| Procedure | Southwest General Health Center | Fairview Hospital | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $56 | $87 | $51 |
| Abdominal fluid drain (paracentesis) | $999 | $2,803 | $284 |
| Abdominal ultrasound | $165 | $477 | $100 |
| Abdominal ultrasound (complete) | $165 | $477 | $114 |
| Abdominal ultrasound (limited) | $380 | $477 | $86 |
| Abscess drainage (complex or multiple) | $547 | $779 | $220 |
| Abscess drainage (simple) | $399 | $387 | $129 |
| Abscess incision and drainage | $467 | $583 | $174 |
| Albumin blood test | $42 | $22 | $5 |
| Aldosterone test | $77 | $183 | $41 |
| Alkaline phosphatase test | $46 | $23 | $5 |
| Alpha-fetoprotein (AFP) test | $128 | $75 | $17 |
| ALT liver enzyme test | $56 | $24 | $5 |
| Ammonia blood test | $98 | $66 | $15 |
| Amniocentesis | $1,457 | $2,264 | $120 |
| Amylase test | $24 | $29 | $6 |
| Annual physical (established patient) | $144 | $176 | — |
| Annual physical (new patient) | $167 | $142 | — |
| Antinuclear antibody (ANA) test | $118 | $54 | $12 |
| Aortic aneurysm repair (AAA) | $3,375 | $19,352 | $1,345 |
| Aortic valve replacement | $3,000 | $9,826 | $1,603 |
| Arterial blood gas (ABG) | $143 | $117 | $26 |
| AST liver enzyme test | $49 | $23 | $5 |
| Barium swallow study | $708 | $798 | $107 |
| Bartholin cyst removal | $367 | $601 | $182 |
| Basic metabolic panel | $67 | $38 | $8 |
| Benign skin lesion removal | $828 | $1,372 | $171 |
| Bilirubin blood test | $77 | $23 | $5 |
| Bladder function test (urodynamics) | $450 | $1,996 | $345 |
| Bladder scope (cystoscopy) | $1,373 | $1,996 | $216 |
| Blood clotting test (PT/INR) | $23 | $20 | $4 |
| Blood crossmatch | $343 | $768 | — |
| Blood glucose test | $35 | $21 | $5 |
| Blood transfusion | $1,126 | $1,634 | $47 |
| Blood type and screen | $115 | $44 | $10 |
| Blood type test | $72 | $14 | $3 |
| Blood type test (ABO group) | $66 | $14 | $3 |
| Blood type test (Rh/D antigen) | $78 | $14 | $3 |
| BNP (heart failure) test | $185 | $176 | $39 |
| Bone density scan (DEXA) | $144 | $477 | $39 |
| Bone marrow biopsy | $1,469 | $5,827 | $172 |
| Bone scan (nuclear) | $1,563 | $1,802 | $259 |
| Breast biopsy | $3,494 | $7,267 | $478 |
| Breast MRI | $2,994 | $1,084 | $216 |
| Breast MRI without contrast | $3,811 | $1,084 | $216 |
| Breast ultrasound | $364 | $436 | $92 |
| Breast ultrasound (complete) | $479 | $477 | $100 |
| Breast ultrasound (limited) | $249 | $395 | $84 |
| Breathing tube insertion (intubation) | $528 | $694 | $133 |
| Bronchoscopy | $253 | $5,156 | $303 |
| Burn dressing and debridement (medium) | $498 | $387 | $166 |
| Burn dressing and debridement (small) | $244 | $387 | $93 |
| Burn treatment | $413 | $387 | $129 |
| C-reactive protein (CRP) | $53 | $23 | $5 |
| CA 19-9 tumor marker test | $47 | $94 | $21 |
| CA-125 ovarian marker test | $47 | $94 | $21 |
| Calcium blood test | $38 | $23 | $5 |
| Capsule endoscopy | $225 | $2,803 | $802 |
| Cardiac ablation | $22,432 | $48,183 | $759 |
| Cardiac catheterization | $5,895 | $12,021 | $1,049 |
| Cardiac rehabilitation | $370 | $471 | $26 |
| Cardiac stress test | $77 | $1,164 | $39 |
