Hospital Brattleboro, VT

Brattleboro Memorial Hospital

Brattleboro Memorial Hospital in Brattleboro, VT publishes cash prices for 341 common procedures listed here, from its own machine-readable price file updated Dec 29, 2025. Compared with other hospitals in the state, its outpatient cash prices are below the Vermont median for 214 of 334 procedures and above it for 82. By typical cash price it ranks #5 of 11 Vermont hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

17 Belmont Ave, Brattleboro, VT 05301 Collected Sep 23, 2026 Source price file Check a bill from this hospital (802) 257-0341

Acute care hospital Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 470011 · CMS hospital register NPI 1306849708

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Brattleboro Memorial Hospital is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 6 actions for a hospital named Brattleboro Memorial Hospital in Brattleboro, VT:

Aug 25, 2021 Warning notice
May 4, 2022 Corrective action plan requested
Nov 10, 2023 Case closed
Sep 11, 2025 Warning notice
Dec 15, 2025 Corrective action plan requested
Jan 14, 2026 Case closed

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen w/ + w/o Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	27% below	30%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen w/ + w/o Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen Complete w/ Decub/Erect	$664.09	$948.70	$82.20–$920.24	5% above	30%
Abdominal X-ray, 2 views CPT 74019 XR Abdomen 2 Views	$664.09	$948.70	$82.20–$920.24	5% above	30%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen Complete w/ Decub/Erect	$664.09	$948.70	$552.14–$920.24	—	30%
Abdominal X-ray, 2 views inpatient CPT 74019 XR Abdomen 2 Views	$664.09	$948.70	$552.14–$920.24	—	30%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle 3 Views Right	$368.41	$526.30	$68.06–$510.51	32% below	30%
Ankle X-ray, complete, 3 or more views one side CPT 73610 XR Ankle 3 Views Left	$368.41	$526.30	$68.06–$510.51	32% below	30%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle 3 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 XR Ankle 3 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 US ABI Single Lvl Bilat	$618.10	$883.00	$99.64–$856.51	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 LIMITED L/U ABI	$283.57	$405.10	$99.64–$392.95	1% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 93922 Extremity Study 2 LVLS TS CHARGE	$283.57	$405.10	$99.64–$392.95	1% above	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 US ABI Single Lvl Bilat	$618.10	$883.00	$513.91–$856.51	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 93922 LIMITED L/U ABI	$283.57	$405.10	$235.77–$392.95	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 93922 Extremity Study 2 LVLS TS CHARGE	$283.57	$405.10	$235.77–$392.95	—	30%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Right	$1,400.00	$2,000.00	$82.20–$1,940.00	34% below	30%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity w/o Contrast Left	$1,400.00	$2,000.00	$82.20–$1,940.00	34% below	30%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Left	$1,400.00	$2,000.00	$1,164.00–$1,940.00	—	30%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity w/o Contrast Right	$1,400.00	$2,000.00	$1,164.00–$1,940.00	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR Esophagus	$1,190.28	$1,700.40	$137.61–$1,649.39	38% above	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 BVT XR Esophagus	$1,190.28	$1,700.40	$137.61–$1,649.39	38% above	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 BVT XR Esophagus	$1,190.28	$1,700.40	$989.63–$1,649.39	—	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR Esophagus	$1,190.28	$1,700.40	$989.63–$1,649.39	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 NM Bone Imaging Whole Body	$1,414.84	$2,021.20	$310.61–$1,960.56	30% below	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM Bone Imaging Whole Body	$1,414.84	$2,021.20	$1,176.34–$1,960.56	—	30%
Breast ultrasound, complete, one breast both sides CPT 76641 US Breast Comp Bilateral	$653.66	$933.80	$82.20–$905.79	—	30%
Breast ultrasound, complete, one breast one side CPT 76641 76641 Ultrasound, breast, unilateral, real time with image docu. (in office)	$416.99	$595.70	$82.20–$577.83	27% below	30%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Left	$653.66	$933.80	$82.20–$905.79	14% above	30%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Comp Right	$653.66	$933.80	$82.20–$905.79	14% above	30%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 US Breast Comp Bilateral	$653.66	$933.80	$543.47–$905.79	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 76641 Ultrasound, breast, unilateral, real time with image docu. (in office)	$416.99	$595.70	$346.70–$577.83	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Left	$653.66	$933.80	$543.47–$905.79	—	30%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Comp Right	$653.66	$933.80	$543.47–$905.79	—	30%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 US Breast Limited Bilateral	$360.64	$515.20	$68.06–$499.74	—	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 BVT US Breast Right	$360.64	$515.20	$68.06–$499.74	37% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 BVT US Breast Left	$360.64	$515.20	$68.06–$499.74	37% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Right	$360.64	$515.20	$68.06–$499.74	37% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast Left	$360.64	$515.20	$68.06–$499.74	37% below	30%
Breast ultrasound, limited (one breast or one area) inpatient both sides CPT 76642 US Breast Limited Bilateral	$360.64	$515.20	$299.85–$499.74	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Left	$360.64	$515.20	$299.85–$499.74	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast Right	$360.64	$515.20	$299.85–$499.74	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 BVT US Breast Left	$360.64	$515.20	$299.85–$499.74	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 BVT US Breast Right	$360.64	$515.20	$299.85–$499.74	—	30%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abdomen/Pelvis	$4,130.91	$5,901.30	$276.06–$5,724.26	5% above	30%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Chest/Abdomen/Pelvis	$4,130.91	$5,901.30	$276.06–$5,724.26	5% above	30%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Chest/Abdomen/Pelvis	$4,130.91	$5,901.30	$3,434.56–$5,724.26	—	30%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abdomen/Pelvis	$4,130.91	$5,901.30	$3,434.56–$5,724.26	—	30%
CT angiography (CTA) of the head CPT 70496 CT Angio Head/Neck	$2,159.57	$3,085.10	$137.61–$2,992.55	38% below	30%
CT angiography (CTA) of the head CPT 70496 CT Angio Head	$2,159.57	$3,085.10	$137.61–$2,992.55	38% below	30%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head/Neck	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Head	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT angiography (CTA) of the neck CPT 70498 BVT CT Angio Neck	$2,142.98	$3,061.40	$137.61–$2,969.56	33% below	30%
CT angiography (CTA) of the neck CPT 70498 CT Angio Neck	$2,159.57	$3,085.10	$137.61–$2,992.55	32% below	30%
CT angiography (CTA) of the neck inpatient CPT 70498 BVT CT Angio Neck	$2,142.98	$3,061.40	$1,781.73–$2,969.56	—	30%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Neck	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 BVT CT Angio Chest	$2,142.98	$3,061.40	$137.61–$2,969.56	25% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT PE Protocol	$2,159.57	$3,085.10	$137.61–$2,992.55	24% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest	$2,159.57	$3,085.10	$137.61–$2,992.55	24% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest w/ + w/o Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	24% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 BVT CT Angio Chest	$2,142.98	$3,061.40	$1,781.73–$2,969.56	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT PE Protocol	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest w/ + w/o Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 BVT CT Abdomen/Pelvis w/o Contrast	$2,449.09	$3,498.70	$186.85–$3,393.74	21% below	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abdomen/Pelvis w/o Contrast	$2,468.13	$3,525.90	$186.85–$3,420.12	21% below	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 BVT CT Abdomen/Pelvis w/o Contrast	$2,449.09	$3,498.70	$2,036.24–$3,393.74	—	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abdomen/Pelvis w/o Contrast	$2,468.13	$3,525.90	$2,052.07–$3,420.12	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 BVT CT Abdomen/Pelvis w/ Contrast	$4,097.94	$5,854.20	$276.06–$5,678.57	3% below	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen/Pelvis w/ Contrast	$4,130.91	$5,901.30	$276.06–$5,724.26	2% below	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 BVT CT Abdomen/Pelvis w/ Contrast	$4,097.94	$5,854.20	$3,407.14–$5,678.57	—	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen/Pelvis w/ Contrast	$4,130.91	$5,901.30	$3,434.56–$5,724.26	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Hematuria/Urogram	$4,130.91	$5,901.30	$276.06–$5,724.26	12% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen/Pelvis w/ + w/o Contrast	$4,130.91	$5,901.30	$276.06–$5,724.26	12% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen/Pelvis w/ + w/o Contrast	$4,130.91	$5,901.30	$3,434.56–$5,724.26	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Hematuria/Urogram	$4,130.91	$5,901.30	$3,434.56–$5,724.26	—	30%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	21% below	30%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen/Chest w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	21% below	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen/Chest w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT scan of the abdomen without contrast CPT 74150 BVT CT Abdomen w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	48% below	30%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen/Chest w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	48% below	30%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	48% below	30%
CT scan of the abdomen without contrast inpatient CPT 74150 BVT CT Abdomen w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen/Chest w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	43% below	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT Head or Brain w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	36% below	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain for Stroke	$1,204.14	$1,720.20	$82.20–$1,668.59	36% below	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Head or Brain w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain for Stroke	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the head with contrast CPT 70460 CT Head or Brain w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	5% below	30%
CT scan of the head with contrast inpatient CPT 70460 CT Head or Brain w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT scan of the head without and with contrast CPT 70470 CT Head or Brain w/ + w/o Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	22% below	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT Head or Brain w/ + w/o Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Spine Lumbar w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	45% below	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Spine Lumbar w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Spine Cervical w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	44% below	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Spine Cervical w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis MSK w/ Contrast	$497.56	$710.80	$137.61–$1,677.21	81% below	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	16% below	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis MSK w/ Contrast	$497.56	$710.80	$413.69–$689.48	—	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Duplex Bilateral	$1,337.63	$1,910.90	$186.85–$1,853.57	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Duplex Bilateral	$1,337.63	$1,910.90	$1,112.14–$1,853.57	—	30%
Chest CT scan without and with contrast CPT 71270 CT Lung Screen F/U w/ + w/o Contrast	$497.56	$710.80	$137.61–$1,344.73	78% below	30%
Chest CT scan without and with contrast CPT 71270 CT Chest w/ + w/o Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	4% below	30%
Chest CT scan without and with contrast inpatient CPT 71270 CT Lung Screen F/U w/ + w/o Contrast	$497.56	$710.80	$413.69–$689.48	—	30%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest w/ + w/o Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
Chest X-ray, 2 views CPT 71046 XR Chest 2 Views	$368.41	$526.30	$68.06–$510.51	21% below	30%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 Views	$368.41	$526.30	$306.31–$510.51	—	30%
Chest X-ray, single view CPT 71045 BVT XR Chest 1 View	$368.41	$526.30	$68.06–$510.51	2% above	30%
Chest X-ray, single view CPT 71045 XR Chest 1 View Portable	$368.41	$526.30	$68.06–$510.51	2% above	30%
Chest X-ray, single view CPT 71045 XR Chest 1 View	$368.41	$526.30	$68.06–$510.51	2% above	30%
Chest X-ray, single view inpatient CPT 71045 BVT XR Chest 1 View	$368.41	$526.30	$306.31–$510.51	—	30%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View Portable	$368.41	$526.30	$306.31–$510.51	—	30%
Chest X-ray, single view inpatient CPT 71045 XR Chest 1 View	$368.41	$526.30	$306.31–$510.51	—	30%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Left	$368.41	$526.30	$68.06–$510.51	27% below	30%
Collarbone (clavicle) X-ray, complete one side CPT 73000 XR Clavicle Right	$368.41	$526.30	$68.06–$510.51	27% below	30%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Left	$368.41	$526.30	$306.31–$510.51	—	30%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 XR Clavicle Right	$368.41	$526.30	$306.31–$510.51	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$653.66	$933.80	$82.20–$905.79	10% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$653.66	$933.80	$543.47–$905.79	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Procedure (DEXA)	$664.09	$948.70	$82.20–$920.24	1% above	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Procedure (DEXA)	$664.09	$948.70	$552.14–$920.24	—	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BVT XR BD DXA Peripheral/Wrist	$368.41	$526.30	$68.06–$510.51	3% above	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BVT XR BD DXA Peripheral/Wrist	$368.41	$526.30	$306.31–$510.51	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Lung Screen F/U w/o Contrast	$303.45	$433.50	$82.20–$805.67	86% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 BVT CT Chest w/o Contrast	$1,194.69	$1,706.70	$82.20–$1,655.50	46% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	46% below	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest/Abdomen/Pelvis w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	46% below	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Lung Screen F/U w/o Contrast	$303.45	$433.50	$252.30–$420.50	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest/Abdomen/Pelvis w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 BVT CT Chest w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Lung Screen F/U w/ Contrast	$497.56	$710.80	$137.61–$1,096.93	82% below	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 BVT CT Chest w/ Contrast	$2,142.98	$3,061.40	$137.61–$2,969.56	21% below	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest/Abdomen/Pelvis w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	20% below	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	20% below	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Lung Screen F/U w/ Contrast	$497.56	$710.80	$413.69–$689.48	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 BVT CT Chest w/ Contrast	$2,142.98	$3,061.40	$1,781.73–$2,969.56	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest/Abdomen/Pelvis w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat	$475.09	$678.70	$96.06–$1,053.02	—	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MA Mammogram Digital Diagnostic Bilat	$475.09	$678.70	$395.00–$658.34	—	30%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Right	$375.41	$536.30	$75.36–$821.33	29% below	30%
Diagnostic mammogram, one breast one side CPT 77065 MA Mammogram Digital Diagnostic Left	$375.41	$536.30	$75.36–$821.33	29% below	30%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Right	$375.41	$536.30	$312.13–$520.21	—	30%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Mammogram Digital Diagnostic Left	$375.41	$536.30	$312.13–$520.21	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US UE Venous Duplex Bilateral	$1,337.63	$1,910.90	$186.85–$1,853.57	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US LE Venous Duplex Bilateral	$1,337.63	$1,910.90	$186.85–$1,853.57	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Insufficiency Bilateral	$1,337.63	$1,910.90	$186.85–$1,853.57	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US LE Venous Duplex Bilateral	$1,337.63	$1,910.90	$1,112.14–$1,853.57	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Insufficiency Bilateral	$1,337.63	$1,910.90	$1,112.14–$1,853.57	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US UE Venous Duplex Bilateral	$1,337.63	$1,910.90	$1,112.14–$1,853.57	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 US Echocardiogram Complete	$2,886.80	$4,124.00	$423.84–$4,000.28	13% above	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 US Echocardiogram Complete	$2,886.80	$4,124.00	$2,400.17–$4,000.28	—	30%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Right	$368.41	$526.30	$68.06–$510.51	9% below	30%
Elbow X-ray, 2 views one side CPT 73070 XR Elbow 2 Views Left	$368.41	$526.30	$68.06–$510.51	9% below	30%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Elbow X-ray, 2 views inpatient one side CPT 73070 XR Elbow 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow 3 Views Min Rt	$368.41	$526.30	$68.06–$510.51	36% below	30%
Elbow X-ray, complete, 3 or more views one side CPT 73080 XR Elbow 3 Views Min Lt	$368.41	$526.30	$68.06–$510.51	36% below	30%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow 3 Views Min Rt	$368.41	$526.30	$306.31–$510.51	—	30%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 XR Elbow 3 Views Min Lt	$368.41	$526.30	$306.31–$510.51	—	30%
Eye socket (orbit) CT scan without contrast CPT 70480 CT IAC w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	46% below	30%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbit w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	46% below	30%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT IAC w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbit w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Facial Bones Minimum 3 Views	$664.09	$948.70	$82.20–$920.24	7% above	30%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR Zygomatic Arches	$664.09	$948.70	$82.20–$920.24	7% above	30%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Zygomatic Arches	$664.09	$948.70	$552.14–$920.24	—	30%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR Facial Bones Minimum 3 Views	$664.09	$948.70	$552.14–$920.24	—	30%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Right	$368.41	$526.30	$68.06–$510.51	21% below	30%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 XR Forearm 2 Views Left	$368.41	$526.30	$68.06–$510.51	21% below	30%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 XR Forearm 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 NM Hepatobiliary Duct System Imaging	$1,414.84	$2,021.20	$310.61–$1,960.56	18% below	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 NM Hepatobiliary Duct System Imaging	$1,414.84	$2,021.20	$1,176.34–$1,960.56	—	30%
Hand X-ray, 2 views both sides CPT 73120 BVT XR Hand 2 Views Bilateral	$664.09	$948.70	$82.20–$920.24	—	30%
Hand X-ray, 2 views both sides CPT 73120 XR Hand 2 Views Bilateral	$664.09	$948.70	$82.20–$920.24	—	30%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Left	$664.09	$948.70	$82.20–$920.24	38% above	30%
Hand X-ray, 2 views one side CPT 73120 XR Hand 2 Views Right	$664.09	$948.70	$82.20–$920.24	38% above	30%
Hand X-ray, 2 views inpatient both sides CPT 73120 XR Hand 2 Views Bilateral	$664.09	$948.70	$552.14–$920.24	—	30%
Hand X-ray, 2 views inpatient both sides CPT 73120 BVT XR Hand 2 Views Bilateral	$664.09	$948.70	$552.14–$920.24	—	30%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Right	$664.09	$948.70	$552.14–$920.24	—	30%
Hand X-ray, 2 views inpatient one side CPT 73120 XR Hand 2 Views Left	$664.09	$948.70	$552.14–$920.24	—	30%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus Min 2 View Rt	$368.41	$526.30	$68.06–$510.51	6% below	30%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 XR Calcaneus Min 2 View Lt	$368.41	$526.30	$68.06–$510.51	6% below	30%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus Min 2 View Rt	$368.41	$526.30	$306.31–$510.51	—	30%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 XR Calcaneus Min 2 View Lt	$368.41	$526.30	$306.31–$510.51	—	30%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Right	$368.41	$526.30	$68.06–$510.51	38% below	30%
