Hospital

Roger Mills Memorial Hospital

Roger Mills Memorial Hospital in Cheyenne, OK publishes cash prices for 196 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 above the Oklahoma median for 127 of 191 procedures and below it for 61. By typical cash price it ranks #29 of 44 Oklahoma hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

501 South L.L. Males Avenue, Cheyenne, OK 73628 Collected Sep 28, 2026 Source price file (580) 497-3336

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 371303 · CMS hospital register

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 1 action for a hospital named Roger Mills Memorial Hospital in Cheyenne, OK:

Jul 2, 2026 Corrective action plan requested

Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE AP/LAT/OBLIQUE VIEW RIGHT	$215.25	$287.00	—	23% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE AP/LAT/OBLIQUE VIEW LEFT	$215.25	$287.00	—	23% above	25%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE AP/LAT/OBLIQUE VIEW LEFT	$215.25	$287.00	—	—	25%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR ANKLE AP/LAT/OBLIQUE VIEW RIGHT	$215.25	$287.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US LOWER EXTREMITY ARTERIAL LEFT	$421.50	$562.00	—	87% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US LOWER EXTREMITY ARTERIAL RIGHT	$421.50	$562.00	—	87% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US UPPER EXTREMITY ARTERIAL RIGHT	$421.50	$562.00	—	87% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US UPPER EXTREMITY ARTERIAL LEFT	$421.50	$562.00	—	87% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US UPPER EXTREMITY ARTERIAL RIGHT	$421.50	$562.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US UPPER EXTREMITY ARTERIAL LEFT	$421.50	$562.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US LOWER EXTREMITY ARTERIAL LEFT	$421.50	$562.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US LOWER EXTREMITY ARTERIAL RIGHT	$421.50	$562.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST	$1,434.00	$1,912.00	—	4% below	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST	$1,434.00	$1,912.00	—	—	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART	$480.75	$641.00	—	355% above	25%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART	$480.75	$641.00	—	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS	$1,797.00	$2,396.00	—	34% above	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN/PELVIS	$1,797.00	$2,396.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W/ ORAL AND IV CONTRAS	$2,281.50	$3,042.00	—	42% above	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W/ ORAL IV CONTRAST	$2,281.50	$3,042.00	—	42% above	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W/ IV CONTRAST	$2,281.50	$3,042.00	—	42% above	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS W/ IV CONTRAST	$2,281.50	$3,042.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS W/ ORAL IV CONTRAST	$2,281.50	$3,042.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS W/ ORAL AND IV CONTRAS	$2,281.50	$3,042.00	—	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN/PELVIS W/WO CONTRAST	$2,636.25	$3,515.00	—	39% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN/PELVIS W/WO CONTRAST	$2,636.25	$3,515.00	—	—	25%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ IV CONTRAST	$1,518.75	$2,025.00	—	27% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/ IV CONTRAST	$1,518.75	$2,025.00	—	—	25%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN	$1,176.75	$1,569.00	—	14% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN	$1,176.75	$1,569.00	—	—	25%
CT scan of the face and sinuses, no contrast dye both sides CPT 70486 CT TEMPORAL BONE BILATERAL	$1,209.75	$1,613.00	—	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL W/O CONTRAST	$1,209.75	$1,613.00	—	38% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS	$1,209.75	$1,613.00	—	38% above	25%
CT scan of the face and sinuses, no contrast dye inpatient both sides CPT 70486 CT TEMPORAL BONE BILATERAL	$1,209.75	$1,613.00	—	—	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT SINUS	$1,209.75	$1,613.00	—	—	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT FACIAL W/O CONTRAST	$1,209.75	$1,613.00	—	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD	$1,227.75	$1,637.00	—	29% above	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD	$1,227.75	$1,637.00	—	—	25%
CT scan of the head with contrast CPT 70460 CT HEAD W/ CONTRAST	$804.00	$1,072.00	—	34% below	25%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD W/ CONTRAST	$804.00	$1,072.00	—	—	25%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST	$1,623.75	$2,165.00	—	27% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST	$1,623.75	$2,165.00	—	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE	$1,573.50	$2,098.00	—	56% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE	$1,573.50	$2,098.00	—	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE	$1,513.50	$2,018.00	—	42% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE	$1,513.50	$2,018.00	—	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST	$804.00	$1,072.00	—	26% below	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/ CONTRAST	$804.00	$1,072.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID BILATERAL	$927.75	$1,237.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US CAROTID BILATERAL	$927.75	$1,237.00	—	—	25%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEW PA/LATERAL VIEW	$227.25	$303.00	—	83% above	25%
Chest X-ray, 2 views inpatient CPT 71046 XR CHEST 2 VIEW PA/LATERAL VIEW	$227.25	$303.00	—	—	25%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW (APICAL LORDOTIC)	$186.00	$248.00	—	4% above	25%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW AP (UPRIGHT)	$186.00	$248.00	—	4% above	25%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW PA (UPRIGHT)	$186.00	$248.00	—	4% above	25%
Chest X-ray, single view CPT 71045 XR CHEST SUPINE AP VIEW	$186.00	$248.00	—	4% above	25%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW (DECUBITUS)	$186.00	$248.00	—	4% above	25%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW PA (UPRIGHT)	$186.00	$248.00	—	—	25%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW (APICAL LORDOTIC)	$186.00	$248.00	—	—	25%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW (DECUBITUS)	$186.00	$248.00	—	—	25%
Chest X-ray, single view inpatient CPT 71045 XR CHEST SUPINE AP VIEW	$186.00	$248.00	—	—	25%
Chest X-ray, single view inpatient CPT 71045 XR CHEST 1 VIEW AP (UPRIGHT)	$186.00	$248.00	—	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys both sides CPT 76770 US RENAL BILATERAL	$548.25	$731.00	—	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient both sides CPT 76770 US RENAL BILATERAL	$548.25	$731.00	—	—	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BONE MINERAL DENSITY TEST	$75.75	$101.00	—	25% below	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BONE MINERAL DENSITY TEST	$75.75	$101.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST	$1,294.50	$1,726.00	—	36% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HIGH RESOLUTION	$1,294.50	$1,726.00	—	36% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST	$1,294.50	$1,726.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT CHEST HIGH RESOLUTION	$1,294.50	$1,726.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST	$1,602.75	$2,137.00	—	43% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT CHEST W/ CONTRAST	$1,602.75	$2,137.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LOWER EXTREMITY VENOUS BILATERAL	$927.75	$1,237.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UPPER EXTREMITY VENOUS BILATERAL	$927.75	$1,237.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LOWER EXTREMITY VENOUS BILATERAL	$927.75	$1,237.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US UPPER EXTREMITY VENOUS BILATERAL	$927.75	$1,237.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO W/COLOR & DOPPLER 93306	$1,264.50	$1,686.00	—	16% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO W/COLOR & DOPPLER 93306	$1,264.50	$1,686.00	—	—	25%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEW AP/LATERAL/SUNRISE LEFT	$244.50	$326.00	—	36% above	25%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEW AP/LATERAL/SUNRISE RIGHT	$244.50	$326.00	—	36% above	25%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEW AP/LATERAL/SUNRISE LEFT	$244.50	$326.00	—	—	25%
