Hospital

Bear Lake County Memorial Hospital

Bear Lake County Memorial Hospital in Montpelier, ID publishes cash prices for 282 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Idaho median for 137 of 278 procedures and above it for 135. By typical cash price it ranks #16 of 23 Idaho hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

164 S 5th Street, Montpelier, ID, 83254 Collected Sep 28, 2026 Source price file (208) 847-1630

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 131316 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 UPR/LWR XTREMITY ARTERL BILAT 1 - 2 LEV	$410.13	$482.50	$76.41–$468.02	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ARTERIAL LIMITED/ABI	$410.13	$482.50	$76.41–$468.02	26% below	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 UPR/LWR XTREMITY ARTERL BILAT 1 - 2 LEV	$410.13	$482.50	$76.41–$468.02	—	15%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US ARTERIAL LIMITED/ABI	$410.13	$482.50	$76.41–$468.02	—	15%
Barium swallow (esophagus X-ray with contrast) CPT 74220 FLUORO BARIUM SWALLOW ESOPHAGUS	$562.28	$661.50	$74.02–$641.66	25% above	15%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 FLUORO BARIUM SWALLOW ESOPHAGUS	$562.28	$661.50	$74.02–$641.66	—	15%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY	$1,418.65	$1,669.00	$239.51–$1,618.93	at median	15%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY	$1,418.65	$1,669.00	$239.51–$1,618.93	—	15%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT CHEST ANGIOGRAPHY	$1,772.68	$2,085.50	$252.38–$2,022.94	14% above	15%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT CHEST ANGIOGRAPHY	$1,772.68	$2,085.50	$252.38–$2,022.94	—	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT KUB	$1,238.03	$1,456.50	$170.13–$1,412.80	32% below	15%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO CONTRAST COMPLEX	$2,144.98	$2,523.50	$170.13–$2,447.80	19% above	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT KUB	$1,238.03	$1,456.50	$170.13–$1,412.80	—	15%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABD PELVIS WO CONTRAST COMPLEX	$2,144.98	$2,523.50	$170.13–$2,447.80	—	15%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELVIS W/ CONTRAST	$2,706.40	$3,184.00	$262.15–$3,088.48	20% above	15%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD PELVIS W/ CONTRAST	$2,706.40	$3,184.00	$262.15–$3,088.48	—	15%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELVIS W/WO CONTRAST	$2,923.58	$3,439.50	$293.18–$3,336.32	29% above	15%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD PELVIS W/WO CONTRAST	$2,923.58	$3,439.50	$293.18–$3,336.32	—	15%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST	$1,449.25	$1,705.00	$193.86–$1,653.85	31% above	15%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ CONTRAST	$1,449.25	$1,705.00	$193.86–$1,653.85	—	15%
CT scan of the abdomen without contrast CPT 74150 CT ABD/URO	$909.50	$1,070.00	$126.68–$1,037.90	1% above	15%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,365.53	$1,606.50	$126.68–$1,558.30	52% above	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABD/URO	$909.50	$1,070.00	$126.68–$1,037.90	—	15%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,365.53	$1,606.50	$126.68–$1,558.30	—	15%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,322.60	$1,556.00	$117.08–$1,509.32	55% above	15%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,322.60	$1,556.00	$117.08–$1,509.32	—	15%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN SKULL W/O CONTRAST	$1,175.55	$1,383.00	$97.79–$1,341.51	23% above	15%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN SKULL W/O CONTRAST	$1,175.55	$1,383.00	$97.79–$1,341.51	—	15%
CT scan of the head with contrast CPT 70460 CT BRAIN SKULL W/ CONTRAST	$1,300.08	$1,529.50	$137.59–$1,483.62	19% above	15%
CT scan of the head with contrast inpatient CPT 70460 CT BRAIN SKULL W/ CONTRAST	$1,300.08	$1,529.50	$137.59–$1,483.62	—	15%
CT scan of the head without and with contrast CPT 70470 CT BRAIN SKULL W/WO CONTRAST	$1,565.70	$1,842.00	$161.14–$1,786.74	15% above	15%
CT scan of the head without and with contrast inpatient CPT 70470 CT BRAIN SKULL W/WO CONTRAST	$1,565.70	$1,842.00	$161.14–$1,786.74	—	15%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR	$1,420.78	$1,671.50	$121.11–$1,621.36	66% above	15%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE LUMBAR	$1,420.78	$1,671.50	$121.11–$1,621.36	—	15%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL	$1,365.53	$1,606.50	$121.72–$1,558.30	59% above	15%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE CERVICAL	$1,365.53	$1,606.50	$121.72–$1,558.30	—	15%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST	$1,405.05	$1,653.00	$189.41–$1,603.41	26% above	15%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST	$1,405.05	$1,653.00	$189.41–$1,603.41	—	15%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID BILATERAL	$1,008.10	$1,186.00	$174.52–$1,150.42	—	15%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILATERAL	$1,008.10	$1,186.00	$174.52–$1,150.42	—	15%
Chest X-ray, 2 views CPT 71046 CHEST 2V N	$315.78	$371.50	$25.58–$360.36	23% above	15%
Chest X-ray, 2 views inpatient CPT 71046 CHEST 2V N	$315.78	$371.50	$25.58–$360.36	—	15%
Chest X-ray, single view CPT 71045 CHEST 1V N	$260.10	$306.00	$16.69–$296.82	17% above	15%
Chest X-ray, single view inpatient CPT 71045 CHEST 1V N	$260.10	$306.00	$16.69–$296.82	—	15%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$730.15	$859.00	$96.11–$833.23	66% above	15%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL COMPLETE	$730.15	$859.00	$96.11–$833.23	—	15%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY 2 SITES AXIAL SKEL	$259.68	$305.50	$35.16–$305.50	20% below	15%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY 2 SITES AXIAL SKEL	$259.68	$305.50	$35.16–$305.50	—	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY 2 SITES APPENDICLR SK	$122.40	$144.00	$23.82–$144.00	35% below	15%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY 2 SITES APPENDICLR SK	$122.40	$144.00	$23.82–$144.00	—	15%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB COMPLETE DETAILED SINGLE FETUS	$671.93	$790.50	$156.31–$766.78	2% above	15%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US OB COMPLETE DETAILED SINGLE FETUS	$671.93	$790.50	$156.31–$766.78	—	15%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$1,449.25	$1,705.00	$123.75–$1,653.85	73% above	15%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST W/O CONTRAST	$1,449.25	$1,705.00	$123.75–$1,653.85	—	15%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST	$1,654.10	$1,946.00	$155.01–$1,887.62	51% above	15%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/ CONTRAST	$1,654.10	$1,946.00	$155.01–$1,887.62	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 MM DIAGNOSTIC MAMMO BILAT	$412.25	$485.00	$143.74–$470.45	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 MM DIAGNOSTIC MAMMO IMPLANT BILAT	$412.25	$485.00	$143.74–$470.45	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 MM DIAG COMBO BILAT W CAD	$508.30	$598.00	$143.74–$580.06	—	15%
Diagnostic mammogram, both breasts both sides CPT 77066 MM DIAG COMBO IMPLANT BILAT W CAD	$508.30	$598.00	$143.74–$580.06	—	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM DIAGNOSTIC MAMMO IMPLANT BILAT	$412.25	$485.00	$143.74–$470.45	—	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM DIAGNOSTIC MAMMO BILAT	$412.25	$485.00	$143.74–$470.45	—	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM DIAG COMBO BILAT W CAD	$508.30	$598.00	$143.74–$580.06	—	15%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MM DIAG COMBO IMPLANT BILAT W CAD	$508.30	$598.00	$143.74–$580.06	—	15%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US ARTERIAL LEG BIL	$969.43	$1,140.50	$218.92–$1,106.28	3% above	15%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US ARTERIAL LEG BIL	$969.43	$1,140.50	$218.92–$1,106.28	—	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS NECK	$801.13	$942.50	$169.79–$914.22	9% below	15%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS UP/LOW-BIL	$1,201.48	$1,413.50	$169.79–$1,371.10	36% above	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS NECK	$801.13	$942.50	$169.79–$914.22	—	15%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS UP/LOW-BIL	$1,201.48	$1,413.50	$169.79–$1,371.10	—	15%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHO COMPLETE	$1,340.03	$1,576.50	$183.59–$1,529.20	26% below	15%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHO COMPLETE	$1,340.03	$1,576.50	$183.59–$1,529.20	—	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM BILIARY SCAN(HIDA) W/O EF	$1,506.20	$1,772.00	$262.70–$1,718.84	6% above	15%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM BILIARY SCAN(HIDA) W/O EF	$1,506.20	$1,772.00	$262.70–$1,718.84	—	15%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 RT HOME SLEEP TEST	$675.33	$794.50	$96.49–$770.66	5% below	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 RT SLEEP STUDY CPAP	$3,189.63	$3,752.50	$653.75–$3,639.92	11% below	15%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 RT SLEEP STUDY CPAP	$3,189.63	$3,752.50	$653.75–$3,639.92	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LTD (SINGLE ORGAN)	$670.65	$789.00	$77.64–$765.33	52% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 OP US ABDOMEN LTD (SINGLE ORGAN)	$670.65	$789.00	$77.64–$765.33	52% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ER US ABDOMEN LTD (SINGLE ORGAN)	$670.65	$789.00	$77.64–$765.33	52% above	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 ER US ABDOMEN LTD (SINGLE ORGAN)	$670.65	$789.00	$77.64–$765.33	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LTD (SINGLE ORGAN)	$670.65	$789.00	$77.64–$765.33	—	15%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 OP US ABDOMEN LTD (SINGLE ORGAN)	$670.65	$789.00	$77.64–$765.33	—	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCREENING	$1,449.25	$1,705.00	$126.98–$1,653.85	77% above	15%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT THORAX LUNG CANCER SCREENING	$1,449.25	$1,705.00	$126.98–$1,653.85	—	15%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MR BREAST BILATERAL W/WO W CAD	$2,105.88	$2,477.50	$316.11–$2,403.18	—	15%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MR BREAST BILATERAL W/WO W CAD	$2,105.88	$2,477.50	$316.11–$2,403.18	—	15%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR LOWER JOINT W & W/O CONTRAST	$2,198.10	$2,586.00	$354.30–$2,508.42	3% below	15%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR LOWER JOINT W & W/O CONTRAST	$2,198.10	$2,586.00	$354.30–$2,508.42	—	15%
MRI of the abdomen without contrast CPT 74181 MR ABDOMEN W/O CONTRAST	$1,601.83	$1,884.50	$180.68–$1,827.96	at median	15%
MRI of the abdomen without contrast CPT 74181 MR ABDOMEN W/ CONTRAST	$2,189.60	$2,576.00	$180.68–$2,498.72	37% above	15%
MRI of the abdomen without contrast inpatient CPT 74181 MR ABDOMEN W/O CONTRAST	$1,601.83	$1,884.50	$180.68–$1,827.96	—	15%
MRI of the abdomen without contrast inpatient CPT 74181 MR ABDOMEN W/ CONTRAST	$2,189.60	$2,576.00	$180.68–$2,498.72	—	15%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR ABDOMINAL W &W/ CONTRAST	$2,381.28	$2,801.50	$312.49–$2,717.46	5% above	15%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR ABDOMINAL W &W/ CONTRAST	$2,381.28	$2,801.50	$312.49–$2,717.46	—	15%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN W/O CONTRAST	$2,365.55	$2,783.00	$182.12–$2,699.51	39% above	15%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN W/O CONTRAST	$2,365.55	$2,783.00	$182.12–$2,699.51	—	15%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN W/WO CONTRAST	$2,601.00	$3,060.00	$295.19–$2,968.20	15% above	15%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN W/WO CONTRAST	$2,601.00	$3,060.00	$295.19–$2,968.20	—	15%
MRI of the lower back, no contrast dye CPT 72148 MR SPINE LUMBAR W/O CONTRAST	$2,026.83	$2,384.50	$178.74–$2,312.96	19% above	15%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR SPINE LUMBAR W/O CONTRAST	$2,026.83	$2,384.50	$178.74–$2,312.96	—	15%
