.80–$199.68	2% below	—
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE 87493	$208.00	$208.00	$72.80–$199.68	—	—
CA 19-9 blood test (tumor marker) CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$387.00	$387.00	$135.45–$371.52	281% above	—
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CDMR CA 19-9PANCREATIC CANCER86301	$387.00	$387.00	$135.45–$371.52	—	—
CA-125 blood test (ovarian cancer marker) CPT 86304 CDMR CA 125 86304	$387.00	$387.00	$135.45–$371.52	137% above	—
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CDMR CA 125 86304	$387.00	$387.00	$135.45–$371.52	—	—
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$164.00	$164.00	$57.40–$157.44	31% above	—
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 CDMR SARS-COV-2 COVID-19 AMP PRB 87635	$164.00	$164.00	$57.40–$157.44	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$85.00	$85.00	$29.75–$81.60	26% below	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$124.00	$124.00	$43.40–$119.04	8% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$124.00	$124.00	$43.40–$119.04	8% above	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 INFECT AGNT NUCLEIC ACID DNA RNA CHLAMYDIA TRACH AMPLIF PROBE 87491	$85.00	$85.00	$29.75–$81.60	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA NUCLEIC ACID DETECTION 87491.901	$124.00	$124.00	$43.40–$119.04	—	—
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACHOMATIS OCULAR PERITONEAL NAA 87491.900	$124.00	$124.00	$43.40–$119.04	—	—
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 80061	$147.00	$147.00	$51.45–$141.12	38% above	—
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 80061	$147.00	$147.00	$51.45–$141.12	—	—
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$66.00	$66.00	$23.10–$63.36	39% below	—
Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$91.00	$91.00	$31.85–$87.36	16% below	—
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC	$66.00	$66.00	$23.10–$63.36	—	—
Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC 85025	$91.00	$91.00	$31.85–$87.36	—	—
Complete blood count (CBC), no differential CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$63.00	$63.00	$22.05–$60.48	26% below	—
Complete blood count (CBC), no differential inpatient CPT 85027 BLOOD COUNT COMPLETE AUTOMATED 85027	$63.00	$63.00	$22.05–$60.48	—	—
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$233.00	$233.00	$81.55–$223.68	42% above	—
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL 80053	$233.00	$233.00	$81.55–$223.68	—	—
D-dimer blood test (blood clot marker) CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$230.00	$230.00	$80.50–$220.80	63% above	—
D-dimer blood test (blood clot marker) inpatient CPT 85379 FIBRIN DEGRADATION PRODUCTS D-DIMER QUANT 85379	$230.00	$230.00	$80.50–$220.80	—	—
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE 82627	$233.00	$233.00	$81.55–$223.68	60% above	—
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE 82627	$233.00	$233.00	$81.55–$223.68	—	—
Estradiol blood test CPT 82670 ESTRADIOL ULTRASENSITIVE 82670.902	$147.00	$147.00	$51.45–$141.12	5% below	—
Estradiol blood test CPT 82670 ESTRADIOL 82670.900	$156.00	$156.00	$54.60–$149.76	at median	—
Estradiol blood test CPT 82670 ESTRADIOL TOTAL 82670	$220.00	$220.00	$77.00–$211.20	41% above	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL ULTRASENSITIVE 82670.902	$147.00	$147.00	$51.45–$141.12	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL 82670.900	$156.00	$156.00	$54.60–$149.76	—	—
Estradiol blood test inpatient CPT 82670 ESTRADIOL TOTAL 82670	$220.00	$220.00	$77.00–$211.20	—	—
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$174.00	$174.00	$60.90–$167.04	60% above	—
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FOLLICLE STIMULATING HORMONE (FSH) 83001	$174.00	$174.00	$60.90–$167.04	—	—
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN 83993	$401.00	$401.00	$140.35–$384.96	63% above	—
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN 83993	$401.00	$401.00	$140.35–$384.96	—	—
Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN 82728	$211.00	$211.00	$73.85–$202.56	74% above	—
Ferritin blood test (iron stores) inpatient CPT 82728 ASSAY OF FERRITIN 82728	$211.00	$211.00	$73.85–$202.56	—	—
Folate (folic acid) blood test CPT 82746 FOLATE 82746	$138.00	$138.00	$48.30–$132.48	34% above	—
Folate (folic acid) blood test inpatient CPT 82746 FOLATE 82746	$138.00	$138.00	$48.30–$132.48	—	—
Free T3 thyroid hormone test CPT 84481 T3 FREE 84481	$308.00	$308.00	$107.80–$295.68	87% above	—
Free T3 thyroid hormone test inpatient CPT 84481 T3 FREE 84481	$308.00	$308.00	$107.80–$295.68	—	—
Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE 84439	$140.00	$140.00	$49.00–$134.40	57% above	—
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 ASSAY OF FREE THYROXINE 84439	$140.00	$140.00	$49.00–$134.40	—	—
Free testosterone test CPT 84402 TESTOSTERONE FREE 84402.900	$29.00	$29.00	$10.15–$27.84	52% below	—
Free testosterone test CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$330.00	$330.00	$115.50–$316.80	450% above	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE 84402.900	$29.00	$29.00	$10.15–$27.84	—	—
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE MEASURED 84402.901	$330.00	$330.00	$115.50–$316.80	—	—
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$48.00	$48.00	$16.80–$46.08	41% below	—
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE POST GLUCOSE DOSE 82950	$48.00	$48.00	$16.80–$46.08	—	—
Glucose tolerance test, 3 samples CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$89.00	$89.00	$31.15–$85.44	46% below	—
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUC TOL 3 SPEC & DOSE 82951	$89.00	$89.00	$31.15–$85.44	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$85.00	$85.00	$29.75–$81.60	2% below	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$124.00	$124.00	$43.40–$119.04	44% above	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 INFECT AGNT NUCLEIC ACID DNA RNA NEISSERIA GONORRHOEAE AMPLIF PROBE 87591	$85.00	$85.00	$29.75–$81.60	—	—
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE NUCLEIC ACID DETECT 87591.901	$124.00	$124.00	$43.40–$119.04	—	—
H. pylori antibody blood test CPT 86677 H PYLORI IGG 86677	$285.00	$285.00	$99.75–$273.60	137% above	—
H. pylori antibody blood test inpatient CPT 86677 H PYLORI IGG 86677	$285.00	$285.00	$99.75–$273.60	—	—
H. pylori stool antigen test CPT 87338 H PYLORI AG STOOL 87338	$265.00	$265.00	$92.75–$254.40	42% above	—
H. pylori stool antigen test inpatient CPT 87338 H PYLORI AG STOOL 87338	$265.00	$265.00	$92.75–$254.40	—	—
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV 1 RNA PCR QNT 87536	$472.00	$472.00	$165.20–$453.12	21% above	—
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV 1 RNA PCR QNT 87536	$472.00	$472.00	$165.20–$453.12	—	—
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 HIV-2 ANTIBODY 86703	$48.00	$48.00	$16.80–$46.08	56% below	—
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 HIV-2 ANTIBODY 86703	$48.00	$48.00	$16.80–$46.08	—	—
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$96.00	$96.00	$33.60–$92.16	10% below	—
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1 AG WHIV-1 & HIV-2 AB 87389/G0475	$96.00	$96.00	$33.60–$92.16	—	—
HPV test for high-risk types, one combined (pooled) result CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$168.00	$168.00	$58.80–$161.28	11% above	—
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 INFECT AGNT DNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES 87624	$168.00	$168.00	$58.80–$161.28	—	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$109.00	$109.00	$38.15–$104.64	38% above	—
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C 83036	$109.00	$109.00	$38.15–$104.64	—	—
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$152.00	$152.00	$53.20–$145.92	39% above	—
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) 86706	$152.00	$152.00	$53.20–$145.92	—	—