Knee X-ray, 3 views inpatient one side CPT 73562 XR KNEE 3 VIEW AP/LATERAL/SUNRISE RIGHT	$244.50	$326.00	—	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED	$421.50	$562.00	—	9% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN LIMITED	$421.50	$562.00	—	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT CHEST LOW DOSE	$1,095.75	$1,461.00	—	232% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT CHEST LOW DOSE	$1,095.75	$1,461.00	—	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIS COMPLETE	$548.25	$731.00	—	13% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIS COMPLETE	$548.25	$731.00	—	—	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 XR A.C. JOINTS 2 VIEW W/&W/OUT WEIGHTS	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 3 VIEW INT/EXT/Y-VIEW RIGHT	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AP VIEW LEFT	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER 3 VIEW INT/EXT/Y-VIEW LEFT	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AP VIEW RIGHT	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AP/LAT VIEW LEFT	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER AP/LAT VIEW RIGHT	$227.25	$303.00	—	17% above	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 XR A.C. JOINTS 2 VIEW W/&W/OUT WEIGHTS	$227.25	$303.00	—	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AP/LAT VIEW RIGHT	$227.25	$303.00	—	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AP VIEW RIGHT	$227.25	$303.00	—	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AP VIEW LEFT	$227.25	$303.00	—	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 3 VIEW INT/EXT/Y-VIEW LEFT	$227.25	$303.00	—	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER 3 VIEW INT/EXT/Y-VIEW RIGHT	$227.25	$303.00	—	—	25%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR SHOULDER AP/LAT VIEW LEFT	$227.25	$303.00	—	—	25%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$591.00	$788.00	—	56% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$591.00	$788.00	—	—	25%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$591.00	$788.00	—	12% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE	$591.00	$788.00	—	—	25%
Ultrasound of the scrotum and testicles both sides CPT 76870 US SCROTUM BILATERAL	$336.75	$449.00	—	—	25%
Ultrasound of the scrotum and testicles inpatient both sides CPT 76870 US SCROTUM BILATERAL	$336.75	$449.00	—	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUES OF HEAD AND NECK	$548.25	$731.00	—	34% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUES OF HEAD AND NECK	$548.25	$731.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UPPER EXTREMITY VENOUS LEFT	$591.00	$788.00	—	19% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXTREMITY VENOUS RIGHT	$591.00	$788.00	—	19% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXTREMITY VENOUS LEFT	$591.00	$788.00	—	19% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UPPER EXTREMITY VENOUS RIGHT	$591.00	$788.00	—	19% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UPPER EXTREMITY VENOUS LEFT	$591.00	$788.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UPPER EXTREMITY VENOUS RIGHT	$591.00	$788.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LOWER EXTREMITY VENOUS LEFT	$591.00	$788.00	—	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LOWER EXTREMITY VENOUS RIGHT	$591.00	$788.00	—	—	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 VIEW AP/LATERAL/OBLIQUE LEFT	$201.75	$269.00	—	12% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST 3 VIEW AP/LATERAL/OBLIQUE RIGHT	$201.75	$269.00	—	12% above	25%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEW AP/LATERAL/OBLIQUE RIGHT	$201.75	$269.00	—	—	25%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR WRIST 3 VIEW AP/LATERAL/OBLIQUE LEFT	$201.75	$269.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2 VIEW W/PELVIS IF DONE LEFT	$156.75	$209.00	—	13% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP AP/LATERAL VIEW RIGHT	$156.75	$209.00	—	13% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP AP/LATERAL VIEW LEFT	$156.75	$209.00	—	13% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2 VIEW UNI W/PELVIS IF DONE RIGHT	$156.75	$209.00	—	13% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP 2 VIEW UNI W/PELVIS IF DONE RIGHT	$156.75	$209.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP AP/LATERAL VIEW RIGHT	$156.75	$209.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP AP/LATERAL VIEW LEFT	$156.75	$209.00	—	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR HIP 2 VIEW W/PELVIS IF DONE LEFT	$156.75	$209.00	—	—	25%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW (UPRIGHT)	$181.50	$242.00	—	4% above	25%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW (KUB)	$181.50	$242.00	—	4% above	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW (KUB)	$181.50	$242.00	—	—	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW (UPRIGHT)	$181.50	$242.00	—	—	25%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE LAT VIEW RIGHT	$181.50	$242.00	—	12% above	25%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE LAT VIEW LEFT	$181.50	$242.00	—	12% above	25%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE AP/LAT VIEW LEFT	$181.50	$242.00	—	12% above	25%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE AP/LAT VIEW RIGHT	$181.50	$242.00	—	12% above	25%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE LAT VIEW RIGHT	$181.50	$242.00	—	—	25%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE AP/LAT VIEW RIGHT	$181.50	$242.00	—	—	25%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE AP/LAT VIEW LEFT	$181.50	$242.00	—	—	25%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR ANKLE LAT VIEW LEFT	$181.50	$242.00	—	—	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 2 VIEW AP/LATERAL RIGHT	$189.75	$253.00	—	18% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3 VIEW RIGHT	$189.75	$253.00	—	18% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 3 VIEW LEFT	$189.75	$253.00	—	18% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER 2 VIEW AP/LATERAL LEFT	$189.75	$253.00	—	18% above	25%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 2 VIEW AP/LATERAL RIGHT	$189.75	$253.00	—	—	25%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 2 VIEW AP/LATERAL LEFT	$189.75	$253.00	—	—	25%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 3 VIEW LEFT	$189.75	$253.00	—	—	25%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR FINGER 3 VIEW RIGHT	$189.75	$253.00	—	—	25%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT AP/LAT VIEW LEFT	$198.00	$264.00	—	22% above	25%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT AP/LAT VIEW RIGHT	$198.00	$264.00	—	22% above	25%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT AP/LAT VIEW LEFT	$198.00	$264.00	—	—	25%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR FOOT AP/LAT VIEW RIGHT	$198.00	$264.00	—	—	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT AP/LAT/OBLIQUE VIEW LEFT	$223.50	$298.00	—	16% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT AP/LAT/OBLIQUE VIEW RIGHT	$223.50	$298.00	—	16% above	25%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT AP/LAT/OBLIQUE VIEW LEFT	$223.50	$298.00	—	—	25%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR FOOT AP/LAT/OBLIQUE VIEW RIGHT	$223.50	$298.00	—	—	25%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND AP/LAT/OBLIQUE VIEW RIGHT	$211.50	$282.00	—	18% above	25%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND AP/LAT/OBLIQUE VIEW LEFT	$211.50	$282.00	—	18% above	25%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND AP/LAT/OBLIQUE VIEW RIGHT	$211.50	$282.00	—	—	25%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR HAND AP/LAT/OBLIQUE VIEW LEFT	$211.50	$282.00	—	—	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE AP/LATERAL VIEW LEFT	$207.00	$276.00	—	18% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE AP/LATERAL VIEW RIGHT	$207.00	$276.00	—	18% above	25%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE AP/LATERAL VIEW RIGHT	$207.00	$276.00	—	—	25%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR KNEE AP/LATERAL VIEW LEFT	$207.00	$276.