Knee X-ray, 3 views one side CPT 73562 XR Knee 3 Views Left	$368.41	$526.30	$68.06–$510.51	38% below	30%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
Knee X-ray, 3 views inpatient one side CPT 73562 XR Knee 3 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 Views w/ Patella Left	$664.09	$948.70	$82.20–$920.24	3% below	30%
Knee X-ray, complete, 4 or more views one side CPT 73564 XR Knee 4 Views w/ Patella Right	$664.09	$948.70	$82.20–$920.24	3% below	30%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 Views w/ Patella Left	$664.09	$948.70	$552.14–$920.24	—	30%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 XR Knee 4 Views w/ Patella Right	$664.09	$948.70	$552.14–$920.24	—	30%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Right	$1,400.00	$2,000.00	$82.20–$1,940.00	33% below	30%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity w/o Contrast Left	$1,400.00	$2,000.00	$82.20–$1,940.00	33% below	30%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Right	$1,400.00	$2,000.00	$1,164.00–$1,940.00	—	30%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity w/o Contrast Left	$1,400.00	$2,000.00	$1,164.00–$1,940.00	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 BVT US Abdomen Limited	$653.66	$933.80	$82.20–$905.79	at median	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen Limited	$653.66	$933.80	$82.20–$905.79	at median	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 BVT US Abdomen Limited	$653.66	$933.80	$543.47–$905.79	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen Limited	$653.66	$933.80	$543.47–$905.79	—	30%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non-Vascular Ltd Rt	$653.66	$933.80	$82.20–$905.79	15% above	30%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 BVT US Extremity Non-Vascular Ltd Rt	$653.66	$933.80	$82.20–$905.79	15% above	30%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 BVT US Extremity Non-Vascular Ltd Lt	$653.66	$933.80	$82.20–$905.79	15% above	30%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non-Vascular Ltd Lt	$653.66	$933.80	$82.20–$905.79	15% above	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 BVT US Extremity Non-Vascular Ltd Rt	$653.66	$933.80	$543.47–$905.79	—	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non-Vascular Ltd Rt	$653.66	$933.80	$543.47–$905.79	—	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non-Vascular Ltd Lt	$653.66	$933.80	$543.47–$905.79	—	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 BVT US Extremity Non-Vascular Ltd Lt	$653.66	$933.80	$543.47–$905.79	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Screen	$667.52	$953.60	$82.20–$924.99	56% below	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Screen	$667.52	$953.60	$555.00–$924.99	—	30%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia +Fibula 2 Views Rt	$368.41	$526.30	$68.06–$510.51	22% below	30%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR Tibia +Fibula 2 Views Lt	$368.41	$526.30	$68.06–$510.51	22% below	30%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia +Fibula 2 Views Rt	$368.41	$526.30	$306.31–$510.51	—	30%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 XR Tibia +Fibula 2 Views Lt	$368.41	$526.30	$306.31–$510.51	—	30%
MR angiography (MRA) of the head without contrast CPT 70544 MRA Head w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	32% below	30%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA Head w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$3,957.52	$5,653.60	$205.20–$5,483.99	—	30%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI Breast w/ + w/o Contrast Bilateral	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Right	$2,364.11	$3,377.30	$186.85–$3,275.98	30% below	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LE Joint w/o Contrast Left	$2,364.11	$3,377.30	$186.85–$3,275.98	30% below	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Right	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LE Joint w/o Contrast Left	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left	$3,957.52	$5,653.60	$276.06–$5,483.99	17% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right	$3,957.52	$5,653.60	$276.06–$5,483.99	17% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Left	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LE Joint w/ + w/o Contrast Right	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	18% below	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen w/ + w/o Contrast	$3,957.52	$5,653.60	$276.06–$5,483.99	1% below	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen w/ + w/o Contrast	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of the brain, no contrast dye CPT 70551 MRI Brain w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	28% below	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain w/ + w/o Contrast	$3,957.52	$5,653.60	$276.06–$5,483.99	18% below	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain w/ + w/o Contrast	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	34% below	30%
MRI of the lower back, no contrast dye CPT 72148 BVT MRI Spine Lumbar Limited	$2,364.11	$3,377.30	$186.85–$3,275.98	34% below	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 BVT MRI Spine Lumbar Limited	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$3,957.52	$5,653.60	$276.06–$5,483.99	16% below	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar w/ + w/o Contrast	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 BVT MRI Spine Thoracic Limited	$2,364.11	$3,377.30	$186.85–$3,275.98	34% below	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	34% below	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 BVT MRI Spine Thoracic Limited	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$3,957.52	$5,653.60	$276.06–$5,483.99	17% below	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical w/ + w/o Contrast	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	31% below	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 BVT MRI Spine Cervical Limited	$2,364.11	$3,377.30	$186.85–$3,275.98	31% below	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 BVT MRI Spine Cervical Limited	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis w/ + w/o Contrast	$3,957.52	$5,653.60	$276.06–$5,483.99	8% below	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis w/ + w/o Contrast	$3,957.52	$5,653.60	$3,290.40–$5,483.99	—	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis w/o Contrast	$2,364.11	$3,377.30	$186.85–$3,275.98	at median	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis w/o Contrast	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Left	$2,364.11	$3,377.30	$186.85–$3,275.98	27% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE Joint w/o Contrast Right	$2,364.11	$3,377.30	$186.85–$3,275.98	27% below	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Left	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE Joint w/o Contrast Right	$2,364.11	$3,377.30	$1,965.59–$3,275.98	—	30%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR Spine Cervical 4-5 Views	$664.09	$948.70	$82.20–$920.24	5% below	30%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR Spine Cervical 4-5 Views	$664.09	$948.70	$552.14–$920.24	—	30%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tissue Neck w/ Contrast	$2,159.57	$3,085.10	$137.61–$2,992.55	10% below	30%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tissue Neck w/ Contrast	$2,159.57	$3,085.10	$1,795.53–$2,992.55	—	30%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tissue Neck w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	42% below	30%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tissue Neck w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Neck soft tissue X-ray CPT 70360 XR Neck Soft Tissue	$368.41	$526.30	$68.06–$510.51	1% below	30%
Neck soft tissue X-ray inpatient CPT 70360 XR Neck Soft Tissue	$368.41	$526.30	$306.31–$510.51	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM Myocardial Perfusion Imaging	$4,919.74	$7,028.20	$1,009.14–$6,817.35	62% above	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM Myocardial Perfusion Imaging	$4,919.74	$7,028.20	$4,090.41–$6,817.35	—	30%
Pelvic CT scan without contrast CPT 72192 CT Pelvis MSK w/o Contrast	$303.45	$433.50	$82.20–$802.52	86% below	30%
Pelvic CT scan without contrast CPT 72192 CT Pelvis w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	44% below	30%
Pelvic CT scan without contrast CPT 72192 BVT CT Pelvis w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	44% below	30%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis MSK w/o Contrast	$303.45	$433.50	$252.30–$420.50	—	30%
Pelvic CT scan without contrast inpatient CPT 72192 BVT CT Pelvis w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 76857 US Limited Gyn Ultrasound (in office)	$144.76	$206.80	$82.20–$247.34	77% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvis Non-OB Limited	$653.66	$933.80	$82.20–$905.79	4% above	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 76857 US Limited Gyn Ultrasound (in office)	$144.76	$206.80	$120.36–$200.60	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvis Non-OB Limited	$653.66	$933.80	$543.47–$905.79	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis and Transvaginal	$653.66	$933.80	$82.20–$905.79	3% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvis Non-OB Complete	$653.66	$933.80	$82.20–$905.79	3% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis Non-OB Complete	$653.66	$933.80	$543.47–$905.79	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvis and Transvaginal	$653.66	$933.80	$543.47–$905.79	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Complete	$653.66	$933.80	$82.20–$905.79	5% below	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 76805 OB Fetal Eval Ultrasound	$703.92	$1,005.60	$82.20–$975.43	2% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Complete	$653.66	$933.80	$543.47–$905.79	—	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 76805 OB Fetal Eval Ultrasound	$703.92	$1,005.60	$585.26–$975.43	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 BVT US Pregnancy Transabdominal	$653.66	$933.80	$82.20–$905.79	16% below	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 BVT US Pregnancy Transabdominal	$653.66	$933.80	$543.47–$905.79	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$653.66	$933.80	$82.20–$905.79	4% above	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$653.66	$933.80	$543.47–$905.79	—	30%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Left	$368.41	$526.30	$68.06–$510.51	30% below	30%
Rib X-ray, one side, 2 views one side CPT 71100 XR Ribs 2 Views Right	$368.41	$526.30	$68.06–$510.51	30% below	30%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 XR Ribs 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Left	$664.09	$948.70	$82.20–$920.24	2% above	30%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 XR Ribs w/ PA Chest Right	$664.09	$948.70	$82.20–$920.24	2% above	30%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Left	$664.09	$948.70	$552.14–$920.24	—	30%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 XR Ribs w/ PA Chest Right	$664.09	$948.70	$552.14–$920.24	—	30%
Screening mammogram, both breasts CPT 77067 MA Mammogram Digital Screening	$385.00	$550.00	$79.52–$868.39	19% above	30%
Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screening Left	$385.00	$550.00	$79.52–$868.39	19% above	30%
Screening mammogram, both breasts one side CPT 77067 MA Mammogram Digital Screening Right	$385.00	$550.00	$79.52–$868.39	19% above	30%
Screening mammogram, both breasts inpatient CPT 77067 MA Mammogram Digital Screening	$385.00	$550.00	$320.10–$533.50	—	30%
Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screening Right	$385.00	$550.00	$320.10–$533.50	—	30%
Screening mammogram, both breasts inpatient one side CPT 77067 MA Mammogram Digital Screening Left	$385.00	$550.00	$320.10–$533.50	—	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Left	$368.41	$526.30	$68.06–$510.51	28% below	30%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 XR Shoulder Complete Right	$368.41	$526.30	$68.06–$510.51	28% below	30%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Right	$368.41	$526.30	$306.31–$510.51	—	30%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 XR Shoulder Complete Left	$368.41	$526.30	$306.31–$510.51	—	30%
Sinus X-ray, complete, 3 or more views CPT 70220 XR Sinuses Complete	$368.41	$526.30	$68.06–$510.51	21% below	30%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR Sinuses Complete	$368.41	$526.30	$306.31–$510.51	—	30%
Skull X-ray, fewer than 4 views CPT 70250 XR Skull < 4 Views	$664.09	$948.70	$82.20–$920.24	25% above	30%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR Skull < 4 Views	$664.09	$948.70	$552.14–$920.24	—	30%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 US Stress Echo	$2,886.80	$4,124.00	$423.84–$4,000.28	8% above	30%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 US Stress Echo	$2,886.80	$4,124.00	$2,400.17–$4,000.28	—	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 XR Barium Swallow	$664.09	$948.70	$137.61–$937.40	12% below	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 XR Barium Swallow	$664.09	$948.70	$552.14–$920.24	—	30%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Rt	$368.41	$526.30	$68.06–$510.51	13% below	30%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 XR Femur 2 Views Lt	$368.41	$526.30	$68.06–$510.51	13% below	30%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Rt	$368.41	$526.30	$306.31–$510.51	—	30%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 XR Femur 2 Views Lt	$368.41	$526.30	$306.31–$510.51	—	30%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Spine Thoracic w/o Contrast	$1,204.14	$1,720.20	$82.20–$1,668.59	32% below	30%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Spine Thoracic w/o Contrast	$1,204.14	$1,720.20	$1,001.16–$1,668.59	—	30%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) 2 Views Min Rt	$368.41	$526.30	$68.06–$510.51	6% below	30%
Toe X-ray, 2 or more views one side CPT 73660 XR Toe(s) 2 Views Min Lt	$368.41	$526.30	$68.06–$510.51	6% below	30%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) 2 Views Min Rt	$368.41	$526.30	$306.31–$510.51	—	30%
Toe X-ray, 2 or more views inpatient one side CPT 73660 XR Toe(s) 2 Views Min Lt	$368.41	$526.30	$306.31–$510.51	—	30%
Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non-OB	$653.66	$933.80	$82.20–$905.79	21% below	30%
Transvaginal pelvic ultrasound CPT 76830 BVT US Transvaginal Non-OB	$653.66	$933.80	$82.20–$905.79	21% below	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 BVT US Transvaginal Non-OB	$653.66	$933.80	$543.47–$905.79	—	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvaginal Non-OB	$653.66	$933.80	$543.47–$905.79	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 US Fetal 1st Trimester	$653.66	$933.80	$82.20–$905.79	9% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 US Pregnancy Transvaginal	$653.66	$933.80	$82.20–$905.79	9% below	30%
Transvaginal ultrasound during pregnancy CPT 76817 BVT US Pregnancy Transvaginal	$653.66	$933.80	$82.20–$905.79	9% below	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Pregnancy Transvaginal	$653.66	$933.80	$543.47–$905.79	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 BVT US Pregnancy Transvaginal	$653.66	$933.80	$543.47–$905.79	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Fetal 1st Trimester	$653.66	$933.80	$543.47–$905.79	—	30%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$653.66	$933.80	$82.20–$905.79	28% below	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$653.66	$933.80	$543.47–$905.79	—	30%
Ultrasound of the scrotum and testicles CPT 76870 US Testicular	$653.66	$933.80	$82.20–$905.79	3% below	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Testicular	$653.66	$933.80	$543.47–$905.79	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 BVT US Thyroid	$653.66	$933.80	$82.20–$905.79	25% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid	$653.66	$933.80	$82.20–$905.79	25% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid	$653.66	$933.80	$543.47–$905.79	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 BVT US Thyroid	$653.66	$933.80	$543.47–$905.79	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR UGI w/o KUB	$1,190.28	$1,700.40	$137.61–$1,649.39	2% above	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 XR Upper GI w/ Small Bowel	$1,361.08	$1,944.40	$137.61–$1,886.07	17% above	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR UGI w/o KUB	$1,190.28	$1,700.40	$989.63–$1,649.39	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 XR Upper GI w/ Small Bowel	$1,361.08	$1,944.40	$1,131.64–$1,886.07	—	30%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus 2 Views Min Rt	$368.41	$526.30	$68.06–$510.51	27% below	30%
Upper arm X-ray (humerus), 2 views one side CPT 73060 XR Humerus 2 Views Min Lt	$368.41	$526.30	$68.06–$510.51	27% below	30%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus 2 Views Min Rt	$368.41	$526.30	$306.31–$510.51	—	30%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 XR Humerus 2 Views Min Lt	$368.41	$526.30	$306.31–$510.51	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Insufficiency Right	$653.66	$933.80	$82.20–$905.79	3% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Right	$700.00	$1,000.00	$82.20–$970.00	4% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Insufficiency Left	$700.00	$1,000.00	$82.20–$970.00	4% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US LE Venous Duplex Left	$700.00	$1,000.00	$82.20–$970.00	4% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Right	$700.00	$1,000.00	$82.20–$970.00	4% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US UE Venous Duplex Left	$700.00	$1,000.00	$82.20–$970.00	4% above	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Insufficiency Right	$653.66	$933.80	$543.47–$905.79	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Insufficiency Left	$700.00	$1,000.00	$582.00–$970.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Duplex Left	$700.00	$1,000.00	$582.00–$970.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Duplex Left	$700.00	$1,000.00	$582.00–$970.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US UE Venous Duplex Right	$700.00	$1,000.00	$582.00–$970.00	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US LE Venous Duplex Right	$700.00	$1,000.00	$582.00–$970.00	—	30%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Left	$368.41	$526.30	$68.06–$510.51	24% below	30%
Wrist X-ray, 2 views one side CPT 73100 XR Wrist 2 Views Right	$368.41	$526.30	$68.06–$510.51	24% below	30%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
Wrist X-ray, 2 views inpatient one side CPT 73100 XR Wrist 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist 3 Views Left	$368.41	$526.30	$68.06–$510.51	37% below	30%
Wrist X-ray, complete, 3 or more views one side CPT 73110 XR Wrist 3 Views Right	$368.41	$526.30	$68.06–$510.51	37% below	30%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist 3 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 XR Wrist 3 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$368.41	$526.30	$68.06–$510.51	35% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$368.41	$526.30	$68.06–$510.51	35% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2 Views Left	$368.41	$526.30	$68.06–$510.51	35% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 XR Hip 2 Views Right	$368.41	$526.30	$68.06–$510.51	35% below	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Lt w/ Pelvis	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 XR Hip 2-3 Views Rt w/ Pelvis	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen KUB	$368.41	$526.30	$68.06–$510.51	7% below	30%
X-ray of the abdomen, 1 view CPT 74018 XR Abdomen 1 View	$368.41	$526.30	$68.06–$510.51	7% below	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen 1 View	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR Abdomen KUB	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Left	$368.41	$526.30	$68.06–$510.51	21% below	30%
X-ray of the ankle, 2 views one side CPT 73600 XR Ankle 2 Views Right	$368.41	$526.30	$68.06–$510.51	21% below	30%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the ankle, 2 views inpatient one side CPT 73600 XR Ankle 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) 2 Views Min Lt	$368.41	$526.30	$68.06–$510.51	6% below	30%
X-ray of the finger(s), 2 or more views one side CPT 73140 XR Finger(s) 2 Views Min Rt	$368.41	$526.30	$68.06–$510.51	6% below	30%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(s) 2 Views Min Lt	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 XR Finger(s) 2 Views Min Rt	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Left	$368.41	$526.30	$68.06–$510.51	23% below	30%
