Hospital

Cibola General Hospital

Cibola General Hospital in Grants, NM publishes cash prices for 326 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the New Mexico median for 201 of 318 procedures and above it for 108. By typical cash price it ranks #4 of 20 New Mexico hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1016 ROOSEVELT AVE, GRANTS, NM 87020 Collected Sep 27, 2026 Source price file (505) 287-5300

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 321308 · CMS hospital register NPI 1780677039

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 3 actions for a hospital named Cibola General Hospital in Grants, NM:

Sep 18, 2025 Warning notice
Dec 22, 2025 Corrective action plan requested
Mar 23, 2026 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Corrective action plan requested: CMS asked the hospital to submit a plan to fix the problems it found. Case closed: CMS closed the case after the hospital addressed the problems.

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs New Mexico	Off list
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE 3+ VIEWS LEFT - REPORT	$179.63	$224.54	$27.17–$202.09	21% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE 3+ VIEWS RIGHT - REPORT	$179.63	$224.54	$27.17–$202.09	21% below	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE 3+ VIEWS RIGHT	$398.82	$498.52	$27.17–$448.67	74% above	20%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR ANKLE COMPLETE 3+ VIEWS LEFT	$398.82	$498.52	$27.17–$448.67	74% above	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI - REPORT	$285.93	$357.41	$67.93–$321.67	29% below	20%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 US ABI	$536.42	$670.53	$67.93–$603.48	33% above	20%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS - REPORT	$274.39	$342.99	$65.66–$308.69	44% below	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST COMPLETE BILAT - REPORT	$956.66	$1,195.83	$65.34–$1,076.25	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST MALE COMPLETE BILATERAL - REPORT	$956.66	$1,195.83	$65.34–$1,076.25	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST MALE COMPLETE BILATERAL	$1,184.09	$1,480.11	$65.34–$1,332.10	—	20%
Breast ultrasound, complete, one breast both sides CPT 76641 US BREAST COMPLETE BILAT	$1,184.09	$1,480.11	$65.34–$1,332.10	—	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE LEFT - REPORT	$477.92	$597.40	$65.34–$1,076.25	at median	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RIGHT - REPORT	$477.92	$597.40	$65.34–$1,076.25	at median	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST MALE COMPLETE LEFT - REPORT	$477.92	$597.40	$65.34–$1,076.25	at median	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST MALE COMPLETE RIGHT - REPORT	$477.92	$597.40	$65.34–$1,076.25	at median	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST MALE COMPLETE LEFT	$591.63	$739.54	$65.34–$1,332.10	24% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE RIGHT	$591.63	$739.54	$65.34–$1,332.10	24% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST MALE COMPLETE RIGHT	$591.63	$739.54	$65.34–$1,332.10	24% above	20%
Breast ultrasound, complete, one breast one side CPT 76641 US BREAST COMPLETE LEFT	$591.63	$739.54	$65.34–$1,332.10	24% above	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST LIMITED BILAT	$891.57	$1,114.46	$50.78–$1,003.01	—	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST LIMITED BILAT - REPORT	$891.57	$1,114.46	$50.78–$1,003.01	—	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST MALE LIMITED BILATERAL	$891.57	$1,114.46	$50.78–$1,003.01	—	20%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US BREAST MALE LIMITED BILATERAL - REPORT	$891.57	$1,114.46	$50.78–$1,003.01	—	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LEFT - REPORT	$442.49	$553.11	$50.78–$1,003.01	66% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST MALE LIMITED RIGHT - REPORT	$442.49	$553.11	$50.78–$1,003.01	66% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST MALE LIMITED LEFT - REPORT	$442.49	$553.11	$50.78–$1,003.01	66% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RIGHT - REPORT	$442.49	$553.11	$50.78–$1,003.01	66% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST MALE LIMITED LEFT	$445.78	$557.23	$50.78–$1,003.01	68% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED LEFT	$445.78	$557.23	$50.78–$1,003.01	68% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST LIMITED RIGHT	$445.78	$557.23	$50.78–$1,003.01	68% above	20%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST MALE LIMITED RIGHT	$445.78	$557.23	$50.78–$1,003.01	68% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST - REPORT	$1,025.06	$1,281.32	$408.56–$1,153.19	34% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W PRO	$1,025.06	$1,281.32	$408.56–$1,153.19	34% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO PE CHEST - REPORT	$1,025.06	$1,281.32	$408.56–$1,153.19	34% below	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO PE CHEST	$3,501.18	$4,376.47	$408.56–$3,938.82	124% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST	$3,501.18	$4,376.47	$408.56–$3,938.82	124% above	20%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 70066 CTA CHEST W	$3,501.18	$4,376.47	$408.56–$3,938.82	124% above	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART CALCIUM SCORING	$234.84	$293.55	$35.20–$264.20	16% above	20%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART CALCIUM SCORING - REPORT	$269.45	$336.81	$35.20–$303.13	33% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT RENAL STONE STUDY - REPORT	$1,008.58	$1,260.72	$227.65–$1,134.65	57% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN AND PELVIS W/O CONTRAST - REPORT	$1,008.58	$1,260.72	$227.65–$1,134.65	57% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELV WO PRO	$1,008.58	$1,260.72	$227.65–$1,134.65	57% below	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT RENAL STONE STUDY	$4,129.89	$5,162.36	$227.65–$4,646.12	77% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELV WO	$4,129.89	$5,162.36	$227.65–$4,646.12	77% above	20%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN AND PELVIS W/O CONTRAST	$4,129.89	$5,162.36	$227.65–$4,646.12	77% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN AND PELVIS W/ CONTRAST PRO	$1,161.02	$1,451.27	$352.09–$1,306.14	58% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN AND PELVIS W/ CONTRAST - REPORT	$1,161.02	$1,451.27	$352.09–$1,306.14	58% below	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD PELV W	$3,979.92	$4,974.90	$352.09–$4,477.41	44% above	20%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN AND PELVIS W/ CONTRAST	$3,979.92	$4,974.90	$352.09–$4,477.41	44% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN AND PELVIS W/ + W/O CONTRAST - REPORT	$1,424.70	$1,780.87	$392.53–$1,602.78	60% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELV WO AND W PRO	$1,424.70	$1,780.87	$392.53–$1,602.78	60% below	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELV WO AND W	$5,000.86	$6,251.07	$392.53–$5,625.96	41% above	20%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN AND PELVIS W/ + W/O CONTRAST	$5,000.86	$6,251.07	$392.53–$5,625.96	41% above	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST - REPORT	$676.50	$845.63	$356.44–$761.07	65% below	20%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/ CONTRAST	$2,935.09	$3,668.86	$356.44–$3,301.97	53% above	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST - REPORT	$638.60	$798.25	$200.55–$718.43	59% below	20%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$2,055.88	$2,569.85	$200.55–$2,312.87	33% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONTRAST - REPORT	$603.99	$754.99	$217.53–$679.49	52% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST - REPORT	$603.99	$754.99	$217.53–$679.49	52% below	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS W/O CONTRAST	$1,759.24	$2,199.05	$217.53–$1,979.15	41% above	20%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,759.24	$2,199.05	$217.53–$1,979.15	41% above	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST - REPORT	$600.70	$750.87	$165.78–$675.78	59% below	20%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$1,799.62	$2,249.52	$165.78–$2,024.57	22% above	20%
CT scan of the head with contrast CPT 70460 CT HEAD W/ CONTRAST - REPORT	$600.70	$750.87	$236.95–$675.78	64% below	20%
CT scan of the head with contrast CPT 70460 CT HEAD W/ CONTRAST	$2,740.62	$3,425.78	$236.95–$3,083.20	63% above	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/ + W/O CONTRAST - REPORT	$674.03	$842.54	$282.23–$758.29	64% below	20%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/ + W/O CONTRAST	$2,631.03	$3,288.79	$282.23–$2,959.91	40% above	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR W/O CONTRAST - REPORT	$617.18	$771.47	$205.40–$694.32	60% below	20%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE LUMBAR W/O CONTRAST	$2,163.82	$2,704.78	$205.40–$2,434.30	42% above	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CONTRAST - REPORT	$617.18	$771.47	$207.03–$694.32	65% below	20%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE CERVICAL W/O CONTRAST	$2,216.56	$2,770.70	$207.03–$2,493.63	24% above	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST - REPORT	$617.18	$771.47	$342.22–$694.32	67% below	20%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/ CONTRAST	$2,770.29	$3,462.86	$356.44–$3,116.57	48% above	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DUPLEX BILATERAL - REPORT	$435.07	$543.84	$145.56–$489.46	—	20%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US CAROTID DUPLEX BILATERAL	$1,211.28	$1,514.10	$145.56–$1,362.69	—	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS - REPORT	$179.63	$224.54	$22.64–$202.09	23% below	20%
Chest X-ray, 2 views CPT 71046 XR CHEST 2 VIEWS	$350.20	$437.75	$22.64–$393.98	50% above	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW - REPORT	$179.63	$224.54	$16.82–$202.09	9% below	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW PORTABLE - REPORT	$179.63	$224.54	$16.82–$202.09	9% below	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW	$299.94	$374.92	$16.82–$337.43	53% above	20%
Chest X-ray, single view CPT 71045 XR CHEST 1 VIEW PORTABLE	$299.94	$374.92	$16.82–$337.43	53% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE - REPORT	$524.06	$655.08	$70.84–$589.57	2% above	20%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL COMPLETE	$829.77	$1,037.21	$70.84–$933.49	61% above	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD BONE DENSITY DEXA AXIAL SKELETON - REPORT	$215.06	$268.83	$29.11–$241.95	14% below	20%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD BONE DENSITY DEXA AXIAL SKELETON	$455.67	$569.59	$29.11–$512.63	81% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB DETAILED COMPLETE FIRST GEST	$824.00	$1,030.00	$85.72–$927.00	80% above	20%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US OB DETAILED COMPLETE FIRST GEST - REPORT	$1,044.01	$1,305.01	$85.72–$1,174.51	128% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO PRO	$619.65	$774.56	$204.60–$697.10	59% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HIGH RESOLUTION - REPORT	$619.65	$774.56	$204.60–$697.10	59% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST - REPORT	$619.65	$774.56	$204.60–$697.10	59% below	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO	$1,815.27	$2,269.09	$204.60–$3,059.10	20% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST HIGH RESOLUTION	$2,719.20	$3,399.00	$204.60–$3,059.10	80% above	20%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST W/O CONTRAST	$2,719.20	$3,399.00	$204.60–$3,059.10	80% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST PRO	$663.32	$829.15	$278.18–$746.24	61% below	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST - REPORT	$663.32	$829.15	$278.18–$746.24	61% below	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W/ CONTRAST	$2,421.74	$3,027.17	$278.18–$2,724.45	43% above	20%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W	$2,421.74	$3,027.17	$278.18–$2,724.45	43% above	20%
Diagnostic mammogram, both breasts both sides CPT 77066 TOMO DIAG BILAT	$99.70	$124.63	$55.29–$557.13	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO IMPLANT DIAG BILATERAL W/ TOMO	$99.70	$124.63	$55.29–$190.31	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 TOMO DIAG BILAT PRO	$269.45	$336.81	$108.36–$581.23	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO DIGITAL DIAGNOSTIC BILAT	$495.22	$619.03	$55.29–$557.13	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO POST CLIP BILATERAL	$495.22	$619.03	$55.29–$557.13	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO DIAGNOSTIC BILATERAL W/ TOMO	$495.22	$619.03	$55.29–$557.13	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG IMPLANT DIAGNOSTIC BILATERAL W/ TOMO	$495.22	$619.03	$55.29–$557.13	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO DIGITAL DIAGNOSTIC BILAT - REPORT	$516.65	$645.81	$108.36–$581.23	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO DIAGNOSTIC BILATERAL W/ TOMO - REPORT	$516.65	$645.81	$108.36–$581.23	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO IMPLANT DIAG BILATERAL W/ TOMO - REPORT	$516.65	$645.81	$108.36–$581.23	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG IMPLANT DIAGNOSTIC BILATERAL W/ TOMO - REPORT	$516.65	$645.81	$108.36–$581.23	—	20%
