Hospital Charlotte-Concord-Gastonia, NC-SC

Iredell Memorial Hospital

Listed in its price file as “Iredell Memorial Hospital Incorporated”.

Iredell Memorial Hospital in Statesville, NC publishes cash prices for 326 common procedures listed here, from its own machine-readable price file updated Dec 31, 2025. Compared with other hospitals in the state, its outpatient cash prices are below the North Carolina median for 298 of 323 procedures and above it for 23. By typical cash price it ranks #2 of 65 North Carolina hospitals and #1 of 19 hospitals in the Charlotte, NC area, cheapest first. Click a procedure to compare it with other hospitals nearby.

557 Brookdale Drive, Statesville NC 28677 Collected Sep 29, 2026 Source price file (704) 878-5661

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 340039 · CMS hospital register NPI 1417944224

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs North Carolina	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast	$673.11	$2,493.00	$571.15–$4,986.00	70% below	73%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views	$105.03	$389.00	$89.12–$778.00	60% below	73%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle 3 Views Left	$95.31	$353.00	$80.87–$706.00	65% below	73%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle 3 Views Right	$95.31	$353.00	$80.87–$706.00	65% below	73%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Limited bilateral arterial studies upper or lower extremitie	$122.58	$454.00	$104.01–$908.00	—	73%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Limited bilat arterial studies upper or lower extremitie IPN	$122.58	$454.00	$104.01–$908.00	—	73%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 UPR/L EXT ART 2LVLS RED	$111.01	$411.15	$94.19–$822.30	69% below	73%
Arm CT scan without contrast (shoulder to hand, any part) both sides CPT 73200 CT Shoulder w/o Contrast Bilateral	$227.86	$843.91	$193.34–$1,687.82	—	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Contrast Right	$230.31	$853.00	$195.42–$1,706.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Humerus w/o Contrast Left	$230.31	$853.00	$195.42–$1,706.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Contrast Right	$230.31	$853.00	$195.42–$1,706.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Forearm w/o Contrast Left	$230.31	$853.00	$195.42–$1,706.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Right	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Left	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Elbow w/o Contrast Right	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Left	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Shoulder w/o Contrast Right	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Left	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Wrist w/o Contrast Right	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Hand w/o Contrast Left	$232.47	$861.00	$197.26–$1,722.00	84% below	73%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Barium Esophagram	$81.27	$301.00	$68.96–$602.00	81% below	73%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Scan	$463.05	$1,715.00	$392.91–$3,430.00	67% below	73%
Breast ultrasound, complete, one breast both sides CPT 76641 US Breast Bilat Complete	$145.34	$538.30	$123.32–$1,076.60	—	73%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Lt	$75.06	$278.00	$63.69–$556.00	84% below	73%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Rt	$75.06	$278.00	$63.69–$556.00	84% below	73%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US Breast Bilateral Limited	$145.34	$538.30	$123.32–$1,076.60	—	73%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 ED US Breast Unilat; limited	$73.44	$271.99	$62.31–$543.98	79% below	73%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Left	$75.06	$278.00	$63.69–$556.00	78% below	73%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Right	$75.06	$278.00	$63.69–$556.00	78% below	73%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen/Pelvis	$832.95	$3,085.00	$706.77–$6,170.00	71% below	73%
CT angiography (CTA) of the head CPT 70496 CT Angiography Head w/ + w/o Contrast	$946.08	$3,504.00	$802.77–$7,008.00	55% below	73%
CT angiography (CTA) of the neck CPT 70498 CT Angiography Neck w/ Contrast	$821.07	$3,041.00	$696.69–$6,082.00	65% below	73%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angiography Pulmonary	$810.00	$3,000.00	$687.30–$6,000.00	61% below	73%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angiography Chest w/ Contrast	$810.00	$3,000.00	$687.30–$6,000.00	61% below	73%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angiography Cardiac	$765.18	$2,834.00	$649.27–$5,668.00	57% below	73%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT Cardiac Calcium Scoring	$118.53	$439.00	$100.57–$878.00	50% below	73%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast	$602.82	$2,232.67	$511.50–$4,465.34	79% below	73%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen/Pelvis w/o Contrast	$810.00	$3,000.00	$687.30–$6,000.00	72% below	73%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w/ Contrast	$1,215.00	$4,500.00	$1,030.95–$9,000.00	62% below	73%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis Triphasic	$1,215.00	$4,500.00	$1,030.95–$9,000.00	62% below	73%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen/Pelvis w/ + w/o Contrast	$1,346.49	$4,987.00	$1,142.52–$9,974.00	65% below	73%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$494.64	$1,832.00	$419.71–$3,664.00	74% below	73%
CT scan of the abdomen with contrast CPT 74160 CT 3D Reconstruction	$727.38	$2,694.00	$617.20–$5,388.00	61% below	73%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$307.53	$1,139.00	$260.94–$2,278.00	78% below	73%
CT scan of the face and sinuses, no contrast dye both sides CPT 70486 CT TMJ w/o Contrast Bilateral	$225.60	$835.55	$191.42–$1,671.10	—	73%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Sinus w/o Contrast	$509.49	$1,887.00	$432.31–$3,774.00	57% below	73%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$509.49	$1,887.00	$432.31–$3,774.00	57% below	73%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast	$540.00	$2,000.00	$458.20–$4,000.00	57% below	73%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Contrast	$647.19	$2,397.00	$549.15–$4,794.00	58% below	73%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Contrast	$925.83	$3,429.00	$785.58–$6,858.00	52% below	73%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$591.57	$2,191.00	$501.96–$4,382.00	61% below	73%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$675.00	$2,500.00	$572.75–$5,000.00	55% below	73%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$494.64	$1,832.00	$419.71–$3,664.00	70% below	73%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Doppler Bilateral	$660.15	$2,445.00	$560.15–$4,890.00	—	73%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Contrast Asbestos	$750.52	$2,779.70	$636.83–$5,559.40	64% below	73%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Contrast	$880.47	$3,261.00	$747.10–$6,522.00	58% below	73%
Chest X-ray, 2 views CPT 71046 XR Chest 2 views	$85.51	$316.70	$72.56–$633.40	63% below	73%
Chest X-ray, 2 views CPT 71046 XR Chest Inspiration/Expiration	$86.36	$319.87	$73.28–$639.74	63% below	73%
Chest X-ray, single view CPT 71045 XR Chest 1 View Frontal	$72.09	$267.00	$61.17–$534.00	61% below	73%
Chest X-ray, single view CPT 71045 XR Chest 1 View Portable	$112.59	$417.00	$95.53–$834.00	40% below	73%
Chest X-ray, single view one side CPT 71045 XR Chest Decubitus Left	$74.52	$276.00	$63.23–$552.00	60% below	73%
Chest X-ray, single view one side CPT 71045 XR Chest Decubitus Right	$74.52	$276.00	$63.23–$552.00	60% below	73%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right	$91.80	$340.00	$77.89–$680.00	60% below	73%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left	$91.80	$340.00	$77.89–$680.00	60% below	73%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$101.25	$375.00	$85.91–$750.00	82% below	73%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$139.32	$516.00	$118.22–$1,032.00	66% below	73%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD Bone Density DEXA App Skeleton	$86.67	$321.00	$73.54–$642.00	61% below	73%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Lung Screen F/U w/o Contrast	$151.20	$560.00	$128.30–$1,120.00	89% below	73%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Sternoclavicular Joint(s)	$225.60	$835.55	$191.42–$1,671.10	83% below	73%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$513.27	$1,901.00	$435.52–$3,802.00	62% below	73%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$800.55	$2,965.00	$679.28–$5,930.00	50% below	73%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Post Clip Placement Bilateral	$67.50	$250.00	$57.28–$500.00	—	73%
Diagnostic mammogram, both breasts both sides CPT 77066 MAM Mammogram Diagnostic Bilateral	$67.50	$250.00	$57.28–$500.00	—	73%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Diagnostic Bilat w/ Tomo.	$67.50	$250.00	$57.28–$500.00	—	73%
Diagnostic mammogram, one breast one side CPT 77065 MAM Mammogram Diagnostic Right	$67.50	$250.00	$57.28–$500.00	71% below	73%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Diagnostic Left w/ Tomo.	$67.50	$250.00	$57.28–$500.00	71% below	73%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Diagnostic Right w/ Tomo.	$67.50	$250.00	$57.28–$500.00	71% below	73%
Diagnostic mammogram, one breast one side CPT 77065 MAM Mammogram Diagnostic Left	$67.50	$250.00	$57.28–$500.00	71% below	73%
Diagnostic mammogram, one breast one side CPT 77065 MA Post Clip Placement Left	$67.50	$250.00	$57.28–$500.00	71% below	73%
Diagnostic mammogram, one breast one side CPT 77065 MA Post Clip Placement Right	$67.50	$250.00	$57.28–$500.00	71% below	73%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LE Arterial Duplex Bilateral	$571.32	$2,116.00	$484.78–$4,232.00	—	73%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Duplex scan lower extremity arteries or art bypass grafts; compl	$265.68	$984.00	$225.43–$1,968.00	46% below	73%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Duplex scan lower extremity arteries or art bypass grafts; c	$265.68	$984.00	$225.43–$1,968.00	46% below	73%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Duplex Bilateral	$571.32	$2,116.00	$484.78–$4,232.00	—	73%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UE Venous Duplex Bilateral	$571.32	$2,116.00	$484.78–$4,232.00	—	73%