MRI of the lower back, without and then with contrast dye CPT 72158 MR SPINE LUMBAR W/WO CONTRAST	$2,591.23	$3,048.50	$296.42–$2,957.04	14% above	15%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR SPINE LUMBAR W/WO CONTRAST	$2,591.23	$3,048.50	$296.42–$2,957.04	—	15%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR SPINE THORACIC W/O CONTRAST	$2,026.83	$2,384.50	$177.51–$2,312.96	18% above	15%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR SPINE THORACIC W/O CONTRAST	$2,026.83	$2,384.50	$177.51–$2,312.96	—	15%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR SPINE CERVICAL W/WO CONTRAST	$2,362.58	$2,779.50	$296.11–$2,696.12	at median	15%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR SPINE CERVICAL W/WO CONTRAST	$2,362.58	$2,779.50	$296.11–$2,696.12	—	15%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR SPINE CERVICAL W/O CONTRAST	$2,026.83	$2,384.50	$177.82–$2,312.96	19% above	15%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR SPINE CERVICAL W/O CONTRAST	$2,026.83	$2,384.50	$177.82–$2,312.96	—	15%
MRI of the pelvis without and with contrast CPT 72197 MR PELVIS W/WO CONTRAST	$2,192.15	$2,579.00	$310.95–$2,501.63	3% below	15%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR PELVIS W/WO CONTRAST	$2,192.15	$2,579.00	$310.95–$2,501.63	—	15%
MRI of the pelvis, no contrast dye CPT 72195 MR PELVIS W/O CONTRAST	$1,844.08	$2,169.50	$211.71–$2,104.42	6% above	15%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR PELVIS W/O CONTRAST	$1,844.08	$2,169.50	$211.71–$2,104.42	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL PERFUSION SPECT (TREADMILL	$2,761.23	$3,248.50	$395.92–$3,248.50	35% below	15%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM MYOCARDIAL PERFUSION SPECT (CHEMICAL	$2,903.60	$3,416.00	$395.92–$3,416.00	32% below	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL PERFUSION SPECT (TREADMILL	$2,761.23	$3,248.50	$395.92–$3,248.50	—	15%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM MYOCARDIAL PERFUSION SPECT (CHEMICAL	$2,903.60	$3,416.00	$395.92–$3,416.00	—	15%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 NM PET IMAGE W/CT SKULL-THIGH	$5,408.55	$6,363.00	$2,481.57–$6,172.11	32% below	15%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 NM PET IMAGE W/CT SKULL-THIGH	$5,408.55	$6,363.00	$2,481.57–$6,172.11	—	15%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIS-NON OB LTD	$368.90	$434.00	$41.41–$420.98	13% below	15%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIS-NON OB LTD	$368.90	$434.00	$41.41–$420.98	—	15%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS-NON OB COMPLETE	$635.80	$748.00	$93.32–$725.56	39% above	15%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS-NON OB COMPLETE	$635.80	$748.00	$93.32–$725.56	—	15%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB LIMITED > 14 WKS SNGL FETUS	$705.08	$829.50	$120.78–$804.62	60% above	15%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB LIMITED > 14 WKS SNGL FETUS	$705.08	$829.50	$120.78–$804.62	—	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 WKS SINGLE FETUS	$198.48	$233.50	$91.07–$233.50	54% below	15%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 WKS SINGLE FETUS	$198.48	$233.50	$91.07–$233.50	—	15%
Screening mammogram, both breasts both sides CPT 77067 MM SCREENING MAMMO BILAT	$303.03	$356.50	$83.74–$345.80	—	15%
Screening mammogram, both breasts both sides CPT 77067 MM SCREENING MAMMO IMPLANT BILAT	$303.03	$356.50	$83.74–$345.80	—	15%
Screening mammogram, both breasts both sides CPT 77067 MM SCREENING COMBO BILAT W CAD	$424.58	$499.50	$83.74–$484.52	—	15%
Screening mammogram, both breasts both sides CPT 77067 MM SCREENING COMBO IMPLANT BILAT W CAD	$424.58	$499.50	$83.74–$484.52	—	15%
Screening mammogram, both breasts CPT 77067 MM SCREENING COMBO W CAD	$424.58	$499.50	$83.74–$484.52	26% above	15%
Sleep study in a lab (polysomnography) CPT 95810 RT SLEEP STUDY BASELINE	$2,901.48	$3,413.50	$622.44–$3,311.10	13% below	15%
Sleep study in a lab (polysomnography) inpatient CPT 95810 RT SLEEP STUDY BASELINE	$2,901.48	$3,413.50	$622.44–$3,311.10	—	15%
Transvaginal pelvic ultrasound CPT 76830 US PELVIS NON OB TRANSVAGINAL	$442.43	$520.50	$103.26–$504.88	at median	15%
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIS NON OB TRANSVAGINAL	$442.43	$520.50	$103.26–$504.88	—	15%
Transvaginal ultrasound during pregnancy CPT 76817 US OB EARLY TRANVAG	$459.85	$541.00	$82.58–$524.77	4% above	15%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB EARLY TRANVAG	$459.85	$541.00	$82.58–$524.77	—	15%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$772.65	$909.00	$103.93–$881.73	66% above	15%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$772.65	$909.00	$103.93–$881.73	—	15%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM	$579.70	$682.00	$57.81–$661.54	31% above	15%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM	$579.70	$682.00	$57.81–$661.54	—	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD/NECK SOFT TISSUE	$747.58	$879.50	$98.30–$853.12	70% above	15%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US HEAD/NECK SOFT TISSUE	$747.58	$879.50	$98.30–$853.12	—	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 FLUORO UPPER GI	$527.00	$620.00	$94.79–$601.40	at median	15%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 FLUORO UPPER GI	$527.00	$620.00	$94.79–$601.40	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS UP/LOW-UNI RT	$752.25	$885.00	$107.37–$858.45	31% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS UP/LOW-UNI LT	$773.93	$910.50	$107.37–$883.18	35% above	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS UP/LOW-UNI RT	$752.25	$885.00	$107.37–$858.45	—	15%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS UP/LOW-UNI LT	$773.93	$910.50	$107.37–$883.18	—	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIPS INFANT OR CHILD	$336.18	$395.50	$34.64–$383.64	45% above	15%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HIPS INFANT OR CHILD	$336.18	$395.50	$34.64–$383.64	—	15%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1V N	$270.73	$318.50	$22.82–$308.94	32% above	15%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1V N	$270.73	$318.50	$22.82–$308.94	—	15%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR/SAC 2 OR 3 VIEWS	$342.98	$403.50	$29.38–$391.40	7% above	15%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR/SAC 2 OR 3 VIEWS	$342.98	$403.50	$29.38–$391.40	—	15%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR MINIMUM 4 VIEWS	$631.13	$742.50	$40.93–$720.22	57% above	15%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR MINIMUM 4 VIEWS	$631.13	$742.50	$40.93–$720.22	—	15%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 THORACIC 2V	$397.80	$468.00	$28.50–$453.96	40% above	15%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 THORACIC 2V	$397.80	$468.00	$28.50–$453.96	—	15%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES-COMP MIN 3V	$316.20	$372.00	$27.47–$360.84	1% below	15%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NASAL BONES-COMP MIN 3V	$316.20	$372.00	$27.47–$360.84	—	15%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL 2 OR 3 VIEWS	$283.90	$334.00	$27.92–$323.98	9% above	15%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL 2 OR 3 VIEWS	$283.90	$334.00	$27.92–$323.98	—	15%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS AP ONLY	$333.20	$392.00	$25.97–$380.24	38% above	15%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS AP ONLY	$333.20	$392.00	$25.97–$380.24	—	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM/COCCYX	$407.58	$479.50	$23.67–$465.12	63% above	15%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM/COCCYX	$407.58	$479.50	$23.67–$465.12	—	15%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALTV	$25.08	$29.50	$5.30–$28.62	4% below	15%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALTV	$25.08	$29.50	$5.30–$28.62	—	15%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$37.40	$44.00	$5.18–$42.68	14% above	15%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$37.40	$44.00	$5.18–$42.68	—	15%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE VIRAL HEPATITIS (HAV, HBV, HCV)	$152.58	$179.50	$47.63–$179.50	30% below	15%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE VIRAL HEPATITIS (HAV, HBV, HCV)	$152.58	$179.50	$47.63–$179.50	—	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN KIWI	$4.68	$5.50	$2.15–$5.50	79% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SUNFLOWER SEED	$4.68	$5.50	$2.15–$5.50	79% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN SOYBEAN	$4.68	$5.50	$2.15–$5.50	79% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 BUDGERIGAR FEATHER IGE	$9.35	$11.00	$4.29–$11.00	58% below	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, GRAIN	$27.20	$32.00	$5.22–$31.04	23% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 PISTACHIO NUT ALLERGEN	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FOOD-VEGETABLE 1	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FOOD-VEGETABLE 2	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN CHOCOLATE/CACAO	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PINEAPPLE	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, ANIMAL MIX	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FOOD	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, SEASONAL ALLERGEN FALL	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, PERENNIAL ALLERGEN	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, SEASONAL, SPRING -TREE	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, SEASONAL-SUMMER, GRASS	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FOOD-FISH	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FOOD-SHELLFISH	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN MINI PROFILE	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE,FOOD-NUTS	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, PEANUT, IgE WITH REFLE	$42.93	$50.50	$5.22–$48.98	94% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, MOLD	$47.60	$56.00	$5.22–$54.32	115% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE, FOOD IGE W/REFLEX	$54.83	$64.50	$5.22–$62.56	148% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN FOOD PROFILE, IgE	$87.74	$103.22	$5.22–$100.12	296% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN PROFILE PEANUT REFLEX CHARGE	$251.18	$295.50	$5.22–$286.64	1035% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 FOOD ALLERGEN COMP PROFILE IMC	$413.95	$487.00	$5.22–$472.39	1771% above	15%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT COMPONENT PANEL, IMMUNOCAP	$581.40	$684.00	$5.22–$663.48	2527% above	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN KIWI	$4.68	$5.50	$2.15–$5.50	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN SOYBEAN	$4.68	$5.50	$2.15–$5.50	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BUDGERIGAR FEATHER IGE	$9.35	$11.00	$4.29–$11.00	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE,FOOD-NUTS	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, PEANUT, IgE WITH REFLE	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PISTACHIO NUT ALLERGEN	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FOOD-FISH	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FOOD	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, SEASONAL ALLERGEN FALL	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, PERENNIAL ALLERGEN	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, SEASONAL, SPRING -TREE	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, SEASONAL-SUMMER, GRASS	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FOOD-SHELLFISH	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN MINI PROFILE	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, ANIMAL MIX	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FOOD-VEGETABLE 1	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FOOD-VEGETABLE 2	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN CHOCOLATE/CACAO	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PINEAPPLE	$42.93	$50.50	$5.22–$48.98	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, MOLD	$47.60	$56.00	$5.22–$54.32	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE, FOOD IGE W/REFLEX	$54.83	$64.50	$5.22–$62.56	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN FOOD PROFILE, IgE	$87.74	$103.22	$5.22–$100.12	