Hospital

Shoshone Medical Center

Listed in its price file as “West Shoshone Hospital District”.

Shoshone Medical Center in Kellogg, ID publishes cash prices for 294 common procedures listed here, from its own machine-readable price file updated Sep 29, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Idaho median for 163 of 289 procedures and below it for 122. By typical cash price it ranks #22 of 33 Idaho hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

25 Jacobs Gulch Rd, Kellogg, ID 83837 Collected Oct 31, 2026 Source price file Check a bill from this hospital (208) 784-1221

Critical access hospital (rural, 25 beds or fewer) Government-owned hospital Emergency department CMS star rating 3 of 5 CCN 131314 · CMS hospital register NPI 1043215437

Financial assistance

Public hospital: ask for its charity care or sliding-scale discount

Shoshone Medical Center is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Abdominal CT scan without and with contrast CPT 74170 74170 CT Abdomen w/ + w/o Contrast: AddOn	$1,607.25	$2,143.00	—	28% above	25%
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast	$1,607.25	$2,143.00	—	28% above	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Contrast	$1,607.25	$2,143.00	—	—	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 74170 CT Abdomen w/ + w/o Contrast: AddOn	$1,607.25	$2,143.00	—	—	25%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views	$231.75	$309.00	—	23% below	25%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views	$231.75	$309.00	—	—	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 Arterial Extermity Study -2 levels Charge	$311.25	$415.00	$178.45–$394.25	25% below	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 93922 Arterial Extermity Study -2 levels Charge	$311.25	$415.00	$178.45–$394.25	—	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$369.00	$492.00	—	12% below	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$369.00	$492.00	—	—	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 74174 CT Angio Abdomen and Pelvis: AddOn	$1,995.00	$2,660.00	—	12% below	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen and Pelvis	$1,995.00	$2,660.00	—	12% below	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 74174 CT Angio Abdomen and Pelvis: AddOn	$1,995.00	$2,660.00	—	—	25%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen and Pelvis	$1,995.00	$2,660.00	—	—	25%
CT angiography (CTA) of the head CPT 70496 CT Angio Brain/Head	$1,517.25	$2,023.00	—	5% above	25%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Brain/Head	$1,517.25	$2,023.00	—	—	25%
CT angiography (CTA) of the neck CPT 70498 70498 CT Angio Neck: AddOn	$1,530.00	$2,040.00	—	4% above	25%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck	$1,530.00	$2,040.00	—	4% above	25%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck	$1,530.00	$2,040.00	—	—	25%
CT angiography (CTA) of the neck inpatient CPT 70498 70498 CT Angio Neck: AddOn	$1,530.00	$2,040.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest/Abd/Pelvis	$1,563.00	$2,084.00	—	1% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest + Abd/Pelvis w/ Cont	$1,563.00	$2,084.00	—	1% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$1,563.00	$2,084.00	—	1% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest + Abd/Pelvis w/ Cont	$1,563.00	$2,084.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest/Abd/Pelvis	$1,563.00	$2,084.00	—	—	25%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$1,563.00	$2,084.00	—	—	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen and Pelvis w/o Contrast	$1,635.00	$2,180.00	—	1% below	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 74176 CT Abdomen and Pelvis w/o Contrast: AddOn	$1,635.00	$2,180.00	—	1% below	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen and Pelvis w/o Contrast	$1,635.00	$2,180.00	—	—	25%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 74176 CT Abdomen and Pelvis w/o Contrast: AddOn	$1,635.00	$2,180.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 74177 CT Abdomen and Pelvis w/ Contrast: AddOn	$1,708.50	$2,278.00	—	25% below	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis w/ Contrast	$2,083.50	$2,778.00	—	8% below	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 74177 CT Abdomen and Pelvis w/ Contrast: AddOn	$1,708.50	$2,278.00	—	—	25%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis w/ Contrast	$2,083.50	$2,778.00	—	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 74178 CT Abdomen and Pelvis w/ + w/o Contrast: AddOn	$2,342.25	$3,123.00	—	1% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$2,342.25	$3,123.00	—	1% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 74178 CT Abdomen and Pelvis w/ + w/o Contrast: AddOn	$2,342.25	$3,123.00	—	—	25%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen and Pelvis w/ + w/o Contrast	$2,342.25	$3,123.00	—	—	25%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$1,352.25	$1,803.00	—	15% above	25%
CT scan of the abdomen with contrast CPT 74160 74160 CT Abdomen w/ Contrast: AddOn	$135,225.00	$180,300.00	—	11364% above	25%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$1,352.25	$1,803.00	—	—	25%
CT scan of the abdomen with contrast inpatient CPT 74160 74160 CT Abdomen w/ Contrast: AddOn	$135,225.00	$180,300.00	—	—	25%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$1,032.00	$1,376.00	—	13% above	25%
CT scan of the abdomen without contrast CPT 74150 74150 CT Abdomen w/o Contrast: AddOn	$1,032.00	$1,376.00	—	13% above	25%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$1,032.00	$1,376.00	—	—	25%
CT scan of the abdomen without contrast inpatient CPT 74150 74150 CT Abdomen w/o Contrast: AddOn	$1,032.00	$1,376.00	—	—	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$995.25	$1,327.00	—	16% above	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$995.25	$1,327.00	—	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head Stroke Alert	$993.75	$1,325.00	—	at median	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain/Head w/o Contrast	$993.75	$1,325.00	—	at median	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head w/o Contrast	$993.75	$1,325.00	—	—	25%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain/Head Stroke Alert	$993.75	$1,325.00	—	—	25%
CT scan of the head with contrast CPT 70460 CT Brain/Head w/ Contrast	$1,168.50	$1,558.00	—	7% above	25%
CT scan of the head with contrast inpatient CPT 70460 CT Brain/Head w/ Contrast	$1,168.50	$1,558.00	—	—	25%
CT scan of the head without and with contrast CPT 70470 CT Brain/Head w/ + w/o Contrast	$1,442.25	$1,923.00	—	11% above	25%
CT scan of the head without and with contrast inpatient CPT 70470 CT Brain/Head w/ + w/o Contrast	$1,442.25	$1,923.00	—	—	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$1,121.25	$1,495.00	—	21% above	25%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$1,121.25	$1,495.00	—	—	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$1,125.75	$1,501.00	—	2% above	25%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$1,125.75	$1,501.00	—	—	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$1,312.50	$1,750.00	—	9% above	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$1,312.50	$1,750.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$690.75	$921.00	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$690.75	$921.00	—	—	25%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Contrast	$1,617.00	$2,156.00	—	4% above	25%
Chest CT scan without and with contrast CPT 71270 CT Chest/Abdomen w/ + w/o Contrast	$1,617.00	$2,156.00	—	4% above	25%
Chest CT scan without and with contrast CPT 71270 CT Chest/Abd/Pelvis w/ + w/o Contrast	$1,617.00	$2,156.00	—	4% above	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest w/ + w/o Contrast	$1,617.00	$2,156.00	—	—	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest/Abd/Pelvis w/ + w/o Contrast	$1,617.00	$2,156.00	—	—	25%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest/Abdomen w/ + w/o Contrast	$1,617.00	$2,156.00	—	—	25%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$192.00	$256.00	—	26% below	25%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$192.00	$256.00	—	—	25%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$168.75	$225.00	—	27% below	25%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$168.75	$225.00	—	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Renal Complete	$468.00	$624.00	—	at median	25%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Renal Complete	$468.00	$624.00	—	—	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Density DEXA Axial Skeleton	$294.00	$392.00	—	10% below	25%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Density DEXA Axial Skeleton	$294.00	$392.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abd/Pelvis w/o Contrast	$1,034.25	$1,379.00	—	15% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abdomen w/o Contrast	$1,034.25	$1,379.00	—	15% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$1,034.25	$1,379.00	—	15% above	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$1,034.25	$1,379.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abd/Pelvis w/o Contrast	$1,034.25	$1,379.00	—	—	25%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abdomen w/o Contrast	$1,034.25	$1,379.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abd/Pelvis w/ Contrast	$1,344.00	$1,792.00	—	13% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abdomen w/ Contrast	$1,344.00	$1,792.00	—	13% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$1,344.00	$1,792.00	—	13% above	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abdomen w/ Contrast	$1,344.00	$1,792.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abd/Pelvis w/ Contrast	$1,344.00	$1,792.00	—	—	25%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$1,344.00	$1,792.00	—	—	25%
Diagnostic mammogram, both breasts both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo	$303.00	$404.00	—	—	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MG Mammo Diagnostic Bilateral w/ Tomo	$303.00	$404.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$682.50	$910.00	—	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 US Lower Ext Arterial Duplex Bilateral	$682.50	$910.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$758.25	$1,011.00	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$758.25	$1,011.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Upper Ext Venous Duplex Bilateral	$758.25	$1,011.00	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Lower Ext Venous Duplex Bilateral	$758.25	$1,011.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echocardiogram Complete w/ Color	$1,284.00	$1,712.00	—	29% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 93306 ECHO W/SPEC and COLOR FLOW DOPPLER CHARGE	$1,322.25	$1,763.00	—	27% below	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echocardiogram Complete w/ Color	$1,284.00	$1,712.