Diagnostic mammogram, both breasts both sides CPT 77066 MG MAMMO POST CLIP BILATERAL - REPORT	$516.65	$645.81	$108.36–$581.23	—	20%
Diagnostic mammogram, both breasts CPT 77066 TOMO IMPLANT DIAG	$99.70	$124.63	$55.29–$557.13	62% below	20%
Diagnostic mammogram, both breasts CPT 77066 TOMO IMPLANT DIAG PRO	$269.45	$336.81	$108.36–$581.23	2% above	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO RT UNI IMP DIAG	$45.32	$56.65	$25.13–$449.60	76% below	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO LT UNI IMP DIAG	$45.32	$56.65	$25.13–$449.60	76% below	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO RT UNI DIAG	$47.79	$59.74	$25.13–$449.60	74% below	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO LT UNI DIAG	$47.79	$59.74	$25.13–$449.60	74% below	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO RT UNI IMP DIAG PRO	$269.45	$336.81	$85.07–$464.43	46% above	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO LT UNI IMP DIAG PRO	$269.45	$336.81	$85.07–$464.43	46% above	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO LT UNI DIAG PRO	$269.45	$336.81	$85.07–$464.43	46% above	20%
Diagnostic mammogram, one breast one side CPT 77065 TOMO RT UNI DIAG PRO	$269.45	$336.81	$85.07–$464.43	46% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIGITAL DIAG RIGHT	$399.64	$499.55	$85.07–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIGITAL DIAG LEFT	$399.64	$499.55	$85.07–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIAGNOSTIC RIGHT W/ TOMO	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIGITAL DIAGNOSTIC LEFT	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIAG RIGHT W/ TOMO	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIGITAL DIAGNOSTIC RIGHT	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIAGNOSTIC LEFT W/ TOMO	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIAG LEFT W/ TOMO	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO POST CLIP PLACEMENT RIGHT	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO POST CLIP PLACEMENT LEFT	$399.64	$499.55	$25.13–$449.60	116% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIAGNOSTIC RIGHT W/ TOMO - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIGITAL DIAGNOSTIC LEFT - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO POST CLIP PLACEMENT RIGHT - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO POST CLIP PLACEMENT LEFT - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIAG RIGHT W/ TOMO - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIAG LEFT W/ TOMO - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIGITAL DIAG RIGHT - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO IMPLANT DIGITAL DIAG LEFT - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIAGNOSTIC LEFT W/ TOMO - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Diagnostic mammogram, one breast one side CPT 77065 MG MAMMO DIGITAL DIAGNOSTIC RIGHT - REPORT	$412.82	$516.03	$85.07–$464.43	123% above	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LOWER EXT ARTERIAL DUPLEX BILATERAL - REPORT	$423.54	$529.42	$186.08–$476.48	—	20%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US LOWER EXT ARTERIAL DUPLEX BILATERAL	$1,233.53	$1,541.91	$186.08–$1,387.72	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LOWER EXT VENOUS DUPLEX BILATERAL - REPORT	$496.87	$621.09	$147.82–$558.98	—	20%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LOWER EXT VENOUS DUPLEX BILATERAL	$1,329.11	$1,661.39	$147.82–$1,495.25	—	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE W/ COLOR - REPORT	$576.80	$721.00	$319.84–$721.00	50% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE W/ CONTRAST - REPORT	$576.80	$721.00	$319.84–$721.00	50% below	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE W/ COLOR	$2,260.23	$2,825.29	$541.16–$2,651.22	97% above	20%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US ECHOCARDIOGRAM COMPLETE W/ CONTRAST	$2,356.64	$2,945.80	$541.16–$2,651.22	106% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS RIGHT - REPORT	$179.63	$224.54	$30.73–$202.09	23% below	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS LEFT - REPORT	$179.63	$224.54	$30.73–$202.09	23% below	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS RIGHT	$420.24	$525.30	$30.73–$472.77	80% above	20%
Knee X-ray, 3 views one side CPT 73562 XR KNEE 3 VIEWS LEFT	$420.24	$525.30	$30.73–$472.77	80% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SOFT TISSUE ABD/PEL - REPORT	$423.54	$529.42	$57.25–$476.48	7% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMEN LIMITED - REPORT	$423.54	$529.42	$57.25–$476.48	7% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 76705 US ABDOMEN/LOWER BACK LIMITED	$763.85	$954.81	$57.25–$859.33	93% above	20%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US SOFT TISSUE ABD/PEL	$763.85	$954.81	$57.25–$859.33	93% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CANCER SCREENING - REPORT	$617.18	$771.47	$97.08–$694.32	45% above	20%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG CANCER SCREENING	$2,366.53	$2,958.16	$97.08–$2,662.34	457% above	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/ + W/O CONT BILAT DYNAMIC - REPORT	$994.57	$1,243.21	$551.49–$1,118.89	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/ + W/O CONTRAST BILATERAL - REPORT	$994.57	$1,243.21	$551.49–$1,118.89	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/ + W/O CONTRAST BILATERAL	$3,676.69	$4,595.86	$578.20–$4,136.27	—	20%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST W/ + W/O CONT BILAT DYNAMIC	$3,676.69	$4,595.86	$578.20–$4,136.27	—	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI FOOT W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI FOOT W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.10–$810.20	51% below	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI FOOT W/O CONTRAST LEFT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST RIGHT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI ANKLE W/O CONTRAST LEFT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST RIGHT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI HIP W/O CONTRAST LEFT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST RIGHT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI KNEE W/O CONTRAST LEFT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI FOOT W/O CONTRAST RIGHT	$2,903.78	$3,629.72	$346.10–$3,266.75	97% above	20%
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 - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI FOOT W/ + W/O CONTRAST LEFT - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
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 - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
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 - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
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 - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI FOOT W/ + W/O CONTRAST RIGHT - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
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 - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
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 - REPORT	$1,147.01	$1,433.76	$636.02–$1,290.38	51% below	20%
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	$3,731.90	$4,664.87	$642.50–$4,241.95	58% above	20%
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	$3,731.90	$4,664.87	$642.50–$4,241.95	58% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI FOOT W/ + W/O CONTRAST RIGHT	$3,770.62	$4,713.28	$642.50–$4,241.95	60% above	20%
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	$3,770.62	$4,713.28	$642.50–$4,241.95	60% above	20%
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	$3,770.62	$4,713.28	$642.50–$4,241.95	60% above	20%
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	$3,770.62	$4,713.28	$642.50–$4,241.95	60% above	20%
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	$3,770.62	$4,713.28	$642.50–$4,241.95	60% above	20%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI FOOT W/ + W/O CONTRAST LEFT	$3,770.62	$4,713.28	$642.50–$4,241.95	60% above	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST - REPORT	$774.56	$968.20	$315.38–$871.38	57% below	20%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$2,754.63	$3,443.29	$315.38–$3,098.96	52% above	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ + W/O CONTRAST - REPORT	$1,198.92	$1,498.65	$579.80–$1,348.79	55% below	20%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ + W/O CONTRAST	$3,835.72	$4,794.65	$579.80–$4,315.19	45% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI IAC W/O CONTRAST - REPORT	$791.04	$988.80	$315.38–$889.92	57% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST - REPORT	$791.04	$988.80	$315.38–$889.92	57% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN AND IAC W/O CONTRAST - REPORT	$791.04	$988.80	$315.38–$889.92	57% below	20%
MRI of the brain, no contrast dye CPT 70551 MRI IAC W/O CONTRAST	$2,900.48	$3,625.60	$315.38–$3,263.04	59% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN AND IAC W/O CONTRAST	$2,900.48	$3,625.60	$315.38–$3,263.04	59% above	20%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$2,900.48	$3,625.60	$315.38–$3,263.04	59% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST - REPORT	$1,261.54	$1,576.93	$523.20–$1,419.24	52% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN AND IAC W/ + W/O CONTRAST - REPORT	$1,261.54	$1,576.93	$523.20–$1,419.24	52% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI IAC W/ + W/O CONTRAST - REPORT	$1,261.54	$1,576.93	$523.20–$1,419.24	52% below	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI IAC W/ + W/O CONTRAST	$3,995.58	$4,994.47	$523.20–$4,495.02	52% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN AND IAC W/ + W/O CONTRAST	$3,995.58	$4,994.47	$523.20–$4,495.02	52% above	20%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/ + W/O CONTRAST	$3,995.58	$4,994.47	$523.20–$4,495.02	52% above	20%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST - REPORT	$684.74	$855.93	$301.63–$770.34	64% below	20%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINE LUMBAR W/O CONTRAST	$2,834.56	$3,543.20	$301.63–$3,188.88	49% above	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR W/ + W/O CONTRAST - REPORT	$1,040.71	$1,300.89	$523.20–$1,170.80	62% below	20%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINE LUMBAR W/ + W/O CONTRAST	$4,031.01	$5,038.76	$523.20–$4,534.88	46% above	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORACIC W/O CONTRAST - REPORT	$856.14	$1,070.17	$300.83–$963.15	54% below	20%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINE THORACIC W/O CONTRAST	$2,822.20	$3,527.75	$300.83–$3,174.98	50% above	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERVICAL W/ + W/O CONTRAST - REPORT	$1,370.31	$1,712.89	$524.83–$1,541.60	49% below	20%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINE CERVICAL W/ + W/O CONTRAST	$4,012.06	$5,015.07	$524.83–$4,513.56	48% above	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICAL W/O CONTRAST - REPORT	$856.14	$1,070.17	$300.03–$963.15	55% below	20%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINE CERVICAL W/O CONTRAST	$2,839.50	$3,549.38	$300.03–$3,194.44	51% above	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ + W/O CONTRAST - REPORT	$1,040.71	$1,300.89	$576.58–$1,170.80	58% below	20%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/ + W/O CONTRAST	$3,850.55	$4,813.19	$576.58–$4,331.87	55% above	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST - REPORT	$780.33	$975.41	$394.63–$877.87	56% below	20%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$2,638.45	$3,298.06	$394.63–$2,968.25	50% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JOINT W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JOINT W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI HAND W/O CONTRAST LEFT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI HAND W/O CONTRAST RIGHT - REPORT	$720.18	$900.22	$346.93–$810.20	50% below	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST LEFT	$2,737.33	$3,421.66	$346.93–$3,169.41	92% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI WRIST W/O CONTRAST RIGHT	$2,737.33	$3,421.66	$346.93–$3,169.41	92% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI HAND W/O CONTRAST RIGHT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST RIGHT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI ELBOW W/O CONTRAST LEFT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST LEFT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI SHOULDER W/O CONTRAST RIGHT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JOINT W/O CONTRAST LEFT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI HAND W/O CONTRAST LEFT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JOINT W/O CONTRAST RIGHT	$2,817.26	$3,521.57	$346.93–$3,169.41	98% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US SOFT TISSUE BUTTOCKS OR PELVIC WALL - REPORT	$271.92	$339.90	$25.88–$305.91	16% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC NON OB LTD - REPORT	$271.92	$339.90	$25.88–$305.91	16% below	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC NON OB LTD	$533.13	$666.41	$25.88–$599.77	65% above	20%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US SOFT TISSUE BUTTOCKS OR PELVIC WALL	$533.13	$666.41	$25.88–$599.77	65% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NON OB COMP - REPORT	$491.93	$614.91	$70.19–$553.42	2% above	20%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NON OB COMP	$844.60	$1,055.75	$70.19–$950.18	75% above	20%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB GREATER THAN 14 WEEKS - REPORT	$532.30	$665.38	$84.42–$598.84	15% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 WEEKS SINGLE - REPORT	$532.30	$665.38	$67.60–$598.84	21% above	20%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 WEEKS SINGLE	$688.04	$860.05	$67.60–$774.05	57% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED - REPORT	$472.98	$591.22	$48.52–$532.10	16% above	20%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB LIMITED	$519.94	$649.93	$48.52–$584.94	28% above	20%