| Cardioversion | $874 | $2,446 | $155 |
| Carotid artery ultrasound | $525 | $650 | $156 |
| Carpal tunnel release | $750 | $8,758 | $483 |
| CEA tumor marker test | $106 | $85 | $19 |
| Celiac disease test | $20 | $52 | $12 |
| Central line placement | $1,609 | $11,764 | $238 |
| Cervical cerclage | $2,029 | $8,267 | $137 |
| Chemotherapy infusion | $747 | $904 | $81 |
| Chemotherapy infusion (each additional) | $647 | $319 | $28 |
| Chemotherapy infusion (first hour) | $848 | $1,488 | $133 |
| Chest fluid drain (thoracentesis) | $1,070 | $1,849 | $311 |
| Chest tube insertion | $1,719 | $4,645 | $143 |
| Chest X-ray | $119 | $395 | $37 |
| Chest X-ray (1 view) | $119 | $395 | $25 |
| Chest X-ray (2 views) | $144 | $395 | $33 |
| Chickenpox (varicella) vaccine | $188 | $427 | — |
| Circumcision | $2,774 | $6,125 | $167 |
| CK-MB heart enzyme test | $135 | $52 | $12 |
| Clotting time test (PTT) | $36 | $27 | $6 |
| Colonoscopy | $488 | $3,526 | $480 |
| Colposcopy | $203 | $909 | $161 |
| Complete blood count (CBC) | $56 | $32 | $7 |
| Complete blood count (CBC) (complete) | $64 | $35 | $8 |
| Comprehensive metabolic panel | $112 | $47 | $11 |
| Contraceptive implant (Nexplanon) | $248 | $778 | $115 |
| Copper blood test | $165 | $56 | $12 |
| Coronary CT angiography | $932 | $1,602 | $326 |
| Cortisol test | $57 | $73 | $16 |
| COVID-19 PCR test | $77 | $230 | $51 |
| CPAP titration study | $323 | $608 | $69 |
| Creatine kinase (CK) test | $68 | $29 | $7 |
| CT angiography of the chest | $2,196 | $798 | $281 |
| CT angiography of the head | $2,137 | $798 | $274 |
| CT scan of the abdomen | $834 | $798 | $230 |
| CT scan of the abdomen and pelvis | $1,020 | $1,602 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $1,505 | $1,602 | $338 |
| CT scan of the abdomen and pelvis with contrast | $1,158 | $1,602 | $300 |
| CT scan of the abdomen and pelvis without contrast | $1,013 | $1,084 | $183 |
| CT scan of the abdomen with and without contrast | $1,436 | $798 | $259 |
| CT scan of the abdomen with contrast | $999 | $798 | $230 |
| CT scan of the abdomen without contrast | $827 | $477 | $136 |
| CT scan of the arm | $1,448 | $798 | $199 |
| CT scan of the arm with contrast | $1,501 | $1,602 | $199 |
| CT scan of the arm without contrast | $1,394 | $477 | $161 |
| CT scan of the chest | $1,683 | $798 | $167 |
| CT scan of the chest with and without contrast | $1,943 | $798 | $196 |
| CT scan of the chest with contrast | $1,020 | $798 | $167 |
| CT scan of the chest without contrast | $879 | $477 | $133 |
| CT scan of the head | $1,288 | $798 | $148 |
| CT scan of the head with and without contrast | $827 | $798 | $173 |
| CT scan of the head with contrast | $1,416 | $798 | $148 |
| CT scan of the head without contrast | $672 | $477 | $107 |
| CT scan of the leg | $1,520 | $798 | $166 |
| CT scan of the leg with contrast | $1,574 | $798 | $166 |
| CT scan of the leg without contrast | $1,466 | $477 | $130 |
| CT scan of the lower back (lumbar spine) | $1,945 | $798 | $169 |
| CT scan of the lower back (lumbar spine) with and without contrast | $2,285 | $798 | $197 |
