Madison Memorial Hospital
Madison Memorial Hospital in Rexburg, ID publishes cash prices for 281 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 164 of 279 procedures and above it for 95. By typical cash price it ranks #11 of 27 Idaho hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
450 E Main St,Rexburg,ID,83440 Collected Sep 29, 2026 Source price file (208) 359-6488
Acute care hospital Emergency department CCN 130025 · CMS hospital register NPI 1992747570
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 Madison Memorial Hospital in Rexburg, ID:
- Jun 4, 2026 Met requirements
Met requirements: CMS reviewed the hospital and found it met the requirements, so no further action was taken.
A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST | $1,120.50 | $1,494.00 | $172.44–$344.88 | 20% below | 25% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST | $1,210.50 | $1,614.00 | $172.44–$344.88 | 13% below | 25% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST | $95.25 | $127.00 | $85.56–$171.12 | 45% below | 25% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $189.00 | $252.00 | $85.56–$171.12 | 15% below | 25% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL | $203.25 | $271.00 | $102.78–$205.56 | 38% below | 25% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS | $429.00 | $572.00 | $234.57–$469.14 | 35% below | 25% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY | $749.25 | $999.00 | $234.57–$469.14 | 15% below | 25% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE W/DOPPLER COMPLETE | $1,639.50 | $2,186.00 | $537.18–$1,074.36 | 10% below | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY INCLUDING HEART RATE; BREATHING; AIRFLOW; AND EFFORT | $462.00 | $616.00 | $156.46–$424.54 | 32% below | 25% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP STUDY UNATT&RESP EFFT | $480.75 | $641.00 | $156.46–$424.54 | 29% below | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 SLEEP STUDY IN SLEEP LAB WITH CONTINUOUS AIRWAY PRESSURE (6 YEARS OR OLDER) | $3,050.25 | $4,067.00 | $844.23–$1,688.46 | 4% below | 25% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS CPAP 4/> PARM | $3,174.75 | $4,233.00 | $844.23–$1,688.46 | at median | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING | $156.00 | $208.00 | $102.78–$205.56 | 81% below | 25% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C- | $162.00 | $216.00 | $102.78–$205.56 | 80% below | 25% |
| MRI of the abdomen without contrast CPT 74181 MRI SCAN OF ABDOMEN WITHOUT CONTRAST | $1,235.25 | $1,647.00 | $234.57–$469.14 | 23% below | 25% |
| MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST | $1,285.50 | $1,714.00 | $234.57–$469.14 | 20% below | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST | $2,094.00 | $2,792.00 | $342.98–$685.96 | 8% below | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN STEM W/O & W/DYE | $2,179.50 | $2,906.00 | $342.98–$685.96 | 4% below | 25% |
| MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/DYE | $1,670.25 | $2,227.00 | $342.98–$685.96 | 26% below | 25% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O DYE | $1,285.50 | $1,714.00 | $234.57–$469.14 | 30% below | 25% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS | $255.75 | $341.00 | $102.78–$205.56 | 35% below | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 SLEEP STUDY IN SLEEP LAB (6 YEARS OR OLDER) | $3,050.25 | $4,067.00 | $844.23–$1,688.46 | 7% below | 25% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 LIVER ENZYME (SGPT); LEVEL | $24.75 | $33.00 | $5.30–$10.60 | 8% below | 25% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALANINE AMINO (ALT) (SGPT) | $25.50 | $34.00 | $5.30–$10.60 | 6% below | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 LIVER ENZYME (SGOT); LEVEL | $24.75 | $33.00 | $5.18–$10.36 | 30% below | 25% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 TRANSFERASE (AST) (SGOT) | $25.50 | $34.00 | $5.18–$10.36 | 28% below | 25% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $217.50 | $290.00 | $47.63–$95.26 | at median | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $14.11 | $18.81 | $5.22–$10.44 | 36% below | 25% |
| Allergy blood test, specific IgE, per allergen CPT 86003 MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE; CRUDE ALLERGEN EXTRACT; EACH | $309.74 | $412.99 | $5.22–$10.44 | 1300% above | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT | $24.53 | $32.70 | $12.95–$25.90 | 60% below | 25% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP ANTIBODY | $180.00 | $240.00 | $12.95–$25.90 | 190% above | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 SCREENING TEST FOR AUTOIMMUNE DISORDER | $49.50 | $66.00 | $12.09–$24.18 | 8% below | 25% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $54.00 | $72.00 | $12.09–$24.18 | at median | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL | $162.00 | $216.00 | $39.26–$78.52 | 3% below | 25% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $168.00 | $224.00 | $39.26–$78.52 | at median | 25% |
| Basic metabolic panel (blood test) CPT 80048 METABOLIC PANEL TOTAL CA | $41.25 | $55.00 | $8.46–$16.92 | 2% below | 25% |
| Basic metabolic panel (blood test) CPT 80048 BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) | $42.75 | $57.00 | $8.46–$16.92 | 2% above | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE; INTERMEDIATE COMPLEXITY | $33.75 | $45.00 | $45.00–$102.46 | 85% below | 25% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 TISSUE EXAM BY PATHOLOGIST | $74.25 | $99.00 | $51.23–$102.46 | 68% below | 25% |
| Blood culture for bacteria CPT 87040 BACTERIAL BLOOD CULTURE | $53.25 | $71.00 | $10.32–$20.64 | 53% below | 25% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $57.75 | $77.00 | $10.32–$20.64 | 49% below | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $27.00 | $36.00 | $9.34–$18.68 | 20% above | 25% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE | $52.50 | $70.00 | $9.34–$18.68 | 133% above | 25% |
| Blood glucose (sugar) test CPT 82947 ASSAY GLUCOSE BLOOD QUANT | $19.50 | $26.00 | $3.93–$7.86 | 23% below | 25% |