X-ray of the foot, 2 views one side CPT 73620 XR Foot 2 Views Right	$368.41	$526.30	$68.06–$510.51	23% below	30%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the foot, 2 views inpatient one side CPT 73620 XR Foot 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot 3 Views Left	$368.41	$526.30	$68.06–$510.51	28% below	30%
X-ray of the foot, complete, 3 or more views one side CPT 73630 XR Foot 3 Views Right	$368.41	$526.30	$68.06–$510.51	28% below	30%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot 3 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 XR Foot 3 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand 3 Views Left	$368.41	$526.30	$68.06–$510.51	27% below	30%
X-ray of the hand, 3 or more views one side CPT 73130 XR Hand 3 Views Right	$368.41	$526.30	$68.06–$510.51	27% below	30%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand 3 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 XR Hand 3 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 2 Views Left	$368.41	$526.30	$68.06–$510.51	26% below	30%
X-ray of the knee, 1 or 2 views one side CPT 73560 XR Knee 2 Views Right	$368.41	$526.30	$68.06–$510.51	26% below	30%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 2 Views Right	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 XR Knee 2 Views Left	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$664.09	$948.70	$82.20–$920.24	at median	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR Spine Lumbosacral 2 or 3 Views	$664.09	$948.70	$552.14–$920.24	—	30%
X-ray of the lower back, 4 or more views CPT 72110 XR Lumbar Spine 5 Views	$664.09	$948.70	$82.20–$920.24	21% below	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR Lumbar Spine 5 Views	$664.09	$948.70	$552.14–$920.24	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 XR Nasal Bones Minimum 3 Views	$368.41	$526.30	$68.06–$510.51	34% below	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR Nasal Bones Minimum 3 Views	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR Exam	$368.41	$526.30	$68.06–$510.51	27% below	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR Exam	$368.41	$526.30	$306.31–$510.51	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR Pelvis 1 or 2 Views	$664.09	$948.70	$82.20–$920.24	52% above	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR Pelvis 1 or 2 Views	$664.09	$948.70	$552.14–$920.24	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR Sacrum/Coccyx Minimum 2 Views	$368.41	$526.30	$68.06–$510.51	27% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR Sacrum/Coccyx Minimum 2 Views	$368.41	$526.30	$306.31–$510.51	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
ACTH blood test CPT 82024 ACTH MAYO	$347.62	$496.60	$37.65–$481.70	10% below	30%
ACTH blood test inpatient CPT 82024 ACTH MAYO	$347.62	$496.60	$289.02–$481.70	—	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 84460	$39.06	$55.80	$5.17–$54.13	at median	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 SGPT	$39.90	$57.00	$5.17–$55.29	2% above	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Alanine Aminotransferase	$42.49	$60.70	$5.17–$58.88	9% above	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 84460	$39.06	$55.80	$32.48–$54.13	—	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 SGPT	$39.90	$57.00	$33.17–$55.29	—	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Alanine Aminotransferase	$42.49	$60.70	$35.33–$58.88	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST	$47.67	$68.10	$5.05–$66.06	24% below	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST	$47.67	$68.10	$39.63–$66.06	—	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel Acute	$416.15	$594.50	$46.44–$576.67	6% below	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel Acute	$416.15	$594.50	$346.00–$576.67	—	30%
Albumin blood test CPT 82040 ALBUMIN	$35.56	$50.80	$4.83–$49.28	17% below	30%
Albumin blood test CPT 82040 Albumin Level	$37.24	$53.20	$4.83–$51.60	13% below	30%
Albumin blood test inpatient CPT 82040 ALBUMIN	$35.56	$50.80	$29.57–$49.28	—	30%
Albumin blood test inpatient CPT 82040 Albumin Level	$37.24	$53.20	$30.96–$51.60	—	30%
Aldosterone blood test CPT 82088 Aldosterone MAYO	$366.73	$523.90	$39.73–$508.18	16% below	30%
Aldosterone blood test inpatient CPT 82088 Aldosterone MAYO	$366.73	$523.90	$304.91–$508.18	—	30%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase, Total & Isoenzymes, S MAYO	$15.21	$21.72	$5.05–$34.70	66% below	30%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase, Tot and Iso S MAYO	$15.21	$21.72	$5.05–$34.70	66% below	30%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$43.39	$61.98	$5.05–$60.12	4% below	30%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$46.83	$66.90	$5.05–$64.89	4% above	30%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase, Total & Isoenzymes, S MAYO	$15.21	$21.72	$12.64–$21.07	—	30%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase, Tot and Iso S MAYO	$15.21	$21.72	$12.64–$21.07	—	30%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKALINE PHOSPHATASE	$43.39	$61.98	$36.07–$60.12	—	30%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Faced Hornet Venom, IgE MAYO	$13.02	$18.60	$5.09–$34.96	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 White Faced Hornet Venom, IgE MAYO	$13.02	$18.60	$5.09–$34.96	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Honeybee Venom, IgE MAYO	$13.02	$18.60	$5.09–$34.96	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Yellow Jacket Venom, IgE MAYO	$13.02	$18.60	$5.09–$34.96	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Wasp Venom, IgE MAYO	$13.02	$18.60	$5.09–$34.96	73% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 86003	$43.33	$61.90	$5.09–$60.04	12% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Eggplant, IgE MAYO	$44.24	$63.20	$5.09–$61.30	10% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Egg White, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Cladosporium (Hormodendrum), IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Bermuda Grass, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Corn-Food, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 English Plantain, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 House Dust Mites/Dermatophagoides farinae, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Cockroach, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Alternaria tenuis, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Milk, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Dog Dander, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Cat Epithelium, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Codfish, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Soybean, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Mold Panel MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Wheat, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Peanut, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Timothy Grass, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Oat, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Oak, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen CPT 86003 Short Ragweed, IgE MAYO	$46.83	$66.90	$5.09–$64.89	4% below	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 White Faced Hornet Venom, IgE MAYO	$13.02	$18.60	$10.83–$18.04	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Jacket Venom, IgE MAYO	$13.02	$18.60	$10.83–$18.04	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wasp Venom, IgE MAYO	$13.02	$18.60	$10.83–$18.04	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Yellow Faced Hornet Venom, IgE MAYO	$13.02	$18.60	$10.83–$18.04	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Honeybee Venom, IgE MAYO	$13.02	$18.60	$10.83–$18.04	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 86003	$43.33	$61.90	$36.03–$60.04	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Eggplant, IgE MAYO	$44.24	$63.20	$36.78–$61.30	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cockroach, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cladosporium (Hormodendrum), IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Milk, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Egg White, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Cat Epithelium, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Dog Dander, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Soybean, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Short Ragweed, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Alternaria tenuis, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 House Dust Mites/Dermatophagoides farinae, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Mold Panel MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Peanut, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Timothy Grass, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oat, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Wheat, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Oak, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Codfish, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Bermuda Grass, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Corn-Food, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 English Plantain, IgE MAYO	$46.83	$66.90	$38.94–$64.89	—	30%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA FETOPROTEIN SERUM	$130.06	$185.80	$16.35–$180.23	11% above	30%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP, Single Marker Scr, Maternal, S MAYO	$130.06	$185.80	$16.35–$180.23	11% above	30%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP Tumor Marker FAH	$130.06	$185.80	$16.35–$180.23	11% above	30%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP Tumor Marker FAH	$130.06	$185.80	$108.14–$180.23	—	30%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA FETOPROTEIN SERUM	$130.06	$185.80	$108.14–$180.23	—	30%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 AFP, Single Marker Scr, Maternal, S MAYO	$130.06	$185.80	$108.14–$180.23	—	30%
Ammonia blood test CPT 82140 Ammonia Level	$132.65	$189.50	$14.21–$183.82	at median	30%
Ammonia blood test inpatient CPT 82140 Ammonia Level	$132.65	$189.50	$110.29–$183.82	—	30%
Amylase blood test CPT 82150 Amylase Level	$52.85	$75.50	$6.32–$73.24	at median	30%
Amylase blood test CPT 82150 Amylase, BF MAYO	$52.85	$75.50	$6.32–$73.24	at median	30%
Amylase blood test inpatient CPT 82150 Amylase, BF MAYO	$52.85	$75.50	$43.94–$73.24	—	30%
Amylase blood test inpatient CPT 82150 Amylase Level	$52.85	$75.50	$43.94–$73.24	—	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 86200	$107.52	$153.60	$12.63–$148.99	7% below	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRULL PEPTIDE ANTIBODY	$110.11	$157.30	$12.63–$152.58	4% below	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Abs, IgG MAYO	$116.20	$166.00	$12.63–$161.02	1% above	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 86200	$107.52	$153.60	$89.40–$148.99	—	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRULL PEPTIDE ANTIBODY	$110.11	$157.30	$91.55–$152.58	—	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Abs, IgG MAYO	$116.20	$166.00	$96.61–$161.02	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANA	$103.18	$147.40	$11.79–$142.98	at median	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA), S MAYO	$108.36	$154.80	$11.79–$150.16	5% above	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Connective Tissue Diseases Cascade MAYO	$108.36	$154.80	$11.79–$150.16	5% above	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANA	$103.18	$147.40	$85.79–$142.98	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Connective Tissue Diseases Cascade MAYO	$108.36	$154.80	$90.09–$150.16	—	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA), S MAYO	$108.36	$154.80	$90.09–$150.16	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP	$312.97	$447.10	$38.28–$433.69	24% above	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Pro-BNP	$312.97	$447.10	$38.28–$433.69	24% above	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP	$312.97	$447.10	$260.21–$433.69	—	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Pro-BNP	$312.97	$447.10	$260.21–$433.69	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Presumptive ID, non-Urine	$34.72	$49.60	$8.40–$57.74	59% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE ROUTINE	$71.12	$101.60	$8.40–$98.55	16% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Ear	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Wound	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Tissue	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Bronchial	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Sputum	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Eye	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Nasal	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Nasopharyngeal	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bill Reproductive Culture	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Respiratory	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Aerobic	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Throat	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture CSF	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Body Fluid	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Genital	$77.14	$110.20	$8.40–$106.89	8% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Catheter Tip	$79.80	$114.00	$8.40–$110.58	5% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Presumptive ID, non-Urine	$34.72	$49.60	$28.87–$48.11	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE ROUTINE	$71.12	$101.60	$59.13–$98.55	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Throat	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Tissue	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bill Reproductive Culture	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Genital	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Nasopharyngeal	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Respiratory	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Sputum	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Body Fluid	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Bronchial	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Wound	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture CSF	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Ear	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Eye	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Nasal	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Aerobic	$77.14	$110.20	$64.14–$106.89	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Catheter Tip	$79.80	$114.00	$66.35–$110.58	—	30%
Basic metabolic panel (blood test) CPT 80048 BMP Standard	$77.14	$110.20	$8.25–$106.89	17% below	30%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP Standard	$77.14	$110.20	$64.14–$106.89	—	30%
Bilirubin blood test, total CPT 82247 82247	$42.49	$60.70	$4.89–$58.88	17% below	30%
Bilirubin blood test, total CPT 82247 BILIRUBIN TOTAL	$42.49	$60.70	$4.89–$58.88	17% below	30%
Bilirubin blood test, total CPT 82247 Bilirubin, BF MAYO	$44.24	$63.20	$4.89–$61.30	13% below	30%
Bilirubin blood test, total CPT 82247 Lipid Analysis, BF MAYO	$44.24	$63.20	$4.89–$61.30	13% below	30%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$110.11	$157.30	$4.89–$152.58	116% above	30%
Bilirubin blood test, total inpatient CPT 82247 BILIRUBIN TOTAL	$42.49	$60.70	$35.33–$58.88	—	30%
Bilirubin blood test, total inpatient CPT 82247 82247	$42.49	$60.70	$35.33–$58.88	—	30%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin, BF MAYO	$44.24	$63.20	$36.78–$61.30	—	30%
Bilirubin blood test, total inpatient CPT 82247 Lipid Analysis, BF MAYO	$44.24	$63.20	$36.78–$61.30	—	30%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$110.11	$157.30	$91.55–$152.58	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$529.69	$756.70	$41.30–$734.00	102% above	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 88305 AP Bill Surgical Pathology Level IV Complexity	$529.69	$756.70	$440.40–$734.00	—	30%
Blood culture for bacteria CPT 87040 Culture Blood	$69.30	$99.00	$10.06–$96.03	49% below	30%
Blood culture for bacteria inpatient CPT 87040 Culture Blood	$69.30	$99.00	$57.62–$96.03	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLLECTION: Venous Draw	$18.27	$26.10	$8.61–$59.14	37% below	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 36415 Collect Blood, Venipuncture	$18.27	$26.10	$8.61–$59.14	37% below	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SPECIMEN: Blood Collection	$18.27	$26.10	$8.61–$59.14	37% below	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Kit Collection Bill Only	$18.27	$26.10	$8.61–$59.14	37% below	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION: Venous Draw	$18.27	$26.10	$15.19–$25.32	—	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 SPECIMEN: Blood Collection	$18.27	$26.10	$15.19–$25.32	—	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Kit Collection Bill Only	$18.27	$26.10	$15.19–$25.32	—	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 36415 Collect Blood, Venipuncture	$18.27	$26.10	$15.19–$25.32	—	30%
Blood glucose (sugar) test CPT 82947 Glucose Level	$37.24	$53.20	$3.83–$51.60	9% below	30%
Blood glucose (sugar) test CPT 82947 Glucose Fasting	$43.33	$61.90	$3.83–$60.04	6% above	30%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Level	$37.24	$53.20	$30.96–$51.60	—	30%
Blood glucose (sugar) test inpatient CPT 82947 Glucose Fasting	$43.33	$61.90	$36.03–$60.04	—	30%
Blood lead test CPT 83655 83655	$102.34	$146.20	$11.81–$141.81	59% above	30%
Blood lead test CPT 83655 LEAD SCREEN	$103.18	$147.40	$11.81–$142.98	61% above	30%
Blood lead test CPT 83655 Lead Profile Occupational Exposure, Blood MAYO	$108.36	$154.80	$11.81–$150.16	69% above	30%
Blood lead test CPT 83655 Lead FAH	$108.36	$154.80	$11.81–$150.16	69% above	30%
Blood lead test inpatient CPT 83655 83655	$102.34	$146.20	$85.09–$141.81	—	30%
Blood lead test inpatient CPT 83655 LEAD SCREEN	$103.18	$147.40	$85.79–$142.98	—	30%
Blood lead test inpatient CPT 83655 Lead FAH	$108.36	$154.80	$90.09–$150.16	—	30%
Blood lead test inpatient CPT 83655 Lead Profile Occupational Exposure, Blood MAYO	$108.36	$154.80	$90.09–$150.16	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 OR Pregnancy Test Urine	$69.30	$99.00	$7.33–$96.03	18% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Serum Standard	$69.30	$99.00	$7.33–$96.03	18% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Pregnancy Test Urine Standard	$69.30	$99.00	$7.33–$96.03	18% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 OR Pregnancy Test Urine	$69.30	$99.00	$57.62–$96.03	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Urine Standard	$69.30	$99.00	$57.62–$96.03	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Pregnancy Test Serum Standard	$69.30	$99.00	$57.62–$96.03	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Cord ABO/Rh	$26.04	$37.20	$20.03–$173.11	69% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood Type ABO/Rh Typing	$27.72	$39.60	$20.03–$173.11	67% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 93 Reference ABO/Rh	$44.24	$63.20	$20.03–$173.11	48% below	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Cord ABO/Rh	$26.04	$37.20	$21.65–$36.08	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Blood Type ABO/Rh Typing	$27.72	$39.60	$23.05–$38.41	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 93 Reference ABO/Rh	$44.24	$63.20	$36.78–$61.30	—	30%
Blood urea nitrogen (BUN) test CPT 84520 Blood Urea Nitrogen	$32.06	$45.80	$3.85–$44.43	24% below	30%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Blood Urea Nitrogen	$32.06	$45.80	$26.66–$44.43	—	30%
C-peptide blood test CPT 84681 C-Peptide MAYO	$186.41	$266.30	$20.29–$258.31	at median	30%
C-peptide blood test inpatient CPT 84681 C-Peptide MAYO	$186.41	$266.30	$154.99–$258.31	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$32.06	$45.80	$5.05–$44.43	47% below	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$32.06	$45.80	$26.66–$44.43	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 C. Diff Toxin	$128.31	$183.30	$36.34–$249.63	45% below	30%
C. difficile toxin gene test (stool PCR) CPT 87493 C. difficile Toxin PCR MAYO	$202.44	$289.20	$36.34–$280.52	13% below	30%