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 93306 ECHO W/SPEC and COLOR FLOW DOPPLER CHARGE	$1,322.25	$1,763.00	—	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbits Sella w/o Contrast	$985.50	$1,314.00	—	15% above	25%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbits Sella w/o Contrast	$985.50	$1,314.00	—	—	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones 3+ Views	$256.50	$342.00	—	16% below	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones 3+ Views	$256.50	$342.00	—	—	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$432.75	$577.00	—	2% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$432.75	$577.00	—	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Low Dose Lung Scan	$207.00	$276.00	—	75% below	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Low Dose Lung Scan	$207.00	$276.00	—	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Brain/Head w/o Contrast	$1,535.25	$2,047.00	—	2% below	25%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Brain/Head w/o Contrast	$1,535.25	$2,047.00	—	—	25%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$1,729.50	$2,306.00	—	5% above	25%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$1,729.50	$2,306.00	—	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$2,304.75	$3,073.00	—	1% above	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$2,304.75	$3,073.00	—	—	25%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$1,679.25	$2,239.00	—	1% below	25%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$1,679.25	$2,239.00	—	—	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$2,466.75	$3,289.00	—	9% above	25%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$2,466.75	$3,289.00	—	—	25%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$1,580.25	$2,107.00	—	1% above	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$1,580.25	$2,107.00	—	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$2,361.00	$3,148.00	—	4% above	25%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$2,361.00	$3,148.00	—	—	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$1,606.50	$2,142.00	—	at median	25%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$1,606.50	$2,142.00	—	—	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$2,346.00	$3,128.00	—	2% above	25%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$2,346.00	$3,128.00	—	—	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$1,581.75	$2,109.00	—	2% below	25%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$1,581.75	$2,109.00	—	—	25%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$2,267.25	$3,023.00	—	at median	25%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$2,267.25	$3,023.00	—	—	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$1,560.00	$2,080.00	—	5% below	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$1,560.00	$2,080.00	—	—	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical 4 or 5 Views	$310.50	$414.00	—	16% below	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical 4 or 5 Views	$310.50	$414.00	—	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT Neck Soft Tissue w/ Contrast	$1,341.00	$1,788.00	—	20% above	25%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck Soft Tissue w/ Contrast	$1,341.00	$1,788.00	—	—	25%
Neck soft tissue CT scan without contrast CPT 70490 CT Neck Soft Tissue w/o Contrast	$993.75	$1,325.00	—	14% above	25%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Soft Tissue w/o Contrast	$993.75	$1,325.00	—	—	25%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue	$188.25	$251.00	—	17% below	25%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue	$188.25	$251.00	—	—	25%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast	$1,050.00	$1,400.00	—	14% above	25%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Contrast	$1,050.00	$1,400.00	—	—	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic Ltd	$309.00	$412.00	—	19% below	25%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic Ltd	$309.00	$412.00	—	—	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Complete	$468.75	$625.00	—	3% below	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Complete	$468.75	$625.00	—	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Weeks	$448.50	$598.00	—	2% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Weeks	$448.50	$598.00	—	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB < 14 weeks	$385.50	$514.00	—	10% below	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB < 14 weeks	$385.50	$514.00	—	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$310.50	$414.00	—	2% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$310.50	$414.00	—	—	25%
Screening mammogram, both breasts both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo	$480.00	$640.00	—	—	25%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Left w/ Tomo	$242.25	$323.00	—	26% below	25%
Screening mammogram, both breasts one side CPT 77067 MG Mammo Screening Right w/ Tomo	$242.25	$323.00	—	26% below	25%
Screening mammogram, both breasts inpatient both sides CPT 77067 MG Mammo Screening Bilateral w/ Tomo	$480.00	$640.00	—	—	25%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screening Left w/ Tomo	$242.25	$323.00	—	—	25%
Screening mammogram, both breasts inpatient one side CPT 77067 MG Mammo Screening Right w/ Tomo	$242.25	$323.00	—	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Paranasal Complete	$242.25	$323.00	—	23% below	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Paranasal Complete	$242.25	$323.00	—	—	25%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views	$231.00	$308.00	—	10% below	25%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull < 4 Views	$231.00	$308.00	—	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Modified Barium Swallow	$370.50	$494.00	—	8% below	25%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Modified Barium Swallow	$370.50	$494.00	—	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast	$1,095.75	$1,461.00	—	6% above	25%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Contrast	$1,095.75	$1,461.00	—	—	25%
Transvaginal pelvic ultrasound CPT 76830 SMCE US TRANSVAGINAL NON-OB	$426.00	$568.00	—	3% below	25%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$426.00	$568.00	—	3% below	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 SMCE US TRANSVAGINAL NON-OB	$426.00	$568.00	—	—	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$426.00	$568.00	—	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 US OB Transvaginal	$348.75	$465.00	—	19% below	25%
Transvaginal ultrasound during pregnancy CPT 76817 SMCE US OB TRANSVAGINAL	$348.75	$465.00	—	19% below	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US OB Transvaginal	$348.75	$465.00	—	—	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 SMCE US OB TRANSVAGINAL	$348.75	$465.00	—	—	25%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$537.00	$716.00	—	1% above	25%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$537.00	$716.00	—	—	25%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum (Contents)	$435.75	$581.00	—	1% below	25%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum (Contents)	$435.75	$581.00	—	—	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Soft Tissue Head/Neck	$423.00	$564.00	—	4% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Soft Tissue Head/Neck	$423.00	$564.00	—	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI w/ Small Bowel	$437.25	$583.00	—	12% below	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI	$437.25	$583.00	—	12% below	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI w/ Small Bowel	$437.25	$583.00	—	—	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI	$437.25	$583.00	—	—	25%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$180.75	$241.00	—	19% below	25%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$180.75	$241.00	—	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$246.75	$329.00	—	18% below	25%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$246.75	$329.00	—	—	25%
X-ray of the lower back, 4 or more views CPT 72110 XR Spine Lumbosacral 4+ Views	$323.25	$431.00	—	20% below	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Spine Lumbosacral 4+ Views	$323.25	$431.00	—	—	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR Spine Thoracic 2 Views	$226.50	$302.00	—	23% below	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR Spine Thoracic 2 Views	$226.50	$302.00	—	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones 3+ Views	$213.75	$285.00	—	17% below	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones 3+ Views	$213.75	$285.00	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Spine Cervical 2 or 3 Views	$220.50	$294.00	—	16% below	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Spine Cervical 2 or 3 Views	$220.50	$294.00	—	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$207.00	$276.00	—	21% below	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$207.00	$276.00	—	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx 2+ Views	$207.75	$277.00	—	17% below	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx 2+ Views	$207.75	$277.00	—	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
ACTH blood test CPT 82024 ACTH LC	$168.75	$225.00	$96.75–$213.75	at median	25%
ACTH blood test inpatient CPT 82024 ACTH LC	$168.75	$225.00	$96.75–$213.75	—	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine aminotransferase	$45.00	$60.00	$25.80–$57.00	40% above	25%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine aminotransferase	$45.00	$60.00	$25.80–$57.00	—	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 Aspartate aminotransferase	$46.50	$62.00	$26.66–$58.90	26% above	25%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Aspartate aminotransferase	$46.50	$62.00	$26.66–$58.90	—	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hep Panel (4) LC	$294.75	$393.00	$168.99–$373.35	36% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hep Panel (4) LC	$294.75	$393.00	$168.99–$373.35	—	25%
Albumin blood test CPT 82040 Albumin Level	$39.00	$52.00	$22.36–$49.40	41% above	25%
Albumin blood test inpatient CPT 82040 Albumin Level	$39.00	$52.00	$22.36–$49.40	—	25%
Aldosterone blood test CPT 82088 Aldosterone LC/MS LC	$160.50	$214.00	$92.02–$203.30	12% below	25%
Aldosterone blood test CPT 82088 Aldost/Renin Ratio LC	$270.75	$361.00	$155.23–$342.95	49% above	25%
Aldosterone blood test inpatient CPT 82088 Aldosterone LC/MS LC	$160.50	$214.00	$92.02–$203.30	—	25%
Aldosterone blood test inpatient CPT 82088 Aldost/Renin Ratio LC	$270.75	$361.00	$155.23–$342.95	—	25%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$39.75	$53.00	$22.79–$50.35	15% above	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$39.75	$53.00	$22.79–$50.35	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 D001-IgE D pteronyssinus LC	$26.25	$35.00	$15.05–$33.25	17% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergens 20 LC	$27.75	$37.00	$15.91–$35.15	23% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 86003 Allergens 20 LC	$27.75	$37.00	$15.91–$35.15	23% above	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 D001-IgE D pteronyssinus LC	$26.25	$35.00	$15.05–$33.25	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergens 20 LC	$27.75	$37.00	$15.91–$35.15	—	25%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003 Allergens 20 LC	$27.75	$37.00	$15.91–$35.15	—	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP Tumor Marker LC	$107.25	$143.00	$61.49–$135.85	18% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP Tumor Marker LC	$107.25	$143.00	$61.49–$135.85	—	25%
Ammonia blood test CPT 82140 Ammonia LC	$115.50	$154.00	$66.22–$146.30	60% above	25%
Ammonia blood test CPT 82140 Ammonia Level	$115.50	$154.00	$66.22–$146.30	60% above	25%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$115.50	$154.00	$66.22–$146.30	—	25%
Ammonia blood test inpatient CPT 82140 Ammonia LC	$115.50	$154.00	$66.22–$146.30	—	25%
Amylase blood test CPT 82150 Amylase Level	$79.50	$106.00	$45.58–$100.70	50% above	25%
