Hospital Kerrville, TX

SID Peterson Memorial Hospital

SID Peterson Memorial Hospital in Kerrville, TX publishes cash prices for 259 common procedures listed here, from its own machine-readable price file updated Aug 17, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Texas median for 204 of 255 procedures and below it for 51. By typical cash price it ranks #197 of 301 Texas hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

551 Hill Country Drive, Kerrville, TX 78028 Collected Sep 29, 2026 Source price file (830) 896-4200

Acute care hospital Emergency department CMS star rating 4 of 5 CCN 450007 · CMS hospital register NPI 1790782704

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3 VIEWS-RIGHT	$455.00	$700.00	$79.81–$665.00	38% above	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE 3 VIEWS-LEFT	$455.00	$700.00	$79.81–$665.00	38% above	35%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3 VIEWS-LEFT	$455.00	$700.00	$455.00–$665.00	—	35%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 ANKLE 3 VIEWS-RIGHT	$455.00	$700.00	$455.00–$665.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US DOPPLER ABI-BILATERAL/LIMIT	$650.00	$1,000.00	$109.03–$1,050.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US DOPPLER VASOSPASTIC UNI UE	$650.00	$1,000.00	$109.03–$1,050.00	7% above	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 TRANSCUTANEOUS OXIMETRY-93922	$650.00	$1,000.00	$109.03–$1,050.00	7% above	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 US DOPPLER ABI-UNILATERAL	$650.00	$1,000.00	$109.03–$1,050.00	7% above	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US DOPPLER ABI-BILATERAL/LIMIT	$650.00	$1,000.00	$650.00–$950.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 US DOPPLER VASOSPASTIC UNI UE	$650.00	$1,000.00	$650.00–$950.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 TRANSCUTANEOUS OXIMETRY-93922	$650.00	$1,000.00	$650.00–$950.00	—	35%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient one side CPT 93922 US DOPPLER ABI-UNILATERAL	$650.00	$1,000.00	$650.00–$950.00	—	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 BARIUM SWALLOW ESOPHAGRAM	$721.50	$1,110.00	$176.20–$1,054.50	44% above	35%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 BARIUM SWALLOW ESOPHAGRAM	$721.50	$1,110.00	$721.50–$1,054.50	—	35%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN WHOLE BODY	$2,034.50	$3,130.00	$270.65–$2,973.50	17% above	35%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN WHOLE BODY	$2,034.50	$3,130.00	$2,034.50–$2,973.50	—	35%
Breast ultrasound, complete, one breast CPT 76641 US BREAST BIL	$845.00	$1,300.00	$105.02–$1,235.00	91% above	35%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL RIGHT	$422.50	$650.00	$105.02–$617.50	4% below	35%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST UNILATERAL LEFT	$422.50	$650.00	$105.02–$617.50	4% below	35%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST BIL	$845.00	$1,300.00	$845.00–$1,235.00	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL RIGHT	$422.50	$650.00	$422.50–$617.50	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US BREAST UNILATERAL LEFT	$422.50	$650.00	$422.50–$617.50	—	35%
Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LTD BIL	$481.00	$740.00	$79.81–$703.00	39% above	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ULTRASOUND BREAST UNIL LTD LT	$351.00	$540.00	$79.81–$513.00	1% above	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ULTRASOUND BREAST UNIL LTD RT	$351.00	$540.00	$79.81–$513.00	1% above	35%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ULTRASOUND BREAST LTD BIL	$481.00	$740.00	$481.00–$703.00	—	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ULTRASOUND BREAST UNIL LTD LT	$351.00	$540.00	$351.00–$513.00	—	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 ULTRASOUND BREAST UNIL LTD RT	$351.00	$540.00	$351.00–$513.00	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST W/WO CONTRAST	$3,646.50	$5,610.00	$176.20–$5,329.50	29% above	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIO CHEST W/WO CONTRAST	$3,646.50	$5,610.00	$3,646.50–$5,329.50	—	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HEART W/CONTRAST	$3,646.50	$5,610.00	$201.82–$5,329.50	119% above	35%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HEART W/CONTRAST	$3,646.50	$5,610.00	$3,646.50–$5,329.50	—	35%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT CALCIUM/CARDIAC SCORING	$260.00	$400.00	$79.81–$380.00	37% above	35%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT CALCIUM/CARDIAC SCORING	$260.00	$400.00	$260.00–$380.00	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT STONE PROTOCOL	$3,900.00	$6,000.00	$233.04–$5,700.00	16% above	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST	$3,900.00	$6,000.00	$233.04–$5,700.00	16% above	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN/PELVIS W/O CONTRAST	$3,900.00	$6,000.00	$3,900.00–$5,700.00	—	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT STONE PROTOCOL	$3,900.00	$6,000.00	$3,900.00–$5,700.00	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN/PELVIS W/CONT	$4,745.00	$7,300.00	$350.46–$6,935.00	22% above	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT SM BOWEL/ENTEROGRAPHY	$4,745.00	$7,300.00	$350.46–$6,935.00	22% above	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN/PELVIS W/CONT	$4,745.00	$7,300.00	$4,745.00–$6,935.00	—	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT SM BOWEL/ENTEROGRAPHY	$4,745.00	$7,300.00	$4,745.00–$6,935.00	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN/PELVIS W/WO/CONT	$5,395.00	$8,300.00	$350.46–$7,885.00	29% above	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT UROGRAM	$5,395.00	$8,300.00	$350.46–$7,885.00	29% above	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT UROGRAM	$5,395.00	$8,300.00	$5,395.00–$7,885.00	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN/PELVIS W/WO/CONT	$5,395.00	$8,300.00	$5,395.00–$7,885.00	—	35%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST	$3,012.75	$4,635.00	$176.20–$4,403.25	15% above	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$2,518.75	$3,875.00	$105.02–$3,681.25	25% above	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$2,518.75	$3,875.00	$2,518.75–$3,681.25	—	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL STEALTH 70486	$2,652.00	$4,080.00	$105.02–$3,876.00	59% above	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$2,652.00	$4,080.00	$105.02–$3,876.00	59% above	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL STEALTH 70486	$2,652.00	$4,080.00	$2,652.00–$3,876.00	—	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$2,652.00	$4,080.00	$2,652.00–$3,876.00	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN W/O CONTRAST	$2,717.00	$4,180.00	$105.02–$3,971.00	42% above	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain Stroke Protocol	$2,717.00	$4,180.00	$105.02–$3,971.00	42% above	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain Stroke Protocol	$2,717.00	$4,180.00	$2,717.00–$3,971.00	—	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT BRAIN W/O CONTRAST	$2,717.00	$4,180.00	$2,717.00–$3,971.00	—	35%
CT scan of the head with contrast CPT 70460 CT BRAIN W/CONTRAST	$2,717.00	$4,180.00	$176.20–$3,971.00	54% above	35%
CT scan of the head with contrast inpatient CPT 70460 CT BRAIN W/CONTRAST	$2,717.00	$4,180.00	$2,717.00–$3,971.00	—	35%
CT scan of the head without and with contrast CPT 70470 CT BRAIN W/WO CONTRAST	$2,827.50	$4,350.00	$176.20–$4,132.50	22% above	35%
CT scan of the head without and with contrast inpatient CPT 70470 CT BRAIN W/WO CONTRAST	$2,827.50	$4,350.00	$2,827.50–$4,132.50	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT L-SPINE W/O CONTRAST	$2,801.50	$4,310.00	$105.02–$4,094.50	36% above	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT L-SPINE W/O CONTRAST	$2,801.50	$4,310.00	$2,801.50–$4,094.50	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT C-SPINE W/O CONTRAST	$3,068.00	$4,720.00	$105.02–$4,484.00	45% above	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT C-SPINE W/O CONTRAST	$3,068.00	$4,720.00	$3,068.00–$4,484.00	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST	$2,895.75	$4,455.00	$176.20–$4,232.25	32% above	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST	$2,895.75	$4,455.00	$2,895.75–$4,232.25	—	35%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 US DOPPLER CAROTID	$1,124.50	$1,730.00	$164.34–$1,643.50	19% below	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 US DOPPLER CAROTID	$1,124.50	$1,730.00	$1,124.50–$1,643.50	—	35%
Chest X-ray, 2 views both sides CPT 71046 CHEST BILAT DECUBS	$487.50	$750.00	$79.81–$712.50	—	35%
Chest X-ray, 2 views CPT 71046 CHEST X-RAY (2 VIEWS)	$487.50	$750.00	$79.81–$712.50	24% above	35%
Chest X-ray, 2 views CPT 71046 CHEST INSPIRATION/EXPIRATION	$487.50	$750.00	$79.81–$712.50	24% above	35%
Chest X-ray, 2 views inpatient both sides CPT 71046 CHEST BILAT DECUBS	$487.50	$750.00	$487.50–$712.50	—	35%
Chest X-ray, 2 views inpatient CPT 71046 CHEST X-RAY (2 VIEWS)	$487.50	$750.00	$487.50–$712.50	—	35%
Chest X-ray, 2 views inpatient CPT 71046 CHEST INSPIRATION/EXPIRATION	$487.50	$750.00	$487.50–$712.50	—	35%
Chest X-ray, single view CPT 71045 CHEST X-RAY (1V) PORTABLE	$438.75	$675.00	$79.81–$641.25	35% above	35%
Chest X-ray, single view CPT 71045 CHEST X-RAY (1 VIEW)	$438.75	$675.00	$79.81–$641.25	35% above	35%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW PICC	$438.75	$675.00	$79.81–$641.25	35% above	35%
Chest X-ray, single view inpatient CPT 71045 CHEST 1 VIEW PICC	$438.75	$675.00	$438.75–$641.25	—	35%
Chest X-ray, single view inpatient CPT 71045 CHEST X-RAY (1V) PORTABLE	$438.75	$675.00	$438.75–$641.25	—	35%
Chest X-ray, single view inpatient CPT 71045 CHEST X-RAY (1 VIEW)	$438.75	$675.00	$438.75–$641.25	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL	$1,160.25	$1,785.00	$105.02–$1,695.75	57% above	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US ECHOGRAM AORTA	$1,160.25	$1,785.00	$105.02–$1,695.75	57% above	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL	$1,160.25	$1,785.00	$1,160.25–$1,695.75	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US ECHOGRAM AORTA	$1,160.25	$1,785.00	$1,160.25–$1,695.75	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL	$393.25	$605.00	$30.63–$574.75	5% below	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY AXIAL	$393.25	$605.00	$393.25–$574.75	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY APPENDICULAR	$344.50	$530.00	$23.43–$503.50	56% above	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY APPENDICULAR	$344.50	$530.00	$344.50–$503.50	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX; WO CONTRAST	$2,600.00	$4,000.00	$105.02–$3,800.00	41% above	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX; WO CTRST HI RESOL	$2,600.00	$4,000.00	$105.02–$3,800.00	41% above	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX; WO CONTRAST	$2,600.00	$4,000.00	$2,600.00–$3,800.00	—	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX; WO CTRST HI RESOL	$2,600.00	$4,000.00	$2,600.00–$3,800.00	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX; W CONTRAST	$3,315.00	$5,100.00	$176.20–$4,845.00	47% above	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX; W CONTRAST	$3,315.00	$5,100.00	$3,315.00–$4,845.00	—	35%
