Tulsa Spine & Specialty Hospital
Tulsa Spine & Specialty Hospital in Tulsa, OK publishes cash prices for 174 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 Oklahoma median for 162 of 171 procedures and above it for 9. By typical cash price it ranks #2 of 56 Oklahoma hospitals and #1 of 16 hospitals in the Tulsa, OK area, cheapest first. Click a procedure to compare it with other hospitals nearby.
6901 South Olympia Ave., Tulsa, OK 74132 Collected Sep 29, 2026 Source price file (918) 388-5701
Acute care hospital Emergency department CCN 370216 · CMS hospital register NPI 1033185293
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 Tulsa Spine & Specialty Hospital in Tulsa, OK:
- Apr 24, 2025 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 Oklahoma | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 X-ray of ankle, minimum of 3 views | $69.38 | $277.54 | $22.64–$180.40 | 60% below | 75% |
| Ankle X-ray, complete, 3 or more views inpatient CPT 73610 X-ray of ankle, minimum of 3 views | $69.38 | $277.54 | $22.64–$180.40 | — | 75% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 HC Doppler Art 1-2 Level Bilat | $78.50 | $314.00 | $78.50–$220.71 | — | 75% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 HC Doppler Art 1-2 Level Bilat | $78.50 | $314.00 | $78.50–$220.71 | — | 75% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Single contrast X-ray of esophagus | $170.50 | $682.00 | $79.60–$443.30 | 41% below | 75% |
| Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Single contrast X-ray of esophagus | $170.50 | $682.00 | $79.60–$443.30 | — | 75% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT scan of blood vessels of chest with contrast | $524.18 | $2,096.74 | $143.26–$1,070.00 | 65% below | 75% |
| CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT scan of blood vessels of chest with contrast | $524.18 | $2,096.74 | $143.26–$1,070.00 | — | 75% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT scan of abdomen and pelvis without contrast | $917.78 | $3,671.11 | $84.69–$2,268.75 | 32% below | 75% |
| CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT scan of abdomen and pelvis without contrast | $917.78 | $3,671.11 | $84.69–$2,268.75 | — | 75% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast | $899.07 | $3,596.29 | $178.32–$2,222.51 | 48% below | 75% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT scan of abdomen and pelvis with contrast | $899.07 | $3,596.29 | $178.32–$2,222.51 | — | 75% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT scan of abdomen and pelvis before and after contrast | $899.07 | $3,596.29 | $201.24–$2,222.51 | 57% below | 75% |
| CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT scan of abdomen and pelvis before and after contrast | $899.07 | $3,596.29 | $201.24–$2,222.51 | — | 75% |
| CT scan of the abdomen with contrast CPT 74160 CT scan of abdomen with contrast | $459.30 | $1,837.20 | $158.53–$1,213.00 | 57% below | 75% |
| CT scan of the abdomen with contrast inpatient CPT 74160 CT scan of abdomen with contrast | $459.30 | $1,837.20 | $158.53–$1,213.00 | — | 75% |
| CT scan of the abdomen without contrast CPT 74150 CT scan of abdomen without contrast | $297.18 | $1,188.74 | $66.90–$1,213.00 | 70% below | 75% |
| CT scan of the abdomen without contrast inpatient CPT 74150 CT scan of abdomen without contrast | $297.18 | $1,188.74 | $66.90–$1,213.00 | — | 75% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT scan of face without contrast | $611.85 | $2,447.41 | $72.57–$1,512.50 | 36% below | 75% |
| CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT scan of face without contrast | $611.85 | $2,447.41 | $72.57–$1,512.50 | — | 75% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT scan head or brain without contrast | $524.44 | $2,097.78 | $55.30–$1,296.43 | 48% below | 75% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT scan head or brain without contrast | $524.44 | $2,097.78 | $55.30–$1,296.43 | — | 75% |
| CT scan of the head with contrast CPT 70460 CT scan head or brain with contrast | $465.36 | $1,861.43 | $125.54–$1,213.00 | 61% below | 75% |
| CT scan of the head with contrast inpatient CPT 70460 CT scan head or brain with contrast | $465.36 | $1,861.43 | $125.54–$1,213.00 | — | 75% |
| CT scan of the head without and with contrast CPT 70470 CT scan of head or brain before and after contrast | $699.26 | $2,797.04 | $94.13–$1,728.57 | 46% below | 75% |
| CT scan of the head without and with contrast inpatient CPT 70470 CT scan of head or brain before and after contrast | $699.26 | $2,797.04 | $94.13–$1,728.57 | — | 75% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT scan of lower spine without contrast | $524.44 | $2,097.78 | $94.70–$1,296.43 | 50% below | 75% |
| CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT scan of lower spine without contrast | $524.44 | $2,097.78 | $94.70–$1,296.43 | — | 75% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT scan of upper spine without contrast | $524.44 | $2,097.78 | $69.06–$1,296.43 | 52% below | 75% |
| CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT scan of upper spine without contrast | $524.44 | $2,097.78 | $69.06–$1,296.43 | — | 75% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast | $481.00 | $1,924.00 | $158.53–$1,213.00 | 56% below | 75% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT scan of pelvis with contrast | $481.00 | $1,924.00 | $158.53–$1,213.00 | — | 75% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Ultrasound of both sides of head and neck blood flow | $180.51 | $722.06 | $180.52–$781.00 | 63% below | 75% |
| Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 Ultrasound of both sides of head and neck blood flow | $180.51 | $722.06 | $180.52–$781.00 | — | 75% |
| Chest X-ray, 2 views CPT 71046 HC Chest 2 Views | $69.60 | $278.40 | $18.87–$180.96 | 62% below | 75% |
| Chest X-ray, 2 views inpatient CPT 71046 HC Chest 2 Views | $69.60 | $278.40 | $18.87–$180.96 | — | 75% |
| Chest X-ray, single view CPT 71045 HC Chest Single View | $69.60 | $278.40 | $14.01–$180.96 | 61% below | 75% |
| Chest X-ray, single view inpatient CPT 71045 HC Chest Single View | $69.60 | $278.40 | $14.01–$180.96 | — | 75% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Complete ultrasound scan behind abdominal cavity | $77.75 | $311.00 | $59.05–$212.68 | 83% below | 75% |
| Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 Complete ultrasound scan behind abdominal cavity | $77.75 | $311.00 | $59.05–$212.68 | — | 75% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT scan of chest without contrast | $297.18 | $1,188.74 | $68.25–$1,213.00 | 69% below | 75% |
| Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT scan of chest without contrast | $297.18 | $1,188.74 | $68.25–$1,213.00 | — | 75% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT scan of chest with contrast | $465.36 | $1,861.43 | $158.53–$1,213.00 | 61% below | 75% |
| Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT scan of chest with contrast | $465.36 | $1,861.43 | $158.53–$1,213.00 | — | 75% |
| Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC Duplex Arterial Low Extrem Complete Bilat | $159.50 | $638.00 | $159.50–$413.87 | — | 75% |
| Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC Duplex Arterial Low Extrem Complete Bilat | $159.50 | $638.00 | $159.50–$413.87 | — | 75% |
| Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Duplex Venous Extremity Bilat | $188.40 | $753.60 | $151.35–$413.87 | — | 75% |
| Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Duplex Venous Extremity Bilat | $188.40 | $753.60 | $151.35–$413.87 | — | 75% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function | $342.75 | $1,371.00 | $161.44–$938.80 | 68% below | 75% |
| Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function | $342.75 | $1,371.00 | $161.44–$938.80 | — | 75% |
| 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) | $1,541.75 | $6,167.00 | $202.00–$4,008.55 | 48% below | 75% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Sleep study in sleep lab with continuous airway pressure (6 years or older) | $1,541.75 | $6,167.00 | $202.00–$4,008.55 | — | 75% |
| Knee X-ray, 3 views CPT 73562 X-ray of knee, 3 views | $69.38 | $277.54 | $25.61–$180.40 | 71% below | 75% |
| Knee X-ray, 3 views inpatient CPT 73562 X-ray of knee, 3 views | $69.38 | $277.54 | $25.61–$180.40 | — | 75% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Limited ultrasound scan of abdomen | $243.00 | $972.00 | $47.74–$426.71 | 37% below | 75% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Limited ultrasound scan of abdomen | $243.00 | $972.00 | $47.74–$426.71 | — | 75% |
| 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 | $75.50 | $302.00 | $75.50–$1,213.00 | 78% below | 75% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 Low dose CT scan of chest for lung cancer screening | $75.50 | $302.00 | $75.50–$1,213.00 | — | 75% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint without contrast | $484.66 | $1,938.63 | $115.42–$1,625.00 | 66% below | 75% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI scan of leg joint without contrast | $484.66 | $1,938.63 | $115.42–$1,625.00 | — | 75% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI scan of leg joint before and after contrast | $588.50 | $2,354.00 | $232.54–$1,625.00 | 65% below | 75% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI scan of leg joint before and after contrast | $588.50 | $2,354.00 | $232.54–$1,625.00 | — | 75% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI scan of abdomen before and after contrast | $764.81 | $3,059.24 | $284.31–$1,890.61 | 59% below | 75% |
| MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI scan of abdomen before and after contrast | $764.81 | $3,059.24 | $284.31–$1,890.61 | — | 75% |
| MRI of the brain, no contrast dye CPT 70551 MRI scan of brain without contrast | $831.72 | $3,326.88 | $105.19–$2,056.01 | 21% below | 75% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI scan of brain without contrast | $831.72 | $3,326.88 | $105.19–$2,056.01 | — | 75% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI scan of brain before and after contrast | $786.98 | $3,147.91 | $174.52–$1,945.41 | 46% below | 75% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI scan of brain before and after contrast | $786.98 | $3,147.91 | $174.52–$1,945.41 | — | 75% |
| MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal without contrast | $646.64 | $2,586.55 | $100.61–$1,625.00 | 46% below | 75% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI scan of lower spinal canal without contrast | $646.64 | $2,586.55 | $100.61–$1,625.00 | — | 75% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI scan of lower spinal canal before and after contrast | $764.81 | $3,059.24 | $174.52–$1,890.61 | 52% below | 75% |
| MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI scan of lower spinal canal before and after contrast | $764.81 | $3,059.24 | $174.52–$1,890.61 | — | 75% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI scan of middle spinal canal without contrast | $484.65 | $1,938.62 | $100.34–$1,625.00 | 56% below | 75% |
| MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI scan of middle spinal canal without contrast | $484.65 | $1,938.62 | $100.34–$1,625.00 | — | 75% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI scan of upper spinal canal before and after contrast | $786.98 | $3,147.91 | $175.06–$1,945.41 | 52% below | 75% |
| MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI scan of upper spinal canal before and after contrast | $786.98 | $3,147.91 | $175.06–$1,945.41 | — | 75% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI scan of upper spinal canal without contrast | $582.20 | $2,328.82 | $100.07–$1,625.00 | 51% below | 75% |
| MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI scan of upper spinal canal without contrast | $582.20 | $2,328.82 | $100.07–$1,625.00 | — | 75% |
| MRI of the pelvis without and with contrast CPT 72197 MRI scan of pelvis before and after contrast | $764.81 | $3,059.24 | $192.33–$1,890.61 | 50% below | 75% |
| MRI of the pelvis without and with contrast inpatient CPT 72197 MRI scan of pelvis before and after contrast | $764.81 | $3,059.24 | $192.33–$1,890.61 | — | 75% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI scan of pelvis without contrast | $484.65 | $1,938.62 | $131.64–$1,625.00 | 53% below | 75% |
| MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI scan of pelvis without contrast | $484.65 | $1,938.62 | $131.64–$1,625.00 | — | 75% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI scan of arm joint without contrast | $484.65 | $1,938.62 | $115.69–$1,625.00 | 67% below | 75% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI scan of arm joint without contrast | $484.65 | $1,938.62 | $115.69–$1,625.00 | — | 75% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Limited ultrasound scan of pelvis | $77.75 | $311.00 | $42.06–$212.68 | 74% below | 75% |
| Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Limited ultrasound scan of pelvis | $77.75 | $311.00 | $42.06–$212.68 | — | 75% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Complete ultrasound scan of pelvis | $77.75 | $311.00 | $77.75–$212.68 | 84% below | 75% |
| Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 Complete ultrasound scan of pelvis | $77.75 | $311.00 | $77.75–$212.68 | — | 75% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-ray of shoulder, minimum of 2 views | $69.38 | $277.54 | $20.75–$270.60 | 70% below | 75% |
| Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 X-ray of shoulder, minimum of 2 views | $69.38 | $277.54 | $20.75–$270.60 | — | 75% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep study in sleep lab (6 years or older) | $1,460.25 | $5,841.00 | $202.00–$3,796.65 | 47% below | 75% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep study in sleep lab (6 years or older) | $1,460.25 | $5,841.00 | $202.00–$3,796.65 | — | 75% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Imaging for evaluation of swallowing function | $110.77 | $443.10 | $100.15–$356.04 | 66% below | 75% |
| Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Imaging for evaluation of swallowing function | $110.77 | $443.10 | $100.15–$356.04 | — | 75% |
| Ultrasound of the abdomen, complete CPT 76700 Complete ultrasound scan of abdomen | $227.25 | $909.00 | $95.90–$590.85 | 57% below | 75% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Complete ultrasound scan of abdomen | $227.25 | $909.00 | $95.90–$590.85 | — | 75% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound scan of head and neck soft tissue | $98.70 | $394.80 | $66.88–$256.62 | 76% below | 75% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Ultrasound scan of head and neck soft tissue | $98.70 | $394.80 | $66.88–$256.62 | — | 75% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Duplex Venous Extremity Unilat | $156.77 | $627.10 | $94.70–$781.00 | 69% below | 75% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Duplex Venous Extremity Unilat | $156.77 | $627.10 | $94.70–$781.00 | — | 75% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-ray of wrist, minimum of 3 views | $63.75 | $255.00 | $33.98–$176.10 | 68% below | 75% |
| Wrist X-ray, complete, 3 or more views inpatient CPT 73110 X-ray of wrist, minimum of 3 views | $63.75 | $255.00 | $33.98–$176.10 | — | 75% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-ray of hip, 2-3 views | $106.63 | $426.54 | $29.93–$277.25 | 44% below | 75% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-ray of hip, 2-3 views | $106.63 | $426.54 | $29.93–$277.25 | — | 75% |
| X-ray of the abdomen, 1 view CPT 74018 HC Abdomen 1 View | $58.00 | $232.00 | $17.25–$176.10 | 65% below | 75% |
| X-ray of the abdomen, 1 view inpatient CPT 74018 HC Abdomen 1 View | $58.00 | $232.00 | $17.25–$176.10 | — | 75% |
| X-ray of the ankle, 2 views CPT 73600 X-ray of ankle, 2 views | $69.38 | $277.54 | $26.39–$180.40 | 61% below | 75% |
| X-ray of the ankle, 2 views inpatient CPT 73600 X-ray of ankle, 2 views | $69.38 | $277.54 | $26.39–$180.40 | — | 75% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-ray of finger, minimum of 2 views | $69.38 | $277.54 | $31.41–$176.10 | 57% below | 75% |
| X-ray of the finger(s), 2 or more views inpatient CPT 73140 X-ray of finger, minimum of 2 views | $69.38 | $277.54 | $31.41–$176.10 | — | 75% |
| X-ray of the foot, 2 views CPT 73620 X-ray of foot, 2 views | $69.38 | $277.54 | $16.98–$180.40 | 59% below | 75% |
| X-ray of the foot, 2 views inpatient CPT 73620 X-ray of foot, 2 views | $69.38 | $277.54 | $16.98–$180.40 | — | 75% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-ray of foot, minimum of 3 views | $69.38 | $277.54 | $28.04–$180.40 | 69% below | 75% |
| X-ray of the foot, complete, 3 or more views inpatient CPT 73630 X-ray of foot, minimum of 3 views | $69.38 | $277.54 | $28.04–$180.40 | — | 75% |
| X-ray of the hand, 3 or more views CPT 73130 X-ray of hand, minimum of 3 views | $76.50 | $306.00 | $30.74–$198.90 | 67% below | 75% |
| X-ray of the hand, 3 or more views inpatient CPT 73130 X-ray of hand, minimum of 3 views | $76.50 | $306.00 | $30.74–$198.90 | — | 75% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-ray of knee, 1-2 views | $69.38 | $277.54 | $21.02–$180.40 | 61% below | 75% |
| X-ray of the knee, 1 or 2 views inpatient CPT 73560 X-ray of knee, 1-2 views | $69.38 | $277.54 | $21.02–$180.40 | — | 75% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-ray of lower and sacral spine, 2-3 views | $69.38 | $277.54 | $23.45–$212.68 | 68% below | 75% |
| X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 X-ray of lower and sacral spine, 2-3 views | $69.38 | $277.54 | $23.45–$212.68 | — | 75% |
| X-ray of the lower back, 4 or more views CPT 72110 X-ray of lower and sacral spine, minimum of 4 views | $116.90 | $467.60 | $31.82–$303.94 | 63% below | 75% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-ray of lower and sacral spine, minimum of 4 views | $116.90 | $467.60 | $31.82–$303.94 | — | 75% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-ray of middle spine, 2 views | $69.38 | $277.54 | $18.87–$212.68 | 67% below | 75% |
| X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 X-ray of middle spine, 2 views | $69.38 | $277.54 | $18.87–$212.68 | — | 75% |
| X-ray of the nasal bones, 3 or more views CPT 70160 X-ray of nose bones, minimum of 3 views | $43.00 | $172.00 | $31.01–$176.10 | 74% below | 75% |
| X-ray of the nasal bones, 3 or more views inpatient CPT 70160 X-ray of nose bones, minimum of 3 views | $43.00 | $172.00 | $31.01–$176.10 | — | 75% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-ray of upper spine, 2-3 views | $69.38 | $277.54 | $23.45–$180.40 | 66% below | 75% |
| X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 X-ray of upper spine, 2-3 views | $69.38 | $277.54 | $23.45–$180.40 | — | 75% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-ray of pelvis, 1-2 views | $69.38 | $277.54 | $15.90–$212.68 | 64% below | 75% |
| X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 X-ray of pelvis, 1-2 views | $69.38 | $277.54 | $15.90–$212.68 | — | 75% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-ray of sacrum and tailbone, minimum of 2 views | $69.38 | $277.54 | $26.96–$180.40 | 61% below | 75% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 X-ray of sacrum and tailbone, minimum of 2 views | $69.38 | $277.54 | $26.96–$180.40 | — | 75% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel | $39.75 | $159.00 | $23.57–$126.22 | 79% below | 75% |
| Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute hepatitis panel | $39.75 | $159.00 | $23.57–$126.22 | — | 75% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Measurement of antibody (IgE) to allergic substance, crude allergen extract, each | $13.98 | $55.94 | $2.58–$36.36 | 41% below | 75% |
| Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Measurement of antibody (IgE) to allergic substance, crude allergen extract, each | $13.98 | $55.94 | $2.58–$36.36 | — | 75% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Screening test for autoimmune disorder | $10.25 | $41.00 | $10.25–$32.04 | 82% below | 75% |
| Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Screening test for autoimmune disorder | $10.25 | $41.00 | $10.25–$32.04 | — | 75% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide (heart and blood vessel protein) level | $41.45 | $165.79 | $34.92–$104.04 | 63% below | 75% |
| BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Natriuretic peptide (heart and blood vessel protein) level | $41.45 | $165.79 | $34.92–$104.04 | — | 75% |
| Basic metabolic panel (blood test) CPT 80048 Blood test, basic group of blood chemicals (Calcium, total) | $45.60 | $182.41 | $4.19–$118.57 | 6% above | 75% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Blood test, basic group of blood chemicals (Calcium, total) | $45.60 | $182.41 | $4.19–$118.57 | — | 75% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology examination of tissue using a microscope, intermediate complexity | $49.57 | $198.29 | $13.72–$128.89 | 66% below | 75% |
| Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Pathology examination of tissue using a microscope, intermediate complexity | $49.57 | $198.29 | $13.72–$128.89 | — | 75% |
| Blood culture for bacteria CPT 87040 Bacterial blood culture | $32.41 | $129.66 | $9.18–$32.42 | 56% below | 75% |
| Blood culture for bacteria inpatient CPT 87040 Bacterial blood culture | $32.41 | $129.66 | $9.18–$32.42 | — | 75% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insertion of needle into vein for collection of blood sample | $15.20 | $60.81 | $8.09–$24.75 | 46% above | 75% |
| Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Insertion of needle into vein for collection of blood sample | $15.20 | $60.81 | $8.09–$24.75 | — | 75% |
| Blood glucose (sugar) test CPT 82947 Blood glucose (sugar) level | $10.49 | $41.95 | $3.50–$10.49 | 59% below | 75% |
| Blood glucose (sugar) test inpatient CPT 82947 Blood glucose (sugar) level | $10.49 | $41.95 | $3.50–$10.49 | — | 75% |
| Blood lead test CPT 83655 Lead level | $30.00 | $120.00 | $10.77–$32.09 | 39% below | 75% |
| Blood lead test inpatient CPT 83655 Lead level | $30.00 | $120.00 | $10.77–$32.09 | — | 75% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin (reproductive hormone) analysis | $19.23 | $76.92 | $6.69–$19.93 | 58% below | 75% |
| Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Gonadotropin (reproductive hormone) analysis | $19.23 | $76.92 | $6.69–$19.93 | — | 75% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood group typing (ABO) | $73.50 | $294.00 | $1.48–$220.71 | 21% above | 75% |
| Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood group typing (ABO) | $73.50 | $294.00 | $1.48–$220.71 | — | 75% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-Reactive Protein | $26.66 | $106.63 | $4.61–$26.66 | 30% below | 75% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-Reactive Protein | $26.66 | $106.63 | $4.61–$26.66 | — | 75% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Detection test by nucleic acid for clostridium difficile, amplified probe technique | $82.26 | $329.03 | $33.15–$98.77 | 2% below | 75% |
| C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Detection test by nucleic acid for clostridium difficile, amplified probe technique | $82.26 | $329.03 | $33.15–$98.77 | — | 75% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | $29.25 | $117.00 | $29.25–$92.99 | 63% below | 75% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | $29.25 | $117.00 | $29.25–$92.99 | — | 75% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $11.25 | $45.00 | $11.25–$35.48 | 84% below | 75% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $11.25 | $45.00 | $11.25–$35.48 | — | 75% |
| 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 | $27.90 | $111.60 | $3.85–$72.54 | 38% below | 75% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $27.90 | $111.60 | $3.85–$72.54 | — | 75% |
| Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test | $17.48 | $69.92 | $3.20–$45.45 | 59% below | 75% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test | $17.48 | $69.92 | $3.20–$45.45 | — | 75% |
| Estradiol blood test CPT 82670 Measurement of total estradiol (hormone) | $19.25 | $77.00 | $19.25–$74.04 | 78% below | 75% |
| Estradiol blood test inpatient CPT 82670 Measurement of total estradiol (hormone) | $19.25 | $77.00 | $19.25–$74.04 | — | 75% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin, follicle stimulating (reproductive hormone) level | $12.75 | $51.00 | $12.75–$49.24 | 81% below | 75% |
| FSH (follicle-stimulating hormone) test inpatient CPT 83001 Gonadotropin, follicle stimulating (reproductive hormone) level | $12.75 | $51.00 | $12.75–$49.24 | — | 75% |
| Folate (folic acid) blood test CPT 82746 Folic acid level, serum | $36.71 | $146.84 | $13.08–$38.96 | 42% below | 75% |
| Folate (folic acid) blood test inpatient CPT 82746 Folic acid level, serum | $36.71 | $146.84 | $13.08–$38.96 | — | 75% |
| Free T3 thyroid hormone test CPT 84481 Thyroid hormone, T3 measurement, free | $14.25 | $57.00 | $14.25–$44.89 | 84% below | 75% |
| Free T3 thyroid hormone test inpatient CPT 84481 Thyroid hormone, T3 measurement, free | $14.25 | $57.00 | $14.25–$44.89 | — | 75% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (thyroid chemical), free | $44.49 | $177.96 | $8.02–$44.49 | 33% below | 75% |
| Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine (thyroid chemical), free | $44.49 | $177.96 | $8.02–$44.49 | — | 75% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | $29.25 | $117.00 | $29.25–$92.99 | 64% below | 75% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | $29.25 | $117.00 | $29.25–$92.99 | — | 75% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Detection test by nucleic acid for HIV-1 virus, quantification | $71.25 | $285.00 | $42.11–$225.52 | 64% below | 75% |
| HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Detection test by nucleic acid for HIV-1 virus, quantification | $71.25 | $285.00 | $42.11–$225.52 | — | 75% |
| HIV-1 and HIV-2 antibody test CPT 86703 Analysis for antibody to HIV-1 and HIV-2 virus | $34.96 | $139.85 | $7.91–$36.33 | 28% below | 75% |
| HIV-1 and HIV-2 antibody test inpatient CPT 86703 Analysis for antibody to HIV-1 and HIV-2 virus | $34.96 | $139.85 | $7.91–$36.33 | — | 75% |
| 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 | $33.22 | $132.90 | $11.92–$86.39 | 30% below | 75% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Detection test by immunoassay technique for HIV-1 antigen and HIV-1 and HIV-2 antibodies | $33.22 | $132.90 | $11.92–$86.39 | — | 75% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C level | $22.72 | $90.90 | $4.80–$59.09 | 37% below | 75% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C level | $22.72 | $90.90 | $4.80–$59.09 | — | 75% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody measurement | $9.00 | $36.00 | $9.00–$28.46 | 80% below | 75% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B surface antibody measurement | $9.00 | $36.00 | $9.00–$28.46 | — | 75% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Detection test by immunoassay technique for hepatitis B surface antigen | $24.82 | $99.29 | $9.19–$27.37 | 40% below | 75% |
| Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Detection test by immunoassay technique for hepatitis B surface antigen | $24.82 | $99.29 | $9.19–$27.37 | — | 75% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody measurement | $34.96 | $139.85 | $7.06–$90.90 | 31% below | 75% |
| Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C antibody measurement | $34.96 | $139.85 | $7.06–$90.90 | — | 75% |
| Herpes blood test, HSV-1 antibody CPT 86695 Analysis for antibody to Herpes simplex virus, type 1 | $11.25 | $45.00 | $11.25–$34.95 | 81% below | 75% |
| Herpes blood test, HSV-1 antibody inpatient CPT 86695 Analysis for antibody to Herpes simplex virus, type 1 | $11.25 | $45.00 | $11.25–$34.95 | — | 75% |
| Herpes blood test, HSV-2 antibody CPT 86696 Analysis for antibody to Herpes simplex virus, type 2 | $16.50 | $66.00 | $16.50–$51.28 | 72% below | 75% |
| Herpes blood test, HSV-2 antibody inpatient CPT 86696 Analysis for antibody to Herpes simplex virus, type 2 | $16.50 | $66.00 | $16.50–$51.28 | — | 75% |
| Iron blood test (serum iron) CPT 83540 Iron level | $13.60 | $54.40 | $3.20–$35.36 | 63% below | 75% |
| Iron blood test (serum iron) inpatient CPT 83540 Iron level | $13.60 | $54.40 | $3.20–$35.36 | — | 75% |
| Kidney function blood test panel CPT 80069 Kidney function blood test panel | $131.75 | $527.00 | $7.72–$131.75 | 103% above | 75% |
| Kidney function blood test panel inpatient CPT 80069 Kidney function blood test panel | $131.75 | $527.00 | $7.72–$131.75 | — | 75% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase (fat enzyme) level | $61.18 | $244.74 | $3.41–$159.08 | 6% above | 75% |
| Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase (fat enzyme) level | $61.18 | $244.74 | $3.41–$159.08 | — | 75% |
| Magnesium blood test CPT 83735 Magnesium level | $17.48 | $69.92 | $5.96–$17.76 | 53% below | 75% |
| Magnesium blood test inpatient CPT 83735 Magnesium level | $17.48 | $69.92 | $5.96–$17.76 | — | 75% |
| Measles (rubeola) antibody test CPT 86765 Analysis for antibody to Rubeola (measles virus) | $11.25 | $45.00 | $11.25–$34.13 | 70% below | 75% |
| Measles (rubeola) antibody test inpatient CPT 86765 Analysis for antibody to Rubeola (measles virus) | $11.25 | $45.00 | $11.25–$34.13 | — | 75% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free | $15.50 | $62.00 | $15.50–$48.73 | 83% below | 75% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (prostate specific antigen) measurement, free | $15.50 | $62.00 | $15.50–$48.73 | — | 75% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total | $69.50 | $278.00 | $16.36–$69.50 | 10% below | 75% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (prostate specific antigen) measurement, total | $69.50 | $278.00 | $16.36–$69.50 | — | 75% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) level | $43.70 | $174.82 | $20.43–$113.63 | 69% below | 75% |
| Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathormone (parathyroid hormone) level | $43.70 | $174.82 | $20.43–$113.63 | — | 75% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood | $17.30 | $69.22 | $2.97–$44.99 | 47% below | 75% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Coagulation assessment blood test, plasma or whole blood | $17.30 | $69.22 | $2.97–$44.99 | — | 75% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $12.85 | $51.40 | $1.94–$33.41 | 61% below | 75% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Blood test, clotting time | $12.85 | $51.40 | $1.94–$33.41 | — | 75% |
| Rapid flu test (influenza antigen) CPT 87804 Detection test by immunoassay with direct visual observation for influenza virus | $12.50 | $50.00 | $12.50–$43.86 | 77% below | 75% |
| Rapid flu test (influenza antigen) inpatient CPT 87804 Detection test by immunoassay with direct visual observation for influenza virus | $12.50 | $50.00 | $12.50–$43.86 | — | 75% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Detection test by immunoassay with direct visual observation for Streptococcus, group A (strep) | $12.50 | $50.00 | $12.50–$43.80 | 75% below | 75% |
| Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Detection test by immunoassay with direct visual observation for Streptococcus, group A (strep) | $12.50 | $50.00 | $12.50–$43.80 | — | 75% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor level | $5.25 | $21.00 | $5.04–$15.03 | 81% below | 75% |
| Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid factor level | $5.25 | $21.00 | $5.04–$15.03 | — | 75% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Red blood cell sedimentation rate, to detect inflammation, automated | $6.99 | $27.97 | $1.34–$18.18 | 66% below | 75% |
| Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Red blood cell sedimentation rate, to detect inflammation, automated | $6.99 | $27.97 | $1.34–$18.18 | — | 75% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool analysis for blood to screen for colon tumors | $15.73 | $62.93 | $3.90–$15.73 | 31% below | 75% |
| Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Stool analysis for blood to screen for colon tumors | $15.73 | $62.93 | $3.90–$15.73 | — | 75% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis detection test | $10.49 | $41.95 | $2.11–$27.27 | 63% below | 75% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis detection test | $10.49 | $41.95 | $2.11–$27.27 | — | 75% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone (hormone) level, total | $17.75 | $71.00 | $17.75–$68.40 | 80% below | 75% |
| Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone (hormone) level, total | $17.75 | $71.00 | $17.75–$68.40 | — | 75% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (autoantibody) measurement | $11.00 | $44.00 | $11.00–$38.56 | 82% below | 75% |
| Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal antibodies (autoantibody) measurement | $11.00 | $44.00 | $11.00–$38.56 | — | 75% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $38.46 | $153.84 | $8.32–$100.00 | 27% below | 75% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $38.46 | $153.84 | $8.32–$100.00 | — | 75% |
| Urinalysis with microscope exam, automated CPT 81001 Manual urinalysis test with examination using microscope, automated | $13.98 | $55.94 | $1.57–$36.36 | 58% below | 75% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Manual urinalysis test with examination using microscope, automated | $13.98 | $55.94 | $1.57–$36.36 | — | 75% |
| Urinalysis without microscope exam, automated CPT 81003 Automated urinalysis test | $11.96 | $47.83 | $1.11–$31.09 | 42% below | 75% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Automated urinalysis test | $11.96 | $47.83 | $1.11–$31.09 | — | 75% |
| Urine culture for bacteria, with colony count CPT 87086 Bacterial colony count, urine | $21.86 | $87.44 | $4.00–$56.84 | 55% below | 75% |
| Urine culture for bacteria, with colony count inpatient CPT 87086 Bacterial colony count, urine | $21.86 | $87.44 | $4.00–$56.84 | — | 75% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (vitamin B-12) level | $38.46 | $153.84 | $13.41–$39.96 | 38% below | 75% |
| Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Cyanocobalamin (vitamin B-12) level | $38.46 | $153.84 | $13.41–$39.96 | — | 75% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D-3 level | $71.67 | $286.69 | $14.65–$186.35 | 45% below | 75% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D-3 level | $71.67 | $286.69 | $14.65–$186.35 | — | 75% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (reproductive hormone) level | $36.71 | $146.84 | $13.39–$39.88 | 40% below | 75% |
| hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Gonadotropin, chorionic (reproductive hormone) level | $36.71 | $146.84 | $13.39–$39.88 | — | 75% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Botox injections for chronic migraine CPT 64615 Injection of chemical for paralysis of facial and neck nerve muscles on both sides of face | $181.77 | $727.10 | $104.73–$2,438.00 | 28% below | 75% |
| Botox injections for chronic migraine inpatient CPT 64615 Injection of chemical for paralysis of facial and neck nerve muscles on both sides of face | $181.77 | $727.10 | $104.73–$2,438.00 | — | 75% |
| Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical snare | $765.63 | $3,062.53 | $765.63–$2,827.00 | 60% below | 75% |
| Colonoscopy with polyp removal inpatient CPT 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical snare | $765.63 | $3,062.53 | $765.63–$2,827.00 | — | 75% |
| Colonoscopy with tissue sample CPT 45380 Biopsy of large bowel using a flexible endoscope | $765.63 | $3,062.53 | $765.63–$2,827.00 | 54% below | 75% |
| Colonoscopy with tissue sample inpatient CPT 45380 Biopsy of large bowel using a flexible endoscope | $765.63 | $3,062.53 | $765.63–$2,827.00 | — | 75% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using a flexible endoscope | $765.63 | $3,062.53 | $765.63–$2,827.00 | 46% below | 75% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic exam of large bowel using a flexible endoscope | $765.63 | $3,062.53 | $765.63–$2,827.00 | — | 75% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Incision of eardrum with placement of eardrum tube under general anesthesia | $2,375.00 | $9,500.00 | $1,262.00–$8,806.50 | 21% below | 75% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 Incision of eardrum with placement of eardrum tube under general anesthesia | $2,375.00 | $9,500.00 | $1,262.00–$8,806.50 | — | 75% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection of substance into middle or upper spine canal using imaging guidance | $634.70 | $2,538.80 | $616.70–$2,438.00 | 4% below | 75% |
| Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Injection of substance into middle or upper spine canal using imaging guidance | $634.70 | $2,538.80 | $616.70–$2,438.00 | — | 75% |
| Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 HC Bilat Inj Paravert Facet Lumb/Sacral Sngl Lvl | $607.50 | $2,430.00 | $607.50–$2,438.00 | — | 75% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection of lower or sacral spine facet joint using imaging guidance, single level | $607.50 | $2,430.00 | $607.50–$2,438.00 | 45% below | 75% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient both sides CPT 64493 HC Bilat Inj Paravert Facet Lumb/Sacral Sngl Lvl | $607.50 | $2,430.00 | $607.50–$2,438.00 | — | 75% |
| Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Injection of lower or sacral spine facet joint using imaging guidance, single level | $607.50 | $2,430.00 | $607.50–$2,438.00 | — | 75% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic exam of lower portion of large bowel using a flexible endoscope | $502.29 | $2,009.15 | $502.29–$2,438.00 | 50% below | 75% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) inpatient CPT 45330 Diagnostic exam of lower portion of large bowel using a flexible endoscope | $502.29 | $2,009.15 | $502.29–$2,438.00 | — | 75% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Insertion of tube and introduction of contrast for X-ray of uterus and fallopian tubes | $316.69 | $1,266.78 | $49.77–$2,438.00 | 65% above | 75% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Insertion of tube and introduction of contrast for X-ray of uterus and fallopian tubes | $316.69 | $1,266.78 | $49.77–$2,438.00 | — | 75% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Simple or single drainage of skin abscess | $122.00 | $488.00 | $122.00–$2,438.00 | 46% below | 75% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Simple or single drainage of skin abscess | $122.00 | $488.00 | $122.00–$2,438.00 | — | 75% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection into tendon or ligament | $181.25 | $725.00 | $181.25–$2,438.00 | 21% below | 75% |
| Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection into tendon or ligament | $181.25 | $725.00 | $181.25–$2,438.00 | — | 75% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound both sides CPT 20610 HC Bilat Arthrocentesis Asp/Inj Major Joint W/O US | $181.22 | $724.90 | $181.23–$2,438.00 | — | 75% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthrocentesis Asp/Inj Major Joint W/O US | $181.22 | $724.90 | $181.23–$2,438.00 | 33% below | 75% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient both sides CPT 20610 HC Bilat Arthrocentesis Asp/Inj Major Joint W/O US | $181.22 | $724.90 | $181.23–$2,438.00 | — | 75% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Arthrocentesis Asp/Inj Major Joint W/O US | $181.22 | $724.90 | $181.23–$2,438.00 | — | 75% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) both sides CPT 20605 HC Bilat Arthrocentesis Asp/Inj Interm Jnt W/O US | $311.02 | $1,244.10 | $262.87–$2,438.00 | — | 75% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Arthrocentesis Asp/Inj Interm Jnt W/O US | $311.02 | $1,244.10 | $262.87–$2,438.00 | 15% above | 75% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient both sides CPT 20605 HC Bilat Arthrocentesis Asp/Inj Interm Jnt W/O US | $311.02 | $1,244.10 | $262.87–$2,438.00 | — | 75% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Arthrocentesis Asp/Inj Interm Jnt W/O US | $311.02 | $1,244.10 | $262.87–$2,438.00 | — | 75% |
| Joint injection or drainage, small joint (fingers, toes) both sides CPT 20600 HC Bilat Arthrocentesis Asp/Inj Small Joint W/O US | $312.12 | $1,248.50 | $262.87–$2,438.00 | — | 75% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Arthrocentesis Asp/Inj Small Joint W/O US | $312.12 | $1,248.50 | $262.87–$2,438.00 | 59% above | 75% |
| Joint injection or drainage, small joint (fingers, toes) inpatient both sides CPT 20600 HC Bilat Arthrocentesis Asp/Inj Small Joint W/O US | $312.12 | $1,248.50 | $262.87–$2,438.00 | — | 75% |
| Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Arthrocentesis Asp/Inj Small Joint W/O US | $312.12 | $1,248.50 | $262.87–$2,438.00 | — | 75% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Inj Epidural Lumb/Caud W/Imaging | $634.70 | $2,538.80 | $616.70–$2,438.00 | 4% below | 75% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Inj Epidural Lumb/Caud W/Imaging | $634.70 | $2,538.80 | $616.70–$2,438.00 | — | 75% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Injection of substance into lower spine canal | $366.75 | $1,467.00 | $366.75–$2,438.00 | 41% below | 75% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Injection of substance into lower spine canal | $366.75 | $1,467.00 | $366.75–$2,438.00 | — | 75% |
| Lower-back nerve root steroid injection, with imaging guidance both sides CPT 64483 HC Bilat Inj Anes/Steroid Trnsf Lumbr/Sac Sngl | $714.72 | $2,858.90 | $714.69–$2,650.20 | — | 75% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | $714.69 | $2,858.77 | $714.69–$2,650.20 | 25% below | 75% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient both sides CPT 64483 HC Bilat Inj Anes/Steroid Trnsf Lumbr/Sac Sngl | $714.72 | $2,858.90 | $714.69–$2,650.20 | — | 75% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | $714.69 | $2,858.77 | $714.69–$2,650.20 | — | 75% |
| Occipital nerve block (injection for headaches) CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $270.32 | $1,081.30 | $262.87–$2,438.00 | 29% below | 75% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $270.32 | $1,081.30 | $262.87–$2,438.00 | — | 75% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent removal fingernail or toenail | $189.50 | $758.00 | $189.50–$2,438.00 | 51% below | 75% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent removal fingernail or toenail | $189.50 | $758.00 | $189.50–$2,438.00 | — | 75% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint | $1,073.70 | $4,294.80 | $1,073.70–$4,783.65 | 40% below | 75% |
| Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint | $1,073.70 | $4,294.80 | $1,073.70–$4,783.65 | — | 75% |
| Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC Colonoscopy Screen Not High Risk | $765.63 | $3,062.53 | $765.63–$2,827.00 | 44% below | 75% |
| Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 HC Colonoscopy Screen Not High Risk | $765.63 | $3,062.53 | $765.63–$2,827.00 | — | 75% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC Colonoscopy Screening High Risk | $765.63 | $3,062.53 | $765.63–$2,827.00 | 45% below | 75% |
| Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 HC Colonoscopy Screening High Risk | $765.63 | $3,062.53 | $765.63–$2,827.00 | — | 75% |
| 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 | $121.75 | $487.00 | $121.75–$2,438.00 | 38% below | 75% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | $121.75 | $487.00 | $121.75–$2,438.00 | — | 75% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $336.68 | $1,346.74 | $336.69–$2,438.00 | 44% below | 75% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $336.68 | $1,346.74 | $336.69–$2,438.00 | — | 75% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection of trigger points, 1-2 muscles | $181.05 | $724.22 | $181.06–$2,438.00 | 22% below | 75% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection of trigger points, 1-2 muscles | $181.05 | $724.22 | $181.06–$2,438.00 | — | 75% |
| 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 | $1,082.86 | $4,331.46 | $1,082.87–$3,248.02 | 43% below | 75% |
| Upper endoscopy (EGD) with balloon widening of the esophagus inpatient CPT 43249 Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm | $1,082.86 | $4,331.46 | $1,082.87–$3,248.02 | — | 75% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Biopsy Single/Multiple | $758.51 | $3,034.06 | $758.52–$2,827.00 | 28% below | 75% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC Egd Biopsy Single/Multiple | $758.51 | $3,034.06 | $758.52–$2,827.00 | — | 75% |
| 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 | $1,082.86 | $4,331.46 | $1,082.87–$3,248.02 | 56% below | 75% |
| Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare | $1,082.86 | $4,331.46 | $1,082.87–$3,248.02 | — | 75% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Insertion of guide wire with dilation of esophagus using a flexible endoscope | $758.51 | $3,034.06 | $758.52–$2,827.00 | 33% below | 75% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 Insertion of guide wire with dilation of esophagus using a flexible endoscope | $758.51 | $3,034.06 | $758.52–$2,827.00 | — | 75% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $758.51 | $3,034.06 | $758.52–$2,438.00 | 34% below | 75% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $758.51 | $3,034.06 | $758.52–$2,438.00 | — | 75% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion of blood or blood products | $288.20 | $1,152.80 | $155.00–$749.32 | 60% below | 75% |
| Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion of blood or blood products | $288.20 | $1,152.80 | $155.00–$749.32 | — | 75% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment for airway obstruction or sputum production | $132.00 | $528.00 | $6.45–$355.93 | 3% above | 75% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhalation treatment for airway obstruction or sputum production | $132.00 | $528.00 | $6.45–$355.93 | — | 75% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, first 30-74 minutes | $453.75 | $1,815.00 | $417.45–$3,195.00 | 52% below | 75% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care, first 30-74 minutes | $453.75 | $1,815.00 | $417.45–$3,195.00 | — | 75% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | $100.00 | $400.00 | $5.10–$260.00 | 22% below | 75% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | $100.00 | $400.00 | $5.10–$260.00 | — | 75% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for problem that may not require health care professional | $62.44 | $249.77 | $57.45–$1,950.00 | 56% below | 75% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency department visit for problem that may not require health care professional | $62.44 | $249.77 | $57.45–$1,950.00 | — | 75% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit with straightforward medical decision making | $107.47 | $429.88 | $98.87–$1,950.00 | 66% below | 75% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency department visit with straightforward medical decision making | $107.47 | $429.88 | $98.87–$1,950.00 | — | 75% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit with low level of medical decision making | $169.12 | $676.49 | $155.59–$1,950.00 | 68% below | 75% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency department visit with low level of medical decision making | $169.12 | $676.49 | $155.59–$1,950.00 | — | 75% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit with moderate level of medical decision making | $271.99 | $1,087.96 | $250.23–$1,950.00 | 64% below | 75% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency department visit with moderate level of medical decision making | $271.99 | $1,087.96 | $250.23–$1,950.00 | — | 75% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit with high level of medical decision making | $401.86 | $1,607.45 | $369.71–$1,950.00 | 65% below | 75% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency department visit with high level of medical decision making | $401.86 | $1,607.45 | $369.71–$1,950.00 | — | 75% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion into a vein for hydration, 31-60 minutes | $134.20 | $536.80 | $134.20–$368.71 | 21% below | 75% |
| IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Infusion into a vein for hydration, 31-60 minutes | $134.20 | $536.80 | $134.20–$368.71 | — | 75% |
| IV infusion of a medicine, first hour CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | $146.85 | $587.40 | $146.85–$368.71 | 37% below | 75% |
| IV infusion of a medicine, first hour inpatient CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | $146.85 | $587.40 | $146.85–$368.71 | — | 75% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle | $44.82 | $179.30 | $44.83–$124.55 | 33% below | 75% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection of drug or substance under skin or into muscle | $44.82 | $179.30 | $44.83–$124.55 | — | 75% |
| Neuromuscular re-education, 15 minutes CPT 97112 Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $29.77 | $119.07 | $27.73–$194.00 | 57% below | 75% |
| Neuromuscular re-education, 15 minutes inpatient CPT 97112 Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $29.77 | $119.07 | $27.73–$194.00 | — | 75% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Evaluation for physical therapy, typically 45 minutes | $63.00 | $252.00 | $61.16–$194.00 | 60% below | 75% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Evaluation for physical therapy, typically 45 minutes | $63.00 | $252.00 | $61.16–$194.00 | — | 75% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Evaluation for physical therapy, typically 20 minutes | $63.00 | $252.00 | $61.16–$194.00 | 44% below | 75% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Evaluation for physical therapy, typically 20 minutes | $63.00 | $252.00 | $61.16–$194.00 | — | 75% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Evaluation Moderate Complexity | $63.00 | $252.00 | $61.16–$194.00 | 52% below | 75% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC Pt Evaluation Moderate Complexity | $63.00 | $252.00 | $61.16–$194.00 | — | 75% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Therapy procedure using manual technique, each 15 minutes | $32.39 | $129.57 | $22.08–$194.00 | 53% below | 75% |
| Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Therapy procedure using manual technique, each 15 minutes | $32.39 | $129.57 | $22.08–$194.00 | — | 75% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $27.45 | $109.81 | $23.94–$194.00 | 61% below | 75% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $27.45 | $109.81 | $23.94–$194.00 | — | 75% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Therapy procedure using functional activities | $28.47 | $113.88 | $28.47–$194.00 | 53% below | 75% |
| Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapy procedure using functional activities | $28.47 | $113.88 | $28.47–$194.00 | — | 75% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Oklahoma | Off list |
|---|---|---|---|---|---|
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration of vaccine | $53.50 | $214.00 | $53.50–$124.55 | 11% below | 75% |
| Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Administration of vaccine | $53.50 | $214.00 | $53.50–$124.55 | — | 75% |