Amylase blood test inpatient CPT 82150 Amylase Level	$79.50	$106.00	$45.58–$100.70	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibodies IgG/IgA LC	$76.50	$102.00	$43.86–$96.90	8% above	25%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibodies IgG/IgA LC	$76.50	$102.00	$43.86–$96.90	—	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Antibodies, IFA LC	$82.50	$110.00	$47.30–$104.50	20% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA) Qual, Multi Immunoassay LC	$82.50	$110.00	$47.30–$104.50	20% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA w/Rflx to 9-biomarker profile LC	$82.50	$110.00	$47.30–$104.50	20% above	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA) Qual, Multi Immunoassay LC	$82.50	$110.00	$47.30–$104.50	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Antibodies, IFA LC	$82.50	$110.00	$47.30–$104.50	—	25%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA w/Rflx to 9-biomarker profile LC	$82.50	$110.00	$47.30–$104.50	—	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-Type Natriuretic Peptide	$191.25	$255.00	$109.65–$242.25	9% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro BNP	$203.25	$271.00	$116.53–$257.45	16% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT-proBNP LC	$203.25	$271.00	$116.53–$257.45	16% above	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 B-Type Natriuretic Peptide	$191.25	$255.00	$109.65–$242.25	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT-proBNP LC	$203.25	$271.00	$116.53–$257.45	—	25%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Pro BNP	$203.25	$271.00	$116.53–$257.45	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Body Fluid Culture, Sterile LC	$106.50	$142.00	$61.06–$134.90	80% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 .Sputum Culture 182354 LC	$106.50	$142.00	$61.06–$134.90	80% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Genital Culture, Routine LC	$106.50	$142.00	$61.06–$134.90	80% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Lower Respiratory Culture LC	$112.50	$150.00	$64.50–$142.50	90% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Upper Respiratory Culture LC	$112.50	$150.00	$64.50–$142.50	90% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Aerobic Bacterial Culture LC	$112.50	$150.00	$64.50–$142.50	90% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Genital Culture, Routine LC	$106.50	$142.00	$61.06–$134.90	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 .Sputum Culture 182354 LC	$106.50	$142.00	$61.06–$134.90	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Body Fluid Culture, Sterile LC	$106.50	$142.00	$61.06–$134.90	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Upper Respiratory Culture LC	$112.50	$150.00	$64.50–$142.50	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Aerobic Bacterial Culture LC	$112.50	$150.00	$64.50–$142.50	—	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Lower Respiratory Culture LC	$112.50	$150.00	$64.50–$142.50	—	25%
Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel	$112.50	$150.00	$64.50–$142.50	105% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel	$112.50	$150.00	$64.50–$142.50	—	25%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$43.50	$58.00	$24.94–$55.10	20% above	25%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$43.50	$58.00	$24.94–$55.10	—	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGICAL PATH GROSS LEVEL 5	$246.75	$329.00	$141.47–$312.55	12% above	25%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGICAL PATH GROSS LEVEL 5	$246.75	$329.00	$141.47–$312.55	—	25%
Blood culture for bacteria CPT 87040 Blood Culture, Routine LC	$89.25	$119.00	$51.17–$113.05	21% below	25%
Blood culture for bacteria inpatient CPT 87040 Blood Culture, Routine LC	$89.25	$119.00	$51.17–$113.05	—	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Collection of venous blood by venipuncture	$22.50	$30.00	$12.90–$28.50	at median	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$22.50	$30.00	$12.90–$28.50	at median	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture	$22.50	$30.00	$12.90–$28.50	at median	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Venipuncture	$22.50	$30.00	$12.90–$28.50	—	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$22.50	$30.00	$12.90–$28.50	—	25%
Blood glucose (sugar) test CPT 82947 Glucose Level	$39.00	$52.00	$22.36–$49.40	47% above	25%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$39.00	$52.00	$22.36–$49.40	—	25%
Blood lead test CPT 83655 Lead, Bld (Pediatric) LC	$55.50	$74.00	$31.82–$70.30	3% below	25%
Blood lead test CPT 83655 Lead, Bld (Adult) LC	$55.50	$74.00	$31.82–$70.30	3% below	25%
Blood lead test inpatient CPT 83655 Lead, Bld (Pediatric) LC	$55.50	$74.00	$31.82–$70.30	—	25%
Blood lead test inpatient CPT 83655 Lead, Bld (Adult) LC	$55.50	$74.00	$31.82–$70.30	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Beta hCG Qualitative	$97.50	$130.00	$55.90–$123.50	50% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Beta hCG Qualitative	$97.50	$130.00	$55.90–$123.50	—	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF Rh Only	$63.75	$85.00	$36.55–$80.75	12% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh Retype	$80.25	$107.00	$46.01–$101.65	41% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO/Rh	$82.50	$110.00	$47.30–$104.50	45% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO Only	$82.50	$110.00	$47.30–$104.50	45% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO Only	$82.50	$110.00	$47.30–$104.50	45% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO/Rh	$147.00	$196.00	$84.28–$186.20	158% above	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF Rh Only	$63.75	$85.00	$36.55–$80.75	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh Retype	$80.25	$107.00	$46.01–$101.65	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO Only	$82.50	$110.00	$47.30–$104.50	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF ABO Only	$82.50	$110.00	$47.30–$104.50	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO/Rh	$82.50	$110.00	$47.30–$104.50	—	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 REF ABO/Rh	$147.00	$196.00	$84.28–$186.20	—	25%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$41.25	$55.00	$23.65–$52.25	10% above	25%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$41.25	$55.00	$23.65–$52.25	—	25%
C-peptide blood test CPT 84681 C-Peptide LC	$100.50	$134.00	$57.62–$127.30	at median	25%
C-peptide blood test inpatient CPT 84681 C-Peptide LC	$100.50	$134.00	$57.62–$127.30	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$65.25	$87.00	$37.41–$82.65	11% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP, Quant LC	$65.25	$87.00	$37.41–$82.65	11% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$65.25	$87.00	$37.41–$82.65	—	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP, Quant LC	$65.25	$87.00	$37.41–$82.65	—	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C difficile Toxin Gene NAA LC	$156.00	$208.00	$89.44–$197.60	6% below	25%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C difficile Toxin Gene NAA LC	$156.00	$208.00	$89.44–$197.60	—	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 LC	$112.50	$150.00	$64.50–$142.50	19% above	25%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 LC	$112.50	$150.00	$64.50–$142.50	—	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen (CA) 125 LC	$129.00	$172.00	$73.96–$163.40	26% above	25%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen (CA) 125 LC	$129.00	$172.00	$73.96–$163.40	—	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2, NAA LC	$68.25	$91.00	$39.13–$86.45	27% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2, NAA LC	$68.25	$91.00	$39.13–$86.45	—	25%
Calcium blood test, total CPT 82310 Calcium Level Urine	$44.25	$59.00	$25.37–$56.05	37% above	25%
Calcium blood test, total CPT 82310 Calcium Level Total	$46.50	$62.00	$26.66–$58.90	44% above	25%
Calcium blood test, total inpatient CPT 82310 Calcium Level Urine	$44.25	$59.00	$25.37–$56.05	—	25%
Calcium blood test, total inpatient CPT 82310 Calcium Level Total	$46.50	$62.00	$26.66–$58.90	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA LC	$137.25	$183.00	$78.69–$173.85	26% above	25%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen	$137.25	$183.00	$78.69–$173.85	26% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA LC	$137.25	$183.00	$78.69–$173.85	—	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen	$137.25	$183.00	$78.69–$173.85	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster V Ab, IgG LC	$77.25	$103.00	$44.29–$97.85	9% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster V Ab, IgG LC	$77.25	$103.00	$44.29–$97.85	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis, NAA LC	$127.50	$170.00	$73.10–$161.50	15% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis, NAA LC	$127.50	$170.00	$73.10–$161.50	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Triglycerides LC	$70.50	$94.00	$40.42–$89.30	25% above	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$111.75	$149.00	$64.07–$141.55	99% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Triglycerides LC	$70.50	$94.00	$40.42–$89.30	—	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$111.75	$149.00	$64.07–$141.55	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC With Differential/Platelet LC	$76.50	$102.00	$43.86–$96.90	50% above	25%
Complete blood count (CBC) with differential CPT 85025 CBC w/ Differential	$76.50	$102.00	$43.86–$96.90	50% above	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC With Differential/Platelet LC	$76.50	$102.00	$43.86–$96.90	—	25%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC w/ Differential	$76.50	$102.00	$43.86–$96.90	—	25%
Complete blood count (CBC), no differential CPT 85027 CBC without Differential	$63.00	$84.00	$36.12–$79.80	47% above	25%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC without Differential	$63.00	$84.00	$36.12–$79.80	—	25%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel	$153.75	$205.00	$88.15–$194.75	107% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel	$153.75	$205.00	$88.15–$194.75	—	25%
Cortisol blood test, total CPT 82533 Cortisol - AM LC	$119.25	$159.00	$68.37–$151.05	52% above	25%
Cortisol blood test, total CPT 82533 Cortisol Total LC	$119.25	$159.00	$68.37–$151.05	52% above	25%
Cortisol blood test, total inpatient CPT 82533 Cortisol Total LC	$119.25	$159.00	$68.37–$151.05	—	25%
Cortisol blood test, total inpatient CPT 82533 Cortisol - AM LC	$119.25	$159.00	$68.37–$151.05	—	25%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$68.25	$91.00	$39.13–$86.45	33% above	25%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$68.25	$91.00	$39.13–$86.45	—	25%
Creatinine blood test CPT 82565 Creatinine iSTAT	$46.50	$62.00	$26.66–$58.90	60% above	25%
Creatinine blood test CPT 82565 Creatinine	$46.50	$62.00	$26.66–$58.90	60% above	25%
Creatinine blood test inpatient CPT 82565 Creatinine iSTAT	$46.50	$62.00	$26.66–$58.90	—	25%
Creatinine blood test inpatient CPT 82565 Creatinine	$46.50	$62.00	$26.66–$58.90	—	25%
Cytomegalovirus (CMV) antibody test CPT 86644 Bill Only CMV	$40.50	$54.00	$23.22–$51.30	47% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus (CMV) Ab, IgG LC	$83.25	$111.00	$47.73–$105.45	10% above	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Bill Only CMV	$40.50	$54.00	$23.22–$51.30	—	25%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus (CMV) Ab, IgG LC	$83.25	$111.00	$47.73–$105.45	—	25%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$124.50	$166.00	$71.38–$157.70	24% above	25%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$124.50	$166.00	$71.38–$157.70	—	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-Sulfate LC	$106.50	$142.00	$61.06–$134.90	6% above	25%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-Sulfate LC	$106.50	$142.00	$61.06–$134.90	—	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 763824 12+Oxy+Crt-Unbund LC	$241.50	$322.00	$138.46–$305.90	46% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 763824 12+Oxy+Crt-Unbund LC	$241.50	$322.00	$138.46–$305.90	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$79.50	$106.00	$45.58–$100.70	38% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$79.50	$106.00	$45.58–$100.70	—	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV Ab VCA, IgG LC	$87.75	$117.00	$50.31–$111.15	3% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA IgM Ab LC	$87.75	$117.00	$50.31–$111.15	3% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA IgG Ab LC	$87.75	$117.00	$50.31–$111.15	3% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV Ab VCA, IgM LC	$87.75	$117.00	$50.31–$111.15	3% above	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV VCA IgM Ab LC	$87.75	$117.00	$50.31–$111.15	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV Ab VCA, IgG LC	$87.75	$117.00	$50.31–$111.15	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV Ab VCA, IgM LC	$87.75	$117.00	$50.31–$111.15	—	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV VCA IgG Ab LC	$87.75	$117.00	$50.31–$111.15	—	25%