Diagnostic mammogram, both breasts both sides CPT 77066 MG DIGITAL DIAGNOSTIC BILAT	$552.50	$850.00	$120.37–$892.50	—	35%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG DIGITAL DIAGNOSTIC BILAT	$552.50	$850.00	$552.50–$807.50	—	35%
Diagnostic mammogram, one breast one side CPT 77065 MG DIGITAL DIAGNOSTIC UNILAT	$552.50	$850.00	$94.06–$892.50	103% above	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MG DIGITAL DIAGNOSTIC UNILAT	$552.50	$850.00	$552.50–$807.50	—	35%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US DUPLEX LOWER EXT ART BILAT	$1,540.50	$2,370.00	$220.92–$2,251.50	—	35%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US DUPLEX LOWER EXT ART BILAT	$1,540.50	$2,370.00	$1,540.50–$2,251.50	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US VENOUS DOPPLER BILATERAL	$1,673.75	$2,575.00	$163.62–$2,446.25	—	35%
Duplex ultrasound of the leg veins, both legs CPT 93970 US DOPPLER VEN UPPR EXT BIL	$1,673.75	$2,575.00	$163.62–$2,446.25	16% below	35%
Duplex ultrasound of the leg veins, both legs CPT 93970 US VENOUS REFLUX	$1,673.75	$2,575.00	$163.62–$2,446.25	16% below	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US VENOUS DOPPLER BILATERAL	$1,673.75	$2,575.00	$1,673.75–$2,446.25	—	35%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US VENOUS REFLUX	$1,673.75	$2,575.00	$1,673.75–$2,446.25	—	35%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 US DOPPLER VEN UPPR EXT BIL	$1,673.75	$2,575.00	$1,673.75–$2,446.25	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM 2D	$2,544.75	$3,915.00	$135.51–$4,110.75	8% above	35%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US ECHOCARDIOGRAM 2D	$2,544.75	$3,915.00	$2,544.75–$3,719.25	—	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM HEPATOBILIARY SCAN	$2,255.50	$3,470.00	$305.61–$3,296.50	41% above	35%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM HEPATOBILIARY SCAN	$2,255.50	$3,470.00	$2,255.50–$3,296.50	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 CPAP/BIPAP TITR/SPLIT NIGHT ST	$6,630.00	$10,200.00	$526.53–$10,710.00	42% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 CPAP/BIPAP TITR/SPLIT NIGHT ST	$6,630.00	$10,200.00	$6,630.00–$9,690.00	—	35%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS RIGHT PORTABLE	$520.00	$800.00	$79.81–$760.00	51% above	35%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS-RIGHT	$520.00	$800.00	$79.81–$760.00	51% above	35%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS-LEFT	$520.00	$800.00	$79.81–$760.00	51% above	35%
Knee X-ray, 3 views one side CPT 73562 KNEE 3 VIEWS LEFT PORTABLE	$520.00	$800.00	$79.81–$760.00	51% above	35%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS RIGHT PORTABLE	$520.00	$800.00	$520.00–$760.00	—	35%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS-LEFT	$520.00	$800.00	$520.00–$760.00	—	35%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS-RIGHT	$520.00	$800.00	$520.00–$760.00	—	35%
Knee X-ray, 3 views inpatient one side CPT 73562 KNEE 3 VIEWS LEFT PORTABLE	$520.00	$800.00	$520.00–$760.00	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US GALL BLADDER	$1,095.25	$1,685.00	$105.02–$1,600.75	74% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US PANCREAS ECHO	$1,095.25	$1,685.00	$105.02–$1,600.75	74% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN/LIMIT F/U ECHO	$1,095.25	$1,685.00	$105.02–$1,600.75	74% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US HEPATIC ECHO	$1,095.25	$1,685.00	$105.02–$1,600.75	74% above	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMEN/LIMIT F/U ECHO	$1,095.25	$1,685.00	$1,095.25–$1,600.75	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US HEPATIC ECHO	$1,095.25	$1,685.00	$1,095.25–$1,600.75	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US GALL BLADDER	$1,095.25	$1,685.00	$1,095.25–$1,600.75	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US PANCREAS ECHO	$1,095.25	$1,685.00	$1,095.25–$1,600.75	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 LOW DOSE CT FOR LUNG CA SCREEN	$260.00	$400.00	$99.00–$380.00	8% above	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 LOW DOSE CT FOR LUNG CA SCREEN	$260.00	$400.00	$260.00–$380.00	—	35%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST BILAT W/WO CONTRAS	$3,510.00	$5,400.00	$293.00–$5,670.00	—	35%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST BILAT W/WO CONTRAS	$3,510.00	$5,400.00	$3,510.00–$5,130.00	—	35%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI HIP W/O CONT-BILATERAL	$3,012.75	$4,635.00	$233.04–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXT JOINT W/O CONT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONT-LEFT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONT-LEFT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONT-RIGHT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONT-LEFT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONT-RIGHT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONT-RIGHT	$3,012.75	$4,635.00	$233.04–$4,403.25	47% above	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient both sides CPT 73721 MRI HIP W/O CONT-BILATERAL	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXT JOINT W/O CONT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONT-LEFT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONT-RIGHT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI ANKLE W/O CONT-LEFT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI KNEE W/O CONT-RIGHT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONT-LEFT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI HIP W/O CONT-RIGHT	$3,012.75	$4,635.00	$3,012.75–$4,403.25	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI HIP W/WO BILATERAL	$3,614.00	$5,560.00	$350.46–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXT W/WO CONT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/WO CONT- LT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/WO CONT- LT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI KNEE W/WO CONT- RT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/WO CONT-RIGHT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI ANKLE W/WO CONT-LEFT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI HIP W/WO CONT- RT	$3,614.00	$5,560.00	$350.46–$5,282.00	28% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient both sides CPT 73723 MRI HIP W/WO BILATERAL	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXT W/WO CONT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/WO CONT-RIGHT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/WO CONT- RT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/WO CONT- LT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI KNEE W/WO CONT- LT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI HIP W/WO CONT- RT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI ANKLE W/WO CONT-LEFT	$3,614.00	$5,560.00	$3,614.00–$5,282.00	—	35%
MRI of the abdomen without contrast CPT 74181 MRI MRCP	$3,120.00	$4,800.00	$233.04–$4,560.00	40% above	35%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$3,120.00	$4,800.00	$233.04–$4,560.00	40% above	35%
MRI of the abdomen without contrast CPT 74181 MRI ABD W/O DYE ENTEROGRAPHY	$3,120.00	$4,800.00	$233.04–$4,560.00	40% above	35%
MRI of the abdomen without contrast inpatient CPT 74181 MRI MRCP	$3,120.00	$4,800.00	$3,120.00–$4,560.00	—	35%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABD W/O DYE ENTEROGRAPHY	$3,120.00	$4,800.00	$3,120.00–$4,560.00	—	35%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$3,120.00	$4,800.00	$3,120.00–$4,560.00	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/WO CONTRAST	$4,550.00	$7,000.00	$350.46–$6,650.00	40% above	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/WO CONTRAST	$4,550.00	$7,000.00	$4,550.00–$6,650.00	—	35%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$3,315.00	$5,100.00	$233.04–$4,845.00	51% above	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN W/O CONTRAST	$3,315.00	$5,100.00	$3,315.00–$4,845.00	—	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/WO CONTRAST	$4,225.00	$6,500.00	$350.46–$6,175.00	40% above	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/IAC'S W/WO CONTRAST	$4,225.00	$6,500.00	$350.46–$6,175.00	40% above	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/ORBITS W/WO CONTRAST	$4,225.00	$6,500.00	$350.46–$6,175.00	40% above	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI PITUITARY/IAC W/WO CONT	$4,225.00	$6,500.00	$350.46–$6,175.00	40% above	35%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN/SELLA W/WO CONTRAST	$4,225.00	$6,500.00	$350.46–$6,175.00	40% above	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/IAC'S W/WO CONTRAST	$4,225.00	$6,500.00	$4,225.00–$6,175.00	—	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI PITUITARY/IAC W/WO CONT	$4,225.00	$6,500.00	$4,225.00–$6,175.00	—	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/WO CONTRAST	$4,225.00	$6,500.00	$4,225.00–$6,175.00	—	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/SELLA W/WO CONTRAST	$4,225.00	$6,500.00	$4,225.00–$6,175.00	—	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN/ORBITS W/WO CONTRAST	$4,225.00	$6,500.00	$4,225.00–$6,175.00	—	35%
MRI of the lower back, no contrast dye CPT 72148 MRI L-SPINE, LIMITED	$1,690.00	$2,600.00	$233.04–$2,470.00	26% below	35%
MRI of the lower back, no contrast dye CPT 72148 MRI L-SPINE W/O CONTRAST	$3,347.50	$5,150.00	$233.04–$4,892.50	46% above	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L-SPINE, LIMITED	$1,690.00	$2,600.00	$1,690.00–$2,470.00	—	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L-SPINE W/O CONTRAST	$3,347.50	$5,150.00	$3,347.50–$4,892.50	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L-SPINE W/WO LIMITED	$2,145.00	$3,300.00	$350.46–$3,135.00	33% below	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI L-SPINE W/WO CONTRAST	$4,225.00	$6,500.00	$350.46–$6,175.00	32% above	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L-SPINE W/WO LIMITED	$2,145.00	$3,300.00	$2,145.00–$3,135.00	—	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI L-SPINE W/WO CONTRAST	$4,225.00	$6,500.00	$4,225.00–$6,175.00	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINE LIMITED	$1,755.00	$2,700.00	$233.04–$2,565.00	18% below	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI T-SPINE W/O CONTRAST	$3,510.00	$5,400.00	$233.04–$5,130.00	64% above	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T-SPINE LIMITED	$1,755.00	$2,700.00	$1,755.00–$2,565.00	—	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI T-SPINE W/O CONTRAST	$3,510.00	$5,400.00	$3,510.00–$5,130.00	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE W/WO LIMITED	$2,600.00	$4,000.00	$350.46–$3,800.00	20% below	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI C-SPINE W/WO CONTRAST	$4,355.00	$6,700.00	$350.46–$6,365.00	33% above	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C-SPINE W/WO LIMITED	$2,600.00	$4,000.00	$2,600.00–$3,800.00	—	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI C-SPINE W/WO CONTRAST	$4,355.00	$6,700.00	$4,355.00–$6,365.00	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE, LIMITED	$1,950.00	$3,000.00	$233.04–$2,850.00	16% below	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI C-SPINE W/O CONTRAST	$3,900.00	$6,000.00	