Screening mammogram, both breasts both sides CPT 77067 MG IMPLANT SCREENING BILATERAL W/ TOMO	$394.70	$493.37	$83.71–$444.03	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG MAMMO IMPLANT DIGITAL SCREENING BILAT	$394.70	$493.37	$83.71–$444.03	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG MAMMO SCREENING BILATERAL W/ TOMO	$394.70	$493.37	$83.71–$444.03	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG MAMMO DIGITAL SCREENING BILATERAL	$394.70	$493.37	$83.71–$444.03	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG MAMMO DIGITAL SCREENING BILATERAL - REPORT	$412.82	$516.03	$89.60–$464.43	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG IMPLANT SCREENING BILATERAL W/ TOMO - REPORT	$412.82	$516.03	$89.60–$464.43	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG MAMMO IMPLANT DIGITAL SCREENING BILAT - REPORT	$412.82	$516.03	$89.60–$464.43	—	20%
Screening mammogram, both breasts both sides CPT 77067 MG MAMMO SCREENING BILATERAL W/ TOMO - REPORT	$412.82	$516.03	$89.60–$464.43	—	20%
Screening mammogram, both breasts CPT 77067 MG MAMMO IMPLANT SCREENING BIL W/ TOMO	$394.70	$493.37	$83.71–$444.03	42% above	20%
Screening mammogram, both breasts CPT 77067 MG MAMMO IMPLANT SCREENING BIL W/ TOMO - REPORT	$412.82	$516.03	$89.60–$464.43	48% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO SCREENING RIGHT W/ TOMO	$394.70	$493.37	$83.71–$444.03	42% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO DIGITAL SCREENING RIGHT	$394.70	$493.37	$83.71–$444.03	42% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO SCREENING LEFT W/ TOMO	$394.70	$493.37	$83.71–$444.03	42% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO DIGITAL SCREENING LEFT	$394.70	$493.37	$83.71–$444.03	42% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO SCREENING LEFT W/ TOMO - REPORT	$412.82	$516.03	$89.60–$464.43	48% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO SCREENING RIGHT W/ TOMO - REPORT	$412.82	$516.03	$89.60–$464.43	48% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO DIGITAL SCREENING LEFT - REPORT	$412.82	$516.03	$89.60–$464.43	48% above	20%
Screening mammogram, both breasts one side CPT 77067 MG MAMMO DIGITAL SCREENING RIGHT - REPORT	$412.82	$516.03	$89.60–$464.43	48% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE 2+ VIEWS LEFT - REPORT	$179.63	$224.54	$24.91–$202.09	21% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE 2+ VIEWS RIGHT - REPORT	$179.63	$224.54	$24.91–$202.09	21% below	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE 2+ VIEWS RIGHT	$402.11	$502.64	$24.91–$452.38	76% above	20%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR SHOULDER COMPLETE 2+ VIEWS LEFT	$402.11	$502.64	$24.91–$452.38	76% above	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US STRESS ECHO - REPORT	$685.57	$856.96	$380.15–$856.96	24% below	20%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US STRESS ECHO	$2,163.00	$2,703.75	$715.25–$2,433.38	139% above	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON-OB - REPORT	$491.93	$614.91	$82.48–$553.42	15% above	20%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL NON-OB	$731.71	$914.64	$82.48–$823.18	72% above	20%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL - REPORT	$538.07	$672.59	$54.67–$605.33	85% above	20%
Transvaginal ultrasound during pregnancy CPT 76817 US OB TRANSVAGINAL	$592.46	$740.57	$54.67–$666.51	103% above	20%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE - REPORT	$581.74	$727.18	$75.04–$654.46	9% above	20%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE	$979.74	$1,224.67	$75.04–$1,102.20	84% above	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM CONTENTS - REPORT	$456.50	$570.62	$67.60–$513.56	10% below	20%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM CONTENTS	$786.10	$982.62	$67.60–$884.36	54% above	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD/NECK SOFT TISSUE - REPORT	$393.87	$492.34	$80.22–$443.11	10% below	20%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US HEAD/NECK SOFT TISSUE	$741.60	$927.00	$80.22–$834.30	70% above	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI W/ SMALL BOWEL - REPORT	$447.43	$559.29	$80.22–$503.36	15% below	20%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UPPER GI - REPORT	$447.43	$559.29	$80.22–$503.36	15% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXT VENOUS DUPLEX LEFT - REPORT	$347.73	$434.66	$94.45–$391.19	33% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UPPER EXT VENOUS DUPLEX RIGHT - REPORT	$347.73	$434.66	$94.45–$391.19	33% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXT VENOUS DUPLEX RIGHT - REPORT	$347.73	$434.66	$94.45–$391.19	33% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UPPER EXT VENOUS DUPLEX LEFT - REPORT	$347.73	$434.66	$94.45–$391.19	33% below	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UPPER EXT VENOUS DUPLEX RIGHT	$909.70	$1,137.12	$94.45–$1,023.41	74% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXT VENOUS DUPLEX RIGHT	$909.70	$1,137.12	$94.45–$1,023.41	74% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LOWER EXT VENOUS DUPLEX LEFT	$909.70	$1,137.12	$94.45–$1,023.41	74% above	20%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UPPER EXT VENOUS DUPLEX LEFT	$909.70	$1,137.12	$94.45–$1,023.41	74% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE 3+ VIEWS RIGHT - REPORT	$179.63	$224.54	$32.02–$202.09	21% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE 3+ VIEWS LEFT - REPORT	$179.63	$224.54	$32.02–$202.09	21% below	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE 3+ VIEWS RIGHT	$386.46	$483.07	$32.02–$434.76	71% above	20%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR WRIST COMPLETE 3+ VIEWS LEFT	$386.46	$483.07	$32.02–$434.76	71% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2-3 VIEWS W/AP PELVIS RIGHT - REPORT	$171.39	$214.24	$35.90–$192.82	20% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2-3 VIEWS W/AP PELVIS LEFT - REPORT	$171.39	$214.24	$35.90–$192.82	20% below	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2-3 VIEWS W/AP PELVIS RIGHT	$358.44	$448.05	$35.90–$403.25	66% above	20%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR HIP 2-3 VIEWS W/AP PELVIS LEFT	$358.44	$448.05	$35.90–$403.25	66% above	20%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW - REPORT	$179.63	$224.54	$20.70–$202.09	20% below	20%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$322.18	$402.73	$20.70–$362.46	43% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RIGHT - REPORT	$179.63	$224.54	$23.61–$202.09	10% below	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LEFT - REPORT	$179.63	$224.54	$23.61–$202.09	10% below	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS RIGHT	$342.78	$428.48	$23.61–$385.63	72% above	20%
X-ray of the ankle, 2 views one side CPT 73600 XR ANKLE 2 VIEWS LEFT	$342.78	$428.48	$23.61–$385.63	72% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER S 2+ VIEWS RIGHT - REPORT	$163.15	$203.94	$30.73–$202.09	4% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER S 2+ VIEWS LEFT - REPORT	$179.63	$224.54	$30.73–$202.09	15% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER S 2+ VIEWS RIGHT	$298.29	$372.86	$30.73–$335.57	90% above	20%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR FINGER S 2+ VIEWS LEFT	$298.29	$372.86	$30.73–$335.57	90% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RIGHT - REPORT	$179.63	$224.54	$20.38–$202.09	7% below	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LEFT - REPORT	$179.63	$224.54	$20.38–$202.09	7% below	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS RIGHT	$329.60	$412.00	$20.38–$370.80	71% above	20%
X-ray of the foot, 2 views one side CPT 73620 XR FOOT 2 VIEWS LEFT	$329.60	$412.00	$20.38–$370.80	71% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE 3+ VIEWS RIGHT - REPORT	$179.63	$224.54	$25.23–$202.09	32% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE 3+ VIEWS LEFT - REPORT	$179.63	$224.54	$25.23–$202.09	32% below	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE 3+ VIEWS RIGHT	$442.49	$553.11	$25.23–$497.80	67% above	20%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR FOOT COMPLETE 3+ VIEWS LEFT	$442.49	$553.11	$25.23–$497.80	67% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE 3+ VIEWS LEFT - REPORT	$179.63	$224.54	$28.14–$202.09	9% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE 3+ VIEWS RIGHT - REPORT	$179.63	$224.54	$28.14–$202.09	9% below	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE 3+ VIEWS RIGHT	$400.46	$500.58	$28.14–$450.52	102% above	20%
X-ray of the hand, 3 or more views one side CPT 73130 XR HAND COMPLETE 3+ VIEWS LEFT	$400.46	$500.58	$28.14–$450.52	102% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS RIGHT - REPORT	$179.63	$224.54	$25.23–$202.09	16% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS LEFT - REPORT	$179.63	$224.54	$25.23–$202.09	16% below	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS LEFT	$349.38	$436.72	$25.23–$393.05	63% above	20%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR KNEE 1 OR 2 VIEWS RIGHT	$349.38	$436.72	$25.23–$393.05	63% above	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR SPINE LUMBOSACRAL 2 OR 3 VIEWS - REPORT	$179.63	$224.54	$28.14–$202.09	35% below	20%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR SPINE LUMBOSACRAL 2 OR 3 VIEWS	$443.31	$554.14	$28.14–$498.73	60% above	20%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL 4PLUS VIEWS - REPORT	$220.01	$275.01	$38.17–$247.51	44% below	20%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL 4PLUS VIEWS	$609.76	$762.20	$38.17–$685.98	56% above	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR SPINE THORACIC 2 VIEWS - REPORT	$179.63	$224.54	$22.64–$202.09	35% below	20%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR SPINE THORACIC 2 VIEWS	$404.58	$505.73	$22.64–$455.16	47% above	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES 3+ VIEWS - REPORT	$179.63	$224.54	$28.46–$202.09	13% below	20%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NASAL BONES 3+ VIEWS	$371.62	$464.53	$28.46–$418.08	79% above	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERVICAL 2 OR 3 VIEWS - REPORT	$179.63	$224.54	$28.14–$202.09	33% below	20%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERVICAL 2 OR 3 VIEWS	$399.64	$499.55	$28.14–$449.60	49% above	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEWS - REPORT	$179.63	$224.54	$19.08–$202.09	7% below	20%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1 OR 2 VIEWS	$355.14	$443.93	$19.08–$399.54	84% above	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX 2+ VIEWS - REPORT	$179.63	$224.54	$23.61–$202.09	27% below	20%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCCYX 2+ VIEWS	$369.15	$461.44	$23.61–$415.30	49% above	20%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs New Mexico	Off list