Estradiol blood test CPT 82670 Estradiol, Sensitive LC	$145.50	$194.00	$83.42–$184.30	8% above	25%
Estradiol blood test CPT 82670 Estradiol LC	$145.50	$194.00	$83.42–$184.30	8% above	25%
Estradiol blood test inpatient CPT 82670 Estradiol, Sensitive LC	$145.50	$194.00	$83.42–$184.30	—	25%
Estradiol blood test inpatient CPT 82670 Estradiol LC	$145.50	$194.00	$83.42–$184.30	—	25%
FSH (follicle-stimulating hormone) test CPT 83001 FSH LC	$114.75	$153.00	$65.79–$145.35	4% above	25%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 FSH LC	$114.75	$153.00	$65.79–$145.35	—	25%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Fecal LC	$179.25	$239.00	$102.77–$227.05	10% below	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Fecal LC	$179.25	$239.00	$102.77–$227.05	—	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$104.25	$139.00	$59.77–$132.05	31% above	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin LC	$104.25	$139.00	$59.77–$132.05	31% above	25%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin LC	$104.25	$139.00	$59.77–$132.05	—	25%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$104.25	$139.00	$59.77–$132.05	—	25%
Folate (folic acid) blood test CPT 82746 Folate Level	$107.25	$143.00	$61.49–$135.85	28% above	25%
Folate (folic acid) blood test CPT 82746 Folate (Folic Acid) LC	$107.25	$143.00	$61.49–$135.85	28% above	25%
Folate (folic acid) blood test inpatient CPT 82746 Folate (Folic Acid) LC	$107.25	$143.00	$61.49–$135.85	—	25%
Folate (folic acid) blood test inpatient CPT 82746 Folate Level	$107.25	$143.00	$61.49–$135.85	—	25%
Free T3 thyroid hormone test CPT 84481 Triiodothyronine (T3), Free LC	$117.00	$156.00	$67.08–$148.20	42% above	25%
Free T3 thyroid hormone test inpatient CPT 84481 Triiodothyronine (T3), Free LC	$117.00	$156.00	$67.08–$148.20	—	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 by Dialysis/Mass Spec LC	$89.25	$119.00	$51.17–$113.05	82% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free T4 Level	$95.25	$127.00	$54.61–$120.65	94% above	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 by Dialysis/Mass Spec LC	$89.25	$119.00	$51.17–$113.05	—	25%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free T4 Level	$95.25	$127.00	$54.61–$120.65	—	25%
Free testosterone test CPT 84402 Testosterone, Free, Direct LC	$118.50	$158.00	$67.94–$150.10	12% above	25%
Free testosterone test inpatient CPT 84402 Testosterone, Free, Direct LC	$118.50	$158.00	$67.94–$150.10	—	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT LC	$57.75	$77.00	$33.11–$73.15	37% above	25%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT LC	$57.75	$77.00	$33.11–$73.15	—	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 Hour	$42.00	$56.00	$24.08–$53.20	7% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 Hour	$42.00	$56.00	$24.08–$53.20	—	25%
Glucose tolerance test, 3 samples CPT 82951 Glucose 1 HOUR	$96.75	$129.00	$55.47–$122.55	21% above	25%
Glucose tolerance test, 3 samples CPT 82951 Glucose 3 Hour	$96.75	$129.00	$55.47–$122.55	21% above	25%
Glucose tolerance test, 3 samples CPT 82951 Glucose 2 Hour	$96.75	$129.00	$55.47–$122.55	21% above	25%
Glucose tolerance test, 3 samples CPT 82951 Glucose 1 Hour	$96.75	$129.00	$55.47–$122.55	21% above	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 1 Hour	$96.75	$129.00	$55.47–$122.55	—	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 2 Hour	$96.75	$129.00	$55.47–$122.55	—	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 1 HOUR	$96.75	$129.00	$55.47–$122.55	—	25%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 3 Hour	$96.75	$129.00	$55.47–$122.55	—	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria gonorrhoeae, NAA LC	$135.00	$180.00	$77.40–$171.00	15% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae, NAA LC	$135.00	$180.00	$77.40–$171.00	—	25%
H. pylori stool antigen test CPT 87338 Helicobacter pylori Stool Ag, EIA LC	$102.75	$137.00	$58.91–$130.15	3% above	25%
H. pylori stool antigen test inpatient CPT 87338 Helicobacter pylori Stool Ag, EIA LC	$102.75	$137.00	$58.91–$130.15	—	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 RealTime Abbott LC	$342.75	$457.00	$196.51–$434.15	10% below	25%
HIV viral load test (HIV-1 RNA, quantitative) one side CPT 87536 RNA, RT PCR (Non-Graph) LC	$342.75	$457.00	$196.51–$434.15	10% below	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 RealTime Abbott LC	$342.75	$457.00	$196.51–$434.15	—	25%
HIV viral load test (HIV-1 RNA, quantitative) inpatient one side CPT 87536 RNA, RT PCR (Non-Graph) LC	$342.75	$457.00	$196.51–$434.15	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1/2 Ag/Ab Combo	$93.75	$125.00	$53.75–$118.75	1% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1/O/2, 4th Generation LC	$93.75	$125.00	$53.75–$118.75	1% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1/2 Ag/Ab Combo	$93.75	$125.00	$53.75–$118.75	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV-1/O/2, 4th Generation LC	$93.75	$125.00	$53.75–$118.75	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c with Estimated Avg Glucose	$51.75	$69.00	$29.67–$65.55	12% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C	$75.00	$100.00	$43.00–$95.00	62% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c with Estimated Avg Glucose	$51.75	$69.00	$29.67–$65.55	—	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C	$75.00	$100.00	$43.00–$95.00	—	25%
Hemoglobin blood test CPT 85018 Hemoglobin	$33.00	$44.00	$18.92–$41.80	64% above	25%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$33.00	$44.00	$18.92–$41.80	—	25%
Hepatitis B core antibody test (total) CPT 86704 Hep B Core Ab, Tot LC	$84.75	$113.00	$48.59–$107.35	32% above	25%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hep B Core Ab, Tot LC	$84.75	$113.00	$48.59–$107.35	—	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HCV Ab LC	$86.25	$115.00	$49.45–$109.25	54% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HCV Ab LC	$86.25	$115.00	$49.45–$109.25	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hep B Surf Antigen Scr LC	$87.00	$116.00	$49.88–$110.20	43% above	25%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hep B Surf Antigen Scr LC	$87.00	$116.00	$49.88–$110.20	—	25%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody RFX to Quant PCR LC Test 144050	$102.00	$136.00	$58.48–$129.20	48% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Ab LC	$108.00	$144.00	$61.92–$136.80	57% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody Cascade(PCR/Geno) LC Test 144127	$108.00	$144.00	$61.92–$136.80	57% above	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody RFX to Quant PCR LC Test 144050	$102.00	$136.00	$58.48–$129.20	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Ab LC	$108.00	$144.00	$61.92–$136.80	—	25%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody Cascade(PCR/Geno) LC Test 144127	$108.00	$144.00	$61.92–$136.80	—	25%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 HCV RT-PCR, Quant (Non-Graph) LC	$267.75	$357.00	$153.51–$339.15	9% above	25%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) LC Test 550553	$267.75	$357.00	$153.51–$339.15	9% above	25%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) 550362 LC	$267.75	$357.00	$153.51–$339.15	9% above	25%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) LC Test 550553	$267.75	$357.00	$153.51–$339.15	—	25%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 HCV RT-PCR, Quant (Non-Graph) LC	$267.75	$357.00	$153.51–$339.15	—	25%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 .HCV RT-PCR, Quant (Non-Graph) 550362 LC	$267.75	$357.00	$153.51–$339.15	—	25%
Herpes blood test, HSV-1 antibody CPT 86695 HSV Type 1-Specific Ab, IgG LC	$63.00	$84.00	$36.12–$79.80	32% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 HSV Types 1 and 2 Spec Abs, IgG LC	$66.75	$89.00	$38.27–$84.55	39% above	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV Type 1-Specific Ab, IgG LC	$63.00	$84.00	$36.12–$79.80	—	25%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV Types 1 and 2 Spec Abs, IgG LC	$66.75	$89.00	$38.27–$84.55	—	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-reactive Protein, Cardiac LC	$84.00	$112.00	$48.16–$106.40	21% above	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 C Reactive Protein/CRP Quant	$84.00	$112.00	$48.16–$106.40	21% above	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C Reactive Protein/CRP Quant	$84.00	$112.00	$48.16–$106.40	—	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-reactive Protein, Cardiac LC	$84.00	$112.00	$48.16–$106.40	—	25%
Homocysteine blood test CPT 83090 Homocyst(e)ine LC	$125.25	$167.00	$71.81–$158.65	57% above	25%
Homocysteine blood test inpatient CPT 83090 Homocyst(e)ine LC	$125.25	$167.00	$71.81–$158.65	—	25%
Insulin blood test CPT 83525 Insulin LC	$75.00	$100.00	$43.00–$95.00	12% above	25%
Insulin blood test inpatient CPT 83525 Insulin LC	$75.00	$100.00	$43.00–$95.00	—	25%
Iron blood test (serum iron) CPT 83540 Iron Level	$60.00	$80.00	$34.40–$76.00	36% above	25%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$60.00	$80.00	$34.40–$76.00	—	25%
Iron-binding capacity (TIBC) test CPT 83550 Total Iron Binding Capacity	$71.25	$95.00	$40.85–$90.25	29% above	25%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Total Iron Binding Capacity	$71.25	$95.00	$40.85–$90.25	—	25%
Kidney function blood test panel CPT 80069 Renal Function Panel	$120.75	$161.00	$69.23–$152.95	69% above	25%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$120.75	$161.00	$69.23–$152.95	—	25%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone, Pediatric LC	$125.25	$167.00	$71.81–$158.65	47% above	25%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone (LH), S LC	$125.25	$167.00	$71.81–$158.65	47% above	25%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone (LH), S LC	$125.25	$167.00	$71.81–$158.65	—	25%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone, Pediatric LC	$125.25	$167.00	$71.81–$158.65	—	25%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid POCT	$69.00	$92.00	$39.56–$87.40	9% below	25%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid Level	$69.00	$92.00	$39.56–$87.40	9% below	25%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid POCT	$69.00	$92.00	$39.56–$87.40	—	25%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid Level	$69.00	$92.00	$39.56–$87.40	—	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$57.00	$76.00	$32.68–$72.20	79% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH LC	$60.75	$81.00	$34.83–$76.95	91% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LD Body Fluid LC	$60.75	$81.00	$34.83–$76.95	91% above	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$57.00	$76.00	$32.68–$72.20	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LD Body Fluid LC	$60.75	$81.00	$34.83–$76.95	—	25%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH LC	$60.75	$81.00	$34.83–$76.95	—	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$88.50	$118.00	$50.74–$112.10	25% above	25%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$88.50	$118.00	$50.74–$112.10	—	25%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$117.00	$156.00	$67.08–$148.20	61% above	25%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$117.00	$156.00	$67.08–$148.20	—	25%
Magnesium blood test CPT 83735 Magnesium Level	$72.00	$96.00	$41.28–$91.20	56% above	25%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$72.00	$96.00	$41.28–$91.20	—	25%