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN PROFILE PEANUT REFLEX CHARGE	$251.18	$295.50	$5.22–$286.64	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 FOOD ALLERGEN COMP PROFILE IMC	$413.95	$487.00	$5.22–$472.39	—	15%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PEANUT COMPONENT PANEL, IMMUNOCAP	$581.40	$684.00	$5.22–$663.48	—	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 XANA	$19.55	$23.00	$8.97–$23.00	64% below	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA 12 PLUS PROFILE	$39.10	$46.00	$12.09–$44.62	28% below	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 REFLEX CHARGE ANA 12 PROFILE	$46.33	$54.50	$12.09–$52.86	14% below	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI-NUCLEAR ANTIBODY, IFA (w/TITER)	$95.20	$112.00	$12.09–$108.64	76% above	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA REFLEX PANEL (NO ANA TITER)	$95.20	$112.00	$12.09–$108.64	76% above	15%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI-NUCLEOLAR	$141.95	$167.00	$12.09–$161.99	163% above	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 XANA	$19.55	$23.00	$8.97–$23.00	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA 12 PLUS PROFILE	$39.10	$46.00	$12.09–$44.62	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 REFLEX CHARGE ANA 12 PROFILE	$46.33	$54.50	$12.09–$52.86	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA REFLEX PANEL (NO ANA TITER)	$95.20	$112.00	$12.09–$108.64	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI-NUCLEAR ANTIBODY, IFA (w/TITER)	$95.20	$112.00	$12.09–$108.64	—	15%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI-NUCLEOLAR	$141.95	$167.00	$12.09–$161.99	—	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B TYPE NATRIURETIC PEPT (LABCORP) NOT NT	$49.73	$58.50	$22.82–$58.50	70% below	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 .B TYPE NATRIURETIC PEPTIDE (LABCORP)	$49.73	$58.50	$22.82–$58.50	70% below	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 *BNP QUANT	$242.25	$285.00	$37.71–$276.45	45% above	15%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-BNP	$255.00	$300.00	$37.71–$291.00	52% above	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B TYPE NATRIURETIC PEPT (LABCORP) NOT NT	$49.73	$58.50	$22.82–$58.50	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 .B TYPE NATRIURETIC PEPTIDE (LABCORP)	$49.73	$58.50	$22.82–$58.50	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 *BNP QUANT	$242.25	$285.00	$37.71–$276.45	—	15%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-BNP	$255.00	$300.00	$37.71–$291.00	—	15%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$102.43	$120.50	$8.46–$116.88	144% above	15%
Basic metabolic panel (blood test) CPT 80048 iSTAT CHEM 8	$102.43	$120.50	$8.46–$116.88	144% above	15%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$102.43	$120.50	$8.46–$116.88	—	15%
Basic metabolic panel (blood test) inpatient CPT 80048 iSTAT CHEM 8	$102.43	$120.50	$8.46–$116.88	—	15%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATH/SURGICAL LEVEL 4	$53.55	$63.00	$58.99–$63.00	77% below	15%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 PATH/SURGICAL LEVEL 4	$53.55	$63.00	$58.99–$63.00	—	15%
Blood culture for bacteria CPT 87040 CULTURE BLOOD (1 AEROB & 1 ANAEROB)	$140.25	$165.00	$10.32–$160.05	30% above	15%
Blood culture for bacteria CPT 87040 CULTURE BLOOD (INTERMOUNTAIN)	$140.25	$165.00	$10.32–$160.05	30% above	15%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD (1 AEROB & 1 ANAEROB)	$140.25	$165.00	$10.32–$160.05	—	15%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD (INTERMOUNTAIN)	$140.25	$165.00	$10.32–$160.05	—	15%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BLOOD DRAW	$31.03	$36.50	$2.77–$35.40	38% above	15%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 BLOOD DRAW	$31.03	$36.50	$2.77–$35.40	—	15%
Blood glucose (sugar) test CPT 82947 HF GLUCOSE	$7.65	$9.00	$3.51–$9.00	70% below	15%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$65.03	$76.50	$3.93–$74.20	157% above	15%
Blood glucose (sugar) test inpatient CPT 82947 HF GLUCOSE	$7.65	$9.00	$3.51–$9.00	—	15%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$65.03	$76.50	$3.93–$74.20	—	15%
Blood lead test CPT 83655 LEAD LEVEL PEDIATRIC	$34.85	$41.00	$12.11–$41.00	37% below	15%
Blood lead test CPT 83655 LEAD LEVEL ADULT	$219.73	$258.50	$12.11–$250.74	298% above	15%
Blood lead test inpatient CPT 83655 LEAD LEVEL PEDIATRIC	$34.85	$41.00	$12.11–$41.00	—	15%
Blood lead test inpatient CPT 83655 LEAD LEVEL ADULT	$219.73	$258.50	$12.11–$250.74	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG PREGNANCY TEST SERUM	$87.55	$103.00	$7.52–$99.91	88% above	15%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG PREGNANCY TEST URINE	$87.55	$103.00	$7.52–$99.91	88% above	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG PREGNANCY TEST URINE	$87.55	$103.00	$7.52–$99.91	—	15%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG PREGNANCY TEST SERUM	$87.55	$103.00	$7.52–$99.91	—	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO/RH LABCORP	$7.65	$9.00	$2.99–$9.00	84% below	15%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB BLOOD GROUP	$62.90	$74.00	$2.99–$71.78	35% above	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB ABO/RH LABCORP	$7.65	$9.00	$2.99–$9.00	—	15%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB BLOOD GROUP	$62.90	$74.00	$2.99–$71.78	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP	$112.20	$132.00	$5.18–$128.04	116% above	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CREACTIVE PROTEIN (CRP) REF LAB	$112.20	$132.00	$5.18–$128.04	116% above	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP	$112.20	$132.00	$5.18–$128.04	—	15%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CREACTIVE PROTEIN (CRP) REF LAB	$112.20	$132.00	$5.18–$128.04	—	15%
C. difficile toxin gene test (stool PCR) CPT 87493 .C DIFF CONFIRMATION ILLUMIGENE	$127.50	$150.00	$37.27–$148.18	23% below	15%
C. difficile toxin gene test (stool PCR) CPT 87493 REFLEX TOXIGENIC C DIFF PCR	$170.00	$200.00	$37.27–$194.00	2% above	15%
C. difficile toxin gene test (stool PCR) CPT 87493 C DIFFICILE TOXIN GENE, REFLEX ONLY	$198.90	$234.00	$37.27–$226.98	20% above	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 .C DIFF CONFIRMATION ILLUMIGENE	$127.50	$150.00	$37.27–$148.18	—	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 REFLEX TOXIGENIC C DIFF PCR	$170.00	$200.00	$37.27–$194.00	—	15%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C DIFFICILE TOXIN GENE, REFLEX ONLY	$198.90	$234.00	$37.27–$226.98	—	15%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$50.58	$59.50	$20.81–$59.50	46% below	15%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$50.58	$59.50	$20.81–$59.50	—	15%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$150.45	$177.00	$20.81–$171.69	59% above	15%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$150.45	$177.00	$20.81–$171.69	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 NOVEL CORONAVIRUS (COVID-19), NAA	$74.38	$87.50	$34.13–$84.88	21% below	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19 INHOUSE (ABBOTT SWAB)	$74.38	$87.50	$34.13–$84.88	21% below	15%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COVID-19, NAA (INTERMOUNTAIN LAB)	$98.60	$116.00	$45.24–$112.52	5% above	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 NOVEL CORONAVIRUS (COVID-19), NAA	$74.38	$87.50	$34.13–$84.88	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19 INHOUSE (ABBOTT SWAB)	$74.38	$87.50	$34.13–$84.88	—	15%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COVID-19, NAA (INTERMOUNTAIN LAB)	$98.60	$116.00	$45.24–$112.52	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 GC AND CHLAMYDIA BY PCR	$95.20	$112.00	$35.09–$112.00	15% below	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA BY NUCLEIC ACID AMPLIFICAT	$110.93	$130.50	$35.09–$130.50	1% below	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 GC AND CHLAMYDIA BY PCR	$95.20	$112.00	$35.09–$112.00	—	15%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA BY NUCLEIC ACID AMPLIFICAT	$110.93	$130.50	$35.09–$130.50	—	15%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$106.25	$125.00	$13.39–$121.25	89% above	15%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$106.25	$125.00	$13.39–$121.25	—	15%
Complete blood count (CBC) with differential CPT 85025 HF CBC	$9.35	$11.00	$4.29–$11.00	76% below	15%
Complete blood count (CBC) with differential CPT 85025 CBC	$101.15	$119.00	$7.77–$115.43	159% above	15%
Complete blood count (CBC) with differential inpatient CPT 85025 HF CBC	$9.35	$11.00	$4.29–$11.00	—	15%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC	$101.15	$119.00	$7.77–$115.43	—	15%
Comprehensive metabolic panel (blood test) CPT 80053 HF COMPREHENSIVE METABOLIC PANEL	$16.15	$19.00	$7.41–$19.00	70% below	15%
Comprehensive metabolic panel (blood test) CPT 80053 CHEM 20	$137.70	$162.00	$10.56–$157.14	158% above	15%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$169.58	$199.50	$10.56–$193.52	217% above	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HF COMPREHENSIVE METABOLIC PANEL	$16.15	$19.00	$7.41–$19.00	—	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CHEM 20	$137.70	$162.00	$10.56–$157.14	—	15%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$169.58	$199.50	$10.56–$193.52	—	15%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER (LABCORP)	$20.83	$24.50	$9.56–$24.50	76% below	15%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$157.68	$185.50	$10.18–$179.94	79% above	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER (LABCORP)	$20.83	$24.50	$9.56–$24.50	—	15%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$157.68	$185.50	$10.18–$179.94	—	15%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS	$229.08	$269.50	$22.23–$261.42	142% above	15%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEAS	$229.08	$269.50	$22.23–$261.42	—	15%
Estradiol blood test CPT 82670 ESTRADIOL	$234.18	$275.50	$27.94–$267.24	73% above	15%
Estradiol blood test CPT 82670 ESTRADIOL, ULTRASENSITIVE	$393.13	$462.50	$27.94–$448.62	191% above	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$234.18	$275.50	$27.94–$267.24	—	15%
Estradiol blood test inpatient CPT 82670 ESTRADIOL, ULTRASENSITIVE	$393.13	$462.50	$27.94–$448.62	—	15%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATING HORMONE (FSH)	$202.30	$238.00	$18.58–$230.86	93% above	15%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FOLLICLE STIMULATING HORMONE (FSH)	$202.30	$238.00	$18.58–$230.86	—	15%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN, FECAL	$303.88	$357.50	$19.63–$346.78	76% above	15%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN, FECAL	$303.88	$357.50	$19.63–$346.78	—	15%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$86.28	$101.50	$13.63–$98.46	26% above	15%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$86.28	$101.50	$13.63–$98.46	—	15%
Folate (folic acid) blood test CPT 82746 FOLATE	$121.13	$142.50	$14.70–$138.22	67% above	15%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$121.13	$142.50	$14.70–$138.22	—	15%
Free T3 thyroid hormone test CPT 84481 T3-FREE REFERENCE LAB	$89.25	$105.00	$16.94–$101.85	21% above	15%
Free T3 thyroid hormone test CPT 84481 *T3-FREE	$265.63	$312.50	$16.94–$303.12	259% above	15%
Free T3 thyroid hormone test inpatient CPT 84481 T3-FREE REFERENCE LAB	$89.25	$105.00	$16.94–$101.85	—	15%
Free T3 thyroid hormone test inpatient CPT 84481 *T3-FREE	$265.63	$312.50	$16.94–$303.12	—	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4-FREE REFERENCE LAB	$89.25	$105.00	$9.02–$101.85	106% above	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4-FREE	$90.53	$106.50	$9.02–$103.30	109% above	15%
Free T4 (free thyroxine) thyroid blood test CPT 84439 *T4-FREE REFERENCE LAB	$185.30	$218.00	$9.02–$211.46	328% above	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4-FREE REFERENCE LAB	$89.25	$105.00	$9.02–$101.85	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4-FREE	$90.53	$106.50	$9.02–$103.30	—	15%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 *T4-FREE REFERENCE LAB	$185.30	$218.00	$9.02–$211.46	—	15%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$155.98	$183.50	$25.47–$178.00	46% above	15%