| Blood lead test CPT 83655 LEAD LEVEL | $50.25 | $67.00 | $12.11–$24.22 | 9% below | 25% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $51.75 | $69.00 | $12.11–$24.22 | 6% below | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS | $61.50 | $82.00 | $7.52–$15.04 | 14% above | 25% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 CHORIONIC GONADOTROPIN ASSAY | $63.75 | $85.00 | $7.52–$15.04 | 18% above | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD GROUP TYPING (ABO) | $11.25 | $15.00 | $15.00–$261.60 | 76% below | 25% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING SEROLOGIC ABO | $191.25 | $255.00 | $128.90–$261.60 | 311% above | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION | $21.00 | $28.00 | $5.18–$10.36 | 64% below | 25% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN | $22.50 | $30.00 | $5.18–$10.36 | 62% below | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE; AMPLIFIED PROBE TECHNIQUE | $153.00 | $204.00 | $37.27–$74.54 | 8% below | 25% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $159.00 | $212.00 | $37.27–$74.54 | 4% below | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 19-9 | $85.50 | $114.00 | $20.81–$41.62 | 9% below | 25% |
| CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSAY TUMOR CA 19-9 | $88.50 | $118.00 | $20.81–$41.62 | 6% below | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN; QUANTITATIVE; CA 125 | $85.50 | $114.00 | $20.81–$41.62 | 9% below | 25% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $88.50 | $118.00 | $20.81–$41.62 | 6% below | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN | $114.75 | $153.00 | $51.31–$102.62 | 22% above | 25% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $119.25 | $159.00 | $51.31–$102.62 | 27% above | 25% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $35.25 | $47.00 | $35.09–$70.18 | 69% below | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) | $63.75 | $85.00 | $13.39–$26.78 | 13% above | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $69.00 | $92.00 | $13.39–$26.78 | 23% above | 25% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT | $51.00 | $68.00 | $7.77–$15.54 | 19% above | 25% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $52.50 | $70.00 | $7.77–$15.54 | 22% above | 25% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST | $42.75 | $57.00 | $6.47–$12.94 | 16% above | 25% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $44.25 | $59.00 | $6.47–$12.94 | 20% above | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHEN METABOLIC PANEL | $54.00 | $72.00 | $10.56–$21.12 | 4% below | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS | $108.00 | $144.00 | $10.56–$21.12 | 92% above | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL | $91.50 | $122.00 | $22.23–$44.46 | 3% below | 25% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 DEHYDROEPIANDROSTERONE | $95.25 | $127.00 | $22.23–$44.46 | 1% above | 25% |
| Estradiol blood test CPT 82670 MEASUREMENT OF TOTAL ESTRADIOL (HORMONE) | $115.50 | $154.00 | $27.94–$55.88 | 5% above | 25% |
| Estradiol blood test CPT 82670 ASSAY OF TOTAL ESTRADIOL | $120.00 | $160.00 | $27.94–$55.88 | 9% above | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN; FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL | $76.50 | $102.00 | $18.58–$37.16 | 27% below | 25% |
| FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $79.50 | $106.00 | $18.58–$37.16 | 24% below | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 STOOL CALPROTECTIN (PROTEIN) LEVEL | $81.00 | $108.00 | $19.63–$39.26 | 62% below | 25% |
| Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL | $84.00 | $112.00 | $19.63–$39.26 | 61% below | 25% |
| Ferritin blood test (iron stores) CPT 82728 FERRITIN (BLOOD PROTEIN) LEVEL | $64.50 | $86.00 | $13.63–$27.26 | 9% below | 25% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $69.75 | $93.00 | $13.63–$27.26 | 1% below | 25% |
| Folate (folic acid) blood test CPT 82746 FOLIC ACID LEVEL; SERUM | $60.75 | $81.00 | $14.70–$29.40 | 16% below | 25% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $63.00 | $84.00 | $14.70–$29.40 | 13% below | 25% |
| Free T3 thyroid hormone test CPT 84481 THYROID HORMONE; T3 MEASUREMENT; FREE | $69.75 | $93.00 | $16.94–$33.88 | 8% below | 25% |
| Free T3 thyroid hormone test CPT 84481 FREE ASSAY (FT-3) | $72.00 | $96.00 | $16.94–$33.88 | 5% below | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE (THYROID CHEMICAL); FREE | $36.75 | $49.00 | $9.02–$18.04 | 15% below | 25% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $39.75 | $53.00 | $9.02–$18.04 | 8% below | 25% |
| Free testosterone test CPT 84402 TESTOSTERONE (HORMONE) LEVEL; FREE | $105.75 | $141.00 | $25.47–$50.94 | at median | 25% |
| Free testosterone test CPT 84402 ASSAY OF FREE TESTOSTERONE | $116.25 | $155.00 | $25.47–$50.94 | 10% above | 25% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL | $97.50 | $130.00 | — | 47% below | 25% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $22.50 | $30.00 | $4.75–$9.50 | 20% below | 25% |
| Glucose tolerance test, 3 samples CPT 82951 BLOOD GLUCOSE (SUGAR) TOLERANCE TEST; 3 SPECIMENS | $52.50 | $70.00 | $12.87–$25.74 | 27% below | 25% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $54.00 | $72.00 | $12.87–$25.74 | 25% below | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA); AMPLIFIED PROBE TECHNIQUE | $182.25 | $243.00 | $35.09–$70.18 | 66% above | 25% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $189.00 | $252.00 | $35.09–$70.18 | 72% above | 25% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $71.25 | $95.00 | $16.85–$33.70 | 24% below | 25% |
| H. pylori stool antigen test CPT 87338 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI (GI TRACT BACTERIA) IN STOOL | $59.25 | $79.00 | $14.38–$28.76 | 38% below | 25% |
| H. pylori stool antigen test CPT 87338 HPYLORI STOOL AG IA | $130.50 | $174.00 | $14.38–$28.76 | 36% above | 25% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS; QUANTIFICATION | $366.00 | $488.00 | $85.10–$170.20 | 2% below | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 ANALYSIS FOR ANTIBODY TO HIV-1 AND HIV-2 VIRUS | $56.25 | $75.00 | $13.71–$27.42 | 41% below | 25% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $58.50 | $78.00 | $13.71–$27.42 | 39% below | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES | $99.00 | $132.00 | $24.08–$48.16 | 11% above | 25% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $102.75 | $137.00 | $24.08–$48.16 | 15% above | 25% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HI-RISK TYP POOLED RSLT | $150.00 | $200.00 | $35.09–$70.18 | 40% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C LEVEL | $45.75 | $61.00 | $9.71–$19.42 | 6% above | 25% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $47.25 | $63.00 | $9.71–$19.42 | 10% above | 25% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY MEASUREMENT | $50.25 | $67.00 | $10.74–$21.48 | 2% below | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN | $42.75 | $57.00 | $10.33–$20.66 | 27% below | 25% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $44.25 | $59.00 | $10.33–$20.66 | 24% below | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY MEASUREMENT | $58.50 | $78.00 | $14.27–$28.54 | 12% below | 25% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST | $60.75 | $81.00 | $14.27–$28.54 | 9% below | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C REVRS TRNSCRPJ | $183.75 | $245.00 | $42.84–$85.68 | 11% below | 25% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS; QUANTIFICATION | $257.33 | $343.10 | $42.84–$85.68 | 25% above | 25% |
| Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 TEST | $55.50 | $74.00 | $13.19–$26.38 | 38% above | 25% |
| Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2 TEST | $84.00 | $112.00 | $19.35–$38.70 | 25% above | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION; HIGH SENSITIVITY | $25.50 | $34.00 | $12.95–$25.90 | 61% below | 25% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $54.75 | $73.00 | $12.95–$25.90 | 16% below | 25% |
| Homocysteine blood test CPT 83090 HOMOCYSTEINE (AMINO ACID) LEVEL | $74.25 | $99.00 | $17.92–$35.84 | 7% below | 25% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $77.25 | $103.00 | $17.92–$35.84 | 3% below | 25% |
| Insulin blood test CPT 83525 INSULIN MEASUREMENT; TOTAL | $54.00 | $72.00 | $11.43–$22.86 | 19% below | 25% |
| Insulin blood test CPT 83525 ASSAY OF INSULIN | $55.50 | $74.00 | $11.43–$22.86 | 17% below | 25% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $30.75 | $41.00 | $6.47–$12.94 | 15% below | 25% |
| Iron blood test (serum iron) CPT 83540 IRON LEVEL | $60.00 | $80.00 | $6.47–$12.94 | 67% above | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $42.75 | $57.00 | $8.74–$17.48 | 6% below | 25% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING CAPACITY | $141.49 | $188.65 | $8.74–$17.48 | 212% above | 25% |
| Kidney function blood test panel CPT 80069 KIDNEY FUNCTION BLOOD TEST PANEL | $42.75 | $57.00 | $8.68–$17.36 | 31% below | 25% |
| LH (luteinizing hormone) test CPT 83002 GONADOTROPIN; LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL | $76.50 | $102.00 | $18.52–$37.04 | 7% below | 25% |
| LH (luteinizing hormone) test CPT 83002 ASSAY OF GONADOTROPIN (LH) | $79.50 | $106.00 | $18.52–$37.04 | 3% below | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE (FAT ENZYME) LEVEL | $33.00 | $44.00 | $6.89–$13.78 | 51% below | 25% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $36.00 | $48.00 | $6.89–$13.78 | 46% below | 25% |
| Liver function blood test panel CPT 80076 LIVER FUNCTION BLOOD TEST PANEL | $38.25 | $51.00 | $8.17–$16.34 | 18% below | 25% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $39.75 | $53.00 | $8.17–$16.34 | 15% below | 25% |
| Lyme disease antibody test CPT 86618 ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA) | $69.75 | $93.00 | $17.03–$34.06 | 16% below | 25% |
| Lyme disease antibody test CPT 86618 LYME DISEASE ANTIBODY | $91.50 | $122.00 | $17.03–$34.06 | 10% above | 25% |
| Magnesium blood test CPT 83735 MAGNESIUM LEVEL | $27.75 | $37.00 | $6.70–$13.40 | 27% below | 25% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $33.00 | $44.00 | $6.70–$13.40 | 13% below | 25% |
| Measles (rubeola) antibody test CPT 86765 RUBEOLA ANTIBODY | $54.00 | $72.00 | $12.88–$25.76 | 10% below | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 SCREENING TEST FOR MONONUCLEOSIS (MONO) | $21.00 | $28.00 | $5.18–$10.36 | 55% below | 25% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $21.75 | $29.00 | $5.18–$10.36 | 53% below | 25% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $204.75 | $273.00 | $47.81–$95.62 | 25% below | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 ASSAY OF PSA FREE | $39.00 | $52.00 | $18.39–$36.78 | 54% below | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; FREE | $75.75 | $101.00 | $18.39–$36.78 | 11% below | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL | $75.75 | $101.00 | $18.39–$36.78 | 14% below | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $78.75 | $105.00 | $18.39–$36.78 | 11% below | 25% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 CYTOPATH C/V THIN LAYER | $86.25 | $115.00 | $20.26–$40.52 | 7% below | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) LEVEL | $169.50 | $226.00 | $41.28–$82.56 | 1% below | 25% |
| Parathyroid hormone (PTH) blood test CPT 83970 ASSAY OF PARATHORMONE | $176.25 | $235.00 | $41.28–$82.56 | 3% above | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $40.50 | $54.00 | $6.01–$12.02 | 19% below | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD | $49.50 | $66.00 | $6.01–$12.02 | 1% below | 25% |
| Progesterone blood test CPT 84144 PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL | $85.50 | $114.00 | $20.86–$41.72 | 5% below | 25% |
| Progesterone blood test CPT 84144 ASSAY OF PROGESTERONE | $88.50 | $118.00 | $20.86–$41.72 | 2% below | 25% |
| Prolactin blood test CPT 84146 PROLACTIN (MILK PRODUCING HORMONE) LEVEL | $80.25 | $107.00 | $19.38–$38.76 | 14% below | 25% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $83.25 | $111.00 | $19.38–$38.76 | 10% below | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $32.50 | $43.33 | $4.29–$8.58 | at median | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 BLOOD TEST; CLOTTING TIME | $58.20 | $77.60 | $4.29–$8.58 | 79% above | 25% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG TEST PRSMV DIR OPT OBS | $50.25 | $67.00 | $12.60–$25.20 | 16% below | 25% |
| Rapid flu test (influenza antigen) CPT 87804 INFLUENZA ASSAY W/OPTIC | $70.50 | $94.00 | $16.55–$33.10 | 6% above | 25% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR LEVEL | $10.61 | $14.14 | $5.67–$11.34 | 65% below | 25% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $13.21 | $17.61 | $5.67–$11.34 | 56% below | 25% |
| Rubella antibody test (immunity check) CPT 86762 ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS) | $59.25 | $79.00 | $14.39–$28.78 | 4% above | 25% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $61.50 | $82.00 | $14.39–$28.78 | 8% above | 25% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RBC SED RATE AUTOMATED | $6.00 | $8.00 | $2.70–$5.40 | 76% below | 25% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN EVALUATION VOLUME; SPERM COUNT; MOTILITY AND ANALYSIS | $51.00 | $68.00 | $12.31–$24.62 | 32% below | 25% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 SEMEN ANAL VOL/COUNT/MOT | $52.50 | $70.00 | $12.31–$24.62 | 30% below | 25% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS | $43.50 | $58.00 | $8.90–$17.80 | at median | 25% |