C. difficile toxin gene test (stool PCR) CPT 87493 Toxigenic C.Diff DNA	$240.17	$343.10	$36.34–$332.81	3% above	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. Diff Toxin	$128.31	$183.30	$106.68–$177.80	—	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C. difficile Toxin PCR MAYO	$202.44	$289.20	$168.31–$280.52	—	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Toxigenic C.Diff DNA	$240.17	$343.10	$199.68–$332.81	—	30%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 MAYO	$186.41	$266.30	$20.29–$258.31	15% below	30%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 CA 19-9 MAYO	$186.41	$266.30	$154.99–$258.31	—	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 FAH	$186.41	$266.30	$20.29–$258.31	at median	30%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 CA 125 FAH	$186.41	$266.30	$154.99–$258.31	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 BinaxNOW Covid-19 Antigen Test Practices POCT	$28.97	$41.38	$24.08–$343.67	72% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (BD MAX) v2	$89.25	$127.50	$50.03–$343.67	15% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2(COVID-19) NAAT (CUE) Emergency POC (RE)	$133.42	$190.60	$50.03–$343.67	27% above	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$143.08	$204.40	$50.03–$343.67	36% above	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 BinaxNOW Covid-19 Antigen Test Practices POCT	$28.97	$41.38	$24.08–$40.14	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (BD MAX) v2	$89.25	$127.50	$74.21–$123.68	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2(COVID-19) NAAT (CUE) Emergency POC (RE)	$133.42	$190.60	$110.93–$184.88	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS-CoV-2 (COVID-19) PCR (GeneXpert)	$143.08	$204.40	$118.96–$198.27	—	30%
Calcium blood test, total CPT 82310 CALCIUM SERUM	$34.72	$49.60	$5.03–$48.11	at median	30%
Calcium blood test, total CPT 82310 Calcium Level	$37.24	$53.20	$5.03–$51.60	7% above	30%
Calcium blood test, total CPT 82310 PTH with Minerals, S MAYO	$37.24	$53.20	$5.03–$51.60	7% above	30%
Calcium blood test, total inpatient CPT 82310 CALCIUM SERUM	$34.72	$49.60	$28.87–$48.11	—	30%
Calcium blood test, total inpatient CPT 82310 Calcium Level	$37.24	$53.20	$30.96–$51.60	—	30%
Calcium blood test, total inpatient CPT 82310 PTH with Minerals, S MAYO	$37.24	$53.20	$30.96–$51.60	—	30%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA FAH	$130.06	$185.80	$18.49–$180.23	31% below	30%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA FAH	$130.06	$185.80	$108.14–$180.23	—	30%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella IgG Ab FAH	$116.20	$166.00	$12.56–$161.02	22% above	30%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella IgG Ab FAH	$116.20	$166.00	$96.61–$161.02	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA AMP PROBE	$121.38	$173.40	$34.21–$235.03	at median	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CTNG PCR DH	$122.29	$174.70	$34.21–$235.03	1% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC Amplified FAH	$122.29	$174.70	$34.21–$235.03	1% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC Amplified, Thin Prep FAH	$122.29	$174.70	$34.21–$235.03	1% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC Amplified, Urine FAH	$122.29	$174.70	$34.21–$235.03	1% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC Amplified Misc. Sites MAYO	$122.29	$174.70	$34.21–$235.03	1% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/GC Amplified, Thin Prep DHMC	$122.29	$174.70	$34.21–$235.03	1% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 C. Trach Amp Probe	$157.78	$225.40	$34.21–$235.03	30% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlam/GC Male	$315.56	$450.80	$34.21–$437.28	160% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia/Gonorrhoeae Amplified RNA MAYO	$315.56	$450.80	$34.21–$437.28	160% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA AMP PROBE	$121.38	$173.40	$100.92–$168.20	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC Amplified, Thin Prep DHMC	$122.29	$174.70	$101.68–$169.46	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC Amplified, Thin Prep FAH	$122.29	$174.70	$101.68–$169.46	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CTNG PCR DH	$122.29	$174.70	$101.68–$169.46	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC Amplified FAH	$122.29	$174.70	$101.68–$169.46	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC Amplified, Urine FAH	$122.29	$174.70	$101.68–$169.46	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/GC Amplified Misc. Sites MAYO	$122.29	$174.70	$101.68–$169.46	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 C. Trach Amp Probe	$157.78	$225.40	$131.18–$218.64	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlam/GC Male	$315.56	$450.80	$262.37–$437.28	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia/Gonorrhoeae Amplified RNA MAYO	$315.56	$450.80	$262.37–$437.28	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$98.00	$140.00	$13.06–$135.80	at median	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel Standard	$98.00	$140.00	$13.06–$135.80	at median	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipoprotein Metabolism Profile MAYO	$133.49	$190.70	$13.06–$184.98	36% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel Standard	$98.00	$140.00	$81.48–$135.80	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$98.00	$140.00	$81.48–$135.80	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipoprotein Metabolism Profile MAYO	$133.49	$190.70	$110.99–$184.98	—	30%
Complete blood count (CBC) with differential CPT 85025 Complete Blood Count Standard	$71.12	$101.60	$7.58–$98.55	2% above	30%
Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count Standard	$71.12	$101.60	$59.13–$98.55	—	30%
Complete blood count (CBC), no differential CPT 85027 Complete Blood Count (No Differential)	$56.98	$81.40	$6.31–$78.96	3% below	30%
Complete blood count (CBC), no differential inpatient CPT 85027 Complete Blood Count (No Differential)	$56.98	$81.40	$47.37–$78.96	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 CMP	$97.09	$138.70	$10.30–$134.54	31% below	30%
Comprehensive metabolic panel (blood test) CPT 80053 CMP Standard	$97.09	$138.70	$10.30–$134.54	31% below	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP Standard	$97.09	$138.70	$80.72–$134.54	—	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP	$97.09	$138.70	$80.72–$134.54	—	30%
Cortisol blood test, total CPT 82533 Cortisol Level	$80.64	$115.20	$15.89–$111.74	34% below	30%
Cortisol blood test, total CPT 82533 Cortisol FAH	$80.64	$115.20	$15.89–$111.74	34% below	30%
Cortisol blood test, total CPT 82533 Cortisol, Stim 30 Min FAH	$146.51	$209.30	$15.89–$203.02	20% above	30%
Cortisol blood test, total CPT 82533 Cortisol, Stim 60 Min FAH	$146.51	$209.30	$15.89–$203.02	20% above	30%
Cortisol blood test, total CPT 82533 Cortisol, Saliva MAYO	$146.51	$209.30	$15.89–$203.02	20% above	30%
Cortisol blood test, total CPT 82533 Cortisol, Stim Baseline FAH	$146.51	$209.30	$15.89–$203.02	20% above	30%
Cortisol blood test, total CPT 82533 Cortisol, Free & Total MAYO	$150.01	$214.30	$15.89–$207.87	23% above	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol Level	$80.64	$115.20	$67.05–$111.74	—	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol FAH	$80.64	$115.20	$67.05–$111.74	—	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Stim 30 Min FAH	$146.51	$209.30	$121.81–$203.02	—	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Stim 60 Min FAH	$146.51	$209.30	$121.81–$203.02	—	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Stim Baseline FAH	$146.51	$209.30	$121.81–$203.02	—	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Saliva MAYO	$146.51	$209.30	$121.81–$203.02	—	30%
Cortisol blood test, total inpatient CPT 82533 Cortisol, Free & Total MAYO	$150.01	$214.30	$124.72–$207.87	—	30%
Creatine kinase (CK) blood test, total CPT 82550 C K	$55.51	$79.30	$6.35–$76.92	25% below	30%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase	$58.10	$83.00	$6.35–$80.51	21% below	30%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase Isoenzyme Rfx, S MAYO	$104.86	$149.80	$6.35–$145.31	42% above	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 C K	$55.51	$79.30	$46.15–$76.92	—	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase	$58.10	$83.00	$48.31–$80.51	—	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase Isoenzyme Rfx, S MAYO	$104.86	$149.80	$87.18–$145.31	—	30%
Creatinine blood test CPT 82565 82565	$42.49	$60.70	$4.99–$58.88	6% below	30%
Creatinine blood test CPT 82565 CREATININE SERUM	$43.33	$61.90	$4.99–$60.04	4% below	30%
Creatinine blood test CPT 82565 Creatinine	$46.83	$66.90	$4.99–$64.89	4% above	30%
Creatinine blood test inpatient CPT 82565 82565	$42.49	$60.70	$35.33–$58.88	—	30%
Creatinine blood test inpatient CPT 82565 CREATININE SERUM	$43.33	$61.90	$36.03–$60.04	—	30%
Creatinine blood test inpatient CPT 82565 Creatinine	$46.83	$66.90	$38.94–$64.89	—	30%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG ANTIBODY	$122.29	$174.70	$14.03–$169.46	53% above	30%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV Ab, IgG, S MAYO	$128.31	$183.30	$14.03–$177.80	60% above	30%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV Abs, IgG and IgM MAYO	$129.15	$184.50	$14.03–$178.97	61% above	30%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG ANTIBODY	$122.29	$174.70	$101.68–$169.46	—	30%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV Ab, IgG, S MAYO	$128.31	$183.30	$106.68–$177.80	—	30%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV Abs, IgG and IgM MAYO	$129.15	$184.50	$107.38–$178.97	—	30%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer	$94.50	$135.00	$9.93–$130.95	at median	30%
D-dimer blood test (blood clot marker) CPT 85379 85379	$105.77	$151.10	$9.93–$146.57	12% above	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer	$94.50	$135.00	$78.57–$130.95	—	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 85379	$105.77	$151.10	$87.94–$146.57	—	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S MAYO	$200.27	$286.10	$21.67–$277.52	23% below	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S MAYO	$200.27	$286.10	$166.51–$277.52	—	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drugs of Abuse Scr, Meconium 5 MAYO	$166.46	$237.80	$60.59–$766.44	at median	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Urine Drug Screen Standard	$177.66	$253.80	$60.59–$416.21	7% above	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen, Prescription/OTC, Urine MAYO	$255.78	$365.40	$60.59–$766.44	54% above	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Fentanyl Screen with Reflex, Urine MAYO	$358.96	$512.80	$60.59–$497.42	116% above	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drugs of Abuse Scr, Meconium 5 MAYO	$166.46	$237.80	$138.40–$230.67	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Urine Drug Screen Standard	$177.66	$253.80	$147.71–$246.19	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen, Prescription/OTC, Urine MAYO	$255.78	$365.40	$212.66–$354.44	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Fentanyl Screen with Reflex, Urine MAYO	$358.96	$512.80	$298.45–$497.42	—	30%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytes Standard	$63.28	$90.40	$6.83–$87.69	22% below	30%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytes Standard	$63.28	$90.40	$52.61–$87.69	—	30%
Epstein-Barr virus (EBV) antibody test CPT 86665 86665	$47.28	$67.54	$17.69–$121.50	58% below	30%
Epstein-Barr virus (EBV) antibody test CPT 86665 EPSTEIN BARR VIRAL CAPSID AB	$121.38	$173.40	$17.69–$168.20	8% above	30%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 86665	$47.28	$67.54	$39.31–$65.51	—	30%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EPSTEIN BARR VIRAL CAPSID AB	$121.38	$173.40	$100.92–$168.20	—	30%
Estradiol blood test CPT 82670 ESTRADIOL SERUM	$234.08	$334.40	$27.24–$324.37	34% above	30%
Estradiol blood test CPT 82670 Estradiol Level	$246.26	$351.80	$27.24–$341.25	41% above	30%
Estradiol blood test CPT 82670 Estradiol Free, S MAYO	$246.26	$351.80	$27.24–$341.25	41% above	30%
Estradiol blood test inpatient CPT 82670 ESTRADIOL SERUM	$234.08	$334.40	$194.62–$324.37	—	30%
Estradiol blood test inpatient CPT 82670 Estradiol Free, S MAYO	$246.26	$351.80	$204.75–$341.25	—	30%
Estradiol blood test inpatient CPT 82670 Estradiol Level	$246.26	$351.80	$204.75–$341.25	—	30%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle Stimulating Hormone1	$170.80	$244.00	$18.12–$236.68	13% below	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle Stimulating Hormone1	$170.80	$244.00	$142.01–$236.68	—	30%
Fecal calprotectin (stool inflammation test) CPT 83993 Bill Calprotectin	$382.34	$546.20	$19.14–$529.81	17% above	30%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Feces MAYO	$382.34	$546.20	$19.14–$529.81	17% above	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Bill Calprotectin	$382.34	$546.20	$317.89–$529.81	—	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Feces MAYO	$382.34	$546.20	$317.89–$529.81	—	30%
Ferritin blood test (iron stores) CPT 82728 Ferritin Serum	$126.63	$180.90	$13.29–$175.47	2% above	30%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin Serum	$126.63	$180.90	$105.28–$175.47	—	30%
Fibrinogen blood test CPT 85384 85384	$42.49	$60.70	$9.48–$65.10	36% below	30%
Fibrinogen blood test CPT 85384 FIBRINOGEN QUANT	$71.96	$102.80	$9.48–$99.72	8% above	30%
Fibrinogen blood test inpatient CPT 85384 85384	$42.49	$60.70	$35.33–$58.88	—	30%
Fibrinogen blood test inpatient CPT 85384 FIBRINOGEN QUANT	$71.96	$102.80	$59.83–$99.72	—	30%
Folate (folic acid) blood test CPT 82746 Folate (Folic Acid), serum	$124.81	$178.30	$14.33–$172.95	10% above	30%
Folate (folic acid) blood test inpatient CPT 82746 Folate (Folic Acid), serum	$124.81	$178.30	$103.77–$172.95	—	30%
Free T3 thyroid hormone test CPT 84481 T3 Free	$155.19	$221.70	$16.52–$215.05	2% above	30%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$155.19	$221.70	$129.03–$215.05	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine Free	$83.23	$118.90	$8.79–$115.33	19% below	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Thyroxine Free	$83.23	$118.90	$69.20–$115.33	—	30%
Free testosterone test CPT 84402 Testosterone, Total, Bioavailable, & Free, S MAYO	$227.99	$325.70	$24.83–$315.93	148% above	30%
Free testosterone test inpatient CPT 84402 Testosterone, Total, Bioavailable, & Free, S MAYO	$227.99	$325.70	$189.56–$315.93	—	30%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 82977	$58.94	$84.20	$7.02–$81.67	28% above	30%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT	$61.53	$87.90	$7.02–$85.26	34% above	30%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Gamma Glutamyl Transferase	$65.94	$94.20	$7.02–$91.37	43% above	30%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 82977	$58.94	$84.20	$49.00–$81.67	—	30%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GAMMA GT	$61.53	$87.90	$51.16–$85.26	—	30%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Gamma Glutamyl Transferase	$65.94	$94.20	$54.82–$91.37	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose, 1HR P 50 GM	$36.40	$52.00	$4.63–$50.44	33% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 .Glucose 2 Hour Urine	$43.33	$61.90	$4.63–$60.04	20% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose, 2 Hr PC	$43.33	$61.90	$4.63–$60.04	20% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose, 2 HR P 75 GM	$43.33	$61.90	$4.63–$60.04	20% below	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose, 1HR P 50 GM	$36.40	$52.00	$30.26–$50.44	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose, 2 Hr PC	$43.33	$61.90	$36.03–$60.04	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose, 2 HR P 75 GM	$43.33	$61.90	$36.03–$60.04	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 .Glucose 2 Hour Urine	$43.33	$61.90	$36.03–$60.04	—	30%
Glucose tolerance test, 3 samples CPT 82951 .Glucose 2 Hour	$105.77	$151.10	$12.55–$146.57	30% below	30%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST - 3 SPECIMEN	$106.68	$152.40	$12.55–$147.83	29% below	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 .Glucose 2 Hour	$105.77	$151.10	$87.94–$146.57	—	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GLUCOSE TOLERANCE TEST - 3 SPECIMEN	$106.68	$152.40	$88.70–$147.83	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC Amp Probe	$157.78	$225.40	$34.21–$235.03	at median	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591(2)	$166.46	$237.80	$34.21–$235.03	6% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591	$166.46	$237.80	$34.21–$235.03	6% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 NEISSERIA GONORRHOEAE AMP PROBE	$166.46	$237.80	$34.21–$235.03	6% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC Amp Probe	$157.78	$225.40	$131.18–$218.64	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 NEISSERIA GONORRHOEAE AMP PROBE	$166.46	$237.80	$138.40–$230.67	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591(2)	$166.46	$237.80	$138.40–$230.67	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591	$166.46	$237.80	$138.40–$230.67	—	30%
H. pylori stool antigen test CPT 87338 H. pylori Ag, Fecal by EIA MAYO	$183.82	$262.60	$14.02–$254.72	14% below	30%
H. pylori stool antigen test CPT 87338 H. pylori Ag, Feces MAYO	$183.82	$262.60	$14.02–$254.72	14% below	30%
H. pylori stool antigen test inpatient CPT 87338 H. pylori Ag, Feces MAYO	$183.82	$262.60	$152.83–$254.72	—	30%
H. pylori stool antigen test inpatient CPT 87338 H. pylori Ag, Fecal by EIA MAYO	$183.82	$262.60	$152.83–$254.72	—	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA Quant Reflex to Resist, P MAYO	$184.24	$263.20	$82.97–$569.99	50% below	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA Quant MAYO	$504.56	$720.80	$82.97–$699.18	36% above	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV-1 RNA Quant w/ Rfx MAYO	$504.56	$720.80	$82.97–$699.18	36% above	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA Quant Reflex to Resist, P MAYO	$184.24	$263.20	$153.18–$255.30	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA Quant MAYO	$504.56	$720.80	$419.51–$699.18	—	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HIV-1 RNA Quant w/ Rfx MAYO	$504.56	$720.80	$419.51–$699.18	—	30%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 Ab FAH	$97.09	$138.70	$13.37–$134.54	9% below	30%
HIV-1 and HIV-2 antibody test CPT 86703 Rapid HIV Standard	$97.09	$138.70	$13.37–$134.54	9% below	30%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2	$97.09	$138.70	$13.37–$134.54	9% below	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2	$97.09	$138.70	$80.72–$134.54	—	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 Ab FAH	$97.09	$138.70	$80.72–$134.54	—	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Rapid HIV Standard	$97.09	$138.70	$80.72–$134.54	—	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV Genotypes 16 and 18, MAYO	$234.99	$335.70	$34.21–$325.63	54% above	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV FAH	$234.99	$335.70	$34.21–$325.63	54% above	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DHMC	$234.99	$335.70	$34.21–$325.63	54% above	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV FAH	$234.99	$335.70	$195.38–$325.63	—	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV Genotypes 16 and 18, MAYO	$234.99	$335.70	$195.38–$325.63	—	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DHMC	$234.99	$335.70	$195.38–$325.63	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1c DC	$87.57	$125.10	$9.47–$121.35	at median	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1c DC	$87.57	$125.10	$72.81–$121.35	—	30%
Hemoglobin blood test CPT 85018 H+H	$22.54	$32.20	$2.31–$31.23	at median	30%
Hemoglobin blood test CPT 85018 Hemoglobin	$22.54	$32.20	$2.31–$31.23	at median	30%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$22.54	$32.20	$18.74–$31.23	—	30%
Hemoglobin blood test inpatient CPT 85018 H+H	$22.54	$32.20	$18.74–$31.23	—	30%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Core Ab FAH	$108.36	$154.80	$11.75–$150.16	8% above	30%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Core Ab FAH	$108.36	$154.80	$90.09–$150.16	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Surface Ab FAH	$96.25	$137.50	$10.47–$133.38	at median	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surf Ab, Qual/Quant MAYO	$96.25	$137.50	$10.47–$133.38	at median	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Bill Hepatitis B surface antibody (HBsAb)	$130.06	$185.80	$10.47–$180.23	35% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hep B Surface Ab	$130.06	$185.80	$10.47–$180.23	35% above	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Surface Ab FAH	$96.25	$137.50	$80.03–$133.38	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surf Ab, Qual/Quant MAYO	$96.25	$137.50	$80.03–$133.38	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Bill Hepatitis B surface antibody (HBsAb)	$130.06	$185.80	$108.14–$180.23	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hep B Surface Ab	$130.06	$185.80	$108.14–$180.23	—	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag FAH	$92.75	$132.50	$10.07–$128.53	at median	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Acute Hepatitis Profile MAYO	$92.75	$132.50	$10.07–$128.53	at median	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE ANTIGEN	$130.06	$185.80	$10.07–$180.23	40% above	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Acute Hepatitis Profile MAYO	$92.75	$132.50	$77.12–$128.53	—	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag FAH	$92.75	$132.50	$77.12–$128.53	—	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HEPATITIS B SURFACE ANTIGEN	$130.06	$185.80	$108.14–$180.23	—	30%