Free testosterone test CPT 84402 TESTOSTERONE F/T/BIO	$263.50	$310.00	$25.47–$300.70	146% above	15%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$155.98	$183.50	$25.47–$178.00	—	15%
Free testosterone test inpatient CPT 84402 TESTOSTERONE F/T/BIO	$263.50	$310.00	$25.47–$300.70	—	15%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GEN HEALTH PANEL	$218.45	$257.00	$100.23–$249.29	19% above	15%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 GEN HEALTH PANEL	$218.45	$257.00	$100.23–$249.29	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE STANDARD 2HR	$82.45	$97.00	$4.75–$94.09	194% above	15%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TOLERANCE GESTATIONAL SCREEN	$118.15	$139.00	$4.75–$134.83	322% above	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE STANDARD 2HR	$82.45	$97.00	$4.75–$94.09	—	15%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE TOLERANCE GESTATIONAL SCREEN	$118.15	$139.00	$4.75–$134.83	—	15%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 6 HOURS	$194.65	$229.00	$12.87–$222.13	164% above	15%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 5 HOURS	$194.65	$229.00	$12.87–$222.13	164% above	15%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST 4 HOURS	$194.65	$229.00	$12.87–$222.13	164% above	15%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE GESTATIONAL	$202.73	$238.50	$12.87–$231.34	175% above	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST 5 HOURS	$194.65	$229.00	$12.87–$222.13	—	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST 6 HOURS	$194.65	$229.00	$12.87–$222.13	—	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST 4 HOURS	$194.65	$229.00	$12.87–$222.13	—	15%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE GESTATIONAL	$202.73	$238.50	$12.87–$231.34	—	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GONOCOCCUS BY NUCLEIC ACID AMPLIFICA	$102.00	$120.00	$35.09–$120.00	at median	15%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GONOCOCCUS BY NUCLEIC ACID AMPLIFICA	$102.00	$120.00	$35.09–$120.00	—	15%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL AGS	$121.13	$142.50	$14.38–$138.22	33% above	15%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL AGS	$121.13	$142.50	$14.38–$138.22	—	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA QUANT PCR	$130.05	$153.00	$59.67–$153.00	66% below	15%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 PCR QUANT RNA HIV	$586.93	$690.50	$85.10–$669.78	55% above	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA QUANT PCR	$130.05	$153.00	$59.67–$153.00	—	15%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 PCR QUANT RNA HIV	$586.93	$690.50	$85.10–$669.78	—	15%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 RAPID	$46.33	$54.50	$13.71–$54.50	54% below	15%
HIV-1 and HIV-2 antibody test CPT 86703 HIV-1 & 2 ANTIBODIES-MOST COMMON ORDER	$169.15	$199.00	$13.71–$193.03	68% above	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 RAPID	$46.33	$54.50	$13.71–$54.50	—	15%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV-1 & 2 ANTIBODIES-MOST COMMON ORDER	$169.15	$199.00	$13.71–$193.03	—	15%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV TYPING HIGH/LOW RISK	$97.75	$115.00	$35.09–$115.00	9% above	15%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV TYPING HIGH/LOW RISK	$97.75	$115.00	$35.09–$115.00	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HF HgB A1c	$24.65	$29.00	$9.71–$29.00	43% below	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HgB A1c	$95.63	$112.50	$9.71–$109.12	122% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB A1C REFERENCE LAB	$95.63	$112.50	$9.71–$109.12	122% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOHEMOGLOBIN	$109.65	$129.00	$9.71–$125.13	155% above	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HF HgB A1c	$24.65	$29.00	$9.71–$29.00	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB A1C REFERENCE LAB	$95.63	$112.50	$9.71–$109.12	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HgB A1c	$95.63	$112.50	$9.71–$109.12	—	15%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOHEMOGLOBIN	$109.65	$129.00	$9.71–$125.13	—	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY	$82.45	$97.00	$10.74–$94.09	63% above	15%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEP B SURFACE ANTIBODY	$82.45	$97.00	$10.74–$94.09	—	15%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B SURFACE AG	$151.30	$178.00	$10.33–$172.66	210% above	15%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEP B SURFACE AG	$151.30	$178.00	$10.33–$172.66	—	15%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$132.18	$155.50	$14.27–$150.84	112% above	15%
Hepatitis C antibody blood test (screening) one side CPT 86803 HEPATITIS C AB W/REFLEX TO QUANT PCR-RT	$25.50	$30.00	$11.70–$30.00	59% below	15%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$132.18	$155.50	$14.27–$150.84	—	15%
Hepatitis C antibody blood test (screening) inpatient one side CPT 86803 HEPATITIS C AB W/REFLEX TO QUANT PCR-RT	$25.50	$30.00	$11.70–$30.00	—	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA, DIAGNOSIS	$68.43	$80.50	$31.40–$80.50	67% below	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT GENOTYPING REFLEX CHARGE	$109.65	$129.00	$42.84–$129.00	47% below	15%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEP C QUANT, RNA PCR RFX TO GENOTYPING	$110.08	$129.50	$42.84–$129.50	46% below	15%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RT-PCR, QUANT	$73.53	$86.50	$33.74–$86.50	64% below	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA, DIAGNOSIS	$68.43	$80.50	$31.40–$80.50	—	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT GENOTYPING REFLEX CHARGE	$109.65	$129.00	$42.84–$129.00	—	15%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEP C QUANT, RNA PCR RFX TO GENOTYPING	$110.08	$129.50	$42.84–$129.50	—	15%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RT-PCR, QUANT	$73.53	$86.50	$33.74–$86.50	—	15%
Herpes blood test, HSV-1 antibody CPT 86695 HSV TYPE 1 SPECIFIC ANTIBODIES, IgG	$29.33	$34.50	$13.19–$33.46	25% below	15%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1/2 IGG	$57.38	$67.50	$13.19–$65.48	46% above	15%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV TYPE 1 SPECIFIC ANTIBODIES, IgG	$29.33	$34.50	$13.19–$33.46	—	15%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1/2 IGG	$57.38	$67.50	$13.19–$65.48	—	15%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 2 SPECIFIC ANTIBODIES, IgG	$43.78	$51.50	$19.35–$51.50	32% below	15%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 1 AND 2, IgM ANTIBODIES INDIREC	$46.33	$54.50	$19.35–$54.50	28% below	15%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 2 SPECIFIC ANTIBODIES, IgG	$43.78	$51.50	$19.35–$51.50	—	15%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 1 AND 2, IgM ANTIBODIES INDIREC	$46.33	$54.50	$19.35–$54.50	—	15%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRPhs	$110.93	$130.50	$12.95–$126.58	74% above	15%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRPhs	$110.93	$130.50	$12.95–$126.58	—	15%
Homocysteine blood test CPT 83090 XHOMOCYSTEINE	$34.85	$41.00	$15.99–$41.00	56% below	15%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$218.45	$257.00	$17.92–$249.29	173% above	15%
Homocysteine blood test inpatient CPT 83090 XHOMOCYSTEINE	$34.85	$41.00	$15.99–$41.00	—	15%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$218.45	$257.00	$17.92–$249.29	—	15%
Insulin blood test CPT 83525 INSULIN	$91.38	$107.50	$11.43–$104.28	37% above	15%
Insulin blood test CPT 83525 INSULIN RESISTANCE PANEL	$91.38	$107.50	$11.43–$104.28	37% above	15%
Insulin blood test CPT 83525 INSULIN, FREE AND TOTAL	$124.10	$146.00	$11.43–$141.62	86% above	15%
Insulin blood test inpatient CPT 83525 INSULIN	$91.38	$107.50	$11.43–$104.28	—	15%
Insulin blood test inpatient CPT 83525 INSULIN RESISTANCE PANEL	$91.38	$107.50	$11.43–$104.28	—	15%
Insulin blood test inpatient CPT 83525 INSULIN, FREE AND TOTAL	$124.10	$146.00	$11.43–$141.62	—	15%
Iron blood test (serum iron) CPT 83540 IRON (SERUM OR PLASMA)	$50.58	$59.50	$6.47–$57.72	61% above	15%
Iron blood test (serum iron) CPT 83540 TRANSFERRIN SATURATION	$72.25	$85.00	$6.47–$82.45	129% above	15%
Iron blood test (serum iron) inpatient CPT 83540 IRON (SERUM OR PLASMA)	$50.58	$59.50	$6.47–$57.72	—	15%
Iron blood test (serum iron) inpatient CPT 83540 TRANSFERRIN SATURATION	$72.25	$85.00	$6.47–$82.45	—	15%
Iron-binding capacity (TIBC) test CPT 83550 TIBC (INCLUDES IRON)	$98.60	$116.00	$8.74–$112.52	127% above	15%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC (INCLUDES IRON)	$98.60	$116.00	$8.74–$112.52	—	15%
Kidney function blood test panel CPT 80069 RENAL PANEL	$126.23	$148.50	$8.68–$144.04	103% above	15%
Kidney function blood test panel inpatient CPT 80069 RENAL PANEL	$126.23	$148.50	$8.68–$144.04	—	15%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$105.40	$124.00	$6.89–$120.28	67% above	15%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$105.40	$124.00	$6.89–$120.28	—	15%
Liver function blood test panel CPT 80076 LIVER PANEL	$122.40	$144.00	$8.17–$139.68	162% above	15%
Liver function blood test panel inpatient CPT 80076 LIVER PANEL	$122.40	$144.00	$8.17–$139.68	—	15%
Lyme disease antibody test CPT 86618 .LYME DISEASE TOTAL ABS W/ REFLEX	$95.20	$112.00	$17.03–$108.64	14% above	15%
Lyme disease antibody test CPT 86618 LYME DISEASE TOTAL ABS IGG/IGM	$98.60	$116.00	$17.03–$112.52	19% above	15%
Lyme disease antibody test inpatient CPT 86618 .LYME DISEASE TOTAL ABS W/ REFLEX	$95.20	$112.00	$17.03–$108.64	—	15%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE TOTAL ABS IGG/IGM	$98.60	$116.00	$17.03–$112.52	—	15%
Magnesium blood test CPT 83735 KIDNEY STONE 8	$22.53	$26.50	$6.70–$26.50	41% below	15%
Magnesium blood test CPT 83735 MAGNESIUM, RBC	$23.38	$27.50	$6.70–$27.50	39% below	15%
Magnesium blood test CPT 83735 URINE MAGNESIUM 24HR	$50.58	$59.50	$6.70–$57.72	33% above	15%
Magnesium blood test CPT 83735 MAGNESIUM	$76.50	$90.00	$6.70–$87.30	101% above	15%
Magnesium blood test inpatient CPT 83735 KIDNEY STONE 8	$22.53	$26.50	$6.70–$26.50	—	15%
Magnesium blood test inpatient CPT 83735 MAGNESIUM, RBC	$23.38	$27.50	$6.70–$27.50	—	15%
Magnesium blood test inpatient CPT 83735 URINE MAGNESIUM 24HR	$50.58	$59.50	$6.70–$57.72	—	15%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$76.50	$90.00	$6.70–$87.30	—	15%
Measles (rubeola) antibody test CPT 86765 RUBEOLA	$82.45	$97.00	$12.88–$94.09	37% above	15%
Measles (rubeola) antibody test CPT 86765 ACUTE MEASLES PANEL, IGM AB AND PCR	$119.43	$140.50	$12.88–$136.28	98% above	15%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA	$82.45	$97.00	$12.88–$94.09	—	15%
Measles (rubeola) antibody test inpatient CPT 86765 ACUTE MEASLES PANEL, IGM AB AND PCR	$119.43	$140.50	$12.88–$136.28	—	15%
Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONO (RAPID)	$79.48	$93.50	$5.18–$90.70	72% above	15%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 INFECTIOUS MONO (RAPID)	$79.48	$93.50	$5.18–$90.70	—	15%
Obstetric blood test panel CPT 80055 .OB PROFILE REFERENCE LAB	$363.80	$428.00	$47.81–$415.16	33% above	15%
Obstetric blood test panel inpatient CPT 80055 .OB PROFILE REFERENCE LAB	$363.80	$428.00	$47.81–$415.16	—	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA-ULTRA SENSITIVE	$107.53	$126.50	$18.39–$122.70	27% above	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (REFERENCE LAB)	$137.70	$162.00	$18.39–$157.14	62% above	15%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA-FREE+TOTAL	$179.78	$211.50	$18.39–$205.16	112% above	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA-ULTRA SENSITIVE	$107.53	$126.50	$18.39–$122.70	—	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (REFERENCE LAB)	$137.70	$162.00	$18.39–$157.14	—	15%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA-FREE+TOTAL	$179.78	$211.50	$18.39–$205.16	—	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING	$121.13	$142.50	$18.39–$138.22	32% above	15%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA	$137.70	$162.00	$18.39–$157.14	50% above	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING	$121.13	$142.50	$18.39–$138.22	—	15%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA	$137.70	$162.00	$18.39–$157.14	—	15%