| Stool ova and parasites exam CPT 87177 SMEAR FOR PARASITES | $45.75 | $61.00 | $8.90–$17.80 | 5% above | 25% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $19.50 | $26.00 | $4.38–$8.76 | 5% below | 25% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS DETECTION TEST | $17.25 | $23.00 | $4.27–$8.54 | 48% below | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TUBERCULOSIS TEST; GAMMA INTERFERON | $243.75 | $325.00 | $61.98–$123.96 | 4% above | 25% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB TEST CELL IMMUN MEASURE | $267.00 | $356.00 | $61.98–$123.96 | 13% above | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE (HORMONE) LEVEL; TOTAL | $105.75 | $141.00 | $25.81–$51.62 | 8% below | 25% |
| Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY OF TOTAL TESTOSTERONE | $109.50 | $146.00 | $25.81–$51.62 | 5% below | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT | $60.00 | $80.00 | $14.55–$29.10 | 16% below | 25% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODY EACH | $62.25 | $83.00 | $14.55–$29.10 | 13% below | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 BLOOD TEST; THYROID STIMULATING HORMONE (TSH) | $80.25 | $107.00 | $16.80–$33.60 | at median | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $87.00 | $116.00 | $16.80–$33.60 | 8% above | 25% |
| Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF | $34.50 | $46.00 | $35.09–$70.18 | 65% below | 25% |
| Uric acid blood test CPT 84550 URIC ACID LEVEL; BLOOD | $21.00 | $28.00 | $4.52–$9.04 | 35% below | 25% |
| Uric acid blood test CPT 84550 ASSAY OF BLOOD/URIC ACID | $21.75 | $29.00 | $4.52–$9.04 | 32% below | 25% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE | $21.00 | $28.00 | $3.17–$6.34 | 29% above | 25% |
| Urinalysis with microscope exam, automated CPT 81001 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED | $39.00 | $52.00 | $3.17–$6.34 | 140% above | 25% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $13.50 | $18.00 | $3.48–$6.96 | 26% below | 25% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS; MANUAL TEST | $19.50 | $26.00 | $3.48–$6.96 | 7% above | 25% |
| Urine culture for bacteria, with colony count CPT 87086 BACTERIAL COLONY COUNT; URINE | $42.00 | $56.00 | $8.07–$16.14 | 20% below | 25% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT | $45.00 | $60.00 | $8.07–$16.14 | 15% below | 25% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $38.25 | $51.00 | $8.61–$17.22 | 1% above | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 CYANOCOBALAMIN (VITAMIN B-12) LEVEL | $61.50 | $82.00 | $15.08–$30.16 | 17% below | 25% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $63.75 | $85.00 | $15.08–$30.16 | 14% below | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D-3 LEVEL | $121.50 | $162.00 | $29.60–$59.20 | at median | 25% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $126.00 | $168.00 | $29.60–$59.20 | 4% above | 25% |
| Zinc blood test CPT 84630 ZINC LEVEL | $47.25 | $63.00 | $11.39–$22.78 | 30% below | 25% |
| Zinc blood test CPT 84630 ASSAY OF ZINC | $48.75 | $65.00 | $11.39–$22.78 | 28% below | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL | $61.50 | $82.00 | $15.05–$30.10 | 23% below | 25% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $63.75 | $85.00 | $15.05–$30.10 | 20% below | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 REMOVAL OF ADENOIDS | $4,788.00 | $6,384.00 | $3,243.07–$6,518.88 | 1% below | 25% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 ARTHRD ANT NTRBDY CERVICAL | $10,068.00 | $13,424.00 | $12,621.76–$25,243.52 | 37% below | 25% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 APPENDECTOMY | $4,086.00 | $5,448.00 | $741.84–$1,483.68 | 2% above | 25% |
| Appendectomy, open surgery CPT 44950 APPENDECTOMY | $4,958.25 | $6,611.00 | $6,239.75–$12,728.88 | 96% above | 25% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 KNEE ARTHROSCOPY/SURGERY | $7,389.75 | $9,853.00 | $7,133.61–$14,267.22 | 33% below | 25% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 SHO ARTHRS SRG RT8TR CUF RPR | $7,313.25 | $9,751.00 | $7,133.61–$14,267.22 | 22% below | 25% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 NSL/SINS NDSC SURG MAX SINS | $8,965.50 | $11,954.00 | $6,922.47–$13,876.44 | 27% above | 25% |
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE | $309.75 | $413.00 | $239.88–$485.00 | 18% below | 25% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE | $309.75 | $413.00 | $239.88–$485.00 | 37% below | 25% |
| Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 COR HLX VLGS DSTL MTAR OSTEO | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 15% below | 25% |
| Bunion correction with removal of part of the big toe joint CPT 28292 COR HLX VLGS RSC PRX PHLX BS | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 21% below | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT | $1,398.75 | $1,865.00 | $649.78–$1,299.56 | 5% below | 25% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $1,455.75 | $1,941.00 | $649.78–$1,299.56 | 1% below | 25% |
| Carpal tunnel release, open surgery CPT 64721 CARPAL TUNNEL SURGERY | $3,114.75 | $4,153.00 | $1,919.73–$3,839.46 | 17% above | 25% |
| Cataract surgery with lens implant CPT 66984 XCAPSL CTRC RMVL W/O ECP | $3,225.75 | $4,301.00 | $2,268.83–$4,537.66 | at median | 25% |
| Cervical biopsy CPT 57500 BIOPSY OF CERVIX | $1,131.00 | $1,508.00 | $870.74–$1,810.98 | 45% above | 25% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 REMOVAL OF FORESKIN (OLDER THAN 28 DAYS) | $2,864.25 | $3,819.00 | $2,048.51–$4,110.12 | 39% below | 25% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION W/REGIONL BLOCK | $4,953.75 | $6,605.00 | $2,048.51–$4,110.12 | 1599% above | 25% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DST RDL FX/EPHYS SEP WO | $309.75 | $413.00 | $239.88–$485.00 | 8% below | 25% |
| Colonoscopy with polyp removal CPT 45385 REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE | $1,195.50 | $1,594.00 | $1,176.43–$2,352.86 | 43% below | 25% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL | $1,826.25 | $2,435.00 | $1,176.43–$2,352.86 | 13% below | 25% |
| Colonoscopy with tissue sample CPT 45380 BIOPSY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,195.50 | $1,594.00 | $1,176.43–$2,352.86 | 44% below | 25% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $1,826.25 | $2,435.00 | $1,176.43–$2,352.86 | 15% below | 25% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $918.75 | $1,225.00 | $911.71–$1,828.50 | 59% below | 25% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $1,402.50 | $1,870.00 | $911.71–$1,828.50 | 37% below | 25% |
| Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 BX OF CERVIX W/SCOPE LEEP | $4,614.00 | $6,152.00 | $3,179.53–$6,364.86 | 164% above | 25% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 BX/CURETT OF CERVIX W/SCOPE | $400.50 | $534.00 | $299.58–$599.16 | 4% above | 25% |
| Complex cataract surgery with lens implant CPT 66982 XCAPSL CTRC RMVL CPLX WO ECP | $3,225.75 | $4,301.00 | $2,268.83–$4,537.66 | 42% below | 25% |