Hepatitis B surface antigen (HBsAg) test CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$48.00	$48.00	$16.80–$46.08	32% below	—
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 INFECT AGNT ATGN DETECT IA HEPATITIS B SURFACE ANTIGEN 87340	$48.00	$48.00	$16.80–$46.08	—	—
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY 86803	$221.00	$221.00	$77.35–$212.16	64% above	—
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY 86803	$221.00	$221.00	$77.35–$212.16	—	—
Hepatitis C viral load (HCV RNA) test CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$410.00	$410.00	$143.50–$393.60	109% above	—
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 INFECT AGNT DETECT NUC ACID HEP C QUANT 87522	$410.00	$410.00	$143.50–$393.60	—	—
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$118.00	$118.00	$41.30–$113.28	34% above	—
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLX VIR1 IGG 86695	$118.00	$118.00	$41.30–$113.28	—	—
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$200.00	$200.00	$70.00–$192.00	116% above	—
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HERPES SMPLX VIR 2 IGG 86696	$200.00	$200.00	$70.00–$192.00	—	—
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$154.00	$154.00	$53.90–$147.84	46% above	—
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HISEN 86141	$154.00	$154.00	$53.90–$147.84	—	—
Homocysteine blood test CPT 83090 CDMR HOMOCYSTINE 83090	$121.00	$121.00	$42.35–$116.16	26% above	—
Homocysteine blood test inpatient CPT 83090 CDMR HOMOCYSTINE 83090	$121.00	$121.00	$42.35–$116.16	—	—
Insulin blood test CPT 83525 INSULIN LEVEL 83525	$106.00	$106.00	$37.10–$101.76	21% above	—
Insulin blood test inpatient CPT 83525 INSULIN LEVEL 83525	$106.00	$106.00	$37.10–$101.76	—	—
Iron blood test (serum iron) CPT 83540 IRON 83540	$102.00	$102.00	$35.70–$97.92	40% above	—
Iron blood test (serum iron) inpatient CPT 83540 IRON 83540	$102.00	$102.00	$35.70–$97.92	—	—
Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY 83550	$85.00	$85.00	$29.75–$81.60	1% below	—
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BINDING CAPACITY 83550	$85.00	$85.00	$29.75–$81.60	—	—
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL 80069	$287.00	$287.00	$100.45–$275.52	106% above	—
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL 80069	$287.00	$287.00	$100.45–$275.52	—	—
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$174.00	$174.00	$60.90–$167.04	1% below	—
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LUTEINIZING HORMONE (LH) 83002	$174.00	$174.00	$60.90–$167.04	—	—
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE 83690	$256.00	$256.00	$89.60–$245.76	113% above	—
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE 83690	$256.00	$256.00	$89.60–$245.76	—	—
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL 80076	$177.00	$177.00	$61.95–$169.92	27% above	—
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL 80076	$177.00	$177.00	$61.95–$169.92	—	—
Lyme disease antibody test CPT 86618 LYMES IGG IGM 86618	$112.00	$112.00	$39.20–$107.52	7% above	—
Lyme disease antibody test CPT 86618 LYMES TOTAL 86618	$131.00	$131.00	$45.85–$125.76	25% above	—
Lyme disease antibody test inpatient CPT 86618 LYMES IGG IGM 86618	$112.00	$112.00	$39.20–$107.52	—	—
Lyme disease antibody test inpatient CPT 86618 LYMES TOTAL 86618	$131.00	$131.00	$45.85–$125.76	—	—
Magnesium blood test CPT 83735 MAGNESIUM RBC SO 83735.900	$66.00	$66.00	$23.10–$63.36	9% below	—
Magnesium blood test CPT 83735 MAGNESIUM 83735	$123.00	$123.00	$43.05–$118.08	69% above	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC SO 83735.900	$66.00	$66.00	$23.10–$63.36	—	—
Magnesium blood test inpatient CPT 83735 MAGNESIUM 83735	$123.00	$123.00	$43.05–$118.08	—	—
Measles (rubeola) antibody test CPT 86765 ANTIBODY RUBEOLA 86765	$146.00	$146.00	$51.10–$140.16	84% above	—
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY RUBEOLA 86765	$146.00	$146.00	$51.10–$140.16	—	—
Mono test (heterophile antibody, Monospot) CPT 86308 MONOSCREEN 86308	$48.00	$48.00	$16.80–$46.08	27% below	—
Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODIES SCREENING	$48.00	$48.00	$16.80–$46.08	27% below	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOSCREEN 86308	$48.00	$48.00	$16.80–$46.08	—	—
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES SCREENING	$48.00	$48.00	$16.80–$46.08	—	—
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE 84154	$124.00	$124.00	$43.40–$119.04	3% above	—
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE 84154	$124.00	$124.00	$43.40–$119.04	—	—
PSA (prostate-specific antigen) blood test, total CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$162.00	$162.00	$56.70–$155.52	4% above	—
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 CDMR ASSAY OF PSA TOTAL 84153	$162.00	$162.00	$56.70–$155.52	—	—
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO CERV THN AUTO 88175	$141.00	$141.00	$49.35–$135.36	37% above	—
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO CERV THN AUTO 88175	$141.00	$141.00	$49.35–$135.36	—	—
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT 83970	$222.00	$222.00	$77.70–$213.12	at median	—
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT 83970	$222.00	$222.00	$77.70–$213.12	—	—
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$97.00	$97.00	$33.95–$93.12	8% above	—
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL PLASMA WHOLE BLOOD (PTT) 85730	$97.00	$97.00	$33.95–$93.12	—	—
Progesterone blood test CPT 84144 PROGESTERONE 84144	$233.00	$233.00	$81.55–$223.68	52% above	—
Progesterone blood test inpatient CPT 84144 PROGESTERONE 84144	$233.00	$233.00	$81.55–$223.68	—	—
Prolactin blood test CPT 84146 MACROPROLACTIN 84146.900	$251.00	$251.00	$87.85–$240.96	95% above	—
Prolactin blood test CPT 84146 PROLACTIN 84146	$287.00	$287.00	$100.45–$275.52	124% above	—
Prolactin blood test inpatient CPT 84146 MACROPROLACTIN 84146.900	$251.00	$251.00	$87.85–$240.96	—	—
Prolactin blood test inpatient CPT 84146 PROLACTIN 84146	$287.00	$287.00	$100.45–$275.52	—	—
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME 85610	$68.00	$68.00	$23.80–$65.28	115% above	—
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME 85610	$68.00	$68.00	$23.80–$65.28	—	—
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$71.00	$71.00	$24.85–$68.16	10% above	—
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305	$71.00	$71.00	$24.85–$68.16	—	—
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A B DIRECT 87804	$48.00	$48.00	$16.80–$46.08	34% below	—
Rapid flu test (influenza antigen) CPT 87804 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION INFLUENZA	$48.00	$48.00	$16.80–$46.08	34% below	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A B DIRECT 87804	$48.00	$48.00	$16.80–$46.08	—	—
Rapid flu test (influenza antigen) inpatient CPT 87804 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION INFLUENZA	$48.00	$48.00	$16.80–$46.08	—	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION STREPOCOCCUS GROUP A	$48.00	$48.00	$16.80–$46.08	37% below	—
Rapid strep A antigen test from a throat swab, read visually CPT 87880 RPD GROUP A STREP SCREEN 87880	$48.00	$48.00	$16.80–$46.08	37% below	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 INFECTIOUS AGENT IMMUNOASSAY DIRECT OBSERVATION STREPOCOCCUS GROUP A	$48.00	$48.00	$16.80–$46.08	—	—
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 RPD GROUP A STREP SCREEN 87880	$48.00	$48.00	$16.80–$46.08	—	—
Rheumatoid factor (RF) test CPT 86431 RA FACTOR QUANT 86431	$22.00	$22.00	$7.70–$21.12	75% below	—
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT 86431	$73.00	$73.00	$25.55–$70.08	16% below	—
Rheumatoid factor (RF) test inpatient CPT 86431 RA FACTOR QUANT 86431	$22.00	$22.00	$7.70–$21.12	—	—
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR QUANT 86431	$73.00	$73.00	$25.55–$70.08	—	—
Rubella antibody test (immunity check) CPT 86762 ANTIBODY RUBELLA 86762	$48.00	$48.00	$16.80–$46.08	32% below	—
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM AB 86762.903	$97.00	$97.00	$33.95–$93.12	38% above	—