Measles (rubeola) antibody test CPT 86765 Measles Antibodies, IgG LC	$66.00	$88.00	$37.84–$83.60	2% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 Measles Antibodies, IgG LC	$66.00	$88.00	$37.84–$83.60	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Mononucleosis Screen	$69.00	$92.00	$39.56–$87.40	34% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Mononucleosis Screen	$69.00	$92.00	$39.56–$87.40	—	25%
Mumps immunity blood test CPT 86735 Mumps Antibodies, IgG LC	$68.25	$91.00	$39.13–$86.45	4% above	25%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies, IgG LC	$68.25	$91.00	$39.13–$86.45	—	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Total+% Free LC	$113.25	$151.00	$64.93–$143.45	20% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (Serial Monitor) LC	$120.75	$161.00	$69.23–$152.95	28% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Ultrasensitive w/o Serial LC	$120.75	$161.00	$69.23–$152.95	28% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate-Specific Ag, Serum LC	$120.75	$161.00	$69.23–$152.95	28% above	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Total+% Free LC	$113.25	$151.00	$64.93–$143.45	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (Serial Monitor) LC	$120.75	$161.00	$69.23–$152.95	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Ultrasensitive w/o Serial LC	$120.75	$161.00	$69.23–$152.95	—	25%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate-Specific Ag, Serum LC	$120.75	$161.00	$69.23–$152.95	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact LC	$209.25	$279.00	$119.97–$265.05	14% above	25%
Parathyroid hormone (PTH) blood test CPT 83970 PTH, Intact	$209.25	$279.00	$119.97–$265.05	14% above	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact	$209.25	$279.00	$119.97–$265.05	—	25%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH, Intact LC	$209.25	$279.00	$119.97–$265.05	—	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, Activated	$75.75	$101.00	$43.43–$95.95	52% above	25%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, Activated	$75.75	$101.00	$43.43–$95.95	—	25%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$50.25	$67.00	$28.81–$63.65	45% above	25%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level	$50.25	$67.00	$28.81–$63.65	—	25%
Potassium blood test CPT 84132 Potassium Level	$48.00	$64.00	$27.52–$60.80	34% above	25%
Potassium blood test inpatient CPT 84132 Potassium Level	$48.00	$64.00	$27.52–$60.80	—	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 MaterniT21 PLUS Core LC	$777.75	$1,037.00	$445.91–$985.15	12% above	25%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 MaterniT21 PLUS Core LC	$777.75	$1,037.00	$445.91–$985.15	—	25%
Progesterone blood test CPT 84144 Progesterone LC	$117.00	$156.00	$67.08–$148.20	22% above	25%
Progesterone blood test inpatient CPT 84144 Progesterone LC	$117.00	$156.00	$67.08–$148.20	—	25%
Prolactin blood test CPT 84146 Prolactin LC	$135.00	$180.00	$77.40–$171.00	41% above	25%
Prolactin blood test inpatient CPT 84146 Prolactin LC	$135.00	$180.00	$77.40–$171.00	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time and INR	$48.00	$64.00	$27.52–$60.80	48% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time and INR	$48.00	$64.00	$27.52–$60.80	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen Urine	$80.25	$107.00	$46.01–$101.65	34% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Screen Urine	$80.25	$107.00	$46.01–$101.65	—	25%
Rapid flu test (influenza antigen) CPT 87804 Flu A Ag (Sofia)	$81.00	$108.00	$46.44–$102.60	17% above	25%
Rapid flu test (influenza antigen) CPT 87804 Flu B Ag (Sofia)	$81.00	$108.00	$46.44–$102.60	17% above	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 Flu A Ag (Sofia)	$81.00	$108.00	$46.44–$102.60	—	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 Flu B Ag (Sofia)	$81.00	$108.00	$46.44–$102.60	—	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Strep A Rapid	$78.75	$105.00	$45.15–$99.75	28% above	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Strep A Rapid	$78.75	$105.00	$45.15–$99.75	—	25%
Renin blood test CPT 84244 Renin Activity LC T 002006	$108.00	$144.00	$61.92–$136.80	5% below	25%
Renin blood test CPT 84244 Aldosterone LC	$270.75	$361.00	$155.23–$342.95	138% above	25%
Renin blood test inpatient CPT 84244 Renin Activity LC T 002006	$108.00	$144.00	$61.92–$136.80	—	25%
Renin blood test inpatient CPT 84244 Aldosterone LC	$270.75	$361.00	$155.23–$342.95	—	25%
Rh blood typing CPT 86901 Rh Typing	$60.75	$81.00	$34.83–$76.95	32% above	25%
Rh blood typing CPT 86901 Rh Only	$63.75	$85.00	$36.55–$80.75	39% above	25%
Rh blood typing inpatient CPT 86901 Rh Typing	$60.75	$81.00	$34.83–$76.95	—	25%
Rh blood typing inpatient CPT 86901 Rh Only	$63.75	$85.00	$36.55–$80.75	—	25%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Arthritis Factor LC	$55.50	$74.00	$31.82–$70.30	79% above	25%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Arthritis Factor LC	$55.50	$74.00	$31.82–$70.30	—	25%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies, IgG LC	$73.50	$98.00	$42.14–$93.10	24% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies, IgG LC	$73.50	$98.00	$42.14–$93.10	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ESR (Erythrocyte Sedimentation Rate)	$41.25	$55.00	$23.65–$52.25	105% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ESR (Erythrocyte Sedimentation Rate)	$41.25	$55.00	$23.65–$52.25	—	25%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Complete	$133.50	$178.00	$76.54–$169.10	56% above	25%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis Complete	$133.50	$178.00	$76.54–$169.10	—	25%
Sodium blood test CPT 84295 Sodium Level	$46.50	$62.00	$26.66–$58.90	42% above	25%
Sodium blood test inpatient CPT 84295 Sodium Level	$46.50	$62.00	$26.66–$58.90	—	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Stool Screen	$33.00	$44.00	$18.92–$41.80	33% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Stool Screen	$33.00	$44.00	$18.92–$41.80	—	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood POC	$35.25	$47.00	$20.21–$44.65	50% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 T pallidum Ab (FTA-Ab) LC	$66.00	$88.00	$37.84–$83.60	3% below	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 T pallidum Ab (FTA-Ab) LC	$66.00	$88.00	$37.84–$83.60	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR, Rfx Qn RPR/Confirm TP Ab LC Test 012005	$50.25	$67.00	$28.81–$63.65	17% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR Syphilis: RPR With Reflex to RPR Titer LC Test006072	$50.25	$67.00	$28.81–$63.65	17% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR, Rfx Qn RPR/Confirm TP Ab LC Test 012005	$50.25	$67.00	$28.81–$63.65	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR Syphilis: RPR With Reflex to RPR Titer LC Test006072	$50.25	$67.00	$28.81–$63.65	—	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 QFT-TB Plus (Client Incubated) LC	$198.00	$264.00	$113.52–$250.80	10% below	25%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 QFT-TB Plus (Client Incubated) LC	$198.00	$264.00	$113.52–$250.80	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone LC	$138.00	$184.00	$79.12–$174.80	30% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total LCMS LC	$138.00	$184.00	$79.12–$174.80	30% above	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone LC	$138.00	$184.00	$79.12–$174.80	—	25%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total LCMS LC	$138.00	$184.00	$79.12–$174.80	—	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver-Kidney Microsomal Ab LC	$83.25	$111.00	$47.73–$105.45	6% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroid Peroxidase (TPO) Ab LC	$85.50	$114.00	$49.02–$108.30	9% above	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver-Kidney Microsomal Ab LC	$83.25	$111.00	$47.73–$105.45	—	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroid Peroxidase (TPO) Ab LC	$85.50	$114.00	$49.02–$108.30	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$81.00	$108.00	$46.44–$102.60	at median	25%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$81.00	$108.00	$46.44–$102.60	—	25%
Total IgE blood test CPT 82785 IgE Total LC	$85.50	$114.00	$49.02–$108.30	5% below	25%
Total IgE blood test CPT 82785 Immunoglobulin E, Total LC	$90.75	$121.00	$52.03–$114.95	1% above	25%
Total IgE blood test inpatient CPT 82785 IgE Total LC	$85.50	$114.00	$49.02–$108.30	—	25%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E, Total LC	$90.75	$121.00	$52.03–$114.95	—	25%
Total cholesterol blood test CPT 82465 lipoprotein	$40.50	$54.00	$23.22–$51.30	27% above	25%
Total cholesterol blood test inpatient CPT 82465 lipoprotein	$40.50	$54.00	$23.22–$51.30	—	25%
Total thyroxine (T4) blood test CPT 84436 Thyroxine (T4) LC	$68.25	$91.00	$39.13–$86.45	80% above	25%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine (T4) LC	$68.25	$91.00	$39.13–$86.45	—	25%
Total triiodothyronine (T3) blood test CPT 84480 Triiodothyronine (T3) LC	$101.25	$135.00	$58.05–$128.25	16% above	25%
Total triiodothyronine (T3) blood test inpatient CPT 84480 Triiodothyronine (T3) LC	$101.25	$135.00	$58.05–$128.25	—	25%
Transferrin blood test CPT 84466 Transferrin LC	$94.50	$126.00	$54.18–$119.70	17% above	25%
Transferrin blood test inpatient CPT 84466 Transferrin LC	$94.50	$126.00	$54.18–$119.70	—	25%
Trichomonas test (NAAT) CPT 87661 Trich vag by NAA LC	$117.00	$156.00	$67.08–$148.20	6% below	25%
Trichomonas test (NAAT) inpatient CPT 87661 Trich vag by NAA LC	$117.00	$156.00	$67.08–$148.20	—	25%
Triglycerides blood test CPT 84478 Triglycerides	$57.00	$76.00	$32.68–$72.20	54% above	25%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$57.00	$76.00	$32.68–$72.20	—	25%
Troponin test, quantitative CPT 84484 Troponin-I	$84.00	$112.00	$48.16–$106.40	16% below	25%
Troponin test, quantitative CPT 84484 Troponin I POCT	$84.00	$112.00	$48.16–$106.40	16% below	25%
Troponin test, quantitative CPT 84484 Troponin-I i-STAT	$84.00	$112.00	$48.16–$106.40	16% below	25%
Troponin test, quantitative inpatient CPT 84484 Troponin-I	$84.00	$112.00	$48.16–$106.40	—	25%
Troponin test, quantitative inpatient CPT 84484 Troponin I POCT	$84.00	$112.00	$48.16–$106.40	—	25%
Troponin test, quantitative inpatient CPT 84484 Troponin-I i-STAT	$84.00	$112.00	$48.16–$106.40	—	25%
Uric acid blood test CPT 84550 Uric Acid	$51.00	$68.00	$29.24–$64.60	47% above	25%
Uric acid blood test inpatient CPT 84550 Uric Acid	$51.00	$68.00	$29.24–$64.60	—	25%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Complete with Culture if Indicated	$37.50	$50.00	$21.50–$47.50	79% above	25%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Complete with Culture if Indicated	$37.50	$50.00	$21.50–$47.50	—	25%
Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick Clinic POC (RE)	$21.00	$28.00	$12.04–$26.60	62% above	25%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis With Micro if Indicated and Culture if Indicated	$21.00	$28.00	$12.04–$26.60	62% above	25%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis with Microscopic if Indicated	$21.00	$28.00	$12.04–$26.60	62% above	25%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis, Routine LC	$36.00	$48.00	$20.64–$45.60	177% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis With Micro if Indicated and Culture if Indicated	$21.00	$28.00	$12.04–$26.60	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis with Microscopic if Indicated	$21.00	$28.00	$12.04–$26.60	—	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis, Routine LC	$36.00	$48.00	$20.64–$45.60	—	25%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture, Routine LC	$77.25	$103.00	$44.29–$97.85	29% above	25%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture, Routine LC	$77.25	$103.00	$44.29–$97.85	—	25%
Urine microalbumin (albumin) test CPT 82043 Albumin, 24-Hr Urine LC	$57.75	$77.00	$33.11–$73.15	39% above	25%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Level 24 Hour Urine	$59.25	$79.00	$33.97–$75.05	42% above	25%