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR L-SPINE 2 VIEW FLEXION/EXTENSION	$244.50	$326.00	—	16% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR L-SPINE 3 VIEW AP/LATERAL	$244.50	$326.00	—	16% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR L-SPINE 2 VIEW FLEXION/EXTENSION	$244.50	$326.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR L-SPINE 3 VIEW AP/LATERAL	$244.50	$326.00	—	—	25%
X-ray of the lower back, 4 or more views CPT 72110 XR L-SPINE 5 VIEW AP/LATERAL/OBLIQUES	$485.25	$647.00	—	67% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR L-SPINE 5 VIEW AP/LATERAL/OBLIQUES	$485.25	$647.00	—	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR T-SPINE 3 VIEWS AP/LATERAL/SWIMMERS	$287.25	$383.00	—	44% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR T-SPINE 2 VIEW FLEXION EXTENSION	$287.25	$383.00	—	44% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR T-SPINE 3 VIEWS AP/LATERAL/SWIMMERS	$287.25	$383.00	—	—	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR T-SPINE 2 VIEW FLEXION EXTENSION	$287.25	$383.00	—	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES 3 VIEW WATERS/LATERALS	$135.00	$180.00	—	17% below	25%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES COMPLETE	$135.00	$180.00	—	17% below	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES COMPLETE	$135.00	$180.00	—	—	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NASAL BONES 3 VIEW WATERS/LATERALS	$135.00	$180.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR C-SPINE 2 VIEW AP/LATERAL/ODONTOID	$249.00	$332.00	—	22% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR C-SPINE FLEXION EXTENSION VIEW	$249.00	$332.00	—	22% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR C-SPINE FLEXION EXTENSION VIEW	$249.00	$332.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR C-SPINE 2 VIEW AP/LATERAL/ODONTOID	$249.00	$332.00	—	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS AP/INLET/OUTLET VIEW	$181.50	$242.00	—	3% below	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS AP VIEW ROUTINE	$451.50	$602.00	—	140% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS JUDET VIEW	$451.50	$602.00	—	140% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS AP/INLET/OUTLET VIEW	$181.50	$242.00	—	—	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS AP VIEW ROUTINE	$451.50	$602.00	—	—	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS JUDET VIEW	$451.50	$602.00	—	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALTV	$47.25	$63.00	—	45% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALTV	$47.25	$63.00	—	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$42.75	$57.00	—	13% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$42.75	$57.00	—	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ZZ... ALLERG SPECIFIC IGE CRUDE EXTR	$21.00	$28.00	—	11% below	25%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUNTAIN CEDAR IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 MEADOW FESCUE IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ALTERNARIA ALTERNATA IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 JOHNSON GRASS IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HICKORY/PECAN TREE IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ELM IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 PENICILLIUM NOTATUM IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 OAK IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 DERMATOPHAGOIDES FARINAE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEED IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 CLADOSPORIUM HERBARUM IGE	$77.25	$103.00	—	229% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ZZ... ALLERG SPECIFIC IGE CRUDE EXTR	$21.00	$28.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 BERMUDA GRASS IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALTERNARIA ALTERNATA IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ASPERGILLUS FUMIGATUS IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CAT DANDER IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 CLADOSPORIUM HERBARUM IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 COMMON RAGWEED IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES FARINAE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DERMATOPHAGOIDES PTERONYSSINUS	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 DOG DANDER IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ELM IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HICKORY/PECAN TREE IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 JOHNSON GRASS IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MAPLE IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MEADOW FESCUE IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 MOUNTAIN CEDAR IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 OAK IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 PENICILLIUM NOTATUM IGE	$77.25	$103.00	—	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 TIMOTHY GRASS IGE	$77.25	$103.00	—	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP AB IGG	$88.50	$118.00	—	25% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP AB IGG	$88.50	$118.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTI-NUCLEAR AB	$80.25	$107.00	—	75% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA W/ REFLEX TO TITER + PATTERN	$80.25	$107.00	—	75% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTI-NUCLEAR AB	$80.25	$107.00	—	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA W/ REFLEX TO TITER + PATTERN	$80.25	$107.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$147.00	$196.00	—	31% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PROBNP	$228.00	$304.00	—	103% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP	$147.00	$196.00	—	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-PROBNP	$228.00	$304.00	—	—	25%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$96.75	$129.00	—	203% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$96.75	$129.00	—	—	25%
Blood culture for bacteria CPT 87040 CULTURE BLOOD 2	$121.50	$162.00	—	88% above	25%
Blood culture for bacteria CPT 87040 CULTURE BLOOD 1	$121.50	$162.00	—	88% above	25%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD 2	$121.50	$162.00	—	—	25%
Blood culture for bacteria inpatient CPT 87040 CULTURE BLOOD 1	$121.50	$162.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$17.25	$23.00	—	77% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$30.75	$41.00	—	215% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE	$17.25	$23.00	—	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE	$30.75	$41.00	—	—	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$42.75	$57.00	—	69% above	25%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE	$42.75	$57.00	—	—	25%