| CT scan of the lower back (lumbar spine) with contrast | $1,995 | $1,602 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $980 | $477 | $130 |
| CT scan of the neck | $1,340 | $798 | $183 |
| CT scan of the neck (cervical spine) | $1,825 | $798 | $168 |
| CT scan of the neck (cervical spine) with and without contrast | $2,198 | $798 | $196 |
| CT scan of the neck (cervical spine) with contrast | $1,867 | $1,602 | $168 |
| CT scan of the neck (cervical spine) without contrast | $924 | $477 | $131 |
| CT scan of the neck with and without contrast | $1,431 | $798 | $220 |
| CT scan of the neck with contrast | $836 | $798 | $183 |
| CT scan of the neck without contrast | $708 | $477 | $150 |
| CT scan of the pelvis | $1,508 | $798 | $226 |
| CT scan of the pelvis with and without contrast | $1,727 | $798 | $251 |
| CT scan of the pelvis with contrast | $1,569 | $798 | $226 |
| CT scan of the pelvis without contrast | $764 | $477 | $133 |
| CT scan of the sinuses | $1,352 | $798 | $152 |
| CT scan of the sinuses with and without contrast | $1,730 | $798 | $184 |
| CT scan of the sinuses with contrast | $1,416 | $798 | $152 |
| CT scan of the sinuses without contrast | $672 | $477 | $128 |
| D-dimer test | $138 | $46 | $10 |
| Defibrillator (ICD) implant | $20,831 | $36,429 | $798 |
| DHEA-sulfate test | $173 | $99 | $22 |
| Diagnostic mammogram | $530 | $412 | $140 |
| Drug screen (urine) | $53 | $279 | $17 |
| Ear pressure test (tympanometry) | $60 | $102 | $16 |
| Ear tubes (myringotomy) | $234 | $3,851 | $174 |
| Echocardiogram | $703 | $904 | $138 |
| Echocardiogram with and without contrast | $623 | $904 | $101 |
| EEG (awake and asleep) | $331 | $1,397 | $482 |
| EKG / ECG (tracing only) | $132 | $222 | $7 |
| Electrocardiogram (EKG) | $38 | $246 | $8 |
| Electroencephalogram (EEG) | $331 | $1,397 | $448 |
| Electrolyte panel | $101 | $31 | $7 |
| Electromyography (EMG) | $182 | $578 | $141 |
| Emergency department visit | $233 | $1,242 | $69 |
| Emergency department visit (level 1) | $141 | $395 | $11 |
| Emergency department visit (level 2) | $255 | $710 | $40 |
| Emergency department visit (level 3) | $445 | $1,242 | $69 |
| Emergency department visit (level 4) | $660 | $1,910 | $118 |
| Emergency department visit (level 5) | $1,087 | $2,750 | $171 |
| Endometrial biopsy | $252 | $601 | $98 |
| Epidural steroid injection | $1,081 | $3,106 | $275 |
| ERCP (bile duct endoscopy) | $450 | $11,376 | $311 |
| Estradiol (estrogen) test | $143 | $125 | $28 |
| Facet joint injection (spine) | $242 | $1,129 | $99 |
| Fallopian tube X-ray (HSG) | $264 | $812 | $164 |
| Family therapy session | $184 | $313 | $110 |
| Fecal occult blood (stool) test | $30 | $46 | $10 |
| Fecal occult blood (stool) test (guaiac, gFOBT) | $29 | $20 | $4 |
| Fecal occult blood (stool) test (immunochemical, FIT) | $30 | $72 | $16 |
| Feeding tube (PEG) placement | $263 | $5,672 | $178 |
| Ferritin (iron) test | $89 | $61 | $14 |
| Fibrinogen test | $101 | $44 | $10 |
| Fibroid removal (myomectomy) | $1,218 | $2,816 | $914 |
| Flexible sigmoidoscopy | $128 | $2,726 | $323 |