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL W/RFX TO CONFIRM. QST	$77.46	$96.82	$30.96–$526.54	72% below	20%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS PANEL ACUTE TC	$468.03	$585.04	$30.96–$526.54	72% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 FOOD SPECIFIC IGG ALLERGY ADULT PNL QS	$15.66	$19.57	$3.39–$101.04	53% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SESAME SEED F10 IGE QSTS	$27.19	$33.99	$3.39–$101.04	19% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PECAN TREE T22 CLASS QSTS	$29.66	$37.08	$3.39–$128.85	12% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON PIGWEED W14 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COW'S MILK F2 IGE QSTS	$32.14	$40.17	$3.39–$128.85	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CABBAGE F216 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CAT DANDER E1 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CHICKEN FEATH E85 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COMMON RAGWEEN W1 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COCKROACH I6 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WHITE MULBERRY T70 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 TIMOTHY GRASS G6 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SHEEP SORREL W18 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 P. NOTATUM M1 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 OAK WHITE T7 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MUSHROOM F212 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE UR PROT E72 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUSE UR PROT E72 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MOUNTAIN CEDAR T6 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MAPLE BOX ELDER T1 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 JOHNSON GRASS G10 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HORSE DANDER E3 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 GOOSE FEATHERS E70 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ELM T8 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 DOG DANDER E5 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 D. PTERONYSSINUS CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 D. FARINAE D2 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COW DANDER E4 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 A. FUMIGATUS M3 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 COTTONWOOD T14 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 A. TENUIS M6 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 APPLE F49 IGE QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BERMUDA GRASS G2 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 BIRCH T3 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 C. HERBARUM M2 CLASS QSTS	$32.14	$40.17	$3.39–$101.04	4% below	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FUMIGATUS QSTS	$35.43	$44.29	$3.39–$101.04	5% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS FLAVUS QSTS	$38.73	$48.41	$3.39–$128.85	15% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 HORSE DANDER E3 CLASS QSTS	$51.09	$63.86	$3.39–$101.04	52% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 GLUTEN F79 IGE QSTS	$77.46	$96.82	$3.39–$128.85	131% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 ASPERGILLUS NIGER QSTS	$89.82	$112.27	$3.39–$101.04	167% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 EGG WHITE F1 IGE QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 TOMATO F25 IGG QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 SOYBEAN F14 IGE QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 PEANUT F13 IGE QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 MAIZE/CORN F8 IGE QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 CODFISH F3 IGE QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Allergy blood test, specific IgE, per allergen CPT 86003 WHEAT F4 IGE QST	$114.54	$143.17	$3.39–$128.85	241% above	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 86200 CCP ANTIBODY	$66.74	$83.43	$8.42–$75.09	30% below	20%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP AB IGG QSTS	$66.74	$83.43	$8.42–$75.09	30% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN IFA W/REFL TTR AND PATT QSTS	$74.98	$93.73	$7.86–$104.75	24% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA SCREEN TC	$74.98	$93.73	$7.86–$104.75	24% below	20%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA MULTIPLEX W/ RFX 11 AB CASCADE QSTS	$93.11	$116.39	$7.86–$104.75	6% below	20%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-PRO BNP	$207.65	$259.56	$25.52–$233.60	26% above	20%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$111.24	$139.05	$5.50–$125.15	8% below	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL SPECIMEN FOR PATHOLOGY TC	$435.07	$543.84	$22.50–$1,156.90	116% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 DERMATOPATHOLOGY TC	$537.25	$671.56	$22.50–$1,156.90	167% above	20%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CYTO NON GNY CELL BLOCK	$1,028.35	$1,285.44	$22.50–$1,156.90	411% above	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD SECOND SET MB TC	$53.56	$66.95	$6.71–$283.66	59% below	20%
Blood culture for bacteria CPT 87040 CULTURE BLOOD MB TC	$53.56	$66.95	$6.71–$283.66	59% below	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$126.07	$157.59	$6.71–$283.66	4% below	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE X 2	$252.14	$315.18	$6.71–$283.66	92% above	20%
Blood culture for bacteria CPT 87040 BLOOD CULTURE BACTERIA AND YEAST TC	$252.14	$315.18	$6.71–$283.66	92% above	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE	$23.07	$28.84	$5.91–$25.96	at median	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION VENOUS DRAW	$23.07	$28.84	$5.91–$25.96	at median	20%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 BILL ONLY VENIPUNCTURE	$23.07	$28.84	$5.91–$25.96	at median	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE 2 HOUR POST PRANDIAL	$21.42	$26.78	$0.01–$24.10	51% below	20%
Blood glucose (sugar) test CPT 82947 GLUC F	$21.42	$26.78	$0.01–$24.10	51% below	20%
Blood glucose (sugar) test CPT 82947 GLUCOSE LEVEL	$21.42	$26.78	$0.01–$24.10	51% below	20%
Blood lead test CPT 83655 CAPILLARY LEAD POCT	$32.96	$41.20	$7.87–$37.08	52% below	20%
Blood lead test CPT 83655 LEAD QSTS	$77.46	$96.82	$7.87–$87.14	13% above	20%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 PREGNANCY TEST SERUM	$140.90	$176.13	$4.89–$158.52	31% above	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CORD ABO/RH 2	$68.39	$85.49	$1.94–$76.94	17% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO/RH	$68.39	$85.49	$1.94–$76.94	17% below	20%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/RH	$68.39	$85.49	$1.94–$76.94	17% below	20%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$63.45	$79.31	$3.37–$71.38	5% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFFICILE PCR TC	$137.61	$172.01	$24.23–$154.81	8% below	20%
C. difficile toxin gene test (stool PCR) CPT 87493 CLOSTRIDIUM DIFFICILE GENEXPERT	$168.92	$211.15	$24.23–$190.04	13% above	20%
C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFF TOXIN BQL PCR QSTS	$168.92	$211.15	$24.23–$190.04	13% above	20%
CA 19-9 blood test (tumor marker) CPT 86301 CANCER ANTIGEN 19-9 CA 19-9 SERUM TC	$129.37	$161.71	$13.53–$145.54	9% below	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CANCER AG 125 TC	$132.66	$165.83	$13.53–$149.25	at median	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 WITH HAMA TREATMENT QSTS	$132.66	$165.83	$13.53–$149.25	at median	20%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 QSTS	$132.66	$165.83	$13.53–$149.25	at median	20%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 PCR GENEXPERT	$181.28	$226.60	$33.35–$203.94	75% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHALMYDIA TRACHOMATIS AND NEISSERIA GONORRHOEAE GENEXPERT	$106.30	$132.87	$22.81–$166.86	13% below	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C.TRACHOMATIS RNAUROGEN QSTS	$148.32	$185.40	$22.81–$166.86	22% above	20%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA/GC AMP TC	$171.39	$214.24	$22.81–$192.82	41% above	20%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL W/RFX DIRECT LDL	$145.85	$182.31	$8.70–$164.08	7% above	20%
Complete blood count (CBC) with differential CPT 85025 CBC W/ DIFF	$94.76	$118.45	$5.05–$106.61	4% above	20%
Complete blood count (CBC) with differential CPT 85025 CBC W/ DIFFERENTIAL	$94.76	$118.45	$5.05–$106.61	4% above	20%
Complete blood count (CBC), no differential CPT 85027 CBC W/O DIFF	$60.98	$76.22	$4.21–$68.60	29% above	20%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$146.67	$183.34	$6.86–$165.01	25% below	20%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL	$146.67	$183.34	$6.86–$165.01	25% below	20%
D-dimer blood test (blood clot marker) CPT 85379 D DIMER	$154.91	$193.64	$6.62–$174.28	48% above	20%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA SULFATE QSTS	$234.84	$293.55	$14.45–$264.20	86% above	20%
Estradiol blood test CPT 82670 ESTRADIOL ULTRASENSITIVE LC/MS/MS QSTS	$157.38	$196.73	$18.16–$177.06	11% below	20%
Estradiol blood test CPT 82670 ESTRADIOL LC/MS QSTS	$157.38	$196.73	$18.16–$177.06	11% below	20%
FSH (follicle-stimulating hormone) test CPT 83001 FSH QSTS	$97.23	$121.54	$12.08–$109.39	31% below	20%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN STOOL QSTS	$215.89	$269.86	$12.76–$242.87	43% above	20%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$82.40	$103.00	$8.86–$92.70	26% below	20%
Folate (folic acid) blood test CPT 82746 FOLATE SERUM QSTS	$93.11	$116.39	$9.56–$104.75	at median	20%
Folate (folic acid) blood test CPT 82746 FOLATE QSTS	$93.11	$116.39	$9.56–$104.75	at median	20%
Free T3 thyroid hormone test CPT 84481 T3 FREE QSTS	$130.19	$162.74	$11.01–$146.47	4% above	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4 LEVEL	$55.21	$69.01	$5.86–$154.81	58% below	20%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 FREE DIRECT DIALYSIS QSTS	$137.61	$172.01	$5.86–$154.81	5% above	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL BILL ONLY	$270.93	$338.66	$22.83–$335.57	36% below	20%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 BILL ONLY GENERAL HEALTH PANEL	$298.29	$372.86	$22.83–$335.57	30% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GESTATIONAL DIABETES SCREEN	$20.60	$25.75	$3.09–$61.18	48% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GTT 1 HR - NO FASTING	$20.60	$25.75	$3.09–$61.18	48% below	20%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 BLOOD GLUCOSE MONITOR POC	$54.38	$67.98	$3.09–$61.18	36% above	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 2 HR	$54.38	$67.98	$0.01–$61.18	54% below	20%
Glucose tolerance test, 3 samples CPT 82951 .GTT 1 HR	$54.38	$67.98	$0.01–$61.18	54% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 CT/NG GENEXPERT	$116.18	$145.23	$22.81–$154.81	14% below	20%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE RNAUROGEN QSTS	$137.61	$172.01	$22.81–$154.81	2% above	20%
H. pylori stool antigen test CPT 87338 HELICOBACTER PYLORI AG DETECTION TC	$64.27	$80.34	$9.35–$72.31	3% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 AB SCRN	$62.62	$78.28	$15.65–$139.98	50% below	20%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1/2 AG AND AB 4TH GEN W/ RFX QSTS	$124.42	$155.53	$15.65–$139.98	at median	20%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV HUMAN PAPILLOMAVIRUS HIGH RISK TC	$173.66	$217.07	$22.81–$195.36	40% above	20%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN A1C	$75.81	$94.76	$6.31–$85.28	2% above	20%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE AB QL QSTS	$74.16	$92.70	$6.98–$83.43	29% below	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG CONF. QSTS	$70.86	$88.58	$6.71–$80.65	at median	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG QSTS	$71.69	$89.61	$6.71–$80.65	1% above	20%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEP B SURFACE AG W/REFL CONFIRM QSTS	$71.69	$89.61	$6.71–$80.65	1% above	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEP C AB W/REFL TO HCV RNA QN PCR QSTS	$52.69	$65.86	$9.28–$296.64	47% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY QSTS	$73.34	$91.67	$9.28–$82.50	26% below	20%
Hepatitis C antibody blood test (screening) CPT 86803 HCV RNA QUANTITATIVE REAL TIME PCR QSTS	$263.68	$329.60	$9.28–$296.64	167% above	20%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPATITIS C QUANTITATIVE BY REAL TIME PCR TC	$168.92	$211.15	$27.85–$221.55	51% below	20%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HEPATITIS C VIRAL RNA QNT RT PCR QSTS	$196.94	$246.17	$27.85–$221.55	43% below	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGM SCREEN QSTS	$63.45	$79.31	$8.57–$111.24	7% below	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 IGM TITER 40527 QSTS	$66.74	$83.43	$8.57–$100.12	3% below	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 AND 2 IGG TYPE-SPECIFIC AB QSTS	$88.99	$111.24	$8.57–$100.12	30% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 TOXOPLASMA ANTIBODY IGM QSTS	$93.94	$117.42	$8.57–$111.24	37% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV1 IGG TYPE SPECIFIC AB QSTS	$93.94	$117.42	$8.57–$111.24	37% above	20%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1 AND 2 AB IGM TC	$243.90	$304.88	$8.57–$274.39	256% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2 IGM TITER 40528 QSTS	$66.74	$83.43	$12.58–$75.09	23% below	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV-2 IGG INHIBITIONIA QSTS	$88.99	$111.24	$12.58–$104.75	2% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 HSV2 IGG TYPE SPECIFIC AB QSTS	$93.11	$116.39	$12.58–$104.75	7% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 RUBELLA ANTIBODY IGG QSTS	$93.94	$117.42	$12.58–$111.24	8% above	20%
Herpes blood test, HSV-2 antibody CPT 86696 RUBELLA ANTIBODY IGM QSTS	$98.88	$123.60	$12.58–$111.24	14% above	20%
Homocysteine blood test CPT 83090 HOMOCYSTEINE QSTS	$107.12	$133.90	$11.65–$120.51	26% below	20%
Insulin blood test CPT 83525 INSULIN QSTS	$61.80	$77.25	$7.43–$69.53	19% below	20%
Iron blood test (serum iron) CPT 83540 IRON LEVEL	$42.85	$53.56	$4.21–$48.20	45% below	20%
Iron-binding capacity (TIBC) test CPT 83550 IRON LEVEL AND TIBC	$42.85	$53.56	$5.68–$73.23	45% below	20%
Iron-binding capacity (TIBC) test CPT 83550 TIBC	$65.10	$81.37	$5.68–$73.23	17% below	20%
Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING CAPACITY	$65.10	$81.37	$5.68–$73.23	17% below	20%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$117.83	$147.29	$5.64–$132.56	23% below	20%
Kidney function blood test panel CPT 80069 RENAL PNL	$117.83	$147.29	$5.64–$132.56	23% below	20%