Blood lead test CPT 83655 LEAD	$183.75	$245.00	—	322% above	25%
Blood lead test inpatient CPT 83655 LEAD	$183.75	$245.00	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG QUANT	$151.50	$202.00	—	270% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG QUANT	$151.50	$202.00	—	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BB ABO	$51.00	$68.00	—	11% below	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BB ABO	$51.00	$68.00	—	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9	$97.50	$130.00	—	7% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9	$97.50	$130.00	—	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125	$90.00	$120.00	—	44% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125	$90.00	$120.00	—	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS COV-2 RNA, QL	$159.00	$212.00	—	108% above	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS COV-2 RNA, QL	$159.00	$212.00	—	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 ZZ... CHLAMYDIA TRACHOMATIS	$264.00	$352.00	—	235% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 ZZ... CHLAMYDIA TRACHOMATIS	$264.00	$352.00	—	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPIDS	$84.00	$112.00	—	29% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPIDS	$84.00	$112.00	—	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTO DIFF	$76.50	$102.00	—	69% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTO DIFF	$76.50	$102.00	—	—	25%
Complete blood count (CBC), no differential CPT 85027 CBC HEMOGRAM	$58.50	$78.00	—	95% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC HEMOGRAM	$58.50	$78.00	—	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$131.25	$175.00	—	165% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL	$131.25	$175.00	—	—	25%
Estradiol blood test CPT 82670 ESTRADIOL	$308.25	$411.00	—	279% above	25%
Estradiol blood test inpatient CPT 82670 ESTRADIOL	$308.25	$411.00	—	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$24.75	$33.00	—	63% below	25%
FSH (follicle-stimulating hormone) test CPT 83001 FSH & LH	$261.75	$349.00	—	295% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$24.75	$33.00	—	—	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH & LH	$261.75	$349.00	—	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN	$222.75	$297.00	—	80% above	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN	$222.75	$297.00	—	—	25%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$80.25	$107.00	—	57% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$80.25	$107.00	—	—	25%
Folate (folic acid) blood test CPT 82746 FOLATE	$80.25	$107.00	—	24% above	25%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$80.25	$107.00	—	—	25%
Free T3 thyroid hormone test CPT 84481 FREE T3	$102.00	$136.00	—	14% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$102.00	$136.00	—	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$72.00	$96.00	—	17% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 FREE T4	$72.00	$96.00	—	—	25%
Free testosterone test CPT 84402 TESTOSTERONE, FREE & TOTAL	$256.50	$342.00	—	196% above	25%
Free testosterone test CPT 84402 TESTOSTERONE, FREE	$385.50	$514.00	—	345% above	25%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE & TOTAL	$256.50	$342.00	—	—	25%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE	$385.50	$514.00	—	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GEST DIABETES MEL SCREEN	$17.25	$23.00	—	41% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GEST DIABETES MEL SCREEN	$17.25	$23.00	—	—	25%
Glucose tolerance test, 3 samples CPT 82951 GTT FIRST 3 SPECIMENS	$47.25	$63.00	—	25% below	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT FIRST 3 SPECIMENS	$47.25	$63.00	—	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE	$264.00	$352.00	—	241% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE	$264.00	$352.00	—	—	25%
H. pylori antibody blood test CPT 86677 H. PYLORI AB	$303.00	$404.00	—	323% above	25%
H. pylori antibody blood test inpatient CPT 86677 H. PYLORI AB	$303.00	$404.00	—	—	25%
H. pylori stool antigen test CPT 87338 H. PYLORI AG EIA	$266.25	$355.00	—	136% above	25%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI AG EIA	$266.25	$355.00	—	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB A1C	$51.00	$68.00	—	1% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB A1C	$51.00	$68.00	—	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE AB	$175.50	$234.00	—	295% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE AB	$175.50	$234.00	—	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG	$66.75	$89.00	—	70% above	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG	$66.75	$89.00	—	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C VIRUS AB W/REFLEX	$51.00	$68.00	—	3% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HCV RNA QN	$51.00	$68.00	—	3% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV RNA QN	$51.00	$68.00	—	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C VIRUS AB W/REFLEX	$51.00	$68.00	—	—	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C VIRUS RNA (VIRAL LOAD)	$793.50	$1,058.00	—	257% above	25%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C VIRUS RNA (VIRAL LOAD)	$793.50	$1,058.00	—	—	25%
Herpes blood test, HSV-2 antibody CPT 86696 HSV TYPE 1/2 DNA, QL	$105.75	$141.00	—	49% above	25%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV TYPE 1/2 DNA, QL	$105.75	$141.00	—	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP	$105.75	$141.00	—	103% above	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 HS-CRP	$105.75	$141.00	—	103% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HS-CRP	$105.75	$141.00	—	—	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP	$105.75	$141.00	—	—	25%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$293.25	$391.00	—	134% above	25%
Homocysteine blood test CPT 83090 ZZ... HOMOCYSTEINE	$293.25	$391.00	—	134% above	25%
Homocysteine blood test inpatient CPT 83090 ZZ... HOMOCYSTEINE	$293.25	$391.00	—	—	25%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE	$293.25	$391.00	—	—	25%
Insulin blood test CPT 83525 INSULIN	$92.25	$123.00	—	101% above	25%
Insulin blood test inpatient CPT 83525 INSULIN	$92.25	$123.00	—	—	25%
Iron blood test (serum iron) CPT 83540 ZZ... IRON	$36.75	$49.00	—	14% above	25%
Iron blood test (serum iron) CPT 83540 IRON	$51.00	$68.00	—	58% above	25%
Iron blood test (serum iron) inpatient CPT 83540 ZZ... IRON	$36.75	$49.00	—	—	25%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$51.00	$68.00	—	—	25%
Iron-binding capacity (TIBC) test CPT 83550 ZZ... IRON BINDING CAPACITY	$54.75	$73.00	—	36% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 ZZ... IRON BINDING CAPACITY	$54.75	$73.00	—	—	25%
LH (luteinizing hormone) test CPT 83002 LH	$29.25	$39.00	—	60% below	25%
LH (luteinizing hormone) test inpatient CPT 83002 LH	$29.25	$39.00	—	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$84.00	$112.00	—	94% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$84.00	$112.00	—	—	25%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$102.00	$136.00	—	130% above	25%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$102.00	$136.00	—	—	25%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODIES, IGM	$234.00	$312.00	—	212% above	25%
Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODIES IGG	$234.00	$312.00	—	212% above	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODIES, IGM	$234.00	$312.00	—	—	25%
Lyme disease antibody test inpatient CPT 86618 LYME DISEASE ANTIBODIES IGG	$234.00	$312.00	—	—	25%
Magnesium blood test CPT 83735 MAGNESIUM	$51.00	$68.00	—	82% above	25%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$51.00	$68.00	—	—	25%