$233.04–$5,700.00	68% above	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE, LIMITED	$1,950.00	$3,000.00	$1,950.00–$2,850.00	—	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI C-SPINE W/O CONTRAST	$3,900.00	$6,000.00	$3,900.00–$5,700.00	—	35%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/WO CONTRAST	$4,485.00	$6,900.00	$350.46–$6,555.00	33% above	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/WO CONTRAST	$4,485.00	$6,900.00	$4,485.00–$6,555.00	—	35%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$3,181.75	$4,895.00	$233.04–$4,650.25	30% above	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$3,181.75	$4,895.00	$3,181.75–$4,650.25	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI UPPER EXT JOINT W/O CONT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONT-LEFT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONT-LEFT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER WO CONT-RIGHT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONT-RIGHT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONT-LEFT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONT-RIGHT	$3,412.50	$5,250.00	$233.04–$4,987.50	91% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI UPPER EXT JOINT W/O CONT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER WO CONT-RIGHT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONT-LEFT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONT-RIGHT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI WRIST W/O CONT-LEFT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI ELBOW W/O CONT-RIGHT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI SHOULDER W/O CONT-LEFT	$3,412.50	$5,250.00	$3,412.50–$4,987.50	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM HEART PERFUSION-LEXISCAN	$4,940.00	$7,600.00	$409.40–$7,220.00	14% above	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM HEART PERFUSION-DOBUTAMINE	$4,940.00	$7,600.00	$409.40–$7,220.00	14% above	35%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM HEART PERFUSION-TREADMILL	$4,940.00	$7,600.00	$409.40–$7,220.00	14% above	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM HEART PERFUSION-LEXISCAN	$4,940.00	$7,600.00	$4,940.00–$7,220.00	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM HEART PERFUSION-DOBUTAMINE	$4,940.00	$7,600.00	$4,940.00–$7,220.00	—	35%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM HEART PERFUSION-TREADMILL	$4,940.00	$7,600.00	$4,940.00–$7,220.00	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC SONOGRAM F/U	$455.00	$700.00	$105.02–$665.00	6% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US URINARY BLADDER ECHO	$455.00	$700.00	$105.02–$665.00	6% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US URINARY BLADDER ECHO	$455.00	$700.00	$455.00–$665.00	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC SONOGRAM F/U	$455.00	$700.00	$455.00–$665.00	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC MASS EVAL ECHO	$1,192.75	$1,835.00	$105.02–$1,743.25	38% above	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC MASS EVAL ECHO	$1,192.75	$1,835.00	$1,192.75–$1,743.25	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB SONO EVAL ECHO	$871.00	$1,340.00	$91.54–$1,273.00	34% above	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB SONO EVAL ECHO	$871.00	$1,340.00	$871.00–$1,273.00	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB SONO-1ST/SINGLE FETUS	$871.00	$1,340.00	$73.52–$1,273.00	42% above	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB SONO-1ST/SINGLE FETUS	$871.00	$1,340.00	$871.00–$1,273.00	—	35%
Screening mammogram, both breasts both sides CPT 77067 MG DIGITAL SCREEN BILAT/UNILAT	$448.50	$690.00	$99.47–$724.50	—	35%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG DIGITAL SCREEN BILAT/UNILAT	$448.50	$690.00	$448.50–$655.50	—	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2 VIEWS-RIGHT	$487.50	$750.00	$79.81–$712.50	59% above	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER 2 VIEWS-LEFT	$487.50	$750.00	$79.81–$712.50	59% above	35%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2 VIEWS-LEFT	$487.50	$750.00	$487.50–$712.50	—	35%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 SHOULDER 2 VIEWS-RIGHT	$487.50	$750.00	$487.50–$712.50	—	35%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$5,557.50	$8,550.00	$500.94–$8,977.50	34% above	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/> YRS 4/> PARAM	$5,557.50	$8,550.00	$5,557.50–$8,122.50	—	35%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS TTE COMPLETE	$1,430.00	$2,200.00	$149.56–$2,310.00	47% below	35%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS TTE COMPLETE	$1,430.00	$2,200.00	$1,430.00–$2,090.00	—	35%
Swallow study (modified barium swallow, video X-ray) CPT 74230 MODIFIED BA SWALLOW W/VIDEO	$526.50	$810.00	$176.20–$769.50	12% below	35%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 MODIFIED BA SWALLOW W/VIDEO	$526.50	$810.00	$526.50–$769.50	—	35%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$757.25	$1,165.00	$88.30–$1,106.75	18% above	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$757.25	$1,165.00	$757.25–$1,106.75	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 US OB SONO/TRANSVAGINAL	$526.50	$810.00	$105.02–$769.50	3% above	35%
Transvaginal ultrasound during pregnancy CPT 76817 BEDSIDE ULTRASOUND	$526.50	$810.00	$105.02–$769.50	3% above	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 BEDSIDE ULTRASOUND	$526.50	$810.00	$526.50–$769.50	—	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB SONO/TRANSVAGINAL	$526.50	$810.00	$526.50–$769.50	—	35%
Ultrasound of the abdomen, complete CPT 76700 US ECHOGRAM ABDOMEN 76700	$1,205.75	$1,855.00	$105.02–$1,762.25	40% above	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ECHOGRAM ABDOMEN 76700	$1,205.75	$1,855.00	$1,205.75–$1,762.25	—	35%
Ultrasound of the scrotum and testicles CPT 76870 US TESTICULAR	$1,027.00	$1,580.00	$105.02–$1,501.00	68% above	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US TESTICULAR	$1,027.00	$1,580.00	$1,027.00–$1,501.00	—	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US ECHO THYROID/SFT TISS HD/NK	$962.00	$1,480.00	$105.02–$1,406.00	53% above	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US ECHO THYROID/SFT TISS HD/NK	$962.00	$1,480.00	$962.00–$1,406.00	—	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UGI	$1,095.25	$1,685.00	$176.20–$1,600.75	49% above	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UGI	$1,095.25	$1,685.00	$1,095.25–$1,600.75	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VEN DOPPLER UPPER EXT UNI	$1,326.00	$2,040.00	$100.19–$1,938.00	65% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US VEN DOPPLER LOWER EXT UNI	$1,326.00	$2,040.00	$100.19–$1,938.00	65% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY	$1,326.00	$2,040.00	$100.19–$1,938.00	65% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US VENOUS REFLUX-LTD/UNILAT	$1,326.00	$2,040.00	$100.19–$1,938.00	65% above	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VEN DOPPLER UPPER EXT UNI	$1,326.00	$2,040.00	$1,326.00–$1,938.00	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 EXTREMITY STUDY	$1,326.00	$2,040.00	$1,326.00–$1,938.00	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 US VEN DOPPLER LOWER EXT UNI	$1,326.00	$2,040.00	$1,326.00–$1,938.00	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US VENOUS REFLUX-LTD/UNILAT	$1,326.00	$2,040.00	$1,326.00–$1,938.00	—	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VW OR MORE-LEFT	$520.00	$800.00	$79.81–$760.00	67% above	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST 3 VW OR MORE-RIGHT	$520.00	$800.00	$79.81–$760.00	67% above	35%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VW OR MORE-LEFT	$520.00	$800.00	$520.00–$760.00	—	35%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 WRIST 3 VW OR MORE-RIGHT	$520.00	$800.00	$520.00–$760.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 C-ARM HIP NAILING IN OR	$455.00	$700.00	$79.81–$665.00	22% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2 VIEWS LEFT PORTABLE	$455.00	$700.00	$79.81–$665.00	22% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP 2 VIEWS RIGHT PORTABLE	$455.00	$700.00	$79.81–$665.00	22% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP/PELVIS UNILAT LT 2-3 VIEWS	$455.00	$700.00	$79.81–$665.00	22% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HIP/PELVIS UNILAT RT 2-3 VIEWS	$455.00	$700.00	$79.81–$665.00	22% above	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 C-ARM HIP NAILING IN OR	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP/PELVIS UNILAT LT 2-3 VIEWS	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2 VIEWS RIGHT PORTABLE	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP 2 VIEWS LEFT PORTABLE	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 HIP/PELVIS UNILAT RT 2-3 VIEWS	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN (1 VIEW)	$403.00	$620.00	$79.81–$589.00	19% above	35%
X-ray of the abdomen, 1 view CPT 74018 KUB (KIDNEY-URETERS-BLADDER)	$403.00	$620.00	$79.81–$589.00	19% above	35%
X-ray of the abdomen, 1 view CPT 74018 KUB (KIDNEY URE BLADDER) PTBL	$403.00	$620.00	$79.81–$589.00	19% above	35%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW PORTABLE	$403.00	$620.00	$79.81–$589.00	19% above	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 KUB (KIDNEY-URETERS-BLADDER)	$403.00	$620.00	$403.00–$589.00	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 KUB (KIDNEY URE BLADDER) PTBL	$403.00	$620.00	$403.00–$589.00	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN (1 VIEW)	$403.00	$620.00	$403.00–$589.00	—	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 ABDOMEN 1 VIEW PORTABLE	$403.00	$620.00	$403.00–$589.00	—	35%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEWS-RIGHT	$455.00	$700.00	$79.81–$665.00	61% above	35%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE 2 VIEWS-LEFT	$455.00	$700.00	$79.81–$665.00	61% above	35%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEWS-LEFT	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of the ankle, 2 views inpatient one side CPT 73600 ANKLE 2 VIEWS-RIGHT	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS-LEFT	$455.00	$700.00	$79.81–$665.00	89% above	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS-RIGHT	$455.00	$700.00	$79.81–$665.00	89% above	35%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGERS-LEFT	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 FINGERS-RIGHT	$455.00	$700.00	$455.00–$665.00	—	35%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS-RIGHT	$406.25	$625.00	$79.81–$593.75	41% above	35%
X-ray of the foot, 2 views one side CPT 73620 FOOT 2 VIEWS-LEFT	$406.25	$625.00	$79.81–$593.75	41% above	35%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS-LEFT	$406.25	$625.00	$406.25–$593.75	—	35%
X-ray of the foot, 2 views inpatient one side CPT 73620 FOOT 2 VIEWS-RIGHT	$406.25	$625.00	$406.25–$593.75	—	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS OR MORE-RIGHT	$487.50	$750.00	$79.81–$712.50	33% above	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT 3 VIEWS OR MORE-LEFT	$487.50	$750.00	$79.81–$712.50	33% above	35%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEWS OR MORE-LEFT	$487.50	$750.00	$487.50–$712.50	—	35%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 FOOT 3 VIEWS OR MORE-RIGHT	$487.50	$750.00	$487.50–$712.50	—	35%