Duplex ultrasound of the leg veins, both legs CPT 93970 US Venous Reflux Study	$571.32	$2,116.00	$484.78–$4,232.00	23% below	73%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 TTE/Transthoracic Echo without contrast, complete, with Dopp	$891.00	$3,300.00	$756.03–$6,600.00	46% below	73%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Left	$92.61	$343.00	$78.58–$686.00	65% below	73%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow Complete Right	$92.61	$343.00	$78.58–$686.00	65% below	73%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit Sella etc. w/o Contrast	$585.63	$2,169.00	$496.92–$4,338.00	58% below	73%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC w/o Contrast	$647.19	$2,397.00	$549.15–$4,794.00	54% below	73%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Minimum 3 Views	$86.94	$322.00	$73.77–$644.00	74% below	73%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm Right	$89.91	$333.00	$76.29–$666.00	63% below	73%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm Left	$89.91	$333.00	$76.29–$666.00	63% below	73%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Duct System Imaging	$376.92	$1,396.00	$319.82–$2,792.00	74% below	73%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneous Left	$90.99	$337.00	$77.21–$674.00	58% below	73%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneous Right	$90.99	$337.00	$77.21–$674.00	58% below	73%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 IMH Sleep Study Unattended Home < 6hrs	$130.01	$481.50	$110.31–$963.00	65% below	73%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 IMH Sleep Study Unattended Home > 6hrs	$130.01	$481.50	$110.31–$963.00	65% below	73%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 PSG (Polysomnography) with intitiation of CPAP >6 hours >3 P	$980.79	$3,632.57	$832.22–$7,265.14	74% below	73%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left	$101.79	$377.00	$86.37–$754.00	62% below	73%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right	$101.79	$377.00	$86.37–$754.00	62% below	73%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Knee w/o Contrast Bilateral	$230.31	$853.00	$195.42–$1,706.00	—	73%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Ankle w/o Contrast Bilateral	$264.87	$981.00	$224.75–$1,962.00	—	73%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Hip w/o Contrast Bilateral	$264.87	$981.00	$224.75–$1,962.00	—	73%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Foot w/o Contrast Bilateral	$264.87	$981.00	$224.75–$1,962.00	—	73%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Femur w/o Contrast Bilateral	$264.87	$981.00	$224.75–$1,962.00	—	73%
Leg CT scan without contrast (hip to foot, any part) both sides CPT 73700 CT Tibia/Fibula w/o Contrast Bilateral	$264.87	$981.00	$224.75–$1,962.00	—	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Contrast Left	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Right	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Ankle w/o Contrast Left	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Tibia/Fibula w/o Contrast Right	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Contrast Left	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Femur w/o Contrast Right	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Right	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Knee w/o Contrast Left	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Right	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Foot w/o Contrast Left	$264.87	$981.00	$224.75–$1,962.00	79% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abdominal Wall	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Spleen	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Liver (Hepatic)	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Gallbladder	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, Spleen	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, One Quadrant	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, Pancreas	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, Liver	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, Biliary Tract	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, Gallbladder	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Biliary	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ED US Abd, Limited/FU	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Pancreas	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Biliary Tract	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 US Right Upper Quadrant	$271.62	$1,006.00	$230.47–$2,012.00	46% below	73%
Limited ultrasound of an arm or leg (non-vascular) both sides CPT 76882 US Upper Extremity Non-Vascular Bilat	$280.53	$1,039.00	$238.03–$2,078.00	—	73%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 ED US Soft Tiss MSK Limted	$140.40	$520.00	$119.13–$1,040.00	65% below	73%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Lower Extremity Non-Vascular Left	$140.40	$520.00	$119.13–$1,040.00	65% below	73%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Upper Extremity Non-Vascular Left	$140.40	$520.00	$119.13–$1,040.00	65% below	73%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Upper Extremity Non-Vascular Right	$140.40	$520.00	$119.13–$1,040.00	65% below	73%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Lower Extremity Non-Vascular Right	$140.40	$520.00	$119.13–$1,040.00	65% below	73%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Screen	$151.20	$560.00	$128.30–$1,120.00	61% below	73%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Left	$90.99	$337.00	$77.21–$674.00	59% below	73%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia/Fibula Right	$90.99	$337.00	$77.21–$674.00	59% below	73%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head w/o Contrast	$547.29	$2,027.00	$464.39–$4,054.00	68% below	73%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$675.81	$2,503.00	$573.44–$5,006.00	—	73%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilat	$675.81	$2,503.00	$573.44–$5,006.00	—	73%
MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Hip w/o Contrast Bilateral	$653.94	$2,422.00	$554.88–$4,844.00	—	73%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Left	$653.94	$2,422.00	$554.88–$4,844.00	66% below	73%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Left	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Right	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Ankle w/o Contrast Left	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Hip w/o Contrast Right	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Knee w/o Contrast Right	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 MRI Hip w/ + w/o Contrast Bilateral	$850.72	$3,150.82	$721.85–$6,301.64	—	73%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Right	$867.78	$3,214.00	$736.33–$6,428.00	70% below	73%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Right	$867.78	$3,214.00	$736.33–$6,428.00	70% below	73%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Ankle w/ + w/o Contrast Left	$867.78	$3,214.00	$736.33–$6,428.00	70% below	73%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Left	$867.78	$3,214.00	$736.33–$6,428.00	70% below	73%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Hip w/ + w/o Contrast Right	$867.78	$3,214.00	$736.33–$6,428.00	70% below	73%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Knee w/ + w/o Contrast Left	$867.78	$3,214.00	$736.33–$6,428.00	70% below	73%
MRI of the abdomen without contrast CPT 74181 MRCP	$777.06	$2,878.00	$659.35–$5,756.00	57% below	73%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$777.06	$2,878.00	$659.35–$5,756.00	57% below	73%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$1,110.51	$4,113.00	$942.29–$8,226.00	57% below	73%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$748.44	$2,772.00	$635.07–$5,544.00	59% below	73%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$1,008.18	$3,734.00	$855.46–$7,468.00	62% below	73%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$705.24	$2,612.00	$598.41–$5,224.00	65% below	73%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$1,066.50	$3,950.00	$904.95–$7,900.00	61% below	73%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$653.94	$2,422.00	$554.88–$4,844.00	68% below	73%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$953.10	$3,530.00	$808.72–$7,060.00	62% below	73%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$653.94	$2,422.00	$554.88–$4,844.00	66% below	73%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$1,031.13	$3,819.00	$874.93–$7,638.00	61% below	73%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$777.06	$2,878.00	$659.35–$5,756.00	54% below	73%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Left	$653.94	$2,422.00	$554.88–$4,844.00	66% below	73%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Elbow w/o Contrast Right	$653.94	$2,422.00	$554.88–$4,844.00	66% below	73%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Left	$653.94	$2,422.00	$554.88–$4,844.00	66% below	73%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Wrist w/o Contrast Right	$653.94	$2,422.00	$554.88–$4,844.00	66% below	73%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Left	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI Shoulder w/o Contrast Right	$777.06	$2,878.00	$659.35–$5,756.00	60% below	73%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical Comp w/ Obliques	$120.15	$445.00	$101.95–$890.00	70% below	73%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck w/ Contrast	$647.19	$2,397.00	$549.15–$4,794.00	61% below	73%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck w/o Contrast	$477.09	$1,767.00	$404.82–$3,534.00	65% below	73%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue	$64.26	$238.00	$54.53–$476.00	73% below	73%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Spect Dobutamine	$799.35	$2,960.55	$678.26–$5,921.10	76% below	73%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Spect Lexiscan	$888.30	$3,290.00	$753.74–$6,580.00	73% below	73%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Stress/Rest MYO ECT	$888.30	$3,290.00	$753.74–$6,580.00	73% below	73%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Cardiolite	$888.30	$3,290.00	$753.74–$6,580.00	73% below	73%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Spect Multi Rest/Stress.	$888.30	$3,290.00	$753.74–$6,580.00	73% below	73%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET w/ CT Scan Skull Base to Midthigh	$1,499.85	$5,555.00	$1,272.65–$11,110.00	62% below	73%
Pelvic CT scan without contrast CPT 72192 CT Pelvis Post Seed Implant	$262.09	$970.70	$222.39–$1,941.40	81% below	73%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast	$307.53	$1,139.00	$260.94–$2,278.00	78% below	73%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 ED US NonOB Pelvic Limited/FollowUp	$53.65	$198.72	$45.53–$397.44	83% below	73%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non-OB Limited	$54.81	$203.00	$46.51–$406.00	83% below	73%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 ED US NonOB Pelvic complete	$271.62	$1,006.00	$230.47–$2,012.00	58% below	73%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Complete	$279.99	$1,037.00	$237.58–$2,074.00	57% below	73%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Complete	$158.87	$588.40	$134.80–$1,176.80	69% below	73%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 ED US OB >=14wks TransAbd; Single	$163.89	$607.00	$139.06–$1,214.00	68% below	73%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB less than 14 weeks	$163.89	$607.00	$139.06–$1,214.00	60% below	73%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 ED US OB less than14wks TransAbd; Single	$163.89	$607.00	$139.06–$1,214.00	60% below	73%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB Ultrasound Preg Uterus Abdomen 1 or More Fetus	$63.45	$235.00	$53.84–$470.00	78% below	73%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 ED US OB lmtd ie,fetlhrtbeat,posit etc	$135.81	$503.00	$115.24–$1,006.00	53% below	73%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Second Trimester	$135.81	$503.00	$115.24–$1,006.00	53% below	73%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 3 Views Left	$61.29	$227.00	$52.01–$454.00	74% below	73%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 3 Views Right	$61.29	$227.00	$52.01–$454.00	74% below	73%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Right	$86.67	$321.00	$73.54–$642.00	72% below	73%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Left	$86.67	$321.00	$73.54–$642.00	72% below	73%