Measles (rubeola) antibody test CPT 86765 ZZ...MEASLES AB IGG	$174.00	$232.00	—	279% above	25%
Measles (rubeola) antibody test CPT 86765 ZZ...MEASLES AB IGM	$174.00	$232.00	—	279% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 ZZ...MEASLES AB IGG	$174.00	$232.00	—	—	25%
Measles (rubeola) antibody test inpatient CPT 86765 ZZ...MEASLES AB IGM	$174.00	$232.00	—	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SPOT	$33.75	$45.00	—	at median	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SPOT	$33.75	$45.00	—	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA	$115.50	$154.00	—	50% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA	$115.50	$154.00	—	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, INTACT W/O CALCIUM	$145.50	$194.00	—	4% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, INTACT W/O CALCIUM	$145.50	$194.00	—	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$47.25	$63.00	—	51% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT	$76.50	$102.00	—	145% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT	$47.25	$63.00	—	—	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT	$76.50	$102.00	—	—	25%
Progesterone blood test CPT 84144 PROGESTERONE	$33.75	$45.00	—	54% below	25%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$33.75	$45.00	—	—	25%
Prolactin blood test CPT 84146 PROLACTIN	$228.75	$305.00	—	144% above	25%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$228.75	$305.00	—	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME W/INR	$51.00	$68.00	—	126% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME W/INR	$51.00	$68.00	—	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN IN HOUSE	$21.75	$29.00	—	43% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 URINE DRUG SCREEN	$42.75	$57.00	—	13% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN IN HOUSE	$21.75	$29.00	—	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 URINE DRUG SCREEN	$42.75	$57.00	—	—	25%
Rapid flu test (influenza antigen) CPT 87804 ZZZ...INFLUENZA A B	$66.75	$89.00	—	12% above	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 ZZZ...INFLUENZA A B	$66.75	$89.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP A	$84.00	$112.00	—	73% above	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 GROUP STREP A AG W/REFLEX	$84.75	$113.00	—	75% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP A	$84.00	$112.00	—	—	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 GROUP STREP A AG W/REFLEX	$84.75	$113.00	—	—	25%
Rheumatoid factor (RF) test CPT 86431 ZZZ...RHEUMATOID FACTOR, QUANT (MAL)	$27.75	$37.00	—	5% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 ZZZ...RHEUMATOID FACTOR, QUANT (MAL)	$27.75	$37.00	—	—	25%
Rubella antibody test (immunity check) CPT 86762 ZZ...RUBELLA AB IGG	$54.00	$72.00	—	5% above	25%
Rubella antibody test (immunity check) CPT 86762 ZZ...RUBELLA AB IGM	$54.00	$72.00	—	5% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 ZZ...RUBELLA AB IGG	$54.00	$72.00	—	—	25%
Rubella antibody test (immunity check) inpatient CPT 86762 ZZ...RUBELLA AB IGM	$54.00	$72.00	—	—	25%
Stool ova and parasites exam CPT 87177 O & P CONCENTRATE AND SMEAR	$88.50	$118.00	—	44% above	25%
Stool ova and parasites exam inpatient CPT 87177 O & P CONCENTRATE AND SMEAR	$88.50	$118.00	—	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD X 3	$38.25	$51.00	—	68% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD X 3	$38.25	$51.00	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR W/REFLEX	$54.75	$73.00	—	114% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR W/REFLEX	$54.75	$73.00	—	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD	$338.25	$451.00	—	102% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON TB GOLD	$338.25	$451.00	—	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL, MALE	$131.25	$175.00	—	52% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL, FEMALE	$131.25	$175.00	—	52% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL, FEMALE	$131.25	$175.00	—	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL, MALE	$131.25	$175.00	—	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$166.50	$222.00	—	202% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$166.50	$222.00	—	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$102.00	$136.00	—	115% above	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$102.00	$136.00	—	—	25%
Uric acid blood test CPT 84550 URIC ACID	$30.75	$41.00	—	22% above	25%
Uric acid blood test inpatient CPT 84550 URIC ACID	$30.75	$41.00	—	—	25%
Urinalysis with microscope exam, automated CPT 81001 URINE MICROSCOPIC	$42.75	$57.00	—	70% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINE MICROSCOPIC	$42.75	$57.00	—	—	25%
Urinalysis without microscope exam, automated CPT 81003 URINE DIP	$42.75	$57.00	—	265% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE DIP	$42.75	$57.00	—	—	25%
Urinalysis without microscope exam, manual CPT 81002 UA W/O MICRO	$17.25	$23.00	—	1% below	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA W/O MICRO	$17.25	$23.00	—	—	25%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$80.25	$107.00	—	68% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE URINE	$80.25	$107.00	—	—	25%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST URINE	$33.75	$45.00	—	25% above	25%
Urine pregnancy test, read by color change CPT 81025 HCG	$58.50	$78.00	—	117% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST URINE	$33.75	$45.00	—	—	25%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG	$58.50	$78.00	—	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 2500MCG SUBL TAB	$24.75	$33.00	—	56% below	25%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$80.25	$107.00	—	42% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12 2500MCG SUBL TAB	$24.75	$33.00	—	—	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$80.25	$107.00	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D, 25-HYDROXY	$57.00	$76.00	—	57% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 QUEST ASSURED VITAMIN D	$268.50	$358.00	—	105% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D, 25-HYDROXY	$57.00	$76.00	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 QUEST ASSURED VITAMIN D	$268.50	$358.00	—	—	25%
Zinc blood test CPT 84630 ZINC	$237.00	$316.00	—	310% above	25%
Zinc blood test inpatient CPT 84630 ZINC	$237.00	$316.00	—	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT CLSD FX DISTLE FIBULA	$335.25	$447.00	—	15% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TRMT CLOSED FX DISTAL FIBULA	$336.75	$449.00	—	16% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TREATMENT CLSD FX DISTLE FIBULA	$335.25	$447.00	—	—	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 TRMT CLOSED FX DISTAL FIBULA	$336.75	$449.00	—	—	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TX CLOSED FX METATARSAL	$252.75	$337.00	—	6% below	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREATMENT CLSD FX METATARSAL	$272.25	$363.00	—	1% above	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TX CLOSED FX METATARSAL	$252.75	$337.00	—	—	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 TREATMENT CLSD FX METATARSAL	$272.25	$363.00	—	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLOSED DISTLE RADIUS FX NO MANIPULATION	$292.50	$390.00	—	12% below	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLSD TX DISTAL RADIUS FX N/MANIP	$336.75	$449.00	—	1% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED DISTLE RADIUS FX NO MANIPULATION	$292.50	$390.00	—	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLSD TX DISTAL RADIUS FX N/MANIP	$336.75	$449.00	—	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION BENIGN LESION FACE	$45.00	$60.00	—	43% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION B9/PREMALIG LESION FIRST	$159.00	$212.00	—	100% above	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION BENIGN LESION FACE	$45.00	$60.00	—	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION B9/PREMALIG LESION FIRST	$159.00	$212.00	—	—	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 CERUMEN REMOVAL IRRIGATION/LAVAGE	$127.50	$170.00	—	106% above	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 CERUMEN REMOVAL IRRIGATION/LAVAGE	$127.50	$170.00	—	—	25%