Hepatitis C antibody blood test (screening) CPT 86803 86803	$110.11	$157.30	$13.91–$152.58	at median	30%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$113.54	$162.20	$13.91–$157.33	3% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Antibody	$130.06	$185.80	$13.91–$180.23	18% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 HCV Antibody	$130.06	$185.80	$13.91–$180.23	18% above	30%
Hepatitis C antibody blood test (screening) CPT 86803 Bill Hepatitis C antibody	$130.06	$185.80	$13.91–$180.23	18% above	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 86803	$110.11	$157.30	$91.55–$152.58	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HEPATITIS C ANTIBODY	$113.54	$162.20	$94.40–$157.33	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Antibody	$130.06	$185.80	$108.14–$180.23	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Bill Hepatitis C antibody	$130.06	$185.80	$108.14–$180.23	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HCV Antibody	$130.06	$185.80	$108.14–$180.23	—	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 HCV RNA Detect/Quant Reflex Geno, S MAYO	$384.02	$548.60	$41.77–$532.14	18% below	30%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 Hepatitis C Virus RNA Detect and Quant RT-PCR MAYO	$384.02	$548.60	$41.77–$532.14	18% below	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HCV RNA Detect/Quant Reflex Geno, S MAYO	$384.02	$548.60	$319.29–$532.14	—	30%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 Hepatitis C Virus RNA Detect and Quant RT-PCR MAYO	$384.02	$548.60	$319.29–$532.14	—	30%
Herpes blood test, HSV-1 antibody CPT 86695 HSV 1,IGG	$111.86	$159.80	$12.86–$155.01	2% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 HSV Type 1 and Type 2 Specific Abs, IgG MAYO	$117.95	$168.50	$12.86–$163.45	7% above	30%
Herpes blood test, HSV-1 antibody CPT 86695 86695	$160.37	$229.10	$12.86–$222.23	46% above	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV 1,IGG	$111.86	$159.80	$93.00–$155.01	—	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HSV Type 1 and Type 2 Specific Abs, IgG MAYO	$117.95	$168.50	$98.07–$163.45	—	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 86695	$160.37	$229.10	$133.34–$222.23	—	30%
Herpes blood test, HSV-2 antibody CPT 86696 86696	$119.63	$170.90	$18.87–$165.77	at median	30%
Herpes blood test, HSV-2 antibody CPT 86696 86696(2)	$160.37	$229.10	$18.87–$222.23	34% above	30%
Herpes blood test, HSV-2 antibody CPT 86696 HSV 2,IGG	$164.71	$235.30	$18.87–$228.24	38% above	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 86696	$119.63	$170.90	$99.46–$165.77	—	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 86696(2)	$160.37	$229.10	$133.34–$222.23	—	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HSV 2,IGG	$164.71	$235.30	$136.94–$228.24	—	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein High Sensitivity	$118.79	$169.70	$12.63–$164.61	24% above	30%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein High Sensitivity	$118.79	$169.70	$98.77–$164.61	—	30%
Homocysteine blood test CPT 83090 Homocysteine, Total, P MAYO	$150.85	$215.50	$17.47–$209.04	26% below	30%
Homocysteine blood test inpatient CPT 83090 Homocysteine, Total, P MAYO	$150.85	$215.50	$125.42–$209.04	—	30%
Insulin blood test CPT 83525 Insulin FAH	$103.18	$147.40	$11.14–$142.98	at median	30%
Insulin blood test inpatient CPT 83525 Insulin FAH	$103.18	$147.40	$85.79–$142.98	—	30%
Iron blood test (serum iron) CPT 83540 IRON	$53.69	$76.70	$6.31–$74.40	23% below	30%
Iron blood test (serum iron) CPT 83540 Iron Level	$58.94	$84.20	$6.31–$81.67	16% below	30%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$53.69	$76.70	$44.64–$74.40	—	30%
Iron blood test (serum iron) inpatient CPT 83540 Iron Level	$58.94	$84.20	$49.00–$81.67	—	30%
Iron-binding capacity (TIBC) test CPT 83550 TIBC IRON BINDING CAPACITY	$74.55	$106.50	$8.52–$103.31	9% below	30%
Iron-binding capacity (TIBC) test CPT 83550 FEIBC	$80.64	$115.20	$8.52–$111.74	1% below	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 TIBC IRON BINDING CAPACITY	$74.55	$106.50	$61.98–$103.31	—	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 FEIBC	$80.64	$115.20	$67.05–$111.74	—	30%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone	$160.37	$229.10	$18.06–$222.23	at median	30%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone (LH) MAYO	$160.37	$229.10	$18.06–$222.23	at median	30%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone	$160.37	$229.10	$133.34–$222.23	—	30%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone (LH) MAYO	$160.37	$229.10	$133.34–$222.23	—	30%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid with Reflex	$98.00	$140.00	$11.28–$135.80	14% below	30%
Lactate (lactic acid) blood test CPT 83605 Lactate	$98.00	$140.00	$11.28–$135.80	14% below	30%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate	$98.00	$140.00	$81.48–$135.80	—	30%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid with Reflex	$98.00	$140.00	$81.48–$135.80	—	30%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH	$51.17	$73.10	$5.89–$70.91	39% below	30%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase BF MAYO	$54.67	$78.10	$5.89–$75.76	34% below	30%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase	$54.67	$78.10	$5.89–$75.76	34% below	30%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH	$51.17	$73.10	$42.54–$70.91	—	30%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase	$54.67	$78.10	$45.45–$75.76	—	30%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase BF MAYO	$54.67	$78.10	$45.45–$75.76	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase, BF MAYO	$41.58	$59.40	$6.72–$57.62	15% below	30%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Level	$42.49	$60.70	$6.72–$58.88	13% below	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase, BF MAYO	$41.58	$59.40	$34.57–$57.62	—	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Level	$42.49	$60.70	$35.33–$58.88	—	30%
Liver function blood test panel CPT 80076 Hepatic Panel1	$73.64	$105.20	$7.97–$102.04	33% below	30%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$73.64	$105.20	$7.97–$102.04	33% below	30%
Liver function blood test panel inpatient CPT 80076 Hepatic Panel1	$73.64	$105.20	$61.23–$102.04	—	30%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$73.64	$105.20	$61.23–$102.04	—	30%
Lyme disease antibody test CPT 86618 LYME ANTIBODY	$121.38	$173.40	$16.60–$168.20	22% above	30%
Lyme disease antibody test CPT 86618 Lyme Ab FAH	$122.29	$174.70	$16.60–$169.46	23% above	30%
Lyme disease antibody test CPT 86618 Lyme Disease Serology, Spinal Fluid MAYO	$128.31	$183.30	$16.60–$177.80	29% above	30%
Lyme disease antibody test CPT 86618 Lyme Disease Serology MAYO	$128.31	$183.30	$16.60–$177.80	29% above	30%
Lyme disease antibody test CPT 86618 Lyme CNS Infection IgG w/ AI Reflex MAYO	$128.31	$183.30	$16.60–$177.80	29% above	30%
Lyme disease antibody test CPT 86618 Tick-Borne Disease Abs Panel MAYO	$161.21	$230.30	$16.60–$223.39	62% above	30%
Lyme disease antibody test inpatient CPT 86618 LYME ANTIBODY	$121.38	$173.40	$100.92–$168.20	—	30%
Lyme disease antibody test inpatient CPT 86618 Lyme Ab FAH	$122.29	$174.70	$101.68–$169.46	—	30%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology MAYO	$128.31	$183.30	$106.68–$177.80	—	30%
Lyme disease antibody test inpatient CPT 86618 Lyme CNS Infection IgG w/ AI Reflex MAYO	$128.31	$183.30	$106.68–$177.80	—	30%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Serology, Spinal Fluid MAYO	$128.31	$183.30	$106.68–$177.80	—	30%
Lyme disease antibody test inpatient CPT 86618 Tick-Borne Disease Abs Panel MAYO	$161.21	$230.30	$134.03–$223.39	—	30%
Magnesium blood test CPT 83735 ELEC&OSMOL PANEL FECES-MAGNESIUM	$56.35	$80.50	$6.53–$78.09	at median	30%
Magnesium blood test CPT 83735 24 Hour Urine Magnesium Level Standard	$58.94	$84.20	$6.53–$81.67	5% above	30%
Magnesium blood test CPT 83735 Magnesium Level	$61.53	$87.90	$6.53–$85.26	9% above	30%
Magnesium blood test CPT 83735 83735	$62.44	$89.20	$6.53–$86.52	11% above	30%
Magnesium blood test CPT 83735 Magnesium, RBC MAYO	$67.62	$96.60	$6.53–$93.70	20% above	30%
Magnesium blood test inpatient CPT 83735 ELEC&OSMOL PANEL FECES-MAGNESIUM	$56.35	$80.50	$46.85–$78.09	—	30%
Magnesium blood test inpatient CPT 83735 24 Hour Urine Magnesium Level Standard	$58.94	$84.20	$49.00–$81.67	—	30%
Magnesium blood test inpatient CPT 83735 Magnesium Level	$61.53	$87.90	$51.16–$85.26	—	30%
Magnesium blood test inpatient CPT 83735 83735	$62.44	$89.20	$51.91–$86.52	—	30%
Magnesium blood test inpatient CPT 83735 Magnesium, RBC MAYO	$67.62	$96.60	$56.22–$93.70	—	30%
Measles (rubeola) antibody test CPT 86765 Rubeola IgG Ab FAH	$116.20	$166.00	$12.56–$161.02	45% above	30%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola IgG Ab FAH	$116.20	$166.00	$96.61–$161.02	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 Rapid Mono Screen Standard	$47.67	$68.10	$5.05–$66.06	at median	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Rapid Mono Screen Standard	$47.67	$68.10	$39.63–$66.06	—	30%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgG and IgM MAYO	$105.77	$151.10	$12.72–$146.57	4% below	30%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgG MAYO	$105.77	$151.10	$12.72–$146.57	4% below	30%
Mumps immunity blood test CPT 86735 86735	$108.36	$154.80	$12.72–$150.16	1% below	30%
Mumps immunity blood test CPT 86735 Mumps Ab IgG FAH	$117.04	$167.20	$12.72–$162.18	6% above	30%
Mumps immunity blood test CPT 86735 Mumps Virus Ab, IgM, S MAYO	$117.04	$167.20	$12.72–$162.18	6% above	30%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgG MAYO	$105.77	$151.10	$87.94–$146.57	—	30%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgG and IgM MAYO	$105.77	$151.10	$87.94–$146.57	—	30%
Mumps immunity blood test inpatient CPT 86735 86735	$108.36	$154.80	$90.09–$150.16	—	30%
Mumps immunity blood test inpatient CPT 86735 Mumps Virus Ab, IgM, S MAYO	$117.04	$167.20	$97.31–$162.18	—	30%
Mumps immunity blood test inpatient CPT 86735 Mumps Ab IgG FAH	$117.04	$167.20	$97.31–$162.18	—	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 .Prostate Health Index Reflex (PHi 13) MAYO	$54.67	$78.10	$17.93–$123.17	62% below	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 84154	$156.87	$224.10	$17.93–$217.38	10% above	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$156.87	$224.10	$17.93–$217.38	10% above	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 .Prostate Health Index Reflex (PHi 13) MAYO	$54.67	$78.10	$45.45–$75.76	—	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$156.87	$224.10	$130.43–$217.38	—	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 84154	$156.87	$224.10	$130.43–$217.38	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Ultrasensitive MAYO	$42.00	$60.00	$17.93–$123.17	69% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Health Index (phi), S MAYO	$109.20	$156.00	$17.93–$151.32	19% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, Total and Free MAYO	$133.49	$190.70	$17.93–$184.98	1% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen Diagnostic	$133.49	$190.70	$17.93–$184.98	1% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA	$156.87	$224.10	$17.93–$217.38	17% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Ultrasensitive MAYO	$42.00	$60.00	$34.92–$58.20	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Health Index (phi), S MAYO	$109.20	$156.00	$90.79–$151.32	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen Diagnostic	$133.49	$190.70	$110.99–$184.98	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, Total and Free MAYO	$133.49	$190.70	$110.99–$184.98	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA	$156.87	$224.10	$130.43–$217.38	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 83970	$187.25	$267.50	$40.25–$276.49	25% below	30%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE	$187.25	$267.50	$40.25–$276.49	25% below	30%
Parathyroid hormone (PTH) blood test CPT 83970 Parathyroid Hormone	$371.07	$530.10	$40.25–$514.20	49% above	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 83970	$187.25	$267.50	$155.69–$259.48	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE	$187.25	$267.50	$155.69–$259.48	—	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathyroid Hormone	$371.07	$530.10	$308.52–$514.20	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 APTT	$54.67	$78.10	$5.86–$75.76	at median	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 Lupus Anticoagulant Profile MAYO	$54.67	$78.10	$5.86–$75.76	at median	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 85730	$71.12	$101.60	$5.86–$98.55	30% above	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Lupus Anticoagulant Profile MAYO	$54.67	$78.10	$45.45–$75.76	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 APTT	$54.67	$78.10	$45.45–$75.76	—	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730	$71.12	$101.60	$59.13–$98.55	—	30%
Phosphorus (phosphate) blood test CPT 84100 84100	$39.90	$57.00	$4.62–$55.29	11% below	30%
Phosphorus (phosphate) blood test CPT 84100 ELEC&OSMOL PANEL FECES-PHOSPHORUS	$40.74	$58.20	$4.62–$56.45	9% below	30%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS SERUM	$40.74	$58.20	$4.62–$56.45	9% below	30%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Level	$42.49	$60.70	$4.62–$58.88	6% below	30%
Phosphorus (phosphate) blood test CPT 84100 84100(2)	$43.33	$61.90	$4.62–$60.04	4% below	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 84100	$39.90	$57.00	$33.17–$55.29	—	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHORUS SERUM	$40.74	$58.20	$33.87–$56.45	—	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 ELEC&OSMOL PANEL FECES-PHOSPHORUS	$40.74	$58.20	$33.87–$56.45	—	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Level	$42.49	$60.70	$35.33–$58.88	—	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 84100(2)	$43.33	$61.90	$36.03–$60.04	—	30%
Potassium blood test CPT 84132 Potassium Level	$41.58	$59.40	$4.64–$57.62	at median	30%
Potassium blood test inpatient CPT 84132 Potassium Level	$41.58	$59.40	$34.57–$57.62	—	30%
Progesterone blood test CPT 84144 Progesterone FAH	$187.25	$267.50	$20.34–$259.48	6% above	30%
Progesterone blood test inpatient CPT 84144 Progesterone FAH	$187.25	$267.50	$155.69–$259.48	—	30%
Prolactin blood test CPT 84146 Prolactin FAH	$173.39	$247.70	$18.90–$240.27	20% above	30%
Prolactin blood test inpatient CPT 84146 Prolactin FAH	$173.39	$247.70	$144.16–$240.27	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 Protime/INR with MELD Score	$30.38	$43.40	$4.18–$42.10	20% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 85610	$32.06	$45.80	$4.18–$44.43	16% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PT	$36.40	$52.00	$4.18–$50.44	4% below	30%
Prothrombin time (PT/INR) clotting test CPT 85610 85610(2)	$118.79	$169.70	$4.18–$164.61	213% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime/INR with MELD Score	$30.38	$43.40	$25.26–$42.10	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610	$32.06	$45.80	$26.66–$44.43	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT	$36.40	$52.00	$30.26–$50.44	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 85610(2)	$118.79	$169.70	$98.77–$164.61	—	30%
Renin blood test CPT 84244 Renin Activity MAYO	$198.59	$283.70	$21.44–$275.19	4% below	30%
Renin blood test inpatient CPT 84244 Renin Activity MAYO	$198.59	$283.70	$165.11–$275.19	—	30%
Rh blood typing CPT 86901 Rh Type	$26.04	$37.20	$20.03–$52.71	46% below	30%
Rh blood typing CPT 86901 Weak D	$27.72	$39.60	$20.03–$52.71	43% below	30%
Rh blood typing inpatient CPT 86901 Rh Type	$26.04	$37.20	$21.65–$36.08	—	30%
Rh blood typing inpatient CPT 86901 Weak D	$27.72	$39.60	$23.05–$38.41	—	30%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor	$52.85	$75.50	$5.53–$73.24	6% below	30%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor	$52.85	$75.50	$43.94–$73.24	—	30%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG Ab FAH	$129.15	$184.50	$14.03–$178.97	32% above	30%
Rubella antibody test (immunity check) CPT 86762 Rubella IgG	$141.26	$201.80	$14.03–$195.75	44% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG Ab FAH	$129.15	$184.50	$107.38–$178.97	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella IgG	$141.26	$201.80	$117.45–$195.75	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Erythrocyte Sedimentation Rate	$25.13	$35.90	$2.63–$34.82	40% below	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Erythrocyte Sedimentation Rate	$25.13	$35.90	$20.89–$34.82	—	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Analysis Fertility	$26.32	$37.60	$12.00–$82.45	82% below	30%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Analysis Fertility	$26.32	$37.60	$21.88–$36.47	—	30%
Sodium blood test CPT 84295 Sodium Level	$39.90	$57.00	$4.69–$55.29	11% below	30%
Sodium blood test inpatient CPT 84295 Sodium Level	$39.90	$57.00	$33.17–$55.29	—	30%
Stool ova and parasites exam CPT 87177 OVA & PARASITE	$75.46	$107.80	$8.68–$104.57	26% below	30%
Stool ova and parasites exam inpatient CPT 87177 OVA & PARASITE	$75.46	$107.80	$62.74–$104.57	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Fecal Occult Blood, Immunoassay	$58.94	$84.20	$15.52–$106.63	40% below	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Screen 1-3	$89.25	$127.50	$15.52–$123.68	8% below	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Fecal Occult Blood, Immunoassay	$58.94	$84.20	$49.00–$81.67	—	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occult Blood Screen 1-3	$89.25	$127.50	$74.21–$123.68	—	30%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Total Abs w/ Reflex, S MAYO	$18.27	$26.10	$12.91–$88.68	68% below	30%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis IgG with Reflex, Enzyme Immunoassay, Serum MAYO	$33.11	$47.30	$12.91–$88.68	43% below	30%
Syphilis antibody test (Treponema pallidum) CPT 86780 .Syphilis Ab, TP-PA MAYO	$55.51	$79.30	$12.91–$88.68	4% below	30%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis Ab by TP-PA, Serum MAYO	$118.79	$169.70	$12.91–$164.61	105% above	30%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Total Abs w/ Reflex, S MAYO	$18.27	$26.10	$15.19–$25.32	—	30%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis IgG with Reflex, Enzyme Immunoassay, Serum MAYO	$33.11	$47.30	$27.53–$45.88	—	30%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 .Syphilis Ab, TP-PA MAYO	$55.51	$79.30	$46.15–$76.92	—	30%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis Ab by TP-PA, Serum MAYO	$118.79	$169.70	$98.77–$164.61	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Qual	$36.40	$52.00	$4.16–$50.44	49% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR Screen, Response to Therapy, S MAYO	$63.28	$90.40	$4.16–$87.69	12% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Rapid Plasma Reagin Screen with Reflex to Titer, Serum MAYO	$63.28	$90.40	$4.16–$87.69	12% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RPR with Reflex to Titer, Serum MAYO	$63.28	$90.40	$4.16–$87.69	12% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 VDRL, Spinal Fluid MAYO	$63.28	$90.40	$4.16–$87.69	12% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 .RPR Screen w/ Reflex, S MAYO	$68.46	$97.80	$4.16–$94.87	5% below	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Qual	$36.40	$52.00	$30.26–$50.44	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Rapid Plasma Reagin Screen with Reflex to Titer, Serum MAYO	$63.28	$90.40	$52.61–$87.69	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR with Reflex to Titer, Serum MAYO	$63.28	$90.40	$52.61–$87.69	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 RPR Screen, Response to Therapy, S MAYO	$63.28	$90.40	$52.61–$87.69	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 VDRL, Spinal Fluid MAYO	$63.28	$90.40	$52.61–$87.69	—	30%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 .RPR Screen w/ Reflex, S MAYO	$68.46	$97.80	$56.92–$94.87	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Mycobacterium tuberculosis by QuantiFERON-TB Gold MAYO	$151.69	$216.70	$60.43–$415.14	24% below	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 Mycobacterium tuberculosis by QuantiFERON-TB Gold MAYO	$151.69	$216.70	$126.12–$210.20	—	30%
Testosterone blood test, total (not free testosterone) CPT 84403 84403	$201.11	$287.30	$25.16–$278.68	at median	30%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total and Free MAYO	$219.38	$313.40	$25.16–$304.00	9% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total, S MAYO	$219.38	$313.40	$25.16–$304.00	9% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone, Total & Bioavailable, S MAYO	$219.38	$313.40	$25.16–$304.00	9% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 84403	$201.11	$287.30	$167.21–$278.68	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total & Bioavailable, S MAYO	$219.38	$313.40	$182.40–$304.00	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total, S MAYO	$219.38	$313.40	$182.40–$304.00	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone, Total and Free MAYO	$219.38	$313.40	$182.40–$304.00	—	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 86376	$120.47	$172.10	$14.19–$166.94	at median	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMIAL ANTIBODIES	$123.13	$175.90	$14.19–$170.62	2% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 Thyroperoxidase Abs MAYO	$130.06	$185.80	$14.19–$180.23	8% above	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 86376	$120.47	$172.10	$100.16–$166.94	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMIAL ANTIBODIES	$123.13	$175.90	$102.37–$170.62	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Thyroperoxidase Abs MAYO	$130.06	$185.80	$108.14–$180.23	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Cascade	$150.85	$215.50	$16.38–$209.04	21% below	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH	$150.85	$215.50	$16.38–$209.04	21% below	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH	$150.85	$215.50	$125.42–$209.04	—	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Cascade	$150.85	$215.50	$125.42–$209.04	—	30%