LH (luteinizing hormone) test CPT 83002 LH QSTS	$93.94	$117.42	$12.04–$105.68	31% below	20%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE LEVEL	$152.44	$190.55	$4.48–$171.50	51% above	20%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$91.46	$114.33	$5.31–$102.90	39% below	20%
Liver function blood test panel CPT 80076 HEP FNCT PNL	$91.46	$114.33	$5.31–$102.90	39% below	20%
Magnesium blood test CPT 83735 MAGNESIUM LEVEL	$64.27	$80.34	$4.36–$72.31	20% below	20%
Measles (rubeola) antibody test CPT 86765 MEASLES ANTIBODY IGM QSTS	$86.52	$108.15	$8.37–$221.55	3% above	20%
Measles (rubeola) antibody test CPT 86765 MEASLES AB IGG QSTS	$140.90	$176.13	$8.37–$158.52	68% above	20%
Measles (rubeola) antibody test CPT 86765 MEASLES ANTIBODY IGG QSTS	$140.90	$176.13	$8.37–$158.52	68% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA IGM AB TC	$196.94	$246.17	$8.37–$221.55	134% above	20%
Measles (rubeola) antibody test CPT 86765 RUBEOLA MEASLES ABS IGG TC	$196.94	$246.17	$8.37–$221.55	134% above	20%
Mono test (heterophile antibody, Monospot) CPT 86308 MONO SCRN	$63.45	$79.31	$3.37–$71.38	18% below	20%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE QSTS	$98.06	$122.57	$11.95–$110.31	11% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL QSTS	$104.65	$130.81	$11.95–$117.73	6% above	20%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA PERCENT FREE INCLUDES TOTAL TC	$299.11	$373.89	$11.95–$336.50	203% above	20%
Pap test (liquid-based, automated screening with review) CPT 88175 HERPES VIRUS 1 AND 2 BY PCR TC	$196.94	$246.17	$17.30–$221.55	111% above	20%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONEINTACT QSTS	$56.03	$70.04	$26.83–$70.04	73% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME QSTS	$63.45	$79.31	$3.91–$71.38	15% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME	$63.45	$79.31	$3.91–$71.38	15% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT	$63.45	$79.31	$3.91–$71.38	15% below	20%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOSIS PNL INTRP TC	$63.45	$79.31	$3.91–$71.38	15% below	20%
Progesterone blood test CPT 84144 PROGESTERONE TC	$126.07	$157.59	$13.56–$141.83	3% above	20%
Progesterone blood test CPT 84144 PROGESTERONE QSTS	$126.07	$157.59	$13.56–$141.83	3% above	20%
Prolactin blood test CPT 84146 PROLACTIN QSTS	$199.41	$249.26	$12.60–$224.33	33% above	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME AND INR	$29.66	$37.08	$2.79–$33.37	43% below	20%
Prothrombin time (PT/INR) clotting test CPT 85610 PT/ INR	$29.66	$37.08	$2.79–$33.37	43% below	20%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 DRUG SCREEN POC	$32.96	$41.20	$8.19–$37.08	84% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA POC	$68.39	$85.49	$10.76–$139.05	46% above	20%
Rapid flu test (influenza antigen) CPT 87804 INFLUENZA A/B	$123.60	$154.50	$10.76–$139.05	164% above	20%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREPTOCOCCUS CULTURE SPECIAL TC	$9.06	$11.33	$5.03–$23.81	86% below	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR TC	$27.19	$33.99	$3.69–$30.59	57% below	20%
Rheumatoid factor (RF) test CPT 86431 86431 RHEUMATOID FACTOR QUANT	$27.19	$33.99	$3.69–$30.59	57% below	20%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QSTS	$27.19	$33.99	$3.69–$30.59	57% below	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY IGM QSTS	$63.45	$79.31	$9.35–$71.38	13% below	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY IGG QSTS	$63.45	$79.31	$9.35–$71.38	13% below	20%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IMMUNE STATUS QSTS	$70.86	$88.58	$9.35–$79.72	3% below	20%
Stool ova and parasites exam CPT 87177 OVA AND PARASITE MB TC	$173.86	$217.33	$5.79–$195.60	35% above	20%
Stool test for hidden blood (guaiac FOBT) CPT 82270 STOOL FOR OCCULT BLOOD POC	$41.20	$51.50	$2.85–$46.35	67% above	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 STOOL FOR OCCULT BLOOD POC	$43.67	$54.59	$10.35–$49.13	35% below	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 POCT HEMOCCULT STOOL	$43.67	$54.59	$10.35–$51.91	35% below	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLD DIAG	$46.14	$57.68	$10.35–$51.91	32% below	20%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 POCT GASTROCCULT	$46.14	$57.68	$10.35–$51.91	32% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR TITER TC	$41.20	$51.50	$2.78–$87.14	14% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RAPID PLASMA REAGIN	$41.20	$51.50	$2.78–$87.14	14% below	20%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR W/ RFLX TITER AND CONFIRM.TESTING QSTS	$77.46	$96.82	$2.78–$87.14	62% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON-TB GOLD PLUS 1 TUBE QST	$92.29	$115.36	$40.29–$115.36	57% below	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD PLUS 4T INCUBATED	$233.19	$291.49	$40.29–$584.94	8% above	20%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QUANTIFERON TB GOLD+ TC	$519.94	$649.93	$40.29–$584.94	142% above	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL LC/MS/MS QSTS	$65.92	$82.40	$16.78–$94.55	50% below	20%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL MS QSTS	$84.05	$105.06	$16.78–$94.55	36% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE ABS QSTS	$70.86	$88.58	$9.46–$79.72	17% below	20%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KIDNEY MICROSOME AB IGG QSTS	$81.58	$101.97	$9.46–$91.77	4% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH QSTS	$105.47	$131.84	$10.92–$118.66	13% below	20%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE	$105.47	$131.84	$10.92–$118.66	13% below	20%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS TC	$90.64	$113.30	$22.81–$101.97	45% above	20%
Uric acid blood test CPT 84550 URIC ACID	$60.98	$76.22	$2.94–$68.60	at median	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK ONLY	$29.66	$37.08	$1.46–$33.37	25% above	20%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIPSTICK	$63.45	$79.31	$1.46–$71.38	168% above	20%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK POC	$41.20	$51.50	$2.26–$46.35	219% above	20%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK POC	$41.20	$51.50	$2.26–$46.35	219% above	20%
Urinalysis without microscope exam, manual CPT 81002 URINE DIPSTICK POCT	$41.20	$51.50	$2.26–$46.35	219% above	20%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE MB TC	$43.67	$54.59	$5.25–$49.13	51% below	20%
Urine culture for bacteria, with colony count CPT 87086 UR CULTURE TC	$74.16	$92.70	$5.25–$83.43	18% below	20%
Urine pregnancy test, read by color change CPT 81025 POCT UPREG QUAL	$41.20	$51.50	$5.60–$46.35	39% above	20%
Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST POC	$41.20	$51.50	$5.60–$46.35	39% above	20%
Urine pregnancy test, read by color change CPT 81025 81025 URINE PREGNANCY TEST BY VISUAL COLOR COMPARISON METHODS	$41.20	$51.50	$5.60–$46.35	39% above	20%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST URINE QUAL	$64.27	$80.34	$5.60–$72.31	116% above	20%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST URINE	$64.27	$80.34	$5.60–$72.31	116% above	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMINB12 QSTS	$88.99	$111.24	$9.80–$100.12	27% below	20%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12 QSTS	$88.99	$111.24	$9.80–$100.12	27% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OH BY IMMUNOASSAY TC	$16.48	$20.60	$4.57–$42.62	91% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY LEVEL	$135.96	$169.95	$19.24–$181.69	22% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 D2D3 LC/MS/MS QSTS	$161.50	$201.88	$19.24–$181.69	8% below	20%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 QUESTASSURED TM INFANTS 25-OH VIT D QSTS	$161.50	$201.88	$19.24–$181.69	8% below	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 B-HCG QUANTITATIVE	$145.85	$182.31	$9.78–$164.08	at median	20%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANTITATIVE	$145.85	$182.31	$9.78–$164.08	at median	20%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs New Mexico	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 44960 APPENDECTOMY FOR RUPTURED APPENDIX WITH ABSCESS	$2,509.90	$3,137.38	$830.63–$2,823.64	18% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG BREAST BIOPSY W/ STEREO GUIDE RIGHT - REPORT	$3,181.46	$3,976.83	$781.44–$3,579.15	19% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG BREAST BIOPSY W/ STEREO GUIDE LEFT - REPORT	$3,181.46	$3,976.83	$781.44–$3,579.15	19% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG BREAST BIOPSY W/ STEREO GUIDE RIGHT	$3,745.90	$4,682.38	$781.44–$4,214.14	40% above	20%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MG BREAST BIOPSY W/ STEREO GUIDE LEFT	$3,745.90	$4,682.38	$781.44–$4,214.14	40% above	20%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE LATERAL MALLEOLUS	$840.48	$1,050.60	$134.08–$945.54	1% below	20%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 CLOSED TREATMENT OF METATARSAL FRACTURE WITHOUT MANIPULATION EACH	$576.80	$721.00	$134.08–$648.90	89% above	20%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 28296 CORRECTION HALLUX VALGUS.	$1,457.49	$1,821.86	$808.18–$2,552.27	72% below	20%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TECHFEE	$1,066.26	$1,332.82	$445.26–$1,199.54	1% below	20%
Cervical biopsy CPT 57500 57500 BIOPSY OF CERVIX SINGLE OR MULTIPLE OR LOCAL EXCISION OF LESION	$374.92	$468.65	$207.89–$549.62	46% below	20%
Cesarean delivery, including prenatal and postpartum care CPT 59510 59510 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE CESAREAN DELIVERY	$4,458.66	$5,573.33	$2,472.33–$5,016.00	16% above	20%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 54161 CIRCUMCISION SURGICAL EXCISION OTHER THAN CLAMP DEVICE OR DORSAL	$706.99	$883.74	$178.97–$1,883.36	77% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 EXCISION PROCEDURES ON THE PENIS	$418.59	$523.24	$146.77–$1,883.36	81% below	20%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 CIRCUMCISION USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE	$418.59	$523.24	$232.11–$1,883.36	81% below	20%
Circumcision, surgical, older than a newborn CPT 54160 CIRCUMCISION CHARGE	$510.06	$637.57	$282.83–$1,883.36	at median	20%
Circumcision, surgical, older than a newborn CPT 54160 54160 CIRCUMCISION SURGICAL EXCISION OTHER THAN CLAMP DEVICE OR DORSAL	$576.80	$721.00	$319.84–$1,883.36	13% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE WITHOUT MANIPULATION	$887.45	$1,109.31	$134.08–$998.38	111% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE EG COLLES OR SMITH	$891.57	$1,114.46	$134.08–$1,003.01	112% above	20%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ CIBO	$891.57	$1,114.46	$134.08–$1,003.01	112% above	20%
Colonoscopy with polyp removal CPT 45385 45385 COLONOSCOPY FLEXIBLE WITH REMOVAL OF TUMOR S POLYP S	$1,185.74	$1,482.17	$475.71–$1,333.95	4% below	20%
Colonoscopy, diagnostic CPT 45378 45378 COLONOSCOPY FLEXIBLE DIAGNOSTIC INCLUDING COLLECTION	$527.36	$659.20	$292.42–$736.49	52% below	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA WITH LOOP	$845.42	$1,056.78	$295.52–$1,621.40	83% below	20%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 57460 COLPOSCOPY OF THE CERVIX INCL. UPPER VAGINA WITH LOOP ELECTRODE BIOPSY S	$845.42	$1,056.78	$468.79–$1,621.40	83% below	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 COLPOSCOPY OF THE CERVIX INCL. VAGINA W/ BIOPSY OF CERVIX AND	$407.88	$509.85	$226.17–$487.99	at median	20%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 57454 COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA WITH BIOPSY	$432.35	$540.44	$239.74–$487.99	6% above	20%
D&C (dilation and curettage), not related to pregnancy CPT 58120 58120 DILATION AND CURETTAGE DIAGNOSTIC AND/OR THERAPEUTIC NONOBSTETRICAL	$769.62	$962.02	$289.38–$1,621.40	83% below	20%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 DESTRUCTION EG LASER SURGERY ELECTROSURGERY CRYOSURGERY CHEMO	$143.38	$179.22	$71.09–$161.30	11% above	20%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 EAR IRRIGATION POC	$36.26	$45.32	$20.10–$67.13	67% below	20%
Earwax removal with instruments, one ear one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION UNILATERAL	$129.37	$161.71	$62.82–$145.54	13% below	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 ENDOMETRIAL SAMPLING BIOPSY WITH OR WITHOUT ENDOCERVICAL SAMPLING	$244.73	$305.91	$95.31–$275.32	6% above	20%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 58100 ENDOMETRIAL BIOPSY WITH OR W/O ENDOCER BIOPSY W/O CERVICAL DILAT	$274.39	$342.99	$123.58–$308.69	19% above	20%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 XR FACET INJECTION LUMB/SACR LV1 BILAT - REPORT	$908.05	$1,135.06	$251.76–$1,030.86	—	20%