Screening mammogram, both breasts both sides CPT 77067 MAM Mammogram Routine Screening Bilat BCE	$67.50	$250.00	$57.28–$500.00	—	73%
Screening mammogram, both breasts both sides CPT 77067 MAM Mammogram Routine Screening Bilat	$67.50	$250.00	$57.28–$500.00	—	73%
Screening mammogram, both breasts both sides CPT 77067 MA Mammogram Screening Bilat w/ Tomo.	$67.50	$250.00	$57.28–$500.00	—	73%
Screening mammogram, both breasts one side CPT 77067 MAM Mammogram Routine Screening Right BCE	$67.50	$250.00	$57.28–$500.00	70% below	73%
Screening mammogram, both breasts one side CPT 77067 MAM Mammogram Routine Screening Left	$67.50	$250.00	$57.28–$500.00	70% below	73%
Screening mammogram, both breasts one side CPT 77067 MAM Mammogram Routine Screening Right	$67.50	$250.00	$57.28–$500.00	70% below	73%
Screening mammogram, both breasts one side CPT 77067 MA Mammogram Screening Left w/ Tomo.	$67.50	$250.00	$57.28–$500.00	70% below	73%
Screening mammogram, both breasts one side CPT 77067 MA Mammogram Screening Right w/ Tomo.	$67.50	$250.00	$57.28–$500.00	70% below	73%
Screening mammogram, both breasts one side CPT 77067 MAM Mammogram Routine Screening Left BCE	$67.50	$250.00	$57.28–$500.00	70% below	73%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder 3 Views Right	$90.99	$337.00	$77.21–$674.00	67% below	73%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder 3 Views Left	$90.99	$337.00	$77.21–$674.00	67% below	73%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Complete	$86.94	$322.00	$73.77–$644.00	73% below	73%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views	$88.61	$328.20	$75.19–$656.40	70% below	73%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull 2 Views	$90.45	$335.00	$76.75–$670.00	69% below	73%
Sleep study in a lab (polysomnography) CPT 95810 PSG < Than 6 Hours	$972.00	$3,600.00	$824.76–$7,200.00	69% below	73%
Sleep study in a lab (polysomnography) CPT 95810 PSG (Polysomnography) >3 Parameters >6 hours	$981.72	$3,636.00	$833.01–$7,272.00	69% below	73%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR BASW Modified	$125.55	$465.00	$106.53–$930.00	66% below	73%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Swallowing Function w/ Video	$125.55	$465.00	$106.53–$930.00	66% below	73%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR BASW Modified w/ Barium Egram	$125.55	$465.00	$106.53–$930.00	66% below	73%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Lt	$182.52	$676.00	$154.87–$1,352.00	13% below	73%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Rt	$182.52	$676.00	$154.87–$1,352.00	13% below	73%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast	$591.57	$2,191.00	$501.96–$4,382.00	59% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Left	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) Right	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Left	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 2nd Digit Right	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Left	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 3rd Digit Right	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Left	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 5th Digit Right	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) Left	$68.85	$255.00	$58.42–$510.00	64% below	73%
Toe X-ray, 2 or more views one side CPT 73660 XR Toes 4th Digit Right	$68.85	$255.00	$58.42–$510.00	64% below	73%
Transvaginal pelvic ultrasound CPT 76830 ED US NonOB TransVag	$189.99	$703.67	$161.21–$1,407.34	61% below	73%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$193.86	$718.00	$164.49–$1,436.00	61% below	73%
Transvaginal ultrasound during pregnancy CPT 76817 OB Ultrasound Preg Uterus Transvaginal	$63.45	$235.00	$53.84–$470.00	85% below	73%
Transvaginal ultrasound during pregnancy CPT 76817 ED US OB TransVag	$188.11	$696.70	$159.61–$1,393.40	54% below	73%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$193.86	$718.00	$164.49–$1,436.00	53% below	73%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$279.99	$1,037.00	$237.58–$2,074.00	58% below	73%
Ultrasound of the scrotum and testicles CPT 76870 ED US Scrotum and contents	$271.07	$1,003.95	$230.00–$2,007.90	47% below	73%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents)	$279.45	$1,035.00	$237.12–$2,070.00	46% below	73%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$274.34	$1,016.06	$232.78–$2,032.12	50% below	73%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 ED US Soft Tiss Head Neck	$279.99	$1,037.00	$237.58–$2,074.00	49% below	73%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Head/Neck Soft Tissue	$279.99	$1,037.00	$237.58–$2,074.00	49% below	73%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI + KUB	$686.61	$2,543.00	$582.60–$5,086.00	38% above	73%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Right	$83.70	$310.00	$71.02–$620.00	64% below	73%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus Left	$83.70	$310.00	$71.02–$620.00	64% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 ED US Focused DVT	$264.87	$981.00	$224.75–$1,962.00	53% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 US Jugular Veins	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Left	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Right	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Right	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Left	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 ED US Duplex Extrem veins unilat/limited	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Mapping Right	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Mapping Left	$294.30	$1,090.00	$249.72–$2,180.00	47% below	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Reflux LE Right	$565.65	$2,095.00	$479.96–$4,190.00	1% above	73%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Reflux LE Left	$565.65	$2,095.00	$479.96–$4,190.00	1% above	73%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist 3 Views Right	$86.94	$322.00	$73.77–$644.00	62% below	73%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist 3 Views Left	$86.94	$322.00	$73.77–$644.00	62% below	73%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2 Views Left	$79.45	$294.25	$67.41–$588.50	66% below	73%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2 Views Right	$80.24	$297.19	$68.09–$594.38	65% below	73%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Rt	$164.16	$608.00	$139.29–$1,216.00	29% below	73%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Lt	$164.16	$608.00	$139.29–$1,216.00	29% below	73%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$182.52	$676.00	$154.87–$1,352.00	21% below	73%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$182.52	$676.00	$154.87–$1,352.00	21% below	73%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen KUB	$105.03	$389.00	$89.12–$778.00	53% below	73%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 2 Views	$105.03	$389.00	$89.12–$778.00	53% below	73%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen AP	$105.03	$389.00	$89.12–$778.00	53% below	73%
X-ray of the abdomen, 1 view one side CPT 74018 XR Abdomen Decubitus Left	$105.03	$389.00	$89.12–$778.00	53% below	73%
X-ray of the abdomen, 1 view one side CPT 74018 XR Abdomen Decubitus Right	$105.03	$389.00	$89.12–$778.00	53% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 4th Digit Left	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) Right	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) Left (Thumb)	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 5th Digit Right	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 5th Digit Left	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 4th Digit Right	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 3rd Digit Right	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 3rd Digit Left	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 2nd Digit Right	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger 2nd Digit Left	$78.30	$290.00	$66.44–$580.00	58% below	73%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot 3 Views Right	$90.99	$337.00	$77.21–$674.00	66% below	73%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot 3 Views Left	$90.99	$337.00	$77.21–$674.00	66% below	73%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand 3 Views Left	$89.64	$332.00	$76.06–$664.00	66% below	73%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand 3 Views Right	$89.64	$332.00	$76.06–$664.00	66% below	73%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 2 Views Left	$82.89	$307.00	$70.33–$614.00	63% below	73%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Patella Sunrise Left	$82.89	$307.00	$70.33–$614.00	63% below	73%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 2 Views Right	$82.89	$307.00	$70.33–$614.00	63% below	73%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Patella Sunrise Right	$82.89	$307.00	$70.33–$614.00	63% below	73%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Lumbar Spine 2 Views	$110.70	$410.00	$93.93–$820.00	61% below	73%
X-ray of the lower back, 4 or more views CPT 72110 XR Lumbar Spine 5 Views	$167.13	$619.00	$141.81–$1,238.00	63% below	73%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Thoracic Spine 2 Views	$88.56	$328.00	$75.14–$656.00	68% below	73%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Minimum 3 Views	$79.11	$293.00	$67.13–$586.00	76% below	73%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Cervical Spine 2 Views	$74.25	$275.00	$63.00–$550.00	75% below	73%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$91.26	$338.00	$77.44–$676.00	60% below	73%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum	$73.83	$273.46	$62.65–$546.92	68% below	73%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Coccyx	$74.25	$275.00	$63.00–$550.00	68% below	73%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx Min 2 Views	$75.33	$279.00	$63.92–$558.00	67% below	73%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs North Carolina	Off list
ACTH blood test CPT 82024 ACTH Plasma SO	$121.50	$450.00	$31.00–$41.11	at median	73%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$34.02	$126.00	$5.63	24% below	73%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate Aminotransferase	$34.02	$126.00	$5.51–$38.00	22% below	73%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel (4) SO	$95.58	$354.00	$31.00–$49.61	70% below	73%
Albumin blood test CPT 82040 Albumin Serum	$33.02	$122.30	$5.27–$38.00	1% above	73%
Aldosterone blood test CPT 82088 ALDOSTERONE	$51.57	$191.00	$31.00–$43.37	46% below	73%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$34.02	$126.00	$5.51–$38.00	8% above	73%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Specific IGE, Each All	$12.69	$47.00	$5.55–$38.00	33% below	73%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein Tumor Marker SO	$57.78	$214.00	$17.85–$38.00	19% below	73%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha Fetoprotein	$60.20	$222.95	$17.85–$38.00	15% below	73%