Pap test (liquid-based, automated screening with review) CPT 88175 THIN PREP SCREENED BY AUTO SYSTEM	$67.58	$79.50	$26.61–$79.50	37% below	15%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 THIN PREP SCREENED BY AUTO SYSTEM	$67.58	$79.50	$26.61–$79.50	—	15%
Parathyroid hormone (PTH) blood test CPT 83970 PTH INTACT(PARATHYROID HORMONE INTAC	$137.70	$162.00	$41.28–$162.00	25% below	15%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH INTACT(PARATHYROID HORMONE INTAC	$137.70	$162.00	$41.28–$162.00	—	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 XPTT	$34.85	$41.00	$6.01–$39.77	18% below	15%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT	$96.90	$114.00	$6.01–$110.58	129% above	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 XPTT	$34.85	$41.00	$6.01–$39.77	—	15%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT	$96.90	$114.00	$6.01–$110.58	—	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MATERNI-T21 PLUS CORE+ESS	$612.85	$721.00	$281.19–$721.00	31% above	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MATERNI-T21 PLUS CORE	$650.25	$765.00	$298.35–$759.05	39% above	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MATERNI-T21 PLUS CORE+ESS+SCA	$797.30	$938.00	$365.82–$909.86	70% above	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MATERNI-T21 PLUS CORE + SCA	$900.15	$1,059.00	$413.01–$1,027.23	92% above	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MATERNI-T21 PLUS CORE+ESS	$612.85	$721.00	$281.19–$721.00	—	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MATERNI-T21 PLUS CORE	$650.25	$765.00	$298.35–$759.05	—	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MATERNI-T21 PLUS CORE+ESS+SCA	$797.30	$938.00	$365.82–$909.86	—	15%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MATERNI-T21 PLUS CORE + SCA	$900.15	$1,059.00	$413.01–$1,027.23	—	15%
Progesterone blood test CPT 84144 PROGESTERONE	$46.75	$55.00	$20.86–$55.00	51% below	15%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$46.75	$55.00	$20.86–$55.00	—	15%
Prolactin blood test CPT 84146 PROLACTIN	$76.50	$90.00	$19.38–$87.30	at median	15%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$76.50	$90.00	$19.38–$87.30	—	15%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME & INR	$67.58	$79.50	$4.29–$77.12	135% above	15%
Prothrombin time (PT/INR) clotting test CPT 85610 FIBRINOGEN (BLMH)	$67.58	$79.50	$4.29–$77.12	135% above	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 FIBRINOGEN (BLMH)	$67.58	$79.50	$4.29–$77.12	—	15%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME & INR	$67.58	$79.50	$4.29–$77.12	—	15%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN URINE INHOUSE	$56.10	$66.00	$12.11–$64.02	6% below	15%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN URINE INHOUSE	$56.10	$66.00	$12.11–$64.02	—	15%
Rheumatoid factor (RF) test CPT 86431 XRF	$19.55	$23.00	$5.67–$23.00	35% below	15%
Rheumatoid factor (RF) test CPT 86431 RF RHEUMATOID FACTOR (IgG)	$37.83	$44.50	$5.67–$43.16	27% above	15%
Rheumatoid factor (RF) test CPT 86431 RHEMATOID FACTOR (IgA)	$37.83	$44.50	$5.67–$43.16	27% above	15%
Rheumatoid factor (RF) test CPT 86431 RF RHEUMATOID FACTOR (IgM) MOST COMMON	$107.53	$126.50	$5.67–$122.70	260% above	15%
Rheumatoid factor (RF) test inpatient CPT 86431 XRF	$19.55	$23.00	$5.67–$23.00	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEMATOID FACTOR (IgA)	$37.83	$44.50	$5.67–$43.16	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RF RHEUMATOID FACTOR (IgG)	$37.83	$44.50	$5.67–$43.16	—	15%
Rheumatoid factor (RF) test inpatient CPT 86431 RF RHEUMATOID FACTOR (IgM) MOST COMMON	$107.53	$126.50	$5.67–$122.70	—	15%
Rubella antibody test (immunity check) CPT 86762 RUBELLA	$82.45	$97.00	$14.39–$94.09	55% above	15%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA	$82.45	$97.00	$14.39–$94.09	—	15%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 POST VAS SEMEN ANALYSIS	$116.03	$136.50	$12.31–$132.40	22% above	15%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 POST VAS SEMEN ANALYSIS	$116.03	$136.50	$12.31–$132.40	—	15%
Stool ova and parasites exam CPT 87177 OVA & PARASITES (LAB CORP)	$14.03	$16.50	$6.44–$16.50	64% below	15%
Stool ova and parasites exam CPT 87177 OVA & PARASITES	$172.98	$203.50	$8.90–$197.40	344% above	15%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES (LAB CORP)	$14.03	$16.50	$6.44–$16.50	—	15%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES	$172.98	$203.50	$8.90–$197.40	—	15%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD iFOB1	$56.10	$66.00	$15.92–$66.00	21% below	15%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD iFOB1	$56.10	$66.00	$15.92–$66.00	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR WITH REFLEX TO QUANT AND CONFIRM	$56.10	$66.00	$4.27–$64.02	70% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR	$56.10	$66.00	$4.27–$64.02	70% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SEXUALLY TRANSMITTED INFECTIONS PROFILE	$56.10	$66.00	$4.27–$64.02	70% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, CSF	$69.28	$81.50	$4.27–$79.06	110% above	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SEXUALLY TRANSMITTED INFECTIONS PROFILE	$56.10	$66.00	$4.27–$64.02	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR	$56.10	$66.00	$4.27–$64.02	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR WITH REFLEX TO QUANT AND CONFIRM	$56.10	$66.00	$4.27–$64.02	—	15%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, CSF	$69.28	$81.50	$4.27–$79.06	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB QUANT GOLD PLUS EMPLOYEE	$51.00	$60.00	$23.40–$60.00	75% below	15%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD PLUS	$234.60	$276.00	$61.98–$267.72	14% above	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB QUANT GOLD PLUS EMPLOYEE	$51.00	$60.00	$23.40–$60.00	—	15%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD PLUS	$234.60	$276.00	$61.98–$267.72	—	15%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL LC/MS-MS WOMEN/CHILD	$110.93	$130.50	$25.81–$126.58	4% below	15%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE	$132.18	$155.50	$25.81–$150.84	15% above	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL LC/MS-MS WOMEN/CHILD	$110.93	$130.50	$25.81–$126.58	—	15%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE	$132.18	$155.50	$25.81–$150.84	—	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE ANTIBODY	$137.70	$162.00	$14.55–$157.14	93% above	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID ANTIMICROSOMAL ANTIBODIES	$172.98	$203.50	$14.55–$197.40	142% above	15%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID ANTIBODIES	$354.03	$416.50	$14.55–$404.00	396% above	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE ANTIBODY	$137.70	$162.00	$14.55–$157.14	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID ANTIMICROSOMAL ANTIBODIES	$172.98	$203.50	$14.55–$197.40	—	15%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID ANTIBODIES	$354.03	$416.50	$14.55–$404.00	—	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HF TSH	$9.35	$11.00	$4.29–$11.00	88% below	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$91.38	$107.50	$16.80–$104.28	19% above	15%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID CASCADE PROFILE	$91.38	$107.50	$16.80–$104.28	19% above	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HF TSH	$9.35	$11.00	$4.29–$11.00	—	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$91.38	$107.50	$16.80–$104.28	—	15%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID CASCADE PROFILE	$91.38	$107.50	$16.80–$104.28	—	15%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS, NAA (URINE)	$55.68	$65.50	$25.55–$65.50	45% below	15%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS, NAA (URINE)	$55.68	$65.50	$25.55–$65.50	—	15%
Uric acid blood test CPT 84550 URIC ACID	$62.90	$74.00	$4.52–$71.78	124% above	15%
Uric acid blood test inpatient CPT 84550 URIC ACID	$62.90	$74.00	$4.52–$71.78	—	15%
Urinalysis with microscope exam, manual CPT 81000 .URINALYSIS WITH MICRO(CHG)	$67.15	$79.00	$3.62–$76.63	117% above	15%
Urinalysis with microscope exam, manual inpatient CPT 81000 .URINALYSIS WITH MICRO(CHG)	$67.15	$79.00	$3.62–$76.63	—	15%
Urinalysis without microscope exam, automated CPT 81003 KIDNEY STONE 1	$7.65	$9.00	$2.25–$9.00	38% below	15%
Urinalysis without microscope exam, automated inpatient CPT 81003 KIDNEY STONE 1	$7.65	$9.00	$2.25–$9.00	—	15%
Urinalysis without microscope exam, manual CPT 81002 SPECIFIC GRAVITY URINE	$32.73	$38.50	$3.13–$37.34	94% above	15%
Urinalysis without microscope exam, manual CPT 81002 .URINALYSIS W/O MICRO(CHG)	$72.68	$85.50	$3.13–$82.94	330% above	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 SPECIFIC GRAVITY URINE	$32.73	$38.50	$3.13–$37.34	—	15%
Urinalysis without microscope exam, manual inpatient CPT 81002 .URINALYSIS W/O MICRO(CHG)	$72.68	$85.50	$3.13–$82.94	—	15%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$93.50	$110.00	$8.07–$106.70	78% above	15%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE	$93.50	$110.00	$8.07–$106.70	—	15%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$143.23	$168.50	$15.08–$163.44	94% above	15%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$143.23	$168.50	$15.08–$163.44	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 OH (BLMH)	$137.70	$162.00	$29.60–$157.14	64% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 .VITAMIN D 25 OH	$137.70	$162.00	$29.60–$157.14	64% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 OH(D2+D3 FRACTIONATED	$236.73	$278.50	$29.60–$270.14	182% above	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 .VITAMIN D 25 OH	$137.70	$162.00	$29.60–$157.14	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 OH (BLMH)	$137.70	$162.00	$29.60–$157.14	—	15%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 OH(D2+D3 FRACTIONATED	$236.73	$278.50	$29.60–$270.14	—	15%
Zinc blood test CPT 84630 ZINC, RBC	$134.30	$158.00	$11.39–$153.26	99% above	15%
Zinc blood test CPT 84630 ZINC, SERUM OR PLASMA	$292.83	$344.50	$11.39–$334.16	333% above	15%
Zinc blood test inpatient CPT 84630 ZINC, RBC	$134.30	$158.00	$11.39–$153.26	—	15%
Zinc blood test inpatient CPT 84630 ZINC, SERUM OR PLASMA	$292.83	$344.50	$11.39–$334.16	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE REF LAB	$40.38	$47.50	$15.05–$47.50	49% below	15%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA QUANTITATIVE	$74.80	$88.00	$15.05–$85.36	6% below	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTITATIVE REF LAB	$40.38	$47.50	$15.05–$47.50	—	15%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA QUANTITATIVE	$74.80	$88.00	$15.05–$85.36	—	15%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Arthroscopic rotator cuff repair of the shoulder CPT 29827 ARTHROSCOPY, SHLDR, W/ ROTATOR CUFF	$2,649.03	$3,116.50	$893.28–$3,023.00	78% below	15%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLTX METATARSAL FX WO MANI	$509.15	$599.00	$219.14–$581.03	19% above	15%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 HALLUX VALGUS CORRECT W/ META OSTEOTO	$1,475.18	$1,735.50	$523.03–$1,683.44	74% below	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION, ELECTRICAL CONVER-ARHYTHM	$578.00	$680.00	$103.78–$659.60	61% below	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION-ELECTRICAL CONVER ARTHYMN	$578.00	$680.00	$103.78–$659.60	61% below	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ER	$811.33	$954.50	$145.25–$925.86	45% below	15%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$827.48	$973.50	$145.25–$944.30	44% below	15%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$827.48	$973.50	$145.25–$944.30	—	15%
Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL	$1,349.80	$1,588.00	$442.21–$1,540.36	49% below	15%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 CIRCUMCISION SURG EXCI > 28 DAYS	$322.15	$379.00	$168.94–$367.63	94% below	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION	$109.23	$128.50	$50.12–$128.50	39% below	15%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION	$109.23	$128.50	$50.12–$128.50	—	15%
Colonoscopy with polyp removal CPT 45385 COLONOSOPY W/LESION REMOVAL	$1,654.53	$1,946.50	$241.36–$1,888.10	28% below	15%