| Flu test | $57 | $74 | $17 |
| Flu vaccine | $30 | $46 | — |
| Folate (folic acid) test | $101 | $66 | $15 |
| Foreign body removal (skin) | $748 | $779 | $157 |
| Free T4 thyroid test | $54 | $40 | $9 |
| FSH hormone test | $145 | $83 | $19 |
| Gallbladder removal (laparoscopic) | $1,013 | $17,445 | $658 |
| Gallbladder scan (HIDA) | $1,434 | $2,108 | $334 |
| Ganglion cyst removal | $506 | $4,785 | $321 |
| GGT liver test | $55 | $33 | $7 |
| Glucose tolerance test | $64 | $38 | $8 |
| Group therapy session | $241 | $542 | $30 |
| H. pylori test | $267 | $302 | $67 |
| Hammertoe repair | $574 | $9,701 | $548 |
| HDL cholesterol test | $65 | $37 | $8 |
| Hearing test (audiometry) | $68 | $407 | $36 |
| Hematocrit test | $26 | $10 | $2 |
| Hemoglobin A1c (diabetes test) | $21 | $44 | $10 |
| Hemorrhoid removal | $300 | $2,726 | $338 |
| Hepatitis A vaccine | $98 | $200 | — |
| Hepatitis B test | $107 | $46 | $10 |
| Hepatitis B vaccine | $337 | $168 | — |
| Hepatitis C test | $154 | $64 | $14 |
| HIV test | $113 | $85 | $19 |
| HIV test (antigen/antibody combo) | $113 | $108 | $24 |
| Holter heart monitor | $105 | $352 | $26 |
| HPV vaccine | $338 | $719 | — |
| Hysterectomy | $1,219 | $3,002 | $933 |
| Hysteroscopy | $1,673 | $9,507 | $1,270 |
| Inguinal hernia repair | $894 | $10,552 | $538 |
| Iron blood test | $35 | $29 | $6 |
| IUD insertion | $150 | $326 | — |
| IUD removal | $409 | $909 | $112 |
| IV infusion therapy | $353 | $576 | $44 |
| IV infusion therapy (each additional) | $236 | $207 | $21 |
| IV infusion therapy (initial) | $470 | $945 | $67 |
| IVC filter placement | $3,898 | $11,946 | $1,885 |
| Joint aspiration (small/intermediate) | $339 | $883 | $57 |
| Joint aspiration or injection (mid-size joint) | $339 | $883 | $57 |
| Joint aspiration or injection (small joint) | $338 | $883 | $56 |
| Kidney biopsy | $1,920 | $4,844 | $492 |
| Kidney scan (nuclear) | $1,500 | $2,414 | $172 |
| Kidney stone shock-wave (lithotripsy) | $7,544 | $10,312 | $760 |
| Kidney ultrasound | $373 | $477 | $84 |
| Kidney ultrasound (limited) | $369 | $477 | $61 |
| Knee joint injection | $346 | $883 | $69 |
| Lactate test | $93 | $52 | $12 |
| Laryngoscopy | $459 | $2,868 | $189 |
| LDH test | $14 | $27 | $6 |
| LDL cholesterol test | $59 | $47 | $11 |
| Leg artery angiogram | $3,332 | $14,117 | $149 |
| Leg vein ultrasound (Doppler) | $522 | $650 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $522 | $397 | $116 |
| LH hormone test | $136 | $83 | $19 |
| Lipase test | $101 | $31 | $7 |
| Lipid (cholesterol) panel | $80 | $60 | $13 |
| Liver biopsy | $910 | $4,844 | $288 |
| Liver function panel | $63 | $36 | $8 |
| Lung function test (PFT) | $196 | $699 | $37 |
| Lung scan (V/Q) | $1,859 | $2,414 | $291 |
| Magnesium blood test | $56 | $30 | $7 |
| MMR vaccine | $154 | $218 | — |
| MRA of the brain | $2,300 | $1,602 | $226 |
| MRA of the brain with contrast | $2,728 | $1,602 | $226 |
| MRA of the brain without contrast | $2,522 | $1,602 | $328 |
| MRA of the neck | $2,328 | $1,602 | $245 |
| MRA of the neck with contrast | $3,085 | $1,602 | $245 |