Earwax removal with instruments, one ear CPT 69210 REMOVAL IMPACTED CERUMEN	$84.00	$112.00	—	13% above	25%
Earwax removal with instruments, one ear CPT 69210 EAR IMPACTED CERUMEN	$84.00	$112.00	—	13% above	25%
Earwax removal with instruments, one ear CPT 69210 CERUMEN REMOVAL INSTRUMENTATION	$127.50	$170.00	—	72% above	25%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN	$84.00	$112.00	—	—	25%
Earwax removal with instruments, one ear inpatient CPT 69210 EAR IMPACTED CERUMEN	$84.00	$112.00	—	—	25%
Earwax removal with instruments, one ear inpatient CPT 69210 CERUMEN REMOVAL INSTRUMENTATION	$127.50	$170.00	—	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D CARBUNCLE ABSCESS CYST SINGLE	$115.50	$154.00	—	45% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION AND DRAINAGE OF ABCESS SIMPLE	$320.25	$427.00	—	51% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D SKIN ABSCESS	$539.25	$719.00	—	155% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D CARBUNCLE ABSCESS CYST SINGLE	$115.50	$154.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION AND DRAINAGE OF ABCESS SIMPLE	$320.25	$427.00	—	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D SKIN ABSCESS	$539.25	$719.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 APSIRATION AND OR INJECTION LARGE JT	$62.25	$83.00	—	73% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION AND/OR INJECTION LARGE JOINT	$127.50	$170.00	—	45% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION LG JOINT	$240.75	$321.00	—	4% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 APSIRATION AND OR INJECTION LARGE JT	$62.25	$83.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION AND/OR INJECTION LARGE JOINT	$127.50	$170.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIRATION LG JOINT	$240.75	$321.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION AND OR INJECTION MEDIUM JOINT	$53.25	$71.00	—	77% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION AND/OR INJ OF MED JOINT	$320.25	$427.00	—	41% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIRATION AND OR INJECTION MEDIUM JOINT	$53.25	$71.00	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIRATION AND/OR INJ OF MED JOINT	$320.25	$427.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRATION AND OR INJ SMALL JOINT	$53.25	$71.00	—	67% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRATION AND/OR INJ OF SMALL JOINT	$168.75	$225.00	—	4% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIRATION AND OR INJ SMALL JOINT	$53.25	$71.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIRATION AND/OR INJ OF SMALL JOINT	$168.75	$225.00	—	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTERMEDIATE REPAIR SCALP/EXTREM 2.5	$159.75	$213.00	—	44% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERMED 2.5CM OR LESS	$325.50	$434.00	—	14% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 INTERMEDIATE REPAIR SCALP/EXTREM 2.5	$159.75	$213.00	—	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTERMED 2.5CM OR LESS	$325.50	$434.00	—	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 ESCISION BENIGN LESION .5CM OR LESS	$66.00	$88.00	—	77% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION B9 LESION TNK ARM LEG 0.5 LESS	$225.00	$300.00	—	22% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXCISION BENIGN LESION - 0.5 OR LESS	$225.00	$300.00	—	22% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 ESCISION BENIGN LESION .5CM OR LESS	$66.00	$88.00	—	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION BENIGN LESION - 0.5 OR LESS	$225.00	$300.00	—	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION B9 LESION TNK ARM LEG 0.5 LESS	$225.00	$300.00	—	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXCISION BENIGN LESION .5 CM OR LESS	$84.75	$113.00	—	81% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION BENIGN LESION .5 CM OR LESS	$84.75	$113.00	—	—	25%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE SINGLE	$80.25	$107.00	—	47% below	25%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL	$168.75	$225.00	—	11% above	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE SINGLE	$80.25	$107.00	—	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION OF NAIL	$168.75	$225.00	—	—	25%
Paracentesis with imaging guidance CPT 49083 ABDOMINAL PARACENTESIS (US GUIDANCE)	$819.00	$1,092.00	—	10% below	25%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS (US GUIDANCE)	$819.00	$1,092.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL MATRIX FOR PERM REMOV	$134.25	$179.00	—	63% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 NAIL EXCISION	$633.00	$844.00	—	75% above	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXC NAIL MATRIX FOR PERM REMOV	$134.25	$179.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 NAIL EXCISION	$633.00	$844.00	—	—	25%
Removal of a breast lump, open surgery CPT 19120 EXC BREAST TISSUE (MASS)	$447.00	$596.00	—	61% below	25%
Removal of a breast lump, open surgery CPT 19120 EXC BREAST TISSUE MASS MALIG/BENIGN	$1,328.25	$1,771.00	—	16% above	25%
Removal of a breast lump, open surgery inpatient CPT 19120 EXC BREAST TISSUE (MASS)	$447.00	$596.00	—	—	25%
Removal of a breast lump, open surgery inpatient CPT 19120 EXC BREAST TISSUE MASS MALIG/BENIGN	$1,328.25	$1,771.00	—	—	25%
Removal of a foreign object under the skin, simple CPT 10120 INCISION AND REMOVAL RB SUBCUTANEOUS	$168.75	$225.00	—	31% below	25%
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMOVAL OF FOREIGN BODY SUBQ	$489.00	$652.00	—	99% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION AND REMOVAL RB SUBCUTANEOUS	$168.75	$225.00	—	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMOVAL OF FOREIGN BODY SUBQ	$489.00	$652.00	—	—	25%
Short arm cast (elbow to hand) CPT 29075 APPLICATION SHORT ARM CAST	$252.75	$337.00	—	23% above	25%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION SHORT ARM CAST	$252.75	$337.00	—	—	25%
Short arm splint (forearm and hand) CPT 29125 APPLICATION OF SHORT ARM SPLINT	$74.25	$99.00	—	42% below	25%
Short arm splint (forearm and hand) CPT 29125 APPLY SHORT ARM SPLINT	$135.00	$180.00	—	6% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION OF SHORT ARM SPLINT	$74.25	$99.00	—	—	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY SHORT ARM SPLINT	$135.00	$180.00	—	—	25%
Short leg cast (below the knee) CPT 29405 APPLICATION SHORT LEG CAST	$78.00	$104.00	—	50% below	25%
Short leg cast (below the knee) CPT 29405 APPLICATION OF SHORT LEG CAST	$300.00	$400.00	—	93% above	25%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION SHORT LEG CAST	$78.00	$104.00	—	—	25%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION OF SHORT LEG CAST	$300.00	$400.00	—	—	25%
Short leg splint (calf to foot) CPT 29515 SHORT LEG SPLINT	$88.50	$118.00	—	37% below	25%
Short leg splint (calf to foot) CPT 29515 APP OF SHORT LEG SPLINT	$198.00	$264.00	—	41% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 SHORT LEG SPLINT	$88.50	$118.00	—	—	25%
Short leg splint (calf to foot) inpatient CPT 29515 APP OF SHORT LEG SPLINT	$198.00	$264.00	—	—	25%