| Cystoscopy with ureteral stent placement CPT 52332 INSERTION OF STENT IN URETER USING AN ENDOSCOPE | $4,893.75 | $6,525.00 | $3,448.97–$6,930.86 | 44% below | 25% |
| Cystoscopy with ureteral stent placement CPT 52332 CYSTOSCOPY AND TREATMENT | $5,152.50 | $6,870.00 | $3,448.97–$6,930.86 | 41% below | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 DIAGNOSTIC EXAM OF BLADDER AND URETHRA USING AN ENDOSCOPE | $978.75 | $1,305.00 | $667.47–$1,371.02 | at median | 25% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY | $1,067.25 | $1,423.00 | $667.47–$1,371.02 | 9% above | 25% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 DILATION AND CURETTAGE | $4,614.00 | $6,152.00 | $3,179.53–$6,364.86 | 54% above | 25% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 CREATE EARDRUM OPENING | $2,353.50 | $3,138.00 | $1,481.28–$3,050.74 | 17% below | 25% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI | $87.75 | $117.00 | $57.99–$115.98 | at median | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF LINING OF UTERUS | $291.75 | $389.00 | $198.75–$397.50 | 80% above | 25% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING | $303.00 | $404.00 | $198.75–$397.50 | 86% above | 25% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 NSL/SINS NDSC W/TOT ETHMDCT | $8,965.50 | $11,954.00 | $6,922.47–$13,876.44 | 26% below | 25% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 EXPLORATION OF NASAL SINUS USING AN ENDOSCOPE | $8,613.00 | $11,484.00 | $6,922.47–$13,876.44 | at median | 25% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 NSL/SINS NDSC FRNT TISS RMVL | $8,965.50 | $11,954.00 | $6,922.47–$13,876.44 | 4% above | 25% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 EXPLORATION MAXILLARY SINUS | $5,401.50 | $7,202.00 | $3,665.35–$7,330.70 | at median | 25% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 ENDOSCOPY MAXILLARY SINUS | $8,965.50 | $11,954.00 | $6,922.47–$13,876.44 | 30% below | 25% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 NJX INTERLAMINAR CRV/THRC | $1,150.50 | $1,534.00 | $692.52–$1,387.90 | 20% below | 25% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV | $1,430.25 | $1,907.00 | $869.53–$1,739.06 | 16% above | 25% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM; REDUCIBLE | $4,671.00 | $6,228.00 | $6,228.00–$12,728.88 | 21% below | 25% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 RPR AA HRN 1ST 3-10 RDC | $4,862.25 | $6,483.00 | $6,239.75–$12,728.88 | 18% below | 25% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 RPR AA HRN 1ST > 10 RDC | $4,862.25 | $6,483.00 | $6,239.75–$12,728.88 | 67% below | 25% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE; EPIGASTRIC; INCISIONAL; VENTRAL; UMBILICAL; SPIGELIAN); ANY APPROACH (IE; OPEN; LAPAROSCOPIC; ROBOTIC); INITIAL; INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED; TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM; REDUCIBLE | $4,671.00 | $6,228.00 | $3,519.91–$7,039.82 | 18% below | 25% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 RPR AA HRN 1ST < 3 CM RDC | $4,862.25 | $6,483.00 | $3,519.91–$7,039.82 | 14% below | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC EXAM OF LOWER PORTION OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $978.00 | $1,304.00 | $911.71–$1,828.50 | 4% below | 25% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 DIAGNOSTIC SIGMOIDOSCOPY | $1,416.75 | $1,889.00 | $911.71–$1,828.50 | 40% above | 25% |
| Gallbladder removal, laparoscopic CPT 47562 REMOVAL OF GALLBLADDER USING AN ENDOSCOPE | $8,070.00 | $10,760.00 | $5,834.36–$11,886.76 | 2% below | 25% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPIC CHOLECYSTECTOMY | $8,400.75 | $11,201.00 | $5,834.36–$11,886.76 | 2% above | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE | $8,070.00 | $10,760.00 | $5,834.36–$11,886.76 | 23% above | 25% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 LAPARO CHOLECYSTECTOMY/GRAPH | $8,400.75 | $11,201.00 | $5,834.36–$11,886.76 | 29% above | 25% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 CHOLECYSTECTOMY | $4,422.00 | $5,896.00 | $910.13–$1,820.26 | 56% above | 25% |
| Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE | $4,122.75 | $5,497.00 | $3,216.72–$6,433.44 | 51% above | 25% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING | $978.00 | $1,304.00 | $911.71–$1,828.50 | at median | 25% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $1,416.75 | $1,889.00 | $911.71–$1,828.50 | 45% above | 25% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 REMOVE INT/EXT HEM 1 GROUP | $4,200.00 | $5,600.00 | $2,728.76–$5,457.52 | 45% above | 25% |
| Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 TOTAL HIP ARTHROPLASTY | $6,235.50 | $8,314.00 | $12,621.76–$25,243.52 | 34% below | 25% |
| Hysterectomy through an abdominal incision (total) CPT 58150 TOTAL HYSTERECTOMY | $5,578.50 | $7,438.00 | $852.76–$1,705.52 | 41% below | 25% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY | $143.25 | $191.00 | $48.14–$96.28 | 48% below | 25% |
| Hysteroscopy with endometrial ablation CPT 58563 HYSTEROSCOPY ABLATION | $6,558.00 | $8,744.00 | $4,917.92–$9,835.84 | 40% below | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE | $4,386.75 | $5,849.00 | $3,179.53–$6,364.86 | 25% above | 25% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 HYSTEROSCOPY BIOPSY | $4,566.00 | $6,088.00 | $3,179.53–$6,364.86 | 30% above | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERTION OF IUD FOR PREGNANCY PREVENTION | $575.25 | $767.00 | — | 140% above | 25% |
| IUD insertion (the device itself billed separately) CPT 58300 INSERT INTRAUTERINE DEVICE | $598.50 | $798.00 | — | 150% above | 25% |
| Incision and drainage of a simple or single skin abscess CPT 10060 SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS | $320.25 | $427.00 | $197.25–$394.50 | 17% above | 25% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR OF GROIN HERNIA (5 YEARS OR OLDER) | $3,210.75 | $4,281.00 | $3,519.91–$7,039.82 | 11% above | 25% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PRP I/HERN INIT REDUC >5 YR | $4,906.50 | $6,542.00 | $3,519.91–$7,039.82 | 70% above | 25% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT | $356.25 | $475.00 | $295.19–$603.52 | 28% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIRATION AND/OR INJECTION OF FLUID FROM LARGE JOINT | $388.50 | $518.00 | $295.19–$603.52 | 2% above | 25% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $604.50 | $806.00 | $295.19–$603.52 | 59% above | 25% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $421.50 | $562.00 | $295.19–$603.52 | 26% above | 25% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $404.25 | $539.00 | $295.19–$603.52 | 30% above | 25% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 KNEE ARTHROSCOPY/SURGERY | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 36% below | 25% |