| MRA of the neck without contrast | $2,549 | $1,602 | $343 |
| MRI of the abdomen | $2,125 | $1,602 | $300 |
| MRI of the abdomen with contrast | $3,407 | $1,602 | $300 |
| MRI of the abdomen without contrast | $1,109 | $1,084 | $194 |
| MRI of the ankle | $2,123 | $1,602 | $261 |
| MRI of the ankle with contrast | $2,123 | $1,602 | $261 |
| MRI of the ankle without contrast | $1,998 | $1,084 | $222 |
| MRI of the brain | $1,140 | $1,602 | $269 |
| MRI of the brain with contrast | $1,232 | $1,602 | $269 |
| MRI of the brain without contrast | $1,115 | $1,084 | $195 |
| MRI of the chest | $2,092 | $1,602 | $371 |
| MRI of the chest with contrast | $2,092 | $3,543 | $371 |
| MRI of the chest without contrast | $2,381 | $1,602 | $466 |
| MRI of the knee | $2,836 | $1,602 | $315 |
| MRI of the knee with contrast | $2,836 | $3,543 | $315 |
| MRI of the knee without contrast | $2,500 | $1,084 | $204 |
| MRI of the lower back (lumbar spine) | $1,151 | $1,602 | $270 |
| MRI of the lower back (lumbar spine) with contrast | $1,242 | $1,602 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $1,123 | $1,084 | $192 |
| MRI of the mid-back (thoracic spine) | $2,392 | $1,602 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $1,566 | $1,602 | $319 |
| MRI of the mid-back (thoracic spine) with contrast | $3,165 | $1,602 | $271 |
| MRI of the mid-back (thoracic spine) without contrast | $1,243 | $1,084 | $190 |
| MRI of the neck (cervical spine) | $2,583 | $1,602 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $1,686 | $1,602 | $318 |
| MRI of the neck (cervical spine) with contrast | $2,842 | $1,602 | $274 |
| MRI of the neck (cervical spine) without contrast | $1,335 | $1,084 | $191 |
| MRI of the pelvis | $1,724 | $1,602 | $268 |
| MRI of the pelvis with contrast | $1,848 | $1,602 | $268 |
| MRI of the pelvis without contrast | $909 | $1,084 | $227 |
| MRI of the shoulder | $2,457 | $1,602 | $313 |
| MRI of the shoulder with contrast | $1,910 | $3,543 | $313 |
| MRI of the shoulder without contrast | $2,457 | $1,084 | $205 |
| MRI of the wrist | $2,092 | $1,602 | $330 |
| MRI of the wrist with contrast | $2,092 | $1,602 | $330 |
| MRI of the wrist without contrast | $1,969 | $1,084 | $303 |
| Nebulizer breathing treatment | $231 | $608 | $9 |
| Nerve conduction study | $174 | $1,397 | $118 |
| Nuchal translucency ultrasound | $399 | $477 | $116 |
| Nuclear cardiac stress test | $1,949 | $5,855 | $428 |
| Occupational therapy evaluation | $226 | $438 | $101 |
| Occupational therapy evaluation (high complexity) | $298 | $438 | $101 |
| Occupational therapy evaluation (low complexity) | $176 | $438 | $101 |
| Occupational therapy evaluation (moderate complexity) | $226 | $438 | $101 |
| Office visit (established patient) | $154 | $110 | $115 |
| Office visit (new patient) | $236 | $113 | $177 |
| Office visit, established patient (level 3) | $128 | $98 | $95 |
| Office visit, established patient (level 4) | $180 | $122 | $136 |
| Office visit, new patient (level 3) | $157 | $90 | $118 |
| Office visit, new patient (level 4) | $236 | $113 | $177 |
| Office visit, new patient (level 5) | $312 | $153 | $237 |