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY RUBELLA 86762	$48.00	$48.00	$16.80–$46.08	—	—
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM AB 86762.903	$97.00	$97.00	$33.95–$93.12	—	—
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$22.00	$22.00	$7.70–$21.12	66% below	—
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE RBC AUTOMATED 85652	$22.00	$22.00	$7.70–$21.12	—	—
Stool ova and parasites exam CPT 87177 OVA AND PARASITES 87177	$141.00	$141.00	$49.35–$135.36	62% above	—
Stool ova and parasites exam inpatient CPT 87177 OVA AND PARASITES 87177	$141.00	$141.00	$49.35–$135.36	—	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$32.00	$32.00	$11.20–$30.72	33% below	—
Stool test for hidden blood (guaiac FOBT) CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$38.00	$38.00	$13.30–$36.48	20% below	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER	$32.00	$32.00	$11.20–$30.72	—	—
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER 82270	$38.00	$38.00	$13.30–$36.48	—	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR OCCULT BLOOD CRC SCREEN (FIT IMMUNOCHEMICAL) G0328 82274.006	$48.00	$48.00	$16.80–$46.08	17% below	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$48.00	$48.00	$16.80–$46.08	17% below	—
Stool test for hidden blood by immunoassay (FIT) CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$48.00	$48.00	$16.80–$46.08	17% below	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3	$48.00	$48.00	$16.80–$46.08	—	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR OCCULT BLOOD CRC SCREEN (FIT IMMUNOCHEMICAL) G0328 82274.006	$48.00	$48.00	$16.80–$46.08	—	—
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 CDMR BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 82274	$48.00	$48.00	$16.80–$46.08	—	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$38.00	$38.00	$13.30–$36.48	35% below	—
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL 86592	$38.00	$38.00	$13.30–$36.48	—	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON GOLD TB TEST	$281.00	$281.00	$98.35–$269.76	2% above	—
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$404.00	$404.00	$141.40–$387.84	47% above	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON GOLD TB TEST	$281.00	$281.00	$98.35–$269.76	—	—
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB TEST CELL MEDIATED IMMUNITY 86480	$404.00	$404.00	$141.40–$387.84	—	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.901	$29.00	$29.00	$10.15–$27.84	72% below	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.904	$41.58	$41.58	$14.55–$39.92	60% below	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL 84403.900	$102.00	$102.00	$35.70–$97.92	1% below	—
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$330.00	$330.00	$115.50–$316.80	220% above	—
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$330.00	$330.00	$115.50–$316.80	220% above	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.901	$29.00	$29.00	$10.15–$27.84	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.904	$41.58	$41.58	$14.55–$39.92	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL 84403.900	$102.00	$102.00	$35.70–$97.92	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 ASSAY OF TESTOSTERONE TOTAL 84403	$330.00	$330.00	$115.50–$316.80	—	—
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL MEASURED 84403.902	$330.00	$330.00	$115.50–$316.80	—	—
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME T1 AB SERUM 86376.900	$111.00	$111.00	$38.85–$106.56	7% below	—
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTITHYROID AB ANTI TPO 86376	$265.00	$265.00	$92.75–$254.40	121% above	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 LIVER KIDNEY MICROSOME T1 AB SERUM 86376.900	$111.00	$111.00	$38.85–$106.56	—	—
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 ANTITHYROID AB ANTI TPO 86376	$265.00	$265.00	$92.75–$254.40	—	—
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$120.00	$120.00	$42.00–$115.20	10% above	—
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH) 84443	$120.00	$120.00	$42.00–$115.20	—	—
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION 87661	$342.00	$342.00	$119.70–$328.32	210% above	—
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS BY NUCLEIC ACID DETECTION 87661	$342.00	$342.00	$119.70–$328.32	—	—
Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$102.00	$102.00	$35.70–$97.92	53% above	—
Uric acid blood test inpatient CPT 84550 ASSAY OF BLOOD/URIC ACID 84550	$102.00	$102.00	$35.70–$97.92	—	—
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$38.00	$38.00	$13.30–$36.48	34% below	—
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$45.00	$45.00	$15.75–$43.20	22% below	—
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE	$38.00	$38.00	$13.30–$36.48	—	—
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/SCOPE 81001	$45.00	$45.00	$15.75–$43.20	—	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$20.00	$20.00	$7.00–$19.20	49% below	—
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIP STICK TABLET REAGENT AUTOMATED WO MICROSCOPY	$30.00	$30.00	$10.50–$28.80	24% below	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS-DIPSTICK ONLY 81003	$20.00	$20.00	$7.00–$19.20	—	—
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIP STICK TABLET REAGENT AUTOMATED WO MICROSCOPY	$30.00	$30.00	$10.50–$28.80	—	—
Urinalysis without microscope exam, manual CPT 81002 URINALYSIS DIP STICK TABLET REAGENT NON-AUTOMATED WO MICROSCOPY	$28.00	$28.00	$9.80–$26.88	22% below	—
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS DIP STICK TABLET REAGENT NON-AUTOMATED WO MICROSCOPY	$28.00	$28.00	$9.80–$26.88	—	—
Urine culture for bacteria, with colony count CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$107.00	$107.00	$37.45–$102.72	4% above	—
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE 87086	$107.00	$107.00	$37.45–$102.72	—	—
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST	$48.00	$48.00	$16.80–$46.08	41% below	—
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST 81025	$48.00	$48.00	$16.80–$46.08	41% below	—
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST 81025	$48.00	$48.00	$16.80–$46.08	—	—
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST	$48.00	$48.00	$16.80–$46.08	—	—
Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$138.00	$138.00	$48.30–$132.48	19% above	—
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 CYANOCOBALAMIN VITAMIN B-12 82607	$138.00	$138.00	$48.30–$132.48	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$148.00	$148.00	$51.80–$142.08	4% below	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$173.00	$173.00	$60.55–$166.08	13% above	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CALCIFEDIOL (25-OH VITAMIN D-3) 82306.900	$148.00	$148.00	$51.80–$142.08	—	—
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 CDMR VITAMIN D 25 HYDROXY 82306	$173.00	$173.00	$60.55–$166.08	—	—
Zinc blood test CPT 84630 ZINC 84630.900	$58.00	$58.00	$20.30–$55.68	113% above	—
Zinc blood test inpatient CPT 84630 ZINC 84630.900	$58.00	$58.00	$20.30–$55.68	—	—
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$211.00	$211.00	$73.85–$202.56	58% above	—
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 GONADOTROPIN CHORIONIC HCG QUANTITATIVE 84702	$211.00	$211.00	$73.85–$202.56	—	—

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 ED 27786 CLSD TX ANKLE FX WO MANIP	$221.00	$221.00	$77.35–$212.16	61% below	—
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLOSED TREAT DISTAL FIBULAR FX (LAT MALLEOLUS) WO MANIP	$1,570.00	$1,570.00	$549.50–$1,507.20	177% above	—
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 ED 27786 CLSD TX ANKLE FX WO MANIP	$221.00	$221.00	$77.35–$212.16	—	—
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLOSED TREAT DISTAL FIBULAR FX (LAT MALLEOLUS) WO MANIP	$1,570.00	$1,570.00	$549.50–$1,507.20	—	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 ED 28470 CLSD TX METATARSAL FX WO MANIP	$221.00	$221.00	$77.35–$212.16	61% below	—