| Knee arthroscopy with meniscus trim CPT 29881 KNEE ARTHROSCOPY/SURGERY | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 33% below | 25% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 KNEE ARTHROSCOPY/SURGERY | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 25% below | 25% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 KNEE ARTHROSCOPY/SURGERY | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 25% below | 25% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 REMOVAL OF APPENDIX USING AN ENDOSCOPE | $8,070.00 | $10,760.00 | $5,834.36–$11,886.76 | 24% above | 25% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 LAPAROSCOPY APPENDECTOMY | $8,400.75 | $11,201.00 | $5,834.36–$11,886.76 | 29% above | 25% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE | $13,685.25 | $18,247.00 | $10,411.22–$20,900.46 | at median | 25% |
| Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 LAPAROSCOPY FUNDOPLASTY | $14,246.25 | $18,995.00 | $10,411.22–$20,900.46 | 4% above | 25% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 REMOVAL OF UTERUS THROUGH ABDOMEN USING AN ENDOSCOPE; 250.0 G OR LESS | $11,984.25 | $15,979.00 | $10,411.22–$20,900.46 | 16% below | 25% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 TLH UTERUS 250 G OR LESS | $14,246.25 | $18,995.00 | $10,411.22–$20,900.46 | at median | 25% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 REMOVAL OF UTERUS; TUBES; AND/OR OVARIES THROUGH ABDOMEN USING AN ENDOSCOPE; 250.0 G OR LESS | $13,543.50 | $18,058.00 | $10,411.22–$20,900.46 | 7% below | 25% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 TLH W/T/O 250 G OR LESS | $14,098.50 | $18,798.00 | $10,411.22–$20,900.46 | 3% below | 25% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 REPAIR OF GROIN HERNIA USING AN ENDOSCOPE | $8,448.75 | $11,265.00 | $5,834.36–$11,886.76 | 4% above | 25% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 LAP ING HERNIA REPAIR INIT | $8,794.50 | $11,726.00 | $5,834.36–$11,886.76 | 8% above | 25% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 LAP ING HERNIA REPAIR RECUR | $8,487.75 | $11,317.00 | $5,834.36–$11,886.76 | 10% below | 25% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE | $8,070.00 | $10,760.00 | $5,834.36–$11,886.76 | 5% above | 25% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 LAPAROSCOPY REMOVE ADNEXA | $8,400.75 | $11,201.00 | $5,834.36–$11,886.76 | 9% above | 25% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $593.25 | $791.00 | $399.53–$799.28 | 64% above | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 NJX INTERLAMINAR LMBR/SAC | $1,150.50 | $1,534.00 | $692.52–$1,387.90 | 7% below | 25% |
| Lower-back epidural injection, without imaging guidance CPT 62322 NJX INTERLAMINAR LMBR/SAC | $1,101.75 | $1,469.00 | $869.53–$1,739.06 | at median | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NJX AA&/STRD TFRM EPI L/S 1 | $1,430.25 | $1,907.00 | $869.53–$1,739.06 | 13% below | 25% |
| Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 LOW BACK DISK SURGERY | $8,358.00 | $11,144.00 | $7,133.61–$14,267.22 | 43% below | 25% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF LOWER SPINAL CORD AND/OR NERVES; 1 SEGMENT | $8,029.50 | $10,706.00 | $7,133.61–$14,267.22 | 46% below | 25% |
| Lumbar laminectomy (spinal decompression), one level CPT 63047 LAM FACETEC & FORAMOT LUMBAR | $8,358.00 | $11,144.00 | $7,133.61–$14,267.22 | 43% below | 25% |
| Lumbar spinal fusion (posterior), one level CPT 22612 ARTHRD PST TQ 1NTRSPC LUMBAR | $16,745.25 | $22,327.00 | $17,237.56–$34,475.12 | 2% below | 25% |
| Lumpectomy (partial mastectomy) CPT 19301 PARTIAL MASTECTOMY | $5,741.25 | $7,655.00 | $3,829.28–$7,698.56 | 5% above | 25% |
| Mastectomy (total removal of the breast) CPT 19303 MAST SIMPLE COMPLETE | $9,567.75 | $12,757.00 | $6,521.46–$13,055.96 | 22% above | 25% |
| Miscarriage treatment with D&C, first trimester CPT 59820 TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER | $4,386.75 | $5,849.00 | $3,179.53–$6,364.86 | 12% above | 25% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC TR-EXT B9+MARG 0.5 CM< | $1,054.50 | $1,406.00 | $696.17–$1,392.34 | 247% above | 25% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC FACE-MM B9+MARG 0.5 CM/< | $1,013.25 | $1,351.00 | $696.17–$1,392.34 | 194% above | 25% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $308.25 | $411.00 | $197.25–$394.50 | 48% above | 25% |
| Paracentesis with imaging guidance CPT 49083 DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE | $1,357.50 | $1,810.00 | $891.66–$1,783.32 | 2% above | 25% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $1,413.00 | $1,884.00 | $891.66–$1,783.32 | 6% above | 25% |
| Partial knee replacement (one compartment) CPT 27446 REVISION OF KNEE JOINT | $18,635.25 | $24,847.00 | $12,621.76–$25,243.52 | 17% above | 25% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED | $588.00 | $784.00 | $399.53–$799.28 | 24% above | 25% |
| Prostate biopsy CPT 55700 BIOPSY OF PROSTATE GLAND | $2,249.25 | $2,999.00 | $2,048.51 | 33% below | 25% |
| Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION | $5,540.25 | $7,387.00 | $3,829.28–$7,698.56 | 72% above | 25% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $497.25 | $663.00 | $399.53–$799.28 | 42% above | 25% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 PARTIAL REMOVAL OF THYROID | $8,487.75 | $11,317.00 | $5,834.36–$11,886.76 | 9% above | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLON CA SCRN NOT HI RSK IND | $996.00 | $1,328.00 | $911.71–$1,828.50 | 60% below | 25% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK | $1,292.25 | $1,723.00 | $911.71–$1,828.50 | 48% below | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK | $1,292.25 | $1,723.00 | $911.71–$1,828.50 | 40% below | 25% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL SCRN; HI RISK IND | $1,344.75 | $1,793.00 | $911.71–$1,828.50 | 38% below | 25% |
| Septoplasty to straighten the nasal septum CPT 30520 RESHAPING OF NASAL CARTILAGE | $3,827.25 | $5,103.00 | $3,243.07–$6,518.88 | 43% below | 25% |
| Septoplasty to straighten the nasal septum CPT 30520 REPAIR OF NASAL SEPTUM | $3,984.00 | $5,312.00 | $3,243.07–$6,518.88 | 40% below | 25% |
| Short arm cast (elbow to hand) CPT 29075 APPLICATION OF FOREARM CAST | $473.25 | $631.00 | $265.58–$549.94 | 115% above | 25% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT | $326.25 | $435.00 | $128.90–$261.60 | 93% above | 25% |