| Orthopedic hardware removal | $544 | $8,557 | $632 |
| Ovarian cyst removal | $1,388 | $14,760 | $698 |
| Ovary removal (oophorectomy) | $713 | $14,760 | $822 |
| Pap smear (cervical screening) | $47 | $105 | $20 |
| Parathyroid hormone (PTH) test | $242 | $185 | $41 |
| Pelvic ultrasound | $420 | $477 | $78 |
| Pelvic ultrasound (complete) | $420 | $477 | $105 |
| Pelvic ultrasound (limited) | $423 | $477 | $51 |
| PET scan | $5,729 | $6,542 | — |
| Phosphorus blood test | $35 | $21 | $5 |
| Physical therapy evaluation | $237 | $393 | $98 |
| Physical therapy evaluation (high complexity) | $310 | $393 | $98 |
| Physical therapy evaluation (moderate complexity) | $237 | $393 | $98 |
| Pilonidal cyst removal | $523 | $5,581 | $541 |
| Platelet count | $34 | $20 | $4 |
| Pneumonia vaccine | $195 | $275 | — |
| Pregnancy blood test (hCG) | $91 | $34 | $8 |
| Pregnancy ultrasound | $478 | $477 | $126 |
| Pregnancy ultrasound (first trimester) | $505 | $477 | $117 |
| Pregnancy ultrasound (second or third trimester) | $478 | $477 | $136 |
| Procalcitonin test | $176 | $122 | $27 |
| Prolactin test | $149 | $87 | $19 |
| Prostate test (PSA) | $131 | $83 | $18 |
| Psychiatric evaluation | $274 | $313 | $188 |
| Psychotherapy session | $272 | $313 | $140 |
| Pulmonary rehabilitation | $149 | $177 | $87 |
| Radiofrequency nerve ablation | $563 | $8,758 | $462 |
| RSV vaccine | $439 | $719 | — |
| Sacroiliac joint injection | $188 | $1,253 | $176 |
| Scoliosis spine X-ray | $272 | $436 | $58 |
| Scoliosis spine X-ray (1 view) | $272 | $395 | $44 |
| Scoliosis spine X-ray (3 views) | $279 | $477 | $72 |
| Screening colonoscopy | $495 | $2,371 | $378 |
| Screening mammogram | $468 | $396 | $126 |
| Scrotal ultrasound | $339 | $477 | $99 |
| Sedimentation rate (ESR) test | $50 | $12 | $3 |
| Sex hormone binding globulin test | $50 | $98 | $22 |
| Shingles vaccine | $210 | $505 | — |
| Simple laceration repair (small, up to 2.5 cm) | $340 | $387 | $114 |
| Simple wound stitches | $340 | $387 | $127 |
| Skin biopsy | $314 | $779 | $121 |
| Skin biopsy (punch) | $478 | $779 | $121 |
| Skin cancer lesion removal | $662 | $1,372 | $240 |
| Skin lesion freezing (cryotherapy) | $53 | $302 | $36 |
| Skin tag removal | $269 | $387 | $92 |
| Soft tissue ultrasound | $228 | $477 | $64 |
| Speech therapy | $249 | $307 | $76 |
| Spinal cord stimulator | $6,025 | $16,516 | $2,388 |
| Spinal tap (lumbar puncture) | $1,460 | $3,106 | $165 |
| Spine fracture repair (kyphoplasty) | $7,323 | $21,360 | $5,803 |
| Spirometry (lung function test) | $181 | $468 | $30 |
| Spirometry with bronchodilator | $340 | $931 | $43 |
| Strep throat test | $46 | $74 | $17 |
| Stress echocardiogram | $1,272 | $2,049 | $209 |
| Stress echocardiogram (complete) | $1,272 | $2,049 | $233 |
| Swallow study | $447 | $371 | $85 |
| T3 thyroid test | $119 | $64 | $14 |
| Tdap (tetanus) vaccine | $131 | $111 | — |
| Testosterone test | $59 | $116 | $26 |
| Thyroid test (TSH) | $101 | $75 | $17 |
| Thyroid ultrasound | $321 | $477 | $109 |
| Thyroid uptake scan | $2,093 | $1,802 | $145 |