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOSED TREAT METATARSAL FX WO MANIP EACH	$1,140.00	$1,140.00	$399.00–$1,094.40	99% above	—
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 ED 28470 CLSD TX METATARSAL FX WO MANIP	$221.00	$221.00	$77.35–$212.16	—	—
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TREAT METATARSAL FX WO MANIP EACH	$1,140.00	$1,140.00	$399.00–$1,094.40	—	—
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$1,358.00	$1,358.00	$475.30–$1,303.68	7% below	—
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$1,358.00	$1,358.00	$475.30–$1,303.68	—	—
Cervical biopsy CPT 57500 BX EXC CERVIX LESN WWO FULGURATION (SEP PROC)	$571.00	$571.00	$199.85–$548.16	65% below	—
Cervical biopsy inpatient CPT 57500 BX EXC CERVIX LESN WWO FULGURATION (SEP PROC)	$571.00	$571.00	$199.85–$548.16	—	—
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION SURGICAL EXC OTHR THN CLAMP DEVICE DORSL SLIT EXCPT NWBRN	$999.00	$999.00	$349.65–$959.04	43% below	—
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 CIRCUMCISION SURGICAL EXC OTHR THN CLAMP DEVICE DORSL SLIT EXCPT NWBRN	$999.00	$999.00	$349.65–$959.04	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 ED 25600 CLSD TX DISTAL RADIAL FX	$221.00	$221.00	$77.35–$212.16	63% below	—
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED TREAT DISTAL RADIAL FX EPIPHYSEAL SEPARATION WO MANIP	$1,570.00	$1,570.00	$549.50–$1,507.20	163% above	—
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 ED 25600 CLSD TX DISTAL RADIAL FX	$221.00	$221.00	$77.35–$212.16	—	—
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TREAT DISTAL RADIAL FX EPIPHYSEAL SEPARATION WO MANIP	$1,570.00	$1,570.00	$549.50–$1,507.20	—	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT PREMALIG LESNS EXCPT SKIN TAGS CUTANEOUS VASC PROLIFERAT LESN	$264.00	$264.00	$92.40–$253.44	27% below	—
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT PREMALIG LESNS EXCPT SKIN TAGS CUTANEOUS VASC PROLIFERAT LESN	$264.00	$264.00	$92.40–$253.44	—	—
Earwax removal with instruments, one ear CPT 69210 ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI	$256.00	$256.00	$89.60–$245.76	37% above	—
Earwax removal with instruments, one ear one side CPT 69210 REMVL IMPACTED CERUMEN (SEP PROC) UNILATERAL	$167.00	$167.00	$58.45–$160.32	11% below	—
Earwax removal with instruments, one ear inpatient CPT 69210 ED 69210 REMV IMPACTED EAR WAX INSTRUMENT UNI	$256.00	$256.00	$89.60–$245.76	—	—
Earwax removal with instruments, one ear inpatient one side CPT 69210 REMVL IMPACTED CERUMEN (SEP PROC) UNILATERAL	$167.00	$167.00	$58.45–$160.32	—	—
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 ENDOMETRIAL BX WWO ENDOCERVICAL BX WO DILATION ANY METH (SEP PROC)	$377.00	$377.00	$131.95–$361.92	16% below	—
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BX WWO ENDOCERVICAL BX WO DILATION ANY METH (SEP PROC)	$377.00	$377.00	$131.95–$361.92	—	—
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 FLEX SIG DIAG	$1,346.00	$1,346.00	$471.10–$1,292.16	18% above	—
Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 FLEX SIG DIAG	$1,346.00	$1,346.00	$471.10–$1,292.16	—	—
Hemorrhoid banding (rubber band ligation) CPT 46221 ED 46221 HEMORRHOIDECTOMY SMPL LIG	$177.00	$177.00	$61.95–$169.92	85% below	—
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 ED 46221 HEMORRHOIDECTOMY SMPL LIG	$177.00	$177.00	$61.95–$169.92	—	—
IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE	$396.00	$396.00	$138.60–$380.16	4% above	—
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERT INTRAUTERINE DEVICE	$396.00	$396.00	$138.60–$380.16	—	—
Incision and drainage of a simple or single skin abscess CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$276.00	$276.00	$96.60–$264.96	40% below	—
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$436.00	$436.00	$152.60–$418.56	4% below	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 ED 10060 I&D SKIN ABSCESS SMPL	$276.00	$276.00	$96.60–$264.96	—	—
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION & DRAINAGE ABSCESS SMPL SNGL	$436.00	$436.00	$152.60–$418.56	—	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 ED 20550 INJECT SLG TENDON SHEATH LIGAMENT APONEUROSISA	$250.00	$250.00	$87.50–$240.00	50% below	—
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ(S) SNGL TENDON SHEATH LIG APONEUROSIS	$335.00	$335.00	$117.25–$321.60	33% below	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 ED 20550 INJECT SLG TENDON SHEATH LIGAMENT APONEUROSISA	$250.00	$250.00	$87.50–$240.00	—	—
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ(S) SNGL TENDON SHEATH LIG APONEUROSIS	$335.00	$335.00	$117.25–$321.60	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID	$341.00	$341.00	$119.35–$327.36	50% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENT ASP INJ MAJOR JOINT BURSA WO US GUID	$403.00	$403.00	$141.05–$386.88	41% below	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ED 20610 ASP INJ JOINT BURSA MAJOR WO US GUID	$341.00	$341.00	$119.35–$327.36	—	—
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENT ASP INJ MAJOR JOINT BURSA WO US GUID	$403.00	$403.00	$141.05–$386.88	—	—
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 INSERT DRUG DELIVERY IMPLANT	$345.00	$345.00	$120.75–$331.20	12% above	—
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG DELIVERY IMPLANT	$345.00	$345.00	$120.75–$331.20	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ED 20605 ASP INJ JOINT BURSA INTERMED WO US GUID	$287.00	$287.00	$100.45–$275.52	41% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENT ASP INJ INTMDTE JOINT BURSA WO US GUID	$351.00	$351.00	$122.85–$336.96	28% below	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ED 20605 ASP INJ JOINT BURSA INTERMED WO US GUID	$287.00	$287.00	$100.45–$275.52	—	—
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENT ASP INJ INTMDTE JOINT BURSA WO US GUID	$351.00	$351.00	$122.85–$336.96	—	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ED 20600 ASP INJ JOINT BURSA SMALL WO US GUID	$250.00	$250.00	$87.50–$240.00	48% below	—
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASP INJ SMALL JOINT BURSA WO US GUID	$305.00	$305.00	$106.75–$292.80	36% below	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ED 20600 ASP INJ JOINT BURSA SMALL WO US GUID	$250.00	$250.00	$87.50–$240.00	—	—
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASP INJ SMALL JOINT BURSA WO US GUID	$305.00	$305.00	$106.75–$292.80	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR <	$628.00	$628.00	$219.80–$602.88	9% below	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM <	$833.00	$833.00	$291.55–$799.68	21% above	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 ED 12031 LYR CLSR OF WND 2.5CM OR <	$628.00	$628.00	$219.80–$602.88	—	—
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE WNDS SCALP AXILLAE TRUNK EXTREM 2.5 CM <	$833.00	$833.00	$291.55–$799.68	—	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENGN SKN LESN INC MARGIN NO SKN TAG TRNK ARM LEG EXC DIA 0.5 CM <	$486.00	$486.00	$170.10–$466.56	40% below	—
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENGN SKN LESN INC MARGIN NO SKN TAG TRNK ARM LEG EXC DIA 0.5 CM <	$486.00	$486.00	$170.10–$466.56	—	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BENIGN SKIN LESN INCL MARGINS FACE EXC DIAM 0.5 CM <	$515.00	$515.00	$180.25–$494.40	44% below	—
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXC BENIGN SKIN LESN INCL MARGINS FACE EXC DIAM 0.5 CM <	$515.00	$515.00	$180.25–$494.40	—	—
Nail removal (partial or complete), one nail CPT 11730 ED 11730 REMV OF NAIL PLATE	$138.00	$138.00	$48.30–$132.48	58% below	—
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL COMP SMPL SNGL	$390.00	$390.00	$136.50–$374.40	19% above	—
Nail removal (partial or complete), one nail inpatient CPT 11730 ED 11730 REMV OF NAIL PLATE	$138.00	$138.00	$48.30–$132.48	—	—
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE PARTIAL COMP SMPL SNGL	$390.00	$390.00	$136.50–$374.40	—	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 ED 11750 REMV OF NAIL BED	$138.00	$138.00	$48.30–$132.48	84% below	—