Urine microalbumin (albumin) test CPT 82043 Microalbumin Level Urine	$60.75	$81.00	$34.83–$76.95	46% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 Albumin, 24-Hr Urine LC	$57.75	$77.00	$33.11–$73.15	—	25%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Level 24 Hour Urine	$59.25	$79.00	$33.97–$75.05	—	25%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin Level Urine	$60.75	$81.00	$34.83–$76.95	—	25%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test Clinic POC (RE)	$78.00	$104.00	$44.72–$98.80	105% above	25%
Urine pregnancy test, read by color change CPT 81025 Beta hCG Qualitative Urine	$78.00	$104.00	$44.72–$98.80	105% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 Beta hCG Qualitative Urine	$78.00	$104.00	$44.72–$98.80	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 and Folate LC	$100.50	$134.00	$57.62–$127.30	21% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 LC	$106.50	$142.00	$61.06–$134.90	28% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$106.50	$142.00	$61.06–$134.90	28% above	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 and Folate LC	$100.50	$134.00	$57.62–$127.30	—	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 LC	$106.50	$142.00	$61.06–$134.90	—	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$106.50	$142.00	$61.06–$134.90	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-Hydroxyvitamin D LCMS D2+D3 LC	$146.25	$195.00	$83.85–$185.25	20% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-Hydroxy LC	$155.25	$207.00	$89.01–$196.65	27% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy Level	$155.25	$207.00	$89.01–$196.65	27% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-Hydroxyvitamin D LCMS D2+D3 LC	$146.25	$195.00	$83.85–$185.25	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy Level	$155.25	$207.00	$89.01–$196.65	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25-Hydroxy LC	$155.25	$207.00	$89.01–$196.65	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Calcitriol (1,25 di-OH Vit D) LC	$162.75	$217.00	$93.31–$206.15	2% below	25%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Calcitriol (1,25 di-OH Vit D) LC	$162.75	$217.00	$93.31–$206.15	—	25%
Zinc blood test CPT 84630 Zinc LC	$63.75	$85.00	$36.55–$80.75	4% below	25%
Zinc blood test CPT 84630 Zinc, Whole Blood LC	$63.75	$85.00	$36.55–$80.75	4% below	25%
Zinc blood test inpatient CPT 84630 Zinc, Whole Blood LC	$63.75	$85.00	$36.55–$80.75	—	25%
Zinc blood test inpatient CPT 84630 Zinc LC	$63.75	$85.00	$36.55–$80.75	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Beta hCG Quantitative	$141.00	$188.00	$80.84–$178.60	59% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Beta hCG Quantitative	$141.00	$188.00	$80.84–$178.60	—	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 - Cardioversion; Elective	$998.25	$1,331.00	$572.33–$1,264.45	33% below	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 - Cardioversion; Elective	$998.25	$1,331.00	$572.33–$1,264.45	—	25%
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 or ring block	$172.50	$230.00	$98.90–$218.50	43% below	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600-Distal Radial w/o Manipulation	$278.25	$371.00	$159.53–$352.45	19% below	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600-Distal Radial w/o Manipulation	$278.25	$371.00	$159.53–$352.45	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 DESTRUCTION PREMALIGNANT LESION; 1ST LESION CHARGE	$89.25	$119.00	$51.17–$113.05	22% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 17000 Destruction premalignant lesions; first lesion	$99.75	$133.00	$57.19–$126.35	13% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 17000 DESTRUCTION PREMALIGNANT LESION; 1ST LESION CHARGE	$89.25	$119.00	$51.17–$113.05	—	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209 Removal impacted cerumen using irrigation/lavage	$28.50	$38.00	$16.34–$36.10	75% below	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209-Cerumen Irrigation/Lavage	$80.25	$107.00	$46.01–$101.65	28% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209-Cerumen Irrigation/Lavage	$80.25	$107.00	$46.01–$101.65	—	25%
Earwax removal with instruments, one ear CPT 69210 69210-Cerumen w/ Instrumentation	$72.00	$96.00	$41.28–$91.20	30% below	25%
Earwax removal with instruments, one ear one side CPT 69210 69210 Removal impacted cerumen requiring instrumentation, unilateral	$57.75	$77.00	$33.11–$73.15	44% below	25%
Earwax removal with instruments, one ear inpatient CPT 69210 69210-Cerumen w/ Instrumentation	$72.00	$96.00	$41.28–$91.20	—	25%
IUD insertion (the device itself billed separately) CPT 58300 58300 Insertion of intrauterine device (IUD)	$90.75	$121.00	$52.03–$114.95	70% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision and drainage of abscess; simple or single	$194.25	$259.00	$111.37–$246.05	32% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 Incision & Drainage Abscess (Simple)	$307.50	$410.00	$176.30–$389.50	8% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$308.25	$411.00	$176.73–$390.45	8% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 Incision & Drainage Abscess (Simple)	$307.50	$410.00	$176.30–$389.50	—	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060-I&D Abscess/Cyst/Hematoma Simple	$308.25	$411.00	$176.73–$390.45	—	25%
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 ultrasound guidance	$81.75	$109.00	$46.87–$103.55	73% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$412.50	$550.00	$236.50–$522.50	35% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Drain/Injection of Joint/Bursa	$412.50	$550.00	$236.50–$522.50	35% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 Arthrocentesis Asp/inj major Jt/Bursa w/o us TechFee	$412.50	$550.00	$236.50–$522.50	35% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Drain/Injection of Joint/Bursa	$412.50	$550.00	$236.50–$522.50	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 Arthrocentesis Asp/inj major Jt/Bursa w/o us TechFee	$412.50	$550.00	$236.50–$522.50	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610-Major Joint Aspirate/Inject w/o US	$412.50	$550.00	$236.50–$522.50	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 11981 Insertion, non-biodegradable drug delivery implant	$113.25	$151.00	$64.93–$143.45	40% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibula	$66.00	$88.00	$37.84–$83.60	75% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$279.00	$372.00	$159.96–$353.40	7% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605-Intermediate Aspiration/Inj w/o US	$279.00	$372.00	$159.96–$353.40	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without	$64.50	$86.00	$36.98–$81.70	78% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$383.25	$511.00	$219.73–$485.45	3% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031-Scalp/Trunk/Extremity Less Than/Equal to 2.5 cm	$383.25	$511.00	$219.73–$485.45	—	25%
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 (unless listed elsewhere), trunk, a	$154.50	$206.00	$88.58–$195.70	54% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 11400 EXC BENIGN LESION INCL MARGINS, TRNK,ARMS/LEGS EXC DIAM 0.5 CM OR LESS CHARGE	$420.00	$560.00	$240.80–$532.00	25% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 11400 EXC BENIGN LESION INCL MARGINS, TRNK,ARMS/LEGS EXC DIAM 0.5 CM OR LESS CHARGE	$420.00	$560.00	$240.80–$532.00	—	25%
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, eyelids, nose, lips < 0.5 cm	$432.75	$577.00	$248.11–$548.15	26% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 11440-excision, benign lesion including margins; face, ears, eyelids, nose, lips < 0.5 cm	$432.75	$577.00	$248.11–$548.15	—	25%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion of nail plate, partial or complete, simple; single	$96.75	$129.00	$55.47–$122.55	53% below	25%
Nail removal (partial or complete), one nail CPT 11730 11730-Avulsion Nail Plate Single	$183.75	$245.00	$105.35–$232.75	11% below	25%
Nail removal (partial or complete), one nail CPT 11730 11730 Remove Nail Plate Charge	$183.75	$245.00	$105.35–$232.75	11% below	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Remove Nail Plate Charge	$183.75	$245.00	$105.35–$232.75	—	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730-Avulsion Nail Plate Single	$183.75	$245.00	$105.35–$232.75	—	25%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection, anesthetic agent; greater occiptal nerve	$95.25	$127.00	$54.61–$120.65	77% below	25%
Occipital nerve block (injection for headaches) CPT 64405 64405-Inject Nerve Block Great Occipital	$453.75	$605.00	$260.15–$574.75	12% above	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405-Inject Nerve Block Great Occipital	$453.75	$605.00	$260.15–$574.75	—	25%
Paracentesis with imaging guidance CPT 49083 US Paracentesis	$1,123.50	$1,498.00	—	17% below	25%
Paracentesis with imaging guidance inpatient CPT 49083 US Paracentesis	$1,123.50	$1,498.00	—	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750-Excision Nail & Matrix	$389.25	$519.00	$223.17–$493.05	24% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Permanent Nail Removal Charge	$389.25	$519.00	$223.17–$493.05	24% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE PERMANENT REMOVAL	$413.25	$551.00	$236.93–$523.45	19% below	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Permanent Nail Removal Charge	$389.25	$519.00	$223.17–$493.05	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750-Excision Nail & Matrix	$389.25	$519.00	$223.17–$493.05	—	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 EXCISION NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE PERMANENT REMOVAL	$413.25	$551.00	$236.93–$523.45	—	25%
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision and removal of foreign body, subcutaneous tissues; simple	$192.00	$256.00	$110.08–$243.20	44% below	25%
Removal of a foreign object under the skin, simple CPT 10120 10120 Incision & removal of Foreign Body Simple Charge	$336.75	$449.00	$193.07–$426.55	2% below	25%
Removal of a foreign object under the skin, simple CPT 10120 10120-Subcutaneous Tissue Simple	$336.75	$449.00	$193.07–$426.55	2% below	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 Incision & removal of Foreign Body Simple Charge	$336.75	$449.00	$193.07–$426.55	—	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120-Subcutaneous Tissue Simple	$336.75	$449.00	$193.07–$426.55	—	25%
Short arm cast (elbow to hand) CPT 29075 29075-Cast Application Elbow to Finger (short arm)	$174.75	$233.00	$100.19–$221.35	20% below	25%
Short arm cast (elbow to hand) inpatient CPT 29075 29075-Cast Application Elbow to Finger (short arm)	$174.75	$233.00	$100.19–$221.35	—	25%
Short arm splint (forearm and hand) CPT 29125 29125-Short Arm	$209.25	$279.00	$119.97–$265.05	4% above	25%
Short arm splint (forearm and hand) inpatient CPT 29125 29125-Short Arm	$209.25	$279.00	$119.97–$265.05	—	25%
Short leg cast (below the knee) CPT 29405 29405-App of Short Leg Cast (below knee to toes)	$172.50	$230.00	$98.90–$218.50	27% below	25%
Short leg cast (below the knee) inpatient CPT 29405 29405-App of Short Leg Cast (below knee to toes)	$172.50	$230.00	$98.90–$218.50	—	25%
Short leg splint (calf to foot) CPT 29515 29515-Short Leg	$213.00	$284.00	$122.12–$269.80	4% below	25%
Short leg splint (calf to foot) inpatient CPT 29515 29515-Short Leg	$213.00	$284.00	$122.12–$269.80	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$269.25	$359.00	$154.37–$341.05	6% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001-Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm	$269.25	$359.00	$154.37–$341.05	—	25%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed); single lesion	$84.00	$112.00	$48.16–$106.40	63% below	25%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch Biopsy of Skin 1 Lesion Charge	$249.00	$332.00	$142.76–$315.40	9% above	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch Biopsy of Skin 1 Lesion Charge	$249.00	$332.00	$142.76–$315.40	—	25%
Skin tag removal, up to 15 tags CPT 11200 11200 REMOVAL OF SKIN TAGES UP TO 15 LESIONS	$120.00	$160.00	$68.80–$152.00	29% below	25%