Ammonia blood test CPT 82140 Ammonia Level	$82.89	$307.00	$15.51–$38.00	12% above	73%
Amylase blood test CPT 82150 Amylase-Urine 2 Hour	$39.49	$146.25	$6.90–$38.00	50% below	73%
Amylase blood test CPT 82150 Amylase Level 24 Hour Urine	$39.49	$146.25	$6.90–$38.00	50% below	73%
Amylase blood test CPT 82150 Amylase-Urine 12 Hour	$39.49	$146.25	$6.90–$38.00	50% below	73%
Amylase blood test CPT 82150 Amylase Urine	$39.49	$146.25	$6.90–$38.00	50% below	73%
Amylase blood test CPT 82150 Amylase Body Fluid	$40.77	$151.00	$6.90–$38.00	49% below	73%
Amylase blood test CPT 82150 Amylase Level	$40.77	$151.00	$6.90–$38.00	49% below	73%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide Ab IgG	$23.49	$87.00	$13.77–$38.00	69% below	73%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibody	$68.04	$252.00	$12.86–$38.00	5% above	73%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$104.22	$386.00	$31.00–$38.00	22% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Quant. Brush Culture	$29.98	$111.05	$9.17–$38.00	61% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Tip Culture	$31.86	$118.00	$9.17–$38.00	59% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Group B Strep Culture	$44.28	$164.00	$9.17–$38.00	43% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Brushings Culture	$52.92	$196.00	$9.17–$38.00	32% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Quantitative BAL/Bronch Wash Culture	$71.01	$263.00	$9.17–$38.00	9% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture - Throat	$71.01	$263.00	$9.17–$38.00	9% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bronchial Wash Culture	$71.01	$263.00	$9.17–$38.00	9% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture - Sputum	$76.68	$284.00	$9.17–$38.00	1% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culuture - Sputum..	$76.68	$284.00	$9.17–$38.00	1% below	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Ear Culture	$82.35	$305.00	$9.17–$38.00	6% above	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Eye Culture	$82.35	$305.00	$9.17–$38.00	6% above	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture - Genital.	$82.35	$305.00	$9.17–$38.00	6% above	73%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Nasal Culture	$82.35	$305.00	$9.17–$38.00	6% above	73%
Basic metabolic panel (blood test) CPT 80048 Metabolic Profile	$70.40	$260.75	$8.53–$38.00	54% below	73%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$90.18	$334.00	$8.53–$38.00	41% below	73%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$33.75	$125.00	$5.34–$38.00	31% below	73%
Bilirubin blood test, total CPT 82247 Bilirubin-Neonatal	$33.75	$125.00	$5.34–$38.00	31% below	73%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$82.62	$306.00	$70.10–$612.00	54% below	73%
Blood culture for bacteria CPT 87040 Cord Blood Culture	$75.11	$278.20	$10.99–$38.00	50% below	73%
Blood culture for bacteria CPT 87040 Culture - Blood	$83.70	$310.00	$10.99–$38.00	44% below	73%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ER - Veni Draw	$6.64	$24.60	$2.34	21% below	73%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$8.53	$31.60	$2.34–$38.00	2% above	73%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS BLOOD - FOR SPEC	$8.53	$31.60	$2.34–$38.00	2% above	73%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Collection of venous blood by venipuncture	$8.91	$33.00	$2.34–$38.00	7% above	73%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ICS Venous Blood Venipuncture	$8.91	$33.00	$2.34–$38.00	7% above	73%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$8.91	$33.00	$2.34–$38.00	7% above	73%
Blood glucose (sugar) test CPT 82947 Glucose I-STAT	$4.20	$15.55	$4.18–$38.00	89% below	73%
Blood glucose (sugar) test CPT 82947 Glucose; quantitative, blood (except reagent strip	$33.02	$122.30	$4.18–$38.00	14% below	73%
Blood glucose (sugar) test CPT 82947 Glucose, Fasting Charge	$33.02	$122.30	$4.18–$38.00	14% below	73%
Blood glucose (sugar) test CPT 82947 Glucose Fasting	$34.02	$126.00	$4.18–$38.00	11% below	73%
Blood lead test CPT 83655 Lead Level	$34.83	$129.00	$12.89–$38.00	4% below	73%
Blood lead test CPT 83655 Lead-Urine	$37.10	$137.41	$12.89–$38.00	2% above	73%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Human Choranic Gonadotropin Qualitative Urine	$39.42	$146.00	$8.00–$38.00	69% below	73%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Qual	$50.76	$188.00	$8.00–$38.00	60% below	73%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord Blood Typing - ABO	$15.66	$58.00	$3.17	68% below	73%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO Blood Type	$18.09	$67.00	$3.17–$38.00	64% below	73%
Blood urea nitrogen (BUN) test CPT 84520 BUN-Peripheral	$33.03	$122.35	$4.20–$38.00	27% below	73%
Blood urea nitrogen (BUN) test CPT 84520 Bun-Arterial	$33.03	$122.35	$4.20–$38.00	27% below	73%
Blood urea nitrogen (BUN) test CPT 84520 BUN Venous	$33.03	$122.35	$4.20–$38.00	27% below	73%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$34.29	$127.00	$4.20–$38.00	24% below	73%
C-peptide blood test CPT 84681 C-Peptide SO	$104.49	$387.00	$16.92–$38.00	34% above	73%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$116.37	$431.00	$5.51–$38.00	83% above	73%
C. difficile toxin gene test (stool PCR) CPT 87493 C.Difficile/EPI by PCR	$89.64	$332.00	$26.10–$38.00	36% below	73%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen 19-9	$108.81	$403.00	$22.14–$38.00	12% above	73%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen 125	$72.90	$270.00	$22.14–$38.00	15% below	73%
Calcium blood test, total CPT 82310 Calcium Level	$34.02	$126.00	$5.49–$38.00	20% below	73%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen	$85.86	$318.00	$20.19–$38.00	47% below	73%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster IgG	$84.51	$313.00	$13.71–$38.00	61% above	73%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia Trachomatis RNA	$43.47	$161.00	$26.10	61% below	73%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$63.99	$237.00	$14.25–$38.00	31% below	73%
Complete blood count (CBC) with differential CPT 85025 CBC-Pediatric	$24.45	$90.55	$8.28–$38.00	76% below	73%
Complete blood count (CBC) with differential CPT 85025 CBC w/Auto Diff	$67.50	$250.00	$8.28–$38.00	34% below	73%
Complete blood count (CBC), no differential CPT 85027 Complete Blood Count without Diff	$67.50	$250.00	$6.89–$38.00	2% above	73%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$112.59	$417.00	$8.99–$38.00	30% below	73%
Comprehensive metabolic panel (blood test) CPT 80053 Chem-12 Neonatal	$112.59	$417.00	$8.99–$38.00	30% below	73%
Cortisol blood test, total CPT 82533 Cortrosyn Stimulation	$52.38	$194.00	$17.35–$38.00	43% below	73%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$37.26	$138.00	$6.93–$38.00	49% below	73%
Creatine kinase (CK) blood test, total CPT 82550 Cardiac Studies Total	$40.77	$151.00	$6.93–$38.00	44% below	73%
Creatinine blood test CPT 82565 Creatinine - iSTAT	$9.72	$36.00	$5.45–$38.00	82% below	73%
Creatinine blood test CPT 82565 Creatinine	$36.72	$136.00	$5.45–$38.00	31% below	73%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus (CMV) Ab IgG	$28.08	$104.00	$15.29–$38.00	56% below	73%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV Red Cross Testing	$37.22	$137.85	$15.29–$38.00	42% below	73%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$88.29	$327.00	$9.80–$38.00	39% below	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Blood	$46.17	$171.00	$39.18–$342.00	4% below	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Medical Drug Screen	$48.33	$178.99	$41.01–$357.98	1% above	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen, Qualitative, Multiple Drug Class, High Compl TO	$52.33	$193.80	$44.40–$387.60	9% above	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Meconium Drug Screen	$71.17	$263.61	$60.39–$527.22	48% above	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Umbilical Cord Drug Detection Panel	$72.63	$269.00	$61.63–$538.00	51% above	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Acetaminophen Level	$96.39	$357.00	$81.79–$714.00	101% above	73%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Salicylate Level	$96.39	$357.00	$81.79–$714.00	101% above	73%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$61.29	$227.00	$7.34–$38.00	29% below	73%
Estradiol blood test CPT 82670 Estradiol Level	$116.91	$433.00	$25.34–$38.00	16% below	73%
FSH (follicle-stimulating hormone) test CPT 83001 FSH Serum	$53.46	$198.00	$19.77–$38.00	44% below	73%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Fecal	$111.51	$413.00	$20.89–$52.00	37% below	73%
Ferritin blood test (iron stores) CPT 82728 Ferritin Serum	$50.49	$187.00	$14.50–$38.00	43% below	73%
Folate (folic acid) blood test CPT 82746 Folates (Folic Acid) Serum	$69.39	$257.00	$15.65–$38.00	24% below	73%
Free T3 thyroid hormone test CPT 84481 T3 Free	$131.76	$488.00	$18.03–$38.00	55% above	73%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine Free	$65.61	$243.00	$9.59–$38.00	9% below	73%
Free testosterone test CPT 84402 Testosterone Free	$19.98	$74.00	$27.10–$38.00	72% below	73%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$61.29	$227.00	$7.66–$38.00	11% above	73%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose Tolerance 2 Hour - Blood Only	$50.22	$186.00	$5.05–$38.00	35% above	73%
Glucose tolerance test, 3 samples CPT 82951 Glucose - 1HR-Blood Only	$45.09	$167.00	$13.70–$38.00	57% below	73%
Glucose tolerance test, 3 samples CPT 82951 Glucose 3 Hour	$48.06	$178.00	$13.70–$38.00	54% below	73%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance - 3HR	$77.92	$288.60	$13.70–$38.00	26% below	73%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance Test	$108.89	$403.30	$13.70–$38.00	4% above	73%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Gonorrhoeae, amplified proble technique	$43.47	$161.00	$26.10–$38.00	61% below	73%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Chlamydia/GC Amplification LC	$43.47	$161.00	$26.10	61% below	73%
H. pylori stool antigen test CPT 87338 Helicobacter pylori Antigen, Fecal by EIA	$19.44	$72.00	$15.30–$38.00	83% below	73%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV Quantitative (PCR)	$89.10	$330.00	$31.00–$56.58	62% below	73%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2	$43.23	$160.10	$12.52–$38.00	23% below	73%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1,2 Combo Ag/Ab	$36.18	$134.00	$25.21–$38.00	57% below	73%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c (Diabetes Center)	$14.13	$52.35	$10.33	81% below	73%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Diabetes - A1C	$14.13	$52.35	$10.33	81% below	73%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C	$44.55	$165.00	$10.33–$38.00	41% below	73%
Hemoglobin blood test CPT 85018 Hemoglobin	$13.23	$49.00	$2.52–$38.00	52% below	73%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Antibody Total	$52.38	$194.00	$12.39–$38.00	41% below	73%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag	$35.10	$130.00	$9.91–$38.00	59% below	73%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab	$63.99	$237.00	$15.19–$38.00	49% below	73%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C RNA, Quant	$158.76	$588.00	$31.00–$38.00	8% below	73%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity	$103.68	$384.00	$13.77–$38.00	32% above	73%