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL NAIL MATRIX PERM REMVL	$709.00	$709.00	$248.15–$680.64	17% below	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 ED 11750 REMV OF NAIL BED	$138.00	$138.00	$48.30–$132.48	—	—
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL NAIL MATRIX PERM REMVL	$709.00	$709.00	$248.15–$680.64	—	—
Removal of a foreign object under the skin, simple CPT 10120 ED 10120 INC&REMV FB SMPL	$276.00	$276.00	$96.60–$264.96	56% below	—
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMVL FB SUBQ TISSUES SMPL	$565.00	$565.00	$197.75–$542.40	11% below	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 ED 10120 INC&REMV FB SMPL	$276.00	$276.00	$96.60–$264.96	—	—
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMVL FB SUBQ TISSUES SMPL	$565.00	$565.00	$197.75–$542.40	—	—
Short arm cast (elbow to hand) CPT 29075 ED 29075 APPL CAST FOREARM ARM	$221.00	$221.00	$77.35–$212.16	28% below	—
Short arm cast (elbow to hand) CPT 29075 APPLN CAST ELBOW TO FINGER (SHORT ARM)	$476.00	$476.00	$166.60–$456.96	55% above	—
Short arm cast (elbow to hand) inpatient CPT 29075 ED 29075 APPL CAST FOREARM ARM	$221.00	$221.00	$77.35–$212.16	—	—
Short arm cast (elbow to hand) inpatient CPT 29075 APPLN CAST ELBOW TO FINGER (SHORT ARM)	$476.00	$476.00	$166.60–$456.96	—	—
Short arm splint (forearm and hand) CPT 29125 ED 29125 APPL SPLINT FOREARM	$256.00	$256.00	$89.60–$245.76	15% below	—
Short arm splint (forearm and hand) CPT 29125 APPLN SHORT ARM SPLINT (FOREARM TO HAND) STATIC	$352.00	$352.00	$123.20–$337.92	16% above	—
Short arm splint (forearm and hand) inpatient CPT 29125 ED 29125 APPL SPLINT FOREARM	$256.00	$256.00	$89.60–$245.76	—	—
Short arm splint (forearm and hand) inpatient CPT 29125 APPLN SHORT ARM SPLINT (FOREARM TO HAND) STATIC	$352.00	$352.00	$123.20–$337.92	—	—
Short leg cast (below the knee) CPT 29405 ED 29405 APPL CAST SHORT LEG	$256.00	$256.00	$89.60–$245.76	18% below	—
Short leg cast (below the knee) CPT 29405 APPLN SHORT LEG CAST (BELOW KNEE TO TOES)	$431.00	$431.00	$150.85–$413.76	38% above	—
Short leg cast (below the knee) inpatient CPT 29405 ED 29405 APPL CAST SHORT LEG	$256.00	$256.00	$89.60–$245.76	—	—
Short leg cast (below the knee) inpatient CPT 29405 APPLN SHORT LEG CAST (BELOW KNEE TO TOES)	$431.00	$431.00	$150.85–$413.76	—	—
Short leg splint (calf to foot) CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$256.00	$256.00	$89.60–$245.76	8% below	—
Short leg splint (calf to foot) CPT 29515 APPLN SHORT LEG SPLINT (CALF TO FOOT)	$414.00	$414.00	$144.90–$397.44	49% above	—
Short leg splint (calf to foot) inpatient CPT 29515 ED 29515 APPL SPLINT SHORT LEG	$256.00	$256.00	$89.60–$245.76	—	—
Short leg splint (calf to foot) inpatient CPT 29515 APPLN SHORT LEG SPLINT (CALF TO FOOT)	$414.00	$414.00	$144.90–$397.44	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 ED 12001 RPR SUPERFCL WND 2.5CM OR<	$387.00	$387.00	$135.45–$371.52	16% below	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITALIA TRNK EXTREM 2.5 CM <	$468.00	$468.00	$163.80–$449.28	2% above	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 ED 12001 RPR SUPERFCL WND 2.5CM OR<	$387.00	$387.00	$135.45–$371.52	—	—
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITALIA TRNK EXTREM 2.5 CM <	$468.00	$468.00	$163.80–$449.28	—	—
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$359.00	$359.00	$125.65–$344.64	23% below	—
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN; SINGLE LESION	$359.00	$359.00	$125.65–$344.64	—	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC MALIG LESN INCL MARGINS TRUNK ARMS LEGS EXC DIAM 0.5 CM <	$755.00	$755.00	$264.25–$724.80	18% below	—
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC MALIG LESN INCL MARGINS TRUNK ARMS LEGS EXC DIAM 0.5 CM <	$755.00	$755.00	$264.25–$724.80	—	—
Skin tag removal, up to 15 tags CPT 11200 REMVL SKIN TAGS MULT FIBROCUTANEOUS TAGS ANY AREA UP TO & INCL 15 LESN	$320.00	$320.00	$112.00–$307.20	21% below	—
Skin tag removal, up to 15 tags inpatient CPT 11200 REMVL SKIN TAGS MULT FIBROCUTANEOUS TAGS ANY AREA UP TO & INCL 15 LESN	$320.00	$320.00	$112.00–$307.20	—	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$417.00	$417.00	$145.95–$400.32	59% below	—
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR DX	$868.00	$868.00	$303.80–$833.28	15% below	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ED 62270 SPINAL TAP LUMBAR DIAG	$417.00	$417.00	$145.95–$400.32	—	—
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE LUMBAR DX	$868.00	$868.00	$303.80–$833.28	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 ED 12002 RPR SUPERFCL WND 2.6-7.5CM	$407.00	$407.00	$142.45–$390.72	20% below	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITAL TRNK EXTREM 2.6-7.5 CM	$533.00	$533.00	$186.55–$511.68	4% above	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 ED 12002 RPR SUPERFCL WND 2.6-7.5CM	$407.00	$407.00	$142.45–$390.72	—	—
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SMPL RPR SUPERL WNDS SCALP NECK AXILLAE GENITAL TRNK EXTREM 2.6-7.5 CM	$533.00	$533.00	$186.55–$511.68	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 ED 12011 RPR SUPERFCL WND 2.5CM OR<	$387.00	$387.00	$135.45–$371.52	18% below	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SMPL RPR SUPERL WNDS FACEUS MEMBRANES 2.5 CM <	$501.00	$501.00	$175.35–$480.96	6% above	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 ED 12011 RPR SUPERFCL WND 2.5CM OR<	$387.00	$387.00	$135.45–$371.52	—	—
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SMPL RPR SUPERL WNDS FACEUS MEMBRANES 2.5 CM <	$501.00	$501.00	$175.35–$480.96	—	—
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION	$285.00	$285.00	$99.75–$273.60	16% below	—
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY OF SKIN; SINGLE LESION	$285.00	$285.00	$99.75–$273.60	—	—
Thoracentesis with imaging guidance CPT 32555 ED 32555 THORACENTESIS W IMAGING	$1,033.00	$1,033.00	$361.55–$991.68	47% below	—
Thoracentesis with imaging guidance inpatient CPT 32555 ED 32555 THORACENTESIS W IMAGING	$1,033.00	$1,033.00	$361.55–$991.68	—	—
Trigger finger release surgery CPT 26055 SURG 26055 TENDON SHEATH INCISION	$3,903.00	$3,903.00	$1,366.05–$3,746.88	1% below	—
Trigger finger release surgery inpatient CPT 26055 SURG 26055 TENDON SHEATH INCISION	$3,903.00	$3,903.00	$1,366.05–$3,746.88	—	—
Trigger point injections, 1 or 2 muscles CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$288.00	$288.00	$100.80–$276.48	52% below	—
Trigger point injections, 1 or 2 muscles CPT 20552 INJ(S) SNGL MULTIPLE TRIGGER POINT(S) 1-2 MUSCLES	$344.00	$344.00	$120.40–$330.24	43% below	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ED 20552 INJ 1-2 MUSC GRPS	$288.00	$288.00	$100.80–$276.48	—	—
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ(S) SNGL MULTIPLE TRIGGER POINT(S) 1-2 MUSCLES	$344.00	$344.00	$120.40–$330.24	—	—
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 VASECTOMY UNILAT BILAT WPOSTOPERATIVE SEMEN EXAM (SEP PROC)	$1,997.00	$1,997.00	$698.95–$1,917.12	—	—
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 VASECTOMY UNILAT BILAT WPOSTOPERATIVE SEMEN EXAM (SEP PROC)	$1,997.00	$1,997.00	$698.95–$1,917.12	—	—
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS 1 TO 14	$436.00	$436.00	$152.60–$418.56	at median	—
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESIONS 1 TO 14	$436.00	$436.00	$152.60–$418.56	—	—
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN & SUBQ TISSUE	$394.00	$394.00	$137.90–$378.24	56% below	—
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SKIN & SUBQ TISSUE	$394.00	$394.00	$137.90–$378.24	—	—

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 0-2 HRS	$1,059.00	$1,059.00	$370.65–$1,016.64	10% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 2-4 HRS	$1,256.00	$1,256.00	$439.60–$1,205.76	30% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 4-6 HRS	$1,441.00	$1,441.00	$504.35–$1,383.36	49% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 6-8 HRS	$1,610.00	$1,610.00	$563.50–$1,545.60	67% above	—