Total IgE blood test CPT 82785 Immunoglobulin E (IgE) MAYO	$147.42	$210.60	$16.05–$204.28	76% above	30%
Total IgE blood test CPT 82785 IgE FAH	$147.42	$210.60	$16.05–$204.28	76% above	30%
Total IgE blood test inpatient CPT 82785 IgE FAH	$147.42	$210.60	$122.57–$204.28	—	30%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E (IgE) MAYO	$147.42	$210.60	$122.57–$204.28	—	30%
Total cholesterol blood test CPT 82465 Cholesterol Total	$39.90	$57.00	$4.24–$55.29	2% below	30%
Total cholesterol blood test CPT 82465 NMR Lipoprofile w/ IR Markers MAYO	$180.32	$257.60	$4.24–$249.87	342% above	30%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total	$39.90	$57.00	$33.17–$55.29	—	30%
Total cholesterol blood test inpatient CPT 82465 NMR Lipoprofile w/ IR Markers MAYO	$180.32	$257.60	$149.92–$249.87	—	30%
Total thyroxine (T4) blood test CPT 84436 84436	$57.19	$81.70	$6.70–$79.25	at median	30%
Total thyroxine (T4) blood test CPT 84436 T4 TOTAL	$58.10	$83.00	$6.70–$80.51	2% above	30%
Total thyroxine (T4) blood test CPT 84436 Thyroxine	$61.53	$87.90	$6.70–$85.26	8% above	30%
Total thyroxine (T4) blood test inpatient CPT 84436 84436	$57.19	$81.70	$47.55–$79.25	—	30%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 TOTAL	$58.10	$83.00	$48.31–$80.51	—	30%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine	$61.53	$87.90	$51.16–$85.26	—	30%
Total triiodothyronine (T3) blood test CPT 84480 T3	$130.06	$185.80	$13.83–$180.23	5% above	30%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3	$130.06	$185.80	$108.14–$180.23	—	30%
Transferrin blood test CPT 84466 Transferrin FAH	$115.29	$164.70	$12.44–$159.76	16% above	30%
Transferrin blood test inpatient CPT 84466 Transferrin FAH	$115.29	$164.70	$95.86–$159.76	—	30%
Trichomonas test (NAAT) CPT 87661 Trich Vag Amp Probe	$31.61	$45.15	$26.28–$235.03	46% below	30%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis Amplified RNA MAYO	$128.31	$183.30	$34.21–$235.03	118% above	30%
Trichomonas test (NAAT) inpatient CPT 87661 Trich Vag Amp Probe	$31.61	$45.15	$26.28–$43.80	—	30%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis Amplified RNA MAYO	$128.31	$183.30	$106.68–$177.80	—	30%
Triglycerides blood test CPT 84478 84478	$47.67	$68.10	$5.60–$66.06	18% above	30%
Triglycerides blood test CPT 84478 TRIGLYCERIDE	$49.42	$70.60	$5.60–$68.48	23% above	30%
Triglycerides blood test CPT 84478 Triglycerides	$52.85	$75.50	$5.60–$73.24	31% above	30%
Triglycerides blood test inpatient CPT 84478 84478	$47.67	$68.10	$39.63–$66.06	—	30%
Triglycerides blood test inpatient CPT 84478 TRIGLYCERIDE	$49.42	$70.60	$41.09–$68.48	—	30%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$52.85	$75.50	$43.94–$73.24	—	30%
Troponin test, quantitative CPT 84484 Troponin I	$90.23	$128.90	$12.16–$125.03	45% below	30%
Troponin test, quantitative CPT 84484 Troponin T Gen 5	$90.23	$128.90	$12.16–$125.03	45% below	30%
Troponin test, quantitative CPT 84484 Troponin-T	$90.23	$128.90	$12.16–$125.03	45% below	30%
Troponin test, quantitative inpatient CPT 84484 Troponin-T	$90.23	$128.90	$75.02–$125.03	—	30%
Troponin test, quantitative inpatient CPT 84484 Troponin I	$90.23	$128.90	$75.02–$125.03	—	30%
Troponin test, quantitative inpatient CPT 84484 Troponin T Gen 5	$90.23	$128.90	$75.02–$125.03	—	30%
Uric acid blood test CPT 84550 Uric Acid	$41.58	$59.40	$4.41–$57.62	36% below	30%
Uric acid blood test inpatient CPT 84550 Uric Acid	$41.58	$59.40	$34.57–$57.62	—	30%
Urinalysis without microscope exam, automated CPT 81003 UA w Culture if Ind	$16.45	$23.50	$2.19–$22.80	57% below	30%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis Dipstick Standard	$16.45	$23.50	$2.19–$22.80	57% below	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA w Culture if Ind	$16.45	$23.50	$13.68–$22.80	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Dipstick Standard	$16.45	$23.50	$13.68–$22.80	—	30%
Urinalysis without microscope exam, manual CPT 81002 Urine Dipstick POC Charge	$6.09	$8.70	$3.39–$23.31	74% below	30%
Urinalysis without microscope exam, manual CPT 81002 81002 URINE DIPSTICK/BIRTH CTR CHARGE	$6.09	$8.70	$3.39–$23.31	74% below	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 81002 URINE DIPSTICK/BIRTH CTR CHARGE	$6.09	$8.70	$5.06–$8.44	—	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urine Dipstick POC Charge	$6.09	$8.70	$5.06–$8.44	—	30%
Urine culture for bacteria, with colony count CPT 87086 Culture Urine	$53.69	$76.70	$7.87–$74.40	30% below	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 Culture Urine	$53.69	$76.70	$44.64–$74.40	—	30%
Urine microalbumin (albumin) test CPT 82043 U Microalbumin	$50.33	$71.90	$5.64–$69.74	at median	30%
Urine microalbumin (albumin) test CPT 82043 Microalbumin, Urine	$62.44	$89.20	$5.64–$86.52	24% above	30%
Urine microalbumin (albumin) test inpatient CPT 82043 U Microalbumin	$50.33	$71.90	$41.85–$69.74	—	30%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin, Urine	$62.44	$89.20	$51.91–$86.52	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level 1	$94.50	$135.00	$14.70–$130.95	15% below	30%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Level	$94.50	$135.00	$14.70–$130.95	15% below	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level	$94.50	$135.00	$78.57–$130.95	—	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Level 1	$94.50	$135.00	$78.57–$130.95	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D, 25-Hydroxy	$273.07	$390.10	$28.86–$378.40	29% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D, 25-Hydroxy	$273.07	$390.10	$227.04–$378.40	—	30%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 1,25-Dihydroxyvitamin D MAYO	$345.87	$494.10	$37.54–$479.28	1% below	30%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 1,25-Dihydroxyvitamin D MAYO	$345.87	$494.10	$287.57–$479.28	—	30%
Zinc blood test CPT 84630 Zinc, Serum MAYO	$103.18	$147.40	$11.11–$142.98	33% below	30%
Zinc blood test CPT 84630 Zinc, RBC MAYO	$103.18	$147.40	$11.11–$142.98	33% below	30%
Zinc blood test CPT 84630 Zinc MAYO	$103.18	$147.40	$11.11–$142.98	33% below	30%
Zinc blood test inpatient CPT 84630 Zinc MAYO	$103.18	$147.40	$85.79–$142.98	—	30%
Zinc blood test inpatient CPT 84630 Zinc, Serum MAYO	$103.18	$147.40	$85.79–$142.98	—	30%
Zinc blood test inpatient CPT 84630 Zinc, RBC MAYO	$103.18	$147.40	$85.79–$142.98	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 84702	$124.81	$178.30	$14.67–$172.95	at median	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG BETA SUB UNIT/QUANT	$128.31	$183.30	$14.67–$177.80	3% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BHCG (Tumor Marker) MAYO	$133.49	$190.70	$14.67–$184.98	7% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Serum Pregnancy Quant	$133.49	$190.70	$14.67–$184.98	7% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 84702	$124.81	$178.30	$103.77–$172.95	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG BETA SUB UNIT/QUANT	$128.31	$183.30	$106.68–$177.80	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Serum Pregnancy Quant	$133.49	$190.70	$110.99–$184.98	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BHCG (Tumor Marker) MAYO	$133.49	$190.70	$110.99–$184.98	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereo Biopsy 1st Lesion Rt	$8,118.67	$11,598.10	$1,252.45–$11,250.16	173% above	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion one side CPT 19081 MA Stereo Biopsy 1st Lesion Lt	$8,118.67	$11,598.10	$1,252.45–$11,250.16	173% above	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereo Biopsy 1st Lesion Lt	$8,118.67	$11,598.10	$6,750.09–$11,250.16	—	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient one side CPT 19081 MA Stereo Biopsy 1st Lesion Rt	$8,118.67	$11,598.10	$6,750.09–$11,250.16	—	30%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee	$896.42	$1,280.60	$185.43–$1,242.18	92% above	30%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee	$896.42	$1,280.60	$745.31–$1,242.18	—	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee	$269.57	$385.10	$185.43–$373.55	31% below	30%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee	$269.57	$385.10	$224.13–$373.55	—	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$591.29	$844.70	$460.11–$878.81	61% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960: CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL ED Charge	$621.60	$888.00	$483.69–$878.81	59% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external	$1,724.31	$2,463.30	$505.84–$2,389.40	13% above	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion with Anesthesia	$1,724.31	$2,463.30	$505.84–$2,389.40	13% above	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 92960 External Cardioversion ED TechFee	$1,724.31	$2,463.30	$505.84–$2,389.40	13% above	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee	$591.29	$844.70	$491.62–$819.36	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960: CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL ED Charge	$621.60	$888.00	$516.82–$861.36	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion with Anesthesia	$1,724.31	$2,463.30	$1,433.64–$2,389.40	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 92960 External Cardioversion ED TechFee	$1,724.31	$2,463.30	$1,433.64–$2,389.40	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion, elective, electrical conversion of arrhythmia; external	$1,724.31	$2,463.30	$1,433.64–$2,389.40	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 54150 CIRCUMCISION W/ Block and Clip	$4,990.02	$7,128.60	$1,583.50–$6,914.74	77% above	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 54150 CIRCUMCISION W/ Block and Clip	$4,990.02	$7,128.60	$4,148.85–$6,914.74	—	30%
Circumcision, surgical, older than a newborn CPT 54160 54160 - Circumcision, surgical excision 28 days or less	$1,599.50	$2,285.00	$515.95–$2,216.45	—	30%
Circumcision, surgical, older than a newborn CPT 54160 Newborn Circumcision	$1,599.50	$2,285.00	$515.95–$2,216.45	—	30%
Circumcision, surgical, older than a newborn inpatient CPT 54160 54160 - Circumcision, surgical excision 28 days or less	$1,599.50	$2,285.00	$1,329.87–$2,216.45	—	30%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Newborn Circumcision	$1,599.50	$2,285.00	$1,329.87–$2,216.45	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee	$269.57	$385.10	$185.43–$373.55	50% below	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee	$269.57	$385.10	$224.13–$373.55	—	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 69209: Removal of ear wax	$18.27	$26.10	$14.22–$79.77	82% below	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 FAC-Removal impacted Cerumen lavage	$130.06	$185.80	$45.92–$180.23	31% above	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 69209: Removal of ear wax	$18.27	$26.10	$15.19–$25.32	—	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 FAC-Removal impacted Cerumen lavage	$130.06	$185.80	$108.14–$180.23	—	30%
Earwax removal with instruments, one ear CPT 69210 69210 Remove Impacted Ear Wax requiring instrumentation	$143.08	$204.40	$45.92–$198.27	14% below	30%
Earwax removal with instruments, one ear one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee	$141.26	$201.80	$45.92–$195.75	15% below	30%
Earwax removal with instruments, one ear inpatient CPT 69210 69210 Remove Impacted Ear Wax requiring instrumentation	$143.08	$204.40	$118.96–$198.27	—	30%
Earwax removal with instruments, one ear inpatient one side CPT 69210 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee	$141.26	$201.80	$117.45–$195.75	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 BVT XR Inj DX/TX Sbst C/T SP w/Image GD	$3,038.56	$4,340.80	$535.32–$4,210.58	62% above	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 BVT XR Inj DX/TX Sbst C/T SP w/Image GD	$3,038.56	$4,340.80	$2,526.35–$4,210.58	—	30%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 XR Inj Facet Joint Lumbar/Sacral	$4,515.77	$6,451.10	$688.19–$6,257.57	95% above	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 XR Inj Facet Joint Lumbar/Sacral	$4,515.77	$6,451.10	$3,754.54–$6,257.57	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 58340 Catherization & introduction of salineor contrast material for SIS or hystero-salpingography	$150.01	$214.30	$116.73–$207.87	60% below	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 BVT US Cath & Introduction Of Saline	$150.85	$215.50	$117.38–$209.04	60% below	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 BVT XR Inj Hysterosalpingography Proc	$1,296.05	$1,851.50	$1,008.51–$1,795.96	248% above	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 58340 Catherization & introduction of salineor contrast material for SIS or hystero-salpingography	$150.01	$214.30	$124.72–$207.87	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 BVT US Cath & Introduction Of Saline	$150.85	$215.50	$125.42–$209.04	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 BVT XR Inj Hysterosalpingography Proc	$1,296.05	$1,851.50	$1,077.57–$1,795.96	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$189.00	$270.00	$147.07–$266.85	59% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$214.20	$306.00	$153.60–$296.82	54% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 I AND D ABSCESS SINGLE CHARGE	$454.44	$649.20	$153.60–$629.72	2% below	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$189.00	$270.00	$157.14–$261.90	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee	$214.20	$306.00	$178.09–$296.82	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 10060 I AND D ABSCESS SINGLE CHARGE	$454.44	$649.20	$377.83–$629.72	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 XR Inj Tendon Ligament	$1,460.76	$2,086.80	$228.18–$2,024.20	411% above	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 XR Inj Tendon Ligament	$1,460.76	$2,086.80	$1,214.52–$2,024.20	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee	$681.90	$974.13	$228.18–$944.91	at median	30%
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 guidan	$681.90	$974.13	$228.18–$944.91	at median	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 XR Arthrocentesis Asp/Inj Major Joint	$1,460.76	$2,086.80	$228.18–$2,024.20	114% above	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee	$681.90	$974.13	$566.94–$944.91	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 20610 - Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidan	$681.90	$974.13	$566.94–$944.91	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 XR Arthrocentesis Asp/Inj Major Joint	$1,460.76	$2,086.80	$1,214.52–$2,024.20	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee	$278.32	$397.60	$216.57–$396.43	at median	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 XR Arthrocentesis Asp/Inj Intermed Joint	$1,460.76	$2,086.80	$228.18–$2,024.20	425% above	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee	$278.32	$397.60	$231.40–$385.67	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 XR Arthrocentesis Asp/Inj Intermed Joint	$1,460.76	$2,086.80	$1,214.52–$2,024.20	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 XR Arthrocentesis Asp/Inj Small Joint	$1,460.76	$2,086.80	$228.18–$2,024.20	307% above	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 XR Arthrocentesis Asp/Inj Small Joint	$1,460.76	$2,086.80	$1,214.52–$2,024.20	—	30%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Capsulotomy Charge	$1,081.08	$1,544.40	$424.07–$1,498.07	at median	30%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Retinal Detachment Charge	$1,081.08	$1,544.40	$424.07–$1,498.07	at median	30%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Subretinal Neovascularization Charge	$1,081.08	$1,544.40	$424.07–$1,498.07	at median	30%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Subretinal Neovascularization	$1,134.84	$1,621.20	$424.07–$1,572.56	5% above	30%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Laser Capsulotomy	$1,134.84	$1,621.20	$424.07–$1,572.56	5% above	30%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Capsulotomy Charge	$1,081.08	$1,544.40	$898.84–$1,498.07	—	30%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Subretinal Neovascularization Charge	$1,081.08	$1,544.40	$898.84–$1,498.07	—	30%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Retinal Detachment Charge	$1,081.08	$1,544.40	$898.84–$1,498.07	—	30%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Subretinal Neovascularization	$1,134.84	$1,621.20	$943.54–$1,572.56	—	30%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 Laser Capsulotomy	$1,134.84	$1,621.20	$943.54–$1,572.56	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 12031 REPAIR INTERMEDIATE SATE 2.5 CM OR LESSTechFee	$291.27	$416.10	$226.65–$536.55	36% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 12031 REPAIR INTERMEDIATE SATE 2.5 CM OR LESSTechFee	$291.27	$416.10	$242.17–$403.62	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 XR Epidural Lumbal Sacral Caudal	$3,534.44	$5,049.20	$535.32–$4,897.72	70% above	30%
Lower-back epidural injection, with imaging guidance CPT 62323 BVT XR Epid Lumbr/Scrl Cdl 1 Lvl w ImgGd	$3,856.93	$5,509.90	$535.32–$5,344.60	86% above	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 XR Epidural Lumbal Sacral Caudal	$3,534.44	$5,049.20	$2,938.63–$4,897.72	—	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 BVT XR Epid Lumbr/Scrl Cdl 1 Lvl w ImgGd	$3,856.93	$5,509.90	$3,206.76–$5,344.60	—	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR Inj Epidural Lumbar/Sacral	$4,515.77	$6,451.10	$688.19–$6,257.57	85% above	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR Inj Epidural Lumbar/Sacral	$4,515.77	$6,451.10	$3,754.54–$6,257.57	—	30%
Miscarriage treatment with D&C, first trimester CPT 59820 Treatment of missed abortion, completed surgically; first trimester	$6,255.42	$8,936.31	$2,457.78–$8,668.22	37% above	30%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 Treatment of missed abortion, completed surgically; first trimester	$6,255.42	$8,936.31	$5,200.93–$8,668.22	—	30%
Nail removal (partial or complete), one nail CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$191.59	$273.70	$149.08–$266.85	53% below	30%
Nail removal (partial or complete), one nail CPT 11730 11730 Avulsion Nail Plate	$467.04	$667.20	$153.60–$647.18	14% above	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee	$191.59	$273.70	$159.29–$265.49	—	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 11730 Avulsion Nail Plate	$467.04	$667.20	$388.31–$647.18	—	30%
Occipital nerve block (injection for headaches) CPT 64405 FAC-Injection Anesthis Agent, Occipital Nerve	$511.49	$730.70	$228.18–$708.78	at median	30%
Occipital nerve block (injection for headaches) CPT 64405 64405 Injection, anesthetic agent; greater occipital nerve	$604.24	$863.20	$228.18–$837.30	18% above	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 FAC-Injection Anesthis Agent, Occipital Nerve	$511.49	$730.70	$425.27–$708.78	—	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 64405 Injection, anesthetic agent; greater occipital nerve	$604.24	$863.20	$502.38–$837.30	—	30%
Paracentesis with imaging guidance CPT 49083 US Guided Paracentesis	$4,418.68	$6,312.40	$724.73–$6,123.03	527% above	30%
Paracentesis with imaging guidance inpatient CPT 49083 US Guided Paracentesis	$4,418.68	$6,312.40	$3,673.82–$6,123.03	—	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee	$475.93	$679.90	$308.84–$659.50	48% below	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 11750 Excision Nail Bed	$899.36	$1,284.80	$308.84–$1,246.26	2% below	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee	$475.93	$679.90	$395.70–$659.50	—	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 11750 Excision Nail Bed	$899.36	$1,284.80	$747.75–$1,246.26	—	30%
Removal of a foreign object under the skin, simple CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$372.75	$532.50	$290.05–$536.55	24% below	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee	$372.75	$532.50	$309.92–$516.53	—	30%
Short arm cast (elbow to hand) CPT 29075 Application, Cast; elbow to finger (short arm)	$613.49	$876.41	$205.29–$850.12	52% above	30%
Short arm cast (elbow to hand) CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM Tech Charge	$613.49	$876.41	$205.29–$850.12	52% above	30%