Homocysteine blood test CPT 83090 Homocysteine Total	$108.81	$403.00	$17.95–$38.00	6% above	73%
Insulin blood test CPT 83525 Insulin Total	$36.99	$137.00	$12.16–$38.00	36% below	73%
Iron blood test (serum iron) CPT 83540 Iron Level	$31.59	$117.00	$6.89–$38.00	52% below	73%
Iron blood test (serum iron) CPT 83540 Iron IBC	$31.59	$117.00	$6.89–$38.00	52% below	73%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity Total	$31.59	$117.00	$9.31–$38.00	49% below	73%
Kidney function blood test panel CPT 80069 Renal Function Panel	$98.01	$363.00	$8.53–$38.00	14% below	73%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$58.86	$218.00	$19.70–$38.00	39% below	73%
Lactate (lactic acid) blood test CPT 83605 Lactate	$69.39	$257.00	$11.36–$38.00	21% below	73%
Lactate dehydrogenase (LDH) blood test CPT 83615 Body Fluid LDH Charge	$33.02	$122.30	$6.42–$38.00	26% below	73%
Lactate dehydrogenase (LDH) blood test CPT 83615 Body Fluid-LDH	$34.02	$126.00	$6.42–$38.00	24% below	73%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$34.02	$126.00	$6.42–$38.00	24% below	73%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$52.38	$194.00	$7.33–$38.00	52% below	73%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$58.32	$216.00	$8.53–$38.00	63% below	73%
Lyme disease antibody test CPT 86618 Lyme Disease Antibody	$71.82	$266.00	$15.44–$38.00	17% below	73%
Magnesium blood test CPT 83735 Magnesium Level	$85.59	$317.00	$7.13–$38.00	75% above	73%
Measles (rubeola) antibody test CPT 86765 Rubeola Ab, IgG	$78.57	$291.00	$13.71–$38.00	48% above	73%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$32.40	$120.00	$5.51–$38.00	66% below	73%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA Free	$69.93	$259.00	$19.57–$38.00	at median	73%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total	$63.18	$234.00	$19.57–$38.00	38% below	73%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone Intra-Op	$79.96	$296.15	$31.00–$43.92	43% below	73%
Parathyroid hormone (PTH) blood test CPT 83970 PTH C-Terminal	$121.50	$450.00	$31.00–$43.92	13% below	73%
Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Time	$36.72	$136.00	$6.39–$38.00	37% below	73%
Partial thromboplastin time (PTT) clotting test CPT 85730 Thrombin Time, Partial	$39.15	$145.00	$6.39–$38.00	33% below	73%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT Mixing Study	$65.07	$241.00	$6.39–$38.00	11% above	73%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$34.02	$126.00	$5.04–$38.00	32% below	73%
Potassium blood test CPT 84132 Potassium I-STAT	$5.40	$20.00	$4.89–$38.00	86% below	73%
Potassium blood test CPT 84132 Potassium Level	$34.02	$126.00	$4.89–$38.00	13% below	73%
Progesterone blood test CPT 84144 Progesterone Level	$53.46	$198.00	$22.20–$38.00	44% below	73%
Prolactin blood test CPT 84146 Prolactin Level	$68.58	$254.00	$20.62–$38.00	47% below	73%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time	$21.87	$81.00	$4.19–$38.00	52% below	73%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Charge Only	$21.87	$81.00	$4.19–$38.00	52% below	73%
Rapid flu test (influenza antigen) CPT 87804 Influenza Screen	$42.58	$157.70	$12.18–$38.00	5% below	73%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Group A Strep Rapid Test	$44.01	$163.00	$12.18–$38.00	24% below	73%
Renin blood test CPT 84244 Renin	$34.56	$128.00	$23.41–$38.00	35% below	73%
Rh blood typing CPT 86901 Cord Blood Typing - RH	$19.17	$71.00	$3.17–$38.00	64% below	73%
Rh blood typing CPT 86901 RH (D) Blood Bank	$19.17	$71.00	$3.17	64% below	73%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgG	$24.30	$90.00	$15.29–$38.00	48% below	73%
Sodium blood test CPT 84295 Sodium I-STAT	$5.40	$20.00	$5.12–$38.00	87% below	73%
Sodium blood test CPT 84295 Sodium Level	$34.02	$126.00	$5.12–$38.00	20% below	73%
Stool ova and parasites exam CPT 87177 Ova and Parasites	$56.70	$210.00	$9.47–$38.00	28% above	73%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis, T. pallidum Antibodies, Qualitative	$5.40	$20.00	$14.09–$38.00	91% below	73%
Syphilis antibody test (Treponema pallidum) CPT 86780 TREPONEMAL ANTIBODIES, TPPA	$22.60	$83.72	$14.09–$38.00	61% below	73%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Test	$27.81	$103.00	$4.54–$38.00	53% below	73%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON-TB Gold Plus, 1 Tube	$92.72	$343.40	$31.00–$65.96	21% below	73%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QuantiFERON TB Gold	$94.77	$351.00	$31.00–$65.96	19% below	73%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Serum	$81.54	$302.00	$27.47–$38.00	9% below	73%
Thyroid peroxidase (TPO) antibody test CPT 86376 Creatinine1	$30.02	$111.20	$14.75–$38.00	42% below	73%
Thyroid peroxidase (TPO) antibody test CPT 86376 Anti-Microsomal AB (Thyroid Peroxidase)	$87.21	$323.00	$14.75–$38.00	68% above	73%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$77.76	$288.00	$17.34–$38.00	5% below	73%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone Charge Only	$77.76	$288.00	$17.34–$38.00	5% below	73%
Total IgE blood test CPT 82785 Immunoglobulin E Total	$49.14	$182.00	$17.53–$38.00	29% below	73%
Total cholesterol blood test CPT 82465 Cholesterol Total	$12.46	$46.16	$4.63–$38.00	59% below	73%
Total thyroxine (T4) blood test CPT 84436 Thyroxine	$68.88	$255.10	$6.14–$38.00	14% below	73%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine	$53.46	$198.00	$15.09–$38.00	20% below	73%
Transferrin blood test CPT 84466 Transferrin	$43.74	$162.00	$13.59–$38.00	46% below	73%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis PCR Urine	$19.44	$72.00	$26.10–$38.00	68% below	73%
Triglycerides blood test CPT 84478 Triglycerides	$34.02	$126.00	$6.12	30% below	73%
Troponin test, quantitative CPT 84484 Troponin I	$127.44	$472.00	$10.47–$38.00	16% above	73%
Uric acid blood test CPT 84550 Uric Acid	$34.02	$126.00	$4.80–$38.00	43% below	73%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Complete	$45.09	$167.00	$3.37–$38.00	7% above	73%
Urinalysis without microscope exam, automated CPT 81003 Urine Protein by Dipstick	$7.12	$26.36	$2.39–$38.00	85% below	73%
Urinalysis without microscope exam, automated CPT 81003 pH Urine	$12.42	$46.00	$2.39–$38.00	74% below	73%
Urinalysis without microscope exam, manual CPT 81002 Acetone Urine	$12.42	$46.00	$2.72–$38.00	56% below	73%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Urine	$48.60	$180.00	$6.15–$38.00	5% above	73%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$69.39	$257.00	$16.04–$38.00	20% below	73%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25 Hydroxy	$44.82	$166.00	$31.00–$38.00	65% below	73%
Zinc blood test CPT 84630 Zinc Level	$19.98	$74.00	$12.11–$38.00	52% below	73%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta HCG	$67.23	$249.00	$9.31–$38.00	56% below	73%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs North Carolina	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion both sides CPT 19081 MA Core Biopsy Breast Bilat	$614.71	$2,276.70	$521.59–$4,553.40	—	73%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Core Biopsy Breast Left	$614.71	$2,276.70	$521.59–$4,553.40	80% below	73%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Core Biopsy Breast Right	$614.71	$2,276.70	$521.59–$4,553.40	80% below	73%
Cardiac catheterization with coronary angiogram one side CPT 93458 Left Heart Cath including injections for Coronary Angiogram +/-	$4,455.00	$16,500.00	$3,780.15–$33,000.00	60% below	73%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CCL Cardioversion	$565.65	$2,095.00	$479.96–$4,190.00	45% below	73%
Cardioversion, elective (restoring heart rhythm) CPT 92960 ER - Cardioversion	$565.65	$2,095.00	$479.96–$4,190.00	45% below	73%
Coronary stent placement, one artery CPT 92928 PRQ NON-DE COR STENT(S)/PTCA 1 MJ ART/BRCH	$6,885.00	$25,500.00	$5,842.05–$51,000.00	39% below	73%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVAL OF CERUMEN IMPACTION ED Charge	$60.75	$225.00	$51.55–$450.00	43% below	73%
Earwax removal with instruments, one ear CPT 69210 CERUMEN REMOVAL 1 OR 2 EARS	$58.28	$215.85	$49.45–$431.70	63% below	73%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 IMH Epidural Inj.Cerv/Thor Sp	$624.29	$2,312.17	$529.72–$4,624.34	59% below	73%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 XR Inj Facet Joint Bil	$797.38	$2,953.26	$676.59–$5,906.52	39% below	73%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 CT Inj Facet Joint Bil	$805.35	$2,982.79	$683.36–$5,965.58	39% below	73%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 XR Inj Facet Joint Lt	$797.38	$2,953.26	$676.59–$5,906.52	39% below	73%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 XR Inj Facet Joint Rt	$797.38	$2,953.26	$676.59–$5,906.52	39% below	73%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 CT Inj Facet Joint Lt	$805.35	$2,982.79	$683.36–$5,965.58	39% below	73%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 CT Inj Facet Joint Rt	$805.35	$2,982.79	$683.36–$5,965.58	39% below	73%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 IMH Hystero-Salpingio Inj.	$62.10	$230.00	$52.69–$460.00	72% below	73%
Incision and drainage of a simple or single skin abscess CPT 10060 ID ABSCESS SINGLE/SIMPLE	$189.54	$702.00	$160.83–$1,404.00	51% below	73%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 IMH Inj/Asp Joint Rt	$111.17	$411.73	$94.33–$823.46	73% below	73%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 IMH Inj/Asp Joint Lt	$111.17	$411.73	$94.33–$823.46	73% below	73%
Left heart catheterization, diagnostic one side CPT 93452 Left Heart Cath including injection(s) for LVgram when performed	$1,291.41	$4,783.00	$1,095.79–$9,566.00	89% below	73%
Lower-back epidural injection, with imaging guidance CPT 62323 IMH Epidural Inj.Lumbar Sp	$504.56	$1,868.75	$428.13–$3,737.50	59% below	73%
Lower-back epidural injection, with imaging guidance CPT 62323 XR Epidural Steroid Injection	$520.02	$1,926.00	$441.25–$3,852.00	58% below	73%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR Inj Nerve Root Bil	$797.38	$2,953.26	$676.59–$5,906.52	51% below	73%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 CT Inj Nerve Root Bil	$805.35	$2,982.79	$683.36–$5,965.58	51% below	73%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 XR Inj Nerve Root Lt	$797.38	$2,953.26	$676.59–$5,906.52	51% below	73%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 XR Inj Nerve Root Rt	$797.38	$2,953.26	$676.59–$5,906.52	51% below	73%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 CT Inj Nerve Root Rt	$821.61	$3,043.00	$697.15–$6,086.00	50% below	73%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 CT Inj Nerve Root Lt	$821.61	$3,043.00	$697.15–$6,086.00	50% below	73%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 ExcisB9 lesn,trunk/arms/legs 0 to .5 cm	$616.14	$2,282.00	$522.81–$4,564.00	36% above	73%
Nail removal (partial or complete), one nail CPT 11730 AVULSION OF NAIL PLATE ONE	$189.54	$702.00	$160.83–$1,404.00	7% below	73%
Pacemaker implant (dual chamber) CPT 33208 Insert or Replace Permanent Pacemaker with TV Leads-Atrial and V	$4,949.64	$18,332.00	$4,199.86–$36,664.00	35% below	73%
Paracentesis with imaging guidance CPT 49083 CT Paracentesis w/ Imaging Guidance	$212.90	$788.50	$180.65–$1,577.00	83% below	73%