Skin tag removal, up to 15 tags CPT 11200 11200-Removal Skin Tag up to 15	$120.00	$160.00	$68.80–$152.00	29% below	25%
Skin tag removal, up to 15 tags CPT 11200 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions	$139.50	$186.00	$79.98–$176.70	18% below	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200-Removal Skin Tag up to 15	$120.00	$160.00	$68.80–$152.00	—	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 11200 REMOVAL OF SKIN TAGES UP TO 15 LESIONS	$120.00	$160.00	$68.80–$152.00	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270-Lumbar Puncture Diagnostic	$709.50	$946.00	$406.78–$898.70	16% below	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270-Lumbar Puncture Diagnostic	$709.50	$946.00	$406.78–$898.70	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$290.25	$387.00	$166.41–$367.65	3% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 Repair Superficial Wound 2.6 cm - 7.5 cm Charge	$290.25	$387.00	$166.41–$367.65	3% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002-Scalp/Neck/Trunk/Genital/Extremity 2.6-7.5 cm	$290.25	$387.00	$166.41–$367.65	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 12002 Repair Superficial Wound 2.6 cm - 7.5 cm Charge	$290.25	$387.00	$166.41–$367.65	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$286.50	$382.00	$164.26–$362.90	at median	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011-Face/Ear/Eyelid/Nose/Lip Less Than/Equal to 2.5 cm	$286.50	$382.00	$164.26–$362.90	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential biopsy of skin (shave,curette); single lesion	$67.50	$90.00	$38.70–$85.50	68% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 Tangential Biopsy of Skin, 1 lesion Charge	$177.00	$236.00	$101.48–$224.20	15% below	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 Tangential Biopsy of Skin, 1 lesion Charge	$177.00	$236.00	$101.48–$224.20	—	25%
Thoracentesis with imaging guidance CPT 32555 32555-Thoracentesis w/ Imaging Guidance	$1,114.50	$1,486.00	$638.98–$1,411.70	4% below	25%
Thoracentesis with imaging guidance inpatient CPT 32555 32555-Thoracentesis w/ Imaging Guidance	$1,114.50	$1,486.00	$638.98–$1,411.70	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$65.25	$87.00	$37.41–$82.65	64% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 20552-Inject Trigger Point 1-2 Muscles	$321.75	$429.00	$184.47–$407.55	79% above	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552-Inject Trigger Point 1-2 Muscles	$321.75	$429.00	$184.47–$407.55	—	25%
Vaginal delivery, including prenatal and postpartum care CPT 59400 59400 Routine obstetric care including antepartum care, vaginal delivery, postpartum care	$4,369.20	$5,825.60	$2,505.00–$5,534.32	—	25%
Wart removal, up to 14 warts CPT 17110 17110 DESTRUCTION BENIGN LESIONS UP TO 14 CHARGE	$117.75	$157.00	$67.51–$149.15	46% below	25%
Wart removal, up to 14 warts CPT 17110 17110 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettemen	$125.25	$167.00	$71.81–$158.65	43% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 17110 DESTRUCTION BENIGN LESIONS UP TO 14 CHARGE	$117.75	$157.00	$67.51–$149.15	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Debridement, subcutaneous tissue; first 20 sq cm or less	$109.50	$146.00	$62.78–$138.70	67% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042-SQ Tissue Less Than/Equal to 1st 20 sq cm	$624.75	$833.00	$358.19–$791.35	87% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042-SQ Tissue Less Than/Equal to 1st 20 sq cm	$624.75	$833.00	$358.19–$791.35	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD TRANSFUSION UP TO 1 UNIT CHARGE	$907.50	$1,210.00	$520.30–$1,149.50	7% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD ADMINISTRATION 2 UNITS CHARGE	$1,181.25	$1,575.00	$677.25–$1,496.25	21% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD ADMINISTRATION 3 UNITS CHARGE	$1,413.00	$1,884.00	$810.12–$1,789.80	44% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 36430 BLOOD ADMINISTRATION 4 UNITS CHARGE	$1,644.75	$2,193.00	$942.99–$2,083.35	68% above	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD TRANSFUSION UP TO 1 UNIT CHARGE	$907.50	$1,210.00	$520.30–$1,149.50	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD ADMINISTRATION 2 UNITS CHARGE	$1,181.25	$1,575.00	$677.25–$1,496.25	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD ADMINISTRATION 3 UNITS CHARGE	$1,413.00	$1,884.00	$810.12–$1,789.80	—	25%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 BLOOD ADMINISTRATION 4 UNITS CHARGE	$1,644.75	$2,193.00	$942.99–$2,083.35	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$222.00	$296.00	$127.28–$281.20	6% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Sputum Induction Initial CHARGE	$222.00	$296.00	$127.28–$281.20	6% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Education/Instruction CHARGE	$222.00	$296.00	$127.28–$281.20	6% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Aerosol Initial CHARGE	$222.00	$296.00	$127.28–$281.20	6% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$222.00	$296.00	$127.28–$281.20	6% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Aerosol Initial CHARGE	$222.00	$296.00	$127.28–$281.20	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Sputum Induction Initial CHARGE	$222.00	$296.00	$127.28–$281.20	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Meter Dose Inhaler Initial CHARGE	$222.00	$296.00	$127.28–$281.20	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Education/Instruction CHARGE	$222.00	$296.00	$127.28–$281.20	—	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 RT Meter Dose Inhaler Subsequent CHARGE	$222.00	$296.00	$127.28–$281.20	—	25%
Critical care, first 30 to 74 minutes CPT 99291 99291 - Critical Care, 30-74	$1,713.00	$2,284.00	$982.12–$2,169.80	26% below	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 - Critical Care, 30-74	$1,713.00	$2,284.00	$982.12–$2,169.80	—	25%
Electrocardiogram (ECG/EKG) with interpretation CPT 93000 93000 EKG COMPLETE	$155.25	$207.00	$62.10–$196.65	19% above	25%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 93000 EKG COMPLETE	$155.25	$207.00	$62.10–$196.65	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Electrocardiogram 12 Lead	$146.25	$195.00	$83.85–$185.25	12% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG POC - Clinic	$150.75	$201.00	$86.43–$190.95	9% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG w/ 12+ leads; Tracing Only	$150.75	$201.00	$86.43–$190.95	9% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 93005 EKG TRACING ONLY CHARGE	$173.25	$231.00	$99.33–$219.45	5% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Electrocardiogram 12 Lead	$146.25	$195.00	$83.85–$185.25	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 93005 EKG TRACING ONLY CHARGE	$173.25	$231.00	$99.33–$219.45	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 - Level 1	$183.75	$245.00	$105.35–$550.00	18% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 - Level 1	$183.75	$245.00	$105.35–$550.00	—	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 - Level 2	$313.50	$418.00	$179.74–$550.00	28% below	25%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 - Level 2	$313.50	$418.00	$179.74–$550.00	—	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 - Level 3	$513.00	$684.00	$294.12–$825.00	32% below	25%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 - Level 3	$513.00	$684.00	$294.12–$825.00	—	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 - Level 4	$1,218.75	$1,625.00	$698.75–$1,543.75	5% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 - Level 4	$1,218.75	$1,625.00	$698.75–$1,543.75	—	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 - Level 5	$1,218.75	$1,625.00	$698.75–$1,543.75	33% below	25%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 - Level 5	$1,218.75	$1,625.00	$698.75–$1,543.75	—	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 Stress Test/Nuclear Stress Test	$924.75	$1,233.00	$530.19–$1,171.35	12% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Stress Test/Nuclear Stress Test	$924.75	$1,233.00	$530.19–$1,171.35	—	25%
Family therapy with the patient, 50 minutes CPT 90847 90847 family session with patient present	$166.50	$222.00	$95.46–$210.90	14% below	25%
Family therapy with the patient, 50 minutes CPT 90847 90847 family session with patient present	$166.50	$222.00	$95.46–$210.90	14% below	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 90847 family session with patient present	$166.50	$222.00	$95.46–$210.90	—	25%
Family therapy without the patient, 50 minutes CPT 90846 90846 family psytx w/o patient present	$159.75	$213.00	$91.59–$202.35	13% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Hydration, first hour	$285.75	$381.00	$163.83–$361.95	14% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360-59 IV Hydration Initial Addl Site w/ Modification	$285.75	$381.00	$163.83–$361.95	14% below	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 INF/H IV Inf Initial 31 - 60 min	$396.75	$529.00	$227.47–$502.55	20% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV INF HYDRATION 31 MIN TO 1HR CHARGE	$396.75	$529.00	$227.47–$502.55	20% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 Hydration, first hour	$285.75	$381.00	$163.83–$361.95	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360-59 IV Hydration Initial Addl Site w/ Modification	$285.75	$381.00	$163.83–$361.95	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 INF/H IV Inf Initial 31 - 60 min	$396.75	$529.00	$227.47–$502.55	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV INF HYDRATION 31 MIN TO 1HR CHARGE	$396.75	$529.00	$227.47–$502.55	—	25%
IV infusion of a medicine, first hour CPT 96365 96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins	$328.50	$438.00	$188.34–$416.10	32% below	25%
IV infusion of a medicine, first hour CPT 96365 96365 IV tx, first hour	$328.50	$438.00	$188.34–$416.10	32% below	25%
IV infusion of a medicine, first hour CPT 96365 96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST >1 HOUR CHARGE	$426.75	$569.00	$244.67–$540.55	11% below	25%
IV infusion of a medicine, first hour CPT 96365 INF/NC IV Infusion Ther Initial	$441.75	$589.00	$253.27–$559.55	8% below	25%
IV infusion of a medicine, first hour inpatient CPT 96365 96365-Infusion Drug Initial up to 1 hr Greater Than 15 mins	$328.50	$438.00	$188.34–$416.10	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV tx, first hour	$328.50	$438.00	$188.34–$416.10	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST >1 HOUR CHARGE	$426.75	$569.00	$244.67–$540.55	—	25%
IV infusion of a medicine, first hour inpatient CPT 96365 INF/NC IV Infusion Ther Initial	$441.75	$589.00	$253.27–$559.55	—	25%
IV push of a medicine, first drug CPT 96374 96374 IV Injection, single/initial	$180.75	$241.00	$103.63–$228.95	22% below	25%
IV push of a medicine, first drug CPT 96374 96374-59 IV Push Initial Drug Addl Site w/ Modification	$180.75	$241.00	$103.63–$228.95	22% below	25%
IV push of a medicine, first drug CPT 96374 96374 IV PUSH SINGLE OR INITIAL SUBSTANCE /DRUG	$257.25	$343.00	$147.49–$325.85	12% above	25%
IV push of a medicine, first drug CPT 96374 INF/NC IV Push Single/Initial Drug	$257.25	$343.00	$147.49–$325.85	12% above	25%
IV push of a medicine, first drug CPT 96374 96374 Ther/proph/diag inj iv push/1ST SBT/DRUG	$257.25	$343.00	$147.49–$325.85	12% above	25%
IV push of a medicine, first drug inpatient CPT 96374 96374-59 IV Push Initial Drug Addl Site w/ Modification	$180.75	$241.00	$103.63–$228.95	—	25%
IV push of a medicine, first drug inpatient CPT 96374 96374 IV Injection, single/initial	$180.75	$241.00	$103.63–$228.95	—	25%
IV push of a medicine, first drug inpatient CPT 96374 96374 IV PUSH SINGLE OR INITIAL SUBSTANCE /DRUG	$257.25	$343.00	$147.49–$325.85	—	25%
IV push of a medicine, first drug inpatient CPT 96374 INF/NC IV Push Single/Initial Drug	$257.25	$343.00	$147.49–$325.85	—	25%