Short arm cast (elbow to hand) inpatient CPT 29075 Application, Cast; elbow to finger (short arm)	$613.49	$876.41	$510.07–$850.12	—	30%
Short arm cast (elbow to hand) inpatient CPT 29075 29075 APPLICATION CAST ELBOW FINGER SHORT ARM Tech Charge	$613.49	$876.41	$510.07–$850.12	—	30%
Short arm splint (forearm and hand) CPT 29125 29125 APPLY STATIC ARM SPLINT	$83.23	$118.90	$64.76–$173.11	63% below	30%
Short arm splint (forearm and hand) CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$173.39	$247.70	$99.64–$240.27	22% below	30%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLY STATIC ARM SPLINT	$83.23	$118.90	$69.20–$115.33	—	30%
Short arm splint (forearm and hand) inpatient CPT 29125 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee	$173.39	$247.70	$144.16–$240.27	—	30%
Short leg splint (calf to foot) CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$364.50	$520.71	$121.97–$505.09	7% above	30%
Short leg splint (calf to foot) inpatient CPT 29515 29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee	$364.50	$520.71	$303.05–$505.09	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$129.15	$184.50	$100.50–$266.85	68% below	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee	$129.15	$184.50	$107.38–$178.97	—	30%
Skin biopsy, punch, one lesion CPT 11104 11104 - Punch biopsy of skin (including simple closure, when performed) single lesion	$464.66	$663.80	$308.84–$643.89	103% above	30%
Skin biopsy, punch, one lesion CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed) single lesion WC	$899.43	$1,284.90	$308.84–$1,246.35	293% above	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 - Punch biopsy of skin (including simple closure, when performed) single lesion	$464.66	$663.80	$386.33–$643.89	—	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 11104 Punch biopsy of skin (including simple closure, when performed) single lesion WC	$899.43	$1,284.90	$747.81–$1,246.35	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TechFee	$493.29	$704.70	$383.85–$930.03	42% below	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 XR Lumbar Puncture	$3,534.44	$5,049.20	$535.32–$4,897.72	319% above	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TechFee	$493.29	$704.70	$410.14–$683.56	—	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 XR Lumbar Puncture	$3,534.44	$5,049.20	$2,938.63–$4,897.72	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$129.15	$184.50	$100.50–$266.85	76% below	30%
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 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee	$129.15	$184.50	$107.38–$178.97	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 12011 SIMPLE REPAIR FEENLM LS THAN 2.5CM TechFee	$129.15	$184.50	$100.50–$266.85	72% below	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 12011 SIMPLE REPAIR FEENLM LS THAN 2.5CM TechFee	$129.15	$184.50	$107.38–$178.97	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 11102 - Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion	$467.04	$667.20	$153.60–$647.18	229% above	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 11102 - Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette) single lesion	$467.04	$667.20	$388.31–$647.18	—	30%
Thoracentesis with imaging guidance CPT 32555 US Guided Thoracentesis	$3,598.56	$5,140.80	$477.91–$4,986.58	186% above	30%
Thoracentesis with imaging guidance inpatient CPT 32555 US Guided Thoracentesis	$3,598.56	$5,140.80	$2,991.95–$4,986.58	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee	$265.23	$378.90	$206.39–$396.43	54% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 XR Inj Single/Mult Trig Point Muscle	$1,460.76	$2,086.80	$228.18–$2,024.20	153% above	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee	$265.23	$378.90	$220.52–$367.53	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 XR Inj Single/Mult Trig Point Muscle	$1,460.76	$2,086.80	$1,214.52–$2,024.20	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Rt	$7,980.91	$11,401.30	$1,252.45–$11,059.26	209% above	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 US Breast Biopsy Lt	$7,980.91	$11,401.30	$1,252.45–$11,059.26	209% above	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Rt	$7,980.91	$11,401.30	$6,635.56–$11,059.26	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 US Breast Biopsy Lt	$7,980.91	$11,401.30	$6,635.56–$11,059.26	—	30%
Vasectomy, one or both sides, including follow-up semen testing both sides CPT 55250 Vasectomy, unilateral or bilateral, incl postoperative semen examination(s)	$528.85	$755.50	$411.52–$2,751.08	—	30%
Vasectomy, one or both sides, including follow-up semen testing inpatient both sides CPT 55250 Vasectomy, unilateral or bilateral, incl postoperative semen examination(s)	$528.85	$755.50	$439.70–$732.84	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee	$372.75	$532.50	$290.05–$536.55	2% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 11042 Excl Debride SubQ 20 sqcm or Less CHARGE	$830.97	$1,187.10	$308.84–$1,151.49	119% above	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee	$372.75	$532.50	$309.92–$516.53	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 11042 Excl Debride SubQ 20 sqcm or Less CHARGE	$830.97	$1,187.10	$690.89–$1,151.49	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Blood transfusion (giving blood or blood components) CPT 36430 Administration of Blood	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE MSII, >1HR, PER HR Charge	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE SCU, >1HR, PER HR Charge	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLD PROD SCU,1HR	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLD PROD MSIII,1HR	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 36430 TRANSFUSE OBS,UP TO 1 HR CHARGE	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSE BLD PROD MSII,1HR Charge	$473.34	$676.20	$337.94–$655.91	29% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 Transfuse blood products	$497.56	$710.80	$337.94–$689.48	26% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS TechFee	$497.56	$710.80	$337.94–$689.48	26% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 36430 TRANSFUSION BLOOD P Charge	$497.56	$710.80	$337.94–$689.48	26% below	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 TRANSFUSE OBS,UP TO 1 HR CHARGE	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE SCU, >1HR, PER HR Charge	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE MSII, >1HR, PER HR Charge	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLD PROD MSII,1HR Charge	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Administration of Blood	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLD PROD MSIII,1HR	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TRANSFUSE BLD PROD SCU,1HR	$473.34	$676.20	$393.55–$655.91	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 TRANSFUSION BLOOD/BLOOD COMPONENTS TechFee	$497.56	$710.80	$413.69–$689.48	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfuse blood products	$497.56	$710.80	$413.69–$689.48	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 36430 TRANSFUSION BLOOD P Charge	$497.56	$710.80	$413.69–$689.48	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction Charge	$478.52	$683.60	$157.22–$663.09	146% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mini-Neb Initial	$478.52	$683.60	$157.22–$663.09	146% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mini-Neb Subsequent.	$478.52	$683.60	$157.22–$663.09	146% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mini-Neb Subsequent	$478.52	$683.60	$157.22–$663.09	146% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mini-Neb Initial.	$478.52	$683.60	$157.22–$663.09	146% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Initial	$478.52	$683.60	$157.22–$663.09	146% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mini-Neb Initial	$478.52	$683.60	$397.86–$663.09	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Initial	$478.52	$683.60	$397.86–$663.09	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mini-Neb Initial.	$478.52	$683.60	$397.86–$663.09	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mini-Neb Subsequent.	$478.52	$683.60	$397.86–$663.09	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction Charge	$478.52	$683.60	$397.86–$663.09	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mini-Neb Subsequent	$478.52	$683.60	$397.86–$663.09	—	30%
Chemotherapy IV infusion, first hour CPT 96413 COMPLEX MED IV MSII 1 HR Charge	$478.59	$683.70	$256.40–$663.19	32% below	30%
Chemotherapy IV infusion, first hour CPT 96413 96413 IV CHEMO ADMIN UP TO 1HR	$753.34	$1,076.20	$256.40–$1,043.91	7% above	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 COMPLEX MED IV MSII 1 HR Charge	$478.59	$683.70	$397.91–$663.19	—	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 96413 IV CHEMO ADMIN UP TO 1HR	$753.34	$1,076.20	$626.35–$1,043.91	—	30%
Critical care, first 30 to 74 minutes CPT 99291 99291 \nCritical Care FCT Charge	$2,947.49	$4,210.70	$651.34–$4,084.38	68% above	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 99291 \nCritical Care FCT Charge	$2,947.49	$4,210.70	$2,450.63–$4,084.38	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG 12 LEAD Charge	$164.71	$235.30	$45.92–$228.24	at median	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG 12-Lead Acquisition	$168.21	$240.30	$45.92–$233.09	2% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG 12 LEAD Charge	$164.71	$235.30	$136.94–$228.24	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG 12-Lead Acquisition	$168.21	$240.30	$139.85–$233.09	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 99281 Level 1 FCT Charge	$253.12	$361.60	$68.06–$350.75	5% below	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 99281 Level 1 FCT Charge	$253.12	$361.60	$210.45–$350.75	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 99282 Level 2 FCT Charge	$443.03	$632.90	$122.41–$613.91	6% above	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 99282 Level 2 FCT Charge	$443.03	$632.90	$368.35–$613.91	—	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 99283 Level 3 FCT Charge	$757.68	$1,082.40	$214.04–$1,049.93	4% above	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 99283 Level 3 FCT Charge	$757.68	$1,082.40	$629.96–$1,049.93	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 Level 4 FCT Charge	$1,263.15	$1,804.50	$329.16–$1,750.37	31% above	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 99284 Level 4 FCT Charge	$1,263.15	$1,804.50	$1,050.22–$1,750.37	—	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 Level 5 FCT Charge	$1,895.11	$2,707.30	$473.93–$2,626.08	40% above	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 99285 Level 5 FCT Charge	$1,895.11	$2,707.30	$1,575.65–$2,626.08	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardiac Stress Test	$651.07	$930.10	$240.71–$902.20	21% below	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardiac Stress Test	$651.07	$930.10	$541.32–$902.20	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV HYDRATION-BC 31-60 MINUTES CHARGE	$227.99	$325.70	$162.86–$315.93	at median	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATE MSII,1ST HR Charge	$239.26	$341.80	$162.86–$331.55	5% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 ACU IV INFUSION, 1ST HR	$239.26	$341.80	$162.86–$331.55	5% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 IV HYDRATION- UP TO 1 HR Charge	$240.17	$343.10	$162.86–$332.81	5% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 ER - IV INFUSION HYDRATION 31 MIN TO 1 HOUR Charge	$251.44	$359.20	$162.86–$348.42	10% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 9636059: IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR ED Charge	$251.44	$359.20	$162.86–$348.42	10% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 96360 Hydration, first hour FCT Charge	$253.12	$361.60	$162.86–$350.75	11% above	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV HYDRATION-BC 31-60 MINUTES CHARGE	$227.99	$325.70	$189.56–$315.93	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATE MSII,1ST HR Charge	$239.26	$341.80	$198.93–$331.55	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 ACU IV INFUSION, 1ST HR	$239.26	$341.80	$198.93–$331.55	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 IV HYDRATION- UP TO 1 HR Charge	$240.17	$343.10	$199.68–$332.81	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 9636059: IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR ED Charge	$251.44	$359.20	$209.05–$348.42	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 ER - IV INFUSION HYDRATION 31 MIN TO 1 HOUR Charge	$251.44	$359.20	$209.05–$348.42	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 96360 Hydration, first hour FCT Charge	$253.12	$361.60	$210.45–$350.75	—	30%
IV infusion of a medicine, first hour CPT 96365 IV MED INFUSE MSII,1ST HR Charge	$239.26	$341.80	$162.86–$331.55	24% below	30%
IV infusion of a medicine, first hour CPT 96365 96365 IV INFUSION; INITIAL Charge	$240.17	$343.10	$162.86–$332.81	23% below	30%
IV infusion of a medicine, first hour CPT 96365 96365 ER - IV INFUSION UPTO 1 HOUR Charge	$251.44	$359.20	$162.86–$348.42	20% below	30%
IV infusion of a medicine, first hour CPT 96365 9636559: IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR ED Charge	$251.44	$359.20	$162.86–$348.42	20% below	30%
IV infusion of a medicine, first hour CPT 96365 96365 IV tx, first hour FCT Charge	$253.12	$361.60	$162.86–$350.75	19% below	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV MED INFUSE MSII,1ST HR Charge	$239.26	$341.80	$198.93–$331.55	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV INFUSION; INITIAL Charge	$240.17	$343.10	$199.68–$332.81	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 ER - IV INFUSION UPTO 1 HOUR Charge	$251.44	$359.20	$209.05–$348.42	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 9636559: IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR ED Charge	$251.44	$359.20	$209.05–$348.42	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 96365 IV tx, first hour FCT Charge	$253.12	$361.60	$210.45–$350.75	—	30%
IV push of a medicine, first drug CPT 96374 IV PUSH MSII, ONE MED Charge	$239.26	$341.80	$162.86–$331.55	1% above	30%
IV push of a medicine, first drug CPT 96374 96374 IV PUSH INITIAL Charge	$240.17	$343.10	$162.86–$332.81	1% above	30%
IV push of a medicine, first drug CPT 96374 96374 IV Injection, single/initial FCT Charge	$253.12	$361.60	$162.86–$350.75	6% above	30%
IV push of a medicine, first drug CPT 96374 BVT NM Injection Isotope	$748.16	$1,068.80	$162.86–$1,036.74	214% above	30%
IV push of a medicine, first drug CPT 96374 BVT XR Injection of Contrast	$1,103.62	$1,576.60	$162.86–$1,529.30	364% above	30%
IV push of a medicine, first drug CPT 96374 BVT MR Inj Contrast	$1,919.40	$2,742.00	$162.86–$2,659.74	706% above	30%
IV push of a medicine, first drug inpatient CPT 96374 IV PUSH MSII, ONE MED Charge	$239.26	$341.80	$198.93–$331.55	—	30%
IV push of a medicine, first drug inpatient CPT 96374 96374 IV PUSH INITIAL Charge	$240.17	$343.10	$199.68–$332.81	—	30%
IV push of a medicine, first drug inpatient CPT 96374 96374 IV Injection, single/initial FCT Charge	$253.12	$361.60	$210.45–$350.75	—	30%
IV push of a medicine, first drug inpatient CPT 96374 BVT NM Injection Isotope	$748.16	$1,068.80	$622.04–$1,036.74	—	30%
IV push of a medicine, first drug inpatient CPT 96374 BVT XR Injection of Contrast	$1,103.62	$1,576.60	$917.58–$1,529.30	—	30%
IV push of a medicine, first drug inpatient CPT 96374 BVT MR Inj Contrast	$1,919.40	$2,742.00	$1,595.84–$2,659.74	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Therapeutic; prophylactic, or diagnostic injection; subcutaneous or intramuscular (MAPP)	$45.08	$64.40	$35.08–$95.58	21% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	$45.08	$64.40	$35.08–$95.58	21% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJECTION BIRTHING CTR CHARGE	$113.54	$162.20	$55.01–$157.33	100% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 INJ;SUBCUTANEOUS/IM Charge	$113.54	$162.20	$55.01–$157.33	100% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 9637259: THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$118.79	$169.70	$55.01–$164.61	109% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM TechFee	$118.79	$169.70	$55.01–$164.61	109% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION IM/SC MSII Charge	$119.63	$170.90	$55.01–$165.77	110% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Subq/IM Injection FCT Charge	$119.63	$170.90	$55.01–$165.77	110% above	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 Tx Px Or Dx Injctn Sq Or Im TS CHARGE	$157.29	$224.70	$55.01–$217.96	177% above	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Therapeutic; prophylactic, or diagnostic injection; subcutaneous or intramuscular (MAPP)	$45.08	$64.40	$37.48–$62.47	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	$45.08	$64.40	$37.48–$62.47	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJECTION BIRTHING CTR CHARGE	$113.54	$162.20	$94.40–$157.33	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 INJ;SUBCUTANEOUS/IM Charge	$113.54	$162.20	$94.40–$157.33	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 9637259: THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$118.79	$169.70	$98.77–$164.61	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM TechFee	$118.79	$169.70	$98.77–$164.61	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJECTION IM/SC MSII Charge	$119.63	$170.90	$99.46–$165.77	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Subq/IM Injection FCT Charge	$119.63	$170.90	$99.46–$165.77	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 96372 Tx Px Or Dx Injctn Sq Or Im TS CHARGE	$157.29	$224.70	$130.78–$217.96	—	30%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 95910 7-8 nerve conduction studies	$386.68	$552.40	$240.71–$535.83	16% above	30%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 95910 7-8 nerve conduction studies	$386.68	$552.40	$321.50–$535.83	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Charges	$100.59	$143.70	$28.04–$139.39	22% below	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Charges	$100.59	$143.70	$83.63–$139.39	—	30%
New patient office visit, about 30 minutes CPT 99203 NEW PAT VST/ONC/LOW COMPLEXITY	$159.53	$227.90	$123.62–$221.06	19% below	30%
New patient office visit, about 30 minutes CPT 99203 99203 Office visit - new patient, level 3	$166.46	$237.80	$129.53–$230.67	15% below	30%
New patient office visit, about 30 minutes CPT 99203 NEW PATIENT E&M,LVL III	$175.98	$251.40	$123.62–$243.86	10% below	30%
New patient office visit, about 30 minutes CPT 99203 NEW PAT SIGNIF SEP E&M-L3	$175.98	$251.40	$123.62–$243.86	10% below	30%
New patient office visit, about 30 minutes CPT 99203 99203 Office or other outpatient visit for the evaluation and mgmt of a new patient, 30 min level 3	$178.64	$255.20	$139.01–$247.54	9% below	30%
New patient office visit, about 30 minutes CPT 99203 99203 NON-PBS VISIT LVL 3	$286.09	$408.70	$123.62–$396.44	46% above	30%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PAT VST/ONC/LOW COMPLEXITY	$159.53	$227.90	$132.64–$221.06	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office visit - new patient, level 3	$166.46	$237.80	$138.40–$230.67	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT E&M,LVL III	$175.98	$251.40	$146.31–$243.86	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 NEW PAT SIGNIF SEP E&M-L3	$175.98	$251.40	$146.31–$243.86	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 Office or other outpatient visit for the evaluation and mgmt of a new patient, 30 min level 3	$178.64	$255.20	$148.53–$247.54	—	30%
New patient office visit, about 30 minutes inpatient CPT 99203 99203 NON-PBS VISIT LVL 3	$286.09	$408.70	$237.86–$396.44	—	30%
New patient office visit, about 45 minutes CPT 99204 99204 Office visit - new patient, level 4	$219.38	$313.40	$170.71–$304.00	13% below	30%
New patient office visit, about 45 minutes CPT 99204 NEW PAT VST/ONC/MODERATE COMPLEXITY	$272.23	$388.90	$123.62–$377.23	8% above	30%
New patient office visit, about 45 minutes CPT 99204 99204 Office or other outpatient visit for the evaluation and mgmt of a new patient, 45 min level 4	$297.69	$425.27	$123.62–$412.51	19% above	30%
New patient office visit, about 45 minutes CPT 99204 NEW PAT SIGNIF SEP E&M L4	$360.64	$515.20	$123.62–$499.74	44% above	30%
New patient office visit, about 45 minutes CPT 99204 NEW PAT E&M,LEVEL IV	$360.64	$515.20	$123.62–$499.74	44% above	30%
New patient office visit, about 45 minutes CPT 99204 99204 NON-PBS WC VISIT LVL 4	$434.35	$620.50	$123.62–$601.89	73% above	30%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office visit - new patient, level 4	$219.38	$313.40	$182.40–$304.00	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PAT VST/ONC/MODERATE COMPLEXITY	$272.23	$388.90	$226.34–$377.23	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 Office or other outpatient visit for the evaluation and mgmt of a new patient, 45 min level 4	$297.69	$425.27	$247.51–$412.51	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PAT E&M,LEVEL IV	$360.64	$515.20	$299.85–$499.74	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 NEW PAT SIGNIF SEP E&M L4	$360.64	$515.20	$299.85–$499.74	—	30%