Facet joint injection, lower back, one level, with imaging guidance both sides CPT 64493 XR FACET INJECTION LUMB/SACR LV1 BILAT	$3,625.60	$4,532.00	$582.41–$4,078.80	—	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 XR FACET INJECTION LUMB/SACR LV1 LEFT - REPORT	$454.02	$567.53	$251.76–$1,030.86	55% below	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 XR FACET INJECTION LUMB/SACR LV1 RIGHT - REPORT	$454.02	$567.53	$251.76–$1,030.86	55% below	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 XR FACET INJECTION LUMB/SACR LV1 RIGHT	$2,285.78	$2,857.22	$582.41–$4,078.80	127% above	20%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 XR FACET INJECTION LUMB/SACR LV1 LEFT	$2,285.78	$2,857.22	$582.41–$4,078.80	127% above	20%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 49593 REPAIR OF ANTERIOR ABDOMINAL HERNIA S IE EPIGASTRIC INC	$1,049.78	$1,312.22	$533.96–$4,250.32	81% below	20%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 49595 REPAIR OF ANTERIOR ABDOMINAL HERNIA S IE EPIGASTRIC INC	$1,412.34	$1,765.42	$716.55–$4,250.32	63% below	20%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 49591 REPAIR OF ANTERIOR ABDOMINAL HERNIA S IE EPIGASTRIC INCISIONAL	$938.54	$1,173.17	$319.68–$4,250.32	73% below	20%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 45330 SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC INCLUDING COLLECTION	$456.50	$570.62	$200.66–$570.62	53% below	20%
Hysterectomy through an abdominal incision (total) CPT 58150 58150 TOTAL ABDOMINAL HYSTERECTOMY CORPUS AND CERVIX	$2,869.17	$3,586.46	$934.91–$3,227.81	31% above	20%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 58340 CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST	$476.27	$595.34	$220.87–$535.81	54% above	20%
Hysteroscopy with endometrial ablation CPT 58563 58563 HYSTEROSCOPY SURGICAL WITH ENDOMETRIAL ABLATION EG ENDOMETRIAL	$4,078.80	$5,098.50	$1,861.80–$5,098.50	30% below	20%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 58558 HYSTEROSCOPY SURGICAL WITH SAMPLING BIOPSY OF ENDOMETRIUM	$3,534.96	$4,418.70	$1,182.61–$3,976.83	9% below	20%
IUD insertion (the device itself billed separately) CPT 58300 58300 INSERTION OF INTRAUTERINE DEVICE IUD	$340.31	$425.39	$188.70–$425.39	33% above	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION AND DRAINAGE OF ABSCESS SIMPLE OR SINGLE	$326.30	$407.88	$117.74–$367.09	23% below	20%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION AND DRAINAGE OF ABSCESS EG CARBUNCLE SUPPURATIVE	$326.30	$407.88	$117.74–$367.09	23% below	20%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 20550 INJECTION S SINGLE TENDON SHEATH OR LIGAMENT APONEUROSIS EG	$149.97	$187.46	$83.16–$206.74	67% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ARTHROCENTESIS ASPIRATION AND/OR INJECTION MAJOR JOINT OR BURSA WITHOUT	$389.75	$487.19	$206.74–$438.47	4% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR JOINT/BURSA MAJOR ARTHR/ASP/INJ LEFT - REPORT	$269.45	$336.81	$149.41–$336.81	34% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR JOINT/BURSA MAJOR ARTHR/ASP/INJ RIGHT - REPORT	$269.45	$336.81	$149.41–$336.81	34% below	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR JOINT/BURSA MAJOR ARTHR/ASP/INJ RIGHT	$887.45	$1,109.31	$206.74–$998.38	117% above	20%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 XR JOINT/BURSA MAJOR ARTHR/ASP/INJ LEFT	$887.45	$1,109.31	$206.74–$998.38	117% above	20%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 INSERTION NON-BIODEGRADABLE DRUG DELIVERY IMPLANT	$280.16	$350.20	$155.35–$350.20	23% above	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIRATION/INJECT. INTERMEDIATE JOINT/BURSA-WC CHARGE	$138.68	$173.35	$54.96–$206.74	61% below	20%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ARTHROCENTESIS ASPIRATION AND/OR INJECTION INTERMEDIATE JOINT OR BURSA	$362.56	$453.20	$201.04–$407.88	3% above	20%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 ARTHROCENTESIS ASPIRATION AND/OR INJECTION SMALL JOINT OR BURSA EG	$136.78	$170.98	$75.85–$206.74	64% below	20%
Knee arthroscopy with meniscus trim CPT 29881 29881 ARTHROSCOPY KNEE SURGICAL WITH MENISCECTOMY MEDIAL OR LATERAL	$978.91	$1,223.64	$505.18–$2,420.12	84% below	20%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 29880 ARTHROSCOPY KNEE SURGICAL WITH MENISCECTOMY MEDIAL AND LATERAL	$1,015.17	$1,268.96	$522.77–$2,420.12	87% below	20%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 29877 ARTHROSCOPY KNEE SURGICAL DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE	$1,123.94	$1,404.92	$576.32–$2,420.12	7% below	20%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 58571 LAPAROSCOPY SURGICAL WITH TOTAL HYSTERECTOMY FOR UTERUS 250 G	$1,625.75	$2,032.19	$828.63–$3,788.76	86% below	20%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 58661 LAPAROSCOPY SURGICAL WITH REMOVAL OF ADNEXAL STRUCTURES	$1,838.34	$2,297.93	$588.43–$3,788.76	64% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 XR INJECTION LMBR/SCRL EPIDURAL - REPORT	$595.75	$744.69	$330.34–$876.53	58% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 CT INJECTION LMBR/SCRL EPIDURAL - REPORT	$701.22	$876.53	$330.34–$876.53	51% below	20%
Lower-back epidural injection, with imaging guidance CPT 62323 CT INJECTION LMBR/SCRL EPIDURAL	$2,031.16	$2,538.95	$608.38–$2,285.06	43% above	20%
Lumpectomy (partial mastectomy) CPT 19301 19301 MASTECTOMY PARTIAL EG LUMPECTOMY TYLECTOMY QUADRANTECTOMY	$1,217.87	$1,522.34	$631.59–$2,002.09	74% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 EXCISION BENIGN LESION INCLUDING MARGINS EXCEPT SKIN TAG	$332.07	$415.09	$120.79–$415.09	51% below	20%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 EXCISION BENIGN LESION INCLUDING MARGINS TRUNK ARMS OR LEGS < 0.5CM	$332.07	$415.09	$184.13–$415.09	51% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 EXCISION BENIGN LESION INCLUDING MARGINS FACE EARS EYELID	$365.86	$457.32	$202.87–$457.32	46% below	20%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 11440 EXCISION OTHER BENIGN LESION INCLUDING MARGINS EXCEPT SKIN TAG	$372.45	$465.56	$134.04–$465.56	45% below	20%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION OF NAIL PLATE PARTIAL OR COMPLETE SIMPLE SINGLE UC	$249.60	$312.00	$71.09–$280.80	28% below	20%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION OF NAIL PLATE PARTIAL OR COMPLETE SIMPLE SINGLE	$291.70	$364.62	$71.09–$328.16	16% below	20%
Paracentesis with imaging guidance CPT 49083 49083 ABD PARACENTESIS W/IMAGING CHARGE	$468.86	$586.07	$259.98–$586.07	50% below	20%
Paracentesis with imaging guidance CPT 49083 US PARACENTESIS - REPORT	$785.27	$981.59	$435.43–$883.43	16% below	20%
Paracentesis with imaging guidance CPT 49083 49083 ABDOMINAL PARACENTESIS DIAGNOSTIC OR THERAPEUTIC WITH IMAGING	$794.34	$992.92	$268.05–$893.63	15% below	20%
Paracentesis with imaging guidance CPT 49083 US PARACENTESIS	$1,902.62	$2,378.27	$445.13–$2,140.44	103% above	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION OF NAIL AND NAIL MATRIX PARTIAL OR COMPLETE EG	$402.11	$502.64	$150.16–$502.64	12% below	20%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION OF NAIL AND NAIL MATRIX PARTIAL OR COMPLETE FOR PERMANENT REMOVAL	$414.47	$518.09	$229.82–$518.09	9% below	20%
Removal of a breast lump, open surgery CPT 19120 19120 EXCISION OF CYST FIBROADENOMA OR OTHER BENIGN OR MALIGNANT TUMOR	$1,210.46	$1,513.07	$555.34–$2,002.09	54% below	20%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION AND REMOVAL OF FOREIGN BODY SUBCUTANEOUS TISSUES SIMPLE	$391.40	$489.25	$217.03–$440.33	42% below	20%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW TO FINGER SHORT ARM	$227.42	$284.28	$126.11–$284.28	1% above	20%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM TECHFEE	$652.61	$815.76	$189.73–$734.18	190% above	20%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION OF SHORT ARM SPLINT FOREARM TO HAND STATIC	$169.74	$212.18	$94.12–$212.18	48% below	20%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TECHFEE	$315.59	$394.49	$158.03–$355.04	3% below	20%
Short leg cast (below the knee) CPT 29405 29405 APPLICATION OF SHORT LEG CAST BELOW KNEE TO TOES	$211.77	$264.71	$117.43–$264.71	1% below	20%
Short leg cast (below the knee) CPT 29405 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TECHFEE	$652.61	$815.76	$189.73–$734.18	205% above	20%
Short leg splint (calf to foot) CPT 29515 29515 ? APPLICATION OF SHORT LEG SPLINTá	$184.58	$230.72	$85.24–$207.65	35% below	20%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TECHFEE	$397.17	$496.46	$85.24–$446.81	40% above	20%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 29824 ARTHROSCOPY SHOULDER SURGICAL DISTAL CLAVICULECTOMY INCLUDING	$1,221.99	$1,527.49	$626.91–$2,420.12	75% below	20%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 29826 ARTHROSCOPY SHOULDER SURGICAL DECOMPRESSION OF SUBACR	$476.27	$595.34	$149.00–$3,948.72	92% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR OF WOUNDS SCALP NECK AXILLAE GENITALIA TRUNK	$242.26	$302.82	$118.15–$272.54	34% below	20%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP NECK AXILLAE EXTERNAL	$247.20	$309.00	$108.42–$278.10	33% below	20%
Skin biopsy, punch, one lesion CPT 11104 11104 PUNCH BX SKIN SINGLE LESION	$318.06	$397.58	$114.28–$374.78	27% below	20%
Skin biopsy, punch, one lesion CPT 11104 11104 PUNCH BIOPSY OF SKIN INCLUDING SIMPLE CLOSURE WHEN PERFORMED	$323.83	$404.79	$179.56–$374.78	25% below	20%
Skin biopsy, punch, one lesion CPT 11104 11104 PUNCH BIOPSY OF SKIN SINGLE LESION WOUND	$1,014.34	$1,267.93	$211.74–$1,141.14	134% above	20%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 11600 EXCISION MALIGNANT LESION INCLUDING MARGINS TRUNK ARMS OR LEGS < 0.5CM	$500.17	$625.21	$277.34–$663.50	34% below	20%
Skin tag removal, up to 15 tags CPT 11200 11200 REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS TAGS ANY AREA	$236.49	$295.61	$118.15–$266.05	23% below	20%
Skin tag removal, up to 15 tags CPT 11200 11200 REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS TAGS ANY AREA UP TO	$236.49	$295.61	$87.51–$266.05	23% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNC LUMB DIA CHARGE	$477.10	$596.37	$264.55–$536.73	44% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 ANES LUMBAR PUNCTURE	$477.10	$596.37	$264.55–$536.73	44% below	20%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TECHFEE	$700.40	$875.50	$301.07–$787.95	18% below	20%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP NECK AXILLAE EXTERNAL	$301.58	$376.98	$118.15–$339.28	25% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR FACE EARS EYELIDS NOSELIPS MUCOUS MEMB <2.5CM	$282.80	$353.50	$118.15–$318.15	16% below	20%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR OF WOUNDS OF FACE EARS EYELIDS NOSE LIPS MUCOUS	$296.64	$370.80	$118.15–$333.72	12% below	20%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 TANGENTIAL BIOPSY OF SKIN EG SHAVE SCOOP SAUCERIZE CURETTE SINGLE LESION	$261.21	$326.51	$144.84–$326.51	62% below	20%
Thoracentesis with imaging guidance CPT 32555 32555 THORACENTESIS NEEDLE OR CATHETER ASPIRATION OF THE PLEURAL SPACE	$888.27	$1,110.34	$293.37–$999.31	23% below	20%
Thoracentesis with imaging guidance CPT 32555 32555 THORACENTESIS ASP W/IMAGING CHARGE	$1,229.41	$1,536.76	$467.76–$1,383.08	6% above	20%
Total hip replacement CPT 27130 27130 ARTHROPLASTY ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC	$2,341.81	$2,927.26	$1,156.97–$14,280.85	84% below	20%
Total knee replacement CPT 27447 27447 ARTHROPLASTY KNEE CONDYLE AND PLATEAU MEDIAL AND LATERAL	$2,340.16	$2,925.20	$1,154.23–$11,783.08	87% below	20%
Total shoulder replacement CPT 23472 23472 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER GLENOID	$2,626.91	$3,283.64	$1,293.56–$21,307.54	86% below	20%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 INJECTION S SINGLE OR MULTIPLE TRIGGER POINT S 1 OR 2 MUSCLE S	$144.20	$180.25	$79.96–$206.74	75% below	20%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 58670 LAPAROSCOPY SURGICAL WITH FULGURATION OF OVIDUCTS WITH	$1,033.30	$1,291.62	$572.96–$3,788.76	91% below	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY RIGHT - REPORT	$2,294.84	$2,868.55	$781.44–$2,581.70	14% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY LEFT - REPORT	$2,294.84	$2,868.55	$781.44–$2,581.70	14% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY LEFT	$3,161.69	$3,952.11	$781.44–$3,556.90	56% above	20%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US BREAST BIOPSY RIGHT	$3,161.69	$3,952.11	$781.44–$3,556.90	56% above	20%
Upper endoscopy (EGD) with biopsy CPT 43239 43239 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY	$1,006.10	$1,257.63	$393.10–$1,252.20	26% below	20%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 43251 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL WITH REMOVAL	$519.12	$648.90	$287.85–$707.46	73% below	20%
Upper endoscopy (EGD), diagnostic CPT 43235 43235 ESOPHAGOGASTRODUODENOSCOPY FLEXIBLE TRANSORAL DIAG	$739.95	$924.94	$303.80–$924.94	39% below	20%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 59610 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE VAGINAL DELIVERY	$4,595.45	$5,744.31	$2,548.18–$5,169.88	at median	20%
Vaginal delivery, including prenatal and postpartum care CPT 59400 59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE VAGINAL DELIVERY	$4,007.94	$5,009.92	$2,222.40–$4,508.93	35% above	20%
Vaginal delivery, including prenatal and postpartum care CPT 59400 59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE VAGINAL	$4,007.94	$5,009.92	$2,222.40–$4,508.93	35% above	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 VASECTOMY UNILATERAL OR BILATERAL SEPARATE PROCEDURE INCLUDING	$930.30	$1,162.87	$331.03–$1,883.36	—	20%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 55250 VASECTOMY UNILATERAL OR BILATERAL INCLUDING POSTOPERATIVE SEMEN	$961.61	$1,202.01	$533.21–$1,883.36	—	20%