X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEWS-LEFT	$471.25	$725.00	$79.81–$688.75	44% above	35%
X-ray of the hand, 3 or more views one side CPT 73130 HAND 3 VIEWS-RIGHT	$471.25	$725.00	$79.81–$688.75	44% above	35%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3 VIEWS-LEFT	$471.25	$725.00	$471.25–$688.75	—	35%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 HAND 3 VIEWS-RIGHT	$471.25	$725.00	$471.25–$688.75	—	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE SINGLE VIEW-RIGHT	$308.75	$475.00	$79.81–$451.25	11% above	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2 VIEWS RIGHT PORTABLE	$308.75	$475.00	$79.81–$451.25	11% above	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2 VIEWS LEFT PORTABLE	$308.75	$475.00	$79.81–$451.25	11% above	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2 VIEWS-LEFT	$308.75	$475.00	$79.81–$451.25	11% above	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE 2 VIEWS-RIGHT	$308.75	$475.00	$79.81–$451.25	11% above	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE SINGLE VIEW-LEFT	$308.75	$475.00	$79.81–$451.25	11% above	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE SINGLE VIEW-RIGHT	$308.75	$475.00	$308.75–$451.25	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2 VIEWS RIGHT PORTABLE	$308.75	$475.00	$308.75–$451.25	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2 VIEWS LEFT PORTABLE	$308.75	$475.00	$308.75–$451.25	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2 VIEWS-LEFT	$308.75	$475.00	$308.75–$451.25	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE 2 VIEWS-RIGHT	$308.75	$475.00	$308.75–$451.25	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 KNEE SINGLE VIEW-LEFT	$308.75	$475.00	$308.75–$451.25	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 2 VIEWS	$650.00	$1,000.00	$105.02–$950.00	39% above	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE 3 VIEWS	$650.00	$1,000.00	$105.02–$950.00	39% above	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 3 VIEWS	$650.00	$1,000.00	$650.00–$950.00	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 LUMBAR SPINE 2 VIEWS	$650.00	$1,000.00	$650.00–$950.00	—	35%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE COMPLETE SERIES	$656.50	$1,010.00	$105.02–$959.50	5% above	35%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE 4 VIEW	$656.50	$1,010.00	$105.02–$959.50	5% above	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE 4 VIEW	$656.50	$1,010.00	$656.50–$959.50	—	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE COMPLETE SERIES	$656.50	$1,010.00	$656.50–$959.50	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 DORSAL THORACIC SPINE 2 VW	$617.50	$950.00	$105.02–$902.50	53% above	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 DORSAL THORACIC SPINE 2 VW	$617.50	$950.00	$617.50–$902.50	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 NOSE NASAL BONES	$497.25	$765.00	$79.81–$726.75	71% above	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 NOSE NASAL BONES	$497.25	$765.00	$497.25–$726.75	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2/3 VIEWS	$682.50	$1,050.00	$79.81–$997.50	82% above	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 CERVICAL SPINE 2/3 VIEWS	$682.50	$1,050.00	$682.50–$997.50	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 VIEW	$419.25	$645.00	$105.02–$612.75	13% above	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS 1 VIEW PORTABLE	$419.25	$645.00	$105.02–$612.75	13% above	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 VIEW	$419.25	$645.00	$419.25–$612.75	—	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 PELVIS 1 VIEW PORTABLE	$419.25	$645.00	$419.25–$612.75	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND/OR COCCYX	$562.25	$865.00	$79.81–$821.75	71% above	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 SACRUM AND/OR COCCYX	$562.25	$865.00	$562.25–$821.75	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT	$78.00	$120.00	$5.30–$126.00	33% above	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT	$78.00	$120.00	$78.00–$114.00	—	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 SGOT	$89.70	$138.00	$5.18–$144.90	59% above	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 SGOT	$89.70	$138.00	$89.70–$131.10	—	35%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$552.50	$850.00	$47.63–$892.50	43% above	35%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$552.50	$850.00	$552.50–$807.50	—	35%
Allergy blood test, specific IgE, per allergen CPT 86003 RAST ALLERGEN/EACH	$27.95	$43.00	$5.22–$45.15	2% above	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 RAST ALLERGEN/EACH	$27.95	$43.00	$27.95–$40.85	—	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 ANTI CCP IgG ANTIBODY	$152.75	$235.00	$12.95–$246.75	179% above	35%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 ANTI CCP IgG ANTIBODY	$152.75	$235.00	$152.75–$223.25	—	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANCA TITER EACH ANTIBODY	$26.00	$40.00	$12.09–$42.00	71% below	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA TITER W/PATTERN	$204.75	$315.00	$12.09–$330.75	125% above	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANCA TITER EACH ANTIBODY	$26.00	$40.00	$26.00–$38.00	—	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA TITER W/PATTERN	$204.75	$315.00	$204.75–$299.25	—	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATR/PEPTIDE	$253.50	$390.00	$39.26–$409.50	36% above	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-TYPE NATR/PEPTIDE	$253.50	$390.00	$253.50–$370.50	—	35%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$253.50	$390.00	$8.46–$409.50	1% above	35%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$253.50	$390.00	$253.50–$370.50	—	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 GROSS/MICRO LEVEL 4	$273.00	$420.00	$49.47–$441.00	8% below	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 GROSS/MICRO LEVEL 4	$273.00	$420.00	$273.00–$399.00	—	35%
Blood culture for bacteria CPT 87040 AEROB BACTERIAL BLOOD CULTURE	$198.25	$305.00	$10.32–$320.25	17% below	35%
Blood culture for bacteria inpatient CPT 87040 AEROB BACTERIAL BLOOD CULTURE	$198.25	$305.00	$198.25–$289.75	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 CAPILLARY HEMOGLOBIN STICK	$14.95	$23.00	$9.34–$24.15	26% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 DNA/BLOOD COLLECTION PROCESS	$16.25	$25.00	$9.34–$26.25	19% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE SPEC COLLECT FEE	$18.20	$28.00	$9.34–$29.40	10% below	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 CAPILLARY HEMOGLOBIN STICK	$14.95	$23.00	$14.95–$21.85	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 DNA/BLOOD COLLECTION PROCESS	$16.25	$25.00	$16.25–$23.75	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 VENIPUNCTURE SPEC COLLECT FEE	$18.20	$28.00	$18.20–$26.60	—	35%
Blood glucose (sugar) test CPT 82947 GLUCOSE/RANDOM	$59.15	$91.00	$3.93–$95.55	30% above	35%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE/RANDOM	$59.15	$91.00	$59.15–$86.45	—	35%
Blood lead test CPT 83655 LEAD	$122.85	$189.00	$12.11–$198.45	132% above	35%
Blood lead test inpatient CPT 83655 LEAD	$122.85	$189.00	$122.85–$179.55	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG SERUM	$175.50	$270.00	$7.52–$283.50	28% above	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG SERUM	$175.50	$270.00	$175.50–$256.50	—	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO	$139.75	$215.00	$107.50–$225.75	58% above	35%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO	$139.75	$215.00	$139.75–$204.25	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$100.75	$155.00	$5.18–$162.75	73% above	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$100.75	$155.00	$100.75–$147.25	—	35%
C. difficile toxin gene test (stool PCR) CPT 87493 CDTOXPCR	$159.25	$245.00	$37.27–$257.25	10% below	35%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 CDTOXPCR	$159.25	$245.00	$159.25–$232.75	—	35%
CA 19-9 blood test (tumor marker) CPT 86301 CA-19-9	$221.00	$340.00	$20.81–$357.00	63% above	35%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA-19-9	$221.00	$340.00	$221.00–$323.00	—	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA-125	$237.25	$365.00	$20.81–$383.25	48% above	35%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA-125	$237.25	$365.00	$237.25–$346.75	—	35%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$126.10	$194.00	$51.31–$203.70	42% above	35%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-COV-2 COVID-19 AMP PRB	$126.10	$194.00	$126.10–$184.30	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA T AMPLIF NA PROBE	$165.75	$255.00	$35.09–$267.75	32% above	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA T AMPLIF NA PROBE	$165.75	$255.00	$165.75–$242.25	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$260.00	$400.00	$13.39–$420.00	30% above	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$260.00	$400.00	$260.00–$380.00	—	35%
Complete blood count (CBC) with differential CPT 85025 CBC W/AUTOMATED DIFF 85025	$156.00	$240.00	$7.77–$252.00	66% above	35%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTOMATED DIFF 85025	$156.00	$240.00	$156.00–$228.00	—	35%
Complete blood count (CBC), no differential CPT 85027 CBC 85027	$139.75	$215.00	$6.47–$225.75	43% above	35%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC 85027	$139.75	$215.00	$139.75–$204.25	—	35%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE PANEL	$373.75	$575.00	$10.56–$603.75	10% above	35%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE PANEL	$373.75	$575.00	$373.75–$546.25	—	35%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$221.00	$340.00	$10.18–$357.00	26% above	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-DIMER	$221.00	$340.00	$221.00–$323.00	—	35%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE	$204.75	$315.00	$22.23–$330.75	33% above	35%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA SULFATE	$204.75	$315.00	$204.75–$299.25	—	35%
Estradiol blood test CPT 82670 ESTRADIOL, TOTAL	$282.75	$435.00	$27.94–$456.75	95% above	35%
Estradiol blood test inpatient CPT 82670 ESTRADIOL, TOTAL	$282.75	$435.00	$282.75–$413.25	—	35%
FSH (follicle-stimulating hormone) test CPT 83001 FSH	$250.25	$385.00	$18.58–$404.25	56% above	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH	$250.25	$385.00	$250.25–$365.75	—	35%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$529.75	$815.00	$19.63–$855.75	148% above	35%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 CALPROTECTIN FECAL	$529.75	$815.00	$529.75–$774.25	—	35%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$175.50	$270.00	$13.63–$283.50	70% above	35%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN	$175.50	$270.00	$175.50–$256.50	—	35%
Folate (folic acid) blood test CPT 82746 FOLATE/SERUM	$165.75	$255.00	$14.70–$267.75	78% above	35%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE/SERUM	$165.75	$255.00	$165.75–$242.25	—	35%
Free T3 thyroid hormone test CPT 84481 FREE T3	$308.75	$475.00	$16.94–$498.75	121% above	35%