| Short leg cast (below the knee) CPT 29405 APPLY SHORT LEG CAST | $575.25 | $767.00 | $265.58–$549.94 | 176% above | 25% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT | $326.25 | $435.00 | $157.79–$319.50 | 48% above | 25% |
| Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 SHO ARTHRS SRG DSTL CLAVICLC | $4,164.75 | $5,553.00 | $3,216.72–$6,433.44 | 2% below | 25% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SHO ARTHRS SRG DECOMPRESSION | $6,504.00 | $8,672.00 | $134.99–$269.98 | 127% above | 25% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.5 CM OR LESS | $308.25 | $411.00 | $197.25–$394.50 | 37% above | 25% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $491.25 | $655.00 | $399.53–$799.28 | 113% above | 25% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 EXC TR-EXT MAL+MARG 0.5 CM/< | $1,054.50 | $1,406.00 | $696.17–$1,392.34 | 98% above | 25% |
| Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAG; 1-15 SKIN TAGS | $247.50 | $330.00 | $197.25–$394.50 | 56% above | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 REMOVAL OF CEREBROSPINAL FLUID WITH LOWER BACK SPINAL TAP FOR DIAGNOSTIC TEST | $1,059.00 | $1,412.00 | $692.52–$1,387.90 | 26% above | 25% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $1,101.75 | $1,469.00 | $692.52–$1,387.90 | 32% above | 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 OF SURFACE WOUND OF SCALP; NECK; UNDERARMS; TRUNK; ARMS; OR LEGS; 2.6-7.5 CM | $308.25 | $411.00 | $197.25–$394.50 | 12% above | 25% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $320.25 | $427.00 | $197.25–$394.50 | 16% above | 25% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR OF SURFACE WOUND OF FACE; EARS; EYELIDS; NOSE; LIPS; OR MOUTH; 2.5 CM OR LESS | $308.25 | $411.00 | $197.25–$394.50 | 5% above | 25% |
| TURP (transurethral resection of the prostate) CPT 52601 REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE | $4,569.75 | $6,093.00 | $5,083.62–$10,542.40 | 57% below | 25% |
| TURP (transurethral resection of the prostate) CPT 52601 PROSTATECTOMY (TURP) | $4,756.50 | $6,342.00 | $5,083.62–$10,542.40 | 55% below | 25% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES | $320.25 | $427.00 | $198.70–$799.28 | 62% above | 25% |
| Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING | $849.00 | $1,132.00 | $616.70–$1,233.40 | 27% below | 25% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 REMOVE TONSILS AND ADENOIDS | $4,788.00 | $6,384.00 | $3,243.07–$6,518.88 | 4% below | 25% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS) | $8,208.00 | $10,944.00 | $5,819.80–$11,639.60 | 3% above | 25% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS AND ADENOIDS | $8,544.00 | $11,392.00 | $5,819.80–$11,639.60 | 7% above | 25% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS (12 YEARS OR OLDER) | $4,552.50 | $6,070.00 | $3,243.07–$6,518.88 | 20% below | 25% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 REMOVAL OF TONSILS | $4,738.50 | $6,318.00 | $3,243.07–$6,518.88 | 17% below | 25% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 REMOVAL OF TONSILS | $8,633.25 | $11,511.00 | $5,819.80–$11,639.60 | 19% above | 25% |
| Total hip replacement CPT 27130 TOTAL HIP ARTHROPLASTY | $18,635.25 | $24,847.00 | $12,621.76–$25,243.52 | 17% above | 25% |
| Total knee replacement CPT 27447 TOTAL KNEE ARTHROPLASTY | $14,208.75 | $18,945.00 | $12,621.76–$25,243.52 | 17% above | 25% |
| Total shoulder replacement CPT 23472 RECONSTRUCT SHOULDER JOINT | $18,635.25 | $24,847.00 | $17,237.56–$34,475.12 | 9% above | 25% |
| Total thyroid removal (thyroidectomy) CPT 60240 REMOVAL OF THYROID | $8,487.75 | $11,317.00 | $5,834.36–$11,886.76 | 44% below | 25% |
| Trigger finger release surgery CPT 26055 INCISE FINGER TENDON SHEATH | $2,166.00 | $2,888.00 | $1,580.83–$3,161.66 | 23% above | 25% |
| Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL | $321.00 | $428.00 | $295.19–$603.52 | 97% above | 25% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 LAPAROSCOPY TUBAL CAUTERY | $8,487.75 | $11,317.00 | $5,834.36–$11,886.76 | 57% above | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 BALLOON DILATION OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE; LESS THAN 3.0 CM | $1,812.75 | $2,417.00 | $1,886.48–$3,772.96 | 24% below | 25% |
| Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 ESOPH EGD DILATION <30 MM | $2,626.50 | $3,502.00 | $1,886.48–$3,772.96 | 10% above | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 BIOPSY OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $1,342.50 | $1,790.00 | $891.66–$1,783.32 | 24% below | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $1,397.25 | $1,863.00 | $891.66–$1,783.32 | 21% below | 25% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $1,412.25 | $1,883.00 | $891.66–$1,783.32 | 39% below | 25% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE | $2,523.75 | $3,365.00 | $1,886.48–$3,772.96 | 17% above | 25% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 EGD REMOVE LESION SNARE | $2,626.50 | $3,502.00 | $1,886.48–$3,772.96 | 21% above | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 DIAGNOSTIC EXAM OF ESOPHAGUS; STOMACH; AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE | $1,342.50 | $1,790.00 | $891.66–$1,783.32 | 28% below | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $1,397.25 | $1,863.00 | $891.66–$1,783.32 | 26% below | 25% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CRUSHING OF STONE OF URETER USING AN ENDOSCOPE | $6,230.25 | $8,307.00 | $5,083.62–$10,542.40 | 33% below | 25% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 CYSTOURETERO W/LITHOTRIPSY | $6,485.25 | $8,647.00 | $5,083.62–$10,542.40 | 31% below | 25% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 CYSTO/URETERO W/LITHOTRIPSY | $4,637.25 | $6,183.00 | $5,083.62–$10,542.40 | 63% below | 25% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OBSTETRICAL CARE | $1,410.00 | $1,880.00 | — | — | 25% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT | $2,625.75 | $3,501.00 | $2,048.51–$4,110.12 | 5% above | 25% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 REMOVAL OF SPERM DUCT(S) | $2,733.00 | $3,644.00 | $2,048.51–$4,110.12 | 9% above | 25% |