Paracentesis with imaging guidance CPT 49083 US Guided Paracentesis	$236.79	$877.00	$200.92–$1,754.00	82% below	73%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCIS OF NAIL PARTIAL OR COMPLETE	$327.44	$1,212.75	$277.84–$2,425.50	44% below	73%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Repair superficial wound(s)	$216.00	$800.00	$183.28–$1,600.00	42% below	73%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE-DIAGNOSTIC	$624.29	$2,312.17	$529.72–$4,624.34	26% below	73%
Thoracentesis with imaging guidance CPT 32555 US Guided Thorocentesis	$120.96	$448.00	$102.64–$896.00	88% below	73%
Ultrasound-guided breast needle biopsy with marker clip, first lesion both sides CPT 19083 US Biopsy Breast Bilateral	$832.91	$3,084.85	$706.74–$6,169.70	—	73%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Biopsy Breast Left	$636.39	$2,357.00	$539.99–$4,714.00	67% below	73%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Biopsy Breast Right	$636.39	$2,357.00	$539.99–$4,714.00	67% below	73%
Vein ablation, radiofrequency, first vein CPT 36475 Endovenous Radiofrequency Ablation 1st Vein	$2,454.30	$9,090.00	$2,082.52–$18,180.00	30% below	73%
Vein ablation, radiofrequency, first vein CPT 36475 Under Endovscular Abl Thrpy Incomp Extrem Veins	$2,454.30	$9,090.00	$2,082.52–$18,180.00	30% below	73%
Wart removal, up to 14 warts CPT 17110 Destruct B9 Lesion(s) no sk tags 1-14	$144.04	$533.48	$122.22–$1,066.96	8% below	73%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SQ 1ST 20 SQ CM	$420.12	$1,556.00	$356.48–$3,112.00	1% above	73%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs North Carolina	Off list
Blood transfusion (giving blood or blood components) CPT 36430 ER - Transfusion	$173.61	$643.00	$147.31–$1,286.00	76% below	73%
Blood transfusion (giving blood or blood components) CPT 36430 ICS Blood Transfusion	$270.00	$1,000.00	$229.10–$2,000.00	63% below	73%
Blood transfusion (giving blood or blood components) CPT 36430 Whole Blood Transfusion	$275.40	$1,020.00	$233.68–$2,040.00	63% below	73%
Blood transfusion (giving blood or blood components) CPT 36430 ICS Blood Transfusion BCE	$275.40	$1,020.00	$233.68–$2,040.00	63% below	73%
Blood transfusion (giving blood or blood components) CPT 36430 Dialysis - Blood Transfusion	$334.26	$1,238.00	$283.63–$2,476.00	55% below	73%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment Manual	$18.74	$69.39	$15.90–$138.78	79% below	73%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Meter Dose Inhaler (MDI) Subsequent	$19.17	$71.00	$16.27–$142.00	79% below	73%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment	$19.17	$71.00	$16.27–$142.00	79% below	73%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPV Subsequent	$292.41	$1,083.00	$248.12–$2,166.00	226% above	73%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 IPV Initial	$503.55	$1,865.00	$427.27–$3,730.00	461% above	73%
Chemotherapy IV infusion, first hour CPT 96413 ICS Chemo IV > 15-90 minutes	$95.04	$352.00	$80.64–$704.00	86% below	73%
Critical care, first 30 to 74 minutes CPT 99291 Lynx Visit Level-99291 - Critical Care	$810.00	$3,000.00	$687.30–$6,000.00	66% below	73%
Critical care, first 30 to 74 minutes CPT 99291 ER - Critical Care 1st 1.25 hr	$945.00	$3,500.00	$801.85–$7,000.00	60% below	73%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG Wake, Drowsy, HV, PS	$347.76	$1,288.00	$295.08–$2,576.00	58% below	73%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG - CCL	$47.79	$177.00	$40.55–$354.00	74% below	73%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG - OP Surgery Area	$90.18	$334.00	$76.52–$668.00	52% below	73%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$90.18	$334.00	$76.52–$668.00	52% below	73%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram	$90.18	$334.00	$76.52–$668.00	52% below	73%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ED ECG 12 lead	$90.18	$334.00	$76.52–$668.00	52% below	73%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Pre-OP Clearance	$90.18	$334.00	$76.52–$668.00	52% below	73%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Lynx Visit Level-99281 - Level 1	$94.50	$350.00	$83.74–$500.00	47% below	73%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ER - Base - Level 1	$94.50	$350.00	$83.74–$500.00	47% below	73%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Lynx Visit Level-99282 - Level 2	$229.50	$850.00	$150.62–$618.00	33% below	73%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ER - Base - Level 2	$229.50	$850.00	$150.62–$618.00	33% below	73%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ER - Base - Level 3	$432.00	$1,600.00	$263.35–$1,323.00	51% below	73%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Lynx Visit Level-99283 - Level 3	$432.00	$1,600.00	$263.35–$1,323.00	51% below	73%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ER - Base - Level 4	$607.50	$2,250.00	$405.00–$2,266.00	51% below	73%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Lynx Visit Level-99284 - Level 4	$607.50	$2,250.00	$405.00–$2,266.00	51% below	73%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ER - Base - Level 5	$810.00	$3,000.00	$583.12–$2,678.00	52% below	73%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Lynx Visit Level-99285 - Level 5	$810.00	$3,000.00	$583.12–$2,678.00	52% below	73%
Exercise stress test, tracing only, the hospital charge CPT 93017 EKG Stress Exercise	$245.43	$909.00	$208.25–$1,818.00	76% below	73%
Exercise stress test, tracing only, the hospital charge CPT 93017 Electrocardiogram Stress Exercise	$250.56	$928.00	$212.60–$1,856.00	76% below	73%
Exercise stress test, tracing only, the hospital charge CPT 93017 EKG Stress Exercise - IRDL	$250.56	$928.00	$212.60–$1,856.00	76% below	73%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardio Stress Test Tracings Only Add-On	$333.99	$1,237.00	$283.40–$2,474.00	67% below	73%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardio Stress Test Tracings Only	$333.99	$1,237.00	$283.40–$2,474.00	67% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATE INIT >31-60 MIN	$68.85	$255.00	$58.42–$510.00	77% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ICS IV Fluids, initial 31-90 mins	$68.85	$255.00	$58.42–$510.00	77% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ENDO - IV Hydration Initial 30-90 minutes	$92.88	$344.00	$78.81–$688.00	68% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 OB IV Hydration Initial 31-90 minutes	$97.47	$361.00	$82.71–$722.00	67% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CCL - IV HYDRATE INIT > 15-90 MINUTES	$119.06	$440.95	$101.02–$881.90	59% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ER - IV Hydrate Initial > 15-90 minutes	$137.70	$510.00	$116.84–$1,020.00	53% below	73%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IMH XR IV Hydrate initial>31-60mins	$166.11	$615.24	$140.95–$1,230.48	43% below	73%
IV infusion of a medicine, first hour CPT 96365 ENDO - IV Infusion Initial 16-90 minutes	$92.88	$344.00	$78.81–$688.00	62% below	73%
IV infusion of a medicine, first hour CPT 96365 CCL - IV NON-CHEMO INIT > 15-90 MINUTES	$119.06	$440.95	$101.02–$881.90	51% below	73%
IV infusion of a medicine, first hour CPT 96365 OB IV Infusion Initial 16-90 minutes	$150.12	$556.00	$127.38–$1,112.00	38% below	73%
IV infusion of a medicine, first hour CPT 96365 ICS IV Non-Chemo >15-90 Mins Initial	$150.12	$556.00	$127.38–$1,112.00	38% below	73%
IV infusion of a medicine, first hour CPT 96365 ICS IV Non-Chemo >15-90m 96365-59	$150.12	$556.00	$127.38–$1,112.00	38% below	73%
IV infusion of a medicine, first hour CPT 96365 ER - IV Infusion Initial > 15-90 minutes	$150.12	$556.00	$127.38–$1,112.00	38% below	73%
IV infusion of a medicine, first hour CPT 96365 IV NON-CHEMO INIT > 15-90 MINS	$150.12	$556.00	$127.38–$1,112.00	38% below	73%
IV infusion of a medicine, first hour CPT 96365 IMH XR initial IV infusion>16-90mins	$167.78	$621.39	$142.36–$1,242.78	31% below	73%
IV push of a medicine, first drug CPT 96374 ENDO - Slow IV Push Initial Single Drug	$41.58	$154.00	$35.28–$308.00	79% below	73%
IV push of a medicine, first drug CPT 96374 CCL SLOW IV PUSH - SINGLE DRUG	$53.81	$199.30	$45.66–$398.60	73% below	73%
IV push of a medicine, first drug CPT 96374 ICS Slow IV Push Single Drug 96374-59	$75.06	$278.00	$63.69–$556.00	62% below	73%
IV push of a medicine, first drug CPT 96374 ICS Slow IV Push Single Drug	$75.06	$278.00	$63.69–$556.00	62% below	73%
IV push of a medicine, first drug CPT 96374 OB Slow IV Push Initial Single Drug	$75.06	$278.00	$63.69–$556.00	62% below	73%
IV push of a medicine, first drug CPT 96374 ER - Slow IV Push Initial	$75.06	$278.00	$63.69–$556.00	62% below	73%
IV push of a medicine, first drug CPT 96374 SIVP-SINGLE DRUG	$75.06	$278.00	$63.69–$556.00	62% below	73%
IV push of a medicine, first drug CPT 96374 IMH XR IV/SIVP Push Initial Drug	$166.11	$615.24	$140.95–$1,230.48	15% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ENDO - Inject SQ/IM Each	$26.78	$99.20	$22.73–$198.40	71% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ICS Subcutaneous/IM Each 96372-59	$48.30	$178.90	$40.99–$357.80	47% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CCL - Injection, SQ/IM Each	$48.79	$180.69	$41.40–$361.38	47% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IMH XR Injection IM/SQ ea	$50.58	$187.32	$42.92–$374.64	45% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Rhogam Mini Dose (fee for injection)	$53.89	$199.58	$45.72–$399.16	41% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION SQ/IM	$62.29	$230.71	$52.86–$461.42	32% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECT SQ/IM	$82.62	$306.00	$70.10–$612.00	10% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ER - Inj SQ/IM Each	$82.62	$306.00	$70.10–$612.00	10% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OB Injection SQ/IM each	$82.62	$306.00	$70.10–$612.00	10% below	73%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 ICS Injection Subcutaneous/IM Each	$82.62	$306.00	$70.10–$612.00	10% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Charges	$54.00	$200.00	$103.00–$284.00	41% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Assistant Units	$54.00	$200.00	$103.00–$284.00	41% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation Rehab Units	$54.00	$200.00	$103.00–$284.00	41% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Units	$59.40	$220.00	$103.00–$284.00	35% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$59.40	$220.00	$103.00–$284.00	35% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 PT Neuromuscular Reeducation Assistant Units	$59.40	$220.00	$103.00–$284.00	35% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 OT Neuromuscular Reeducation	$59.40	$220.00	$103.00–$284.00	35% below	73%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation	$59.40	$220.00	$103.00–$284.00	35% below	73%
New patient office visit, about 30 minutes CPT 99203 ICS - New Patient Visit - 30 minutes	$50.74	$187.91	$43.05–$375.82	73% below	73%
New patient office visit, about 30 minutes CPT 99203 New Consult Level 3	$80.44	$297.92	$68.25–$595.84	57% below	73%
New patient office visit, about 30 minutes CPT 99203 IWC LEVEL 3-NEW	$124.47	$461.00	$105.62–$922.00	34% below	73%
New patient office visit, about 45 minutes CPT 99204 ICS - New Patient Visit - 40 minutes	$54.10	$200.38	$45.91–$400.76	78% below	73%
New patient office visit, about 45 minutes CPT 99204 New Consult Level 4	$140.67	$521.00	$119.36–$1,042.00	42% below	73%