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN >8 HRS	$1,939.00	$1,939.00	$678.65–$1,861.44	101% above	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 0-2 HRS	$1,059.00	$1,059.00	$370.65–$1,016.64	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 2-4 HRS	$1,256.00	$1,256.00	$439.60–$1,205.76	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 4-6 HRS	$1,441.00	$1,441.00	$504.35–$1,383.36	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 6-8 HRS	$1,610.00	$1,610.00	$563.50–$1,545.60	—	—
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN >8 HRS	$1,939.00	$1,939.00	$678.65–$1,861.44	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PRESSURIZED NONPRESSURIZED INHALATION RX AIRWAY OBSTRUCTION DX SPUTUM	$160.00	$160.00	$56.00–$153.60	27% below	—
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NEB INITIAL TX	$319.00	$319.00	$111.65–$306.24	45% above	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PRESSURIZED NONPRESSURIZED INHALATION RX AIRWAY OBSTRUCTION DX SPUTUM	$160.00	$160.00	$56.00–$153.60	—	—
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NEB INITIAL TX	$319.00	$319.00	$111.65–$306.24	—	—
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HR	$1,035.00	$1,035.00	$362.25–$993.60	37% above	—
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HR	$1,035.00	$1,035.00	$362.25–$993.60	—	—
Critical care, first 30 to 74 minutes CPT 99291 CRIT CARE E&M 30-74 MIN	$1,032.00	$1,032.00	$361.20–$990.72	17% below	—
Critical care, first 30 to 74 minutes CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$2,251.00	$2,251.00	$787.85–$2,160.96	81% above	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRIT CARE E&M 30-74 MIN	$1,032.00	$1,032.00	$361.20–$990.72	—	—
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED 99291 CRITICAL CARE E&M 30-74 MIN	$2,251.00	$2,251.00	$787.85–$2,160.96	—	—
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS WINTERP & REPORT	$148.00	$148.00	$51.80–$142.08	263% above	—
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS WINTERP & REPORT	$148.00	$148.00	$51.80–$142.08	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS TRACING ONLY WO INTERP	$90.00	$90.00	$31.50–$86.40	63% below	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG TRACING WO INTERP	$247.00	$247.00	$86.45–$237.12	2% above	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ELECTROCARDIOGRAM ROUTINE WAT LEAST 12 LEADS TRACING ONLY WO INTERP	$90.00	$90.00	$31.50–$86.40	—	—
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG TRACING WO INTERP	$247.00	$247.00	$86.45–$237.12	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPT VISIT LVL I	$145.00	$145.00	$50.75–$139.20	7% below	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED 99281 EMER CASE LEVEL I	$361.00	$361.00	$126.35–$346.56	131% above	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY DEPT VISIT LVL I	$145.00	$145.00	$50.75–$139.20	—	—
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED 99281 EMER CASE LEVEL I	$361.00	$361.00	$126.35–$346.56	—	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT LVL II	$211.00	$211.00	$73.85–$202.56	39% below	—
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED 99282 EMER CASE LEVEL II	$529.00	$529.00	$185.15–$507.84	53% above	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPT VISIT LVL II	$211.00	$211.00	$73.85–$202.56	—	—
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED 99282 EMER CASE LEVEL II	$529.00	$529.00	$185.15–$507.84	—	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LVL III	$364.00	$364.00	$127.40–$349.44	19% below	—
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED 99283 EMER CASE LEVEL III	$709.00	$709.00	$248.15–$680.64	59% above	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPT VISIT LVL III	$364.00	$364.00	$127.40–$349.44	—	—
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED 99283 EMER CASE LEVEL III	$709.00	$709.00	$248.15–$680.64	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT LVL IV	$610.00	$610.00	$213.50–$585.60	28% below	—
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED 99284 EMER CASE LEVEL IV	$1,175.00	$1,175.00	$411.25–$1,128.00	39% above	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPT VISIT LVL IV	$610.00	$610.00	$213.50–$585.60	—	—
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED 99284 EMER CASE LEVEL IV	$1,175.00	$1,175.00	$411.25–$1,128.00	—	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT LVL V	$851.00	$851.00	$297.85–$816.96	29% below	—
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED 99285 EMER CASE LEVEL V	$1,877.00	$1,877.00	$656.95–$1,801.92	56% above	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPT VISIT LVL V	$851.00	$851.00	$297.85–$816.96	—	—
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED 99285 EMER CASE LEVEL V	$1,877.00	$1,877.00	$656.95–$1,801.92	—	—
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST TRACING	$1,053.00	$1,053.00	$368.55–$1,010.88	11% below	—
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST TRACING	$1,053.00	$1,053.00	$368.55–$1,010.88	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT	$285.00	$285.00	$99.75–$273.60	34% below	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$940.00	$940.00	$329.00–$902.40	118% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRAT INITIAL 31-60MINS	$940.00	$940.00	$329.00–$902.40	118% above	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT	$285.00	$285.00	$99.75–$273.60	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRAT INITIAL 31-60MINS	$940.00	$940.00	$329.00–$902.40	—	—
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR	$940.00	$940.00	$329.00–$902.40	—	—
IV infusion of a medicine, first hour CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$1,035.00	$1,035.00	$362.25–$993.60	133% above	—
IV infusion of a medicine, first hour CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$1,035.00	$1,035.00	$362.25–$993.60	133% above	—
IV infusion of a medicine, first hour inpatient CPT 96365 ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR	$1,035.00	$1,035.00	$362.25–$993.60	—	—
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION TX PROPH DX INIT TO 1HR	$1,035.00	$1,035.00	$362.25–$993.60	—	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER PROPHY DIAG INJ SC IM	$94.00	$94.00	$32.90–$90.24	1% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SC IM INJECTION	$140.00	$140.00	$49.00–$134.40	51% above	—
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$206.00	$206.00	$72.10–$197.76	122% above	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER PROPHY DIAG INJ SC IM	$94.00	$94.00	$32.90–$90.24	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SC IM INJECTION	$140.00	$140.00	$49.00–$134.40	—	—
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ED 96372 THER PROPH DIAG INJECTION SQ IM	$206.00	$206.00	$72.10–$197.76	—	—
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$141.00	$141.00	$49.35–$135.36	18% above	—
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE ED EA 15MIN 97112	$141.00	$141.00	$49.35–$135.36	—	—
New patient office visit, about 30 minutes CPT 99203 OFFICE OP VISIT NEW PT LEVEL III	$320.00	$320.00	$112.00–$307.20	44% above	—
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE OP VISIT NEW PT LEVEL III	$320.00	$320.00	$112.00–$307.20	—	—
New patient office visit, about 45 minutes CPT 99204 OFFICE OP VISIT NEW PT LEVEL IV	$487.00	$487.00	$170.45–$467.52	45% above	—
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE OP VISIT NEW PT LEVEL IV	$487.00	$487.00	$170.45–$467.52	—	—
New patient office visit, about 60 minutes CPT 99205 OFFICE OP VISIT NEW PT LEVEL V	$611.00	$611.00	$213.85–$586.56	62% above	—
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE OP VISIT NEW PT LEVEL V	$611.00	$611.00	$213.85–$586.56	—	—
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE OP VISIT NEW PT LEVEL II	$221.00	$221.00	$77.35–$212.16	27% above	—