Free T3 thyroid hormone test inpatient CPT 84481 FREE T3	$308.75	$475.00	$308.75–$451.25	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE	$178.75	$275.00	$9.02–$288.75	99% above	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 FREE	$178.75	$275.00	$178.75–$261.25	—	35%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$250.25	$385.00	$25.47–$404.25	126% above	35%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$250.25	$385.00	$250.25–$365.75	—	35%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$455.00	$700.00	$35.32–$735.00	2% above	35%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$455.00	$700.00	$455.00–$665.00	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLU POST GLUCOSE DOSE	$78.00	$120.00	$4.75–$126.00	17% below	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLU POST GLUCOSE DOSE	$78.00	$120.00	$78.00–$114.00	—	35%
Glucose tolerance test, 3 samples CPT 82951 GTT URINE 2/3/4/5/6 HOUR	$237.25	$365.00	$12.87–$383.25	56% above	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT URINE 2/3/4/5/6 HOUR	$237.25	$365.00	$237.25–$346.75	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA AMPLIF NA PROBE	$188.50	$290.00	$35.09–$304.50	33% above	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA AMPLIF NA PROBE	$188.50	$290.00	$188.50–$275.50	—	35%
H. pylori antibody blood test CPT 86677 AB; HELICOBACTER PYLORI	$182.00	$280.00	$16.85–$294.00	39% above	35%
H. pylori antibody blood test inpatient CPT 86677 AB; HELICOBACTER PYLORI	$182.00	$280.00	$182.00–$266.00	—	35%
H. pylori stool antigen test CPT 87338 HELICOBACTOR AG STOOL	$169.00	$260.00	$14.38–$273.00	78% above	35%
H. pylori stool antigen test inpatient CPT 87338 HELICOBACTOR AG STOOL	$169.00	$260.00	$169.00–$247.00	—	35%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA BY PCR	$682.50	$1,050.00	$85.10–$1,102.50	112% above	35%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA BY PCR	$682.50	$1,050.00	$682.50–$997.50	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV Ag/Ab COMBO	$122.85	$189.00	$24.08–$198.45	13% below	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV Ag/Ab COMBO	$122.85	$189.00	$122.85–$179.55	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN	$149.50	$230.00	$9.71–$241.50	62% above	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED HEMOGLOBIN	$149.50	$230.00	$149.50–$218.50	—	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFACE ANTIBODY	$139.75	$215.00	$10.74–$225.75	116% above	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY	$139.75	$215.00	$139.75–$204.25	—	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA	$156.00	$240.00	$10.33–$252.00	100% above	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE AG IA	$156.00	$240.00	$156.00–$228.00	—	35%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$198.25	$305.00	$14.27–$320.25	128% above	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$198.25	$305.00	$198.25–$289.75	—	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C RNA/PCR	$682.50	$1,050.00	$42.84–$1,102.50	132% above	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HEPATITIS C RNA/PCR	$682.50	$1,050.00	$682.50–$997.50	—	35%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES SIMPLEX TYPE 1 IgM.	$191.75	$295.00	$13.19–$309.75	143% above	35%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HERPES SIMPLEX TYPE 1 IgM.	$191.75	$295.00	$191.75–$280.25	—	35%
Herpes blood test, HSV-2 antibody CPT 86696 AB:HSV TYPE 2	$172.25	$265.00	$19.35–$278.25	91% above	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 AB:HSV TYPE 2	$172.25	$265.00	$172.25–$251.75	—	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 CRP WIDE RANGE	$165.75	$255.00	$12.95–$267.75	108% above	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 CRP WIDE RANGE	$165.75	$255.00	$165.75–$242.25	—	35%
Homocysteine blood test CPT 83090 HOMOCYSTEINE (PLASMA)	$292.50	$450.00	$17.92–$472.50	95% above	35%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE (PLASMA)	$292.50	$450.00	$292.50–$427.50	—	35%
Insulin blood test CPT 83525 INSULIN	$191.75	$295.00	$11.43–$309.75	130% above	35%
Insulin blood test inpatient CPT 83525 INSULIN	$191.75	$295.00	$191.75–$280.25	—	35%
Iron blood test (serum iron) CPT 83540 IRON SERUM	$99.45	$153.00	$6.47–$160.65	12% above	35%
Iron blood test (serum iron) inpatient CPT 83540 IRON SERUM	$99.45	$153.00	$99.45–$145.35	—	35%
Iron-binding capacity (TIBC) test CPT 83550 IRON BIND CAPACITY	$126.10	$194.00	$8.74–$203.70	29% above	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 IRON BIND CAPACITY	$126.10	$194.00	$126.10–$184.30	—	35%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$237.25	$365.00	$8.68–$383.25	25% above	35%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$237.25	$365.00	$237.25–$346.75	—	35%
LH (luteinizing hormone) test CPT 83002 LUTENIZING HORMONE	$237.25	$365.00	$18.52–$383.25	57% above	35%
LH (luteinizing hormone) test inpatient CPT 83002 LUTENIZING HORMONE	$237.25	$365.00	$237.25–$346.75	—	35%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$175.50	$270.00	$6.89–$283.50	79% above	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE	$175.50	$270.00	$175.50–$256.50	—	35%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$146.25	$225.00	$8.17–$236.25	42% below	35%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL	$146.25	$225.00	$146.25–$213.75	—	35%
Lyme disease antibody test CPT 86618 AB:LYMES DISEASE	$292.50	$450.00	$17.03–$472.50	254% above	35%
Lyme disease antibody test inpatient CPT 86618 AB:LYMES DISEASE	$292.50	$450.00	$292.50–$427.50	—	35%
Magnesium blood test CPT 83735 MAGNESIUM	$96.85	$149.00	$6.70–$156.45	98% above	35%
Magnesium blood test inpatient CPT 83735 MAGNESIUM	$96.85	$149.00	$96.85–$141.55	—	35%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB IgG	$139.75	$215.00	$12.88–$225.75	288% above	35%
Measles (rubeola) antibody test inpatient CPT 86765 RUBEOLA AB IgG	$139.75	$215.00	$139.75–$204.25	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCREEN	$139.75	$215.00	$5.18–$225.75	64% above	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONO SCREEN	$139.75	$215.00	$139.75–$204.25	—	35%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$191.75	$295.00	$18.39–$309.75	70% above	35%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$191.75	$295.00	$191.75–$280.25	—	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN/PSA	$204.75	$315.00	$18.39–$330.75	127% above	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING	$204.75	$315.00	$18.39–$330.75	127% above	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN/PSA	$204.75	$315.00	$204.75–$299.25	—	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING	$204.75	$315.00	$204.75–$299.25	—	35%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE	$308.75	$475.00	$41.28–$498.75	41% above	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHORMONE	$308.75	$475.00	$308.75–$451.25	—	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMO TIME	$97.50	$150.00	$6.01–$157.50	81% above	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMO TIME	$97.50	$150.00	$97.50–$142.50	—	35%
Progesterone blood test CPT 84144 PROGESTERONE	$178.75	$275.00	$20.86–$288.75	58% above	35%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$178.75	$275.00	$178.75–$261.25	—	35%
Prolactin blood test CPT 84146 PROLACTIN/SERUM	$237.25	$365.00	$19.38–$383.25	105% above	35%
Prolactin blood test inpatient CPT 84146 PROLACTIN/SERUM	$237.25	$365.00	$237.25–$346.75	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME/INR	$78.00	$120.00	$4.29–$126.00	65% above	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME/INR	$78.00	$120.00	$78.00–$114.00	—	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN/COMM/HR/10	$52.65	$81.00	$12.60–$85.05	58% below	35%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG SCREEN/COMM/HR/10	$52.65	$81.00	$52.65–$76.95	—	35%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A or B SCREEN	$133.25	$205.00	$16.55–$215.25	40% above	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFLUENZA A or B SCREEN	$133.25	$205.00	$133.25–$194.75	—	35%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR	$99.45	$153.00	$5.67–$160.65	78% above	35%
Rheumatoid factor (RF) test inpatient CPT 86431 RHEUMATOID FACTOR	$99.45	$153.00	$99.45–$145.35	—	35%
Rubella antibody test (immunity check) CPT 86762 RUBELLA	$162.50	$250.00	$14.39–$262.50	234% above	35%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA	$162.50	$250.00	$162.50–$237.50	—	35%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 AUTOM ERYTHROCYTE SED RATE	$85.80	$132.00	$2.70–$138.60	54% above	35%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 AUTOM ERYTHROCYTE SED RATE	$85.80	$132.00	$85.80–$125.40	—	35%
Stool ova and parasites exam CPT 87177 OVA & PARASITES DIR SMR W ID	$133.25	$205.00	$8.90–$215.25	50% above	35%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITES DIR SMR W ID	$133.25	$205.00	$133.25–$194.75	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD STOOL	$54.60	$84.00	$4.38–$88.20	42% above	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD STOOL	$54.60	$84.00	$54.60–$79.80	—	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLOOD FECAL/ELISA	$116.35	$179.00	$15.92–$187.95	59% above	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLOOD FECAL/ELISA	$116.35	$179.00	$116.35–$170.05	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON TREP QU	$89.70	$138.00	$4.27–$144.90	67% above	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 SYPHILIS TEST NON TREP QU	$89.70	$138.00	$89.70–$131.10	—	35%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON	$308.75	$475.00	$61.98–$498.75	45% above	35%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QUANTIFERON	$308.75	$475.00	$308.75–$451.25	—	35%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOST, TOTAL FEM/MALE/PED	$234.00	$360.00	$25.81–$378.00	136% above	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOST, TOTAL FEM/MALE/PED	$234.00	$360.00	$234.00–$342.00	—	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL AB EACH	$198.25	$305.00	$14.55–$320.25	121% above	35%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL AB EACH	$198.25	$305.00	$198.25–$289.75	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH 3RD GENERATION	$214.50	$330.00	$16.80–$346.50	72% above	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH 3RD GENERATION	$214.50	$330.00	$214.50–$313.50	—	35%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$126.10	$194.00	$35.09–$203.70	44% above	35%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$126.10	$194.00	$126.10–$184.30	—	35%
Uric acid blood test CPT 84550 URIC ACID	$78.00	$120.00	$4.52–$126.00	16% below	35%
Uric acid blood test inpatient CPT 84550 URIC ACID	$78.00	$120.00	$78.00–$114.00	—	35%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS ROUTINE	$119.60	$184.00	$3.17–$193.20	11% above	35%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS ROUTINE	$119.60	$184.00	$119.60–$174.80	—	35%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS/DIPSTICK ANY NUMBER	$36.40	$56.00	$2.25–$58.80	27% below	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS/DIPSTICK ANY NUMBER	$36.40	$56.00	$36.40–$53.20	—	35%
Urine culture for bacteria, with colony count CPT 87086 URINE/CULTURE	$182.00	$280.00	$8.07–$294.00	28% above	35%
Urine culture for bacteria, with colony count inpatient CPT 87086 URINE/CULTURE	$182.00	$280.00	$182.00–$266.00	—	35%