Wart removal, up to 14 warts CPT 17110 17110 DESTRUCTION EG LASER SURGERY ELECTROSURGERY CRYOSURGERY CHEMOSUR	$290.87	$363.59	$104.54–$327.23	36% above	20%
Wart removal, up to 14 warts CPT 17110 17110 DESTRUCTION OF BENIGN LESIONS 1-14 LESIONS	$290.87	$363.59	$118.15–$327.23	36% above	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE INCLUDES EPIDERMIS AND DERMIS	$332.07	$415.09	$125.55–$400.63	71% below	20%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEB SUBQ TIS 20 SQ CM/<	$1,014.34	$1,267.93	$226.34–$1,141.14	11% below	20%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 25607 OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE	$1,330.76	$1,663.45	$683.20–$5,296.10	80% below	20%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs New Mexico	Off list
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD ADMIN FEE CHARGE	$1,301.10	$1,626.37	$273.47–$1,524.92	97% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSF 1-2UNIT	$1,355.48	$1,694.35	$273.47–$1,524.92	106% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE RED BLOOD CELLS BRIDGE	$1,355.48	$1,694.35	$273.47–$1,524.92	106% above	20%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE PLATELET PRODUCT BRIDGE	$1,355.48	$1,694.35	$273.47–$1,524.92	106% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 AIRWAY INHALATION TREATMENT	$44.50	$55.62	$24.67–$197.47	64% below	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT AEROSOL SUBSEQUENT CHARGE	$223.30	$279.13	$123.82–$280.16	82% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 MED NEB SUBSEQUENT CHARGE	$223.30	$279.13	$123.82–$280.16	82% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT AEROSOL INITIAL CHARGE	$224.13	$280.16	$123.82–$280.16	82% above	20%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 94640 MED NEB INITIAL CHARGE	$224.13	$280.16	$123.82–$280.16	82% above	20%
Comprehensive eye exam, returning patient CPT 92014 92014 OPHTHALMOLOGICAL SERVICES MEDICAL EXAMINATION AND EVALUATION WITH	$331.25	$414.06	$83.62–$372.65	—	20%
Critical care, first 30 to 74 minutes CPT 99291 99291 FACILITY LEVEL CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$2,346.75	$2,933.44	$594.46–$2,640.10	14% above	20%
EEG (brain wave test), awake and drowsy, routine CPT 95816 95816 EEG AWAKE AND DROWSY	$1,065.43	$1,331.79	$194.47–$1,198.61	18% above	20%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 93000 EKG W/ 12+ LEADS TRACING/INTERP/REPORT	$45.32	$56.65	$25.13–$50.99	43% below	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC	$253.79	$317.24	$94.13–$285.52	40% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG W/ 12+ LEADS TRACING ONLY	$253.79	$317.24	$94.13–$285.52	40% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG TRACING ONLY	$253.79	$317.24	$94.13–$285.52	40% above	20%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 CV ECG ACQUISITION	$253.79	$317.24	$94.13–$285.52	40% above	20%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 ED VISIT FOR EANDM PATIENT LEV 1 MAY NOT REQ PRESENCE OF PHYSICIAN	$219.18	$273.98	$63.79–$246.58	15% above	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282-EANDM REQ. A MEDICALLY APPROPRIATE HX AND/OR EXAM AND STRAIGHTFORWARD	$114.54	$143.17	$63.51–$143.17	49% below	20%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 ED VISIT EANDM PATIENT LEV 2 REQ MED APPROP HSTRY/EXAM/MDM CC	$351.02	$438.78	$105.42–$394.90	57% above	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283-EANDM REQ. A MEDICALLY APPROPRIATE HX AND/OR EXAM AND LOW LEVEL MEDICAL	$196.11	$245.14	$108.74–$245.14	63% below	20%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 ED VISIT EANDM PATIENT LEV 3 REQ MED APPROP HSTRY/EXAM/LOW MDM CC	$528.18	$660.23	$168.22–$594.21	1% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284-EANDM REQ. A MEDICALLY APPROPRIATE HX AND/OR EXAM AND MODERATE LEVEL	$328.78	$410.97	$182.31–$410.97	62% below	20%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 ED VISIT EANDM PATIENT LEV 4 REQ MED APPROP HSTRY/EXAM/MODERATE MDM CC	$1,083.56	$1,354.45	$267.80–$1,219.01	26% above	20%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 ED VISIT E M PATIENT LEV 5 REQ MED APPROP HSTRY/EXAM/HIGH MDM CC	$1,793.85	$2,242.31	$395.68–$2,018.08	27% above	20%
Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIAC STRESS TEST	$1,051.42	$1,314.28	$285.54–$1,182.85	81% above	20%
Family therapy with the patient, 50 minutes CPT 90847 90847 FAMILY PSYCHOTHERAPY W/ PATIENT PRESENT CONJOINT	$185.40	$231.75	$102.80–$231.75	at median	20%
Family therapy without the patient, 50 minutes CPT 90846 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT	$267.80	$334.75	$148.50–$316.45	51% above	20%
Group psychotherapy session CPT 90853 90853 GROUP PSYCHOTHERAPY OTHER THAN OF A MULTIPLE-FAMILY GROUP	$76.63	$95.79	$42.49–$95.79	23% below	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV INFUSION HYDRATION INITIAL 31 MINUTES TO 1 HOUR	$468.00	$585.00	$90.83–$526.50	29% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 HYDRATE IV INFUSE 1ST HR CHARGE	$530.66	$663.32	$90.83–$596.99	46% above	20%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 - ED HYDRATION FIRST HOUR	$530.66	$663.32	$90.83–$596.99	46% above	20%
IV infusion of a medicine, first hour CPT 96365 96365 IV INFUSION FOR THERAPY/PROPHYLAXIS OR DIAGNOSIS INITAL UP TO ONE HOUR	$458.40	$573.00	$152.14–$515.70	3% above	20%
IV infusion of a medicine, first hour CPT 96365 96365 IN INFUSION INTIAL UP TO 1HR CHARGE	$519.12	$648.90	$152.14–$584.01	16% above	20%
IV infusion of a medicine, first hour CPT 96365 96365- ED IV TX FIRST HOUR	$519.12	$648.90	$152.14–$584.01	16% above	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJECTION SUBCUTANEOUS	$80.00	$100.00	$30.80–$90.00	32% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJECTION SUBC	$80.00	$100.00	$30.80–$90.00	32% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJ IM OR SUBQ CHARGE	$90.64	$113.30	$30.80–$101.97	23% below	20%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 ED SUBQ/IM INJECTION	$90.64	$113.30	$30.80–$101.97	23% below	20%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION	$226.60	$283.25	$124.96–$254.93	4% below	20%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 NERVE CONDUCTION STUDIES 7-8 STUDIES	$456.50	$570.62	$48.90–$513.56	39% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSCULAR REEDUCATION CHARGES	$117.01	$146.26	$56.92–$131.63	8% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMUSCULAR REEDUCATION ASSIST UNIT	$117.01	$146.26	$56.92–$131.63	8% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION CHARGES	$117.01	$146.26	$56.92–$131.63	8% above	20%
Neuromuscular re-education, 15 minutes CPT 97112 OT NEUROMUSCULAR REEDUCATION ASSIST UNIT	$117.01	$146.26	$56.92–$131.63	8% above	20%
New patient office visit, about 30 minutes CPT 99203 99203 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 3 30-44 MIN	$286.75	$358.44	$159.00–$322.60	55% above	20%
New patient office visit, about 30 minutes CPT 99203 99203 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 3 - 30-44 MIN	$286.75	$358.44	$159.00–$322.60	55% above	20%
New patient office visit, about 30 minutes CPT 99203 99203 OFFICE VISIT NEW PT LEVEL 3	$286.75	$358.44	$159.00–$322.60	55% above	20%
New patient office visit, about 30 minutes CPT 99203 44187 OUTPATIENT REMOTE E/M CONSULT COMPREHENSIVE - 30 MINUTES CMS	$435.07	$543.84	$241.25–$489.46	135% above	20%
New patient office visit, about 30 minutes CPT 99203 99203 OUTPATIENT REMOTE E/M CONSULT COMPREHENSIVE - 30 MINUTES CMS	$435.07	$543.84	$241.25–$489.46	135% above	20%
New patient office visit, about 45 minutes CPT 99204 99204 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 4 45-59 MIN	$440.84	$551.05	$244.45–$495.95	52% above	20%
New patient office visit, about 45 minutes CPT 99204 99204 OFFICE VISIT NEW PT LEVEL 4	$440.84	$551.05	$244.45–$495.95	52% above	20%
New patient office visit, about 45 minutes CPT 99204 99204 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 4 - 45-59 MIN	$440.84	$551.05	$233.64–$495.95	52% above	20%
New patient office visit, about 60 minutes CPT 99205 99205 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 5 60 MIN	$558.67	$698.34	$309.78–$628.51	57% above	20%
New patient office visit, about 60 minutes CPT 99205 99205 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 5 - 60-74 MIN	$558.67	$698.34	$233.64–$628.51	57% above	20%
New patient office visit, about 60 minutes CPT 99205 99205 OFFICE VISIT NEW PT LEVEL 5	$558.67	$698.34	$309.78–$628.51	57% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OPIB 20 MINUTES NEW PT	$190.34	$237.93	$31.53–$214.14	74% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OFFICE VISIT NEW PT. LEVEL 2	$201.88	$252.35	$111.94–$227.12	84% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 2 15-29 MINS	$201.88	$252.35	$111.94–$227.12	84% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OFFICE/OUTPATIENT VISIT - NEW PATIENT LEVEL 2 - 15-29 MIN	$201.88	$252.35	$111.94–$233.64	84% above	20%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 OUTPATIENT REMOTE E/M CONSULT LIMITED - 15 MINUTES CMS	$435.07	$543.84	$241.25–$489.46	297% above	20%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 MEDICAL NUTRITION THERAPY INITIAL ASSESSMENT AND INTERVENTION EACH 15 MIN	$98.06	$122.57	$54.37–$110.31	71% above	20%
Occupational therapy evaluation, low complexity CPT 97165 OT LOW COMPLEX UNITS	$190.34	$237.93	$105.55–$237.93	17% below	20%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT HIGH COMPLEX UNITS	$374.10	$467.62	$170.06–$420.86	1% above	20%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT LOW COMPLEX UNITS	$190.34	$237.93	$105.55–$237.93	21% below	20%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT MODERATE COMPLEX UNITS	$279.34	$349.17	$154.89–$314.25	7% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL THERAPY ASSISTANT UNITS	$131.84	$164.80	$45.84–$148.32	26% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY CHARGE UNITS	$131.84	$164.80	$45.84–$148.32	26% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY CHARGE UNITS	$131.84	$164.80	$45.84–$148.32	26% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL TRACTION CHARGE	$131.84	$164.80	$45.84–$148.32	26% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 OT MANUAL THERAPY ASSISTANT UNITS	$131.84	$164.80	$45.84–$148.32	26% above	20%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT MANUAL TRACTION ASSISTANT UNITS	$131.84	$164.80	$45.84–$148.32	26% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISE CHARGES	$127.72	$159.65	$49.69–$143.69	25% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE CHARGES	$127.72	$159.65	$49.69–$143.69	25% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 OT THERAPEUTIC EXERCISE ASSISTANT UNITS	$127.72	$159.65	$49.69–$143.69	25% above	20%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT THERAPEUTIC EXERCISE ASSIT UNITS	$127.72	$159.65	$49.69–$143.69	25% above	20%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 PREVENTIVE EVALUATION NEW PT 18-39 YRS	$126.90	$158.62	$70.36–$158.62	27% below	20%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 PREVENTIVE EVAL INITIAL NEW PT. 18-39 YEAR AGE	$126.90	$158.62	$70.36–$158.62	27% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 PREVENTIVE EVAL INITIAL NEW PT. 40-64 YEAR AGE	$126.90	$158.62	$70.36–$142.76	31% below	20%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 PREVENTIVE EVALUATION NEW PT 40-64 YRS	$126.90	$158.62	$70.36–$142.76	31% below	20%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 PREVENTIVE EVALUATION NEW PT 65+ YRS	$126.90	$158.62	$70.36–$142.76	at median	20%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 PREVENTIVE EVAL INITIAL NEW PT. > 65 YEAR AGE	$126.90	$158.62	$70.36–$142.76	at median	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 PREVENTIVE EVALUATION ESTABLISHED PT 18-39 YRS	$126.90	$158.62	$70.36–$158.62	13% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395S PREVENTIVE EVALUATION ESTABLISHED PT 18-39 YRS	$126.90	$158.62	$70.36–$158.62	13% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395F PREVENTIVE EVALUATION ESTABLISHED PT 18-39 YRS	$126.90	$158.62	$70.36–$158.62	13% below	20%
Preventive checkup, returning patient aged 18–39 CPT 99395 99395 PREVENTIVE EVAL EST PT. 18-39 YEAR AGE	$126.90	$158.62	$70.36–$158.62	13% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396F PREVENTIVE EVALUATION ESTABLISHED PT 40-64 YRS	$126.90	$158.62	$70.36–$142.76	17% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 PREVENTIVE EVAL EST PT. 40-64 YEAR AGE	$126.90	$158.62	$70.36–$142.76	17% below	20%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 PREVENTIVE EVALUATION ESTABLISHED PT 40-64 YRS	$126.90	$158.62	$70.36–$142.76	17% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 PREVENTIVE EVALUATION ESTABLISHED PT 65+ YRS	$126.90	$158.62	$70.36–$142.76	24% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397F PREVENTIVE EVALUATION ESTABLISHED PT 65+ YRS	$126.90	$158.62	$70.36–$142.76	24% below	20%
Preventive checkup, returning patient aged 65 or older CPT 99397 99397 PREVENTIVE EVAL EST PT. >65 YEAR AGE	$126.90	$158.62	$70.36–$142.76	24% below	20%
Psychiatric evaluation with medical services CPT 90792 90792 PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES	$280.16	$350.20	$124.96–$315.18	7% above	20%