New patient office visit, about 45 minutes CPT 99204 IWC LEVEL 4-NEW	$164.97	$611.00	$139.98–$1,222.00	32% below	73%
New patient office visit, about 60 minutes CPT 99205 New Consult Level 5	$178.16	$659.84	$151.17–$1,319.68	40% below	73%
New patient office visit, about 60 minutes CPT 99205 IWC LEVEL 5-NEW	$225.45	$835.00	$191.30–$1,670.00	24% below	73%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 ICS - New Patient Visit - 20 minutes	$50.74	$187.91	$43.05–$375.82	65% below	73%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New Consult Level 2	$54.11	$200.42	$45.92–$400.84	62% below	73%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 IWC LEVEL 2-NEW	$94.50	$350.00	$80.19–$700.00	34% below	73%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Individual MNT New Each 15 minutes	$7.56	$28.00	$6.41–$56.00	83% below	73%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Diabetes - Adult Weight Management/Individual MNT New each 15 mi	$7.56	$28.00	$6.41–$56.00	83% below	73%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Diabetes - Ped Weight Management/Individual MNT New each 15 minu	$7.56	$28.00	$6.41–$56.00	83% below	73%
Occupational therapy evaluation, low complexity CPT 97165 Occupational Therapy Evaluation Charge Low Complexity (97165	$47.25	$175.00	$103.00–$284.00	74% below	73%
Occupational therapy evaluation, low complexity CPT 97165 OT Evaluation Low Complexity Units	$59.40	$220.00	$103.00–$284.00	67% below	73%
Occupational therapy evaluation, low complexity CPT 97165 OT Evaluation Low Complexity	$59.40	$220.00	$103.00–$284.00	67% below	73%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Physical Therapy Evaluation Charge High Complexity (97163)	$47.25	$175.00	$103.00–$284.00	84% below	73%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Evaluation High Complexity	$54.00	$200.00	$103.00–$284.00	82% below	73%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT Evaluation High Complexity Units	$54.00	$200.00	$103.00–$284.00	82% below	73%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 OT Re Evaluation CHARGE	$22.96	$85.05	$103.00–$284.00	89% below	73%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Physical Therapy Evaluation Charge Low Complexity (97161)	$45.36	$168.00	$103.00–$284.00	78% below	73%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Evaluation Low Complexity	$59.40	$220.00	$103.00–$284.00	71% below	73%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Evaluation Low Complexity Units	$59.40	$220.00	$103.00–$284.00	71% below	73%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 OT Reevaluation Charge	$65.88	$244.00	$103.00–$284.00	67% below	73%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 OT Re-Evaluation	$68.04	$252.00	$103.00–$284.00	66% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 OT Re-Evaluation Units	$22.96	$85.05	$103.00–$284.00	90% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Re-evaluation for OT	$22.96	$85.05	$103.00–$284.00	90% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 OT Reevaluation Charge	$22.96	$85.05	$103.00–$284.00	90% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Physical Therapy Evaluation Charge Medium Complexity (97162)	$45.36	$168.00	$103.00–$284.00	81% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Re-evaluation for PT	$47.25	$175.00	$103.00–$284.00	80% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 OT Evaluation Charge	$47.25	$175.00	$103.00–$284.00	80% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Evaluation Charge Medicaid	$54.00	$200.00	$103.00–$284.00	77% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Units	$54.00	$200.00	$103.00–$284.00	77% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Charge	$55.08	$204.00	$103.00–$284.00	77% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Moderate Complexity	$59.40	$220.00	$103.00–$284.00	75% below	73%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Evaluation Moderate Complexity Units	$59.40	$220.00	$103.00–$284.00	75% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Assistant Units	$47.25	$175.00	$103.00–$284.00	61% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Training	$47.25	$175.00	$103.00–$284.00	61% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Joint Mobilization Charges	$54.00	$200.00	$103.00–$284.00	56% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Units	$54.00	$200.00	$103.00–$284.00	56% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Traction Charge	$54.00	$200.00	$103.00–$284.00	56% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy Charge Units	$54.00	$200.00	$103.00–$284.00	56% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Myofacial Release Charges	$54.00	$200.00	$103.00–$284.00	56% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Myofacial Release Charges	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Units	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT Manual Therapy	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Units	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Joint Mobilization Charges	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Soft Tissue Mobilization Charges	$59.40	$220.00	$103.00–$284.00	51% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE CHARGE ST	$28.28	$104.75	$103.00–$284.00	70% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 ST Therapeutic Exercise	$28.28	$104.75	$103.00–$284.00	70% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges ST	$28.28	$104.75	$103.00–$284.00	70% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Assistant Units	$54.00	$200.00	$103.00–$284.00	42% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise	$59.40	$220.00	$103.00–$284.00	37% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$59.40	$220.00	$103.00–$284.00	37% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise	$59.40	$220.00	$103.00–$284.00	37% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Units	$59.40	$220.00	$103.00–$284.00	37% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Charges	$59.40	$220.00	$103.00–$284.00	37% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT Therapeutic Exercise Rehab Units	$59.40	$220.00	$103.00–$284.00	37% below	73%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Units	$59.40	$220.00	$103.00–$284.00	37% below	73%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco Cess Individual Counsel 3 - 10 minutes	$12.34	$45.70	$10.47–$91.40	44% below	73%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Diabetes - Tobacco Cess Individual 3-10 minutes	$12.34	$45.70	$10.47–$91.40	44% below	73%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 WC-TOBACCO CESS INDIVIDUAL 3-10m	$12.46	$46.16	$10.58–$92.32	43% below	73%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Established Consult Level 5	$117.71	$435.96	$99.88–$871.92	56% below	73%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Established Followup Level 5	$117.71	$435.96	$99.88–$871.92	56% below	73%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 IWC LEVEL 5-ESTABLISHED	$164.97	$611.00	$139.98–$1,222.00	39% below	73%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Established Followup Level 3	$34.06	$126.16	$28.90–$252.32	82% below	73%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ICS - Established Patient Visit - 30 minutes	$51.84	$192.00	$43.99–$384.00	73% below	73%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Established Consult Level 3	$55.89	$207.00	$47.42–$414.00	71% below	73%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ENDO Level 3	$70.20	$260.00	$59.57–$520.00	63% below	73%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OB Level 3 - Fetal Monitor 13-24 Hours or Accept Transfer	$73.98	$274.00	$62.77–$548.00	61% below	73%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 IWC LEVEL 3-ESTABLISHED	$94.50	$350.00	$80.19–$700.00	50% below	73%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established Followup Level 4	$52.30	$193.72	$44.38–$387.44	76% below	73%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established Consult Level 4	$53.46	$198.00	$45.36–$396.00	75% below	73%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ICS - Established Patient Visit - 40 minutes	$54.10	$200.38	$45.91–$400.76	75% below	73%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ENDO Level 4	$90.45	$335.00	$76.75–$670.00	58% below	73%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OB-Level 4 - Fetal Monitor > 24 Hours or Transfer	$92.61	$343.00	$78.58–$686.00	57% below	73%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 IWC LEVEL 4-ESTABLISHED	$124.47	$461.00	$105.62–$922.00	42% below	73%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established Consult Level 2	$32.67	$121.00	$27.72–$242.00	85% below	73%
Speech and language evaluation CPT 92523 Speech-Language/Cognition Evaluation	$47.25	$175.00	$103.00–$284.00	87% below	73%
Speech and language evaluation CPT 92523 Speech Thearpy Language/Cognition Evaluation	$47.25	$175.00	$103.00–$284.00	87% below	73%
Speech and language evaluation CPT 92523 SLP Sound Prod w/ Lang Comp Eval Units	$50.76	$188.00	$103.00–$284.00	86% below	73%
Speech and language evaluation CPT 92523 Speech Sound Prod w/ Langugae Charge	$50.76	$188.00	$103.00–$284.00	86% below	73%
Speech therapy session, individual CPT 92507 Speech Language Cognition Treatment	$47.25	$175.00	$103.00–$284.00	73% below	73%
Speech therapy session, individual CPT 92507 Mod/Train Voice Prosthesis Charge	$95.32	$353.05	$103.00–$284.00	46% below	73%
Speech therapy session, individual CPT 92507 Auditory Processing Tx	$127.10	$470.75	$103.00–$284.00	28% below	73%
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid	$141.48	$524.00	$103.00–$284.00	20% below	73%
Speech therapy session, individual CPT 92507 SLP Auditory Processing Tx Time	$141.48	$524.00	$103.00–$284.00	20% below	73%
Speech therapy session, individual CPT 92507 Mod/Train Voice Prosthesis	$141.48	$524.00	$103.00–$284.00	20% below	73%
Speech therapy session, individual CPT 92507 Speech/Language/Voice/Auditory Charge	$141.48	$524.00	$103.00–$284.00	20% below	73%
Spirometry (breathing test) CPT 94010 RT Vital Capacity, Total Charge	$51.57	$191.00	$43.76–$382.00	78% below	73%
Spirometry (breathing test) CPT 94010 FVC Charge	$52.11	$193.00	$44.22–$386.00	78% below	73%
Spirometry (breathing test) CPT 94010 Incentive Spirometry Initial	$54.00	$200.00	$45.82–$400.00	77% below	73%
Spirometry before and after a bronchodilator CPT 94060 Pre Post Spiro FVC, MVV Charge	$107.38	$397.70	$91.11–$795.40	79% below	73%