| Tilt table test | $1,040 | $1,983 | $168 |
| Total IgE allergy test | $38 | $74 | $16 |
| Total protein test | $8 | $16 | $4 |
| Tracheostomy | $488 | $9,697 | $273 |
| Transesophageal echocardiogram (TEE) | $1,278 | $2,049 | $239 |
| Transesophageal echocardiogram (TEE) with and without contrast | $1,278 | $2,049 | $239 |
| Transvaginal ultrasound | $357 | $477 | $118 |
| Trigger finger release | $883 | $4,785 | $630 |
| Trigger point injection | $342 | $883 | $56 |
| Trigger point injection (1-2 muscles) | $337 | $883 | $52 |
| Triglycerides test | $61 | $26 | $6 |
| Troponin (heart) test | $151 | $56 | $12 |
| Turning a breech baby (version) | $4,209 | $8,267 | $94 |
| Upper GI endoscopy (EGD) | $338 | $2,803 | $371 |
| Upper GI series (barium) | $623 | $798 | $128 |
| Uric acid (gout) test | $58 | $20 | $5 |
| Urinalysis | $38 | $12 | $3 |
| Urine microalbumin test | $27 | $25 | $5 |
| Urine pregnancy test | $21 | $38 | $9 |
| Vaccine administration | $83 | $90 | $19 |
| Vaccine administration (each additional) | $77 | $42 | $16 |
| Varicose vein ablation | $5,258 | $11,764 | $1,018 |
| Vitamin B12 test | $123 | $68 | $15 |
| Vitamin D test | $49 | $133 | $30 |
| Wart removal | $165 | $387 | $121 |
| Well-child visit | $124 | $99 | — |
| Wound debridement | $680 | $986 | $186 |
| X-ray of the abdomen | $252 | $477 | $36 |
| X-ray of the ankle | $205 | $395 | $37 |
| X-ray of the collarbone | $171 | $395 | $33 |
| X-ray of the elbow | $303 | $395 | $33 |
| X-ray of the facial bones | $284 | $436 | $39 |
| X-ray of the foot | $174 | $395 | $34 |
| X-ray of the forearm | $182 | $395 | $29 |
| X-ray of the hand | $191 | $395 | $38 |
| X-ray of the hip | $186 | $395 | $49 |
| X-ray of the hip (1 view) | $186 | $395 | $34 |
| X-ray of the hip (3 views) | $125 | $395 | $49 |
| X-ray of the hip (4 views) | $251 | $477 | $63 |
| X-ray of the knee | $97 | $395 | $42 |
| X-ray of the knee (2 views) | $201 | $395 | $34 |
| X-ray of the knee (3 views) | $221 | $395 | $42 |
| X-ray of the knee (4+ views) | $97 | $477 | $49 |
| X-ray of the lower back (lumbar spine) | $287 | $477 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $245 | $477 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $354 | $477 | $53 |
| X-ray of the lower leg | $194 | $395 | $31 |
| X-ray of the mid-back (thoracic spine) | $45 | $477 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $45 | $477 | $33 |
| X-ray of the mid-back (thoracic spine) (3 views) | $233 | $477 | $39 |
| X-ray of the neck (cervical spine) | $243 | $436 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $234 | $395 | $40 |
| X-ray of the pelvis | $178 | $477 | $36 |
| X-ray of the pelvis (1 view) | $178 | $477 | $28 |
| X-ray of the ribs | $179 | $477 | $42 |
| X-ray of the ribs (2 views) | $176 | $395 | $36 |
| X-ray of the ribs (3 views) | $179 | $477 | $42 |
| X-ray of the shoulder | $188 | $395 | $36 |
| X-ray of the skull | $251 | $477 | $40 |
| X-ray of the upper arm | $188 | $395 | $32 |
| X-ray of the wrist | $227 | $395 | $43 |
| Zinc blood test | $118 | $51 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