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	$110.25	$147.00	—	43% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE RPR SCLP//NECK/AX/GNTL/TRNK 2.5 L	$223.50	$298.00	—	15% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR 2.5 CM OR LESS	$110.25	$147.00	—	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE RPR SCLP//NECK/AX/GNTL/TRNK 2.5 L	$223.50	$298.00	—	—	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY OF SKIN	$287.25	$383.00	—	2% below	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY OF SKIN	$287.25	$383.00	—	—	25%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS UP TO 15 LESIONS	$66.00	$88.00	—	58% below	25%
Skin tag removal, up to 15 tags CPT 11200 SKIN TAG REMOVAL FIRST 15	$159.00	$212.00	—	2% above	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS UP TO 15 LESIONS	$66.00	$88.00	—	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 SKIN TAG REMOVAL FIRST 15	$159.00	$212.00	—	—	25%
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 2.6 TO 7.5 CM	$143.25	$191.00	—	28% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMPLE REPAIR 2.6CM TO 7.5CM	$256.50	$342.00	—	29% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR 2.6 TO 7.5 CM	$143.25	$191.00	—	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR 2.6CM TO 7.5CM	$256.50	$342.00	—	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR FACE 2.5 CM OR LESS	$135.00	$180.00	—	32% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR FACE 2.5CM OR LESS	$249.00	$332.00	—	25% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR FACE 2.5 CM OR LESS	$135.00	$180.00	—	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR FACE 2.5CM OR LESS	$249.00	$332.00	—	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER PT LIGAMENT GANGLION	$57.75	$77.00	—	75% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER PT LIGAMENT 1 OR 2	$295.50	$394.00	—	30% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION TRIGGER PT LIGAMENT GANGLION	$57.75	$77.00	—	—	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION TRIGGER PT LIGAMENT 1 OR 2	$295.50	$394.00	—	—	25%
Wart removal, up to 14 warts CPT 17110 DESTURCTION WARTS ANY METHOD UP TO 15	$48.00	$64.00	—	70% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 DESTURCTION WARTS ANY METHOD UP TO 15	$48.00	$64.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SKIN/SUBCUTANEOUS TISSUE	$88.50	$118.00	—	78% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBCU TISS 20 SQ CM OR <	$531.00	$708.00	—	31% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SKIN/SUBCUTANEOUS TISSUE	$88.50	$118.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBCU TISS 20 SQ CM OR <	$531.00	$708.00	—	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION < 2 HOURS	$506.25	$675.00	—	23% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION 2-4 HOURS	$675.00	$900.00	—	3% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION >4 HOURS	$1,180.50	$1,574.00	—	80% above	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION < 2 HOURS	$506.25	$675.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION 2-4 HOURS	$675.00	$900.00	—	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION >4 HOURS	$1,180.50	$1,574.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 LEVALBUTEROL (XOPENEX) 0.63MG NEB SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RACEPINEPHRINE (S2) 2.25% INH SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ALBUTEROL (PROVENTIL) 2.5MG/3ML NEB SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ALBUTEROL/IPRATROPIUM(DUONEB)3ML NEB SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HAND HELD NEBUL EA TX INCLUDING MEDS	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BUDESONIDE (PULMICORT) 0.5MG/2ML NEB SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 NS 0.9 (SALINE) 5ML INH SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 ARFORMOTEROL (BROVANA) 15MCG SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BUDESONIDE(PULMICORT) 0.25MG/2ML NEB SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BUDESONIDE (PULMICORT) 1MG/2ML NEB SOL	$252.75	$337.00	—	100% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ALBUTEROL/IPRATROPIUM(DUONEB)3ML NEB SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ALBUTEROL (PROVENTIL) 2.5MG/3ML NEB SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 LEVALBUTEROL (XOPENEX) 0.63MG NEB SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HAND HELD NEBUL EA TX INCLUDING MEDS	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BUDESONIDE(PULMICORT) 0.25MG/2ML NEB SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RACEPINEPHRINE (S2) 2.25% INH SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BUDESONIDE (PULMICORT) 0.5MG/2ML NEB SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BUDESONIDE (PULMICORT) 1MG/2ML NEB SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 ARFORMOTEROL (BROVANA) 15MCG SOL	$252.75	$337.00	—	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 NS 0.9 (SALINE) 5ML INH SOL	$252.75	$337.00	—	—	25%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE 30-74 MINUTES	$1,518.75	$2,025.00	—	85% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE 30-74 MINUTES	$1,518.75	$2,025.00	—	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$147.00	$196.00	—	24% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$147.00	$196.00	—	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY EXAM LEVEL 1	$127.50	$170.00	—	9% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED LEVEL 1	$147.00	$196.00	—	25% above	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY EXAM LEVEL 1	$127.50	$170.00	—	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED LEVEL 1	$147.00	$196.00	—	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY ROOM EXAM LEVEL 2	$127.50	$170.00	—	23% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED LEVEL 2	$201.75	$269.00	—	22% above	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY ROOM EXAM LEVEL 2	$127.50	$170.00	—	—	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED LEVEL 2	$201.75	$269.00	—	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY EXAM LEVEL 3	$168.75	$225.00	—	42% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED LEVEL 3	$345.75	$461.00	—	19% above	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY EXAM LEVEL 3	$168.75	$225.00	—	—	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED LEVEL 3	$345.75	$461.00	—	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY ROOM EXAM LEVEL 4	$211.50	$282.00	—	49% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED LEVEL 4	$591.00	$788.00	—	44% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY ROOM EXAM LEVEL 4	$211.50	$282.00	—	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED LEVEL 4	$591.00	$788.00	—	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY EXAM LEVEL 5	$295.50	$394.00	—	53% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED LEVEL 5	$780.75	$1,041.00	—	23% above	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY EXAM LEVEL 5	$295.50	$394.00	—	—	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED LEVEL 5	$780.75	$1,041.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INTRAVENOUS INFUS HYDRA INITIAL 1HR	$47.25	$63.00	—	71% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION INITITAL 31 MIN TO 1HR	$215.25	$287.00	—	34% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV FUSION HYDRATION INITIAL 31 MIN-1 HR	$236.25	$315.00	—	47% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INTRAVENOUS INFUS HYDRA INITIAL 1HR	$47.25	$63.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATION INITITAL 31 MIN TO 1HR	$215.25	$287.00	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV FUSION HYDRATION INITIAL 31 MIN-1 HR	$236.25	$315.00	—	—	25%