New patient office visit, about 45 minutes inpatient CPT 99204 99204 NON-PBS WC VISIT LVL 4	$434.35	$620.50	$361.13–$601.89	—	30%
New patient office visit, about 60 minutes CPT 99205 99205 Office visit - new patient, level 5	$300.79	$429.70	$234.06–$416.81	3% below	30%
New patient office visit, about 60 minutes CPT 99205 99205 Office or other outpatient visit for the evaluation and mgmt of a new patient, 60 min level 5	$348.53	$497.90	$271.21–$482.96	12% above	30%
New patient office visit, about 60 minutes CPT 99205 NEW PAT VST/ONC/HIGH COMPLEXITY	$351.96	$502.80	$123.62–$487.72	13% above	30%
New patient office visit, about 60 minutes CPT 99205 NEW PAT E&M,LEVEL V	$494.20	$706.00	$123.62–$684.82	59% above	30%
New patient office visit, about 60 minutes CPT 99205 NEW PAT SIGNIF SEP E&M L5	$494.20	$706.00	$123.62–$684.82	59% above	30%
New patient office visit, about 60 minutes CPT 99205 99205 NON-PBS WC VISIT LVL 5	$505.47	$722.10	$123.62–$700.44	63% above	30%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office visit - new patient, level 5	$300.79	$429.70	$250.09–$416.81	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 Office or other outpatient visit for the evaluation and mgmt of a new patient, 60 min level 5	$348.53	$497.90	$289.78–$482.96	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PAT VST/ONC/HIGH COMPLEXITY	$351.96	$502.80	$292.63–$487.72	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PAT SIGNIF SEP E&M L5	$494.20	$706.00	$410.89–$684.82	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 NEW PAT E&M,LEVEL V	$494.20	$706.00	$410.89–$684.82	—	30%
New patient office visit, about 60 minutes inpatient CPT 99205 99205 NON-PBS WC VISIT LVL 5	$505.47	$722.10	$420.26–$700.44	—	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PAT VST/ONC/STRAIGHT-FORWARD	$104.86	$149.80	$81.60–$173.07	31% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 LACTATION CONSULT/EXTENDED CHARGE	$131.81	$188.30	$102.57–$182.65	13% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PAT SIGNIF SEP E&M-L2	$134.40	$192.00	$104.58–$186.24	11% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 NEW PATIENT E&M,LEVEL II	$134.40	$192.00	$104.58–$186.24	11% below	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 Office or other outpatient visit for the evaluation and mgmt of a new patient, 20 min level 2	$154.35	$220.50	$120.11–$213.89	2% above	30%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 99202 PBS New Patient Level 2 CHARGE	$197.61	$282.30	$123.62–$273.83	30% above	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PAT VST/ONC/STRAIGHT-FORWARD	$104.86	$149.80	$87.18–$145.31	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 LACTATION CONSULT/EXTENDED CHARGE	$131.81	$188.30	$109.59–$182.65	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PAT SIGNIF SEP E&M-L2	$134.40	$192.00	$111.74–$186.24	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 NEW PATIENT E&M,LEVEL II	$134.40	$192.00	$111.74–$186.24	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 Office or other outpatient visit for the evaluation and mgmt of a new patient, 20 min level 2	$154.35	$220.50	$128.33–$213.89	—	30%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 99202 PBS New Patient Level 2 CHARGE	$197.61	$282.30	$164.30–$273.83	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 NUTRITION INIT VST/15 MIN CHARGE	$71.12	$101.60	$27.45–$98.55	27% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 97802 DBE MNT ASSESS/15 MIN CHARGE	$71.12	$101.60	$27.45–$98.55	27% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 97802 DBE MNT ASSESS/15 MIN CHARGE	$71.12	$101.60	$59.13–$98.55	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 97802 NUTRITION INIT VST/15 MIN CHARGE	$71.12	$101.60	$59.13–$98.55	—	30%
Occupational therapy evaluation, low complexity CPT 97165 OT Low Complex Units	$205.45	$293.50	$87.99–$284.70	32% below	30%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT Low Complex Units	$205.45	$293.50	$170.82–$284.70	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT High Complex Units	$269.57	$385.10	$85.69–$373.55	17% below	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT High Complex Units	$269.57	$385.10	$224.13–$373.55	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT Low Complex Units	$176.82	$252.60	$85.69–$245.02	41% below	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT Low Complex Units	$176.82	$252.60	$147.01–$245.02	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT ReEval Units	$195.09	$278.70	$85.69–$270.34	35% below	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT Moderate Complex Units	$222.81	$318.30	$85.69–$308.75	25% below	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT ReEval Units	$195.09	$278.70	$162.20–$270.34	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT Moderate Complex Units	$222.81	$318.30	$185.25–$308.75	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy Charge Units	$88.41	$126.30	$23.77–$122.51	31% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 PT Manual Therapy Assistant Units	$88.41	$126.30	$23.77–$122.51	31% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy Charge Units	$88.41	$126.30	$73.51–$122.51	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 PT Manual Therapy Assistant Units	$88.41	$126.30	$73.51–$122.51	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PT Therapeutic Exercise Assistant Units	$96.25	$137.50	$25.20–$133.38	24% below	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercise Charges	$96.25	$137.50	$25.20–$133.38	24% below	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT Therapeutic Exercise Assistant Units	$96.25	$137.50	$80.03–$133.38	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercise Charges	$96.25	$137.50	$80.03–$133.38	—	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ONCOLOGY CRITICAL CARE VISIT	$232.33	$331.90	$123.62–$321.94	19% below	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 Office visit - established patient, level 5	$232.33	$331.90	$180.79–$321.94	19% below	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 ESTAB PAT E&M,LEVEL V	$360.64	$515.20	$123.62–$499.74	26% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 EST PAT SIGNIF SEP E&M L5	$360.64	$515.20	$123.62–$499.74	26% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 BC Facility Level 5 Est Patient	$368.41	$526.30	$286.68–$510.51	29% above	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 99215 WC NON PBS EST VISIT LVL 5	$384.93	$549.90	$123.62–$533.40	35% above	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ONCOLOGY CRITICAL CARE VISIT	$232.33	$331.90	$193.17–$321.94	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 Office visit - established patient, level 5	$232.33	$331.90	$193.17–$321.94	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 ESTAB PAT E&M,LEVEL V	$360.64	$515.20	$299.85–$499.74	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 EST PAT SIGNIF SEP E&M L5	$360.64	$515.20	$299.85–$499.74	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 BC Facility Level 5 Est Patient	$368.41	$526.30	$306.31–$510.51	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 99215 WC NON PBS EST VISIT LVL 5	$384.93	$549.90	$320.04–$533.40	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB PT/ONC/LOW COMPLEX VISIT	$106.68	$152.40	$83.01–$173.07	34% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Office visit - established patient, level 3	$134.40	$192.00	$104.58–$186.24	17% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 EST PAT SIGNIF SEP E&M-L3	$134.40	$192.00	$104.58–$186.24	17% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTAB PAT E&M,LEVEL III	$134.40	$192.00	$104.58–$186.24	17% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 WC NON-PBS VISIT LVL 3	$192.43	$274.90	$123.62–$266.65	19% above	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 BC Facility Level 3 Est Patient	$242.76	$346.80	$188.90–$336.40	50% above	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Cardiac Rehab Eval	$324.24	$463.20	$123.62–$449.30	100% above	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 99213 Pulmonary Rehab Eval	$324.24	$463.20	$123.62–$449.30	100% above	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTAB PT/ONC/LOW COMPLEX VISIT	$106.68	$152.40	$88.70–$147.83	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 EST PAT SIGNIF SEP E&M-L3	$134.40	$192.00	$111.74–$186.24	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Office visit - established patient, level 3	$134.40	$192.00	$111.74–$186.24	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 ESTAB PAT E&M,LEVEL III	$134.40	$192.00	$111.74–$186.24	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 WC NON-PBS VISIT LVL 3	$192.43	$274.90	$159.99–$266.65	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 BC Facility Level 3 Est Patient	$242.76	$346.80	$201.84–$336.40	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Cardiac Rehab Eval	$324.24	$463.20	$269.58–$449.30	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 99213 Pulmonary Rehab Eval	$324.24	$463.20	$269.58–$449.30	—	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB PT VST/ONC/MODERATE COMPLEX	$164.71	$235.30	$123.62–$228.24	22% below	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 Office visit - established patient, level 4	$166.46	$237.80	$129.53–$230.67	22% below	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTAB PAT E&M,LEVEL IV	$272.23	$388.90	$123.62–$377.23	28% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 EST PAT SIGNIF SEP E&M L4	$272.23	$388.90	$123.62–$377.23	28% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 BC Facility Level 4 Est Patient	$277.41	$396.30	$215.86–$384.41	31% above	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 99214 WC Non PBS Est Visit Lvl 4	$283.50	$405.00	$123.62–$392.85	34% above	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTAB PT VST/ONC/MODERATE COMPLEX	$164.71	$235.30	$136.94–$228.24	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 Office visit - established patient, level 4	$166.46	$237.80	$138.40–$230.67	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 EST PAT SIGNIF SEP E&M L4	$272.23	$388.90	$226.34–$377.23	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 ESTAB PAT E&M,LEVEL IV	$272.23	$388.90	$226.34–$377.23	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 BC Facility Level 4 Est Patient	$277.41	$396.30	$230.65–$384.41	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 99214 WC Non PBS Est Visit Lvl 4	$283.50	$405.00	$235.71–$392.85	—	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB PT ONC/STRAIGHTFORWARD VST	$52.85	$75.50	$41.12–$173.07	52% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 WC G0463 VISIT CODE	$117.04	$167.20	$91.07–$173.07	6% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 99212 Office visit - established patient, level 2	$125.65	$179.50	$97.77–$174.12	14% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 EST PAT SIGNIF SEP E&M-L2	$127.47	$182.10	$99.19–$176.64	15% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTAB PAT,E&M,LEVEL II	$127.47	$182.10	$99.19–$176.64	15% above	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 BC Facility Level 2 Est Patient	$210.70	$301.00	$163.95–$291.97	91% above	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTAB PT ONC/STRAIGHTFORWARD VST	$52.85	$75.50	$43.94–$73.24	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 WC G0463 VISIT CODE	$117.04	$167.20	$97.31–$162.18	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 99212 Office visit - established patient, level 2	$125.65	$179.50	$104.47–$174.12	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 ESTAB PAT,E&M,LEVEL II	$127.47	$182.10	$105.98–$176.64	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 EST PAT SIGNIF SEP E&M-L2	$127.47	$182.10	$105.98–$176.64	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 BC Facility Level 2 Est Patient	$210.70	$301.00	$175.18–$291.97	—	30%
Speech and language evaluation CPT 92523 SLP Evaluation of speech sound production with evaluation of language comprehension and expression - Speech Sound Prod w/ Language Charge	$382.20	$546.00	$195.11–$529.62	at median	30%
Speech and language evaluation inpatient CPT 92523 SLP Evaluation of speech sound production with evaluation of language comprehension and expression - Speech Sound Prod w/ Language Charge	$382.20	$546.00	$317.77–$529.62	—	30%
Speech therapy session, individual CPT 92507 SLP Treatment of speech, language, voice, communication, and/or auditory processing disorder - Tx of Speech/Lang/Voice/Comm/Auditory Charge	$126.49	$180.70	$65.55–$175.28	64% below	30%
Speech therapy session, individual CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid	$246.26	$351.80	$65.55–$341.25	31% below	30%
Speech therapy session, individual inpatient CPT 92507 SLP Treatment of speech, language, voice, communication, and/or auditory processing disorder - Tx of Speech/Lang/Voice/Comm/Auditory Charge	$126.49	$180.70	$105.17–$175.28	—	30%
Speech therapy session, individual inpatient CPT 92507 Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid	$246.26	$351.80	$204.75–$341.25	—	30%
Spirometry (breathing test) CPT 94010 Bedside Spirometry	$312.55	$446.49	$120.94–$433.10	at median	30%
Spirometry (breathing test) CPT 94010 PFT Simple Spirometry W/out Bronchodilator	$359.87	$514.10	$120.94–$498.68	15% above	30%
Spirometry (breathing test) CPT 94010 RT Spirometry with Graphic Record Charge	$359.87	$514.10	$120.94–$498.68	15% above	30%
Spirometry (breathing test) inpatient CPT 94010 Bedside Spirometry	$312.55	$446.49	$259.86–$433.10	—	30%
Spirometry (breathing test) inpatient CPT 94010 PFT Simple Spirometry W/out Bronchodilator	$359.87	$514.10	$299.21–$498.68	—	30%
Spirometry (breathing test) inpatient CPT 94010 RT Spirometry with Graphic Record Charge	$359.87	$514.10	$299.21–$498.68	—	30%
Spirometry before and after a bronchodilator CPT 94060 RT Pre & Post Spiro Charge	$658.35	$940.50	$240.71–$912.29	at median	30%
Spirometry before and after a bronchodilator CPT 94060 PFT Complete with Bronchodilator	$658.35	$940.50	$240.71–$912.29	at median	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 RT Pre & Post Spiro Charge	$658.35	$940.50	$547.37–$912.29	—	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT Complete with Bronchodilator	$658.35	$940.50	$547.37–$912.29	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Charges	$103.18	$147.40	$30.38–$142.98	8% below	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 Functional Training Charges	$103.18	$147.40	$30.38–$142.98	8% below	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Functional Training Charges	$103.18	$147.40	$85.79–$142.98	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Charges	$103.18	$147.40	$85.79–$142.98	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy, Therapeutic (Separate Procedure)	$192.43	$274.90	$99.64–$266.65	13% below	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 99195 Phlebotomy Therapeutic (separate Procedure)	$233.17	$333.10	$99.64–$323.11	6% above	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy, Therapeutic (Separate Procedure)	$192.43	$274.90	$159.99–$266.65	—	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 99195 Phlebotomy Therapeutic (separate Procedure)	$233.17	$333.10	$193.86–$323.11	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Vermont	Off list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 influenza virus vaccine, adjuvanted 2025-2025 [BVT]	$123.04	$175.77	$82.24–$207.66	3% above	30%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use BMH	$123.04	$175.77	$82.24–$207.66	3% above	30%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use BMH	$123.04	$175.77	$102.30–$170.50	—	30%
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older inpatient CPT 90653 influenza virus vaccine, adjuvanted 2025-2025 [BVT]	$123.04	$175.77	$102.30–$170.50	—	30%
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Moderna COVID Vax 12+ 50 mcg/0.5 mL [BVT]	$238.23	$340.32	$159.23–$330.11	7% above	30%
COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Moderna COVID Vax 12+ 50 mcg/0.5 mL [BVT]	$238.23	$340.32	$198.07–$330.11	—	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Pfizer COVID-19 Vax 12+ 30 mcg/0.3 mL [BVT]	$382.90	$547.00	$153.56–$530.59	234% above	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Pfizer COVID-19 Vax 12+ 30 mcg/0.3 mL [BVT]	$382.90	$547.00	$318.35–$530.59	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza vaccine, standard 2024-2025 [BVT]	$36.08	$51.53	$22.01–$55.59	2% below	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza vaccine, standard 2024-2025 [BVT]	$36.08	$51.53	$29.99–$49.98	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 1 mL IM Sus [BVT]	$52.85	$75.49	$43.94–$175.06	44% below	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus	$53.92	$77.02	$44.83–$175.06	43% below	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 hepatitis B adult vaccine 20 mcg/mL IM Sus [BVT]	$53.92	$77.02	$44.83–$175.06	43% below	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 1 mL IM Sus [BVT]	$53.78	$76.82	$44.71–$74.52	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 20 mcg/mL IM Sus [BVT]	$53.92	$77.02	$44.83–$74.71	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 hepatitis B adult vaccine 20 mcg/mL Sus	$53.92	$77.02	$44.83–$74.71	—	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B pedi vaccine 0.5 mL Sus Free [BVT]	$39.72	$56.74	$30.31–$76.53	27% below	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 hepatitis B pedi vaccine 10 mcg/0.5 mL Sus [BVT]	$39.72	$56.74	$30.31–$76.53	27% below	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B pedi vaccine 0.5 mL Sus Free [BVT]	$39.72	$56.74	$33.02–$55.04	—	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 hepatitis B pedi vaccine 10 mcg/0.5 mL Sus [BVT]	$39.72	$56.74	$33.02–$55.04	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 90662 Fluzone High-Dose Charge BRAT 2022-2023	$124.81	$178.30	$82.24–$207.66	22% above	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 90662 Fluzone High-Dose Charge BRAT 2022-2023	$124.81	$178.30	$103.77–$172.95	—	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles-mumps-rubella vaccine SubQ Inj [BVT]	$71.46	$102.08	$59.41–$230.05	54% below	30%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles-mumps-rubella vaccine SubQ Inj [BVT]	$154.77	$221.09	$128.67–$214.46	—	30%
Meningococcal B vaccine (Trumenba) CPT 90621 meningococcal group B vaccine fully recombinant 0.5 mL [BVT]	$282.29	$403.27	$234.70–$473.23	—	30%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 meningococcal group B vaccine fully recombinant 0.5 mL [BVT]	$282.29	$403.27	$234.70–$391.17	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5 mL [BVT]	$484.75	$692.50	$293.57–$741.31	1% below	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 pneumococcal 20-valent conjugate vaccine 0.5 mL [BVT]	$484.75	$692.50	$403.04–$671.73	—	30%
Rabies vaccine, one dose CPT 90675 rabies vaccine 2.5 units/mL IM Inj 1 mL [BVT]	$695.37	$993.38	$270.66–$963.58	65% above	30%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine 2.5 units/mL IM Inj 1 mL [BVT]	$695.37	$993.38	$578.15–$963.58	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 tetanus-diphtheria toxoids IM Susp 0.5 mL [BVT]	$47.02	$67.16	$39.09–$108.60	9% above	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 tetanus-diphtheria toxoids IM Susp 0.5 mL [BVT]	$63.28	$90.40	$52.61–$87.69	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus-diphtheria-pertussis Vax (Tdap) [BVT]	$74.64	$106.62	$62.05–$103.42	33% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus-diphtheria-pertussis Vaccine [BVT]	$84.18	$120.25	$69.99–$116.64	50% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus-diphtheria-pertussis Vaccine [BVT]	$74.64	$106.62	$62.05–$103.42	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus-diphtheria-pertussis Vax (Tdap) [BVT]	$74.64	$106.62	$62.05–$103.42	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 90471 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE TechFee	$70.28	$100.40	$54.69–$97.39	46% above	30%
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	$70.28	$100.40	$58.43–$97.39	—	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 Each additional vaccine, single or combination vaccine/toxoid	$21.63	$30.90	$16.83–$29.97	28% below	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee	$21.63	$30.90	$16.83–$29.97	28% below	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee	$21.63	$30.90	$17.98–$29.97	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 90472 Each additional vaccine, single or combination vaccine/toxoid	$21.63	$30.90	$17.98–$29.97	—	30%

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://sthpiprd.blob.core.windows.net/machine-readable-files/10714/030107300_brattleboro-memorial-hospital_standardcharges.csv