Urine pregnancy test, read by color change CPT 81025 HCG URINE QUALITATIVE	$73.45	$113.00	$8.61–$118.65	15% below	35%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG URINE QUALITATIVE	$73.45	$113.00	$73.45–$107.35	—	35%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$162.50	$250.00	$15.08–$262.50	79% above	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$162.50	$250.00	$162.50–$237.50	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D,25 HYDROXY INHOUSE	$276.25	$425.00	$29.60–$446.25	124% above	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D,25 HYDROXY INHOUSE	$276.25	$425.00	$276.25–$403.75	—	35%
Zinc blood test CPT 84630 ZINC	$133.25	$205.00	$11.39–$215.25	93% above	35%
Zinc blood test inpatient CPT 84630 ZINC	$133.25	$205.00	$133.25–$194.75	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANTITATIVE	$237.25	$365.00	$15.05–$383.25	116% above	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANTITATIVE	$237.25	$365.00	$237.25–$346.75	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Cardiac catheterization with coronary angiogram CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$18,590.00	$28,600.00	$598.24–$30,030.00	56% above	35%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L HRT ARTERY/VENTRICLE ANGIO	$18,590.00	$28,600.00	$18,590.00–$27,170.00	—	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION	$1,560.00	$2,400.00	$277.04–$2,520.00	8% above	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECT/EXT	$1,755.00	$2,700.00	$277.04–$2,835.00	22% above	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION	$1,560.00	$2,400.00	$1,560.00–$2,280.00	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECT/EXT	$1,755.00	$2,700.00	$1,755.00–$2,565.00	—	35%
Coronary stent placement, one artery CPT 92928 STENT SINGLE MAJOR OR BRANCH	$17,875.00	$27,500.00	$768.95–$28,875.00	53% above	35%
Coronary stent placement, one artery inpatient CPT 92928 STENT SINGLE MAJOR OR BRANCH	$17,875.00	$27,500.00	$17,875.00–$26,125.00	—	35%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ INTERLAM C/T W IM GUID-BIL	$1,807.00	$2,780.00	$276.00–$3,300.00	26% above	35%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ INTERLAM C/T W IM GUID	$1,807.00	$2,780.00	$276.00–$3,300.00	26% above	35%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ INTERLAM C/T W IM GUID-BIL	$1,807.00	$2,780.00	$1,807.00–$2,641.00	—	35%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ INTERLAM C/T W IM GUID	$1,807.00	$2,780.00	$1,807.00–$2,641.00	—	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$2,255.50	$3,470.00	$277.04–$3,300.00	33% above	35%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 INJ PARAVRT F JNT L/S 1 LV-BIL	$2,255.50	$3,470.00	$277.04–$3,300.00	33% above	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVRT F JNT L/S 1 LV-BIL	$2,255.50	$3,470.00	$2,255.50–$3,296.50	—	35%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 INJ PARAVERT F JNT L/S 1 LEV	$2,255.50	$3,470.00	$2,255.50–$3,296.50	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABSCESS	$276.25	$425.00	$68.31–$403.75	41% below	35%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D ABSCESS-10060	$276.25	$425.00	$68.31–$403.75	41% below	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D ABSCESS-10060	$276.25	$425.00	$276.25–$403.75	—	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D ABSCESS	$276.25	$425.00	$276.25–$403.75	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ TENDON SHEATH/LIGAMENT	$403.00	$620.00	$24.72–$589.00	9% below	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ TENDON SHEATH/LIGAMENT	$403.00	$620.00	$403.00–$589.00	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ MAJ JT/BURSA WO US	$1,576.25	$2,425.00	$29.36–$2,303.75	166% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRN/INJ MAJ JT/BURS WO US-BIL	$1,576.25	$2,425.00	$29.36–$2,303.75	166% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ MAJ JT/BURSA WO US	$1,576.25	$2,425.00	$1,576.25–$2,303.75	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRN/INJ MAJ JT/BURS WO US-BIL	$1,576.25	$2,425.00	$1,576.25–$2,303.75	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRN/INJ INTER JT/BURS WO US	$1,491.75	$2,295.00	$24.72–$2,180.25	153% above	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 DRN/INJ INTER JT/BURS WO US	$1,491.75	$2,295.00	$1,491.75–$2,180.25	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRN/INJ SM JT/BRS WO US	$861.25	$1,325.00	$23.84–$1,258.75	143% above	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 DRN/INJ SM JT/BRS WO US	$861.25	$1,325.00	$861.25–$1,258.75	—	35%
Left heart catheterization, diagnostic one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$9,035.00	$13,900.00	$598.24–$14,595.00	8% below	35%
Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HRT CATH W/VENTRCLGRPHY	$9,035.00	$13,900.00	$9,035.00–$13,205.00	—	35%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ INTERLAM L/S W IM GUID-BIL	$2,106.00	$3,240.00	$276.00–$3,300.00	26% above	35%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ INTERLAMINAR L/S W IM GUID	$2,106.00	$3,240.00	$276.00–$3,300.00	26% above	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ INTERLAM L/S W IM GUID-BIL	$2,106.00	$3,240.00	$2,106.00–$3,078.00	—	35%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ INTERLAMINAR L/S W IM GUID	$2,106.00	$3,240.00	$2,106.00–$3,078.00	—	35%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ INTERLAM L/S WO IMGUID-BIL	$2,177.50	$3,350.00	$276.00–$3,300.00	73% above	35%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ INTERLAM L/S WO IMGUID-BIL	$2,177.50	$3,350.00	$2,177.50–$3,182.50	—	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TFRM EPI LUMBAR/SACRAL 1 LVL	$2,177.50	$3,350.00	$277.04–$3,182.50	58% above	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S	$2,177.50	$3,350.00	$277.04–$3,182.50	58% above	35%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPIDURAL L/S-BIL	$2,177.50	$3,350.00	$277.04–$3,182.50	58% above	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S-BIL	$2,177.50	$3,350.00	$2,177.50–$3,182.50	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 TFRM EPI LUMBAR/SACRAL 1 LVL	$2,177.50	$3,350.00	$2,177.50–$3,182.50	—	35%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPIDURAL L/S	$2,177.50	$3,350.00	$2,177.50–$3,182.50	—	35%
Nail removal (partial or complete), one nail CPT 11730 AVULSION/NAIL PLATE-11730	$305.50	$470.00	$116.33–$493.50	5% above	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION/NAIL PLATE-11730	$305.50	$470.00	$305.50–$446.50	—	35%
Occipital nerve block (injection for headaches) CPT 64405 GREATER OCCIP NERVE BLOCK	$1,027.00	$1,580.00	$31.69–$1,662.00	140% above	35%
Occipital nerve block (injection for headaches) CPT 64405 GREATER OCCIP NERVE BLK-BIL	$1,027.00	$1,580.00	$31.69–$1,662.00	140% above	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 GREATER OCCIP NERVE BLK-BIL	$1,027.00	$1,580.00	$1,027.00–$1,501.00	—	35%
Occipital nerve block (injection for headaches) inpatient CPT 64405 GREATER OCCIP NERVE BLOCK	$1,027.00	$1,580.00	$1,027.00–$1,501.00	—	35%
Pacemaker implant (dual chamber) CPT 33208 INSRT HEART PM ATRIAL & VENT	$17,225.00	$26,500.00	$891.04–$25,175.00	9% below	35%
Pacemaker implant (dual chamber) inpatient CPT 33208 INSRT HEART PM ATRIAL & VENT	$17,225.00	$26,500.00	$17,225.00–$25,175.00	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED	$308.75	$475.00	$88.95–$490.04	41% below	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 REMOVAL OF NAIL BED	$308.75	$475.00	$308.75–$451.25	—	35%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 DESTROY LUMB/SAC FACET JNT	$4,108.00	$6,320.00	$425.44–$6,004.00	46% above	35%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DESTROY LUMB/SAC FACET JNT	$4,108.00	$6,320.00	$4,108.00–$6,004.00	—	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY	$9,490.00	$14,600.00	$768.95–$13,870.00	32% above	35%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY	$9,490.00	$14,600.00	$9,490.00–$13,870.00	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR SCALP/NECK/AX/GE	$367.25	$565.00	$139.84–$593.25	1% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR SCALP/NECK/AX/GE	$367.25	$565.00	$367.25–$536.75	—	35%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$393.25	$605.00	$83.43–$3,300.00	12% below	35%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$393.25	$605.00	$393.25–$574.75	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCT LUMB DIAG NO RAD	$1,179.75	$1,815.00	$276.00–$1,724.25	13% above	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCT LUMB DIAG NO RAD	$1,179.75	$1,815.00	$1,179.75–$1,724.25	—	35%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LES	$432.25	$665.00	$67.44–$3,300.00	20% above	35%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LES	$432.25	$665.00	$432.25–$631.75	—	35%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W IMAGING	$1,807.00	$2,780.00	$234.94–$3,300.00	27% above	35%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W/ IMAGING	$1,807.00	$2,780.00	$234.94–$3,300.00	27% above	35%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W IMAGING	$1,807.00	$2,780.00	$1,807.00–$2,641.00	—	35%
Thoracentesis with imaging guidance inpatient CPT 32555 ASPIRATE PLEURA W/ IMAGING	$1,807.00	$2,780.00	$1,807.00–$2,641.00	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$861.25	$1,325.00	$24.42–$3,300.00	49% above	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE	$861.25	$1,325.00	$24.42–$3,300.00	49% above	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCL	$861.25	$1,325.00	$861.25–$1,258.75	—	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT 1/2 MUSCLE	$861.25	$1,325.00	$861.25–$1,258.75	—	35%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN	$5,525.00	$8,500.00	$524.04–$8,075.00	33% above	35%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RF 1ST VEIN-BIL	$11,050.00	$17,000.00	$524.04–$16,150.00	166% above	35%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF 1ST VEIN	$5,525.00	$8,500.00	$5,525.00–$8,075.00	—	35%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF 1ST VEIN-BIL	$11,050.00	$17,000.00	$11,050.00–$16,150.00	—	35%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SKIN/SUBQ-11042	$1,218.75	$1,875.00	$150.23–$1,954.00	20% above	35%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SKIN/SUBQ-11042	$1,218.75	$1,875.00	$1,218.75–$1,781.25	—	35%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLD/BLD PRODUCTS	$1,127.75	$1,735.00	$32.27–$3,300.00	28% above	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLD/BLD PRODUCTS	$1,127.75	$1,735.00	$1,127.75–$1,648.25	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 EZPAP	$234.00	$360.00	$89.10–$378.00	15% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 BRONCHODILATOR TRTMT < 1 HOUR	$234.00	$360.00	$89.10–$378.00	15% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 METERED DOSE INHALER	$234.00	$360.00	$89.10–$378.00	15% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 EZPAP	$234.00	$360.00	$234.00–$342.00	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 BRONCHODILATOR TRTMT < 1 HOUR	$234.00	$360.00	$234.00–$342.00	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 METERED DOSE INHALER	$234.00	$360.00	$234.00–$342.00	—	35%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION 1ST HOUR-96413	$552.50	$850.00	$143.08–$892.50	2% above	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION 1ST HOUR-96413	$552.50	$850.00	$552.50–$807.50	—	35%