IV infusion of a medicine, first hour CPT 96365 IV DRUG INFUSION INITIAL UP TO 1 HOUR	$380.25	$507.00	—	66% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 IV DRUG INFUSION INITIAL UP TO 1 HOUR	$380.25	$507.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMINISTRATION FOR VFC	$16.50	$22.00	—	74% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM OR SUBQ INJECTION	$84.00	$112.00	—	31% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN OF IM OR SUB Q INJECTION (ER)	$88.50	$118.00	—	38% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ADMIN OF IM OR SUB Q INJECTION (OP TR)	$88.50	$118.00	—	38% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SUBQ INJECTION	$168.75	$225.00	—	163% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADMINISTRATION FOR VFC	$16.50	$22.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM OR SUBQ INJECTION	$84.00	$112.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADMIN OF IM OR SUB Q INJECTION (OP TR)	$88.50	$118.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ADMIN OF IM OR SUB Q INJECTION (ER)	$88.50	$118.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SUBQ INJECTION	$168.75	$225.00	—	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMUSCULAR RE-EDUCATION	$72.00	$96.00	—	2% below	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 PT NEUROMUSCULAR RE-EDUCATION	$72.00	$96.00	—	—	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVALUATION HIGH LEVEL COMPLEXITY	$201.75	$269.00	—	20% above	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVALUATION HIGH LEVEL COMPLEXITY	$201.75	$269.00	—	—	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVALUATION LOW COMPLEXITY	$168.75	$225.00	—	52% above	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVALUATION LOW COMPLEXITY	$168.75	$225.00	—	—	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVALUATION MODERATE COMPLEXITY	$186.00	$248.00	—	38% above	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVALUATION MODERATE COMPLEXITY	$186.00	$248.00	—	—	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY TECHNIQUES 15 MIN	$66.75	$89.00	—	15% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT MANUAL THERAPY TECHNIQUES 15 MIN	$66.75	$89.00	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXERCISE 15 MIN	$69.75	$93.00	—	at median	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXERCISE 15 MIN	$69.75	$93.00	—	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OUTPATIENT TREATMENT	$186.00	$248.00	—	120% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OUTPATIENT TREATMENT	$186.00	$248.00	—	—	25%
Speech and language evaluation CPT 92523 WITH EVAL OF LANG COMP AND EXPRESS	$445.50	$594.00	—	153% above	25%
Speech and language evaluation inpatient CPT 92523 WITH EVAL OF LANG COMP AND EXPRESS	$445.50	$594.00	—	—	25%
Speech therapy session, individual CPT 92507 TREATMENT OF SPEECH, LANGUAGE, VOICE	$150.75	$201.00	—	36% above	25%
Speech therapy session, individual inpatient CPT 92507 TREATMENT OF SPEECH, LANGUAGE, VOICE	$150.75	$201.00	—	—	25%
Spirometry before and after a bronchodilator CPT 94060 PULMONARY FUNCTION STUDY	$83.25	$111.00	—	79% below	25%
Spirometry before and after a bronchodilator CPT 94060 PULMONARY FUNCTION	$329.25	$439.00	—	16% below	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 PULMONARY FUNCTION STUDY	$83.25	$111.00	—	—	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 PULMONARY FUNCTION	$329.25	$439.00	—	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVITIES 15 MIN	$72.00	$96.00	—	26% above	25%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 PT THERAPEUTIC ACTIVITIES 15 MIN	$72.00	$96.00	—	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$114.00	$152.00	—	8% below	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 THERAPEUTIC PHLEBOTOMY	$114.00	$152.00	—	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Oklahoma	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA (CHICKEN POX) VIRUS VACCINE	$228.00	$304.00	—	29% below	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA (CHICKEN POX) VIRUS VACCINE	$228.00	$304.00	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL	$284.25	$379.00	—	31% above	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL	$284.25	$379.00	—	—	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE ADULT DOSAGE	$180.75	$241.00	—	15% above	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE ADULT DOSAGE	$180.75	$241.00	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEP B (ENGERIX) 20MCG/ML INJ	$167.44	$223.25	—	7% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEP B (ENGERIX) 20MCG/ML INJ	$167.44	$223.25	—	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 INFLUENA VACCINE (FLUZONE HD) 0.5ML	$117.00	$156.00	—	31% below	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 INFLUENA VACCINE (FLUZONE HD) 0.5ML	$117.00	$156.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR	$130.50	$174.00	—	8% above	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 VFC MMR VACCINE	$137.63	$183.50	—	13% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR	$130.50	$174.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 VFC MMR VACCINE	$137.63	$183.50	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMONIA 23 VACCINE ADULT DOSE	$162.75	$217.00	—	at median	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMONIA 23 VACCINE ADULT DOSE	$162.75	$217.00	—	—	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE IM	$373.50	$498.00	—	44% below	25%
Rabies vaccine, one dose CPT 90675 IMOVAX RABIES IM PWD FOR SUSP 2.5IU	$461.25	$615.00	—	31% below	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE (RABAVERT) INJ	$467.25	$623.00	—	30% below	25%
Rabies vaccine, one dose CPT 90675 RABIES IMM GLOB (Kedrab)10ML	$2,235.75	$2,981.00	—	235% above	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM	$373.50	$498.00	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 IMOVAX RABIES IM PWD FOR SUSP 2.5IU	$461.25	$615.00	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE (RABAVERT) INJ	$467.25	$623.00	—	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES IMM GLOB (Kedrab)10ML	$2,235.75	$2,981.00	—	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS, DIPTHERIA (TENIVAC) INJ VAC	$75.75	$101.00	—	8% below	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS, DIPTHERIA (TENIVAC) INJ VAC	$75.75	$101.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP ADACEL OVER 7 YEARS	$106.50	$142.00	—	35% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 VFC BOOSTRIX INTRAMUSCULAR SUSPENSION	$112.50	$150.00	—	43% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS, DIPTH, PERTUSSIS(ADACEL)INJ VAC	$114.75	$153.00	—	45% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP ADACEL OVER 7 YEARS	$106.50	$142.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 VFC BOOSTRIX INTRAMUSCULAR SUSPENSION	$112.50	$150.00	—	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS, DIPTH, PERTUSSIS(ADACEL)INJ VAC	$114.75	$153.00	—	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VACCINE	$63.00	$84.00	—	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 TYPHOID VACCINE	$63.00	$84.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRATION	$17.25	$23.00	—	70% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN ONE VACCINE	$54.75	$73.00	—	4% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMINISTRATION	$17.25	$23.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN ONE VACCINE	$54.75	$73.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 EACH ADDITIONAL IMMUN ADM	$17.25	$23.00	—	39% below	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EA ADD'L VACCINE	$109.50	$146.00	—	287% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 EACH ADDITIONAL IMMUN ADM	$17.25	$23.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EA ADD'L VACCINE	$109.50	$146.00	—	—	25%

Source file: https://www.rmmhonline.com/uploads/8/1/4/1/81415636/roger_mills_mem_hosp.csv