Colonoscopy with polyp removal CPT 45385 COLONOSOPY W/LESION REMOVAL	$1,746.33	$2,054.50	$464.31–$1,992.86	24% below	15%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSOPY W/LESION REMOVAL	$1,746.33	$2,054.50	$464.31–$1,992.86	—	15%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W/ BIOPSY	$937.98	$1,103.50	$191.45–$1,070.40	60% below	15%
Colonoscopy with tissue sample CPT 45380 COLONOSCOPY FLEXIBLE WITH BIOPSY	$1,568.68	$1,845.50	$444.57–$1,790.14	34% below	15%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY FLEXIBLE WITH BIOPSY	$1,568.68	$1,845.50	$444.57–$1,790.14	—	15%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY W/O BIOPSY	$913.75	$1,075.00	$176.95–$1,042.75	64% below	15%
Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLX DIAGNOSTIC	$1,820.28	$2,141.50	$350.23–$2,077.26	27% below	15%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLX DIAGNOSTIC	$1,820.28	$2,141.50	$350.23–$2,077.26	—	15%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$420.75	$495.00	$76.42–$480.15	50% below	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCT BENIGN PREMAL LESION 1ST	$334.90	$394.00	$61.83–$382.18	193% above	15%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCT BENIGN PREMAL LESION 1ST	$334.90	$394.00	$61.83–$382.18	—	15%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 TYMPANOSTOMY LOC/TOPICAL ANES UNIL	$456.03	$536.50	$187.17–$520.40	5% below	15%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 TYMPANOSTOMY LOC/TOPICAL ANES UNIL	$456.03	$536.50	$187.17–$520.40	—	15%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVE IMPACTED EAR WAX UNILAT	$106.68	$125.50	$15.52–$121.74	2% below	15%
Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN 1-2 EARS	$107.95	$127.00	$29.23–$123.19	33% above	15%
Earwax removal with instruments, one ear one side CPT 69210 REMOVE IMPACTED EAR WAX UNILAT	$106.68	$125.50	$44.47–$121.74	32% above	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 ANESTHESIA UNIT X 15MIN	$671.08	$789.50	$256.82–$765.82	53% below	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ DX/THER INTRLMNR CRV/THRC W IMAG	$681.28	$801.50	$256.82–$777.46	53% below	15%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 CERVIAL OR THORACIC EPIDURAL W/GUIDANCE	$681.28	$801.50	$256.82–$777.46	53% below	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 ANESTHESIA UNIT X 15MIN	$671.08	$789.50	$256.82–$765.82	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ DX/THER INTRLMNR CRV/THRC W IMAG	$681.28	$801.50	$256.82–$777.46	—	15%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 CERVIAL OR THORACIC EPIDURAL W/GUIDANCE	$681.28	$801.50	$256.82–$777.46	—	15%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 ANESTHESIA UNIT X 15MIN	$594.58	$699.50	$177.02–$678.52	39% below	15%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARA FA JNT L/S 1 LEV W GUID	$706.78	$831.50	$177.02–$806.56	27% below	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 ANESTHESIA UNIT X 15MIN	$594.58	$699.50	$177.02–$678.52	—	15%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARA FA JNT L/S 1 LEV W GUID	$706.78	$831.50	$177.02–$806.56	—	15%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR ANTERIOR ABDOMINAL HERIA 3-10 CM	$943.08	$1,109.50	$470.81–$1,076.22	89% below	15%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR ABDOMINAL HERIA	$813.03	$956.50	$283.67–$927.80	90% below	15%
Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY; CHOLECYSTECTOMY	$3,230.43	$3,800.50	$568.81–$3,686.48	71% below	15%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAP; CHOLE W/CHOLANIGIOGRAPHY	$3,777.83	$4,444.50	$615.61–$4,311.16	45% below	15%
Hammertoe correction surgery CPT 28285 REPAIR HAMMERTOE	$1,123.70	$1,322.00	$398.45–$1,282.34	46% below	15%
Hemorrhoidectomy (internal and external), one area CPT 46255 HEMORRHOIDECTOMY NTRNL/XTRNL 1 GROUP	$2,069.33	$2,434.50	$370.30–$2,361.46	21% below	15%
Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY SURGICAL W/ ENDO ABLATION1	$901.43	$1,060.50	$229.70–$1,060.50	92% below	15%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY W/ BIOPSY OF ENDOMETRIUM	$908.23	$1,068.50	$216.42–$1,068.50	70% below	15%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D OF ABSCESS	$369.33	$434.50	$119.54–$421.46	59% above	15%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE OF ABCESS	$381.65	$449.00	$119.54–$435.53	65% above	15%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D OF ABSCESS	$369.33	$434.50	$119.54–$421.46	—	15%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR HERNIA INGUINAL UNIL >5YRS	$1,794.35	$2,111.00	$457.51–$2,047.67	55% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ANESTHESIA UNIT X 15MIN	$195.08	$229.50	$63.42–$222.62	33% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHRO ASPIR INJECT JOINT OR BURSA	$271.15	$319.00	$63.42–$309.43	7% below	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHOCENTESIS LARGE JOINT	$299.20	$352.00	$42.18–$341.44	2% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION/INJECTION MAJOR JOINT	$681.28	$801.50	$63.42–$777.46	133% above	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ANESTHESIA UNIT X 15MIN	$195.08	$229.50	$63.42–$222.62	—	15%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION/INJECTION MAJOR JOINT	$681.28	$801.50	$63.42–$777.46	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ANESTHESIA UNIT X 15MIN	$150.45	$177.00	$53.12–$171.69	51% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHRO ASP INJ INTERME JT BURS WO US	$180.63	$212.50	$53.12–$206.12	41% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHRO ASP INJ INTERME JT BURS WO US	$263.93	$310.50	$53.12–$301.18	14% below	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ANESTHESIA UNIT X 15MIN	$150.45	$177.00	$53.12–$171.69	—	15%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHRO ASP INJ INTERME JT BURS WO US	$180.63	$212.50	$53.12–$206.12	—	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHOCENTESIS SMALL JOINT	$218.88	$257.50	$33.81–$249.78	24% below	15%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASPIR/INJ SMALL JT	$309.40	$364.00	$52.14–$353.08	7% above	15%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASPIR/INJ SMALL JT	$309.40	$364.00	$52.14–$353.08	—	15%
Knee arthroscopy with meniscus trim CPT 29881 ARTROSCOP KNEE W PARTIAL MENISECT	$1,468.80	$1,728.00	$471.85–$1,676.16	79% below	15%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 ARTHROSCOPY, KNEE, SURG; W/ MENISCECTOMY	$2,106.73	$2,478.50	$487.75–$2,404.14	69% below	15%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 ARTHROSCOPY, KNEE, SURG; DEBRIDE/SHAVE	$1,887.43	$2,220.50	$536.74–$2,153.88	73% below	15%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPRASCOPY APPENDECTOMY	$2,276.73	$2,678.50	$520.99–$2,598.14	50% below	15%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 LAPAROSCOPY SURG W/ TOTAL HYSTERECTOMY	$2,616.73	$3,078.50	$666.76–$2,986.14	88% below	15%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 LAP SURG W/ TOTAL HYST UTERUS 250G OR <	$2,533.43	$2,980.50	$757.13–$2,891.08	88% below	15%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAPAROSCOPY SURG RPR INIT INGUINAL HERNI	$830.03	$976.50	$382.49–$947.20	94% below	15%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPROSCOPY W RMVL ADNEXA STRUCTURES	$4,609.55	$5,423.00	$537.07–$5,260.31	40% below	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSE S,A,T,E EA ADD	$115.60	$136.00	$53.04–$136.00	64% below	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAC MED S/A/T/E <2.05	$365.93	$430.50	$167.90–$417.58	15% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSE S,A,T,E 2.5CM >LESS	$376.55	$443.00	$172.77–$429.71	18% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 I&D FOREIGN BODY SUBCU TISS SIMPLE	$422.45	$497.00	$193.83–$482.09	33% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REP INTMD SCLP AX TRNK EXT X HA FT 2.5 <	$497.68	$585.50	$143.04–$567.94	56% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LACER REP INTMED TRUNK, EXCLUD HANDS/FT	$497.68	$585.50	$143.04–$567.94	56% above	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSE S,A,T,E EA ADD	$115.60	$136.00	$53.04–$136.00	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSE S,A,T,E 2.5CM >LESS	$376.55	$443.00	$172.77–$429.71	—	15%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 I&D FOREIGN BODY SUBCU TISS SIMPLE	$422.45	$497.00	$193.83–$482.09	—	15%
Lower-back epidural injection, with imaging guidance CPT 62323 ANESTHESIA UNIT X 15MIN	$665.13	$782.50	$253.53–$759.02	46% below	15%
Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR OR SACRAL EPIDURAL WITH GUIDANCE	$668.53	$786.50	$253.53–$762.90	46% below	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 ANESTHESIA UNIT X 15MIN	$665.13	$782.50	$253.53–$759.02	—	15%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBAR OR SACRAL EPIDURAL WITH GUIDANCE	$668.53	$786.50	$253.53–$762.90	—	15%
Lower-back epidural injection, without imaging guidance CPT 62322 ANESTHESIA UNIT X 15MIN	$425.00	$500.00	$135.77–$485.00	62% below	15%
Lower-back epidural injection, without imaging guidance CPT 62322 STEROID EPIDURAL	$681.28	$801.50	$135.77–$777.46	38% below	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 ANESTHESIA UNIT X 15MIN	$425.00	$500.00	$135.77–$485.00	—	15%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 STEROID EPIDURAL	$681.28	$801.50	$135.77–$777.46	—	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TRANS EPI L/S 1ST LEVEL	$681.28	$801.50	$246.08–$777.46	59% below	15%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 ANESTHESIA UNIT X 15MIN	$771.80	$908.00	$246.08–$880.76	53% below	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TRANS EPI L/S 1ST LEVEL	$681.28	$801.50	$246.08–$777.46	—	15%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 ANESTHESIA UNIT X 15MIN	$771.80	$908.00	$246.08–$880.76	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN LES TRNK/ARM/LEG TO .5 CM	$237.15	$279.00	$81.74–$270.63	17% below	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC BENIGN LESION T,A,L <.5CM	$334.90	$394.00	$118.40–$382.18	17% above	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TUMOR S TISS F,S <.5CM	$930.75	$1,095.00	$118.40–$1,062.15	224% above	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC BENIGN LESION T,A,L <.5CM	$334.90	$394.00	$118.40–$382.18	—	15%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC TUMOR S TISS F,S <.5CM	$930.75	$1,095.00	$118.40–$1,062.15	—	15%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC BENIGN LES FACE ETC TO .5 CM	$383.35	$451.00	$104.79–$437.47	54% above	15%
Nail removal (partial or complete), one nail CPT 11730 AVUL NAIL PLATE PART/COMP SINGLE	$240.55	$283.00	$53.36–$274.51	20% above	15%
Nail removal (partial or complete), one nail CPT 11730 NAIL REMOVAL SINGLE	$262.23	$308.50	$104.17–$299.24	31% above	15%
Nail removal (partial or complete), one nail CPT 11730 NAIL REMOVEL 1	$392.28	$461.50	$104.17–$447.66	96% above	15%
Nail removal (partial or complete), one nail inpatient CPT 11730 NAIL REMOVEL 1	$392.28	$461.50	$104.17–$447.66	—	15%
Occipital nerve block (injection for headaches) CPT 64405 ANESTHESIA UNIT X 15MIN	$320.88	$377.50	$71.84–$366.18	9% below	15%
Occipital nerve block (injection for headaches) CPT 64405 OCCIPITAL NERVE BLOCK	$681.28	$801.50	$71.84–$777.46	94% above	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 ANESTHESIA UNIT X 15MIN	$320.88	$377.50	$71.84–$366.18	—	15%
Occipital nerve block (injection for headaches) inpatient CPT 64405 OCCIPITAL NERVE BLOCK	$681.28	$801.50	$71.84–$777.46	—	15%
Paracentesis with imaging guidance CPT 49083 US PARACENTESIS W/ IMAGING GUIDANCE	$511.70	$602.00	$234.78–$583.94	62% below	15%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTISIS W IMAGING GUIDANCE	$793.48	$933.50	$263.58–$905.50	40% below	15%