Critical care, first 30 to 74 minutes CPT 99291 EMERGENCY ROOM CRITICAL CARE	$4,309.50	$6,630.00	$666.66–$6,961.50	66% above	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 EMERGENCY ROOM CRITICAL CARE	$4,309.50	$6,630.00	$4,309.50–$6,298.50	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD	$334.75	$515.00	$55.01–$540.75	15% above	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD	$334.75	$515.00	$334.75–$489.25	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 TRIAGE LEVEL	$292.50	$450.00	$66.83–$472.50	12% above	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY ROOM LEVEL I VISIT	$357.50	$550.00	$69.62–$577.50	36% above	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 TRIAGE LEVEL	$292.50	$450.00	$292.50–$427.50	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY ROOM LEVEL I VISIT	$357.50	$550.00	$357.50–$522.50	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY ROOM LEVEL II VISIT	$552.50	$850.00	$126.23–$892.50	18% above	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY ROOM LEVEL II VISIT	$552.50	$850.00	$552.50–$807.50	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY ROOM LEVEL III VISIT	$1,053.00	$1,620.00	$223.34–$1,701.00	33% above	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY ROOM LEVEL III VISIT	$1,053.00	$1,620.00	$1,053.00–$1,539.00	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY ROOM LEVEL IV VISIT	$1,300.00	$2,000.00	$351.79–$2,100.00	1% below	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY ROOM LEVEL IV VISIT	$1,300.00	$2,000.00	$1,300.00–$1,900.00	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY ROOM LEVEL V VISIT	$2,275.00	$3,500.00	$504.51–$3,675.00	13% above	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY ROOM LEVEL V VISIT	$2,275.00	$3,500.00	$2,275.00–$3,325.00	—	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST	$1,407.25	$2,165.00	$216.91–$2,273.25	10% above	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 PHARMACOLOGICAL STRESS TEST	$1,407.25	$2,165.00	$216.91–$2,273.25	10% above	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CARDIAC STRESS TEST	$1,407.25	$2,165.00	$1,407.25–$2,056.75	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 PHARMACOLOGICAL STRESS TEST	$1,407.25	$2,165.00	$1,407.25–$2,056.75	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OBS INF HYDRATION 1ST HR-96360	$455.00	$700.00	$38.56–$735.00	1% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATE IV INF INIT<=1 HR	$455.00	$700.00	$38.56–$735.00	1% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER INF HYDRATION 1ST HR-96360	$455.00	$700.00	$38.56–$735.00	1% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ACC INF HYDRATION 1ST HR-96360	$455.00	$700.00	$38.56–$735.00	1% above	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HYDRATE IV INF INIT<=1 HR	$455.00	$700.00	$455.00–$665.00	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ER INF HYDRATION 1ST HR-96360	$455.00	$700.00	$455.00–$665.00	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ACC INF HYDRATION 1ST HR-96360	$455.00	$700.00	$455.00–$665.00	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 OBS INF HYDRATION 1ST HR-96360	$455.00	$700.00	$455.00–$665.00	—	35%
IV infusion of a medicine, first hour CPT 96365 TX IV INF INIT <=1 HR	$455.00	$700.00	$72.80–$735.00	3% below	35%
IV infusion of a medicine, first hour CPT 96365 OBS INITIAL INFUSION-96365	$455.00	$700.00	$72.80–$735.00	3% below	35%
IV infusion of a medicine, first hour CPT 96365 ER INITIAL INFUSION-96365	$455.00	$700.00	$72.80–$735.00	3% below	35%
IV infusion of a medicine, first hour CPT 96365 ACC INITIAL INFUSION-96365	$455.00	$700.00	$72.80–$735.00	3% below	35%
IV infusion of a medicine, first hour inpatient CPT 96365 TX IV INF INIT <=1 HR	$455.00	$700.00	$455.00–$665.00	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 ER INITIAL INFUSION-96365	$455.00	$700.00	$455.00–$665.00	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 ACC INITIAL INFUSION-96365	$455.00	$700.00	$455.00–$665.00	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 OBS INITIAL INFUSION-96365	$455.00	$700.00	$455.00–$665.00	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ACC SQ/IM INJECTION-96372	$146.25	$225.00	$55.69–$236.25	4% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM96372	$146.25	$225.00	$55.69–$236.25	4% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER SQ/IM INJECTION-96372	$146.25	$225.00	$55.69–$236.25	4% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OBS SQ/IM INJECT-96372	$146.25	$225.00	$55.69–$236.25	4% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 SQ/IM INJECTION	$146.25	$225.00	$55.69–$236.25	4% below	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ER SQ/IM INJECTION-96372	$146.25	$225.00	$146.25–$213.75	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THER/PROPH/DIAG INJ SC/IM96372	$146.25	$225.00	$146.25–$213.75	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 ACC SQ/IM INJECTION-96372	$146.25	$225.00	$146.25–$213.75	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 SQ/IM INJECTION	$146.25	$225.00	$146.25–$213.75	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 OBS SQ/IM INJECT-96372	$146.25	$225.00	$146.25–$213.75	—	35%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-ED	$139.75	$215.00	$31.90–$225.75	23% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR RE-EDUCATION	$139.75	$215.00	$31.90–$225.75	23% above	35%
Neuromuscular re-education, 15 minutes CPT 97112 CAP/NEUROMUSCULAR RE-EDUC	$146.25	$225.00	$31.90–$236.25	29% above	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-EDUCATION	$139.75	$215.00	$139.75–$204.25	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSCULAR RE-ED	$139.75	$215.00	$139.75–$204.25	—	35%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 CAP/NEUROMUSCULAR RE-EDUC	$146.25	$225.00	$146.25–$213.75	—	35%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT/LEVEL 3-99203	$227.50	$350.00	$77.48–$367.50	7% above	35%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT/LEVEL 3-99203	$227.50	$350.00	$227.50–$332.50	—	35%
New patient office visit, about 45 minutes CPT 99204 NEW PATIENT/LEVEL 4-99204	$292.50	$450.00	$111.38–$472.50	8% below	35%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT/LEVEL 4-99204	$292.50	$450.00	$292.50–$427.50	—	35%
New patient office visit, about 60 minutes CPT 99205 NEW PATIENT/LEVEL 5 99205	$357.50	$550.00	$115.93–$577.50	6% above	35%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT/LEVEL 5 99205	$357.50	$550.00	$357.50–$522.50	—	35%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT/LEVEL 2-99202	$162.50	$250.00	$51.54–$262.50	9% below	35%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT/LEVEL 2-99202	$162.50	$250.00	$162.50–$237.50	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 MNT INIT INDIV ASSMT/15 MIN	$56.55	$87.00	$21.53–$91.35	2% below	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 TH MNT INIT INDIV ASSMT/15 MIN	$56.55	$87.00	$21.53–$91.35	2% below	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MNT INIT INDIV ASSMT/15 MIN	$56.55	$87.00	$56.55–$82.65	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 TH MNT INIT INDIV ASSMT/15 MIN	$56.55	$87.00	$56.55–$82.65	—	35%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL LOW COMPLEXITY	$227.50	$350.00	$86.63–$367.50	6% below	35%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL LOW COMPLEXITY	$227.50	$350.00	$227.50–$332.50	—	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL HIGH COMPLEXITY	$308.75	$475.00	$86.49–$498.75	1% above	35%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL HIGH COMPLEXITY	$308.75	$475.00	$308.75–$451.25	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEXITY	$214.50	$330.00	$81.68–$346.50	3% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 CAP PT EVAL LOW COMPLEXITY	$214.50	$330.00	$81.68–$346.50	3% above	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 CAP PT EVAL LOW COMPLEXITY	$214.50	$330.00	$214.50–$313.50	—	35%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL LOW COMPLEXITY	$214.50	$330.00	$214.50–$313.50	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 CAP PT EVAL MOD COMPLEXITY	$234.00	$360.00	$86.49–$378.00	12% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEXITY	$234.00	$360.00	$86.49–$378.00	12% below	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL MOD COMPLEXITY	$234.00	$360.00	$234.00–$342.00	—	35%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 CAP PT EVAL MOD COMPLEXITY	$234.00	$360.00	$234.00–$342.00	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY	$130.00	$200.00	$27.03–$210.00	16% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 CAP/MANUAL TREATMENT	$130.00	$200.00	$27.03–$210.00	16% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL TREATMENT	$130.00	$200.00	$27.03–$210.00	16% above	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 CAP/MANUAL TREATMENT	$130.00	$200.00	$130.00–$190.00	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY	$130.00	$200.00	$130.00–$190.00	—	35%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL TREATMENT	$130.00	$200.00	$130.00–$190.00	—	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE 15 MIN	$133.25	$205.00	$28.33–$215.25	16% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE 15 MIN	$133.25	$205.00	$28.33–$215.25	16% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 CAP/OT THERAPEUTIC EXER 15MIN	$133.25	$205.00	$28.33–$215.25	16% above	35%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 CAP/THERAPEUTIC EXERCISE 15 MI	$133.25	$205.00	$28.33–$215.25	16% above	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISE 15 MIN	$133.25	$205.00	$133.25–$194.75	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE 15 MIN	$133.25	$205.00	$133.25–$194.75	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 CAP/OT THERAPEUTIC EXER 15MIN	$133.25	$205.00	$133.25–$194.75	—	35%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 CAP/THERAPEUTIC EXERCISE 15 MI	$133.25	$205.00	$133.25–$194.75	—	35%
Preventive checkup, new patient aged 40–64 CPT 99386 PCC/EVAL NEW PT 40-64 99386	$249.60	$384.00	$95.04–$403.20	77% above	35%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PCC/EVAL NEW PT 40-64 99386	$249.60	$384.00	$249.60–$364.80	—	35%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING/TOBACCO CESS >3=10MIN	$116.35	$179.00	$12.61–$187.95	171% above	35%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING/TOBACCO CESS >3=10MIN	$116.35	$179.00	$116.35–$170.05	—	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OB TRIAGE LEVEL V 99215	$325.00	$500.00	$112.80–$525.00	5% above	35%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTABLISHED LEVEL 5-99215	$341.25	$525.00	$112.80–$551.25	10% above	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OB TRIAGE LEVEL V 99215	$325.00	$500.00	$325.00–$475.00	—	35%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTABLISHED LEVEL 5-99215	$341.25	$525.00	$341.25–$498.75	—	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED LEVEL 3-99213	$247.00	$380.00	$51.90–$399.00	21% above	35%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB TRIAGE LEVEL III 99213	$260.00	$400.00	$51.90–$420.00	27% above	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTABLISHED LEVEL 3-99213	$247.00	$380.00	$247.00–$361.00	—	35%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OB TRIAGE LEVEL III 99213	$260.00	$400.00	$260.00–$380.00	—	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED LEVEL 4-99214	$276.25	$425.00	$80.01–$446.25	25% above	35%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OB TRIAGE LEVEL IV 99214	$292.50	$450.00	$80.01–$472.50	33% above	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTABLISHED LEVEL 4-99214	$276.25	$425.00	$276.25–$403.75	—	35%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OB TRIAGE LEVEL IV 99214	$292.50	$450.00	$292.50–$427.50	—	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED LEVEL 2-99212	$211.25	$325.00	$25.95–$341.25	29% above	35%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OB TRIAGE LEVEL II 99212	$227.50	$350.00	$25.95–$367.50	39% above	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTABLISHED LEVEL 2-99212	$211.25	$325.00	$211.25–$308.75	—	35%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OB TRIAGE LEVEL II 99212	$227.50	$350.00	$227.50–$332.50	—	35%