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE OP VISIT NEW PT LEVEL II	$221.00	$221.00	$77.35–$212.16	—	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$52.00	$52.00	$18.20–$49.92	6% below	—
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INITIAL INDIVIDUAL15 MIN	$52.00	$52.00	$18.20–$49.92	—	—
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY 97165	$228.00	$228.00	$79.80–$218.88	13% below	—
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY 97165	$228.00	$228.00	$79.80–$218.88	—	—
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$322.00	$322.00	$112.70–$309.12	8% above	—
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY 97163	$322.00	$322.00	$112.70–$309.12	—	—
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY 97161	$218.00	$218.00	$76.30–$209.28	3% below	—
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY 97161	$218.00	$218.00	$76.30–$209.28	—	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$270.00	$270.00	$94.50–$259.20	3% above	—
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MODERATE COMPLEXITY 97162	$270.00	$270.00	$94.50–$259.20	—	—
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15 MIN 97140	$126.00	$126.00	$44.10–$120.96	12% above	—
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15 MIN 97140	$126.00	$126.00	$44.10–$120.96	—	—
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THER EXERCISE EA 15 MIN 97110	$137.00	$137.00	$47.95–$131.52	15% above	—
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THER EXERCISE EA 15 MIN 97110	$137.00	$137.00	$47.95–$131.52	—	—
Preventive checkup, new patient aged 18–39 CPT 99385 PREV MED E&M NEW 18-39 Y O	$388.00	$388.00	$135.80–$372.48	98% above	—
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PREV MED E&M NEW 18-39 Y O	$388.00	$388.00	$135.80–$372.48	—	—
Preventive checkup, new patient aged 40–64 CPT 99386 PREV MED E&M NEW 40-64 Y O	$450.00	$450.00	$157.50–$432.00	71% above	—
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PREV MED E&M NEW 40-64 Y O	$450.00	$450.00	$157.50–$432.00	—	—
Preventive checkup, new patient aged 65 or older CPT 99387 PREV MED E&M NEW 65 AND OVER	$488.00	$488.00	$170.80–$468.48	80% above	—
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 PREV MED E&M NEW 65 AND OVER	$488.00	$488.00	$170.80–$468.48	—	—
Preventive checkup, returning patient aged 18–39 CPT 99395 PREV MED E&M EST 18-39 Y O	$350.00	$350.00	$122.50–$336.00	68% below	—
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PREV MED E&M EST 18-39 Y O	$350.00	$350.00	$122.50–$336.00	—	—
Preventive checkup, returning patient aged 40–64 CPT 99396 PREV MED E&M EST 40-64 Y O	$374.00	$374.00	$130.90–$359.04	68% above	—
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PREV MED E&M EST 40-64 Y O	$374.00	$374.00	$130.90–$359.04	—	—
Preventive checkup, returning patient aged 65 or older CPT 99397 PREV MED E&M EST 65 AND OVER	$401.00	$401.00	$140.35–$384.96	70% above	—
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PREV MED E&M EST 65 AND OVER	$401.00	$401.00	$140.35–$384.96	—	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE OP VISIT EST PT LEVEL V	$427.00	$427.00	$149.45–$409.92	32% above	—
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB LEVEL 5	$495.00	$495.00	$173.25–$475.20	54% above	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE OP VISIT EST PT LEVEL V	$427.00	$427.00	$149.45–$409.92	—	—
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTAB LEVEL 5	$495.00	$495.00	$173.25–$475.20	—	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE OP VISIT EST PT LEVEL III	$216.00	$216.00	$75.60–$207.36	44% above	—
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB LEVEL 3	$272.00	$272.00	$95.20–$261.12	81% above	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE OP VISIT EST PT LEVEL III	$216.00	$216.00	$75.60–$207.36	—	—
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTAB LEVEL 3	$272.00	$272.00	$95.20–$261.12	—	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE OP VISIT EST PT LEVEL IV	$317.00	$317.00	$110.95–$304.32	39% above	—
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB LEVEL 4	$393.00	$393.00	$137.55–$377.28	72% above	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE OP VISIT EST PT LEVEL IV	$317.00	$317.00	$110.95–$304.32	—	—
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTAB LEVEL 4	$393.00	$393.00	$137.55–$377.28	—	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HORMONAL TESTING CONSULT	$71.00	$71.00	$24.85–$68.16	43% below	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE OP VISIT EST PT LEVEL II	$134.00	$134.00	$46.90–$128.64	7% above	—
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB LEVEL 2	$161.00	$161.00	$56.35–$154.56	28% above	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HORMONAL TESTING CONSULT	$71.00	$71.00	$24.85–$68.16	—	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE OP VISIT EST PT LEVEL II	$134.00	$134.00	$46.90–$128.64	—	—
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTAB LEVEL 2	$161.00	$161.00	$56.35–$154.56	—	—
Specialist consultation, low complexity or 30+ minutes CPT 99243 OFFICE OP CONSULT NEW/EST LOW MDM 30 MIN	$465.00	$465.00	$162.75–$446.40	82% above	—
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE OP CONSULT NEW/EST LOW MDM 30 MIN	$465.00	$465.00	$162.75–$446.40	—	—
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE OP CONSULT NEW/EST MOD MDM 40 MIN	$608.00	$608.00	$212.80–$583.68	36% above	—
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE OP CONSULT NEW/EST MOD MDM 40 MIN	$608.00	$608.00	$212.80–$583.68	—	—
Speech and language evaluation CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$408.00	$408.00	$142.80–$391.68	4% below	—
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL LANG COMP EXPRESSION 92523	$408.00	$408.00	$142.80–$391.68	—	—
Speech therapy session, individual CPT 92507 SPEECH THERAPY TX 92507	$305.00	$305.00	$106.75–$292.80	9% above	—
Speech therapy session, individual inpatient CPT 92507 SPEECH THERAPY TX 92507	$305.00	$305.00	$106.75–$292.80	—	—
Spirometry (breathing test) CPT 94010 PF 94010 BREATHING CAPACITY	$54.00	$54.00	$18.90–$51.84	83% below	—
Spirometry (breathing test) CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$180.00	$180.00	$63.00–$172.80	43% below	—
Spirometry (breathing test) CPT 94010 SPIROMETRY WGRAPHIC RECORD VITAL CAPACITY FLOW RATE WWO MAXIMAL VOLU	$191.00	$191.00	$66.85–$183.36	40% below	—
Spirometry (breathing test) inpatient CPT 94010 PF 94010 BREATHING CAPACITY	$54.00	$54.00	$18.90–$51.84	—	—
Spirometry (breathing test) inpatient CPT 94010 PFT SCREEN SPIROMETRY (NO BD)	$180.00	$180.00	$63.00–$172.80	—	—
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY WGRAPHIC RECORD VITAL CAPACITY FLOW RATE WWO MAXIMAL VOLU	$191.00	$191.00	$66.85–$183.36	—	—
Therapeutic activities (functional training), 15 minutes CPT 97530 THER ACTIVITIES EA15 MIN 97530	$134.00	$134.00	$46.90–$128.64	12% above	—
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THER ACTIVITIES EA15 MIN 97530	$134.00	$134.00	$46.90–$128.64	—	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$166.00	$166.00	$58.10–$159.36	32% below	—
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC (SEP PROC)	$357.00	$357.00	$124.95–$342.72	47% above	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$166.00	$166.00	$58.10–$159.36	—	—
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC (SEP PROC)	$357.00	$357.00	$124.95–$342.72	—	—

Vaccines

Procedure	Cash price	List price	Insurers pay	vs South Dakota	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Influenza Vac Type A&B Surface Ant Adj Susp Pref Syr 0.5 ML	$65.99	$65.99	$23.10–$63.35	2% below	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 CDMR FLU VACCINE ADJUVANT IM	$97.00	$97.00	$33.95–$93.12	43% above	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 Influenza Vac Type A&B Surface Ant Adj Susp Pref Syr 0.5 ML	$65.99	$65.99	$23.10–$63.35	—	—
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 CDMR FLU VACCINE ADJUVANT IM	$97.00	$97.00	$33.95–$93.12	—	—