IV push of a medicine, first drug inpatient CPT 96374 96374 Ther/proph/diag inj iv push/1ST SBT/DRUG	$257.25	$343.00	$147.49–$325.85	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous o	$25.50	$34.00	$14.62–$32.30	78% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Subq/IM Injection	$89.25	$119.00	$51.17–$113.05	22% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372-59 SQ/IM Injection w/ Modification	$95.25	$127.00	$54.61–$120.65	17% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJ IM/SUB THERAPUTIC/DIAGNOS	$131.25	$175.00	$75.25–$166.25	14% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Subq/IM Injection	$89.25	$119.00	$51.17–$113.05	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372-59 SQ/IM Injection w/ Modification	$95.25	$127.00	$54.61–$120.65	—	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJ IM/SUB THERAPUTIC/DIAGNOS	$131.25	$175.00	$75.25–$166.25	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 90791 PSYCHIATRIC DIAGNOSTIC EVAL	$232.50	$310.00	$133.30–$294.50	1% below	25%
New patient office visit, about 30 minutes CPT 99203 99203 Office/Outpatient Visit - New Patient, Level 3 (30 min)	$147.00	$196.00	$58.80–$186.20	4% above	25%
New patient office visit, about 30 minutes CPT 99203 99203 Office Visit New Pt. Level 3	$147.00	$196.00	$58.80–$186.20	4% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office Visit New Pt. Level 3	$147.00	$196.00	$58.80–$186.20	—	25%
New patient office visit, about 45 minutes CPT 99204 99204 Office Visit New Pt. Level 4	$156.00	$208.00	$62.40–$197.60	21% below	25%
New patient office visit, about 45 minutes CPT 99204 99204 Office/Outpatient Visit - New Patient, Level 4 (45 min)	$239.25	$319.00	$95.70–$303.05	21% above	25%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office Visit New Pt. Level 4	$156.00	$208.00	$62.40–$197.60	—	25%
New patient office visit, about 60 minutes CPT 99205 99205 Office Visit New Pt. Level 5	$279.00	$372.00	$111.60–$353.40	4% below	25%
New patient office visit, about 60 minutes CPT 99205 99205 Office/Outpatient Visit - New Patient, Level 5 (60 min)	$325.50	$434.00	$130.20–$412.30	12% above	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office/Outpatient Visit - New Patient, Level 2 (20 min)	$84.00	$112.00	$33.60–$106.40	11% below	25%
Preventive checkup, new patient aged 18–39 CPT 99385 99385 Preventive Evaluation, New Pt; 18-39 Yrs	$168.00	$224.00	$67.20–$212.80	35% below	25%
Preventive checkup, new patient aged 40–64 CPT 99386 99386 Preventive Evaluation, New Pt; 40-64 Yrs	$165.75	$221.00	$66.30–$209.95	35% below	25%
Preventive checkup, new patient aged 65 or older CPT 99387 99387 Preventive Evaluation, New Pt; 65+ Yrs	$218.25	$291.00	$87.30–$276.45	19% below	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 99396 Preventive Evaluation, Established Pt; 40-64 Yrs	$166.50	$222.00	$66.60–$210.90	21% below	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 90839 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES	$211.50	$282.00	$121.26–$267.90	11% below	25%
Psychotherapy session, 30 minutes CPT 90832 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES	$112.50	$150.00	$64.50–$142.50	7% below	25%
Psychotherapy session, 45 minutes CPT 90834 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES	$147.75	$197.00	$84.71–$187.15	4% below	25%
Psychotherapy session, 45 minutes CPT 90834 90834 INDIVIDUAL THERAPY 45 MIN	$147.75	$197.00	$84.71–$187.15	4% below	25%
Psychotherapy session, 60 minutes CPT 90837 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES	$218.25	$291.00	$125.13–$276.45	at median	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/outpatient established high MDM 40 min Techfee	$257.25	$343.00	$102.90–$325.85	at median	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office/Outpatient Visit - Established Patient, Level 5 (40 min)	$257.25	$343.00	$102.90–$325.85	at median	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office/outpatient established high MDM 40 min Techfee	$257.25	$343.00	$102.90–$325.85	—	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office/Outpatient Visit - Established Patient, Level 3 (15 min)	$118.50	$158.00	$47.40–$150.10	24% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office Visit Established Pt. Level 3	$126.75	$169.00	$50.70–$160.55	18% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 OP TREATMENT ROOM TECH FEE	$162.00	$216.00	$64.80–$205.20	5% above	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office Visit Established Pt. Level 3	$126.75	$169.00	$50.70–$160.55	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 OP TREATMENT ROOM TECH FEE	$162.00	$216.00	$64.80–$205.20	—	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Established patient visit level 4 Charge	$167.25	$223.00	$66.90–$211.85	1% below	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office/Outpatient Visit - Established Patient, Level 4 (25 min)	$174.00	$232.00	$69.60–$220.40	3% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office Visit Established Pt. Level 4	$185.25	$247.00	$74.10–$234.65	10% above	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Established patient visit level 4 Charge	$167.25	$223.00	$66.90–$211.85	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office Visit Established Pt. Level 4	$185.25	$247.00	$74.10–$234.65	—	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office/Outpatient Visit - Established Patient, Level 2 (10 min)	$63.00	$84.00	$25.20–$79.80	31% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office Visit Established Pt. Level 2	$112.50	$150.00	$45.00–$142.50	23% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office Visit Established Pt. Level 2	$112.50	$150.00	$45.00–$142.50	—	25%
Spirometry (breathing test) CPT 94010 RT CHARGE PFT -> Spirometry	$285.00	$380.00	$163.40–$361.00	16% above	25%
Spirometry (breathing test) inpatient CPT 94010 RT CHARGE PFT -> Spirometry	$285.00	$380.00	$163.40–$361.00	—	25%
Spirometry before and after a bronchodilator CPT 94060 RT CHARGE PFT -> Spirometry before & after	$522.75	$697.00	$299.71–$662.15	3% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT CHARGE PFT -> Spirometry before & after	$522.75	$697.00	$299.71–$662.15	—	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 PHLEBOTOMY THERAPEUTIC	$219.00	$292.00	$125.56–$277.40	3% below	25%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 99195 PHLEBOTOMY THERAPEUTIC	$219.00	$292.00	$125.56–$277.40	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Idaho	Off list
Flu shot, recombinant, egg-free (Flublok) CPT 90673 influenza virus vaccine, inactivated recombinant hemagglutinin trivalent preservative-free Sol UD [SMCE]	$284.57	$379.42	$113.82–$360.44	399% above	25%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 influenza virus vaccine, inactivated recombinant hemagglutinin trivalent preservative-free Sol UD [SMCE]	$284.57	$379.42	$113.82–$360.44	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AMB influenza vacc Charge -> 90656 no prsv 3+>	$186.78	$249.04	$74.71–$236.58	419% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus UD [SMCE]	$186.78	$249.04	$74.71–$236.58	419% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 AMB influenza Charge -> Fluzone - single dose	$186.78	$249.04	$74.71–$236.58	419% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine, inactivated preservative-free trivalent Sus UD [SMCE]	$186.78	$249.04	$74.71–$236.58	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus UD [SMCE]	$284.57	$379.42	$113.82–$360.44	149% above	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 influenza virus vaccine, inactivated high-dose preservative-free trivalent Sus UD [SMCE]	$284.57	$379.42	$113.82–$360.44	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR Hospital virus vaccine - Pow [SMCE]	$171.36	$228.48	$68.54–$217.05	8% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMR Hospital virus vaccine - Pow [SMCE]	$171.36	$228.48	$68.54–$217.05	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Biofreeze 4% Gel [SMCE]	$34.88	$46.50	$13.95–$44.17	82% below	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Biofreeze 4% Gel [SMCE]	$34.88	$46.50	$13.95–$44.17	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 pneumococcal 13-valent conj vacc [SMCE]	$406.22	$541.63	$162.48–$514.54	41% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 AMB pneumococcal 13-valent conjugate vac Charge -> vaccine pneumococcal 13-valent conjugate (Prevnar)	$435.75	$581.00	$174.30–$551.95	51% above	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 pneumococcal 13-valent conj vacc [SMCE]	$406.22	$541.63	$162.48–$514.54	—	25%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 pneumococcal 15-valent conj vacc [SMCE]	$400.58	$534.11	$160.23–$507.40	49% below	25%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 AMB pneumococcal 15-valent conjugate vac Charge -> Pneumococcal 15-valent Conjugate Vaccine	$412.50	$550.00	$165.00–$522.50	47% below	25%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) inpatient CPT 90671 pneumococcal 15-valent conj vacc [SMCE]	$400.58	$534.11	$160.23–$507.40	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 measles/mumps/rubella/varicella virus vaccine - Pow MMR-V [SMCE]	$469.46	$625.94	$187.78–$594.64	19% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 AMB pneumococcal 20-valent vaccine Charge -> vaccine pneumococcal 20-valent conjugate	$485.25	$647.00	$194.10–$614.65	23% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 measles/mumps/rubella/varicella virus vaccine - Pow MMR-V [SMCE]	$469.46	$625.94	$187.78–$594.64	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [SMCE]	$210.74	$280.99	$84.29–$266.94	41% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 AMB pneumococcal 23-valent vaccine Charge -> vaccine pneumococcal 23-valent conjugate	$216.75	$289.00	$86.70–$274.55	45% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 pneumococcal 23-polyvalent vaccine injectable solution 0.5 mL [SMCE]	$210.74	$280.99	$84.29–$266.94	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Adacel (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [SMCE]	$123.40	$164.53	$49.35–$156.30	20% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 AMB Tdap Charge -> Tdap 90715 AGE OVER 7	$132.00	$176.00	$52.80–$167.20	28% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Adacel (Tdap) adult/adol 5 units-2 units-15.5 mcg/0.5 mL intramuscular suspension 0.5 mL [SMCE]	$123.40	$164.53	$49.35–$156.30	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Admin Immunization Charge -> Adult First Vaccine 90471	$21.75	$29.00	$12.47–$27.55	59% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471-Immunization administration; first vaccine	$37.50	$50.00	$21.50–$47.50	30% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471-Adult Vaccine Administration	$54.00	$72.00	$30.96–$68.40	1% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee	$54.00	$72.00	$30.96–$68.40	1% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 ADULT IMMUNIZ ADMIN 1 VACC	$84.00	$112.00	$48.16–$106.40	57% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471-Adult Vaccine Administration	$54.00	$72.00	$30.96–$68.40	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee	$54.00	$72.00	$30.96–$68.40	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 90471 ADULT IMMUNIZ ADMIN 1 VACC	$84.00	$112.00	$48.16–$106.40	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472- Adult Vaccine Administration Each Addl	$24.75	$33.00	$9.90–$31.35	25% below	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Admin Immunization Charge -> Adult Each Additional 90472	$26.25	$35.00	$10.50–$33.25	20% below	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472- Adult Vaccine Administration Each Addl	$24.75	$33.00	$9.90–$31.35	—	25%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://mrfs.hyvehealthcare.com/WestShoshoneHospitalDistrict/826003924_west-shoshone-hospital-district_standardcharges.csv