Speech and language evaluation CPT 92523 CAP SPEECH EVAL COMPREHENSION	$455.00	$700.00	$173.25–$735.00	7% above	35%
Speech and language evaluation CPT 92523 SPEECH EVAL COMPREHENSION	$455.00	$700.00	$173.25–$735.00	7% above	35%
Speech and language evaluation inpatient CPT 92523 SPEECH EVAL COMPREHENSION	$455.00	$700.00	$455.00–$665.00	—	35%
Speech and language evaluation inpatient CPT 92523 CAP SPEECH EVAL COMPREHENSION	$455.00	$700.00	$455.00–$665.00	—	35%
Speech therapy session, individual CPT 92507 SPEECH/LANGUAGE TRAIN 15 MIN	$227.50	$350.00	$74.47–$367.50	5% above	35%
Speech therapy session, individual CPT 92507 SPEECH/LANGUAGE TRAIN 45 MIN	$227.50	$350.00	$74.47–$367.50	5% above	35%
Speech therapy session, individual CPT 92507 CAP SPEECH/LANGUAGE TRAIN 45	$227.50	$350.00	$74.47–$367.50	5% above	35%
Speech therapy session, individual CPT 92507 SPEECH/LANGUAGE TRAIN 30	$276.25	$425.00	$74.47–$446.25	28% above	35%
Speech therapy session, individual CPT 92507 SPEECH/HEARING 30 MIN-92507GN	$331.50	$510.00	$74.47–$535.50	53% above	35%
Speech therapy session, individual CPT 92507 SPEECH/LANGUAGE TRAIN 60 MIN	$331.50	$510.00	$74.47–$535.50	53% above	35%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANGUAGE TRAIN 45 MIN	$227.50	$350.00	$227.50–$332.50	—	35%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANGUAGE TRAIN 15 MIN	$227.50	$350.00	$227.50–$332.50	—	35%
Speech therapy session, individual inpatient CPT 92507 CAP SPEECH/LANGUAGE TRAIN 45	$227.50	$350.00	$227.50–$332.50	—	35%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANGUAGE TRAIN 30	$276.25	$425.00	$276.25–$403.75	—	35%
Speech therapy session, individual inpatient CPT 92507 SPEECH/HEARING 30 MIN-92507GN	$331.50	$510.00	$331.50–$484.50	—	35%
Speech therapy session, individual inpatient CPT 92507 SPEECH/LANGUAGE TRAIN 60 MIN	$331.50	$510.00	$331.50–$484.50	—	35%
Spirometry (breathing test) CPT 94010 SPONTANEOUS MECHANICS/TIDAL	$562.25	$865.00	$138.35–$908.25	58% above	35%
Spirometry (breathing test) inpatient CPT 94010 SPONTANEOUS MECHANICS/TIDAL	$562.25	$865.00	$562.25–$821.75	—	35%
Spirometry before and after a bronchodilator CPT 94060 SPIROMETRY/BRONCHO PFS	$763.75	$1,175.00	$47.21–$1,233.75	28% above	35%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY/BRONCHO PFS	$763.75	$1,175.00	$763.75–$1,116.25	—	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITY	$146.25	$225.00	$34.02–$236.25	30% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 CAP/PT THERAPEUTIC ACTIVITY 15	$146.25	$225.00	$34.02–$236.25	30% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 CAP/OT THERAPEUTIC ACT 15MIN	$146.25	$225.00	$34.02–$236.25	30% above	35%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACTIVITY 15 MIN	$146.25	$225.00	$34.02–$236.25	30% above	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 OT THERAPEUTIC ACTIVITY 15 MIN	$146.25	$225.00	$146.25–$213.75	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUTIC ACTIVITY	$146.25	$225.00	$146.25–$213.75	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 CAP/PT THERAPEUTIC ACTIVITY 15	$146.25	$225.00	$146.25–$213.75	—	35%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 CAP/OT THERAPEUTIC ACT 15MIN	$146.25	$225.00	$146.25–$213.75	—	35%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$169.00	$260.00	$64.35–$273.00	29% below	35%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$169.00	$260.00	$169.00–$247.00	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Texas	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella Virus Vaccine Live 0.5 mL	$124.40	$191.37	$47.36–$200.94	75% below	35%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE	$236.60	$364.00	$90.09–$382.20	52% below	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varicella Virus Vaccine Live 0.5 mL	$124.40	$191.37	$124.39–$181.80	—	35%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE	$236.60	$364.00	$236.60–$345.80	—	35%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Flu Vac 25-26 (6mos up)/PF Syr	$42.58	$65.50	$16.21–$68.78	11% below	35%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Flu Vac 25-26 (6mos up)/PF Syr	$42.58	$65.50	$42.58–$62.23	—	35%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A Vaccine 1,440 Units/mL Syringe	$57.74	$88.82	$21.98–$93.26	74% below	35%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 U/ML	$160.55	$247.00	$61.13–$259.35	29% below	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 Hepatitis A Vaccine 1,440 Units/mL Syringe	$57.74	$88.82	$57.73–$84.38	—	35%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE 1440 U/ML	$160.55	$247.00	$160.55–$234.65	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HD VACCINE 0.5ML	$89.05	$137.00	$33.91–$143.85	40% below	35%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Flu Vac HD25-26(65 up)/PF Syr	$159.42	$245.25	$43.13–$257.51	7% above	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HD VACCINE 0.5ML	$89.05	$137.00	$89.05–$130.15	—	35%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Flu Vac HD25-26(65 up)/PF Syr	$159.42	$245.25	$159.41–$232.99	—	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles/Mumps/Rubella (Live) Vaccine 0.5 mL	$62.24	$95.74	$23.70–$100.53	75% below	35%
MMR vaccine (measles, mumps and rubella), live CPT 90707 M M R 0.5ML VACCINE SDV	$136.50	$210.00	$51.98–$220.50	45% below	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 Measles/Mumps/Rubella (Live) Vaccine 0.5 mL	$62.24	$95.74	$62.23–$90.95	—	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M M R 0.5ML VACCINE SDV	$136.50	$210.00	$136.50–$199.50	—	35%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM	$255.45	$393.00	$85.08–$412.65	28% below	35%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENACWYD/MENACWYCRM VACC IM	$255.45	$393.00	$255.45–$373.35	—	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACCINE IM	$341.42	$525.25	$130.00–$551.51	44% below	35%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENB-4C VACCINE IM	$341.42	$525.25	$341.41–$498.99	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal 20-Valent Conjugate/PF 0.5 mL Syringe	$205.67	$316.41	$78.31–$409.20	63% below	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PREVNAR-20 PNEUMONIA VACCINE	$472.72	$727.25	$179.99–$763.61	16% below	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Pneumococcal 20-Valent Conjugate/PF 0.5 mL Syringe	$205.67	$316.41	$205.67–$300.59	—	35%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PREVNAR-20 PNEUMONIA VACCINE	$472.72	$727.25	$472.71–$690.89	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal Vaccine Polyvalent 0.5 mL Vial	$76.11	$117.08	$28.98–$160.16	70% below	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNU IMMUNE 23 EACH DOSE	$185.90	$286.00	$70.79–$300.30	26% below	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumococcal Vaccine Polyvalent 0.5 mL Vial	$76.11	$117.08	$76.10–$111.23	—	35%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNU IMMUNE 23 EACH DOSE	$185.90	$286.00	$185.90–$271.70	—	35%
Rabies vaccine, one dose CPT 90675 Rabies Vaccine (PCEC)/PF 2.5 Unit/mL Vial	$293.80	$451.99	$111.87–$474.59	71% below	35%
Rabies vaccine, one dose CPT 90675 RABIES IMOVAX 1CC INJ	$643.50	$990.00	$245.03–$1,039.50	37% below	35%
Rabies vaccine, one dose inpatient CPT 90675 Rabies Vaccine (PCEC)/PF 2.5 Unit/mL Vial	$293.80	$451.99	$293.79–$429.39	—	35%
Rabies vaccine, one dose inpatient CPT 90675 RABIES IMOVAX 1CC INJ	$643.50	$990.00	$643.50–$940.50	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Tetanus-Diphtheria-Acell Pertussis Tdap 0.5 mL Injection (Adult)	$31.74	$48.83	$12.09–$51.27	80% below	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 ADACEL VACCINE SDV	$83.85	$129.00	$31.93–$135.45	46% below	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tetanus-Diphtheria-Acell Pertussis Tdap 0.5 mL Injection (Adult)	$31.74	$48.83	$31.74–$46.39	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 ADACEL VACCINE SDV	$83.85	$129.00	$83.85–$122.55	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN FLU VACCINE	$39.00	$60.00	$14.85–$86.79	48% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OBS FLU VACCINE ADM/CARE	$39.00	$60.00	$14.85–$86.79	48% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OBS PNEUMO VAC ADM/CARE	$52.00	$80.00	$19.80–$86.79	30% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN PNEU VACCINE	$52.00	$80.00	$19.80–$86.79	30% below	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADM VACCINE SINGLE	$105.30	$162.00	$40.10–$170.10	41% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN VACCINE	$105.30	$162.00	$40.10–$170.10	41% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 OBS VACCINE ADM-90471	$105.30	$162.00	$40.10–$170.10	41% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN FLU VACCINE	$39.00	$60.00	$39.00–$57.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OBS FLU VACCINE ADM/CARE	$39.00	$60.00	$39.00–$57.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OBS PNEUMO VAC ADM/CARE	$52.00	$80.00	$52.00–$76.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN PNEU VACCINE	$52.00	$80.00	$52.00–$76.00	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN VACCINE	$105.30	$162.00	$105.30–$153.90	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADM VACCINE SINGLE	$105.30	$162.00	$105.30–$153.90	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 OBS VACCINE ADM-90471	$105.30	$162.00	$105.30–$153.90	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADM VACCINE ADD-ON	$91.00	$140.00	$12.97–$147.00	70% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 OBS VACCINE ADD'L-90472	$91.00	$140.00	$12.97–$147.00	70% above	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN VACCINE ADDTL	$91.00	$140.00	$12.97–$147.00	70% above	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 OBS VACCINE ADD'L-90472	$91.00	$140.00	$91.00–$133.00	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADM VACCINE ADD-ON	$91.00	$140.00	$91.00–$133.00	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN VACCINE ADDTL	$91.00	$140.00	$91.00–$133.00	—	35%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/11782/742557820_sid-peterson-memorial-hospital_standardcharges.csv