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 CDMR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$209.00	$209.00	$73.15–$200.64	1% above	—
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML	$440.08	$440.08	$154.03–$422.48	113% above	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 CDMR SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE	$209.00	$209.00	$73.15–$200.64	—	—
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 COVID-19 mRNA Vaccine-Moderna IM Susp Pref Syr 50 MCG/0.5ML	$440.08	$440.08	$154.03–$422.48	—	—
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 CDMR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$209.00	$209.00	$73.15–$200.64	9% below	—
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 CDMR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$209.00	$209.00	$73.15–$200.64	—	—
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE SUBQ USE	$214.00	$214.00	$74.90–$205.44	at median	—
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE SUBQ USE	$214.00	$214.00	$74.90–$205.44	—	—
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 CDMR INFLUENZA VACCINE TRIVALENT PRESER FREE 0.5 ML DOSAGE IM	$31.00	$31.00	$10.85–$29.76	13% above	—
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 CDMR INFLUENZA VACCINE TRIVALENT PRESER FREE 0.5 ML DOSAGE IM	$31.00	$31.00	$10.85–$29.76	—	—
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS 6 11 16 18 31 33 45 52 58 NONAVALENT 3 DOSE IM	$542.00	$542.00	$189.70–$520.32	78% above	—
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS 6 11 16 18 31 33 45 52 58 NONAVALENT 3 DOSE IM	$542.00	$542.00	$189.70–$520.32	—	—
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine Susp Prefilled Syr 50 Unit/ML	$146.37	$146.37	$51.23–$140.52	20% above	—
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE ADULT DOSAGE IM USE	$158.00	$158.00	$55.30–$151.68	29% above	—
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine Susp Prefilled Syr 50 Unit/ML	$146.37	$146.37	$51.23–$140.52	—	—
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE ADULT DOSAGE IM USE	$158.00	$158.00	$55.30–$151.68	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VACCINE ADULT DOSAGE IM USE	$90.00	$90.00	$31.50–$86.40	at median	—
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B Vaccine (Recombinant) Susp 10 MCG/ML	$101.64	$101.64	$35.57–$97.57	13% above	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE ADULT DOSAGE IM USE	$90.00	$90.00	$31.50–$86.40	—	—
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Hepatitis B Vaccine (Recombinant) Susp 10 MCG/ML	$101.64	$101.64	$35.57–$97.57	—	—
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 CDMR FLU VACC PRSV FREE INC ANTIG	$97.00	$97.00	$33.95–$93.12	53% above	—
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 CDMR FLU VACC PRSV FREE INC ANTIG	$97.00	$97.00	$33.95–$93.12	—	—
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES MUMPS AND RUBELLA VIRUS VACCINE (MMR) LIVE SUB-Q USE	$134.00	$134.00	$46.90–$128.64	27% above	—
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES MUMPS AND RUBELLA VIRUS VACCINE (MMR) LIVE SUB-Q USE	$134.00	$134.00	$46.90–$128.64	—	—
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL CONJUGATE VACCINE SEROGROUPS A C Y & W-135(4-VALENT) IM	$267.00	$267.00	$93.45–$256.32	48% above	—
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL CONJUGATE VACCINE SEROGROUPS A C Y & W-135(4-VALENT) IM	$267.00	$267.00	$93.45–$256.32	—	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE FOR INTRAMUSCULAR USE	$445.00	$445.00	$155.75–$427.20	40% above	—
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PCV20 VACCINE FOR INTRAMUSCULAR USE	$445.00	$445.00	$155.75–$427.20	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE 23-VALENT ADULT IMMUNOSUPPRESSED P	$161.00	$161.00	$56.35–$154.56	14% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$252.82	$252.82	$88.49–$242.71	79% above	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE 23-VALENT ADULT IMMUNOSUPPRESSED P	$161.00	$161.00	$56.35–$154.56	—	—
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML	$252.82	$252.82	$88.49–$242.71	—	—
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM USE	$684.00	$684.00	$239.40–$656.64	33% above	—
Rabies vaccine, one dose CPT 90675 Rabies Vaccine, PCEC For Inj	$1,179.90	$1,179.90	$412.97–$1,132.70	130% above	—
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM USE	$684.00	$684.00	$239.40–$656.64	—	—
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine, PCEC For Inj	$1,179.90	$1,179.90	$412.97–$1,132.70	—	—
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VACCINE HZV, RECOMBINANT, SUBUNIT, ADJUVANTED, INTRAMUSCULAR	$254.00	$254.00	$88.90–$243.84	45% below	—
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$451.78	$451.78	$158.12–$433.71	2% below	—
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VACCINE HZV, RECOMBINANT, SUBUNIT, ADJUVANTED, INTRAMUSCULAR	$254.00	$254.00	$88.90–$243.84	—	—
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Zoster Vac Recombinant Adjuvanted for IM Inj 50 MCG/0.5ML	$451.78	$451.78	$158.12–$433.71	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD TOXOIDS ABSORBED PRESERVATIVE FREE	$84.00	$84.00	$29.40–$80.64	13% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML	$94.84	$94.84	$33.19–$91.05	27% above	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD TOXOIDS ABSORBED PRESERVATIVE FREE	$84.00	$84.00	$29.40–$80.64	—	—
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML	$94.84	$94.84	$33.19–$91.05	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML	$101.97	$101.97	$35.69–$97.89	20% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2-15.5 LF-MCG/0.5ML	$102.10	$102.10	$35.74–$98.02	20% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP 7 YRS OR OLDER IM	$116.00	$116.00	$40.60–$111.36	36% above	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML	$101.97	$101.97	$35.69–$97.89	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tet-Diph-Acell Pertuss Ad Pref Syr 5-2-15.5 LF-MCG/0.5ML	$102.10	$102.10	$35.74–$98.02	—	—
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP 7 YRS OR OLDER IM	$116.00	$116.00	$40.60–$111.36	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN INFLUENZA VIR VAC	$45.00	$45.00	$15.75–$43.20	31% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEUMOCOCCAL VAC	$45.00	$45.00	$15.75–$43.20	31% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$45.00	$45.00	$15.75–$43.20	31% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUN ADMIN 1 VACCINE	$45.00	$45.00	$15.75–$43.20	31% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN HEPATITIS B VACCINE	$45.00	$45.00	$15.75–$43.20	31% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION 1 SNGL COMBINATION VACCINE TOXOID	$46.00	$46.00	$16.10–$44.16	29% below	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEUMOCOCCAL VAC	$45.00	$45.00	$15.75–$43.20	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN INFLUENZA VIR VAC	$45.00	$45.00	$15.75–$43.20	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN 1 VACCINE	$45.00	$45.00	$15.75–$43.20	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ED 90471 IMMUNE ADMIN 1 VACCINE	$45.00	$45.00	$15.75–$43.20	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN HEPATITIS B VACCINE	$45.00	$45.00	$15.75–$43.20	—	—
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION 1 SNGL COMBINATION VACCINE TOXOID	$46.00	$46.00	$16.10–$44.16	—	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$45.00	$45.00	$15.75–$43.20	38% below	—
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION EACH ADDL SNGL COMBINATION VACCINE TOXOID	$48.00	$48.00	$16.80–$46.08	34% below	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN EA ADDL VACCINE	$45.00	$45.00	$15.75–$43.20	—	—
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMINISTRATION EACH ADDL SNGL COMBINATION VACCINE TOXOID	$48.00	$48.00	$16.80–$46.08	—	—

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/8088/460260288_pioneer-memorial-hospital-and-health-services_standardcharges.csv