Paracentesis with imaging guidance inpatient CPT 49083 US PARACENTESIS W/ IMAGING GUIDANCE	$511.70	$602.00	$234.78–$583.94	—	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION INGROWN TOENAIL PART OR COMPLET	$523.18	$615.50	$101.98–$597.04	38% above	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED, PERMANENT	$671.50	$790.00	$147.06–$766.30	77% above	15%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 NAIL-MATRIX EXC	$719.10	$846.00	$147.06–$820.62	89% above	15%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 NAIL-MATRIX EXC	$719.10	$846.00	$147.06–$820.62	—	15%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 ANESTHESIA UNIT X 15MIN	$1,068.45	$1,257.00	$432.07–$1,219.29	66% below	15%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 FJN LUMB/SAC SINGLE	$2,012.80	$2,368.00	$432.07–$2,296.96	36% below	15%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 ANESTHESIA UNIT X 15MIN	$1,068.45	$1,257.00	$432.07–$1,219.29	—	15%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 FJN LUMB/SAC SINGLE	$2,012.80	$2,368.00	$432.07–$2,296.96	—	15%
Removal of a foreign object under the skin, simple CPT 10120 FB REMOVAL SUBCU TISSUE SIMPLE	$348.93	$410.50	$145.82–$398.18	at median	15%
Removal of a foreign object under the skin, simple CPT 10120 INCISION &REMOVAL FB SKIN SIMPLE	$349.78	$411.50	$109.39–$399.16	at median	15%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY ON INDIV NOT HIGH RISK	$850.85	$1,001.00	$177.13–$970.97	66% below	15%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLONOSCOPY SCRN NOT HI RSK IND	$1,568.68	$1,845.50	$350.38–$1,790.14	37% below	15%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLONOSCOPY SCRN NOT HI RSK IND	$1,568.68	$1,845.50	$350.38–$1,790.14	—	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY ON INDIV AT HIGH RISK	$878.48	$1,033.50	$176.95–$1,002.50	63% below	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLONOSCOPY HIGH RISK	$1,807.10	$2,126.00	$350.23–$2,062.22	24% below	15%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLONOSCOPY HIGH RISK	$1,807.10	$2,126.00	$350.23–$2,062.22	—	15%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY EXTRACORPOREAL SHOCK WAVE	$704.45	$828.77	$381.23–$803.91	92% below	15%
Short arm cast (elbow to hand) CPT 29075 APPLICATION FOREARM CAST	$351.48	$413.50	$89.64–$401.10	61% above	15%
Short arm cast (elbow to hand) CPT 29075 CAST ELBOW TO FINGER	$368.90	$434.00	$89.64–$420.98	69% above	15%
Short arm cast (elbow to hand) inpatient CPT 29075 CAST ELBOW TO FINGER	$368.90	$434.00	$89.64–$420.98	—	15%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT (FOREARM TO HAND)	$217.60	$256.00	$43.42–$248.32	30% above	15%
Short arm splint (forearm and hand) CPT 29125 SHORT ARM SPLINT APPLICATION	$217.60	$256.00	$43.42–$248.32	30% above	15%
Short arm splint (forearm and hand) CPT 29125 SPLINT APP SHORT ARM	$297.93	$350.50	$72.79–$339.98	78% above	15%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SPLINT FOREARM	$297.93	$350.50	$72.79–$339.98	78% above	15%
Short arm splint (forearm and hand) inpatient CPT 29125 SPLINT APP SHORT ARM	$297.93	$350.50	$72.79–$339.98	—	15%
Short leg cast (below the knee) CPT 29405 CAST LEG BELOW KNEE	$393.98	$463.50	$80.96–$449.60	115% above	15%
Short leg cast (below the knee) CPT 29405 APPLICATION CAST SHORT LEG BELOW KNEE	$393.98	$463.50	$80.96–$449.60	115% above	15%
Short leg cast (below the knee) inpatient CPT 29405 CAST LEG BELOW KNEE	$393.98	$463.50	$80.96–$449.60	—	15%
Short leg splint (calf to foot) CPT 29515 APPLICATION OF SHORT LEG SPLINT (CALF TO	$240.13	$282.50	$52.77–$274.02	18% above	15%
Short leg splint (calf to foot) CPT 29515 SPLINT APP SH LEG CALF TO FOOT	$280.93	$330.50	$76.01–$320.58	39% above	15%
Short leg splint (calf to foot) CPT 29515 APPLICATION SPLINT LOWER LEG/ANKLE	$303.88	$357.50	$76.01–$346.78	50% above	15%
Short leg splint (calf to foot) inpatient CPT 29515 SPLINT APP SH LEG CALF TO FOOT	$280.93	$330.50	$76.01–$320.58	—	15%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 ARTHROSCOPY, SHLDR, W/ DIS CLAVICULECTOM	$2,055.30	$2,418.00	$584.97–$2,345.46	64% below	15%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSCOPY, SHLDR, DECOMPRESS	$2,045.53	$2,406.50	$134.99–$2,334.30	28% below	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR 2.5 CM OR LESS	$299.63	$352.50	$46.08–$341.92	33% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR SCALP, NCK, AXILLAE 2.5 <	$299.63	$352.50	$46.08–$341.92	33% above	15%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 LAC SIMPLE <2.5	$331.93	$390.50	$104.29–$378.78	48% above	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC LESION T,A,L <.5	$534.23	$628.50	$183.64–$609.64	at median	15%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11600 EXC LESION T,A,L <.5	$534.23	$628.50	$183.64–$609.64	—	15%
Skin tag removal, up to 15 tags CPT 11200 REM SKIN/MULTI FIBRO TAGS TO 15	$224.40	$264.00	$74.23–$256.08	54% above	15%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS<15	$231.63	$272.50	$85.75–$264.32	59% above	15%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS<15	$231.63	$272.50	$85.75–$264.32	—	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 ANESTHESIA UNIT X 15MIN	$226.10	$266.00	$103.74–$258.02	72% below	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LUMBAR SPINAL PUNCTURE	$760.75	$895.00	$150.65–$868.15	5% below	15%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$776.90	$914.00	$150.65–$886.58	3% below	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 ANESTHESIA UNIT X 15MIN	$226.10	$266.00	$103.74–$258.02	—	15%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 LUMBAR PUNCTURE	$776.90	$914.00	$150.65–$886.58	—	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REP SIMPLE SCALP ETC 2.5 CM TO 7.5 CM	$365.93	$430.50	$60.08–$417.58	47% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR SCALP NCK 2.6 CM TO 7.5 CM	$365.93	$430.50	$60.08–$417.58	47% above	15%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 LAC SIMPLE 2.6 TO 7.5	$377.40	$444.00	$127.52–$430.68	52% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 LAC FACE/EAR SIMPLE <2.5 CM	$327.25	$385.00	$127.79–$373.45	22% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE RPR FACE EARS EYES ETC 2.5 <	$365.93	$430.50	$56.84–$417.58	37% above	15%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMP RPR FACE EAR ETC 2.5 CM OR LESS	$365.93	$430.50	$56.84–$417.58	37% above	15%
TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY TURP	$839.22	$987.32	$454.17–$957.70	93% below	15%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W/ IMAGINING GUIDANCE	$460.28	$541.50	$211.19–$525.26	60% below	15%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS W IMAGING GUIDANCE	$545.70	$642.00	$250.38–$622.74	53% below	15%
Thoracentesis with imaging guidance CPT 32555 CT ASPIRATE PLEURA W/IMAGING	$648.55	$763.00	$288.71–$740.11	44% below	15%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS W/ IMAGINING GUIDANCE	$460.28	$541.50	$211.19–$525.26	—	15%
Thoracentesis with imaging guidance inpatient CPT 32555 CT ASPIRATE PLEURA W/IMAGING	$648.55	$763.00	$288.71–$740.11	—	15%
Total hip replacement CPT 27130 TOTAL HIP ARTHOPLASTY	$4,490.13	$5,282.50	$1,059.65–$5,124.02	72% below	15%
Total knee replacement CPT 27447 REPLACEMENT KNEE TOTAL	$4,493.10	$5,286.00	$1,057.64–$5,127.42	72% below	15%
Total shoulder replacement CPT 23472 ARTHROPLASTY SHOULDER	$4,668.20	$5,492.00	$1,188.84–$5,327.24	73% below	15%
Trigger finger release surgery CPT 26055 INC TENDON SHEATH-TRIGGER FINGER	$1,005.98	$1,183.50	$303.61–$1,148.00	42% below	15%
Trigger point injections, 1 or 2 muscles CPT 20552 ANESTHESIA UNIT X 15MIN	$167.45	$197.00	$48.29–$191.09	11% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJECT/ONE OR TWO MUSCLES	$286.88	$337.50	$38.57–$327.38	89% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINTS	$480.25	$565.00	$48.29–$548.05	217% above	15%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINTS 1 -2 MUSCLES	$480.25	$565.00	$48.29–$548.05	217% above	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 ANESTHESIA UNIT X 15MIN	$167.45	$197.00	$48.29–$191.09	—	15%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINTS	$480.25	$565.00	$48.29–$548.05	—	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY RT	$1,643.48	$1,933.50	$440.57–$1,875.50	34% below	15%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY LT	$1,643.48	$1,933.50	$440.57–$1,875.50	34% below	15%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD BALLOON DILATION ESO <30MM	$1,745.90	$2,054.00	$147.02–$1,992.38	32% below	15%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD BALLOON DIL ESO <30MM DIAM	$1,789.68	$2,105.50	$821.15–$2,042.34	30% below	15%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 EGD BALLOON DIL ESO <30MM	$1,813.05	$2,133.00	$831.87–$2,069.01	29% below	15%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD BALLOON DIL ESO <30MM DIAM	$1,789.68	$2,105.50	$821.15–$2,042.34	—	15%
Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 EGD BALLOON DIL ESO <30MM	$1,813.05	$2,133.00	$831.87–$2,069.01	—	15%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD W/ BIOPSY SINGLE/MULTIPLE	$763.30	$898.00	$133.27–$871.06	57% below	15%
Upper endoscopy (EGD) with biopsy CPT 43239 EGD GASTROSCOPE W BIOPSY	$1,295.83	$1,524.50	$387.53–$1,478.76	27% below	15%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD GASTROSCOPE W BIOPSY	$1,295.83	$1,524.50	$387.53–$1,478.76	—	15%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$778.60	$916.00	$119.12–$888.52	62% below	15%
Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$1,001.73	$1,178.50	$298.71–$1,143.14	52% below	15%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 EGD DIAGNOSTIC BRUSH WASH	$1,001.73	$1,178.50	$298.71–$1,143.14	—	15%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 VASECTOMY	$669.80	$788.00	$307.32–$764.36	35% below	15%
Vasectomy, one or both sides, including follow-up semen testing inpatient CPT 55250 VASECTOMY	$669.80	$788.00	$307.32–$764.36	—	15%
Wart removal, up to 14 warts CPT 17110 DESTRUCT BENIGN LESION UP TO 14	$334.90	$394.00	$103.10–$382.18	64% above	15%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT BENIGN LESION UP TO 14	$334.90	$394.00	$103.10–$382.18	—	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT, SUB 1ST 20 SQ CM OR LESS	$107.95	$127.00	$58.42–$123.19	68% below	15%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT, SUB 1ST 20 SQ CM OR LESS	$285.60	$336.00	$122.67–$325.92	14% below	15%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT, SUB 1ST 20 SQ CM OR LESS	$285.60	$336.00	$122.67–$325.92	—	15%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPEN TRMNT DIST RAD XTRA ARTICULAR FRACT	$2,166.23	$2,548.50	$638.45–$2,472.04	77% below	15%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 1 UNIT	$940.53	$1,106.50	$43.19–$1,073.30	4% below	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN/UNIT OBSERVE	$940.53	$1,106.50	$43.19–$1,073.30	4% below	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN/UNIT OP	$949.45	$1,117.00	$43.19–$1,083.49	3% below	15%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION THERAPY PER VISIT	$991.10	$1,166.00	$43.19–$1,131.02	1% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 2 UNITS	$1,307.30	$1,538.00	$43.19–$1,491.86	34% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 3 UNITS	$1,626.48	$1,913.50	$43.19–$1,856.10	66% above	15%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN 4 UNITS	$1,996.65	$2,349.00	$43.19–$2,278.53	104% above	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 1 UNIT	$940.53	$1,106.50	$43.19–$1,073.30	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN/UNIT OBSERVE	$940.53	$1,106.50	$43.19–$1,073.30	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN/UNIT OP	$949.45	$1,117.00	$43.19–$1,083.49	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSION THERAPY PER VISIT	$991.10	$1,166.00	$43.19–$1,131.02	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 2 UNITS	$1,307.30	$1,538.00	$43.19–$1,491.86	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 3 UNITS	$1,626.48	$1,913.50	$43.19–$1,856.10	—	15%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN 4 UNITS	$1,996.65	$2,349.00	$43.19–$2,278.53	—	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT INHALATION TREATMENT	$133.45	$157.00	$7.84–$152.29	32% below	15%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT INHALATION TREATMENT	$133.45	$157.00	$7.84–$152.29	—	15%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR	$601.80	$708.00	$122.31–$686.76	11% below	15%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO IV INFUSION 1 HR	$601.80	$708.00	$122.31–$686.76	—	