Psychotherapy session, 30 minutes CPT 90832 90832 PSYCHOTHERAPY 30 MIN WITH PATIENT	$166.45	$208.06	$92.30–$233.64	20% above	20%
Psychotherapy session, 30 minutes CPT 90832 90832 PSYCHOTHERAPY 30 MIN CHARGE	$191.17	$238.96	$92.30–$233.64	38% above	20%
Psychotherapy session, 30 minutes CPT 90832 90832 PSYCHOTHERAPY 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER	$201.06	$251.32	$92.30–$233.64	45% above	20%
Psychotherapy session, 45 minutes CPT 90834 90834 PSYCHOTHERAPY 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER	$221.66	$277.07	$122.91–$249.36	30% above	20%
Psychotherapy session, 45 minutes CPT 90834 90834 PSYCHOTHERAPY 45 MIN CHARGE	$253.79	$317.24	$140.73–$317.24	49% above	20%
Psychotherapy session, 60 minutes CPT 90837 90837 PSYCHOTHERAPY 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER	$332.90	$416.12	$124.96–$374.51	45% above	20%
Psychotherapy session, 60 minutes CPT 90837 90837 PSYCHOTHERAPY 60 MIN CHARGE	$379.86	$474.83	$174.94–$474.83	66% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 SMOKING AND TOBACCO CESSATION COUNSEL VISIT INTERMEDIATE 3-10 MINUTES	$36.26	$45.32	$20.10–$45.32	14% above	20%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 99406 SMOKING/TOBACCO CESSATION COUNSELING 3-10 MIN	$36.26	$45.32	$20.10–$44.88	14% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENTLEVEL 5 40-54 MIN	$389.75	$487.19	$216.12–$438.47	55% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 OFFICE VISIT ESTABLISHED PT LEVEL 5	$389.75	$487.19	$216.12–$438.47	55% above	20%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENT LEVEL 5 40-54 MIN .	$389.75	$487.19	$216.12–$438.47	55% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 OFFICE VISIT ESTABLISHED PT LEVEL 3	$198.58	$248.23	$110.11–$223.41	39% above	20%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENT LEVEL 3	$198.58	$248.23	$110.11–$223.41	39% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 OFFICE VISIT ESTABLISHED PT LEVEL 4	$289.22	$361.53	$160.37–$325.38	51% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENT LEVEL 4	$289.22	$361.53	$160.37–$325.38	51% above	20%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENTLEVEL 4 30-39 MIN	$289.22	$361.53	$160.37–$325.38	51% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 SPORTS PHYSICAL	$18.13	$22.66	$10.05–$199.31	77% below	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENT LEVEL 2	$146.67	$183.34	$81.33–$165.01	82% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 OFFICE VISIT ESTABLISHED PT LEVEL 2	$177.16	$221.45	$10.05–$199.31	120% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 OFFICE/OUTPATIENT VISIT - ESTABLISHED PATIENTLEVEL 2 10-19 MIN	$177.16	$221.45	$98.24–$221.45	120% above	20%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 FACILITY FEE-WOUND CARE	$317.24	$396.55	$175.91–$356.90	295% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 OFFICE CONSULTATION LEVEL 3	$269.45	$336.81	$149.41–$303.13	63% above	20%
Specialist consultation, low complexity or 30+ minutes CPT 99243 99243 OFFICE CONSULT NEW OR EST. L3 PT 40 MIN	$269.45	$336.81	$149.41–$303.13	63% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 OFFICE CONSULT NEW OR EST. L4 PT 60 MIN	$435.07	$543.84	$241.25–$489.46	58% above	20%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 99244 OFFICE CONSULTATION LEVEL 4	$435.07	$543.84	$241.25–$489.46	58% above	20%
Speech and language evaluation CPT 92523 SPEECH SOUND PROD W/ LANGUAGE CHARGE	$380.69	$475.86	$141.48–$428.27	20% above	20%
Speech therapy session, individual CPT 92507 TX OF SPEECH/LANG/VOICE/COMM/AUDITORY CHG	$261.21	$326.51	$70.52–$293.86	22% above	20%
Spirometry (breathing test) CPT 94010 SPIROMETRY POC	$65.10	$81.37	$36.10–$355.97	64% below	20%
Spirometry (breathing test) CPT 94010 RT CHARGE PFT -> SPIROMETRY	$316.42	$395.52	$36.10–$355.97	73% above	20%
Spirometry before and after a bronchodilator CPT 94060 RT CHARGE PFT -> SPIROMETRY BEFORE AND AFTER	$582.57	$728.21	$20.10–$655.39	56% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES CHARGE	$128.54	$160.68	$33.95–$144.61	12% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACTIVITIES CHARGES	$128.54	$160.68	$33.95–$144.61	12% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT THERAPEUTIC ACTIVITIES ASSISTANT UNITS	$128.54	$160.68	$33.95–$144.61	12% above	20%
Therapeutic activities (functional training), 15 minutes CPT 97530 PT THERAPEUTIC ACTIVITY ASSISTANT UNITS	$128.54	$160.68	$33.95–$144.61	12% above	20%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPEUTIC PHLEBOTOMY	$238.96	$298.70	$94.55–$268.83	33% above	20%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs New Mexico	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 INFLUENZA VACCINE INACTIVATED IIV SUBUNIT ADJUVANTED FOR INTRA	$47.52	$59.40	$26.35–$53.46	49% below	20%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 90653 INFLUENZA VACCINE INACTIVATED IIV SUBUNIT ADJUVANTED FOR INTRA	$47.52	$59.40	$26.35–$53.46	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 91320 COVID-19 VACCINE NON-VFC	$332.74	$415.92	$184.50–$1,095.27	92% above	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 COMIRNATY VACCINE MRNA HOSPITAL 12 YO +	$973.58	$1,216.97	$184.50–$1,095.27	462% above	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 91320 COVID-19 VACCINE NON-VFC	$332.74	$415.92	$184.50–$1,095.27	—	20%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 COMIRNATY VACCINE MRNA HOSPITAL 12 YO +	$973.58	$1,216.97	$184.50–$1,095.27	—	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 90716 VARICELLA VIRUS VACCINE LIVE FOR SUBCUTANEOUS USE	$196.80	$246.00	$109.13–$221.40	26% below	20%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE SUBQ INJ	$212.54	$265.68	$117.86–$239.11	20% below	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 90716 VARICELLA VIRUS VACCINE LIVE FOR SUBCUTANEOUS USE	$196.80	$246.00	$109.13–$221.40	—	20%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE SUBQ INJ	$212.54	$265.68	$117.86–$239.11	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 90656 INFLUENZA VIRUS VACCINE INACTIVATED PF TRIVALENT FLUARIX 0.5ML DOSAGE	$52.86	$66.07	$29.09–$168.19	15% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLUARIX STANDARD DOSE	$149.50	$186.88	$29.09–$168.19	224% above	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 90656 INFLUENZA VIRUS VACCINE INACTIVATED PF TRIVALENT FLUARIX 0.5ML DOSAGE	$52.86	$66.07	$29.09–$168.19	—	20%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUARIX STANDARD DOSE	$149.50	$186.88	$29.09–$168.19	—	20%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 90651 VACCINE- GARDASIL 9	$424.80	$531.00	$235.55–$477.90	1% above	20%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 90651 VACCINE- GARDASIL 9	$424.80	$531.00	$235.55–$477.90	—	20%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 90636 HEPATITIS A AND HEPATITIS B VACCINE HEPA-HEPB ADULT DOSAGE	$300.00	$375.00	$16.92–$337.50	40% above	20%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 90636 HEPATITIS A AND HEPATITIS B VACCINE HEPA-HEPB ADULT DOSAGE	$300.00	$375.00	$16.92–$337.50	—	20%
Hepatitis A vaccine, adult dose CPT 90632 90632 HEPATITIS A VACCINE ADULT DOSAGE FOR INTRAMUSCULAR USE	$160.00	$200.00	$88.72–$180.00	25% above	20%
Hepatitis A vaccine, adult dose inpatient CPT 90632 90632 HEPATITIS A VACCINE ADULT DOSAGE FOR INTRAMUSCULAR USE	$160.00	$200.00	$88.72–$180.00	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 90746 VACCINE - HEPATITIS B ADULT VACCINE	$168.00	$210.00	$73.76–$189.00	78% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B ADULT VACCINE 10 MCG/ML SUS	$231.37	$289.21	$73.76–$260.29	145% above	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 90746 VACCINE - HEPATITIS B ADULT VACCINE	$168.00	$210.00	$73.76–$189.00	—	20%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B ADULT VACCINE 10 MCG/ML SUS	$231.37	$289.21	$73.76–$260.29	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 INFLUENZA VIRUS VACCINE HIGH DOSE INACTIVATED PF TRIVALENT	$151.77	$189.71	$58.84–$351.72	65% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLUZONE HIGH DOSE	$312.64	$390.80	$58.84–$351.72	240% above	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 INFLUENZA VIRUS VACCINE HIGH DOSE INACTIVATED PF TRIVALENT	$151.77	$189.71	$58.84–$351.72	—	20%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE HIGH DOSE	$312.64	$390.80	$58.84–$351.72	—	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 90707 MEASLES MUMPS AND RUBELLA VIRUS VACCINE MMR LIVE FOR SUBCUTANEOUS USE	$120.00	$150.00	$66.54–$135.00	6% below	20%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES/MUMPS/RUBELLA VIRUS VACCINE SUBQ INJ	$219.94	$274.92	$121.95–$247.43	73% above	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 90707 MEASLES MUMPS AND RUBELLA VIRUS VACCINE MMR LIVE FOR SUBCUTANEOUS USE	$120.00	$150.00	$66.54–$135.00	—	20%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES/MUMPS/RUBELLA VIRUS VACCINE SUBQ INJ	$219.94	$274.92	$121.95–$247.43	—	20%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 90734 MENINGOCOCCAL CONJUGATE VACCINE QUADRIVALENT FOR INTRAMUSCULAR USE	$312.00	$390.00	$112.58–$351.00	102% above	20%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 90734 MENINGOCOCCAL CONJUGATE VACCINE QUADRIVALENT FOR INTRAMUSCULAR USE	$312.00	$390.00	$112.58–$351.00	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE	$716.76	$895.95	$0.01–$1,107.40	72% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE - SUS	$984.35	$1,230.44	$0.01–$1,107.40	136% above	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE	$716.76	$895.95	$0.01–$1,107.40	—	20%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE - SUS	$984.35	$1,230.44	$0.01–$1,107.40	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE 23-VALENT FOR SUBC	$288.00	$360.00	$118.62–$324.00	71% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL 23-VALENT VACCINE INJ SOL 0 ML	$312.39	$390.49	$118.62–$351.44	85% above	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 90732 PNEUMOCOCCAL POLYSACCHARIDE VACCINE 23-VALENT FOR SUBC	$288.00	$360.00	$118.62–$324.00	—	20%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL 23-VALENT VACCINE INJ SOL 0 ML	$312.39	$390.49	$118.62–$351.44	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV VACCINE PREF A-PREF B RECOMBINANT PRESERVATIVE-FREE 60 MCG-60 MCG INJ	$583.39	$729.24	$0.01–$656.32	11% below	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 HOSPITAL NIRSEVIMAB CVX 306 ALIP PRESERVATIVE-FREE 50 MG/0.5 ML SOL[CIBO]	$1,957.82	$2,447.28	$1,085.61–$2,202.55	200% above	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 RSV VACCINE PREF A-PREF B RECOMBINANT PRESERVATIVE-FREE 60 MCG-60 MCG INJ	$583.39	$729.24	$0.01–$656.32	—	20%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 HOSPITAL NIRSEVIMAB CVX 306 ALIP PRESERVATIVE-FREE 50 MG/0.5 ML SOL[CIBO]	$1,957.82	$2,447.28	$1,085.61–$2,202.55	—	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTH TOXOIDS TD ADULT/ADOL 5 UNITS-2 UNITS/0.5 ML	$179.51	$224.39	$99.54–$201.95	200% above	20%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTH TOXOIDS TD ADULT/ADOL 5 UNITS-2 UNITS/0.5 ML	$179.51	$224.39	$99.54–$201.95	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 90715 TDAP WHEN ADMINISTERED TO INDIVIDUALS 7 YEARS OR OLDER FOR INTRAMUSCULAR	$84.00	$105.00	$46.58–$94.50	at median	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPHTHERIA/PERTUSSIS ACEL ADACEL	$111.30	$139.13	$61.72–$188.48	32% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS/DIPHTHERIA/PERTUSSIS ACEL TDAP	$167.54	$209.42	$61.72–$188.48	99% above	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 90715 TDAP WHEN ADMINISTERED TO INDIVIDUALS 7 YEARS OR OLDER FOR INTRAMUSCULAR	$84.00	$105.00	$46.58–$94.50	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPHTHERIA/PERTUSSIS ACEL ADACEL	$111.30	$139.13	$61.72–$188.48	—	20%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS/DIPHTHERIA/PERTUSSIS ACEL TDAP	$167.54	$209.42	$61.72–$188.48	—	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IMMUNIZATION ADMINISTRATION FIRST VACCINE	$16.00	$20.00	$8.87–$30.80	65% below	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 ADM VACCINE SINGLE CHARGE.	$45.32	$56.65	$25.13–$54.53	at median	20%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TECHFEE	$45.32	$56.65	$25.13–$54.53	at median	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 IMMUNIZATION ADMINISTRATION EACH ADDITIONAL VACCINE	$16.00	$20.00	$8.87–$30.80	36% below	20%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472ááIM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TECHFEE	$45.32	$56.65	$25.13–$54.53	82% above	20%

Dental

Procedure	Cash price	List price	Insurers pay	vs New Mexico	Off list
Deep cleaning (scaling and root planing), 4 or more teeth in one quadrant CDT D4341 D4341 DDS PERIO4OR>PERQUAD	$819.06	$1,023.82	$276.00–$921.44	—	20%
Removal of an impacted tooth fully covered by bone, often a wisdom tooth CDT D7240 D7240 DDS IMPCT TOOTH REMO	$819.06	$1,023.82	$276.00–$921.44	—	20%
Simple extraction of a tooth or exposed root that is above the gum CDT D7140 D7140 DDS SIMPLE EXTRACT	$819.06	$1,023.82	$276.00–$921.44	at median	20%

Source file: https://cibolahospital.com/wp-content/uploads/2026/03/cibola-general-hospital_standardcharges-03-2026.csv