Spirometry before and after a bronchodilator CPT 94060 RT Pre Post Spiro Charge	$108.45	$401.68	$92.02–$803.36	79% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Assistant Units	$54.00	$200.00	$103.00–$284.00	47% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Functional Activities Charges	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Assistant Units	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT Therapeutic Activity Units	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Functional Activities	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charge	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activity	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Rehab Units	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT Therapeutic Activities Charges	$59.40	$220.00	$103.00–$284.00	41% below	73%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Therapeutic Phlebotomy	$32.13	$119.00	$27.26–$238.00	85% below	73%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 ICS - Phlebotomy Therapy	$32.40	$120.00	$27.49–$240.00	85% below	73%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 ICS - Phlebotomy Therapy BCE	$32.40	$120.00	$27.49–$240.00	85% below	73%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs North Carolina	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza virus vaccine 0.5 mL inact (Fluad) PFS TIV [IMH]	$30.98	$114.75	$26.29–$229.50	95% below	73%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza virus vaccine 0.5 mL inact (Fluad) PFS TIV [IMH]	$30.98	$114.75	$26.29–$229.50	95% below	73%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 influenza virus vaccine 0.5 mL inact (Fluad) PFS TIV [IMH]	$30.98	$114.75	$26.29–$229.50	—	73%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARS-CoV-2 (COVID-19) Vaccine PF 30 mcg/0.3 mL [IMH]	$117.58	$435.47	$99.77–$870.94	76% below	73%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARS-CoV-2 (COVID-19) Vaccine PF 30 mcg/0.3 mL [IMH]	$117.58	$435.47	$99.77–$870.94	76% below	73%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARS-CoV-2 (COVID-19) Vaccine PF 30 mcg/0.3 mL [IMH]	$117.58	$435.47	$99.77–$870.94	—	73%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine SubQ 0.5ml Pwd-Inj [IMH]	$144.70	$535.91	$122.78–$1,071.82	52% below	73%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 varicella virus vaccine SubQ 0.5ml Pwd-Inj [IMH]	$144.70	$535.91	$122.78–$1,071.82	52% below	73%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 varicella virus vaccine SubQ 0.5ml Pwd-Inj [IMH]	$144.70	$535.91	$122.78–$1,071.82	—	73%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine 0.5 mL inactivated PF quad (Fluarix) Susp Inj[IMH]	$7.97	$29.52	$6.76–$59.04	83% below	73%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine 0.5 mL inactivated PF quad (Fluarix) Susp Inj[IMH]	$7.97	$29.52	$6.76–$59.04	83% below	73%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine 0.5 mL inactivated PF quad (Fluarix) Susp Inj[IMH]	$7.97	$29.52	$6.76–$59.04	—	73%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus vaccine 9-valent (HPV) 0.5 mL Inj [IMH]	$129.56	$479.85	$109.93–$959.70	66% below	73%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 human papillomavirus vaccine 9-valent (HPV) 0.5 mL Inj [IMH]	$129.56	$479.85	$109.93–$959.70	66% below	73%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 human papillomavirus vaccine 9-valent (HPV) 0.5 mL Inj [IMH]	$129.56	$479.85	$109.93–$959.70	—	73%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A adult vaccine 1440 units/mL PF Susp [IMH	$69.48	$257.32	$58.95–$514.64	46% below	73%
Hepatitis A vaccine, adult dose CPT 90632 hepatitis A adult vaccine 1440 units/mL PF Susp [IMH	$69.48	$257.32	$58.95–$514.64	46% below	73%
Hepatitis A vaccine, adult dose inpatient CPT 90632 hepatitis A adult vaccine 1440 units/mL PF Susp [IMH	$69.48	$257.32	$58.95–$514.64	—	73%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine (Engerix-B) 20 mcg/mL Susp [IMH]	$44.22	$163.78	$37.52–$327.56	61% below	73%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine (Engerix-B) 20 mcg/mL Susp [IMH]	$44.22	$163.78	$37.52–$327.56	61% below	73%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B vaccine ped 10 mcg/0.5mL IM [IMH]	$44.48	$164.74	$37.74–$329.48	61% below	73%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B vaccine ped 10 mcg/0.5mL IM [IMH]	$44.48	$164.74	$37.74–$329.48	61% below	73%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine (Engerix-B) 20 mcg/mL Susp [IMH]	$44.22	$163.78	$37.52–$327.56	—	73%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B vaccine ped 10 mcg/0.5mL IM [IMH]	$44.48	$164.74	$37.74–$329.48	—	73%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine (PedVaxHIB) 0.5 mL Susp Inj [IMH]	$16.41	$60.77	$13.92–$121.54	69% below	73%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine (PedVaxHIB) 0.5 mL Susp Inj [IMH]	$16.41	$60.77	$13.92–$121.54	69% below	73%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 haemophilus b conjugate (PRP-OMP) vaccine (PedVaxHIB) 0.5 mL Susp Inj [IMH]	$16.41	$60.77	$13.92–$121.54	—	73%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus b conj (PRP-T) vaccine IM 0.5mL [IMH]	$32.54	$120.51	$27.61–$241.02	26% below	73%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 haemophilus b conj (PRP-T) vaccine IM 0.5mL [IMH]	$32.54	$120.51	$27.61–$241.02	26% below	73%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 haemophilus b conj (PRP-T) vaccine IM 0.5mL [IMH]	$32.54	$120.51	$27.61–$241.02	—	73%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 measles/mumps/rubella/varicella virus vaccine (ProQuad) 0.5 mL Pwd-Inj [IMH]	$144.66	$535.78	$122.75–$1,071.56	61% below	73%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 measles/mumps/rubella/varicella virus vaccine (ProQuad) 0.5 mL Pwd-Inj [IMH]	$144.66	$535.78	$122.75–$1,071.56	61% below	73%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 measles/mumps/rubella/varicella virus vaccine (ProQuad) 0.5 mL Pwd-Inj [IMH]	$144.66	$535.78	$122.75–$1,071.56	—	73%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conj vacc group ACYW Sol [IMH]	$58.46	$216.50	$49.60–$433.00	73% below	73%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conj vacc group ACYW Sol [IMH]	$58.46	$216.50	$49.60–$433.00	73% below	73%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conjugate vaccine 0.5 mL [IMH]	$113.60	$420.74	$96.39–$841.48	47% below	73%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 meningococcal conjugate vaccine 0.5 mL [IMH]	$113.60	$420.74	$96.39–$841.48	47% below	73%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conj vacc group ACYW Sol [IMH]	$58.46	$216.50	$49.60–$433.00	—	73%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 meningococcal conjugate vaccine 0.5 mL [IMH]	$113.60	$420.74	$96.39–$841.48	—	73%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 meningococcal conj vac polys tetanus toxoid grp ACYW 0.5mL Sol [IMH]	$40.64	$150.52	$34.48–$301.04	81% below	73%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 meningococcal conj vac polys tetanus toxoid grp ACYW 0.5mL Sol [IMH]	$40.64	$150.52	$34.48–$301.04	81% below	73%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 meningococcal conj vac polys tetanus toxoid grp ACYW 0.5mL Sol [IMH]	$40.64	$150.52	$34.48–$301.04	—	73%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal grp B vac recom OMV adju 0.5 mL Susp (Bexsero) [IMH]	$101.89	$377.37	$86.46–$754.74	65% below	73%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 meningococcal grp B vac recom OMV adju 0.5 mL Susp (Bexsero) [IMH]	$101.89	$377.37	$86.46–$754.74	65% below	73%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 meningococcal grp B vac recom OMV adju 0.5 mL Susp (Bexsero) [IMH]	$101.89	$377.37	$86.46–$754.74	—	73%
Meningococcal B vaccine (Trumenba) CPT 90621 meningococcal grp B vaccine recombinant Sus 0.5 mL [IMH]	$142.21	$526.71	$120.67–$1,053.42	58% below	73%
Meningococcal B vaccine (Trumenba) CPT 90621 meningococcal grp B vaccine recombinant Sus 0.5 mL [IMH]	$142.21	$526.71	$120.67–$1,053.42	58% below	73%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 meningococcal grp B vaccine recombinant Sus 0.5 mL [IMH]	$142.21	$526.71	$120.67–$1,053.42	—	73%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5 mL [IMH]	$219.14	$811.64	$185.95–$1,623.28	67% below	73%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5 mL [IMH]	$219.14	$811.64	$185.95–$1,623.28	67% below	73%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5 mL [IMH]	$219.14	$811.64	$185.95–$1,623.28	—	73%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 pneumococcal 21-valent conjugate vaccine 0.5 mL [IMH]	$163.51	$605.60	$138.74–$1,211.20	77% below	73%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 pneumococcal 21-valent conjugate vaccine 0.5 mL [IMH]	$163.51	$605.60	$138.74–$1,211.20	77% below	73%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 pneumococcal 21-valent conjugate vaccine 0.5 mL [IMH]	$163.51	$605.60	$138.74–$1,211.20	—	73%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Nirsevimab (cvx 307) alip PF 100 mg/mL Susp Inj [IMH]	$213.30	$790.00	$180.99–$1,580.00	82% below	73%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Nirsevimab (cvx 307) alip PF 100 mg/mL Susp Inj [IMH]	$213.30	$790.00	$180.99–$1,580.00	82% below	73%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 Nirsevimab (cvx 307) alip PF 100 mg/mL Susp Inj [IMH]	$213.30	$790.00	$180.99–$1,580.00	—	73%
Rabies vaccine, one dose CPT 90675 rabies vaccine 2.5 intl units IM PI [IMH]	$279.87	$1,036.54	$237.47–$2,073.08	61% below	73%
Rabies vaccine, one dose CPT 90675 rabies vaccine 2.5 intl units IM PI [IMH]	$279.87	$1,036.54	$237.47–$2,073.08	61% below	73%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine 2.5 intl units IM PI [IMH]	$279.87	$1,036.54	$237.47–$2,073.08	—	73%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 rotavirus vaccine monovalent (Rotarix) 1.5 mL Susp [IMH]	$44.13	$163.46	$37.45–$326.92	78% below	73%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 rotavirus vaccine monovalent (Rotarix) 1.5 mL Susp [IMH]	$44.13	$163.46	$37.45–$326.92	78% below	73%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 rotavirus vaccine monovalent (Rotarix) 1.5 mL Susp [IMH]	$44.13	$163.46	$37.45–$326.92	—	73%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 zoster vaccine inactivated IM 50 mcg/0.5 mL Pwd-Inj [IMH]	$104.25	$386.12	$88.46–$772.24	63% below	73%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 zoster vaccine inactivated IM 50 mcg/0.5 mL Pwd-Inj [IMH]	$104.25	$386.12	$88.46–$772.24	63% below	73%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 zoster vaccine inactivated IM 50 mcg/0.5 mL Pwd-Inj [IMH]	$104.25	$386.12	$88.46–$772.24	—	73%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertussis (Tdap) 0.5mL Inj CB[IMH]	$13.50	$50.00	$11.46–$100.00	85% below	73%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertussis (Tdap) 0.5mL Inj CB[IMH]	$13.50	$50.00	$11.46–$100.00	85% below	73%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertussis (Tdap) 0.5mL Inj CB[IMH]	$13.50	$50.00	$11.46–$100.00	—	73%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMINISTRATION OF MENACTRA VACCINE	$8.64	$32.00	$7.33–$64.00	88% below	73%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ICS Immunization Administration	$15.39	$57.00	$13.06–$114.00	78% below	73%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN OF Tdap VACCINE	$26.72	$98.98	$22.68–$197.96	62% below	73%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 BP - Tdap ADMINISTRATION; 1 VACC	$27.27	$101.00	$23.14–$202.00	61% below	73%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ER - Immunization Admin Each Additional	$4.05	$15.00	$3.44–$30.00	93% below	73%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZ ADMIN; EA ADDL VACCINE	$14.85	$55.00	$12.60–$110.00	74% below	73%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 BP - Tdap ADMINISTRATION; EA ADDL VACC	$26.46	$98.00	$22.45–$196.00	54% below	73%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN OF Tdap VACCINE	$26.46	$98.00	$22.45–$196.00	54% below	73%

Source file: https://iredell.pt.panaceainc.com/MRFDownload/iredell/iredell