15%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE REQUIRE PHYS PRES 1ST HR	$535.50	$630.00	$216.55–$611.10	73% below	15%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 1ST 30 - 74 MIN	$1,707.65	$2,009.00	$289.40–$1,948.73	14% below	15%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG COMPLETE 12 LEADS W INTERP AND REP	$221.00	$260.00	$14.29–$252.20	93% above	15%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG COMPLETE 12 LEADS W INTERP AND REP	$221.00	$260.00	$14.29–$252.20	—	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$194.65	$229.00	$6.30–$222.13	6% above	15%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$194.65	$229.00	$6.30–$222.13	—	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER STRAIGHT	$107.95	$127.00	$10.36–$123.19	37% below	15%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 E&M LEVEL 1	$153.43	$180.50	$10.36–$175.08	11% below	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER LOW	$141.10	$166.00	$38.02–$161.02	50% below	15%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 E&M LEVEL 2	$438.60	$516.00	$38.02–$500.52	54% above	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER MODERATE	$179.78	$211.50	$65.21–$205.16	60% below	15%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 E&M LEVEL 3	$649.83	$764.50	$65.21–$741.56	44% above	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER MODERTATE COMPLX DEC	$265.20	$312.00	$110.88–$302.64	63% below	15%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 E&M LEVEL 4	$1,105.85	$1,301.00	$110.88–$1,261.97	54% above	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER HIGH	$310.68	$365.50	$161.16–$354.54	71% below	15%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 E&M LEVEL 5	$1,434.80	$1,688.00	$161.16–$1,637.36	35% above	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASC STRESS; TRACING ONLY	$128.78	$151.50	$35.65–$146.96	83% below	15%
Exercise stress test, tracing only, the hospital charge CPT 93017 NM CARDIO STRESS TEST W/O INTERPRET & R	$800.28	$941.50	$35.65–$913.26	6% above	15%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 NM CARDIO STRESS TEST W/O INTERPRET & R	$800.28	$941.50	$35.65–$913.26	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT 31 MIN-1 HOUR	$340.43	$400.50	$31.03–$388.48	at median	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INITIAL 1ST HR/31 - 60 MIN	$480.25	$565.00	$31.03–$548.05	41% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITIAL 1ST HR	$480.25	$565.00	$31.03–$548.05	41% above	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATION IV INFUSION INIT 31 MIN-1 HOUR	$340.43	$400.50	$31.03–$388.48	—	15%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITIAL 1ST HR	$480.25	$565.00	$31.03–$548.05	—	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION DRUG 1ST HR	$398.65	$469.00	$61.73–$454.93	15% below	15%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT	$404.60	$476.00	$61.73–$461.72	14% below	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION DRUG 1ST HR	$414.38	$487.50	$61.73–$472.88	12% below	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION DRUG 1ST HR	$447.95	$527.00	$61.73–$511.19	5% below	15%
IV infusion of a medicine, first hour CPT 96365 IV INFUSION DRUG 1ST HOUR	$447.95	$527.00	$61.73–$511.19	5% below	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION DRUG 1ST HR	$398.65	$469.00	$61.73–$454.93	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 THER/PROPH/DIAG IV INF INIT	$404.60	$476.00	$61.73–$461.72	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION DRUG 1ST HR	$414.38	$487.50	$61.73–$472.88	—	15%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INFUSION DRUG 1ST HOUR	$447.95	$527.00	$61.73–$511.19	—	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SQ/IM INJECTION	$71.83	$84.50	$14.44–$81.96	36% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SQ/IM INJECTION	$76.93	$90.50	$14.44–$87.78	32% below	15%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC / IM	$119.85	$141.00	$14.44–$136.77	7% above	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SQ/IM INJECTION	$71.83	$84.50	$14.44–$81.96	—	15%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC / IM	$119.85	$141.00	$14.44–$136.77	—	15%
Neuromuscular re-education, 15 minutes CPT 97112 OT NEURO RE-ED EA 15 MIN	$115.60	$136.00	$30.27–$131.92	43% above	15%
Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMUSCULAR RE-EDUCATION	$117.73	$138.50	$30.27–$134.34	45% above	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 OT NEURO RE-ED EA 15 MIN	$115.60	$136.00	$30.27–$131.92	—	15%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEUROMUSCULAR RE-EDUCATION	$117.73	$138.50	$30.27–$134.34	—	15%
Occupational therapy evaluation, low complexity CPT 97165 OT EVALUATION LOW COMPLEXITY	$227.38	$267.50	$78.17–$259.48	at median	15%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVALUATION LOW COMPLEXITY	$227.38	$267.50	$78.17–$259.48	—	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION HIGH COMPLEXITY	$249.05	$293.00	$94.00–$284.21	1% above	15%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION HIGH COMPLEXITY	$249.05	$293.00	$94.00–$284.21	—	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION LOW COMPLEXITY	$197.63	$232.50	$73.85–$225.52	2% below	15%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION LOW COMPLEXITY	$197.63	$232.50	$73.85–$225.52	—	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION MODERATE COMPLEXITY	$223.55	$263.00	$73.85–$255.11	at median	15%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION MODERATE COMPLEXITY	$223.55	$263.00	$73.85–$255.11	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY	$106.68	$125.50	$24.33–$121.74	57% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY TECHNIQUES 15 MIN	$117.73	$138.50	$24.33–$134.34	73% above	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 OT MANUAL THERAPY	$106.68	$125.50	$24.33–$121.74	—	15%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MANUAL THERAPY TECHNIQUES 15 MIN	$117.73	$138.50	$24.33–$134.34	—	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPUTIC EXERCISE- 15 MIN EACH	$81.60	$96.00	$26.48–$93.12	13% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC PROCEDURE 15 MIN	$110.08	$129.50	$26.48–$125.62	53% above	15%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE EA 15 MIN	$113.05	$133.00	$26.48–$129.01	57% above	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPUTIC EXERCISE- 15 MIN EACH	$81.60	$96.00	$26.48–$93.12	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC PROCEDURE 15 MIN	$110.08	$129.50	$26.48–$125.62	—	15%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE EA 15 MIN	$113.05	$133.00	$26.48–$129.01	—	15%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYC-ER CRISIS INTERVENTION 30-74 MIN	$226.95	$267.00	$104.13–$258.99	31% below	15%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYC-ER CRISIS INTERVENTION 30-74 MIN	$226.95	$267.00	$104.13–$258.99	—	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CONSULT LEVEL III	$202.30	$238.00	$63.23–$230.86	34% above	15%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 CLINIC E&M LEVEL3	$276.68	$325.50	$89.71–$315.74	84% above	15%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 CLINIC E&M LEVEL3	$276.68	$325.50	$89.71–$315.74	—	15%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST OUTPT L4 DTL H&E MOD COMPLX DEC	$252.03	$296.50	$92.90–$287.60	18% above	15%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 CLINIC E&M LEVEL2	$218.88	$257.50	$55.67–$249.78	129% above	15%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 CLINIC E&M LEVEL2	$218.88	$257.50	$55.67–$249.78	—	15%
Spirometry (breathing test) CPT 94010 RT SPMTRY W/VC EXPIRATORY FLO	$110.50	$130.00	$27.50–$126.10	54% below	15%
Spirometry (breathing test) inpatient CPT 94010 RT SPMTRY W/VC EXPIRATORY FLO	$110.50	$130.00	$27.50–$126.10	—	15%
Spirometry before and after a bronchodilator CPT 94060 RT PULMONARY FUNCTIONS TEST	$295.38	$347.50	$40.21–$337.08	37% below	15%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT PULMONARY FUNCTIONS TEST	$295.38	$347.50	$40.21–$337.08	—	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACTIVITY DIRECT PT CONTAC	$119.85	$141.00	$33.29–$136.77	39% above	15%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVITIES 15 MIN	$136.85	$161.00	$33.29–$156.17	59% above	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPEUTIC ACTIVITY DIRECT PT CONTAC	$119.85	$141.00	$33.29–$136.77	—	15%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTIC ACTIVITIES 15 MIN	$136.85	$161.00	$33.29–$156.17	—	15%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$221.85	$261.00	$89.60–$253.17	3% below	15%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$221.85	$261.00	$89.60–$253.17	—	15%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIOVASC STRESS; EKG MONITOR INTERP	$225.68	$265.50	$68.96–$257.54	25% above	15%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 NM CARDIO STRESS TEST W/INTERPRET & RPT	$900.15	$1,059.00	$68.96–$1,027.23	400% above	15%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 NM CARDIO STRESS TEST W/INTERPRET & RPT	$900.15	$1,059.00	$68.96–$1,027.23	—	15%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUZONE 0.5 ML 2025-2026	$44.63	$52.50	$19.77–$50.92	24% above	15%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE 0.5 ML 2025-2026	$44.63	$52.50	$19.77–$50.92	—	15%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGH-DOSE 0.5 ML 2025-2026	$83.30	$98.00	$38.22–$95.06	40% below	15%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HIGH-DOSE 0.5 ML 2025-2026	$83.30	$98.00	$38.22–$95.06	—	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR 20 0.5ML IM SUSP	$304.30	$358.00	$139.62–$347.26	26% below	15%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR 20 0.5ML IM SUSP	$304.30	$358.00	$139.62–$347.26	—	15%
RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 AREXVY (RSV) 120MCG/0.5ML	$816.85	$961.00	$374.79–$932.17	—	15%
RSV vaccine with adjuvant (Arexvy), one dose for older adults inpatient CPT 90679 AREXVY (RSV) 120MCG/0.5ML	$816.85	$961.00	$374.79–$932.17	—	15%
Rabies vaccine, one dose CPT 90675 RABAVERT IM PWD FOR SUSP 2.5IU	$1,030.63	$1,212.50	$318.06–$1,176.12	147% above	15%
Rabies vaccine, one dose CPT 90675 IMOVAX RABIES IM PWD FOR SUSP 2.5IU	$1,199.35	$1,411.00	$318.06–$1,368.67	187% above	15%
Rabies vaccine, one dose inpatient CPT 90675 RABAVERT IM PWD FOR SUSP 2.5IU	$1,030.63	$1,212.50	$318.06–$1,176.12	—	15%
Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES IM PWD FOR SUSP 2.5IU	$1,199.35	$1,411.00	$318.06–$1,368.67	—	15%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 SHINGRIX IM SUSP 50MCG/0.5ML	$588.63	$692.50	$270.08–$671.72	82% above	15%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 SHINGRIX IM SUSP 50MCG/0.5ML	$588.63	$692.50	$270.08–$671.72	—	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL IM SUSP 0.5ML (TDAP) 7 YRS >	$215.48	$253.50	$34.06–$245.90	171% above	15%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL IM SUSP 0.5ML (TDAP) 7 YRS >	$215.48	$253.50	$34.06–$245.90	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 TB INJECTION	$99.03	$116.50	$19.29–$113.00	71% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN 1 VACCINE	$99.03	$116.50	$19.29–$113.00	71% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 TETNUS 7 YR OR OLDER	$99.03	$116.50	$19.29–$113.00	71% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION 1 VACCINE	$99.03	$116.50	$19.29–$113.00	71% above	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 TETNUS 7 YR OR OLDER	$99.03	$116.50	$19.29–$113.00	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 TB INJECTION	$99.03	$116.50	$19.29–$113.00	—	15%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION 1 VACCINE	$99.03	$116.50	$19.29–$113.00	—	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EA ADDITNL	$56.10	$66.00	$15.00–$64.02	56% above	15%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMINISTRATION EACH ADDTL	$58.23	$68.50	$15.00–$66.44	62% above	15%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EA ADDITNL	$56.10	$66.00	$15.00–$64.02	—	15%

Source file: https://blmh.health/wp-content/uploads/2026/06/826001195_bear-lake-county-memorial-hospital_standardcharges.csv