| Wart removal, up to 14 warts CPT 17110 DESTRUCTION OF SKIN GROWTH; 1-14 GROWTHS | $308.25 | $411.00 | $197.25–$394.50 | 22% above | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $497.25 | $663.00 | $399.53–$799.28 | 48% above | 25% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS | $593.25 | $791.00 | $399.53–$799.28 | 76% above | 25% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 OPTX DST RD XARTC FX/EPI SEP | $7,389.75 | $9,853.00 | $7,133.61–$14,267.22 | 5% below | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Idaho | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS | $777.00 | $1,036.00 | $433.72–$867.44 | 21% below | 25% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT | $808.50 | $1,078.00 | $433.72–$867.44 | 17% below | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $279.75 | $373.00 | — | — | 25% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT FOR AIRWAY OBSTRUCTION OR SPUTUM PRODUCTION | $284.25 | $379.00 | — | — | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 ADMINISTRATION OF CHEMOTHERAPY INTO VEIN; 1 HOUR OR LESS | $450.00 | $600.00 | $324.72–$649.44 | 35% below | 25% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $468.00 | $624.00 | $324.72–$649.44 | 32% below | 25% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE; FIRST 30-74 MINUTES | $1,848.00 | $2,464.00 | $812.07–$1,624.14 | 11% below | 25% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE AND DROWSY | $396.75 | $529.00 | $212.27–$424.54 | 61% below | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING | $186.00 | $248.00 | $57.99–$115.98 | at median | 25% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $201.00 | $268.00 | $57.99–$115.98 | 8% above | 25% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD SEVERITY | $228.75 | $305.00 | $82.90–$165.80 | 2% above | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY | $416.25 | $555.00 | $150.95–$301.90 | at median | 25% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM | $449.25 | $599.00 | $150.95–$301.90 | 8% above | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY | $732.75 | $977.00 | $268.37–$536.74 | at median | 25% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $791.25 | $1,055.00 | $268.37–$536.74 | 8% above | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY | $1,153.50 | $1,538.00 | $410.21–$820.42 | at median | 25% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $1,245.75 | $1,661.00 | $410.21–$820.42 | 8% above | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY | $1,655.25 | $2,207.00 | $585.47–$1,170.94 | at median | 25% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM | $1,788.00 | $2,384.00 | $585.47–$1,170.94 | 8% above | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 EXERCISE OR DRUG-INDUCED HEART STRESS TEST WITH ELECTROCARDIOGRAM (ECG) | $664.50 | $886.00 | $212.27–$424.54 | 12% below | 25% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST | $715.50 | $954.00 | $212.27–$424.54 | 5% below | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INFUSION INTO A VEIN FOR HYDRATION; 31-60 MINUTES | $277.50 | $370.00 | $209.11–$418.22 | 18% below | 25% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $313.50 | $418.00 | $209.11–$418.22 | 8% below | 25% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS | $391.50 | $522.00 | $209.11–$418.22 | 20% below | 25% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $407.25 | $543.00 | $209.11–$418.22 | 17% below | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $149.25 | $199.00 | $70.78–$141.56 | 30% above | 25% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION OF DRUG OR SUBSTANCE UNDER SKIN OR INTO MUSCLE | $432.00 | $576.00 | $70.78–$141.56 | 276% above | 25% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MEDICAL NUTRITION INDIV IN | $42.75 | $57.00 | $25.54–$51.08 | 11% below | 25% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES | $150.00 | $200.00 | $94.00–$188.00 | 25% below | 25% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN | $159.75 | $213.00 | $119.89–$239.78 | 38% below | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES | $205.50 | $274.00 | $54.98–$109.96 | 36% above | 25% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN | $213.75 | $285.00 | $54.98–$109.96 | 42% above | 25% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN | $168.75 | $225.00 | $80.78–$161.56 | 12% below | 25% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN | $95.25 | $127.00 | $29.55–$59.10 | 3% above | 25% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $245.25 | $327.00 | $156.46–$424.54 | 1% above | 25% |
| Spirometry before and after a bronchodilator CPT 94060 TEST TO MEASURE EXPIRATORY AIRFLOW AND VOLUME CHANGES BEFORE AND AFTER MEDICATION ADMINISTRATION | $454.50 | $606.00 | $311.40–$733.70 | at median | 25% |
| Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING | $472.50 | $630.00 | $311.40–$733.70 | 4% above | 25% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 DRAWING OF BLOOD FOR A MEDICAL PROBLEM | $154.50 | $206.00 | $128.90–$261.60 | 32% below | 25% |
| Treadmill or drug stress test with ECG, supervision and report CPT 93015 CARDIOVASCULAR STRESS TEST | $362.25 | $483.00 | — | 23% above | 25% |
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 2025-2026 Formula PFS | $18.75 | $25.00 | — | 48% below | 25% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Fluzone 2024-2025 Formula PFS | $22.50 | $30.00 | — | 38% below | 25% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Engerix-B | $134.33 | $179.10 | — | 30% above | 25% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Fluzone High-Dose 2024-2025 Formula | $86.00 | $114.66 | — | at median | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC | $42.75 | $57.00 | — | 73% below | 25% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II | $178.16 | $237.54 | — | 13% above | 25% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Menactra | $268.70 | $358.27 | — | 42% above | 25% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumovax 23 | $223.52 | $298.02 | — | 50% above | 25% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Beyfortus | $966.45 | $1,288.60 | — | 62% above | 25% |
| Rabies vaccine, one dose CPT 90675 RabAvert | $771.23 | $1,028.30 | $319.75–$639.50 | 66% above | 25% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingrix | $120.00 | $160.00 | — | 63% below | 25% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac | $75.50 | $100.66 | — | 2% below | 25% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Adacel | $95.10 | $126.80 | — | 6% above | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF VACCINE | $55.50 | $74.00 | $70.78–$141.56 | 2% below | 25% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $57.75 | $77.00 | $70.78–$141.56 | 2% above | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD | $21.75 | $29.00 | — | 40% below | 25% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMINISTRATION OF VACCINE; EACH ADDITIONAL VACCINE | $24.00 | $32.00 | — | 33% below | 25% |
Source file: https://apim.services.craneware.com/api-pricing-transparency/api/public/d21636a85e43647a836d7449da69027c/charges/mrf